How a Nice Christian Nurse Learned to Think Like a Snake
Twylla Downey
This article originally appeared in the April 2022 issue of FOCUS.
I remember overhearing a resident ask the professor of Palliative Care Medicine, “Why did you choose palliative care?” His response, “Because it is God’s work.”
I believe that God had made me to be a palliative care nurse. I feel that my gifts, strengths, and experiences had all been given me to serve His kingdom in this way. I felt that I was living out God’s purpose for my life and I loved my job. I was caring for the most vulnerable of patients and saw it as acts of serving God. As in Matthew 25:40, “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’” In the words of Mother Teresa, “I see God in every human being, when I wash the leper’s wounds, I feel I am nursing the Lord himself. Is it not a beautiful experience?”
Then on June 6, 2016, everything appeared to change. Canadian legislation had passed which legalized the act of a physician terminating a patient’s life, otherwise known as euthanasia, also known as medical assistance in dying, (MAID). My workplace became increasingly uncomfortable for me. Every day was emotionally challenging as I fought back tears during patient rounds, (sometimes unsuccessfully), as I learned of another patient requesting to have their life terminated. I feel that everyone would agree that suicide is tragic, yet suddenly, the act of suicide on another person’s conscience had appeared to have been embraced by a nation. Meeting after meeting was taking place informing us how we were expected to respond when a patient verbalized a request for MAID. Scripts were provided regarding what should be said and warnings of what was not to be said. Hostility appeared rampant to anyone who voiced any type of resistance or disagreement with the act. Meanwhile, stories of persecution towards nurses began to appear. One nurse was reprimanded for refusing to start an IV with the knowledge that it was to be used to end a patient’s life that morning. A nurse manager had been fired for allowing nurses that did not want to be involved in the care of a patient receiving MAID to opt out. I felt silenced, muzzled, and anxious as the words of Martin Luther echoed in my brain, “You are not only responsible for what you say, but also for what you do not say.” In my nurse manager’s office, I was informed, “When someone asks for MAID, you are to treat it just like any other medical procedure, just like you would a broken hip.” I stared at her, thinking but not saying, “You will never in my life convince me that a physician terminating a patient’s life is equivalent to the repair of a broken hip.”
Everything in me was screaming that MAID was evil and wrong, both personally as a Christian who believes in God’s sovereignty and the sanctity of human life; and professionally, as a nurse who believes in the philosophy of palliative care medicine. I felt that these terminally ill patients were vulnerable, scared, and without hope. Legislation had been passed with certain rules in place, yet even these rules appeared to be getting broken. The first patient I cared for that had requested MAID was already actively dying. He was dying naturally, appeared comfortable and peaceful, and I felt that he would not survive the ten-day waiting period from MAID request documentation to termination of life by lethal injection. I later discovered that on day five, the MAID team had reduced my patient’s pain medication so that he would arouse enough, (obviously in pain), to let them know that he still wanted them to end his life and proceeded to complete the task fulfilling his wishes. I felt like I was powerless to defend my patients and powerless to fight against it; I had never felt more like ‘a sheep among wolves.’ The scripture verse of Matthew 10:16 began ruminating in my head, “I am sending you out like sheep among wolves. Therefore, be as shrewd as snakes and as innocent as doves.” I was feeling like a victim, muzzled and incapable of action. I was so caught up in what I could not do, that I had lost focus of what I could do.
The book of Jeremiah tells of the Israelite people in Babylon. They were to seek the well being of the city they were in, as when the city flourishes – the inhabitants will flourish as well. (Kevin DeYoung and Greg Gilbert, What is the Mission of the Church? Making Sense of Social Justice, Shalom, and the Great Commission, (Wheaton, Crossway, 2011), 201.) DeYoung and Gilbert link relevance to Christians in that they may settle in, as “we are to have a faithful presence within a fallen culture,” adding that like the Israelites in Babylon, Christians may be viewed as exiles and strangers in the world, and thus “seek the good for our society.” We are to be “zealous for what is good,” engage the culture we are in, and have lives that display our identity as believers in Christ, being the “salt and light” wherever we go while living in faithfulness. (Ibid, 203.)
