Holy Dying: Stories and Struggles

CHAPTER 1

Harder Days

They did not ask, Where is the LORD, who brought us up out of Egypt and led us through the barren wilderness, through a land of deserts and ravines, a land of drought and utter darkness, a land where no one travels and no one lives?

—JEREMIAH 2:6

Several years into what I thought would be a lifetime career as a rural family physician, I came to believe that much of what was brought into my homey solo practice and laid into my lap over the years was a kind of suffering for which I did not have a ready balm. There was physical illness to be managed to be sure, and I tried to offer advice and guidance to help my patients stay as healthy as possible in the face of burdensome illness. Most of my energy, however, was consumed by trying to care for problems of a more challenging sort. The joyful office days were filled with well babies, routine check-ups, medication refill visits, mild contagious diseases that got better, and good catch-up conversations usually about hunting, fishing, upcoming holidays, or grandchildren. The harder days were marked by a pervasive sense of brokenness: patients who could not manage to take their medications, check their blood sugars, get any sleep, leave abusive relationships, stop smoking, or even attempt to exercise. Their chronic conditions provided the diagnosis code for their visits, but it was the headaches, the back pain, the chronic coughing, and the indigestion that brought them in. The underbelly of the presenting symptoms was lined with grief, sorrow, loneliness, depression, marital and family discord and dysfunction, alcohol or drug addiction, troubled children or grandchildren, difficulty on the job or unemployment and financial distress, or just the mounting weight of being overwhelmed with life as they knew it.

I could offer a medical test, a prescription, a referral to a medical specialist or a counselor, and a sympathetic ear—mostly they came in to be listened to. I began to see that all my sincere offers of insight, context, and perspective fell short of the mark, and that I was not really able to help in any fundamental way; I could not make them better. Opportunities to explore root causes of psychosocial distress were generally declined in favor of a search for root causes of physical illness, so instead of being able to offer healing, I offered blood tests, CAT scans, prescriptions, and referrals. The search for a real diagnosis, the identification of the precise place where the body had failed, became the focus of attention. With due diligence I used all my powers of knowledge and experience to find a disease, to give it a name, and to access every means, therapeutic, pharmacologic, or technologic, to eliminate it. Still, most of the time, I could not make them better, if better meant wholeness of body, mind, and spirit.

And then, some of them got really sick. Sometimes it was that chronic condition suffering for lack of attention that got away from them. The high blood pressure became the heart failure became the kidney failure or stroke. Sometimes it was the unexpected out of the blue rare disease—usually cancer—that rocked their worlds in that I never thought it would happen to me way. The nature of the threat would call for a specialist; I would refer the patient, and then be relegated to the side wings of the stage while a stronger magic was sought for and delivered by experts whose authority and credibility increased with the geographical distance from my small town. Patients whom I had considered mine, in my small primary care practice, belonged for a time to the specialist(s), and while they suffered every effort to prolong their lives threatened by terminal disease, I waited for them to come home.

Usually they did come home, and some of them taught me something remarkable about dying that I had never learned in medical school or training. When all medicines and treatments had run their course and were exhausted, when patients were often the most uncomfortable, the most weak, the most anxious, and the least able to maintain their defenses, an unbidden grace would surface, creating openings in their lives and relationships, making room for repentance and forgiveness, and for healing— even as their bodies were failing.

Where did that grace come from, and what was it about the project of facing death that called it forth? Which people paid attention to that grace and which ones denied and declined it? What was it that allowed some people facing their final weeks and days to finally see what was important in their lives and to attend to their unfinished business? What kept others from this path that seemed to lead to a spiritual peace in the setting of a failing body? What was I missing in all my efforts to doctor my patients? I wanted to harness this healing power and offer it to everyone who was struggling, as if I could write prescriptions for grace, repentance, or forgiveness.

My identity as a physician slowly evolved through the many stories in my career from one of director of the production, as I believed myself trained to be, to one of witness and companion to those who suffered. I suppose this shift in identity smoothed the way to the eventual transition from doctor to priest. At first this was uncomfortable, and encompassed an acknowledgement of failure to really fix things, for I was long and dutifully and expensively educated for many years of my life to do just that— fix things. Over time and experience, especially with dying patients, I saw that fixing role begin to unravel; I stepped back for a wider view, and began to un-learn what I thought I knew about healing.

One of my earliest teachers was Robert; he was my first-ever hospice patient. A transplant to the Deep South, a child-follower who after retirement moved from Chicago to live with his daughter and the sweet Southern boy she married. Robert was intelligent and feisty, thin and polished and a fish out of water, but the family bond was strong and Robert’s daughter and son-in-law brought him into their home.

