By Rev. Alejandro De Jesus
Jim was a 72-year old veteran admitted to the Community Living Center from a nursing home. He served in the Army for four years, post-Korea. Afflicted with advanced amyotrophic lateral sclerosis (ALS), he used an electric wheelchair and communicated through electronic devices. He also presented with depression due to PTSD. He had no history of alcohol or substance abuse. He was Roman Catholic.
Jim had been divorced four times. One son had no relationship with him, while another was in prison. He refused to talk about his children in general, and preferred not to discuss his marriages. When he was admitted, he was placed on 24-hour watch due to his prior attempt at suicide – by driving his wheelchair to the middle of street.
My initial spiritual assessment centered on two main concerns: (a) a deepening loss of meaning in life, exacerbated by his worsening ALS as well as family issues; and (b) intense need for emotional support, a broken self-image and deep disappointment at his life and the lives of his children. In terms of spiritual distress, this veteran could be rated as between 9 and 10, with 10 as the highest suffering.
However, a couple of things were going right: his strong faith and his steadfast devotion to the sacraments and other spiritual resources. He attended not just Sunday Masses but also the weekday Masses, and regularly received Holy Communion. I also taught him to use his iPad, and later his keyboard, to count the Hail Marys when praying the rosary, since he could not use the beads. Much later, when he could not use even the keyboard, I provided him with rosary prayers on CD.
Jim’s outstanding spiritual resources were an effective counterbalance to his level of suffering, lowering it to perhaps 5, or even a 4, since he not only identified the resources that could help him cope and find meaning, but had also learned to ardently utilize them.
My care plan, therefore, helped him use his faith to make sense of a worsening disease, as well as broken family relationships and expectations. During Lent, I guided him through meditation on the sufferings of the Lord, leading him to realize tearfully that he shared in those sufferings through his debilitating and “humiliating” illness that seemed close to the “violence done to Jesus” (actual quotes from his iPad and monitor). I affirmed his realization and pointed out that receiving Communion unites us with the Lord, in both his joys and suffering.
He slowly opened up to me, expressing gratitude for being able to gradually accept the limitations imposed by his illness. I helped him identify the hurts and fears that underlay his anger, realizing it was uncertainty about the future that caused his anxiety. A few weeks into the care plan, he scribbled, “body wrek inside good” (sic).
A few days before he passed away, he struggled to make a few sounds and to move his body to tell me something. I replied, “I know what you mean, Jim. I love you, too.”
The prophet Jeremiah (4:19) cried: “My heart, my heart – I writhe in pain! My heart pounds within me! I cannot be still.” In similar verses, the prophet uses what theologians call the language of lament. We have almost lost this language in our religious communities but it is one that humanity fully understands – for who has not experienced pain in their lives? Esther Fleece notes that we need lament, since it pertains to that “passionate expression of our pain that God meets us in. It’s real talk with God about ways we are hurting. It’s an honest prayer to God about where we are, not where we are pretending to be.”
Jim’s entire world was crumbling, together with his physical body and his tortured mind. What saved him was his ability to express all this in lamentation, in a free-wheeling weeping and pleas for mercy to a God he was convinced was still listening to him. The spiritual writer Ron Rolheiser pointed to the Book of Lamentations in the Bible as precisely describing Jim’s dilemma: that sometimes, all we can do is put our mouths to the dust and wait! The moment Jim discovered that lamentation is also prayer, his journey of hope in God was facilitated.
By receiving the sacraments, praying the devotionals, coming to confession, writing about his feelings, and remaining open to inspiration, Jim was actually overcoming the fear of dying. How inspiring indeed to do this while his debilitating illness was fast curtailing his modes of expression, until he could hardly move anything. But none of this could silence Jim’s lament. Esther Fleece truly describes Jim’s journey: “Lament is about tapping honestly into our emotions in a deep and primal way that sometimes transcends words. I am comforted to know that God meets us here, any way we choose to cry out.”
Jim is sadly not an exception with regard to suicide ideation and other mental health problems. Federal data shows that an average of 16 veterans die by suicide a day.
As a mental health problem that develops after life-threatening events, like combat encounters, PTSD manifests in upsetting memories, trouble with sleeping or nightmares, and frightening thoughts. At other times, the sufferer may exhibit avoidance symptoms such as staying away from things that remind them of the traumatic experience or avoiding thoughts or feelings related to it.
Medically, it can manifest as high blood pressure, respiratory distress, or obesity. A person can become easily startled and feel on edge, or even unexplainable anger. It also manifests in distrust of others as well as emotional numbness. Many patients also deal with other mental problems such as depression, anxiety, alcohol and substance use disorder, as well as thoughts about harming themselves.
Complicated as PTSD already is, now try to imagine these sufferers at the end of life. Some of them experience what is termed as trauma triggers, that is, experiences that cause “instantaneous, unconscious, and highly charged associations with the traumatic event.” I witnessed an 88-year-old World War II veteran, a couple of days before he died, screaming at the top of his lungs, “Sulfur! Sulfur!”
Ministry to veterans require a compassionate heart that understands their profound woundedness and fragility of spirit. The scars of the war go deeper than the surface, and many moral and spiritual wounds pester them till their dying moments. Those who minister to them must be willing, ready and be of strong character to hold their bleeding and throbbing hearts gently.
Rev. Alejandro De Jesus is board certified by the NACC, the National Conference of Veterans Affairs Catholic Chaplains, and the National Association of Veterans Affairs Chaplains, and has a specialty certification in mental health as well as hospice and palliative care. This article is adapted from a talk at the Integrative Medicine and Mental Health Conference at the University of California Los Angeles, on March 9, 2019.