What Was Life Like Before? (Death and Terminal Illness Aren’t the Only Things We Deny)

In the television program Virgin River, Melinda Monroe (“Mel”) has left her Nurse Practitioner position in Los Angeles and moved into the wilds of California’s Northstate (very like the communities I served for over two decades). Mel’s decision follows the death of her husband Mark, and others around her and in his family especially demonstrate the kinds of behaviors chaplains, counselors, social workers, and other hospice staff members refer to kindly as “family dynamics.”

 But in the midst of varying layers of drama, at one point she’s questioned about her perspective on their marriage and its challenges. Wanting Mel to return "the family's" wedding ring, her sister-in-law asks, “If Mark were still alive, do you think you’d be still married?"

 True, those around the bereaved can often be horribly insensitive. But this scene (in Episode 5 of Season 2) reminds me, too, of how often our patients’ loved ones fall prey to pretending that everything in the patient’s relationships were uncomplicated by conflict, or that somehow being gravely ill results in some new sense of nobility, respect, or at least stability in the life of the patient.

 As we’ve seen frequently in recent months, though, even as our patients face their impending end-of-life, they are still who they have been. We work with families where relationships have been damaged by substance abuse, abandonment, disagreements, religious conflicts, and many other factors. The questions raised by these realities sometimes needs to be asked:

 “If your loved one wasn’t dying, would you let them live with you?”

 “If your loved one wasn’t dying, would you have taken an interest in their religious beliefs?”

 “If your loved one wasn’t dying, would you have stopped the divorce proceedings?”

 “If your loved one wasn’t dying, would you…?”

You cannot resolve what you will not address. Ask the questions.

 

So Much Can Go Wrong: Tropical Fish Edition

 At San Francisco State University, our Biology professor noted that he didn’t believe in any personal deity, and so we should take his terminology with a grain of salt. “But,” he said, “there is so much that can go wrong with the human body that it’s a miracle that any of us survive until birth.” As hospice workers, we get to see a lot of what can go wrong. In eight years of law enforcement chaplaincy, I think I saw most of all the other things that can go wrong.

 

To illustrate that, I looked up a list of all the things that need to go right in order to be a successful pet owner for tropical fish. According to those who admittedly want to sell you supplies and equipment related to keeping fish alive in your home, here’s the list:

 

1 – Get everything out of your household water that will kill your fish. Chlorine is just one of the many poisons that we tolerate, but that your fish will not.

2 – Don’t shock your fish with rapid temperature changes.

3 – Don’t shock your fish with sudden changes in their aquarium.

4 – Maintain a consistently proper pH and other chemical levels.

5 – Maintain a consistently proper temperature in the aquarium.

6 – Change 25% of the water monthly, without messing up any of the above.

7 – Clean the tank regularly so that all of the above are maintained without waste building up.

8 – Don’t put fish in with other fish that will kill and/or eat them.

9 – Also, don’t put fish in with other fish that they will kill and/or eat – because the uneaten remains of dead fish will violate #7 on the list.

10 – Don’t overfeed your fish, since it’s not just uneaten dead fish that will violate #7 on the list.

 

As hospice workers, we could compile a similar list for our patients, their friends and family members, caregivers and collaborators, and even our own team members. But here’s the point I’d like us to remember:

 

There is so much that can go wrong, that we will never give anyone “The Perfect Hospice Experience.” Still, providing them with hospice care is so much better than the alternatives that it wouldn’t be inaccurate to call it, if not perfect, then at least a miracle.

Living in Light of Death: Thoughts inspired by Lewis H. Lapham’s essay, “Memento Mori”

Never blame a patient, family member, friend, caregiver, or yourself for having difficulty in dropping Denial. It does serve a purpose at times. But it is pathologically reinforced by almost everything and everybody around us, all the time. Still, the mistaken belief in our own immortality is a dangerous delusion. Correcting that mistake, breaking through Denial, and awakening one another to the reality of mortality is a holy calling to which hospice workers should be among the most devoted.

 

In an essay entitled “Memento Mori” (Latin for “Remember you must die.”), Lewis H. Lapham is commenting on Woody Allen’s famous quote about death: “It’s not that I’m afraid to die, I just don’t want to be there when it happens.” Lapham writes,

 

I admire the stoic fortitude, but at the age of seventy-eight I know I won’t be skipping out on the appointment, and I notice that it gets harder to remember just why it is that I’m not afraid to die. My body routinely produces fresh and insistent signs of its mortality, and within the surrounding biosphere of the news and entertainment media it is the fear of death—24/7 in every shade of hospital white and doomsday black—that sells the pharmaceutical, political, financial, film, and food product promising to make good the wish to live forever.

