We die together

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.

Be sure to take a look at his piece, here.

Treat someone as you would want your loved one treated

There is this general ethos in contemporary healthcare that physicians should remain neutral, impartial, objective, and detached. To some extent, this seems fitting so to prevent burnout and enable doctors to see so many patients with a plethora of dramatic conditions and circumstances.

However, sometimes this goes too far and is detrimental and dehumanizing not only for patients but even for the doctors themselves.

One thing a former patient shared with me in this regard struck me. She said it was greatly reassuring for her when her doctors would preface their medical judgment or recommendation with the words, “If you were my spouse…” or “If you were my daughter…”

This indicated to her that the doctor truly had her best interest at heart. If he was willing to advise something in the case of his own loved one, then it was clear that he was making his recommendation very sincerely and had considered it seriously.

And so, this leads me to reflect on how we really want to be treated by others not only as they want to be treated but also as they would want their own loved ones to be treated.

I think doctors extending this kind of empathetic imagination to their patients can be an excellent form of accompaniment and help in having crucial conversations in the meeting between doctor and patient.

“Why hasn’t God taken me home yet?”

This evening my friend who is a doctor shared with me an anecdote from the past week.

She had a 90-year-old patient named Laurence who was admitted for recurrent falls and who may not be able to return to independent living in her own home because she lives alone.

Laurence never married and does not have any children, but her nieces and nephews help her out with cooking, shopping, and managing her finances and appointments.

During the hospitalization, my friend had a few conversations with Laurence and, many times, she would ask, “Why hasn’t God taken me home yet? I’m 90-years-old now. I’m sure I will go to heaven, and I don’t know what else to do here.”

My friend noted that Laurence had mentioned on a few occasions that one of her defects is impatience.

“All I do every day is pray the rosary again and again,” Laurence said.

My friend thought quickly about how to help Laurence to see the value in her continued days.

“Maybe God is not taking you home just yet, because there’s something in which you’re meant to still grow – your patience.”

She gave a smile of compliant recognition and replied, “Yeah, maybe.”

Later that afternoon, as Laurence was leaving the unit to be transferred to another hospital, she said goodbye to my friend and said, “I know what my mission is now – to work on my patience!”

What a beautiful encounter of helping another to discover a new mission, even in her old age.

Prepare to fall

This evening I was speaking with one of my dear friends who is a doctor.

She told me, “I know you’re looking for uplifting stories for your blog, but lately I have been seeing a lot of elderly patients who have had bad falls. Since many of them live alone and are not able to get back up by themselves, sometimes they are not found until the next day or two. When that is the case, the person may be found sitting in their own feces or urine, profoundly helpless, until a support worker or relative comes to visit.”

Of course the best situation is when a vulnerable person can live in a family home so that their presence and wellbeing is continually and naturally monitored by their loved ones. The next best thing for the elderly would be to live in retirement homes where many services are provided and there are attendant nurses. This, however, is quite expensive and not within everyone’s reach.

On hearing about this from my friend, I remembered a recent conversation I had with a senior buddy of mine with whom I have been having weekly phone calls throughout the pandemic.

He and I have never met, but we have sure gotten to know one another through our Wednesday visits.

This gentleman with whom I speak just turned 90-years-old. His wife passed away last year and so he lives alone. Some of his adult children who live in town visit him and each week he brings his 88-year-old sister some shawarma.

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A Patient’s Fight to Be a Protagonist

Today is the 40th anniversary of the attempted assassination of Pope John Paul II.

Cardinal Stanislaw Dziwisz, the pope’s longtime secretary, was in Rome today marking the occasion and remembering cradling the pope as he felt “his body slip as if paralyzed and fall into my arms.”

The cardinal also reflected, “Today, 40 years after that event, and 16 years after his death, I think with fear of what it would have been like if we had lost him in St. Peter’s Square back then. How poor and different the world and our homeland, Poland, would have been without his witness of faith and doctrine, without his indications and his warnings in the face of the dangers and turmoil that can threaten us in today’s world.”

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An Appetite for Affection

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.”

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At the End of Life, the Artist is Necessary

According to the Cambridge Dictionary, the word “clinical” may denote “expressing no emotion or feelings” or “showing no character and warmth.” The sentence that is given to illustrate its meaning is this: “We were going to paint our kitchen white, but we decided that would look too clinical.”

Do you ever wonder why hospitals and doctor’s offices are so drab? Why does there seem to be so little attention paid to aesthetics? What impact does this have on doctors, nurses, patients, and visitors?

One day, Cecily Saunders, the British pioneer of modern-day hospice care, was “magnetically drawn” to an oil painting in a gallery window. She was so taken by it that she parked her car and entered the gallery moments before they were closing on the last day of the exhibition. Cecily Saunders moved eagerly from painting to painting. The blue Crucifixion had been the piece to catch her eye from the window, but the piece she impulsively chose to purchase was of ‘Christ Calming the Waters.’

The following day, she wrote the following to the artist, Marian Bohusz-Szyszko:

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Achievement in Dying

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.

Later, in the same address she says:

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Have you tried something at which you could fail lately?

I find it striking that palliative care nurse Bronnie Ware found the top regret of the dying patients she encountered to be, “I wish I’d had the courage to live a life true to myself, not the life others expected of me.”

Today I have been reflecting on the reasons for why this might be. Is it because others’ expectations are in real tension with our own? Or, is it because the expectations of others are so apparent to us and we do not actually know ourselves well enough to have expectations of our own?

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A Death Chat Over Wine and Cheese

Years ago, one cold December night, I approached St. Christopher’s Hospice in South London. Through the window, I could see several people getting seated around a table. I went to the main entrance and informed the receptionist that I was here for the Death Chat, and she pointed me toward the room that I had seen through the window.

Those who were there greeted me warmly. A man named Anthony was speaking and it was the opposite of small talk. After a few others had arrived, Kostas, a principal social worker in Social Work, Bereavement, and Welfare, facilitated the introductions.

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