By Sara Carroll Johnson

End-of-Life Care: Reflections for All Saints' Day

“O blest communion, fellowship divine!
We feebly struggle, they in glory shine;
yet all are one in Thee, for all are Thine.
Alleluia, Alleluia!”

— For All the Saints (William Walsham How, 1823-1897)

When people ask me what I do for work and I say, “I work in palliative care and hospice psychology,” I am seldom met with a neutral reaction. For many, of course, the mere mention of end-of-life care brings back a flood of painful memories. Some offer questions of polite interest. Many ask no follow-up questions and quickly change the subject. Others, however, lean in and recount their own stories of grief and caring for loved ones as they died. Sharing about my work serves as a reminder of mortality, memento mori, the reality of death that many of us invest a good deal of effort avoiding. All responses to this reminder are valid. But for now, I invite you to lean in with me.

Looking back, I see how God has carefully prepared me for this work. The event that played the biggest role in my formation for palliative psychology was the death of my precious mother in 2019. I found the experience of caring for her at the end of her life to be terrifying, heart-wrenching, and beautiful. Avoiding the reality of death was no longer an option for me. Grief brought me into such close contact with the grace and mercy of our Lord, which shaped me into a person who is, at least marginally, less afraid of death.

In 2021, when I was still acutely hurting and in need of healing, my mentor began teaching me about the doctrine of the communion of saints. I learned that all Christians are part of the mystical body of Christ, whether they sleep in their graves or sit in the pew next to me on Sunday mornings. If we are in fact bound together in Christ, that powerful love does not end at the time of death. After all, Christ defeated death in his resurrection and is the “the firstborn from the dead” (Colossians 1:18). This radically changed the way I relate to death and approach worship. Just as I might join my prayers with a fellow parishioner, I can do the same with the saints who have died and are with Christ. I am sure that my mother is among these faithful departed, and worshiping alongside her is a great joy.

The communion table of Christ’s Church extends far beyond what I see in my parish on a Sunday morning. When I gather with others in the name of Christ, not only is our Lord among us, but we join “a great cloud of witnesses” in worship (Hebrews 12:1). I am in my second year of living and working in the state of New Mexico. This land is where Native American and Spanish cultures meet against a backdrop of rugged mountains, lush forests, and hauntingly beautiful deserts. The mystical atmosphere of this place has shaped my spirituality as I have made my home here. On All Saints’ Day, it is the practice of many New Mexicans, including those in my parish, to set up ofrendas in front of the high altar with pictures of our loved ones who have died. On this special day, celebrated also as Día de los Muertos, we remember each loved one by name and enjoy the visual reminder of their presence among us. This practice has been deeply healing for me.

All of this prepared me for my assignment to the palliative care department in my first psychology job at a veterans’ hospital. It is a tremendous privilege for me to tend to the psychological needs of the dying and their families. There is beauty, as well as pain, in this tender stage of life. When I am getting to know patients who have been referred to me, often after receiving a terminal diagnosis, I ask, “If your time were short, how would you hope to spend your days?” In answering this question, people dare to speak aloud the things they hold most dear; family, faith, love, etc. This question also brings fear to the surface and the particular sort of anxiety that bubbles up when we see that we are holding a scarce resource in our hands. I learned early on in my psychology training that I cannot simply talk people out of fear and anxiety. It must be faced with courage, humility, and openness. In these raw moments, I have found the most therapeutic interventions are compassionate presence, well-timed questions, and simply holding the patient’s hand. Just as Christ draws near to his beloved people in their suffering, I hope to convey a peaceful and loving presence to my patients, unafraid of their pain and holding hope on their behalf that peace in Christ is waiting for them on the other side of death; hope that they will join me at the table in the communion of saints.

As we approach All Saints’ Day and Día de los Muertos, may we rest in the hope of the resurrection. Just as we surely know we will die, may we be equally assured that we will be raised out of our tombs on the final day. Our graves will today be places of mourning, but will one day be transformed into places of celebration and resurrection. “For since by man came death, by man came also the resurrection of the dead. For as in Adam all die, even so in Christ shall all be made alive.” (1 Corinthians 15:21-28, KJV)



Photo by Kelly Ishmael on StockSnap


About the Author

Sara Carroll Johnson holds a doctorate in clinical psychology from Georgia Southern University. She lives in Albuquerque, New Mexico where she is completing a postdoctoral fellowship in health psychology with a focus in palliative care. While her clinical work is primarily with older adults, her dissertation research was focused on mental health and suicide prevention in graduate students. In her spare time, Sara can be found cycling, walking along the Rio Grande, and serving in her parish.

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