 

Lapham explores some literature, and especially his experiences of how up-close and personal death can be, before making his recommendation that we turn away and pretend, that we resume our devotion to Denial. The final sentence of his essay reads, “Certain only that the cause of my death is one that I can neither foresee nor forestall, I’m content, at least for the time being, to let the sleeping dog lie.”

 

Though everyone and everything around is always telling us differently, you and I are going to die. And that knowledge can make us ever more determined to live. Unless, much as Woody Allen wants to play hooky from his death, you choose to sleep through your life.

 

The Power of Place – Thinking of Amy Grant’s “If These Walls Could Speak”

This past Sunday, I was privileged to hear some stories told, corrected, and embellished with added details from others who had been present for the events. One example will give you the tone, I believe.

My Uncle John came to the party for my dad’s 85^th birthday. John had been in the vehicle following my father as Dad drove the family’s newly purchased vehicle home, or at least in the direction of home. Downshifting to pass a truck on a two-lane highway, the rear wheels passed the front wheels and the back bumper was perfectly centered on the concrete-based steel gatepost when it cleaved the trunk neatly in two.

Other stories, though, tracked a little more consistently than the hapless Dodge described above. But not without some meandering into other lanes and events, if not entirely different topics. Be sure to listen to the stories you can while they can still be told intact. My father’s were. Intact. But with enough side-trips and stops along the way that I sometimes wondered when it would be appropriate to ask (as I’m sure I did on hundreds of childhood treks up, down, and across the state of Ohio), “Are we there yet?”

But in thinking of the influential “theres” of my childhood, I would ask, “Is anyone there yet?” No Myerses that I know of are at 610 Joycie Lane in Waynesville. I think a cousin now lives in my other grandparents’ place at 120 Washington Street in West Union. And although I feel like I went home from school to 1080 Warren Drive in Wilmington almost as often as I went to my own home, I know that it was sold after my aunt and uncle were both gone.

And, of course, it’s not just the consistency of grandparents’ and others’ homes (Where Robert Frost would tell me that, once I have to go there, they have to take me in.), but there are other powerful memories locked up in places where I slept most of my childhood nights: 374 Randolph Street in Wilmington, 416 Shade Drive in West Carrollton, and then…San Francisco. But there are so many memorable California places, we’ll save those for another time.

Where are your “theres”? And of whom could you say, “It was theirs,” and perhaps even “I was theirs.” I’m writing this as one of my weekly reflections intended for my colleagues. We work at a hospice where the founder was recently removed, and where many of us were hired by the Executive Director who started our office and, it was announced yesterday, was just removed as well. So, as we meet today, our “wheres” and “theirs” have become a little less certain. Our stories have just taken a turn. Perhaps, for some of us, it’s just a brief meandering from the main road. For some, it may seem that we’ve swapped ends and are backing toward an immovable gatepost.

Whatever course today finds you on please know, at least for now, that there are others who will one day be able to tell, correct, and embellish your story with their own perspectives. My prayer is that we will patiently consider what has been, and what is, and ask ourselves frankly, “Are we there, yet?”

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Here’s a place to find Amy Grant’s “If These Walls Could Speak.” It’s a song that’s been haunting me since Sunday: https://www.youtube.com/watch?v=vNzwQI9eSAU&list=RDvNzwQI9eSAU&start_radio=1&ab_channel=BettyAttoms

 

Rainer Maria Rilke’s “Day in Autumn” – being read amidst an even later season of life

I recently posted another meme. Above the high-tide explosion of waves against the golden-hour stones of Asilomar Beach, it reads, “Hope less. Live more.” I am at the stage in life (and, truthfully, I have been so for longer than I would care to admit) in which the list of what I once planned to accomplish, what I once imagined I would have time to accomplish, is shortened more and more by the cumulative effects of old injuries, gradual infirmities, and surprising indignities.

Although my spiritual traditions include “the sure and certain hope of the resurrection,” my life today, in the meantime, has become very different than I imagined it would be. But while I could choose to grieve and mourn past abilities passed, or seek some future restoration or renewal, I now cannot live any other day but this one. I cannot surround myself with any other group, team, or family than those now here.

This Fall-ing of life, when we recognize that some things will now always be what they are, how they are, where they are, and with whom they are—is what I think the Austrian poet Rainer Maria Rilke was getting at in his poem “Day in Autumn.” (Translated by Mary Kinzie.)

After the summer's yield, Lord, it is time

to let your shadow lengthen on the sundials

and in the pastures let the rough winds fly.

 

As for the final fruits, coax them to roundness.

Direct on them two days of warmer light

to hale them golden toward their term, and harry

the last few drops of sweetness through the wine.

