The New Testament describes the office of the elder as being pastoral par excellence (Acts 20:28; 1 Peter 5:2). The elders are "well-doers." Their work is that of the Shepherd, who searches for the lost, brings back the straying, binds up the injured and strengthens the weak, as Ezekiel 34 puts it. Through their labour the great Shepherd of the sheep interacts, in a most personal way, with those who belong to Him.

Therefore, elders are called to visit the members of the congregation who are ill.

The Situation of the Sick⤒🔗

As we begin to discuss the pastoral care of the sick, the topic must be defined further. Who are the sick? We do not intend to focus on the mentally disturbed. These people require another approach, and the sub­ject requires separate treatment. Lately much mate­rial dealing with this aspect has been published, and we refer the reader to it?¹ Also guidance for the dying must be left out of this discussion. Within the frame­work of our subject only a few remarks regarding this will have to suffice.²

We will deal with the large group of sick people who, because of physical ailments are confined to bed, either at home or in the hospital. There are many reasons for those who hold the office of elder to deal with the sick person.

Illness, particularly a lengthy one, places a per­son in a peculiar situation. It can be said that to some extent illness isolates a person. The healthy person occupies his place in the family, at work, and in society. Life constantly makes demands to which he must react in a responsible manner. People count on him, there is a work rhythm, which daily demands his attention. The healthy person can make plans and is capable of initiatives.

For a longer or shorter period of time illness re­moves a person from ordinary life. The sick person has been placed in a different world.³ A world in which suffering, incapacity, the thermometer and medicines dominate.

The beginning of each serious illness is a caesura, a halt. Ordinary life is cut off and replaced by another, the character of which is not known. The sorrow and suffering, perhaps sharply surmised but nevertheless not comprehended, and its eventual value which could not possibly be seen, cannot give this life form. One is impotent to live this new life. One undergoes it: defeated, bewildered, rebellious or – equally unfruitful ­resigned.

It is the experience of a complete surprise attack, which a healthy person can hardly imagine; of suddenly becoming uncertain of what was most taken for granted, such as: the personal function in life with others, the necessity or even indis­pensability of that function, the faith in the in­violability of one's own body – even when one "theoretically" was fully aware that this and similar sureties were far from certain.⁴

It is, therefore, no wonder, that people who become seriously ill are often somewhat disoriented. Previous certainties begin to crumble. Anxiety as­sails the sick person. Why does this happen to me? What is the sense of life now that one has to suffer?

The pain, the prospect of a serious operation confronts him with the brittleness of human life. Someone has said, "In every illness death sneaks up to you." In the stillness of the sickbed, a person sometimes experiences an intense threat to his life. A mysterious power rages in his body, which assails the life he led.

Those who have contact with the sick discover that often they are burdened by worries. They worry about the course of the illness, hoping it will not last long or become more serious. There is a risk for there are factors outside of the doctor's control. The sick person may worry about the home situation. How will it go with the business? What about income? Mothers worry about the household and the chil­dren.

It has been pointed out that a sick person has much time for oppressive reflection.⁵ It appears to him that he is standing still and has too much time to look back at his own life. In doing so he may dis­cover what he did wrong, and where he was at fault, so that regrets and guilt plague him.

The problems can be caused by the sickness itself. When healthy, we never stop to think much about sickness or suffering, but when we have been forced into non-activity, we begin to worry about matters relating to God's providence. Clearly this causes anxious questions and they suddenly make us unsure of our faith and trust.

A remarkable regression sometimes occurs with chronic patients. That is to say: a return to suppressed or conquered infantile behaviour patterns, slipping into an earlier stage which, when healthy, was left far behind. The sick person may loose his "manners," become demanding, jealous, inclined to self pity, soon mollified and appeased with small gifts.

Lying in bed, being dependent on others, and restricted in movement which normally is one of the greatest sources for our feeling of independence creates the infantile climate to which many sick people soon revert.⁶ We are quick to say that illness causes egocentricity. It would be more judicial when we see the egocentricity as an exponent of regres­sion; the infantile climate in which the sick person often finds himself.

In John 5 we read how Christ asks the man who has been ill for thirty-eight years, "Do you want to get well?" That is not a superfluous question! It can and does happen that one resigns himself to being sick, because one no longer dares to accept the re­sponsibility that a full life requires. The sick person is satisfied to be confined to bed in the comfort of his sick room and gladly leaves to others the responsi­bilities which a healthy life would demand of him.

In broad lines we hope to have sketched the situation in which we may encounter the sick. Of course it is not nearly complete. J.H. van den Berg writes correctly: "...everyone experiences illness differently, each sick person begins his illness with his own part and with his own expectation of the future; each sick person makes his sickbed his strict­ly personal situation, which is incomparable in the final analysis."⁷ There is a difference between the a­cutely ill person with a good chance of recovery and the acutely ill person who finds himself in a life-threatening situation. There is also the chronic pa­tient who is faced with increasingly painful prob­lems as well as the patient who slowly slides into death.

