How to Go About Dying

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.

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6 Responses to “How to Go About Dying”

  1. David Graham Says:

    Atul Gawande is an excellent writer. I recommend his books “Complications” and “Better”. My impression is that the U.S. is more in denial than most countries about death, probably due to a medical system that heals so many cases that historically would have been hopeless. On the whole, I don’t think doctors do a good enough job of informing familes about death and dying of a loved one – it is important to do so in order that both patients and families can a) be prepared for the inevitable and b) not suffer unnecessarily.

  2. Paul Vander Klay Says:

    More from pre-hospital monastic hostels: “one of the most important functions of the Benedictine monastery was the preparation for death, involving sick brethren who failed to recover.” Among other things, Risse notes that “periodic visits to the sick by members continued. Some brethren remained with the dying inmate throughout the day and night, praying and reading from the Scriptures by candlelight. The point of this vigil was to ensure ‘proper passing’; nobody should be left to die alone. If death became imminent, the whole monastic community was summoned and the monks congregated around the sick on both sides of the bed alternately to pray and sing, using music to ‘unbind’ the pain and thus provide the departing with spiritual nourishment for the journey to the beyond. ”
    from http://gratefultothedead.wordpress.com/2010/08/06/medieval-monateries-in-the-history-of-hospitals/

  3. TRH Says:

    The process of death is an individual experience, both for the dying and to a much lesser significance for those attending the event. Some are no doubt less traumatic, more peaceful, than others; but in any case death—especially a lingering death— in my personal experience is neither pleasant to either experience or to attend, although admittedly I have yet to undergo the process of personally dying. It is devastating. As one exposed to institutional as well as hospice-home terminal situations of loved ones I can find faults and benefits in both approaches. The longer the dying process drags out, the more wrenching it is. Few if any die with so called dignity—look up the term—they just in anguish die. Unless you have experienced this process “up-close and personally,” speaking about it in the abstract, even in Christian terms is somewhat hollow, though certainly well intentioned. It may well be a “transition” to another life, but if it represents rebirth, it certainly appears more ugly and traumatic on the one making the journey than was his or her original arrival here on earth, in my humble opinion. I’ve come to realize that religion, hope, is for the living, not for the dead or, more sadly, the dying. After a certain point they have no time for it: They’re dying. There is, or course, always the possibility that I am wrong in my judgment about this. But I reckon it to be a very small probability.
    T R H

    • timstafford Says:

      I think what you’re saying is that death is death, no matter what institutional or family situation one meets it in. I agree. But there is a great difference in terms of one’s ability to say good-bye, to prepare spiritually, to reconcile–and there are also different experiences physically. Medicine generally aims to preserve life, almost at all costs. Palliative care does its best to make the dying process less lonely, more aware, and less agonizing.

  4. Beth Says:

    thanks Tim for your post. From my view point as a hospice social worker, I love it when hospice information/theory is “out there” for people to understand. Hospice can be so spiritually, emotionally, psychologically “life giving” to a family system. It is a beautiful thing to die well. Thanks for your reflection.

  5. Links and Notes from March 30 | Leadingchurch.com Says:

    […] the sermon doing some work on dying. Tim Stafford’s blog on dying and Grateful to Dead on the history of […]

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