FRANK S. MOYER, M.A.
Corporate Consultant on Ethics
Rockford Memorial Corporation
2400 N. Rockton
Rockford, IL 61103

In their 1936 classic, The Art of Ministering To the Sick, chaplain Russell L. Dicks and physician Richard C. Cabot asked: "Has the Protestant minister of today any good reason to visit the sick? The doctor diagnoses and treats them. The apothecary prepares their medicines. The nurse or the family give bedside care. The social worker looks after domestic, legal and industrial difficulties. The librarian supplies books. The occupational therapist gives manual work. The Catholic priest hears confessions, gives absolution and administers extreme unction. But can the Protestant minister be anything but a nuisance? By what authority, then, does the minister go to the sick room?" (emphasis added).

There are even greater challenges to pastoral care in the modern hospital of the late twentieth century! The number of professionals and paraprofessionals involved in the care of the sick have increased significantly, as have the varieties of services offered. Financing these health-care givers and their services has become a national concern that has had a major impact on patients as they struggle with shorter stays and other efforts to control costs. The most dramatic challenge, though, results from changes in our understandings of disease and its genesis and in our expectations for treatment. The knowledge explosion underlying this challenge is the principal factor in the changes evident in the numbers, varieties and costs of services and providers.

Thus patients, health-care givers, hospital administrators and society are engaged today in a highly technical and complex process within which roles, functions, and costs are carefully defined, monitored and contained. It is in the context of that process that we must wrestle with our questions, and our answers will determine whether pastoral care in the hospital is integral, parallel, contradictory or irrelevant to that process.

At an educational program for clergy several years ago, four discharged patients (all of whom were active in their local parishes) and four community clergy (all of whom had many years experience) were asked in separate sessions the question posed by Cabot and Dicks: "Has the Protestant minister of today any good reason to visit the sick?" Their answers were remarkably compatible and identified eight motives, functions or related roles. All of them agreed on "tradition," "friend," "listener," and "witness" as the most important The laity identified "diversionary" as fifth on their list, while clergy added "membership on the health team," "healer of the estrangement of illness," and "personal satisfaction" to their list. While two of the functions ("healer" and "team member") openly claim an integral role for the pastor, and none see it as contradictory, the majority would be classified as parallel or irrelevant to the patient-staff-hospital process.

Many voices today cry out for greater integration of pastoral rare with those who are sick. Contemporary changes in providing health care have often resulted in a process that is experienced as damaging to patient, staff, and community. Courses and seminars on "Guest Relations," "Wholistic Health Clinics," "Home Health," "Patient Advocacy" and many other topics represent some of the attempts being madc to insure a process of caring which is not destructive. Many of these involve clergy and parishes (lay visitation programs, classes on "The Nurse in the Church"). If clergy, parish and health-care givers are to discover ways to integrate programs with pastoral care, then attention must be given to three questions: 1. By what authority do we visit the sick? 2. What is our understanding of disease? 3. What objectives do we have in visiting the sick?

Questions—and answers—regarding authority for pastoral care to the sick have existed for centuries. They were apparent in the scriptures (e.g. John 9 and the healing or the blind), and their presence throughout history has been ably discussed by John McNeill in A History of the Cure of the Cure of Souls, by Daniel Williams in The Minister and the Care of Souls, among others. As Williams observed: "There is no place in the life of the church where the issues concerning the nature of the minister's authority become more sharply defined or where they lead to more fateful consequences than at the point where he [or she] becomes responsible for a soul in need." While the struggles of modern hospitals, health professionals and clergy with these issues are not substantively different than those experienced throughout history, there are new facets which raise other concerns. Alistair V. Campbell speaks of a confusion "partly caused by the extraordinary successes of the human sciences . . . in shedding light on the causes of human distress and the nature of helping relationships" which helps to alienate us from an emphasis upon "priestly or ministerial authority." What, then, might be some of the sources or images of such an authority?

One source of authority in the care of the sick is permission. Has the patient given permission for such care? Certainly the invitation by the sick person to share in his or her journey is important in any assessment of authority. Much has been written about informed consent and the rights of patients. A Presidential Commission stated it quite appropriately: "Informed consent is rooted in the fundamental recognition—rcflectcd in the legal presumption of competency adults arc entitled to accept or reject health care interventions on the basis of their own personal values and in furtherance of their own personal goals." Determining whether such permission has been given knowingly is, however, not a simple task. Does the patient have all the data? Has the data been presented free from verbal or nonverbal pressures? Is the patient competent to make such a decision? Arc the rights of others (i.e. the hospital staff) also protected by such a decision? At a more pragmatic level, patient confidentiality, scheduling concerns in busy treatment programs, and security issues have often resulted in regulations which permit visitors only during identified times. Thus. permission alone is a limited source of authority for the pastor who seeks to visit the sick.

