This past fall I've had to face a lot of death. My dear friend Steve Creech is gone. My Aunt, Joan Konicki, passed away just a few weeks ago. After a battle with lung cancer, Kathy Zoeller died just a few short weeks ago. Just yesterday, we received word that Ruby Jones, a woman who lived catty-corner from us and was a member of the first church to which Lisa was appointed, died recently after a stroke, at the age of 91. Her passing marked the end of an era of sorts in the little town of Jarratt, VA, and there are few who remain from that once wonderful, confounding congregation with which we shared five years of our lives, including the birth of our first child.
I have faced death in different ways in my life, from my childhood loss of my paternal grandfather - my first real encounter with death - to the suicide of my best childhood friend to the sudden, inexplicable loss of my wife's father a little over seven years ago. Now, however, I am entering the age where it will be, if not a constant companion, at least always a shadow in the background, waiting perhaps around if not the next corner, then down the street a ways. Dealing with death, with the reality of the final answer to all of life's mysteries, is never easy. Knowing it is real, knowing it sits there for all of us, yet takes us piece by piece in the deaths of those we know and love before it comes for us is hard. Of course, we are lucky because this is a nation- and culture-specific issue. Were we to live in, say, Zimbabwe (according to an article in today's Washington Post), the issue of death and dying would be far different. Were we living in Congo, the site of a war that has already brought much death and destruction to central Africa with no end in sight, we would face a whole different set of questions, issues, challenges, griefs, etc.
None of this is to say our challenges are not real, or of less urgency than others. Only to say they are different.
In any event, I was brought to mind of these issues and questions, fears and anger, in reading this article in today's Washington Post. Written by a Minnesota-based internist, Chris Bowron, the article explores one physician's frustration as he deals with issues surrounding what are now called "end of life" issues. As he points out, with interesting new medicines and technologies created to prolong life, very often doctors, nurses, and families face increasingly difficult choices as to how best to deal with and care for those who are declining toward death.
I have to admit I was first a bit off-put by the initial presentation, as well as the way Bowron framed the fundamental question - how do we, as individuals, as families, as health-care providers, as a society at large, to come to grips with burgeoning life-extending technologies, yet still coping with the fundamental reality that death comes to us all? Reading a doctor's musings on the reality that death is not the enemy, but perhaps dying, or even the prevention of death (in some though certainly not all cases), was eye-opening. Of course, for his question, I believe there is no final answer. There is no "one way" that fits all situations, and doctors and nurses, families and loved-ones all face difficult choices - despite his assertion at the end that this "choice" is largely illusory - for which we have little guidance. Even the assertion of preference - a Do Not Resuscitate Order in one case; an order to do everything possible in another, similar set of circumstances - can be meaningless in the face of loved-ones, or health-care providers in the heat of the moment (Dr. Bowron offers an example of a patient brought to his hospital from a nursing home when there existed an order that no such measures be taken; the nursing home administration probably just followed their Policies and Procedures without reference to individual preference in this case).
In The True and Only Heaven, the late historian and cultural critic Christopher Lasch offers the view of the differences between two societies - early-Victorian Britain and contemporary America - as members of each faced death. He uses the death scene of Little Nell as a template; here is a little girl, dying (as many young people did) surrounded by family and loved-ones (a not-uncommon occurrence). He makes the point that this was a ritual played out innumerable times. When a member of the family was dying, the whole family was paraded past, to see and offer one last goodbye, to be with so the final moment is not one spent alone.
We, on the other hand, keep a certain distance. Dying is done less and less at home (although that is changing) and more frequently at hospitals and nursing homes. Even if family is present, they are kept at a distance through the intrusive technologies and the insistence of doctors and nurses whose intervention is not always wanted or even needed. We attempt to shield our children from the reality of death, believing it unnecessary to expose them to this final state because "they won't understand it".
Yet, none of us understand it. Not really. Yet, is understanding really necessary? Whether we understand it or not, or even accept its inevitability or not, death awaits us all at some point. Dying can be long and drawn out, with or without technological helps. Or it can come in an instant, unexpected, stealing others from us in a blink of an eye. Whether we understand it or not, it is there. How we deal with it, how we face it as families, as health-care providers, as supportive loved-ones and friends, comes down, I think, in the end, to our ability to stare the abyss in the face, allow it to stare back at us, and not fall in to it ourselves.
