An Examined life

As the on-call chaplain, I had answered a page to the neurological ICU to be with family as doctors reported unequivocal results of testing. The patient was brain dead and not going to survive the stroke that caused her hospitalization. Her distraught daughter cried, “It’s too soon!” The patient was 85 years old. Is there an age at which death is appropriate?

It’s a cultural taboo. We don’t like talking about life’s end. When people ask about my thesis topic and I say death, I watch them flinch. It’s a conversation-stopper for most people. But you can’t be immersed in thinking about and researching end-of-life without realizing a truth. Dying just happens to be the last developmental phase of the life-cycle. However, unlike birth, there is reluctance to talk about dying, even though it will happen to everyone who has been born. Failing to plan can mean torturous interventions and emotional turmoil.

There actually are a few guidebooks, including “Dying for Dummies” a 19-line poem published in the New Yorker.

I’m watching my cohort
master the skills at each grade
of incapacity
and get promoted to the next.
“Dying for Dummies,” Chana Bloch

Some philosophically-oriented books such as Being Mortal and When Breath Becomes Air have become bestsellers, interestingly both written by medical doctors. While insightful, these books and others of the genre share a commonality: They are too late. No one has considered “The End” before it is on their doorstep, similar to many patients who arrive at the hospital ER or ICU emergently without advance medical directives. Until death was likely, patients and loved ones had not really considered that mortality applied to them.

The same magical thinking goes into buying lottery tickets as a retirement plan or ignoring weather reports or tornado sirens until a storm is bearing down. We forgo planning in the expectation of miracles, even if by definition, a miracle doesn’t require high-tech medical care or hospitals or doctors. Hoping for a fantasy is easier than pondering and planning for What to Expect When You’re Expecting Death (which is not a published book).

Wisdom and knowledge shall be the stability of thy times. Isaiah 33:6

During one of my shifts as an Arlington Lady, I noticed the tombstone of PFC Albert Gallo at Arlington National Cemetery. Several things struck me. This soldier was a World War II POW (prisoner of war) and he received the Purple Heart, a medal awarded to those wounded (or killed) while serving. Engraved at the base of the marker is a reference to Abraham Lincoln’s 2nd inaugural address “With malice toward none.” The President delivered this speech just before the Civil War ended. He was seeking reconciliation and encouraging understanding as the war wound down. It takes a big person to look beyond injuries and captivity to find the capacity to forgive. PFC Gallo’s legacy is carved in stone.

We have alarms to remind us of appointments or to wake us up from sleep. But I wonder if there is a way to awaken while we are alive. My puzzlement leads me to continue pondering and writing about death, as a reminder that life provides no guarantees or warranties. We are members of a club few acknowledge and nobody wants to be part of, a mortal race. Living life to the fullest means being prepared for it to end. Life begets death.

In a bedtime prayer, children recite: “If I should die before I wake, I pray to God my soul to take.”^[1] While attending to patients and families during the dying process, I’ve wondered if some of the anxiety and reluctance stemmed from a sense of incompletion: relationships unhealed, loveliness unappreciated, things undone. Our prayer should be to wake before eternal sleep: If I should live for other days, I pray that awe guides my ways. May we learn how to make a life, not just a living, and add life to years, not just years to life.^[2] Let us live a life of purpose, prepare for the end, and ensure that the things that matter most prevail over someone else’s agenda or a system’s protocols. We can live fully, deeply, and humbly knowing: “Even if we lived forever, we could still do it wrong.”^[1]