 

Whoever's homeless now, will build no shelter;

who lives alone will live indefinitely so,

waking up to read a little, draft long letters,  

and, along the city's avenues,

fitfully wander, when the wild leaves loosen.

Whatever fruits, however sweet, you have yet to bear; whatever falling and fallen leaves may swirl around you already; and whatever signs and symptoms of encroaching decrepitude you find afflicting you; may you also find the courage, the tenacity, and the joy necessary to live the day you have today.

 

“…Like Lepers” – C.S. Lewis Helps Us Serve the Dying in Their Own Bereavement

In his journals following the death of his wife (published under the title A Grief Observed), C.S. Lewis recognized what we would call today a third-level loss.

The first level of loss is in many cases, of course, the lost presence of the loved one who has died. But most notice a second level of loss, in which the bereaved survivor recognizes the vacant roles in their life that were once filled by the loved one: the checkbook balancer, the birthday card buyer, the fitted-sheet folder, or simply the socially-acceptable sex partner.

Beyond those primary and secondary losses, though, even for those with whom we are very close, we miss the signs of the third level of loss—often because we ourselves are what is lost. When we lose a loved one, we lose their person and presence, their roles and responsibilities, and we lose the character of the community and companions who were previously used to relating to us as “we,” not just “I.”Here's part of what Lewis writes about that experience:

An odd byproduct of my loss is that I’m aware of being an embarrassment to everyone I meet. At work, at the club, in the street, I see people, as they approach me, trying to make up their minds whether they’ll ‘say something about it’ or not. I hate it if they do, and if they don’t. Some funk it altogether. R. has been avoiding me for a week. I like best the well brought-up young men, almost boys, who walk up to me as if I were a dentist, turn very red, get it over, and then edge away to the bar as quickly as they decently can. Perhaps the bereaved ought to be isolated in special settlements like lepers.

 

To some I’m worse than an embarrassment. I am a death’s head. Whenever I meet a happily married pair I can feel them both thinking, ‘One or other of us must some day be as he is now.’

When we’re serving the dying and bereaved…

And remember that the dying are also bereaved, having lost so much, long before they die.

When we’re serving the dying and bereaved, we have the opportunity to open ourselves to them, to be authentic, transparent, and vulnerable with them. We can ask questions to which we don’t already know the answers, and let them be authentic, transparent, and vulnerable as well. Usually, in my limited experience, it only takes taking the time to ask them, “What should I know?” and let them tell us whatever they are or are not feeling in that moment.

 

 

Some Theological Thoughts on Henley’s “Invictus”

 Invictus 

By William Ernest Henley

 

Out of the night that covers me,

      Black as the pit from pole to pole,

I thank whatever gods may be

      For my unconquerable soul.

 

In the fell clutch of circumstance

      I have not winced nor cried aloud.

Under the bludgeonings of chance

      My head is bloody, but unbowed.

 

Beyond this place of wrath and tears

      Looms but the Horror of the shade,

And yet the menace of the years

      Finds and shall find me unafraid.

 

It matters not how strait the gate,

      How charged with punishments the scroll,

I am the master of my fate,

      I am the captain of my soul.

 

 Most spiritual traditions have a way of describing two ends of a spectrum and various points in between. In my tradition, most use the terms “Free Will” and “Determinism” to label the ends of that spectrum. At one extreme, life is generally chaotic, unpredictable, and uncontrollable…with no means of ensuring any outcomes or consequences. At the other, every detail is controlled, prescribed, and…well, determined for us, with no responsibility for outcomes and consequences.

 But even at the extremes, whether one believes that everything is inevitable or that anything is impossible, and certainly anywhere in between those extremes – whether our abilities are merely an illusion or whether our impotence is merely an excuse – we each have a sense of purpose, a convergence of our passions, gifts, and experiences that define not just what we are called to do, but effects decisions that affect every facet of who we are. And that is where our lives are, and where life is—in the decisions we make and actions we take, whatever our options may be or may only seem to be.

 So, let me ask you to read that again.

 

 Invictus 

By William Ernest Henley

 

Out of the night that covers me,

      Black as the pit from pole to pole,

I thank whatever gods may be

      For my unconquerable soul.

 

In the fell clutch of circumstance

      I have not winced nor cried aloud.

Under the bludgeonings of chance

      My head is bloody, but unbowed.

 

Beyond this place of wrath and tears

      Looms but the Horror of the shade,

And yet the menace of the years

      Finds and shall find me unafraid.

 

It matters not how strait the gate,

      How charged with punishments the scroll,

I am the master of my fate,

      I am the captain of my soul.