I was not about to quit my job, and as a sheep among wolves, I began to focus on the words of Matthew 10:16. I could be as innocent as a dove – that part was easy. What did it mean to be as shrewd as a serpent? Genesis 3:1 states: “Now the serpent was more crafty than any of the wild animals the Lord God had made” and 2 Corinthians 11:3 states that “Eve was deceived by the serpent’s cunning.” The Dictionary defines the word shrewd as “having or showing sharp powers of judgment; astute.” In my mind, I attributed that I was to be smart about things and maybe even a little bit sneaky.I was aware of what I could not do – but what could I do? Colossians 3:12 states, “Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience.”
As an experienced palliative care nurse, I could explore my patients fears about dying, asking, “Is there anything about dying that scares you – anything that you would like to talk to me about?” Upon listening to my patient’s fears, I could offer emotional support and reassurance. I could provide options to my patients: offering to discuss what a natural death looks like, talk about hospice, and explain palliative care philosophy. In doing so, I discovered a patient who had requested MAID as she did not want to die alone, others who were afraid they would suffer physically and many that did not want to burden their families. I met with the nurse from the MAID team and asked her what options she informs the patients about when they request MAID. She responded, “I present MAID as an option.” This is not the only option for our patients and we need to ensure they are aware of this. We need to equip and support our physicians and nurses by educating them regarding quality palliative care medicine, which helps to ensure our patients receive optimal symptom management, and end of life care.
I could continue to support my patient’s family and friends as they suffer anticipatory grief. I could support my co-worker when she confides in me that she continues to have nightmares weeks after witnessing MAID on a patient with a curable, treatable cancer. I could listen when a physician tells me there are now “images forever etched on my retinas” after providing MAID to a patient.
I could take part in government surveys regarding MAID, discuss my experiences with other Christians and write and submit an article to The Canadian Nurse magazine to express support of our colleagues who are struggling with MAID due to their own personal beliefs. I was respectful of my patients’ right to choose, followed College and Association of Registered Nurses of Alberta and Alberta Health Services guidelines, and yet could also be a vessel of God’s love and compassion in my workplace and to the patients and families I serve.
I was once asked, “What’s the big deal? Aren’t all your patients dying anyways?” I could go on for several more pages in response to this question, but I will limit my reaction to these two main points. The big deal is that every patient is made in the image of God and our God is sovereign. Psalm 139:16 states, “Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be.” God’s book – not your book, not my book, not Dr. So and So’s book – His book.
You never know when someone will come to Christ. Even in the eleventh hour, as it was in the case of the thief crucified on the cross next to Jesus, one may come to Christ. I feel it must be difficult to live without hope, but even more so, to die without hope. As a Registered Nurse, I may help foster hope in the life of my dying patient. There is always hope, but sometimes the nature of that hope changes.
I recognize that when I have done all that I am able to do – it is of utmost importance to lay my concerns at the foot of the cross – taking it to God in prayer and letting go. I cannot be the best nurse to my patients, the best mom to our children or wife to my husband, if I continue to carry the weight of each MAID request on my shoulders. There will always be things in healthcare out of my control, but God is bigger than this issue, and certainly bigger than me.
I became aware of a nurse who was to appear before the CARNA committee accused of praying with patients. I have certainly prayed with my patients throughout my years of nursing, and this troubled me. One day at work, I sat at the bedside of an extremely anxious patient with her rosary and scripture within reach. As I held her hand and looked into her frightened eyes, words of Christian scripture flowed out of my mouth. I said to her, “The Bible tells us we are to pray without ceasing, we are not to be anxious for anything, but in every situation, by prayer and thanksgiving, present our requests to God. We are to cast our burdens upon the Lord and know that He will sustain us. As God takes care of the sparrow in the sky, how much more will He care for His beloved daughter?” (A meshing of scripture from 1 Thes 5:17, Phi 4:6, Ps 55:22 and Matt 6:26). It was one of those moments when it just came out! I instantly thought, I am in a room of four patients with three other families and I just referenced Biblical scripture – I may be in trouble if anyone in that room decides to report me. And yet, I want to be like Paul and share God’s word boldly and without fear of persecution.
Later, when I came home that night, I told my husband and he replied, “But, she is a Christian, it isn’t like you were quoting Christian scripture to a Muslim.” And then God gave me some wisdom.
