The Last Hour: Thoughts on Dying and Letting Go
Posted Tuesday, September 08, 2009
This article is an excerpt from Be Not Afraid.
Even in his late eighties, my father-in-law, Hans, made trips from Connecticut to Europe. A self-taught scholar with a passion for history and religion, he wasn’t going to let age get in the way of conferences and tours. If meeting interesting people required flying long distances, so be it. After all, traveling didn’t wear him out. It rejuvenated him. A family member predicted, “When he dies, he’ll die in harness.”
On Christmas Eve, 1992, at the age of ninety, Hans was sitting on a hay bale, a shepherd’s cloak over his shoulders and a wooden staff in his hand, having volunteered to join in an outdoor nativity pageant. Feeling cold, he asked to be taken indoors, and soon someone was driving him home, just a stone’s throw away. But Hans never made it. Opening the car door for him after the ride, his driver found that he was no longer alive.
To lose a friend or family member unexpectedly is always a shock. True, it can also be a blessing, if he or she is elderly, and has lived a fulfilled life. Surely most people, if they were allowed to choose, would elect to die as Hans did – happily and quickly. But few go that way. For most, the end comes gradually.
Dying almost always involves a hard struggle. Part of it is fear, which is often rooted in uncertainty of the unknown and unknowable future. Part of it may be the urge to fulfill unmet obligations or to be relieved of past regrets or guilt. But part of it is also our natural resistance to the thought that everything we know is coming to an end. Call it survival instinct, the will to live, or whatever – it is a powerful primal force. And except in rare cases (those who die in a heavily medicated state, for instance) it can give a person amazing resilience.
Maureen, an old friend, fell and broke her hip in her mid-nineties; since then her younger sister has died, and so has one of her sons. She herself is bedridden much of the day, and confined to a wheelchair the rest of the time. Still, this “tough old bird” (as she calls herself) who likes to shock visitors by sneaking a rubber mouse into their coffee has more sparkle than many people half her age. Having met her previous goal of reaching the year 2000, she set a new goal of sticking around until she turned 100 – a milestone she’s just passed. In resisting old age with every fiber of her being, she has literally kept herself alive.
Then there is Esther, the stepdaughter of one of my sisters, who was diagnosed with an aggressive cancer when she was ten. Within days this lively girl who loved to skip rope, play tag, and go horse riding with her father found herself confined to a bed. Soon afterward one of her legs had to be amputated. Esther wept, then pulled herself together and asked for a prosthesis. “I’ll be walking by Christmas – just wait and see,” she promised. Later she went blind. Again she refused to be cowed, and spoke of continuing to take piano lessons anyway. Cheerful and plucky, she didn’t die of cancer so much as fight it until the end.
With the will to live, a person can overcome unbelievable odds. But death cannot be forestalled forever, and eventually physical life must draw to a close. Strangely, our culture resists this truth. In Florida, thousands of the elderly congregate in retirement communities where they dance, date, exercise, and sunbathe – and pay exorbitant amounts for facelifts to keep up the appearance of perpetual youth. No one would begrudge the aged a chance to have fun or “live life to the full.” But at the same time there is something disturbing about acting like you’re twenty when you’re really seventy – as if such a pretense could stave off wrinkles and heart disease, incontinence and memory loss.
In past centuries, warfare, famine, and disease decimated whole towns and cities, and sooner or later every family was touched. Babies routinely died in infancy, and sometimes their mothers were lost with them. As writer Philip Yancey has pointed out, “No one could live as if death did not exist.” Nowadays, thanks to modern medicine, improved nutrition, public sanitation, and greater life expectancy, death no longer seems such an unavoidable reality. And when we can’t avoid it, we try to hide it. To quote Yancey again, “Health clubs are a booming industry, as are nutrition and health food stores. We treat physical health like a religion. Meanwhile we wall off death’s blunt reminders – mortuaries, intensive care units, cemeteries.”