A second source for authority, given considerable attention in recent decades, is knowledge. Historically, parishioners and others have recognized clergy as being among the educated in their midst, but the concern with knowledge has been given a new impetus in the proliferation of specialties in the various helping professions. Credentials have become critical as a wary public hopes to identify qualified helpers.

Much recent effort in pastoral care education has focused upon the development of an expertise which can be identified and certified. Clergy have participated in Clinical Pastoral Education programs, in organizations such as the Academy of Parish Clergy, and in the various professional certification processes offered by the Association for Clinical Pastoral Education, College of Chaplains, Association of Mental Health Clergy, National Association of Catholic Chaplains, and others. As with other professionals, authority for the pastoral visit would be founded upon education, certification, and peer review.

While the knowledge level concerning the human sciences among clergy has been demonstrably strengthened, it has proved to be of limited value as a source of authority for pastoral care of the sick. Theological consensus in our society does not exist, nor is it particularly desired! As Campbell observed, "However much some theologians and church leaders might wish it otherwise, the absence of doctrinal unanimity—and the welcoming of this—remains a feature of our time." Nor is there consensus among the other human sciences, as indicated by a statement of Carl Rogers' which Campbell cites: "It has gradually been driven home to me that I cannot be of help . . . by means of any intellectual or training procedure. No approach which relies upon knowledge, upon training, upon the acceptance of something that is taught, is of any use . . . The failure of any such approach through the intellect has forced me to recognize that change appears to come about through experience in a relationship."

For others today, experience in a relationship has become the source of their authority for pastoral care of the sick. The church has always had a strong interest in the ministry of all believers, and there are many today who are quite willing to implement such ministries. Since there is little agreement on knowledge, relationship seems to be all the authority needed. That source appears primarily, informed by a personal relationship between the care giver and his or her God and of their understanding of how such an experience might be helpful to the patient. They come in a spirit of friendship—and trust that the visit will be beneficient.

Certainly the value of friendship as a major pastoral resource is significant. In The Christian Pastor, Wayne E. Oates identifies it as the first level of pastoral care. "The ministry of friendship is the indispensable necessity for all other deeper levels of pastoral work. It is the seedbed of any fruitful service to people. Furthermore, a great majority of the real help that comes to people in crises is through persons whom they would term 'just a good friend' and not through professional people. " However, friendship is neither the authority upon which our visits are founded nor the objective of those visits. Many persons offer friendship to those who are sick, and do so successfully, independent from professional education for, or ordination to, ministry. Also, as Oates further states, "the most outstanding limitation of the social level of a pastor's ministry [is that] there are some things a person can tell only to a stranger."

The shortcomings of permission, knowledge, and relationship as sufficient sources of authority are illustrated in an incident reported several years ago. A parish in England employed a man who was a skilled public speaker to preach and conduct worship, but who was also an avowed atheist! He certainly had permission and expertise, and his willingness to associate with a parish was indicative of a "faith" relationship. Yet few would argue that such a ministry had authority. Even though he was hired to perform some of the tasks of ministry, there was no Call or sense of vocation to give his work authority.

Cabot and Dicks answered the issue of authority in these words: "The minister goes to the sickroom because he is the duly recognized representative of Him." Joseph Sittler, in Gravity and Grace, defines pastoral authority in terms which include Word and Sacrament: "The Church insists on preparing a designated cadre to see to it that the constitutive story is told, and that the nurturing sacraments are administered." Pastoral care of the sick confronts you in multiple ways with your Call. When you visit the sick as a pastor, you enter that person's pain. That, in itself, demands something unique of you as a person, and it is to this that Henri Nouwen refers when he remarks, in his book In Memoriam, that "I realized that sorrow is an unwelcome companion and that anyone who willingly enters into the pain of a stranger is truly a remarkable person."

Entering into another's pain also demands something unique in your understanding of other persons and of care. Tillich speaks to this in his essay on "Theology of Pastoral Care":

When I hear the term pastoral care, I sometimes imagine myself to be in the situation of receiving pastoral care, and imagining this, I somehow feel humiliated. Someone else makes me an object of his care, but no one wants to become an object and, therefore, he resists such situations like pastoral care . . . . There are two reasons for this possibility. The first is the fact that care, including pastoral care, is something universally human. It is going on always in every moment of human existence. The second more important reason is that care is essentially mutual: [the one] who gives care also receives care."