Robert had a delightful talent with skills he had honed over years of his life. He created tiny panoramas inside eggshells— whole miniature worlds inside eggs of all sizes from every imaginable species of bird or fowl that had laid them. Every one I saw was an exquisite work of unimaginable patience and skill; some of them even included tiny artificial lights inside the finished tableaus, running off of tiny batteries. These were no seasonal bunny cutouts in sugared shells; these were works of art and craft like I have never seen since, except in a museum.

Robert had enjoyed his retirement and practicing his art in his daughter’s home, which had been remodeled to provide a studio filled with stacks of tiny drawers filled with the miniscule objects he placed inside the eggs and around the edges of their openings. He was a gracious person and was generous in showing off his treasures and works-in-progress. He had been blessed with good health and had stayed active and trim for much of his life, most of which was spent working in automobile manufacturing plants in Michigan. When he began to develop symptoms that lead to a diagnosis of a stage IV cancer with a prognosis of less than six months, I would have expected one so committed to the smallest details of his art to have researched and attacked his cancer with the same diligence. I would have expected him to find a specialist to guide his pilgrimage towards healing himself of this intrusive and objectionable interruption in his life, just when he was beginning to really enjoy retirement and make new friends.

Robert did approach his cancer with attention to details, but without the shock and subsequent emotional desperation that was familiar to me. He kept himself aware of his disease progression, was particular about his symptom management, and would only accept disease-directed treatment that had great odds of helping him, and small odds of making him miserable; he said yes to radiation, and no to chemotherapy, which in his case had little chance of offering him extended time with the quality of life that he wanted. Instead, Robert concentrated on who and what he loved and conserved his energy for his art. He got his affairs in order, talked openly about dying, and became a pioneer patient in a small south Georgia town for a new medical service called hospice. He went about bringing to life those ideas still in his imagination—unfinished work in eggshells of every size and shade of ivory that sat still in their pristine forms, like blank canvases cushioned in straw. He worked in his studio every day, until he was too weak from his illness to sit up for long. When he began the dying phase of his illness, he was calm, at peace, and full of gratitude for his life.

I do not remember Robert using language that was particularly religious; I doubt if he ever used the word healing, and yet he saw his life as part of a greater context in which he was only a part, and not the central fulcrum. I do not remember any stories he might have told about his life before I knew him, though I am sure he carried as many stories as most of us. He did look forward to reuniting after his death with people he had loved who had died before him—his wife, and a brother. I do remember that he did not seem to be afraid of dying, something that was rare at that time in my professional life and experience.

Robert, and many who came after him, taught me that healing was not something I was to conjure up and present to my patients, but something that comes from within each person. Healing is not rendered in the pursuit of the diagnosis, or the treatment of it, as my doctor brain had been trained to believe. Healing comes from the heart of one who is open to believing in something greater than self, one who sees the cycle of human life as part of a greater whole, one who believes in a God who is merciful and gracious, slow to anger, and abounding in steadfast love and faithfulness (Exodus 34:6). As I have grown in my understanding and authenticity to speak of spiritual matters, I have come to believe that healing is the breath of God that falls on each of us, just as the sun and the rain. It is a mercy that is not wanton or wasteful, but waits for each of us to recognize its presence when we need it most, on those harder days when hopelessness and brokenness seem to be the order of the day. This healing is that thing we are all looking for and do not know it. It is that thing that makes the difference—not between living and dying, but between dying in stress and anxiety and dying in peace.

How can we recognize healing in ourselves and in others? Is healing something that we can promote or just recognize and accept? Does it require specific requests in prayer? How can we embrace an understanding of healing that is deeper and more powerful than just restoration to a life without illness or brokenness?

CHAPTER 2

Take Me Home to Die

The sparrow has found her a house

and the swallow a nest where she may lay her young;

by the side of your altars, O LORD of hosts,

my King and my God.

—PSALM 84:2 BCP

Much of the life of a small town doctor is like any other life: a balance of home and work, schedules and schedule adjustments, routine and crisis, frustrations and satisfactions, and relationships, both professional and personal, most of which are connected to other relationships. In my solo family practice the wonderful people who ran my office knew everyone in our town, who they were married to or related to, and sometimes who they used to be married to, and this gave me not only a needed heads-up with my own patients, but a deeper appreciation for how complexly woven any one life could be. It was my great joy to care for newborn infants and great grandmothers, siblings in preschool and siblings who were grandparents themselves. Family was a concept that extended far into the community, encompassing partners, neighbors, long time coworkers, church members, in-laws from long-dissolved marriages, and assorted indefinable relationships—from the previously estranged offspring to the long-term paid household helper evolving into compassionate