In the series “Close to the end”, Bas de Vries, Jesse Gruiters and Ginette Hesselmann, together with colleagues, reflect on an uncomfortable subject: death. A subject that we sometimes seem to prefer to avoid. How do healthcare professionals actually relate to the end of life? In the fourth interview they speak with Tjeerd Visser (1973). He works as a spiritual counselor at UMC Utrecht.
What was your first encounter with death?
“In my youth, I felt like death was absent. Only old people die, I thought. It was only during my high school graduation period that I really came into contact with death. We were told that a classmate had taken his own life. I can’t explain how awful and confusing that was. I sat next to him almost every lesson. It was so sudden, so abrupt…”
“We had spent the day earlier with our group of friends. It had been a fantastic afternoon. We knew he was having a hard time, but as friends we never saw such a self-chosen ending coming…”
“This event also brought me into contact with everything that comes with the end of life for the first time. The school guided us very well in this. I remember we talked a lot at school. A small memorial corner was also set up for him.”
“It was all very confrontational. Suddenly I was walking with classmates with his coffin on my shoulder. At the same time, the daily rhythm of school life continued as usual. Not long after, I was sitting in a large classroom struggling with my final exams. The table in front of me remained empty. Only his nameplate was on it.”
You have had quite a career in the church. How did you end up at the UMC?
“I have now been working as a spiritual counselor at the UMC for two and a half years. The corona crisis has played an important role in this. Like many people, I saw images of overcrowded hospitals on the news at home. Those images made a huge impression on me. I felt something of a calling: a strong feeling that I had to be there. It happens there in the hospitals. Maybe so: I can be of value there. I am now very happy with my work in the hospital. I am also proud to be part of such a group of enthusiastic people.”
How do you, as a spiritual counselor, encounter death in the hospital?
“Death is a common topic in conversations with patients and their families. In the beginning, I had to find a way to fulfill my role as a spiritual counselor in the palliative phase.”
“As a pastor, as an office holder, my role had been very self-evident for many years. For example, I visited people to give the anointing of the sick or led the funeral. The division of roles was then very clear.”
“It is very different at the UMC. That also makes it very interesting. My work mainly consists of conducting counseling conversations with patients and their family members. The central theme in these conversations is often: how should I relate to the suffering that happens to me?”
“I find that incredibly fascinating. Every person has his or her own answer. It is also often about the meaning of the illness or impending death. I always approach these questions from a relational perspective: what does it mean for you and what does that mean for you in relation to the other person?”
“I try not to approach incurable or terminal patients differently than other patients. My deeper task for myself is to help patients feel human. By that I mean that I want to broaden their horizons. ‘You are not only a patient, you are not only terminally ill, you are also and above all a human being.’”
“I’ve actually always had this approach. I just love people so much. Call it humanity. I also feel a strong curiosity. Who is man?”
What strikes you in conversations with people about death?
“A lot of things, actually. People generally experience the heaviness surrounding death strongly. I’ve learned that people like it when you don’t make the subject more difficult. It may sound crazy, but humor is a meaningful dimension in guidance for me. Not to push the sadness away, humor can actually make room for sadness.”
“For example, I was recently talking to a religious patient who was very helpful. His hands could create what his eyes saw. In our counseling conversation we talked about a Bible passage that says: ‘In my father’s house there is room for many’. “Yes, I know that passage,” said the patient. I said, “Maybe our dear Lord could use a handyman upstairs.” A broad smile broke out on the man’s face. Such an innocent remark momentarily breaks the heaviness of talking about death. It gives air and space.”
Do people also have questions about death? Does God exist? Is there a heaven? Will I see my loved ones again?
“I don’t have any answers. That is not my role in the UMC either. I am there to help people find their own answers to life’s big questions. What’s the point of it all? What is important now? Who or what gives me comfort?”
“I have of course had to face these questions myself. In my personal life, it comforts me that I expect to see the people I lost again.”
How can you, as a spiritual counselor, help people who are on the eve of death?
“What I think is wonderful is when you can help people to become more surrendered. I see many people on the nursing wards struggling with this. Nurses and doctors indirectly too. It is difficult to care for a patient who shows in everything that he or she does not want to say goodbye to life.”
“Surrender is perhaps a word that is not used very often. I see surrender as an existential component of the broader concept of acceptance. Now that I talk about it like this, I think: maybe acceptance is mainly cognitive, something that mainly takes place in your head. For me, surrender is really something from your heart, maybe even from your gut.”
“Sometimes you see the beginning of surrender during a conversation. It is very wonderful to experience that. Sometimes you literally see a physical reaction in people’s faces. People shed tears or breathe a deep sigh of relief. It is wonderful to witness that. Something like that can deeply move me.”
Many healthcare providers find dealing with the impending death of their patients emotionally difficult. What’s that like for you?
“Good question. I think it is very important that I can turn to my colleagues. Sitting down and sharing what touches you can make such a difference. The other person doesn’t actually have to do anything. Listening is often enough. ”
“I also believe in the power of rituals. If I have had an emotionally difficult day, I walk past the silence center before I go home and light a candle there. After a day of talking, I’m quiet for a while.”
“I also sometimes tell that to patients. ‘At the end of the day I will light a candle. One for you, but also one for myself.’ It touches people when I share that with them. I think they find it a touching gesture. Maybe it also touches them because I show some of my own vulnerability.”
What is a good death for you?
“It makes me think of the topic we discussed earlier. For me, a good death is connected with a certain surrender, no matter how difficult. Let me put it in a modern way: when people at the end of life are ‘okay’ with how their lives turned out, with the good and less good moments.”
“I also always hope that people don’t die with unsolved cases. The latter is the reason why I always pay attention to this in conversations with dying people. ‘Has everything that needs to be said been said? Have you expressed everything to each other? Is there anything else on your mind?’ For me, completing life is part of preparing for death. In this way, a patient, but also the people around him or her, can let go of life better.”
“Loved ones are often present during these final conversations. It is special to be present at such intimate moments. Two people who have to let go of each other.”
“These are important questions, and certainly not always easy to answer. It’s quite a question: have you said everything that needs to be said? Still, these questions can help people. They open up a deeper layer of conversation. These types of questions allow you to talk about the most essential things in life.”
“There are of course also people who are angry or aggrieved just before death. For example, because of injustice that has happened to them and has never been corrected. In the conversations I try to talk about forgiveness. For example, I ask: ‘Can you forgive unilaterally?’ People usually understand what I mean right away.”
“If people can forgive unilaterally, then the stone on the heart is gone. When asking this question, it also helps that there is great urgency. Death is approaching, it’s now or never. In that sense, finitude also has a special effect on people. Sometimes people have gone to therapy for years in vain. Then just before the end there can suddenly be a breakthrough.”
The interview started with a profound childhood experience. How has your classmate’s suicide affected you?
“I recently attended my high school reunion. I bumped into my French teacher there. We were talking about my classmate’s suicide. I told how I experienced everything and how much I appreciated the support from the school.”
“Looking back on that moment, I realize that high school was a crucial phase in my life. It shaped me in a way. I have lost my open-minded view of life. Yet the experience with death has helped me to come closer to life. I have learned to live more intensely. Many people think that preachers and priests are very concerned with the afterlife, whatever that may be. Death teaches me to focus on the present day.
Other parts of the series “Close to the end”
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