Failure to recognize this important uniqueness is damaging to the patient because it perpetuates a passive stance in the healing process. Michael Wilson puts it quite beautifully: " . . . as we approach this sick [person, she or he] speaks to us in a voice we do not recognize. 'It is I . . . Inasmuch as ye did it unto one of these my children, . . . ye did it unto me.' (Matthew 25:40)." Failure in this matter also results in damage to the pastor, which James M. Gustafson refers. to as becoming a "pseudo-charismatic manipulator."

Your authority arises from your Call and all that has been associated with your process in discerning it, preparing for it, and affirming it. Your permission, knowledge, and relationship are completely intertwined with your understanding of that Call. In Prophetic Imagination, Walter Brueggemann suggests some implications of that Call which are helpful to remember as you go to visit the sick. Using the story of Moses leading the Israelites from Egypt, Brueggemann sees the need for a pastoral care enhanced by a prophetic imagination, an imagination that posits a free God, not bound by any system or culture. "If we believe in a free God—free to come and go, free from and even against the regime, free to hear and even answer slaves’ cries, free from all proper godness as defined by the empire—then [our belief, our faith] will impact life and make justice and compassion possible."

Pastoral care of the sick, in and out of the hospital, must always be defined in terms of the authority of the Call. Tillich's argument that care is both universal and mutual reminds us that there are many giving care in God's name, and that the forms of the giving are not easily distinguishable by the title of the one caring. In short, we have no monopoly on either care or any particular form. Our authority is the Call and the process we use daily to discern continually that call. If you believe that God has called you to visit the sick, as God called Moses, Jonah, Mary, Mary Magdalene, Paul, Hildegard of Bingen and countless other men and women in history, then you have the responsibility to wrestle with the purposes for that visit—"sustaining, healing, guiding, reconciling." Only in that context will theological superficiality and psychological manipulation in our visits be avoided!

The wise pastor regularly takes time to reflect upon the authority which serves as the foundation for his or her visits to the sick. Those visits are sacred opportunities for proclaiming the ancient and living message of God's journey with the infirm and suffering. God's claim on your life, represented in your Call, is your authority. It is an awesome task and deserves your fullest attention.

And the Lord will take away from thee all sickness, and will put none of the evil diseases of Egypt, which thou knowest, upon thee; but will lay them upon all them that hate thec. [Deuteronomy 7:15 KJV]

And, behold, there came a leper and worshipped him, saying, Lord, if thou wilt, thou canst make me clean. [Matthew 8:2 KJV]

Is any sick among you? let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord: And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him. [James 5: 14-15 KJV]

Throughout much of recorded history, men and women believed that disease was caused by God, or by evil spirits working upon or through a person's body or by styles of patterns of behavior which, in themselves, were either evil or in dissonance with the mores of the society. Diagnosis meant an examination of a person's relationship with the Divine, with the community, and with ones own self. Certainly the spiritual director or advisor played an important role in the life of the sick person.

Unfortunately, such an approach often hindered the advances of scientists as they sought to gain better understandings of the pathophysiology of disease and frequently burdened the sick with isolation and judgment. Disease is now believed to be caused by chemical agents, bacteria, viruses, genes, and anatomical malformations. Certain lifestyles are still to be avoided, but for reasons of health rather than any communal morality. As modern technological medicine exploded with knowledge, the doctor replaced the shaman, the medicine man or woman, the witch doctor, and the priest or priestess. If today's pastoral-care giver identifies closely with the historical view of disease, she or he will find minimal acceptance from parishioners and even less from hospital staff and personnel. Yet close identification with the modern view frequently results in a pastoral ministry which focuses on supportive factors associated with the patient's attitude toward the disease. At best this is a process parallel to the work of modern medicine and contributes little to either an understanding of the origin of the disease or its actual treatment.

Nor are pastors the only persons troubled with these contrasting views of disease. Harold Merskey, Professor of Psychiatry at London Psychiatric Hospital, London, Ontario, writes:

It is argued that there is no agreed definition of disease. Purely biological definitions are inadequate and combined biological and social definitions are not yet satisfactory . . . In practice, the weight given to the idea of disease varies according to what it will imply about obligations and privileges."