Hopefully these few notes will help the pastor recognize the distress to which a sick member of the congregation is subject.

The Purpose of a Visit to the Sick←⤒🔗

The visit that the elder extends to a sick person is not brought for reasons of friendship or interest. The elder comes to the sickbed as an office-bearer. He is the shepherd who looks out for those sheep of his flock who are experiencing difficulties.

He comes to the sick person to talk about his illness and to let the Word of the Lord shine through his circumstances. J. Firet points out that in pastoral concerns we are dealing with parakalein, as the Greek New Testament calls it.⁸ It is not always dear how this Greek word ought to be translated. In many cases where we have translated it as admonishing, it could have been translated as comforting. It de­pends on the nature of the matter.

"In any case one can say that parakalein embra­ces the idea of a calling out – kalein: calling or speaking. One speaks and another is spoken to; one turns to another in the form of an address – para. In other words, parakalein contains the idea of an ad­dress to a contingent situation of a person or a group of persons."⁹ The New Testament underlines that parakalein is the task of the office bearers (1 Timothy 4:13; 2 Timothy 4:2; Titus 1:9; 2:6).

The elder who visits the sick is called to parakalein. That means that he has to let the Word of God speak to the situation in which he finds the sick person. Precisely there it must become clear that the Gospel is a liberating message which is personal and very direct. The elder appears in the sickroom be­cause Christ wishes to come with His Word as it pertains to the sickroom. He must come to terms with his illness in faith. In all his pain, worry and dis­appointments, the patient must maintain his child­like attitude (Romans 8:14-16). For him the joy of the Lord should be present in all circumstances (Philip­pians 2:17, 18) and God's peace must transcend all understanding (4:7). The elder comes to the sickbed with admonition and comfort to keep him in, or to renew the patient's participation in the glorious free­dom of God's children.

The Light of the Word←⤒🔗

Those who visit the sick discover that they are often occupied with the questions; "Why is this happening to me? Why am I forced into idleness, while others can go on? Why has the Lord placed me on this road full of pain and want?" I do not believe that we can dismiss these intensely serious questions with the argument, "You must not ask 'why,' but 'what for.'"

When we turn to the Bible it appears that it certainly entertains the question of "why." The Bible reveals that God can bring sickness into our lives in order to uncover sin (Psalms 30&32; Matthew 9:1-8; 1 Corinthians 11:30), in order to test us and to further our faith (Isaiah 38:17; Hebrews 12:7-11; James 1:2­4), to glorify His name (John 9:3; 11:4), to be a blessing to others (2 Corinthians 1:4). I am of the opinion that there must be ample room for discussion about the "why?" at the sickbed. I, however, underline the re­mark of G. Brillenburgh Wurth:

The pastor may not answer the question "why" himself. He did not sit in on God's tribunal. God did not make him privy to the secrets of His council.... He, however, may and must encour­age the sick person to come to grips with the essence of the cross which God has put upon him in his illness and to ask himself what God in­tends with it in his life. It is, however, his calling to point out that every illness is a reminder of our sinfulness in general and as such a call for humiliation before God.¹⁰

As far as the latter is concerned, the comfort for the sick in our church book begins with humbly remind­ing us of the fall into sin by our disobedience in the Garden of Eden. That there is sickness, suffering and death in the world is our fault.

It can be liberating to point out to the sick person that the texts, which cite illness as punishment for sin, deal with concrete, demonstrable sin in which the sinner persisted. A child of God, who knows himself to be free of "great transgression" (Psalm 19:13) and has a good relationship with the Lord, may see his suffering in the light of John 15:2: "...every branch that does bear fruit he prunes, that it may bear more fruit."

Even though suffering in the New Testament for the most part concerns suffering for Christ's sake,¹¹ we may apply the statement of Paul and James to sickbed suffering as well. James casts a liberating light on the tears and pain of God's children. They may view it as a testing. Through it God is working with them. He works on the precious fruit of perse­verance (James 1:1-4). And Paul exclaims: "...we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces char­acter, and character produces hope." (Romans 5:3, 4). We may also tell our sick that in their illness they receive a special opportunity to glorify God and be a blessing to others. The power of the Word of life (Philippians 2:16) is nowhere more clearly visible than in a sickroom where suffering is born with perseverance and joy. As Paul writes in 2 Corinthi­ans 1:4: "...who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we our­selves are comforted by God." Many a visitor to the sick has experienced how God transforms sick people into comforters (paracletes).

