Friday, March 11, 2016

Let's talk about death

I swear to God, when you were young you used to gather your cloak about you and go where you wanted to go.  But when you have grown old, you'll stretch out your arms, and someone else will get you ready and take you where you don't want to go."--John 21:18, SV

You have to imagine a goofy-looking skinny guy in a yellow raincoat with a water-proof hat on, seated, holding a duck, and looking earnestly at the camera as he says:

"Let's talk about death."

Except he says "ducks."  It's an actor portraying a character from "Greater Tuna," the play about small-town Texas that almost made a career for the two actors who wrote and acted it for many years.  The line doesn't appear in the play; it's from an ad for the play that ran so many times I remember the ad better than most of the play itself, which I saw not quite as many times as the ad.  I do remember another line from the play, an advertising slogan for the town's (the smallest town in Texas, supposedly) gun store, run by DeeDee and named for her:  "If DeeDee's can't kill it, it's immortal!"

Let's talk about death.

Interesting book review at Slate on this topic, again concerned with how we die.  The one book I've read on this topic, back in seminary, doesn't get mentioned specifically, but does point to where these conversations usually go:  nowhere.  That book, How We Die, made a splash when it appeared, gave its author some celebrity, won some notable awards, and disappeared without a trace.    Books do that.  Rare is the book that actually changes the conversation, and it is the conversation about death that The Good Death wants to prompt.  I know this because the author of that book actually responded to comments at the Slate review, which kept the comments from descending into the usual internet blather.

The "good death," as I've said before, is our new obsession.  In the mid-19th century when coma was an undefined term and hadn't yet entered the medical lexicon, much less the common vocabulary, the concern was with premature burial.  Poe didn't invent that anxiety, he exploited it.  People who were thought dead were buried alive; at least that was the story.  Suddenly every death had the potential of being, not final, but merely postponed until a date to be announced later.  When Twain quipped that the rumors of his death had been greatly exaggerated he was picking up on this still-remembered fear as much as mocking his reappearance in public life.  And then, of course, he had the good grace to die when he wanted to; when Halley's comet returned to this neck of the solar system.

Good death, indeed.

I've actually participated in one "good death," and it was good.  The father was dying (of cancer, IIRC) and hospice care was treating him at home.  As the family pastor I was there the night he died. It wasn't easy on the family, but it was easier than standing vigil in a hospital room.  He died in his own bed.

Then again, I've known people who refused to allow the funeral of their spouse in the church they'd attended together all their adult lives, because they didn't want the memories of the place tainted by seeing the loved one there in a casket.  Imagine returning to the bedroom your spouse died in, much less the bed.  How many of us could do that?

Death is a very personal thing.  A "good death" for you might be a terrible death for me.  And then there are all the societal concerns with death.   We investigate deaths in ways we don't other incidents.  This morning there is news of a traffic jam due to the investigation of an accident that involved at least one fatality.  "Steer it clear it" is the law here; you don't wait for the police to show up to restore traffic flow, and in minor accidents there's little investigation at all.  But in the case of death, care must be taken, responsibility assessed much more seriously.  Which sets up this exchange in comments at that Slate article:

Bradley WilliamsWe do need to read and digest the language of the assisted suicide Oregon model laws/bills before we expound on our positions.

They are riddled with loopholes that work together to eviscerate the flaunted safeguards.

For example how many times have you nodded your head when the proponents declared that the lethal dose must be self-administered?

Well, read the language of the law/bill and you will find that there is no means provided to insure that marketing point. For example “self-administrate” was mentioned 6 times in the 20 page Colorado HB 16-1054 and yet there was no means provided to confirm that the lethal dose was forced on not.

In fact what is provided in all the bills/laws is that there may be no investigations allowed after the death. This is a red flag to repair our public safety net.

According to their own records in OR and WA a dangerous public policy that is being established is a low bar of "medical standard of care" is poisoning for people that "fear" the loss of autonomy.

We are all at risk of abuse by these poorly composed laws/bills.

PS: What other activities in the US prohibit investigations?

Ann Neumann @Bradley Williams There are myriad dangerous substances that we regulate quite well in society. I fear that opponents of aid in dying are stuck in a look where they demand proof of wrongdoing, coercion and elder abuse and when they don't find it, they say, Look! Just because it can't be proved doesn't mean it doesn't exist. The laws are quite specific and not a case of abuse has come out of Oregon after being on the books for more than two decades.

I looked and looked for clear cases of abuse or coercion. All those who claim it exists have ideological reasons to do so. I'd love a good argument for how these laws endanger elders, who are miserable and suffering and dying. I've yet to find one.