By maintaining such taboos, we have largely removed death from our day-to-day experience. But there is a flip side: we have also lost the ability to accept the end of life when it does finally come. I do not mean that we should belittle a dying person’s fears by coaxing him to accept death as a friend, as some experts do. There is good reason to view death as an enemy, which is the way the Bible describes it. Like the writer of the Psalms, who begs for God’s hand to steady him as he goes through the “valley of the shadow of death,” most people do not look forward to dying, but are apprehensive about it. Even my uncle Herman, though he died confidently, struggled to get to that point and admitted his fear that it would be like entering a long, dark tunnel.
Much has been written on how to comfort the terminally ill, but it should be remembered that each individual has unique needs and desires. One person will be talkative and nervous, the next quiet and sullen, the next completely distraught. One will be depressed, another will try to bargain with God, still another will be calm. These are all normal responses, and none of them is right or wrong. After all, dying is a complex process and involves the entire tangled spectrum of human emotions – dread, anxiety and exhaustion; hope and relief. And these feelings affect not only the dying, but those around him too.
It is important to consider a dying person’s surroundings. A hospital may be best for recovering from surgery, but it is hardly the ideal place to die. For one thing, it cannot possibly match the familiarity and comfort of a home; for another, visiting hours do not allow for the spontaneous coming and going of close friends and family members.
The choice between home and hospital is sometimes excruciatingly difficult. One person will find the environment of a hi-tech intensive care unit reassuring; for another, the maze of wires and IV lines and the constant bleeping of electronic monitors is so disruptive that it prevents sleep. Either way, it is vital to try to discern a dying person’s wishes and to communicate them to the attending physician, even if they go against our own gut feelings, and even at the risk of being misunderstood. Medical technology has made great advances in recent years, but beyond a certain point it may prolong dying, instead of extending life. The line between the two is often very fine.
Naturally, a private setting is no guarantee of a peaceful death. When adult children who have not lived together for years gather at the home of a dying parent, they just as often clash as harmonize. And when wills and inheritances are involved, even carefully hidden tensions may explode into the open. All the more it is important that when we enter the room of someone who is near death, we are aware of his need for peace, and respect it. It cannot be said strongly enough: a deathbed is no place to bring up old grievances. Nor is it the place to belatedly press for reconciliation.
It is different if the dying person feels the need to resolve something, or if we can set something right by offering a simple apology. According to hospice nurse Maggie Callanan, co-author of the book Final Gifts, the emotional needs of the dying are often more painful than their physical ailments, and the failure to address them can leave them so unsettled that they feel unable to die. Remembering a dying Vietnam vet she once helped, she writes:
One day I received an urgent call from the nurse on duty.
“Please get here fast,” she said. “Everything seemed to be going okay, but now Gus is very confused and anxious, and we’re losing it.”
“No, I bet we’re finally getting it,” I thought to myself. I had wondered how long Gus would be able to keep up the tough-guy façade. I felt there must be times he felt frightened – even if he wouldn’t talk about it, or allow his fear to show.
The scene was chaotic. Gus was crying out in anguish; his speech was so disjointed it was hard to make any sense of it. But in his confused language were the words “villages,” “babies,” “napalm,” “burning” – and the tragic words “I did it, I did it!”
Eventually, Gus’s caregivers figured out that he wanted to see a chaplain – a request they were happy to meet. Shortly afterward, Gus died, relieved at having been able to unburden himself to a local priest.
Sometimes the distress of the dying is rooted in the worry that no one knows what they are going through –or that they are about to go. This fear may be present even in people who are surrounded by a large circle of friends or family members. To quote Final Gifts once more:
Many dying people are lonely, not only because people don’t visit, but also because of what happens when people do visit. Visitors may spend their time with the person wrapped up in idle talk about the weather, sports, or politics. Perhaps because, consciously or unconsciously, it’s intended to do so, their chatter keeps the dying person from being able to speak intimately. A dying person’s world shrinks, narrowing to a few important relationships and the progress of his illness. When dying people aren’t allowed to talk about what’s happening to them, they become lonely, even amid loving, concerned people. They may feel isolated and abandoned, and in turn become resentful and angry.
