The Presence at the Bedside

Christians and non-Christians alike are familiar with the story. Jesus tells his disciples to go into Jerusalem on the first day of Unleavened Bread, when the Passover Lamb is sacrificed (Mk. 14:12). The disciples meet there a man carrying a jug of water who guides them to a secret location, which is already furnished and ready for the preparation of the Passover meal. This kind of espionage was necessary. Jesus had become something of a local celebrity, a hero among the people for witnessing in rhetoric and action against the injustice of Roman domination of Judea. If it was evening or later, Jesus’ movements needed to stay quiet. The authorities were already planning on his arrest and execution, but they knew they couldn’t carry it out in broad daylight for fear of the people (Mk. 14:2). So Jesus joins the disciples later, when they sit down to eat. During the meal, Jesus lifts up the bread and the wine, blesses them, and proclaims them his body and blood (“of the covenant, which is poured out for many”). He instructs his disciples to eat and drink in his presence, and to recognize the holiness of the meal shared freely.

Mark’s account of the institution of the sacrament of Holy Communion is very straightforward in its portrayal of its own radicalism. It takes place during a celebration of liberation from slavery. The meal is shared among zealous sectarians at odds with their ruling government and religious authorities. The story features secret rooms and shady meetings and transportation after nightfall. It ends, of course, in betrayal, execution, and ultimate denial of authoritarianism’s claim over the forces of life and death. We share the meal to acknowledge, participate in, and experience afresh the new covenant with God in Jesus—a covenant that affirms God’s care for the excluded, the overlooked, the marginalized, the unfit. The whole thing is very paradigm-shifting and boundary-crossing and it asks much of the recipient. This makes the Eucharist, for the chaplain, a daunting religious experience to bring to the bedside of a dying patient. When one is facing the end of life, parsing through existential dilemmas or spending precious final moments with loved ones, Communion can feel like a step too far—a harsh demand to lay before a suffering individual. Spiritual caregivers (perhaps especially this writer) may soften the language or theological presentation of the liturgy, or forego its presentation altogether. This is ill-advised, as humans have neither the authority to restrict God’s table nor the right to filter God’s call. When this hubris is laid aside, however, and the challenge of God is embraced, the transformative power of Communion and its purpose at the bedside begin to reveal themselves.

According to orthodox Christian theology, “the most important aspect of Eucharist is what happens to those who participate in it” (Mitchell, Nathan D. “Eucharist.” in New & Enlarged Handbook of Christian Theology. 180). The Eucharist—the authentic Eucharist—changes the practitioner. It sustains them, yes, but it also encourages them and compels them beyond receiving. It initiates response. “As Augustine noted, in every ordinary meal humans transform food into themselves; but at Eucharist, Christians become what they eat. Sharing the meal, they ‘receive what they are,’ Christ’s body” (ibid.). Those who eat with the risen Christ have their eyes opened and recognize the presence of the ultimate (Lk 24), the divinity in their neighbors, the challenge of deep need and the mediating force of human relationship. Holy Communion is decidedly immediate. “The invitation and call [to Communion] celebrate not only the memory of a meal that is past, but an actual meal with the risen Christ,” states the United Church of Christ’s Book of Worship (32). It acknowledges past and promises future but its purpose is present. The immediacy of the Eucharist and its power to compel and transform is context-specific and meets both the need and the ability of the disciple. Christ does not ask more than can be reasonably given (which often, terrifyingly, is everything), and Christ meets emergent need with intimate peculiarity. With this in mind, the meal and its context-specific power is always directly relevant to the disciple (this is, of course, assuming that the meal administered is not simply the reinforcement of dogmatic obedience disguised as Eucharist; the Eucharist is for the disciple with Christ, not for the church through the disciple). Therefore, Communion—unfiltered and in its utterly transformative significance—is appropriate for the dying. We need not soften its meaning just because we are uncomfortable.

