Faith and Reason: Deadly afraid of dying all alone: The Rev Robert Rea, of Newark, New Jersey, gives an account of the challenge of trying to give individual care to an Aids patient in the last days of his life in an American city.

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I NOTICED in a recent gospel reading that when the Son of Man comes, he comes to judge the nations. We usually hear a judgement of our individual behaviour in this reading. And we can usually find things we individuals do to help the least. But what if that is not the question being asked? What if our national behaviour is at issue? What if it is presidents and legislators and administrators that are to be judged? So I thought I would detail what I have been doing over the last few days that I do, and my agency does, on behalf of, and instead of, the nation. But that is preface.

Greetings from Calcutta, USA, and the St Somebody Aids Resource Center. Thursday I got a call from the local visiting nurse in our church about a man, call him Jose. Jose has been hyperactive and clinging to the home health help, because he is dying and afraid and he has only eight hours a day of her services, so he causes a fuss when she has to go home at 4pm leaving him alone. Maybe as a priest I could go in and pray with him and calm him down. So I did. It worked some, but he is alone all night.

If you've seen the figure of Christ on the most agonised possible Spanish crucifix, you know what Jose looks like. No muscle mass to speak of, lying on the couch because he is too uncomfortable on his hospital bed. Besides which, think what it must mean to him to climb into that hospital bed. Deadly afraid to die, wanting to die at home, and not in a nursing home. One of his best friends died last week, the other is now dying in the hospital.

Jose is in pain but they can't or won't do anything about it because he is an intravenous drug user and they are afraid to mix in any other pain meds. Come to think of it, he hasn't been able to go out and get his methadone for two weeks, let alone street drugs. So not only is he facing death, but he is going though withdrawal at the same time. No wonder he is in pain. I do my job, I comfort and talk to him about all this. I anoint him and give him communion. Later, when I check back in after the nurse has gone home, I have to help him clean himself up and change his diaper. The comforts of religion, Last Rites and diaper change.

I talk to the visiting nurses. He's not sick enough to get round-the- clock care. They will try for more hours but it takes a while to get approval from Medicaid - ie, welfare here in Calcutta, USA. So I see him again Friday. And leave him alone again. I can't stay with him. It is in a neighbourhood where I as a white person am not very safe. And my car was stolen earlier in the week. But he is supposed to have health workers over the weekend.

He says he doesn't want to die alone. I tell him I will do my best to see that he doesn't. I tell him he isn't going to die Thursday night. Friday I tell him he won't die over the weekend. I believe this; I can see he's not quite that close. And he isn't. I tell him I will see him after church Sunday.

Sunday it turns out his sister-in- law came Saturday and found him alone, so she took him home. Nobody is around to tell me where to find him. Well, at least he's not alone.

Today the health worker calls me to tell me where he is. So I see him and sit with him a while. Today he can't hold his head up to eat or drink. We, the worker and I, sit him up and his head falls back and hits the couch with a nasty crunch. Finally we get a pillow behind his head. He can't use his atomiser for his asthma any more either. The nurse covers his legs, which he doesn't want. She says he's got to or he'll catch pneumonia. I think to mayself that it would be a merciful end. He asks for the oils which I had not brought. I was reverting to my job as social worker. Tomorrow, I promise him, I will bring the oils.

Later I talk to the health worker who takes such wonderful care of him. She says she isn't sure she can continue. The neighbourhood isn't safe enough for her to come to. She gets off at 4pm and has to take a taxi to a streetcorner safe enough to wait at for a bus.

Later yet I talk to his sister-in- law. (This is Hispanic for some sort of relative. She calls him her uncle.) She says that she is getting another eight hours of health aid care arranged. If she can do that she can take the other eight hours of the day, and move him back to his own apartment. I applaud that heartily. We will work on getting him to use the hospital bed, where we can crank him up so he won't choke and suffocate.

The sister-in-law says she won't have him be alone and incontinent. I applaud that even more. She is going to try to get him into the nursing home where she works, but the paperwork takes several weeks, and then there is a waiting list. I tell her I don't think we have time. He is going to die sooner than that. This shocks her somewhat. We talk about that for a while. So now we are making plans to find people to stay for the gap between when the sister-in-law goes to work and the aid comes in the morning. That much even I may be able to do.

So this morning the sister-in-law called the ambulance and sent him to the hospital. This time the hospital is keeping him. He has meningitis, they think, and gangrene on his feet. So he has a couple of days. They think he will make it tonight. His condition is stable. He's in a lot of agony but the vital signs are


He can't really talk anymore. He makes sounds but you can't tell what he's trying to tell you. So I anointed him and said goodbye in case I didn't make it back to see him again. Tomorrow is our day to give out the turkeys and dinners for our clients. If I get a chance I will try to see him again. If not, I will try to get by on Thanksgiving. Without a car, it's difficult.

Next we think about a funeral.

So keep all of us in your prayers.

I think I know what the son of Man would say about our individual work. What would he say about the nation that allows people to get into this state?