It has been said that a sick person, also one who is chronically ill, may never resign himself to the fact that he is ill.¹²There may be resistance, not against God's guidance in this life, but against the illness as such. We were not created to be ill. Illness is some­thing foreign in God's creation. There is in it the brute force of Satan who tyrannizes people (Mat­thew 9:32; Luke 11:14; Luke 13:11).

Peter beautifully summarizes Christ's work: "...he went about doing good and healing all that were oppressed by the devil, for God was with him" (Acts 10:38). Therefore, in illness we come in contact with the devil's power. In Hebrews 2:14 the Devil is de­scribed as "him who has the power of death."¹³ Satan not only handles the power of death but also the power that precedes death and that can lead to death, namely illness. In 2 Corinthians 12:7, Paul speaks about "a thorn was given to me in the flesh, a messenger of Satan, to harass me." The apostle means a physical suffering which we are unable to diagnose.¹⁴ In that painful suffering Paul sees the work of an angel from Satan.

Satan does not do his evil work alone. He is the commander of an army of evil powers. In what makes him suffer, Paul sees the work of a repre­sentative of Satan. Just as the S.S. bully of the German concentration camps executed prison­ers as he saw fit, on orders of the authorities of that day, so the angel of Satan received permis­sion to give free rein to his evil passion in the case of Paul.¹⁵

We, however, may not overlook the fact that Paul emphatically says, "there was given to me." Behind it all the apostle sees God's guidance and leave. God gives the devil room to keep His servant humble, to protect him from conceit.

The elder who sees one of God's children suffer­ing greatly, meets the power of the evil one. But he may open up a comforting vista in that this power does not operate outside of God's loving care for His children. It is the hand of the Father who sometimes gives the devil room, a Father's hand who also in this power "works for the good of those who love Him."

The Prayer for the Healing←⤒🔗

Those who officially visit the sick cannot be silent about the prayer for healing. The Lord made a close connection between praying and receiving.

In His relationship with us He made the rule that He will give us all things not because of our prayer, but in the way of our prayer. James emphatically points the sick to prayer (James 5:13-18). The Lord commands, "Call upon me in the day of trouble; I will deliver you, and you shall glorify me." (Psalm 50:15). And the Lord impresses upon us "Ask and it will be given to you; seek, and you will find; knock and it will be opened to you." (Matthew 7:7).

The sick person must expect his healing from God in prayer. To be sure, that does not exclude the use of medicine or surgery. King Hezekiah received the message that the Lord would heal him, but at the same time the prophet Isaiah gave the instruction: "Let them take a cake of figs, and apply it to the boil, that he may recover" (Isaiah 38:21).

The prayer for healing must be a request for the Lord to bless the medicine or operation. Psalm 107:20 says it beautifully, "He sent forth his word and healed them." If medicine is to be effective, then the Lord must send His blessed Word of Power. We must impress upon our sick people that man does not live by medicine, but by the Word that proceeds from God's mouth.¹⁶

Even though we may forcefully pray for healing, pleading on God's promises, we must not forget that we are little, limited human beings. Especially in prayer, humility may not be missing.

J.G. Woelderink writes:

We may not turn our prayer of faith into an act such as flipping a switch which turns on the light. Or to put it differently, in prayer we may not declare ourselves to be God, who speaks and it is, who commands and it stands. It must remain a prayer, an asking in all humility. We do not hand God our shopping list like a house­wife hands one to the grocer to deliver her the goods. The appropriate humility reminds us that God in heaven decides about our prayer in His omnipotence. Although we do not always have to use David's words, "Be pleased to save me" (Psalm 40:13), our prayers ought always to be a sounding board which reverberates with the words, "Be pleased, O Lord!"¹⁷

Calvin says the same thing. Where there is no firm promise, he writes in The Institutes, we must pray to God with the addition of a condition.¹⁸

Therefore, before we make any prayer for ourselves, we pray that His will be done. By these words we subject our will to His in order that, restrained as by a bridle, it may not presume to control God but may make Him the arbiter and director of all its entreaties.¹⁹

More than once it will be necessary for the elder to encourage the sick person to persevere in his re­quests for healing. The Lord has many ways to advance His children in the school of faith. Some­times He postpones the answer in order to test the faith of those who belong to Him. It must become apparent that in spite of everything they cling to His promises and that they leave the time and the man­ner of answering to Him. There must be persever­ance in prayer. How many times do we not read that Jesus spent the night in prayer? And how many Psalms do not testify of a wrestling in prayer? It would be amiss not to pass on Calvin's words on the subject. He writes:

On account of these things, our most merciful Father, although He never either sleeps or idles, still very often gives the impression of one sleep­ing or idling in order that He may thus train us, otherwise idle and lazy, to seek, ask, and entreat Him to our great our great good.²⁰

Must we also pray for healing at the bedside of the chronically ill and for those for whom the doctors no longer have any hope? After what has been said it ought to be clear that the request for healing may not be discontinued too soon. We have a God who can work miracles. The Lord can halt the process of death sometimes in a manner incomprehensible to us. Situations occur which amaze the doctors.

