Sacred Ground at the Bedside:

The Hospice Caregiver as Partner of God's Compassion

Sr. ELIZABETH A. JOHNSON, Ph.D.

      In exploring the meaning of the role of the hospice caregiver, a story in the book of Exodus comes to mind. There a crucial encounter takes place between a man minding his flocks and God who wants to free the Israelites from their awful slavery in the land of Egypt Moses, the shepherd, sees a burning bush which is not consumed despite the fact that it is blazing. The voice of God calls to him from the bush: "Remove the sandals from your feet, for the place on which you are standing is holy ground." Moses does so, and then the sacred voice resounds with a magnificent disclosure: "I have seen the misery of my people who are in Egypt; I have heard their cry because of their taskmasters; I know well what they are suffering. Therefore I have come down to deliver them out of that land and bring them into a good land flowing with milk and honey.… So come, I will send you to Pharaoh to bring my people, the Israelites, out of Egypt." Quite taken aback and fearful, Moses objects. But God ends the encounter by saying simply, "I will be with you." The rest, as they say, is history. (Exodus 3:1-12).

     In this encounter, a certain patch of ground becomes holy because God is present there, pouring out divine love in the form of compassion for people who are suffering. The verbs used in the divine address from the flaming bush are highly instructive. Rather than being distant and far removed from the turmoil of earth, the Holy One suffers with those who are sore distressed: I have seen, I have heard, I know what they are suffering. Know, in this instance, means a knowing in the heart, a felt experience,

Sr. ELIZABETH A JOHNSON, Ph.D., CSJ, University Distinguished Professor of Theology at Fordham University. She is the author of several books and dozens of essays in scholarly journals, chapters in edited books, encyclopedia entries, and articles in popular journals. Her work has been translated into German, Portuguese, Spanish, Italian, French, and Korean. She is past president of the Catholic Theological Society of America, she has received three honorary doctorates, and been honored with the annual award from U.S. Catholic Journal for promoting the cause of women in the church.

as when the Bible says that "Adam knew his wife," indicating sexual intercourse. God's own heart feels experientially what the people are going through. And moved by this compassion, God takes action to deliver them, I have come down, and does so in a typical way by calling a human being to act as a partner of divine compassion in the world: Come, I will send you.

     The bedside of the hospice patient is sacred ground for the same reason that the ground around the burning bush is sacred: because someone is suffering, because God is present there and shares this pain, and because the caregiver is called to be a co-partner of God's compassion in accompanying the dying person throughout the time of transition, out of the place of pain. In effect, the voice of God says to the caregiver: Come, I will send you to bring my presence, warmth, and help to these suffering persons in and through your own human heart and expert care.

     The term compassion comes from joining the Latin words cum meaning with, and pati meaning to suffer. It means to "suffer with" someone; to have a certain fellow feeling that allows you to gain an interior connection to someone else's pain; to enter into a relationship with a suffering person in such a way that he or she feels respected and empowered; simply to stand with someone, recognizing that despite the pain or disfigurement he or she is a person of mystery, beauty, and strength. Through their own compassionate hearts, those who do hospice care have the profound calling of embodying divine compassion, of being the ones through whom God's care is in reality poured out over dying persons.
It is instructive to trace how often in the Bible the compassion of God is imaged in female metaphors. Of course, God is neither male nor female but Creator of both in the divine image and likeness. Since both male and female image God, the experience of both can provide metaphors for speaking about God. But in the course of history, a prejudice against the goodness and blessedness

and even the full humanity of women titled our language in favor of male images of God. It was thought that a woman's life, her body and emotions, were not worthy to image God. In our day, however, the upsurge in women's awareness around the world is reclaiming the dignity of being female, even before God, and thus female images of God are once again being put into play.
Using female metaphors to speak of God does not mean that God is literally female, just as using male images does not indicate a literal maleness in God. No images are adequate, for the holy mystery of God goes for beyond human ability to comprehend. We use metaphors and analogies simply to point, to say the way God acts and feels and relates is something like this. With regard to suffering, women's experiences of caring and loving provide beautiful language for divine compassion.

