AIDS And You Chapter 6

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If we are going to look after people who are dying then we need to have come to terms ourselves what we think about death.

Shaken by the violence

It takes a lot of bottle to look death in the eye and keep on looking. The first time it happened to me I was still at school. I was walking along a busy road and saw a bus collide with a woman. She was smashed to the ground instantly. There she was lying in the road bleeding, gasping for breath. We all gathered round. I had never done First Aid at school and didn't know what to do. Someone was holding her head. The driver had got out of his cab shocked, and someone had called for an ambulance. As I watched from a distance she suddenly vomited, choked, went rapidly blue and died.

I went home shaken at the violence of what had happened You can see 100 things like that on the television but when you see it close up it becomes real. What shocked me even more was to discover afterwards that she had died because she was lying on her back and had drowned in her own vomit.

My second experience of death was after I had just school. It was a dark wet night and I was sitting on the bottom deck at the front of a big bus with an open rear doorway. As it sped along the black greasy road, I was surrounded the crash of loose change on the deck. I turned round and saw nothing, and then to my horror through the back window saw the bus conductor lying in the road. He had slipped, hitting his head on the deck before bouncing out onto the tarmac.

I rushed to the bell and rang it for what seemed an eternity before the heavy bus pulled to a halt. I

leapt out and raced back. A queue of cars had already stopped. A nurse got out and gave some assistance but he later died of his massively fractured skull.

Most of us don't like to talk about death. We deny death exists. By the way some people talk, you would think they are immortal. In some countries children are often kept well away from funerals, perhaps because adults are embarrassed to cry in front of them.

It is this fear of death, the fear of the unknown that is the main reason why AIDS is so scary. People often ask me how I could spend so much time with people who are dying - it used to be cancer, then it was AIDS. The answer was because I know where I'm going.

When I had just qualified as a doctor, one of, first patients I had was a retired woman who was dying of cancer. I remember sitting on her bed one afternoon and she took my hand. 'You'll remember me when I've gone, won't you,' she said. I nodded and she went on: 'You know where you're don't you. You believe?'

I had never said anything her about faith. I do not carry a label, or a symbol, or a Bible, but she had picked something up. She sensed that I was at peace with her dying. She could see that I was not afraid and that I was not going to abandon her because hope of her cure had abandoned me.

It is only as we get older that we get screwed up about dying. Young children are very matter of fact. Children who are dying usually treat it as a part of normal conversation, and are then very suprised to find out that all the adults cannot cope. They quickly learn to shut up so as not to upset their parents and the nursing staff.

I think some of the fears I used to have stemmed from some of the things I had been told such as, 'He would have swallowed his dentures so we take them out' (how anyone could swallow a set of false teeth was beyond me, but it made me that something violent happened after death. I was also told that after people died it was like the floodgates opened: waterworks and bowels emptied over the bed. You can imagine how relieved I was as a medical student to discover that these things do not happen: when managed properly, death is almost always a peaceful and dignified thing. Often the relative in the room is not even sure if the person has died or not; he or she just appears to be sleeping.

Death is a mystery

If you have ever had the privilege of sitting with someone who is dying at the moment of death, you have experienced a mystery. Here is a woman bounded by place and time. You are sitting there holding her hand. She is breathing quietly. Most of time she is asleep, but occasionally she opens her eyes or says a word. She is not in any pain, she is not anxious and she knows exactly what is happening. She is not afraid and is at peace.

As you are sitting there you notice that her breathing has become more laboured, and she seems sleepier. Over what seems like hours, but is in fact a few minutes, the breathing changes again. The nurse comes in and says her pulse is very weak and rapid now. There are small beads of sweat on her brow.

Gradually her breathing seems to fade away, and is gone. You wonder if she has died. After a few minutes you get a shock when she suddenly takes another deep breath before all is quiet again. And after a while you realise she has gone.