Noted bioethicist H. Tristram Engelhardt, Jr., observes that

physicians have come to use the word disease to designate the underlying nexus of causal forces that produces the symptoms experienced by the patient, which cluster of symptoms is often referred to as an illness. There is a temptation, then, to think of this underlying structure as discoverable without reference to particular values.'

And in The Healer's Art, Eric J. Cassell uses these most poetic words in describing our confusion over the meaning of disease:

The drama of medical care is carried out in the arena of society; and while the primary roles are played by patient and doctor, other members of the social group play active roles. In our culture the rules for this interplay seem to have been stable for a long time, but today the rules are changing because of the technological revolution of our times . . . The success of medicine has created a strain: the doctor sees his role as the curer of disease and "forgets" his role as healer of the sick; and patients wander disabled but without a culturally acceptable mantle of disease with which to clothe the nakedness of their pain.

The sick in our age need a definition of disease which will bring their "whole" self into clear focus and avoid any fragmentation into a mind-body-soul division. Such a definition has been offered by chaplain Robert Reeves in his classic article (and cassette tape), "The Meaning and Message of Illness": Disease is the response of the organism as a whole to whatever seriously alters its equilibrium.

Let us examine certain aspects of Reeves' definition. First, disease is a response. Much of our common language speaks of disease as if it is something that happens to us: "The flu bug got me," or "I had a heart attack," or "I don't know why this happened to me." Such language reflects the belief that the sick individual is relieved of responsibility for his or her illness. She or he is a victim, and cannot be held liable for what has happened. That concept has produced many positive results. Developments such as sick pay benefits and the availability of treatment programs for substance abuse are but two of these. Society is certainly served when individuals and families are not destroyed financially and when assistance is substituted for judgment.

The price for the patient, however, is a sense of victimization in a secular medical world which no longer gives significant credence to the presence of evil as a reality. If medicine did so believe, such a concept would at least open the person to the realm of his or her psyche and soul. Treatment would require behavior changes directed at appeasing the gods or vanquishing evil. Modern health care, despite recent commentary by such people as Scott Peck in People of the Lie or Karl Menninger in Whatever Became of Sin? is essentially devoid of any consideration of the lie, the sin or the evil. Reeves' definition highlights an awareness that disease is a response. That is, disease is a person's answer or reply, behaviorally, and treatment must not only focus upon that reply, but must also discover the question (or stimulation).

The second aspect of Reeves' defnition which deserves our attention is that the response is of the organism as a whole. Hospitals and health care organizations generally strive to design their programs so as to offer treatment to "whole persons." These can range from well-staffed Pastoral Services, Social Services and Guest Relation programs to HBO, art carts, and landscaping. Each of these has supportive research literature indicating its contribution to getting well quicker or staying well longer. While many of these services struggle with decreasing finances, modern marketing concerns dictate their continued presence in some form. Yet almost all of these are viewed as ancillary services and are seldom used diagnostically. Reeves would insist, however, that persons might experience disease as a response to such stimuli as value conflicts, family stress, and even aesthesia.

An approach which does not see the whole as significant in the genesis of a disease is, at best, one which seeks only to remove symptoms. The bug is destroyed the heart muscle is repaired, the "bad" organ is removed, and the patient returns home without struggling with the meaning of the disease—"Why are you sick, now?" More than a century ago the medical researcher Claude Bernard said: "Illnesses hover constantly about us, their seeds blown by the wind, but they do not set in the terrain unless the terrain is ready to receive them." And Louis Pasteur is reported to have acknowledged in his final words: "Bernard is right. The germ is nothing; the terrain all."

Reeves' final phrase also merits attention. "Disease is a response of the organism as a whole to whatever seriously alters its equilibrium. First, the "whatever" recognizes stimuli beyond the narrow limits of the physical or physiological. Technology may hear a patient's symptoms and respond that all tests indicate there is nothing wrong. Allowing for "whatever" helps assure that the patient will not be abandoned. Second, the word "equilibrium" introduces the concept of homeostasis. Living organisms seek to achieve balance in order to insure survival. A sliver under the skin is slowly forced to the surface through mechanisms which could be viewed as symptoms of a disease. So too with many other adaptations to the stresses of everyday life. Hans Selye's work on stress indicates that each person has a general adaptive syndrome which, if stressed enough, can adapt to the point of sickness." (Radiation oncologist O. Carl Simonton lifts this up for his patients when he asks: "Why do you think you have cancer at this time?")

If we believe that the whole of a person involves a dynamic integration of spirit-mind-body-community, then disease would be related to that dynamic. Furthermore, we would affirm to the patient that many of the symptoms which are experienced as unwelcome are, in fact, communications from the whole which suggest areas or concerns which need attention. Such an affirmation eliminates the notion of a victim and invites the patient into a partnership with his or her healers.