     One major discovery of recent years has been that the Hebrew word for compassion comes from the same root (rhm) as the word for a woman's womb. When the scripture says that God has compassion on suffering people, the underlying metaphor signals that God is loving them as a mother loves the child of her womb. The prophet Isaiah writes, "The Lord has comforted his people, and will have compassion (womb love) on the suffering ones;" and again, God says, "Can a woman forget her sucking baby, that she should have no compassion (womb love) on the child of her womb? Yet even should she forget, yet I will not forget you." In compassion God is more of a mother than any mother. From an organ of the female body to a physical state: the metaphor suggests the meaning of compassion as self-giving participation in life for the sake of the other whom one helps and protects but does not control. In the New Testament even Jesus, who himself showed such compassion, used the maternal metaphor, telling Nicodemus that a person must be born again of water and the Spirit in order to enter the kingdom of God. In other words, the Spirit of God is like a mother birthing us into new life.

     Another powerful female image of God's compassion is the shechinah, or the great Spirit of God who dwells in the world. Mobil and free, she doesn't just dwell there, but accompanies people wherever they go. No place is too hostile. She walks with them through the desert once they have escaped from slavery and, centuries later, she goes with them into exile again, never abandoning them through all the byways of rough times. As the rabbis wrote: "Come and see how beloved are the Israelites before God, for withsoever they journeyed in their captivity the shechinah journeyed with them." In other words, God's indwelling Spirit was with them and her accompaniment gave rise to hope and encouragement in the darkness, a sense God was with them to see them through. When the people are brought low then the shechinah lies in the dust with them,

anguished by human suffering. Even when a criminal is hanged, God feels compassion. As the rabbis write, "When a human being suffers what does the shechinah say? My head is too heavy for Me; My arm is too heavy for Me. And if God is so grieved over the blood of the wicked that is shed, how much more so over the blood of the righteous." The biblical understanding that the Spirit of God moves throughout the world to bring life and blessing here receives a special twist in situations of conflict and trouble, God's presence, imaged in female form, embracing those who suffer in this divine compassion is a source of peace, vitality, and consolation in the struggle.

     God's compassion, spoken of in female form, becomes embodied in the many women and men who are hospice caregivers. The relationship they set up with patients at the edge of life can be of mutual benefit. The patients are in need; they face the darkness of death and need to feel that they are not abandoned but are enfolded in care. Those who are people of faith also need to feel deeply the nearness of God's compassion. Being carried by God's love, they can believe that their dying opens upon a future where it seems empirically there is no future in this suffering, each patient has the dignity of a human person and can respond in deeply human ways with gratitude, humor, and relief; even merely by being there they have given others the privilege of serving them.

     The caregivers are replete with riches to give; their medical expertise relieves pain and soothes jangled bodies, but even more, their own human compassion is the medium that reaches patients at the deepest level of personal need. At the same time, caregivers also have a full range of human emotions that must be respected, including the need to get away or to protect themselves from drowning in too much sorrow. The temptation here, as for other health-care professionals, is to reduce patients to objects, referring to them as a bed number or a room number and forgetting that they are fellow human beings. Hospice principles set up a different idea, asking caregivers to relate to patients on a more person-to-person level in this relationship, both can grow to be more fully and maturely themselves in different ways, provided they honor their own and each other's humanity.

     The bedside is sacred ground in the spirit of Hospice, caregivers' work brings them to see and hear and know well what dying persons are suffering. They come to deliver patients from pain, but even more profoundly to share their suffering in a compassionate relationship that sustains human dignity and sees them through the end. In this, they are midwifing persons throughout the "birth" process into the hands of God. They are coworkers with God at a most critical moment of life. Accompanying and giving hospice care to the dying, they image and embody in a beautiful and real sense the infinite mystery of divine compassion.