A dead body is still alive

Nearly all the cells in her body are still alive. Her kidneys will be useful to someone if removed in the next half an hour - so long as she does not have cancer or HIV. Her brain- cells are too damaged to live for long, but her skin will still be alive in a week. The cornea (the clear bit of the eye) if removed by late tomorrow, will give a child sight and her heart may still have cells within it which are beating. Her gut is still contracting and the stomach is still digesting food. All the proteins in her body are still there, the bone marrow is still producing new blood cells. So what has happened?

At the end of the day it is a mystery. I always say that the nearest an atheist ever gets to a profound religious experience is his own death, and death heightens spiritual awareness in every way. It is a brave person who has just watched this mystery, or perhaps watched the birth of a child, who can walk away as convinced as before that there is no God.

Four reactions to dying

When you know you are dying, four things start happen. The first is that your priorities change. What is the point in carrying on with your College course when the doctors have told you that you will probably ably he dead by Christmas?

The second thing is it alters your relationships. You find your best friend can't cope and hasn't visited you once in hospital, while someone in the same year who you never thought much of has been a real support and nothing is ever too much trouble. Sometimes it takes a terminal diagnosis for some people to really work out who they are, and who is important to them.

It can be a time of great regrets and some people find themselves looking back and wondering how they would have done things differently if they had known life was going to be so short.

Finally, people find they are looking forward. Most people I talk to are not so much afraid of death as afraid of dying: they are afraid of becoming incontinent of losing control, of becoming a burden, of being totally dependent, afraid of pain, afraid of suffocating to death, afraid of losing the ability to think, move or remember.

And then there is another dimension: is there really no more to life than life? Is there really no more to me as a person than the molecules that go to make up my body? When I die, will that be the end, or is there another kind of existence after this one?

Deathbed conversion

These and many other questions often cause people to search. They go to mediums, spiritualists, traditional healers and any other agency that will reassure them that there is in fact life beyond the grave. Deathbed conversion is very common and very real. The thief on the cross turned to Christ in the act of dying. I remember a man with lung cancer who came into St Joseph's Hospice while I was there. He looked at the nuns and said: I'm an atheist. Do I have to be catholic to be here?'

We explained that people of all faiths and none were equally welcome. I don't think anyone asked him about any matter regarding personal faith or beliefs, until some two weeks later he suddenly raised the matter again and asked to see a priest. He had undergone a profound turnaround as he approached the end, without a single word being said.

More to life than life

As a Christian I believe that there is a life after this one, and that death is merely a gateway from a physical world, limited by space and time, to another dimension Jesus taught quite clearly that when this is all over each of us will have to give an account of what we have done with our lives.

Jesus also showed us that no one is perfect in and of ourselves: none of us can please God. None of us is perfect enough to enter his presence and survive, But the good news is that God has bridged that huge gulf between us and him by sending Jesus. The things that you and I have done wrong have eternal consequences. We're responsible, and the penalty for what we have do is ultimately death and extinction.

But God sent Jesus to receive the punishment should have been ours. By dying for us, Jesus set us free from the effects of our own wrongdoing. Through Jesus, for those who accept him and receive him, God has chosen to forgive us completely a wipe the record completely clean. Through Jesus we call on the unreachable, unknowable, unfathomable God as our Father.

For those who believe, the moment of death is for us a change from being only partly aware of God and his love, to being fully and completely in his presence, an experience of heaven itself. For someone who never knew God and the things of God, the Bible teaches us that life death will be an unpleasant, uncomfortable disappointment.

This teaching about what happens after death has always been a central part of the church, but immediately raises a question in many people's minds especially when they read that many Churches are becoming involved in providing practical care for people with AIDS. If Christians believe some people may find themselves separated from God after death, then they will surely want to get at every person they meet who is dying and preach the gospel?

I was talking to a prominent member of an AIDS organisation recently who also incidentally has AIDS himself. He is a convert to Buddhism and freely admitted with a smile that when he was with people who had AIDS all he really wanted to do was tell them about his faith, but he knew he could not.