If we are to overcome the dualism in both the understanding of disease and treatment resources which fragments patients, then pastors must involve themselves in the struggle to define disease more wholistically. The work of Reeves is but one suggestion. Today there are many voices insisting that such a paradigm for disease is needed. Lawrence LeShan, the Simontons, Eric Cassell, Norman Cousins, and others call us to change our concept to one that is more (w)holistic."

In The Art of Ministering to the Sick, Cabot and Dicks stated three goals or objectives of the pastoral visit. While recognizing the changes since 1936, those divisions are still useful:

a) To counteract the evils of specialization. One may only speculate at the reaction of the authors to today's scene of specialists, sub-specialists and super-sub-specialists! The exponential growth of knowledge relative to the parts and workings of human life is both the cause and the result of an increase in specialization. Hopefully they would be grateful for a development which has enabled medicine to offer hope far beyond the dreams of our fathers and mothers.

In itself, specialization is not an evil, nor are those who pursue it to be condemned. Rather, it is the misuse or abuse of specialization which is the source of the evils we need to counteract. These evils include a fragmentation of the individual which treats him or her as little more than one body part; the pursuit of knowledge with little concern for the value or cost to the patient and to society; the loss of a generalist advocate who is able to assist the patient in her or his journey through the maze of specialties and institutional regulations; and the isolation from the healing community of family and friends which occurs as the many specialist helpers become a barrier to such interaction. The presence of each of these is well documented in the literature. So too are the many outcries against it.

The caring pastor counteracts such evils in at least two ways: first, by recognizing that such evil exists and is a theological issue. The misuse and abuse of specialization occurs when individuals operate from a value system which is faulty or ineffective in the face of philosophical questions concerning the nature, beginning and end point of life and issues related to the uses of technology, and knowledge and limited resources. These value systems are faulty due to a belief system which functions as if knowledge, science or technology is God and are ineffective due to an educational process which has not assisted values clarification. Pastors may address such issues as Preacher, as Priest, as Teacher, and as Administrator. There is no other professional in our society with such unique opportunities. Second, a pastor may counteract the evils arising from specialization in a very specific manner by serving as his or her parishioner's advocate in relating to the health system. This requires a ministry which does not attempt to smooth over problems resulting from abuses or misuses of specialization and treatment. It demands a ministry that is unwilling to function only parallel to the health team, and which is willing to move assertively into relationships wherein data and evaluations and prognoses are shared. Such a ministry will probably not endear the pastor to the persons within that health care system and may result in the loss of some privileges and perquisites of office (clergy parking, relaxed visiting hours, notification of patient admission, and the like). However, the value of such a pastor will greatly exceed any loss of either stature or privilege.

b) To give a devotion such as only religion can permanently inspire. A familiar story tells of a rich person observing a nun cleansing excrement from a dying patient and saying, "I wouldn't do that for a million dollars", to which the nun replies, "Nor would I." Such devotion is what pastors ought to bring to patients. Cabot and Dicks remarked that "devotion is the minister's badge of office when he [or she] goes to a sufferer." It is also an answer to the question, "By what right do I visit this sick person?"—"only by right of serving you."

In practical terms, this will require greater preparation by the pastor before the visit, including reviewing what is known about the patient's spiritual development, personal and family history and work relationships; creatively imagining what might be issues and concerns in both the causes and the results of his or her illness and hospitalization; and seeking out knowledge about the particular disease process from physicians, nurses, chaplains and others in order to better gain a wholistic picture. Finally, the pastor must commit himself or herself in meditation and prayer to offer personal availability to the patient both in the hospital as well as during recuperation at home.

Such devotion also requires an investment of time after each visit. Pastors need to develop their own charting or note systems, rather than arrogantly acting as if their memories were sufficient. We need to further seek out the other care givers—physicians, nurses, chaplains, social workers, family members—and share and critique our assessments. And we need to spend a few moments in planning for and about our future ministries with each patient. Such devotion is represented in the statement of Jesus that "I was sick and ye visited me." It is costly in terms of time and energy, yet it is the greatest gift the pastor offers to the patient, the patient's family and the other care-givers.