As I pondered that night, the words of Matthew 10:16 began ruminating in my head, “I am sending you out like sheep among wolves. Therefore, be as shrewd as snakes and as innocent as doves.” With the previous lessons learned, I began to think, “What would a snake do?” My response – a snake would accumulate his defense before he was convicted of a crime. I need to be smart about things and I reviewed my registering body’s Standards of Practice and my employer’s policy.
The College and Association of Registered Nurses of Alberta Practice Standards for Regulated Members, (as is outlined in the Health Professions Act), contains the following. (a) “Based on an ethic of caring and the goals and circumstances of those receiving nursing services, registered nurses apply nursing knowledge, skill and judgement to” (i) “assist individuals, families, groups and communities to achieve their optimal physical, emotional, mental and spiritual health and wellbeing.” (College and Association of Registered Nurses of Alberta, Practice Standards for Regulated Members, January 2013. R.S.A. 2000, c.H-7, Sch.24, s3, 2.)
Alberta Health Services Policy, Document #HCS-224, Palliative and End-of-Life Care Programs and Services 3.4 states: “Patient care interventions are based on the patients assessed unmet needs. Palliative and end-of-life care services should include, but not limited to: (e). spiritually sensitive care that maintains patient dignity.” Principles of Palliative care include: “Safe, Ethical and Quality Care: Comprehensive assessments by adequately skilled professionals and providers are at the heart of quality and ethical care delivery. The provision of care that is appropriate to all domains including physical, psychological, emotional, social and spiritual requires knowledge and tools related to assessment in these areas. Practice that promotes consistency, coordinated activities, and collaborative approaches with minimal duplication will foster best outcomes.” (Alberta Health Services Policy, Palliative and End-of-life Care, Document #HCS-224, effective August 22, 2018, 3, 7.)
Under these guidelines, I am expected to attend to the spiritual needs of my patients. My husband’s words were clear, I shared Christian scripture with a patient who was Christian. There is nothing wrong with that. However, what would be my best defense if I am ever accused of sharing Christian scripture? I accumulated my defense, which included memorizing words of comfort from every major world religion that I generally encounter within the multi-cultural matrix of the University of Alberta Hospital. If I am ever accused of sharing my Christian faith and Christian scripture with my patients my defense is as follows.
“I shared Christian scripture with my Christian patient. If my patient were Muslim it would have been more appropriate to share words of comfort from the Quran such as Ayah 13:24 which states “Peace be upon you for what you patiently endured. And excellent is the final home.” (Iman, “5 Verses of the Quran That Will Comfort a Broken Heart,” n.p. Cited 6 October 2017. Online: www.patheos.com/blogs/mostlymuslem/2017/10/ayahs-verses-quran-comfort-broken-heart) If my patient were Buddhist it would be more appropriate to quote from Buddha’s teaching, which includes: “Even death is not to be feared by one who has lived wisely.” (Norbert Juma “Buddha Quotes About Life, Death, Peace and Love” n.p. www.everydaypower.com/buddha-quotes-on-love)
If my patient practiced indigenous spirituality words of comfort may include words of a Minquass Proverb which states, “The soul would have no rainbow if the heart had no tears.” (The Spiritual Life, “Native American Proverbs,” n.p. www.slife.org/native-american-proverbs)
I did not memorize words of comfort for my dying Jewish patient, however I may provide Psalm 121, “I lift up my eyes to the mountains – where does my help come from? My help comes from the Lord, the Maker of heaven and earth. He will not let your foot slip – he who watches over you will not slumber; indeed, he who watches over Israel will neither slumber nor sleep. The Lord watches over you–the Lord is your shade at your right hand; the sun will not harm you by day, nor the moon by night. The Lord will keep you from all harm – he will watch over your life; the Lord will watch over your coming and going both now and forevermore.”
I am not sure that I would ever quote words of comfort from another world religion to my dying patient and their family. I certainly do not quote Christian scripture to every Christian patient I visit. However, I feel it is important to know and understand how members of other world religions find comfort. I hope that everything I do brings glory to God and that all that I do provides a reflection of his love, compassion, and peace. I feel that I have accumulated a good defense if I am ever questioned about sharing Christian scripture within my workplace, and I did so, by learning how to think like a snake.