Pilgrim's prognosis: while a chronic illness often means constant visits to the hospital, it can also become a spiritual journey.

We think of pilgrimages as long walks to remote holy places, but even a short walk to the supermarket has the potential to become a pilgrimage. There are also pilgrimage journeys that have little or nothing to do with changing location. For example, there is the pilgrimage of illness.

In my own case these past few years, the most common of pilgrimages has been going to the hospital, just five minutes from our front door. These days I make that small pilgrimage three times a week.

It's a journey that began several years ago when a blood test revealed that the creatinine level in my blood was higher than it should be. Our family doctor referred me to a specialist at the hospital for further tests. More tests made it clear that my kidneys were gradually failing. Sometime in the not-distant future, the doctor said, I would need dialysis--use of an artificial kidney machine--in order to stay alive.

Dialysis! Not something I was in a rush to experience. During the 30 months between diagnosis and the first session of dialysis, while taking all the medication my doctor prescribed, I looked into alternative treatments. I changed my diet. I found a local acupuncturist who made no promises but said acupuncture might help.

I often prayed for a healing miracle, and many prayed for me. For several years I have been on a list of people for whom our parish prays at every liturgy. The fact that there has been no miracle is disappointing, and yet I have felt greatly helped by the prayer. I think it was a major factor in coming to terms with my illness, an inner shift that happened quite slowly. It may well have been the prayer of others that helped me realize I was on a pilgrimage. For the better part of three years, I'm embarrassed to say such a thought never crossed my mind.

The pilgrimage begins

In that period of regular hospital visits, far from seeing myself on a pilgrim's path leading more and more deeply into the kingdom of God, it seemed to me that I was simply a victim of bad luck. Each trip to the hospital was a painful reminder of a dark, confining future that was relentlessly coming my way. I rejoiced each time my doctor told me that dialysis wasn't yet needed, but he also made me aware that month by month my creatinine level was rising, a sure sign of kidney failure. Whatever prayer, changed diet, and acupuncture were achieving, at the very best the progress of my illness was simply being slowed.

During each visit to the hospital, I had a glimpse of patients undergoing dialysis. It seemed to me a nightmare vision. Transparent plastic tubes filled with dark red blood ran from the bandaged arms of men and women into machines that looked like props from Star Wars. I hoped against hope that I would not eventually have to join them.

And yet I have. A year ago last January my doctor looked at the latest blood tests, then called the dialysis unit to make an appointment for me to start dialysis the following day.

What I had so hoped to avoid is now "normal." Dialysis is part of the structure of each week. Blood-filled plastic tubes now link my arm to a dialysis machine. Nurses that I saw caring for others now care for me. People who were unenviable strangers are now people I know by name. We're all in the same boat.

In the process it has finally dawned on me that the hospital I dreaded visiting is actually holy ground and that my frequent journeys there could become acts of pilgrimage. It's the blessing of going to a place where nearly everyone is sick, caring for the sick, or visiting the sick.

Hard lessons

Worse things can happen than being chronically ill. Unlike people burdened with the illusions that come with good health, the sick are well aware that they are unable to survive on their own. We're intensely conscious of our dependence on others. It's hard to be seriously ill and not be poor in spirit, the first of Christ's Beatitudes. Because of that, the sick are by definition on the ladder of the Beatitudes. Each of us may still have quite some climbing to do, but thanks to illness, at least we've made a start. We're on the first rung.

In a culture that prizes individuality and independence, most of us are reluctant to realize how much we depend on others, though in reality there has never been a day of our lives when this wasn't the case. We started that dependence the instant we were conceived, and it continues without interruption until our last breath.

We depend on others for love, for encouragement, for inspiration. We depend on others for food. We depend on others for the words and gestures that make communication possible. We depend on others for all the skills we slowly acquired while growing up. We depend on others for wisdom.

And yet for much of our lives we manage to nourish the illusion that we are independent. We even pat ourselves on the back for whatever good things come our way. The phrase thank you, however often it is said out of social necessity, doesn't necessarily reflect a deeply felt attitude.

Being sick changes that. The words thank you begin to rise from the depths of the heart. In the community of the sick, there aren't many people unaware how much they depend on the care of others. It's not only dependence on the doctors and nurses but also those with such unheralded tasks as doing laboratory analyses or keeping the hospital clean.

Directly or indirectly, what all these people are doing is trying to keep us alive a little longer and even trying to keep our spirits up. They are professional lifesavers, yet none see themselves as heroes. They do what they do with the matter-of-factness of a teacher writing 2+2=4 on a blackboard or a plumber repairing a sink.

At the end of a session of dialysis, I sometimes say to the nurses who helped me that day, "Thank you for saving my life." They always look surprised to hear such a declaration. Generally people are too polite to express appreciation that plainly, though anyone with a chronic illness knows he or she is living on borrowed time. Every dialysis patient knows that he or she, without dialysis, wouldn't have long to live.

Visiting the sick

It's not only the professional caregivers who make a hospital holy ground, but also those who visit the sick. Typically they arrive carrying flowers, though some bring books, magazines, chocolates, juice, balloons, or music. They're looking for ways to give someone they love a little extra energy for coping with illness.

It's holy work and often done despite a temptation not to be there. Hospitals, after all, are places exploding with reminders of a human mortality. Also hospitals are not the healthiest places to be in. Yet crowds of people each day manage to overcome their hesitation, even their fear, and cross the border.

After all, it's not easy to communicate the bond of love while physically avoiding the person you love. Greeting cards and telephone phone calls aren't bad, but they sure don't equal being there.

Visiting is a healing work as crucial and powerful as what the doctors and nurses are doing. There is nothing more healing than love. Love can be expressed far more openly by the visitor than the health-care professional. Whether visitors sit silently or talk non-stop, they manifest how much the sick person they are visiting matters to them.

All who visit the sick are also pilgrims, for they are meeting not only someone familiar but Christ as well. It was he who said, "I was sick ... and you visited me."

Journey's end 

Sickness has its blessings. If you happen to love books, as I do, illness will give you time for a lot of quiet reading. In my life, that qualifies as an answered prayer. Prefer watching TV? Normally I don't, but there's a TV close at hand should I find myself too tired to read and yet unwilling to take a nap. I happened to catch an excellent program on monastic life the other day. Love films? Suggest to the family that you could make good use of a portable DVD player.

The pilgrimages of illness being made by others are often far harder than mine--or more difficult to bear. I sometimes encounter children who are gravely ill. I often see people who are in great pain and distress. I see faces collapsing with discouragement and grief.

There is usually nothing at all I can do but silently pray, which may in fact be an achievement in the face of the overwhelming powerlessness I sometimes feel when I witness what other people are up against. Prayer seems so meager a response--in moments of doubt, just another form of nothing. But not to pray is itself a kind of dying.

Being among the sick is being among those who include the dying. Just a few days ago, a frail man in his 80s died before my eyes in the dialysis ward. I thought he had dozed off. So did the nurses. But at the end of his session, when a nurse attempted to wake him up, it was discovered he had quietly left this world. His pilgrimage was ended.

In fact pilgrimage has always been a dress rehearsal for dying. What better death is there than to die on pilgrimage?

Whoever is on the pilgrimage of illness cannot help but be more aware of last things than many others, but the job of the pilgrim is not dying but living. As St. Ireneaus, one of the theologians of the second century, said, "The glory of God is man fully alive." Even if it is a life of confined borders, it is no less a life.

By JIM FOREST, author of The Wormwood File: E-Mail from Hell (Orbis, 2004). This essay will appear in The Road to Emmaus: Pilgrimage as a Way of Life, available in October from Orbis Books.