Caring for the Suffering in the Shadow of the Cross: Faith-Based Health Care

Hospitals are filled with people who suffer -- not just people who are ill or diseased, but also people who suffer. Surely, not all suffer, but very many do. Their suffering takes various forms the suffering that arises from physical pain as well as that arising from soul pain. The latter has multiple causes. At times it results from temporary or permanent disruptions in the sufferer's daily routines, relationships, future, or even identity. At other times it comes about because of the sufferer's experience of the loss of various functions or opportunities, the loss of control, dependency on others, or perhaps a sense of powerlessness. Isolation, loneliness, and abandonment can also result in soul pain as can a loss of life's meaning and a sense of one's own dignity and worth.

All too often, this rampant suffering goes "untreated" despite claims to a holistic approach to patient care. Health care facilities after all exist primarily to cure illness and disease or to treat symptoms, not to alleviate suffering. They are often characterized by hi-tech and low touch. Most, of course, have chaplains who attend to patients' spiritual needs, some of which have to do with suffering. But is this sufficient, especially in health care institutions that claim to be faith-based? It would seem not. What should we be able to expect from health care facilities that claim to be faith-based, particularly those in the Christian tradition? The claim to be faith-based must be much more than sponsorship of the organization by a religious body (i.e. one or more congregations of religious women or a particular religious denomination such as the Lutheran or Adventist churches). It must be more than signage and symbols and even more than mission and values statements.

Being faith-based must have something to do with the culture of the organization -- with the beliefs, values, attitudes, policies, practices, and behaviors that are expressed in the daily activities of the organization as a whole, as well as in and by its employees. In turn, that culture ought to be grounded in, shaped and guided by the core elements of the faith tradition in question. This rootedness ought to contribute to a particular way of being and doing, one that arises out of, is consistent with, and expressive of the core elements and commitments of the faith tradition. In other words, to be faith-based means that an institution's grounding beliefs inform its character or identity as well as its behavior.

For health care institutions created in the Christian tradition, being faith-based means that we are rooted in the life and ministry of Jesus Christ. While various Christian traditions may have different angles of vision, somewhat different interpretations of the Christ-event, it is nonetheless faith in the person and mission of Jesus that is the starting point, the foundation, the basis of their ministry of healing. Those who engage in the work of curing and healing ought to be and act in ways that are consistent with and expressive of the life and ministry of Jesus Christ. This does not mean that all must espouse the core beliefs of the particular religious tradition. It does mean, however, that they carry out their work in ways that are consistent with those beliefs. They must be able to embody in their care of patients and in their other relationships the tradition's and institution's fundamental values.

What does all this have to do with suffering and a theology of the cross? Quite obviously, the cross is central to the life and mission of Jesus. As a core element of the Christ-event, the cross should have some bearing on the culture of health care organizations that claim to be based in the Christian tradition. This statement might well strike those working in Christian faith-based health care as odd. They have probably never considered the implications of the cross for the culture of the organization or for how care is delivered to patients. But if a faith-based health care organization is "in the Christian tradition," somehow this core element of the Christ-event must have some bearing on the organization's character and behavior. What might that be?

In order to begin to answer this question, we need to consider the relationship of the cross to suffering. What does the cross say to human suffering? Surely there are many ways to answer this question. The mystery of the cross is ultimately inexhaustible. But as I reflect on the death of Jesus and the events leading up to and surrounding it, several things strike me. First of all, Jesus' suffering was real. It was physical, emotional, social, and spiritual. Jesus experienced physical pain from the blows, the scourging, the crowning, the carrying of the cross, and the crucifixion itself. He also suffered soul pain. He experienced humiliation from his appearance, the way he was treated, the mocking of the crowd and the soldiers, and from being spit upon. He suffered the agony of betrayal and abandonment by his own people, his followers, and even his God. "My God, my God, why have you forsaken me?" is one of the most poignant cries that one can imagine (Mt. 27:46). The one who lived his life in utter obedience to God's will and in complete devotion to preaching the Kingdom of God, feels, in the end, that the one with whom and for whom he has lived his life has abandoned him. His cry is not only an expression of abandonment, but a calling into question of the very purpose and meaning of his existence. Was his life ending in utter rejection and failure? Had it all been in vain? Where is his God when he is most in need?

