My friend Tom passed away last night, peacefully, with his wife Joyce holding his hand. He had been unconscious to the world for several days. Thankfully, the skilled helpers at hospice were able to make him comfortable and ease the distress that is natural in this final great transition.
Coincidentally, I just read a wonderful essay in The New Yorker by Atul Gawande, a doctor who often writes on medical issues. This essay has to do with how we die, and how we cope with death through the heroic interventions of modern medicine. Since many of the deaths I’ve witnessed in recent years have been hospice deaths, I’ve come to think (naively) that everyone is aware of hospice as an alternative way to leave this life. In Gawande’s perspective, however, even very experienced medical personnel may have only a cursory awareness of hospice, and they are often very uncomfortable “giving up the fight,” even in cases where they know the patient has almost no chance of recovery. Doctors don’t, Gawande says, usually talk frankly to their patients and their patients’ family about what is really going on. They mostly offer one heroic intervention after another, knowing that the chances of success grow diminishingly small. The result is that people end their lives in drugged states, in cramped ICUs, with tubes in every orifice of their bodies. They don’t get much chance to say good-bye. Nobody is at peace.
It’s a complex subject, and there are many reasons why people persist to the end taking heroic measures. I think, however, that often people do so because they are not able to face death. Gawande suggests that the medical establishment is complicit in this denial, perhaps because the doctors themselves are not able to face death.
Most people, when asked how they hope to die, say they want to go without warning in their sleep. In medieval times, however, that was regarded as the worst way to die–unprepared spiritually, without time to repent and reconcile and make charitable contributions, without time to say good-bye. That is the course I want to follow. Every one of us is going to die someday, and we cannot control the hour of our death. We often can, however, have a choice of whether we die peacefully, in our own homes, with our family and friends more prominently present than monitors and tubes.