Pamlet @Ann Neumann @Bradley Williams Well, what is concerning is more subtle cases of coercion -- the "I don't want to be a burden" people.  Or the people whose lives could be made more bearable by appropriate mental health or palliative care.  There are so many problems with the way healthcare is delivered in this country that I'd like to be absolutely sure all of that is in place before I feel there's a level playing field where people are making this decision from the best state possible.
I'm never comfortable with claims that the law prohibits something that seems to be commonsense and especially common in all other matters of death (a cause of death must be officially established, no matter how cursory the procedure for doing so), so I can't speak to the allegation that Oregon law prohibits investigations of assisted suicides.  It seems pretty dubious to me, in fact; but the final comment raises the more serious question (and Ann Neumann ducks the issue of those legal questions entirely, which was disappointing):  the "subtle cases of coercion."

Ms. Neumann has an entire conversation in the comments about how we monetize life (and we do) and how we hide that fact from ourselves.  But that's part of the problem of the "level playing field" and how we, as a society, establish that people are "making this decision from the best state possible."  For all the talk about "liberty" in the comments, choosing to die (i.e., suicide) is not an individual decision.  Society has always had an interest in the deaths of any one of its members.  It's rather absurdly libertarian to say that it doesn't.  But I can tell you, as the child of parents still living and now living in town near me, the idea that parents are a burden on their children is a real one; and it can shape the decisions parents (and children) make.

I don't mean anything dramatic by that; but the elderly can easily feel they are more burden than blessing, and while such thoughts don't always turn to suicide, they do cloud the pleasure of living  It can be a slippery slope down to "it's better for everyone if I just die now."  It also gives us some comfort that we will be in control to the very end of our days.  But often, we simply aren't.

I have been in the room when a family member was asked by the doctor whether to remove care or continue it.  That is not a simple decision, and it shouldn't be.  The fact is, just as in the case of a suicide, you live with the consequences of that decision, no matter what it is.  Death by "natural causes" is always easier to reconcile than death by assistance, or by removing machines or restraining efforts.  My parents have "DNR" orders, but someone will still ask me, when the time comes, what I want done.  I've seen people face that question, and it's never as simple a decision as you think it will be.

And until I have to answer the question, I honestly do not know what my answer will be.  Change the facts, change the outcome, and that's the problem.  We never know the facts ahead of time, and while there are cases of people being kept alive because of some hope of recovery which has actually long passed (one such incident is noted in the Salon review, citing the book), when we review such cases we are never the ones who have to live with the responsibility of turning off the machine, of letting our loved one die.

There is a reason we struggle with that; and it's a good reason.

"Good death" sounds so good; but who is it good for?  Us?  The person who is dying?  "Whose life is it, anyway?," was once the question.  But the right question is:  whose death is it?  While everyone dies alone, death is still a social activity.  It involves people other than the person dying.  "No man is an island, separate unto himself," Donne wrote; and he was right.  Every person's death involves me, especially when that person is a family member.  I've been in the room when people died, and the relief of knowing you did all you could, and their time had simply come, is palpable.  Or the comfort of knowing you let them die as they wished, in their own bed, among family, doing nothing more than alleviating what pain you could, can also be a comfort.  But change the family, change the outcome:  one size does not fit all, and circumstances can change at every moment.  "Good death" is a good idea, but you have no guarantee you'll get that.  And you have no guarantee you'll leave that for your family.

The biggest problem with death is that it is final, and we have such a problem imagining that for ourselves, even for our loved ones.  I don't talk to my parents daily, but I still can if I choose to.  I try to imagine what life will be like when they are gone, but if I'm honest with myself, I can't.   I may find it easier to accept their deaths than they found it to be for their parents, if only because I'm older now than my parents were when my grandparents died, one by one.  But am I so old I won't miss my mother and father when they are no more?

"My death, is it possible?"  Word comes today of the funeral of Nancy Reagan, which order of service she specified from the opening tune to the closing song.   It left me wondering if she specified that women wear dresses and no clogs would be allowed.   I'm honestly glad I never had to do a funeral like that; funerals were my domain, since weddings were the province of bridezillas and their mothers (it was usually the mothers).  I could do a funeral as I saw fit, maybe working in music that was requested, but even that was rare.  No doubt such direction from beyond the grave suited the family; one less things to worry about, one more memory of the dearly departed.  But if the family had decided on their own service, on doing a memorial that remembered the woman they loved, what could Nancy Reagan have done about it?

"My death, is it possible?"

Funerals are for the living, not the dead.  I even did a funeral for an atheist.  His wife was the church organist, he had wanted nothing to do with the church.  I didn't even know she was married until he died.  It was an interesting funeral because it was at the church, as she wanted.  His friends were perplexed by the ritual, the prayers, the funeral sermon.  I didn't care.  I did it for her.  He was beyond caring, but she wasn't.  I wasn't defiant; I was just calm.  It was so much easier than doing the graveside service for my beloved uncle, while I was in seminary.  He was a preacher's kid, but he'd left the church as soon as he could and never looked back.  I did it for my aunt, for my cousins I am still closest to of all the cousins (his wife was/is my mother's twin; my father was his best friend since college).  I did it for them, but it certainly wasn't for me.