What do you want? If someone with AIDS asks to see a chaplain, he is asking for spiritual help. If all the chaplain is interested in doing is visiting him at home to do cooking, wash clothes, help with the children and bring water, you can imagine he might well feel let down. However, if someone with AIDS has asked for someone to help with the washing and all the person seems to want to do is talk religion, you can imagine the person might well have good cause to feel annoyed.

It is a real privilege to be allowed to be with someone who is approaching the end of his or her life. It is a very special time, as all who have been involved will know. People are rightly very sensitive to others rushing in insensitively to someone who may he too weak to say 'no' or 'please go away. Often it is only afterwards that the upset comes out and the person who is ill pleads for a certain person never to come into their home again. Behind the polite facade there can be real anguish which is often not expressed a the time. If you are vulnerable you think twice before antagonising someone on whom your life could depend.

Helpful or dreadful

If a doctor at a clinic asks a volunteer agency for a community visitor, he expects practical help, not a chaplain. If it gets back that a particular visitor spent all night (it may not be true, but only a tiny part true) trying to convert his patient, the doctor may well feel justifiably angry. As far as he is concerned, the community service is completely useless.

It is not a service to him as a doctor because he would be extremely worried about asking someone else to go in from that group again. It is not a service for the patient because what the patient wanted was good company and a helping hand, and he got a preacher!

The doctor comes to the conclusion that the AIDS programme is only interested in serving the local priest by trying to convert people. If that is the case, he as a doctor will campaign to make sure everyone knows about these dreadful people.

Guest and servant

There is a right time and a right place for everything. And it all depends on local culture and custom, For example, in many parts of Uganda the level of church commitment is so strong that it would be very strange for a visitor from a church-based AIDS programme not to offer a prayer at every visit. Indeed if you do not offer to pray it is very likely that you will be asked to do so in any case. Christian prayer in the home is a usual, expected part of that community ministry. Prayer is a way of life. But in Thailand or parts of India the expectations may be very different. And we need to be very sensitive to these things.

It depends so much on the nature of the service you have advertised and that people are referring to. However whatever the culture, however hostile it may be to the Christian faith, the following is always true:

If you are making someone a meal and because he has noticed that you are always there, you never complain, you accept him as a person, you are, happy to look after him even though he senses you do not share his views on lifestyle, because of all these things and because he knows you go to church he asks you about your faith, then this is a wonderful time to share a little of the hope that is in you, and perhaps to bring spiritual comfort and peace.

He is driving the conversation, and it would be stupid and unfriendly not to answer his questions. You might find that in the context of his own searchings, he finds it reassuring to have someone around like you who has a faith. You might even find that he asks you to pray for him-it is surprising how often an atheist has faith in the prayers of someone else! But in everything, your attitude must be that of a servant: how can I be of most help today? Also that you are always there as a guest to and never to take over.

Schools education

The same principles apply in schools education. Schools work is a very sensitive area where everyone may have strong views on how sex education and AIDS should be taught. And again this will vary between countries, areas, communities and schools. People can be afraid that activists will try to use the AIDS crisis to promote inappropriate condom use in schools or to promote extreme moral views and attitudes.

A schools educator is there at the invitation of the teacher to he a servant to the school, as a guest in the classroom. Topics to be covered, methods and general approach should all be agreed beforehand.

Working in schools is a privilege and should not be a platform for promotion of personal beliefs, without the approval of those whose guest you are. However, if in the context of religious or life skill classes an educator is asked by teacher or pupil to present a personal perspective for example on the Christian hope of life after death or view of sexuality, then that is a different matter, so long as it is presented as a personal view open to discussion debate. But as I say, be guided in all things by the local school and the teachers within it. They will often give you far greater freedom than you might have imagined.