It says in Psalm 25 that God teaches the humble His ways. When a sick person lives close to God, the Lord will also make it dear what His way is and how we must pray. Psalm 25 gives witness of the Lord's continuing education in the course of His children's life. The elder, who is experienced in visiting the seriously ill, knows that a moment will come in the illness when God takes away the confidence to pray for healing.

The hidden intercourse with God is so delicate, that sometimes the one who wishes to pray notices that he cannot. I, however, would not like to bind the Holy Spirit in this way. How often does it not happen that a sick person humbly and in faith prays for healing and waits for it, until the time comes when God makes it clear to him that He wishes to take him home.²¹

When the sick bed becomes the deathbed, the elder may let the comforting light of the Gospel fall on "the last enemy." Christ's death has radically changed our dying. It may now be "an entrance into eternal life." God's children may dose their eyes in believing Christ's mighty word:

I am the resurrec­tion and the life; he who believes in me, though he die, yet shall he live, and whoever lives and believes in me will never die.John 11:25

Our Action←⤒🔗

In his booklet, Psychologie van het ziekbed (Psychology of the sickbed), J.H. Van den Berg advises the visitor about a number of things. I would like to pass them on. Those who visit the sick must take their time. That does not mean that they should stay for a long time, but that they should give the sick person the impression that all their attention is directed to conversation with him.

A hurried conversation dis­turbs the relaxed order of time which characterizes the sickbed. It leaves the sick person upset, confused or even defeated.²²

It is important that they sit down, take off their overcoat and hat. Precisely in sitting down, even if the conversation cannot last long, the visitor shows that he has time for the sick person and that he wants to listen to him. Those who visit the sick should also not forget that the person is sick and may still be experiencing the effects of his illness and perhaps longs for the moment of his visitor's depar­ture so that he can call the nurse.

Those who are not completely absorbed in what they themselves have to say, but carefully and discretely observe how the sick person listens and reacts to him, soon know that their presence is no longer welcome. They should then leave, saving the sick person the embarrassment of ter­minating the conversation and having to ex­plain the interruption.²³

Because the physical condition of the sick person plays an important role, it is good to begin with a careful inquiry concerning that. Carefully! It can be very painful for the sick person to have to admit that all is not going well. When it is surmised that it is indeed not going well, it is perhaps better to begin with some questions about the room or care being received. By means of a detour, one will end up dis­cussing the condition of the person.

We talked about listening in the context of fam­ily visits, but it is even more important when visi­ting the sick. Those who cannot listen, cannot visit the sick. A good pastor only needs half a word, a secret hint, to understand the spiritual condition of the sick person. By listening and careful inquiries, the elder can discover the sick man's situation. When he has discovered that, there can be parakalein: i.e. to let God's Word speak to the present situation of the patient.

It is not correct to visit the sick with a prepared and immovable plan. Those who do that run the risk of missing a real meeting with the sick. The chronic patient, who joyfully bore his illness last week, may suddenly be rebellious. The elder must close his conversation with Scripture reading and prayer. The Scripture passage must link up with the conversa­tion. It may be necessary to forego a previously selected passage and substitute it with one which may be the liberating Word of God as it concerns the man's situation. Those who visit the sick must know their Bible.

The prayer must especially be one of thanksgiv­ing and intercession. There is much to be thankful for, even at a sickbed: God's gift in Christ, His mercy, which is better than life, and the many favours we receive each day anew.

Regarding intercession: the office-bearer prays for healing, for God's blessed Word of power as it pertains to an operation and medicine, for resigna­tion and patience, for grace while ill and for God's name to be glorified. Included in this prayer should be the family members, about whom the sick person no doubt worries. It should be clear that our visit to the seriously ill must be short and to the point. Sometimes a few words from the Scriptures, fol­lowed by a short prayer will suffice. In such cases it is best to recite a well-known word from the Scrip­tures slowly and clearly.

Finally a few remarks about visits to the hospital. Those who visit a patient in the hospital should inquire at the information desk and, if necessary, at the nurses station. Almost always one will receive permission to speak with the patient. If the room is large and privacy is needed, pull the curtain. In that way the work in the room itself can continue. If a patient is in a small room and his condition is not serious, other patients can be included in the visit. One should, however, ask whether or not Bible read­ing and prayer are appreciated. There is almost always room to read from the Scriptures and for a brief prayer. In any case, pay attention to the other patients present with either a brief conversation or a greeting.