Given that, sensitively conducted, a Communion rite will be different for each situation, this short essay could not pretend to describe the fullness of its significance(s) nor suggest comprehensive alterations for those interested. There is space, however, to consider the context of the author. I serve as a hospice chaplain in Collier County, FL. Collier County has, according to a 2016 Naples Daily News article, the third steepest class disparity in the United States. The average individual in the top 1% of Collier County earners makes 73.2 times as much as the average individual in the bottom 99%. Consequently, I minister to a great variety of individuals in both serious need and lavish excess. Impending death is the uniting factor. Unlike ministers in pastoral contexts, the tasks of challenging ideology and reforming societal injustices are not primary job responsibilities. While chaplains still interact with harmful theologies and seek to undo injustice, their first responsibility is relational, emotional, and spiritual care to patients and families for short and intense periods of time. The setting for the Eucharistic meal, then, is on familial and relational disparities, reestablishing and reaffirming human dignity (especially for the patient, but also for any loved ones who may have been estranged or abused), offering promise of respite, and forming a foundation for real encounter and even genuine confession and absolution among families. This will be disparately lived out among families against (and within) social, economic, and racial backdrops. Some patients may have been exploited and utilized all their lives for the wants of others. Some may have been seated in power and privilege and are now experiencing actual vulnerability and suffering for the first time. Christ’s transformative and even transgressive presence interrupts the unjust mechanisms that produce disparity and hatred in the simple act of recognition and affirmation. It halts processes of cynical exchange or extraction of value and speaks value into what is perceived by society to be valueless. Consequently, it may initiate significant discomfort or reflection. This is good and right. Communion empowers individuals to reflect upon their participation in and dehumanization by unjust systems just as it gives them opportunity to be counter to those systems. This process is impossible without some friction, to which the chaplain might minister seeking stability and compassion.

Recognizing the particularity of each individual’s encounter with Christ in Eucharist demands that ritual must be tailored by the minister to reflect and respond to reality. Only the individuals in a certain situation can truly speak to what liberative formal changes might be made to better and more clearly recognize Christ’s presence at their respective bedsides, but some general suggestions could be made from my (brief) experience. The words of institution have often proven unhelpful. Rather than orient those involved to Christ, they evoke the guilt mongering of the church and the dispassionate gore of substitutiary atonement soteriology. This is a shame because the words of institution are wonderful and harrowing, but without (lots and lots) of reflection and exploration, they simply repeat an organization’s false accusations about what the disciple has done to God, what God then had to do to Jesus, and what God has engineered now for the individual. Scriptural settings that plant the rite in the surprising and empowering immediacy of Christ in the midst of terror (the Road to Emmaus) or the indiscriminate and distinctly physical care of God in Christ without asking anything in return (the Feeding of the Five Thousand) tend to be more congruent with the purposes of the sacrament in these particular caring relationships. Further, the use of formal liturgies that aren’t memorized or spoken for the patient, those that are read word-for-word from a resource, are interpreted as impersonal and disinterested by the patient (this may be the one unanimous complaint I have received about chaplains who work in the hospitals from which our patients are transferred). People nearing death have very little time for bullshit, and will tell you as much. Consistency with institutional language and thought is inferior to the needs of those cared for. Finally, the Eucharist does not have to be ritual. The most identifiably Eucharistic experience I have yet had in hospice was sharing a soda with a grieving daughter. The solidarity and fellowship of drinking together, the encounter it enabled, were clearly and vitally Christian without the need for any traditionally theological or “religious” trappings. That said, ritual is also very empowering and important for some, so again the primacy of the patient’s experience complicates the task of general reflection.

The Eucharist’s power and purpose at the bedside lies in Christ’s distinct and intimate concern for each in their peculiarity, in the affirmation of their ongoing value and humanity, and in the dual reassurance/invitation that ongoing relational work is possible. This is, of course, a limited essay about an unlimited subject. It does not remotely address all the dynamics of any single caring relationship let alone suggest broad implications for all of chaplaincy. It does, however, propose a theological orientation for a caring and liberative sacrament, an evasive and ephemeral subject which needs consistent attention and revision from those who seek to administer it.