Let's talk about death.

Is it a process, or a final event?  I first realized that question while teaching "The Death of Ivan Ilyich."  Is that title about the entire story, or about the final sentence?  "The Death of a Salesman" raises the same question:  the entire play, or just the last few lines of Act II, and the epilogue?   Yes; no; maybe.

Let's talk about death.

It is Lent and two weeks from today will be Good Friday.  I will not observe it.  I will be taking my mother to see her twin sister, who now lives near her children, about 2 hours away.  My aunt has dementia; Alzheimer's, senility, call it what you like, it means the same thing.  She is not as lost as Alzheimer's patients I've known, but she lives in a world of memory and fantasy now.  She is confused.  She is lost to us.  My mother is going to see her for what will probably be the last time.

We're going on Good Friday, because it's a good day to travel.  We will be observing Good Friday.  We just won't realize it.

Let's talk about death.

There is no sacrament of death in the Christian church.  Thomas Merton pointed that out, explaining that the ashes on Ash Wednesday neither started Lent (Lent begins the first Sunday of Lent, not before) nor death.  But the closest the church comes to paying attention to death anymore is during Lent.  We stare it in the face on Good Friday.  Which is why so few of us gather together at a church. We don't want to talk about death.  We don't want to share it.  We want Easter Sunday:  candles and lilies and sunrise services and hymns about life and victory.  O death, where is thy sting?  Back there, on Good Friday.  We took that day off.  We skipped over it.  We slept in so we could get up early on Sunday during daylight savings time and see the sun come up and sing a hymn to it.

Wallace  Stevens has nothing on us.  Wallace Stevens was a piker.  Wallace Stevens as a porto-New Atheist, thinking he understood something we Christians don't.  He was wrong.  We're still pagans at heart.  We'd still rather chant our boisterous devotion to the sun than visit the domain of the blood and sepulcher.  We don't like ghosts either; we don't want to linger on the porch where they might be found, the yawning hole that is indeed the grave of Jesus where he lay.  It reminds us of death, of our death.  We'd rather plan our funerals.

Let's talk about death.

"My death, is it possible?"

God grant me a good death, and if not, at least grant me the ability to find a good death on my own.

You are going home this night to your home of winter,
To your home of autumn, of spring, and of summer;
You are going home this night to your perpetual home,
To your eternal bed, to your eternal slumber.

Sleep you, sleep, and away with your sorrow,
Sleep you, sleep, and away with your sorrow,
Sleep you, sleep, and away with your sorrow,
Sleep, O beloved, in the Rock of the fold.

The shade of death lies upon your face, beloved,
But the Jesus of grace has His hand round about you;
In the nearness to the Trinity farewell to your pains,
Christ stands before you and peace is in His mind.

Sleep, O sleep in the calm of all calms.
Sleep, O sleep in the guidance of guidance,
Sleep, O sleep in the love of all loves.
Sleep, O beloved, in the Lord of life
Sleep, O beloved, in the God of life.

Let's not talk about death.  Let's just rest.  Rest is good.

1 comment:

  1. My mother's death was not easy, it was six weeks of a horror show due to her doctor not understanding that very, very old patients shouldn't be given certain benzodiazepines drugs which led to what should be a criminal stay in the hospital in which something was done to her that she spent several of her last weeks struggling to recover from. We've never been able to find out what the "hospitalist" at the hospital did to her, the records seem to be amazingly vague but they did something to her that probably led to her death.

    It was a horrible period but in the months and then years after it we've come to some rather profound understandings of what parts of it meant, some of those understandings we agree on, some we have our own interpretation of. It was a horrible, hard, but ultimately profound experience of the kind that you would never choose to go through again but which you would be better off for having gone through it. We think it was the same for her in the end. The last morning when she woke up entirely lucid for the first time in weeks, when she said she thought she'd been dreaming what happened in the weeks before was a comfort when she died early in the afternoon. She was so much better than she had been that when the visiting nurse came and she, more or less, said she was going to die the nurse checked her vital signs, including her oxygen level and said they were good, she said the oxygen level was very good. The nurse called in my mother's doctor saying she was agitated and I was on the phone with her telling her that I wouldn't give our mother any more of the benzodiazapine that she wanted to prescribe when my mother died because it was making thing worse. She died as herself instead of the terrified shadow of herself that she had been the weeks before, at home, with several of us with her.

    Those are just the outlines of an experience which was very hard, often very frightening but which, later, provided a lot of meaning that we didn't get as we were going through it. The "scientific" way of dealing with that would be to accuse us of rationalizing it or something, part of the great ideological ruse which psychology is, made by people who have no basis on which to make that accusation. They can dismiss and mock their own experience, ours doesn't belong to them, they don't know what they're talking about.