In summary then, AIDS is a terrible disease that kills a great number of people, spread by a virus through sharing needles or sex with infected people. It hits us in two areas where we feel most vulnerable: our morality and our mortality, and makes us question what we do and what we are.

Now is the time for action.

Time for Action

The first thing you may need to do is sort your own life out. I find it depressing to see how many people or older people only really work out the meaning of their lives when their lives are almost at an end. Will it take a terminal diagnosis for you before you put your own house in order? Urgent decisions may need to be made today to change your sex life or injecting drugs, as well as to work out what important to you.

What is important to you?

What will really make you happy in the long term? Who are your most important relationships? I don't just mean this year, but over the next few years in the future. Do you know who your real friends are and to whom you belong?

These are important questions. Many people say after becoming Christians: 'If only I had known then what I know now, my life would n ever have been such a mess.' The tragedy is that it often a terminal diagnosis, or a near fatal accident, to someone to a full stop for long enough to think feel straight. Most people you know are probably happy enough at the moment to hurtle through life one relationship to another, from job to job, no long-term plan in mind, just living for a good ay.

But people living like that often find themselves washed up on a beach. A woman discovers at thirty-eight that man she has been living with and promised her marriage and children has been cheating with another woman for the past two years and is leaving her. A man finds he has achieved the dream of his business, but at the cost of losing his wife and children He discovers too late that money buys lots of attention but no friends. Another man discovers after a string of relationships that he is disillusioned and is not sure what love is any more.

Living life to the full

You are important. I believe you were made for a purpose and that you will find your greatest happiness finding that purpose for yourself. Part of that involves starting to live for others. Jesus said that the only way you could find your true self, that is becoming trully human, is by losing yourself - not by becoming a passive doormat that everyone else can tread on, but by letting go of the right to run your life your ownway, and instead inviting Jesus to show you how to live his life. I believe God has a plan for you and that because he loves you, his plan is the one that will make you truly happy.

The most important part of that plan is that wants you to know him personally, not as a 'human being', but as your friend, and that he wants to you have new power, strength and inner resources so that you can live life to the full. Often this brings healing and sometimes physical healing as well.

Getting involved

Secondly, there is some action you can take will be of practical help to those who have AIDS. You might want to become a volunteer, to offer, to visit someone who is ill, or to help support their family. Or you might want to help save lives by telling people how to protect themselves against HIV. Why not talk to others in your church, or to other people involved already in a Christian response to AIDS, and offer time to them. You will find many resources to help you on the ACET International Alliance website. You can download them and print them out.

What can be done?

Start with what you have. I recently visited a school for AIDS orphans and an income generation project started by six grandmothers in a very poor area of Uganda. They started with what they had and got on with it themselves, gradually mobilising others in the village and little by little the work has been established. The saved up and bought some land. Then they saved to buy a cow. The milk from that cow pays to run the school. Gradually they made bricks and replaced straw roof on poles with a small building. And then they built another. They started to teach the children as best they could in their own spare time. Everyone was helping. Some brought food, others cooked, others carried water each day so the thirsty children could drink. The grandmothers realised they needed some training and went off to government programmes to get a basic qualification. A visitor came and gave them money to get electricity. Another provided a pipe for running water. Another gave them a sewing machine to train older girls. and gradually the work has grown.

Every church can encourage members to do something to help. As George Hoffman once said, the founder of Tear Fund: "You can't change the whole world but you can change someone's world somewhere.

Go and save someone's life today.

Go with food to a family stricken by AIDS today.

Go and comfort a widow or an orphan today.

Go and encourage someone who is giving their lives to AIDS ministry today.

Pray for God's protection on them and for God's provision.

And you may be part of the answer to those prayers !

Practical help

Thirdly, you may want to talk to someone about some of the matters raised in this book. For example you may be worried that you are infected or someone you know may be. You may need to talk with your pastor, or to your doctor to get the expert advice that you need.

AIDS And You Contents

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