By Linda F. Piotrowski
Rituals serve many purposes. Foremost is to remind us that God does not abandon us. Rituals also help us to step out of chronos time to enter into kairos time. Rituals are defined as a stylized prescribed manner of marking a religious ceremony. They remind us, as Ecclesiastes states, “there is a time for everything.”
To the Preacher’s list, we could also add that there is a time for patients and a time for families. Using a basic template, with room for variation, can greatly help families process the loss of a loved one.
At the bedside, I’ve found that most people are not disposed to a long, involved ceremony. Keeping in mind the spiritual/religious beliefs of the patient and loved ones, a simple template is: statement of purpose, opening prayer, short reading, symbolic action, perhaps a song/hymn, and closing. I try to involve everyone present if that is at all possible.
One evening I was called in to the bedside of an elderly man. The patriarch of the family was in the process of dying. He was no longer awake or alert. Several of his children and grandchildren were present, as well as his second wife. (His first wife was deceased.) They asked for prayers of farewell. After listening to them talk about him, I invited them to gather around his bedside. I invited everyone present to place a hand on him. His wife and eldest son stood on either side of him and placed a hand on his face. Speaking to him by name, I explained that the people who loved him wanted to help him on his journey by praying.
I briefly prayed for all of us to remember God’s presence with us. I then invited those present to come forward to speak into his ear some message they wanted him to take with him. I carefully explained that this was not required but if they felt confident doing so they were welcome to. Each one present came forward and spoke in a quiet whisper into his ear. Some kissed him. There were lots of tears and expressions of love and some of forgiveness, while one asked for forgiveness. I asked if they had a hymn or a song that was his favorite. His eldest son said that his dad always liked “Danny Boy.” He began to sing, and the others joined in. I prayed a blessing to end the service.
A more formalized ritual is the ceremony celebrated weekly by the palliative care team. Wanting to care for ourselves, as well as the families we serve, led me to develop two ceremonies (one for staff and one for loved ones) to honor the lives of the deceased.
Preparation includes setting out a large glass bowl with colored glass beads the color of water. First, an index card with the name of a deceased patient, along with a star, is put at places around the meeting table. When the staff is all gathered the presider recites, “The time has come for us to remember and celebrate the lives of the people we’ve been privileged to serve.”
Ring a singing bowl. When the sound ceases, the presider recites an Eskimo saying: “Perhaps they are not stars, but rather openings in the heavens where the love of our lost ones shines through to let us know their souls are at peace.” One by one, staff members come forward, read aloud the name, place the star in the bowl, stand in silence for a moment, and then return to their seat. When all the stars have been placed and names read, the service ends with a moment of silence.
This simple ritual was expanded to include all the families of the deceased patients when we held quarterly family services of remembrance. Family members of patients who had died within the previous four months are invited, and the service is publicized throughout the medical center. Members of the palliative care team are involved. Some read texts, some sing, some read names. The service takes place in a hospital meeting room. A staff member plays the harp as people gather, during the reading of names, and after the service. Staff and members of the volunteer program also play guitar and sing. Volunteers help to set up, welcome, mingle, serve refreshments, and clean up.
This is the template for the quarterly family service of remembrance.
Welcome by the director of palliative care
Gathering prayer by presider
First Reading (Hebrew Scriptures, usually Psalm 23, read by staff member)
Litany of Remembrance Reflective Song/Music
Second Reading (suggested and read by a staff member)
Ritual of Remembrance (This is the same ritual described above and used for the team. The presider explains how the ritual is used on a weekly basis to remember and celebrate their loved ones. Staff members read the names. Family and friends are invited to come forward to place a star in the bowl when they hear their loved one’s name read.)
Final reading Selected and read by a staff member.
Blessing and Sending Forth (includes invitation for everyone to remain, share refreshments, and speak with staff)
Most of the time, keeping a simple template in mind while allowing for spontaneity is the best way to minister to a family that needs the comfort and support of a ritual ceremony. As every chaplain knows, we do ongoing assessment of what will best serve the patient and family. Remembering their religious/spiritual beliefs helps us to minister with compassion, giving them and us a kairos moment that can comfort. And although rituals may be formal and complex, they may also be as simple as holding hands while the chaplain prays.
Linda Piotrowski, BCC, is a retired palliative care chaplain at Dartmouth Hitchcock Medical Center in Lebanon, N.H.