Accepting Death

Ken Murray has a good article in Saturday’s Wall Street Journal about how doctors die. Excerpts:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.

Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made “arrangements,” as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

An Honest Look at Dying, Death and Life

Professor William Stuntz died of cancer last week at age 52. He knew he was going to die for a long time. This interview is a remarkable look inside an honest Christian, his regrets over life and his impending death. The following question and answer are a poignant example:

Your life is ending sooner than you must have expected.  Are you pleased with the life you lived?

No.

I’m not displeased in the sense that I never got to see that or do this or enjoy something else.  I have almost none of those feelings.  I am utterly satisfied with my life in those terms.  I have gotten many more good things than I could deserve in any conceivable way.  I have been incredibly more blessed, along multiple dimensions, than I would have imagined when I was young.  In that sense, I am perfectly pleased with my life.

What I am displeased with is my own living of life.  I feel an acute sense that I ought to have done better with the circumstances I was given.  This is one of the reasons why it cut me so deeply when people suggested that suffering is God’s discipline — because I find it so very, very easy to believe in a God who is profoundly disappointed in me.

It seems utterly natural to believe in the Disappointed God, because I myself am disappointed.  He must be even more disappointed, I think, because his standards are so much higher than mine.  How could he not be disappointed?  That makes complete sense to me.

It’s the other God, the God who does not experience that kind of disappointment, the God who sees me the way that Prodigal Son’s father saw him — that is the harder God for me to believe in.  It takes work for me to believe in that God.

Respect for the Dead

The Catechism of the Catholic Church is a masterful document – I wish we Anglicans had something like it. Due to my Mom’s death, I read what it says about the treatment of the dead:

The dying should be given attention and care to help them live their last moments in dignity and peace. They will be helped by the prayer of their relatives, who must see to it that the sick receive at the proper time the sacraments that prepare them to meet the living God.
The bodies of the dead must be treated with respect and charity, in faith and hope of the Resurrection. The burial of the dead is a corporal work of mercy; it honors the children of God, who are temples of the Holy Spirit.
Autopsies can be morally permitted for legal inquests or scientific research. The free gift of organs after death is legitimate and can be meritorious.
The Church permits cremation, provided that it does not demonstrate a denial of faith in the resurrection of the body.

I love how the Catechism deals with just about everything you can think of in life. I don’t like autopsies, giving organs or cremation, but the Catholic approach does seem sensible to me. And it must be comforting to know that there are answers to these things rather than simply making up an answer.

Outside the Catechism, canon law states:

ECCLESIASTICAL FUNERALS (Cann. 1176 – 1185)
§3. The Church earnestly recommends that the pious custom of burying the bodies of the deceased be observed; nevertheless, the Church does not prohibit cremation unless it was chosen for reasons contrary to Christian doctrine.

Thoughts on Death

One thing that strikes me in thinking about death is that when someone dies, their way of ordering the world is gone. There is something about the things that they touched, wrote, painted and so on that we are inclined to preserve. I was looking at some cards from my Mom that were fairly insignificant, but now they mean a lot to me because that’s her writing on the paper. Her thoughts are expressed and they are now inaccessible to me going forward.

What I mean by ordering the world is the way that we keep our things. Mom placed articles and books in certain places in her house. Everything in the house was a certain way. Clothes were here, pictures there. Boxes were put in this closet, the old high chair in that one, etc. You might cut your grass and trim your hedge a certain way. These are very tedious and in some sense, minor details, but as soon as you die or are struck ill, they begin to evaporate and vanish from the world as if you had never been. This is probably one reason behind why some people keep rooms exactly as the deceased left them and refuse to alter them. Altering the room would break apart some of the last remaining traces of the dead person’s affect on the world. Taking this further, it is easy to see some of the motivations behind preserving the relics of saints in the form of pieces of clothing, bone, teeth, hair and so on. I’m certainly not agreeing with that practice, just seeing a possible origin for it.

As soon as you die, the way you kept your house and trimmed your hedge begins to fade. Someone else may be left living in it and decide to change things to the way they want it. Or it might be sold to someone entirely different and all traces of you living there will be gone. For those in nursing homes this uncaring process starts earlier. The world does not care about you or I and it will keep right on turning without us.

But traces of us (and our ancestors) linger on if our own children do things the way we did them. Perhaps they organize their things in similar ways to us, make the same recipes or like the same authors. A hundred little things pass from generation to generation, most of them unconscious and hidden in plain sight.

The urge to preserve something of who we were is a primary motivation for writers of history and seekers of glory who want to emblazon their memory onto the wax of history. Unfortunately for many of them, the vast bulk of people couldn’t care less for what happened five days ago, much less five centuries or millenia ago. Anna Comnena admirably summarizes the urge of the historian to preserve:

The stream of Time, irresistible, ever moving, carries off and bears away all things that come to birth and plunges them into utter darkness, both deeds of no account and deeds which are mighty and worthy of commemoration; as the playwright says, it ‘brings to light that which was unseen and shrouds from us that which was manifest’. Nevertheless, the science of History is a great bulwark against this stream of Time; in a way it checks this irresistible flood, it holds in a tight grasp whatever it can seize floating on the surface and will not allow it to slip away into the depths of Oblivion.

I think this is also the motivation of the family historian, researching genealogy. It is often a lonely task and you wonder why you are doing it. But that is why: to try to preserve some slim reed of what was against the overwhelming tide of time which sweeps on ahead.

The ultimate hope for the Christian is that these small things which make up the essence of who we are will be continued in the future age. Perhaps when we are resurrected our way of doing things, perfected and renewed, will be carried on in the new heavens and new earth. When I walk into wherever my resurrected Mom “lives” – if such a concept makes sense then [and I think it will] – it will be recognizably her space as her way of doing things will be obvious to me. At least, that’s my theory.

Books on Death

Since my Mom died, the subject of death interests me in more than an academic fashion. I have pulled out some books on death, grief and the afterlife that I plan to read or skim in order to solidify in my mind what is going on. One thing that is key to remember in this situation is that my Mom is now experiencing life after death but that it isn’t the goal or the end of the story. The final act is what N.T. Wright calls life after life after death – the resurrection of the dead. That can get lost in all our talk about heaven. Our future isn’t a disembodied state in the clouds. It’s in our body, perfected and raised, in a new heavens and new earth. Mom was buried (as I believe all bodies still are) with her feet facing east. Why? Because Jesus comes from the east and when we are raised, the presumption is that we will face his glorious appearance.

So, the books I am looking at so far are:

1. C.S. Lewis, A Grief Observed

2. N.T. Wright, The Resurrection of the Son of God

3. Philippe Aries, The Hour of Our Death

If I can, I’ll share some things I find interesting out of reading these texts. Hopefully they will help me deal with my Mom’s death. As great as the Christian hope is during the death of a loved one, the inability to communicate with that person over the gulf of death is (I think) one of the cruelest parts about death. I am thankful for the example of Jesus, who wept at the death of Lazarus, and for the fact that the Bible calls death an enemy, although a defeated one. We don’t have to be pie in the sky, happy at the time of death. I’m not in favor of trying to “celebrate” at death. I want a grim funeral with the 1928 Book of Common Prayer liturgy when I die. Ashes to ashes, dust to dust. Yes, we have hope. Yes, the future will be glorious. But yes, the pain is real and the loneliness in the midst of a world that keeps turning and doesn’t care that you are here today and gone tomorrow is real. It all has to be worked through somehow.