From a human perspective, what is perhaps most significant about this event is the way in which the suffering Jesus responds to his situation. In the Garden of Gethsemane, Jesus pleads with his Father to take away the cup of suffering (Mt. 26:39). He does not want to have to endure what lies ahead. But taking away his suffering is not to be, so Jesus endures through to the very end (Mt. 26:42). And in the midst of the physical pain, the awful humiliation, the powerlessness and loss of control, the betrayal, and the sense of abandonment, Jesus utters another cry: "Father, into your hands I commend my spirit" (Lk. 23:46). This is an expression of ultimate surrender and trust. In the darkness and the silence, Jesus opts not for despair but for surrender into the hands of his God. This could only occur because he trusted utterly in the abiding presence and love of God -- the God who would raise him up, thereby conquering suffering and death and transforming it into new life. Ultimately, the cross tells us that suffering and death, as terrible as they might be, are not the last word. Ever present in the suffering sometimes hidden and silent is the God of abiding love who gives life. This is the basis for hope when all seems hopeless hope that in the end God, love and life will triumph. This, however, requires an attitude of surrender and trust.

What could all this possibly mean for health care institutions grounded in the Christian tradition? What does the cross have to do with the culture of these organizations? What difference should the cross make for the character and behavior of these institutions and those who work within them? The cross is ultimately a word of hope. Jesus' entrusting himself to God is an act of hope. And God's abiding love and transformation of suffering and death into new life is the basis for hope. In the words of the late Cardinal Bernadin, "Trusting in God's love from which we can never be separated, we are confident that it is always possible to continue with life despite the chaos we encounter along our pilgrim journey" (A Sign of Hope, 1995, p.3). This is not fundamentally a hope for something. It is rather a confidence that in the end God's abiding love and new life will win out (2 Cor. 5:6-10).

Health care that is grounded in the Christian tradition should also be a word of hope to those it serves. Again, in the words of the late Cardinal Bernadin, "As Christians, we are called, indeed empowered, to comfort others in the midst of their suffering by giving them a reason to hope. We are called to help them experience God's enduring love for them. This is what makes Christian healthcare truly distinctive. We are to do for one another what Jesus did: comfort others by inspiring in them hope and confidence in life. "The ultimate goal of our care is to give those who are ill, through our care, a reason to hope" (A Sign of Hope, pp. 4-5).

How might this occur? However it occurs, it means cultivating certain beliefs, attitudes, dispositions, and practices among caregivers and staff. At a minimum, it would seem to require a fostering of attentiveness to suffering in all its dimensions. The caregiver's concern would need to move beyond the patient's illness or disease to encompass his or her suffering. Relief of suffering in its various manifestations (including physical suffering) would need to be seen as a legitimate goal of health care. This in turn would suggest a genuine commitment to providing holistic care and a concern for healing as well as curing. High touch as well as high tech, caring with compassion as well as skill, a readiness to be present to the suffering, as well as creating an environment of hospitality would also likely foster hope in those who suffer. In other words, taking the cross seriously in the context of a health care institution ultimately means creating a different kind of culture -- a different environment and a very different way in which care is provided. This is nothing less than institutional transformation an extremely difficult challenge, especially in an age of abundant technology and a shortage of time and personnel. Equally, and perhaps even more difficult, is directly addressing patients' suffering -- identifying the cause of their suffering, trying to alleviate or eliminate it or at least helping patients to bear it. Briefer hospital stays and over-stretched staff pose a significant challenge to what would be difficult in the best of circumstances. But this is not an impossible task even for staff not trained in pastoral care or counseling. Attentive listening, touch, and the right word at the right time can often go a long way toward compassion.

Faith-based hospitals often struggle with identity. They wonder about what it is that distinguishes them from secular health care institutions. In some ways, asking about what is distinctive is the wrong approach. Rather, they might ask "Who should we be and how should we act given our fundamental commitments?" In answering this question, these institutions, among other things, should have to struggle with the meaning of the cross for the kinds of institutions they are and become and for how they act. If they are successful in naming and embodying the meaning of the cross, they might in fact become distinguished as communities of care, hospitality, and hope because they care for people, in the words of Cardinal Bernadin, "in such a way that they have hope" (A Sign of Hope, p. 7).