c) To care for the growth of souls. Cabot and Dicks raised three questions which pastors must consider in caring for the growth of souls: "Is all growth spiritual growth?" "What are the foods of growth?" and "Why is one [individual's] growth-food another's poison?" Discovering answers in order to minister effectively is a significant challenge. Spiritual growth occurs best when the assistance given meets the individual's growing edges. Pastors, as well as others, frequently assume in offering help that the person is much further along in the process of spiritual growth. "Have faith," "pray," "trust in God," are too often used in a way that stops or interferes with the process. The crisis of disease and illness strips away the bland platitudes symptomatic of spiritual stagnation and opens the person to both the dangers and the opportunities involved in exploring new spiritual growth. This is not an easy task for the pastor. It requires time for truly understanding what and where the patient is and patience with that location. And what is perhaps even more difficult, it demands the pastor's willingness to grow also. The mutuality of care referred to earlier includes a mutuality of spiritual growth. As pastors wrestle with questions of suffering, their theologies will either grow or wither.

The "food" or matrix needed for spiritual growth may be offered in varieties of ways, yet will usually represent one or more of the five categories suggested by Cabot and Dicks: "love, learn[ing] beauty, service and suffering well borne." Each of these is worthy of dedicated time for reflection and consideration in the pastor's own spiritual development, as well as in his or her ministries with the sick.

Love is essential for growth—all growth. Love is gentle as well as hard; encouraging as well as challenging; fulfilling as well as demanding. Loving your patient will not always be easy! Persons who are sick can be demanding, insensitive and uncaring. While our task is not to judge, neither is it to confront the ill with bland superficialities or passive-aggressive infrequencies of visitation. Loving the patient will engage the pastor in a dynamic strong enough to stand against those elements in modern health care which can be violently damaging to a person's well-being.

To learn is to recognize the teaching opportunity of disease and illness. Disease is an opportunity for learning, and the wise pastor offers himself or herself as a mentor, raising questions which encourage self-reflection and awareness and providing or seeking information about the body and about the disease. In the face of a slow and tedious challenge, the pastor will give encouragement.

Beauty is vital to healing. One recent study observed shorter hospital stays for surgical patients whose windows offered views of trees! Even in 1936 Cabot and Dicks noted the need for an appreciation of beauty in this country. While we may not be able to insure windows which look out to trees, we can work to insure art work suitable to the particular struggle of a particular patient, to develop state-of-the-art interior decorating that is stress-reductive for both patients and staff and to encourage the uses of audio and visual media that lift a patient's horizons beyond the sterility and despair which do exist in hospitals. We certainly can do this in the way we offer our patients the sacraments while hospitalized. Well-designed communion and baptismal wares, linens, candles, flowers—these would add considerably to enhancing beauty in the patient's life. Beauty would also include the good use of humor. Cabot and Dicks knew this almost 50 years before Norman Cousins called our attention to it in Anatomy of an Illness. While this is not an open invitation to make the pastoral visit a string of jokes, it is a reminder that humor does offer a healthy means of detachment from situations which threaten to engulf us.

Service as a means for spiritual growth refers to our attitude toward the patient's worth as an individual. Rehabilitation centers require this by demanding that patients learn to feed, dress and move themselves to the limits of their capabilities. Cardiac and oncology units challenge patients to discover ways to live fully with their diseases, rather than surrender meekly as if they had no value in life. Pastors ought to do no less. Patients may also be members of prayer chains for others. Recuperating patients may be invited to share their stories with others in order to broaden the teaching value. Shut-ins may he asked to make telephone calls, fold bulletins or stuff envelopes. Each human being, but especially each patient, needs to have affirmed that he or she is still of service to the community.

Suffering well borne, while appropriate as food for growth, is easier to see retrospectively than prospectively. Certainly there are dangers in even mentioning it. It should never be used as a dictum to the patient to stifle expressions of pain, anger and guilt. No circle in hell is too low for those who would use it in such a manner. Rather, it is most useful as a tenet or belief from which the pastor can operate. It is a truth which encourages him or her when the journey with the sufferer becomes long and discouraging—a reminder that growth is essentially a process and not a goal.

Pastoral care in the modern hospital has become exceedingly complex. Such ministry challenges our vocation, stretches our understanding of what it means to be sick, and demands an attention to and struggle with our theologies. It requires us to become knowledgeable of human dynamics, including the processes of disease, and to be creative in our applications and forms of ministry. Further, it must usually be done in a hierarchical, interdisciplinary system in which the pastor has, at best, an ill-defined role and acceptance.

Involvement in another's struggle with disease is a rare and a demanding privilege. "I was sick and ye visited me" is a helpful paradigm for that involvement and the source of grace for an involvement which is so often beyond our skills.