Small talk and humor have a place alongside prayers, of course; there is nothing more oppressive than unnatural holiness. But far more significant than words are simple deeds of love: a cloth offered to cool a burning forehead, a hand reached out to steady a shaking shoulder, ointment to moisten dry lips. Though modest, such acts of kindness are all most people want or need at the end. Helen Prejean, a nun who has accompanied prison inmates to their deaths, notes that even when there is nothing you can do, you can still ensure that at least one face he sees as he goes will be comforting him with eyes of love.
Unfortunately, the dying often take their last breaths alone. Sometimes a person appears to be slipping away, but hangs on for weeks or months. In other cases, a person may seem to be on the mend, only to surprise everyone by dying suddenly. Interestingly, hospice workers have found that when a person is worried that his death might distress loved ones, he may try to spare them by waiting until he is alone, and only then breathing his last.
On the day that Rob, a friend, died a few years ago, he called his wife and children to his room, told them each how much he loved them, and wished them well for the future. Hours later he was gone. Brad, another friend, was unable to say goodbye. When he fell ill, his children (all adults) traveled long distances to see him one more time. One of them always remained at his bedside, ready to call the others at a moment’s notice. When the end came, however, it came so quickly that most of his children were not in the house. All were deeply disappointed, and some even felt guilty.
In trying to help this family through their grief, I reassured them that whether or not we are there, no one is truly alone at the hour of death. On the contrary, I believe that the dying are always in God’s hands.
Recalling the last night he spent with a patient who died of cancer, a doctor I know wrote in his journal:
Although intermittently confused, Mark made several lucid comments between labored breaths. At one point he said something about “going” somewhere, and I replied, “Yes, you can go, Jesus will take you!”
“But it’s so hard!” he responded.
I said, “Don’t cling to us. Cling to God!”
“I’m trying,” he said, “but I don’t know what to do next. It’s so unfamiliar!”
“Yes, but you are going before us,” his mother said. “And then you can tell us how to get there.”
Later Mark asked his father to read something from the Bible, which he did. Just as he was finishing Romans 8, Mark said, “Maybe Jesus will come!” Several of us responded, “He will come!”
Later he said quite loudly, “Can’t wait much longer!”
Over the next half hour, Mark’s breathing became more labored, though every few minutes he would say something. Sometimes it was just one word; sometimes a whole sentence, but hurriedly spoken between gasps, and hard to understand. His eyes were open, but he didn’t seem to see us any more: “This is a great struggle…You don’t know how tired I am! Pathetic…Don’t focus on…but on the spiritual.” And later: “Gotta go…Jesus…Amazing! Very real…”
After a pause, he added “I feel real bad, but I can’t do anything about it now.” We assured him that whatever he regretted, he was forgiven; that God would take him; and that it would be very soon. Mark then asked for water, and said, “Gonna go very shortly…One of my best days…”
About an hour and a half later, he took his last breath.
As Mark’s story shows, dying is a mystery before which we can do little but stand in awe. If someone is fighting for life, we can uphold him and fight with him; if he seems ready to die, we can assure him that we understand, and release him. Beyond that, however, we must get out of the way. I say this because ultimately, nothing is so crucial at the bed of a dying person than an atmosphere of peace. And as long as we focus on ourselves and our attempts to ease his pain, we risk disrupting and distracting him, and preventing him from finding this peace.
When life draws to a close, everything – no matter how important it once seemed to be – falls away. And when it is gone, nothing matters but the state of the soul. We cannot look into a person’s heart; nor is it our place to worry about how he stands before God. But in opening our eyes and ears to what he is going through, we can share his suffering by letting it become ours, and we can pray that he finds mercy and grace. Finally, we must let the dying go, trusting, as Henri Nouwen puts it, “that death does not have the last word. We can look at them…and give them hope; we can hold their bodies in our arms. And we can trust that mightier arms than ours will receive them and give them the peace and joy they desire.”