This is my 336th post about death and dying on this blog. And I am now into the final month of this yearlong project.
I am amazed and grateful that I get to contemplate dying so intentionally and comfortably before it is happening. I know that I will not always be up for this work.
Some friends of mine, while they have been hospitalized or sick, have testified to me that it is not possible for them to read and think about death under such circumstances. It seems too raw and too sad.
This makes sense.
We have investment accounts and retirement savings so that we do not need to think and worry too much about money later in life.
It seems worthwhile to store away reflection on the last things and to build an accounting of what matters ultimately when we are young and healthy so that we do not need to worry about this so much when we are sick or dying.
This is a short post to direct you over to the excellent, thoughtful piece by Joshua Briscoe published in the summer edition of The New Atlantis titled, “Dying, But Not Alone.”
Here are two of my favourite paragraphs:
A patient’s choice to end her life is not “defined” by her, if by that we mean that it is a choice that is just about herself. Rather, it is a declaration about what kind of life is worth living. It is thus also a statement about other people’s lives, a statement to others about when their own lives are worth living or not.
This is why choices about how we die are not just about us; they are also about how others think about us and are involved in our care. When someone says, “I would never want to live like that,” “She’s just a shell of who she once was,” or “This death is undignified,” the person is expressing our culture’s prejudices about aging and dying, and in doing so is further reinforcing them and thus shaping how others view themselves.
A lot has been written about the lonely and solitary dimensions of death but not enough attention is paid in our time to its social dimensions. Briscoe highlights this in his piece and makes the case that our cultural attitudes toward death concern and implicate us long before the hour of our death.
The other day I was having a call with my aunt and godmother who is a hospice nurse in the U.S.
She had texted me to ask, “Have you talked about dying and food? How our bodies need less and less but families want to keep feeding the dying person? Food = Life = Love. It’s quite a psychological issue.”
I was interested to hear more from her about this, so I gave her a call.
She told me, “I have some patients who, if left on their own, wouldn’t eat. They would just stop eating and it’s not that they would be starving. It’s simply that their body doesn’t need the food anymore because they are approaching death. However, their loved ones worry they’ll starve and so they think that they must feed them.”
Sometimes hospice caregivers will spend an hour trying to feed someone a bowl of oatmeal or three hours trying to feed someone a shake, she told me.
My aunt expressed some frustration over this saying that is makes her wonder: “Why are you doing this? You’re forcing it.”
Founder of modern palliative care, Cecily Saunders, was the 1981 Laureate of the Templeton Prize.
In her address, this section, in which she speaks about “achievement in dying”, especially struck me:
The first challenge was for the better understanding and control of pain. The seven years part time volunteer experience in St Luke’s and the later seven years full time developing this in St. Joseph’s laid the foundation for the increasingly sophisticated symptom control that means hospice today. There was much more to learn from St. Joseph’s from the strength and prayerfulness of the community of the Irish Sisters of Charity and, above all, from uncounted hours with the patients. It was they who showed me by their achievements how important the ending of life could be and many that I knew briefly and a few long stay patients, friends over the years, are the real founders of St. Christopher’s. One, another Pole, special among them all, left me other key phrases. When I told him he had not much further to go, he asked me, ‘Was it hard for you to tell me that?’ When I said that it had been, he said, ‘Thank you. It is hard to be told, but it is hard to tell too. Thank you’. We have to care what we say; this work is hard and demanding as well as rewarding. Two other things he said were separated by some three weeks. The first, ‘I do not want to die, I do not want to die’. The second, ‘I only want what is right’. Sometimes people ask me what I mean by achievement in dying. Here was one, Gethsemane made present today.
Yesterday, I was flipping through a new book by Rabbi Steve Leder titled, The Beauty of What Remains: How Our Greatest Fear Becomes Our Greatest Gift. The book emerged from a popular sermon the rabbi delivered about death on Yom Kippur, from the rabbi’s extensive experience accompanying the dying and their grieving families and, importantly, from the fruit of his own experience suffering the loss of his father.
I read the initial chapters and this paragraph in particular really struck me:
Whoever wrote the third chapter of Ecclesiastes (later made famous by the Byrds) was right. There really is a time for everything. Most people are ready for death the way we are all ready for sleep after a long and exhausting day. We just want to pull the covers up around our aching heads and settle in for the peace of it all. We are not anxious about sleeping. We are not depressed about it. We are not afraid of it. Disease, age, and life itself prepare us for death. There is a time for everything, and when it is our time to die, death is as natural a thing as life itself. Consider this very good news for those of us who fear death. Dying people are not afraid of dying. If you are afraid of dying, it is not your day. Anxiety is for the living. So if you are worried and anxious about dying, you’re not dying. Which means you have time to let death teach you about living and loving your life.
Do you have any reason to dispute Rabbi Leder on this?
If not, does this explanation change your understanding of death?
Lastly, does hearing of the peace that comes with rest alter the anxiety of living at all?
Surveys consistently indicate that the majority of people would prefer to die at home instead of in a hospital. However, a minority actually do.
Cicely Saunders International just published You Matter Because You Are You, an action plan better palliative care, in which the charity explores the key challenges faced at the end of life.
The report notes that “Too many people with life-limiting illnesses – as well as those approaching death – spend long periods of time in hospital, in part due to a lack of social or community care. Meanwhile, hospital admissions are rising to unsustainable levels across the country, something that was made all the more apparent as parts of the NHS risked being overwhelmed during the COVID-19 pandemic.”
Most people want to die at home and most hospital workers would be in favour of much greater home care.
Some of the main obstacles to this include: the weakness of social and familial ties, lack of “coordination and information sharing between health and social care providers”, and inadequate emphasis on professional palliative home care.
Lately I have been reading Martin Buber’s Tales of the Hasidim. In his Introduction, Buber discusses how “the core of hasidic teachings is the concept of a life of fervour, of exalted joy” and that “The world in which you live, just as it is and not otherwise affords you that association with God, which will redeem you and whatever divine aspect of the world you have been entrusted with.”