It was like one of those political rallies. You know, when one person yells “What do we want?” followed by an uncoordinated chant that should probably be narrowed down to one key idea. What works is when the crowd responds with something like “Peace!” When it really breaks down is when that key idea is something like “Affordable Healthcare!”
Anyway, that’s how I felt when I spoke with the nurse who was trying to care for my grandmother as best as she knew how. She said “Well, death is the enemy. We’re going to fight this.” It’s as if she were chanting by herself, and she wanted me to chant along with her:
“What do we want?”
“For patients not to die, ever!”
“When do we want it?”
“Now!”
Perhaps she was hoping I would chant along with her curative philosophy and agree that the preeminent value in life… is life. In the moment, I didn’t say anything, but perhaps my silence disappointed her.
Meanwhile, my grandmother, a week or so shy of 93, is bleeding uncontrollably and actively dying. The hospital staff took heroic measures to “bring her back” from the edge of death, including unending amounts of blood that frankly might have been put to better use on someone who had a chance. I’m not saying I wanted my grandmother to bleed to death, but I am saying we already knew the end was here for my dear Granny. There was no need to inject her and ventilate her and feed her medicine that would make her vomit. That is no way to die. Here, death is not the enemy, but this torture is. I believe in dying a good death, and this was not how I would chose to die if I were blessed enough to have a choice in the matter.
Great strides have been taken in medicine to take into account the dignity of patients who are in pain or nearing death. An entirely new medical specialty called “palliative care” has been established to help people who are in pain feel better. Another philosophy called “hospice,” which often makes use of palliative care principles, helps people who are dying become comfortable and safe. Sometimes this means withdrawing medications so the patient can talk to family members again and feel as normal as possible. Sometimes, this means giving pain medication. And sometimes it means providing comfort and pastoral care to family members while the patients decline. To that end, chaplaincy now offers a “palliative care specialty certificate,” which provides training beyond board certification as a chaplain. The medical specialty for MDs and chaplaincy certification for MDivs together provide that patients like my grandmother will feel comfortable and safe in their final days of life. Additionally, the chaplain certificate will help ministers and seminarians become more competent pastoral caregivers.
The enemy is not death, and the goal should not always be life. Dying a good death can also be a goal—particularly when death is immanent. Regardless of whether my grandmother received palliative care at the end of her life, she was still going to die of her condition. MDs and MDivs now have language and tools to help them better care for their patients—patients like my grandmother—and to help them die with dignity, as well as providing better pastoral care to their families.
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For more information on the chaplaincy Palliative Care Specialty Certificate, see http://www.healthcarechaplaincy.org/palliative-care-chaplaincy.html.
Photo courtesy of M.D. Anderson Cancer Center of the University of Texas.
Thanks for sharing, Daniel. All of us need to a better job talking about and understanding death. Having worked as a hospice chaplain, I found thinking about my own death a lot to be much more freeing than I would have imagined. I feel much more comfortable with the eventuality–not that I want it to come quickly, but I am less afraid of it coming.
And may your grandmother’s memory be for a blessing.
Death is not the end, but a new and different beginning. Having been declared dead by 3 doctors at the Trauma Center in 1998…and, by the grace of G-d, returned, has brought me to a reconsideration of the process. Not knowing what will happen after death creates the FEAR (False Evidence Appearing Real). All our life we refuse to dwell on the process of dying…albeit, when others around us go through the process we quickly put it from our thoughts. Knowing that eventually that time will come in our lives helps us prepare (if only in the back of our minds) for the joyous occasion. Everyone wants to go to Heaven…but no one wants to die! How then do we get there?
I know I’ll walk through that corridor again…now is when I am making proper Spiritual preparation for the journey. That doesn’t mean that I withdraw from everyday life, on the contrary I’ve stepped up to the plate and embraced what seems like the mundane. We are co-creators of our personal life and the life of this world. What have we/I made of the time we’ve been allotted in this life? When I was young days seemed drawn out to that of weeks…now, at age 67, weeks seem to fly by as if they were days! I’ve seen the people on the streets with signs “the world is ending today”. Well for many people it has… were they “prepared”? Since we just don’t know when our “string” is going to be cut… let’s just try to live the life we were meant to live embracing the earthly and the Spiritual in a meaningful way. Never forget to tell those you love…that you love them. Do this daily before you leave the house…you just may not see them again!
Thank you for this article, beautifully written and with compelling thoughts. I’m currently studying at Harvard Divinity School, where I’m the only rabbinical student, and last year I did an internship at Lemuel Shattuck State Hospital in Boston. I learned to agree with you, death is not the enemy, it is a natural part of the life cycle. Whether they be a grandmother who’s lived a long and full life, or an indigent old man whose “days were short and full of trouble,” everyone deserves the kavod (honour) of a dignified death in which they themselves make as many decisions about their own care as feasible. I would like to die with dignity when my time comes, and it is so important to provide everyone else with that same dignity in their last hours. Thank you for the work you do.
I don’t know what a good death is. I imagine that it’s wildly different for different people, and even for the same person at different stages in their lives. However, I think you hit the nail on the head with your questions!
As a culture we need to work on to relax our death grip on life and begin to have conversations about what’s actually happening. I think the nurse who was taking care of your grandmother was in a state of mind that most of us live in – terror of death. Whatever the transition from this life does or does not involve, terror and the refusal to face reality will not help.
I think that perhaps one of the biggest gifts we can give people who are coming closer to death’s door (but also everyone else) is to be clear in that we’re open to the conversation, to be clear that we’re open to hearing them reflect on the kind of life they have lived, to their fears, and to their wishes up to the last moment of their death. The person who is close to death may not be able to walk through the door that we open, but I think we have the responsibility to at least make it known that there is a door there.