Monday, March 26, 2007

March 20, 2007 - A Good Death

Today I receive an emergency call, to come to the critical-care unit of Jersey Shore University Medical Center. It’s Bill, one of the elders of our church. He’s dying.

Bill has been in “the Unit” for some weeks, being treated for complications of CLL, Chronic Lymphocytic Leukemia. He’s been in and out of hospitals for the past couple of years, but this time it’s pneumonia, and it’s not going away. His leukemia has flared up, his immune system is depressed, and it’s hard for his body to fight off the invaders. On Saturday, they put him on a ventilator, but the downward spiral continued. Earlier today, the doctor told Bill and his family there’s nothing more that medical science can do for him. He had a grim choice: stay on the ventilator and live a little longer, or remove it and let nature take its course.

Bill, who’s quite conscious and lucid, made the decision himself (thus, sparing his family a hard choice). Taking a pad of paper, he wrote, “Let’s get started.” Soon after I get there and say a prayer with Bill and a dozen or so family members, all of us holding hands around his bed, the nurse asks us to step out into the hallway for a few moments, while she and a technician remove the tubes. We return a few moments later and begin the vigil.

I’ve been in hospital rooms with dying people numerous times, but I think this is the first time the patient has ever been completely lucid as the ventilator was removed. To me, this makes the moment all the more powerful. I feel in awe of this man, who’s able to face his own death with such calm determination. Will it be so for me, when my moment comes?

The nurse increases the morphine drip, then turns off the computer monitor displaying his vital signs. She’ll keep track of the numbers from her monitor out in the nurses’ station, but here in the room the screen is blackened, except for the word, “Privacy.”

Time stands still, as it often does in such situations. The morphine beckons Bill into a merciful sleep, as his life slowly ebbs away. There’s no single moment when we can all say to each other, “There, it’s over.” Death (at least, this kind of death) is more of a process than a single pinpoint in time. It’s not as it so often is in the movies, when a too-healthy-looking actor says something profound, then falls back into the pillows. Yet, there does come a time, after the breathing has stopped, when the family members raise their heads, look up at one another and confirm, with a glance and a sigh, “Yes, he’s gone.”

We say another prayer. Hugs. Tears. First discussions about funeral plans. This is a close and loving family. They hate to be here, but at the same time there’s no other place in the world where any of them would rather be. They’re here for him. Joy and sorrow intermingle, in a sadly beautiful way. I feel it, too, because Bill was my friend. Then, the family goes off to get some well-earned rest, and I drive over to the church to conduct the monthly meeting of the Session, our governing board. It’s another one of those abrupt transitions, that are part and parcel of this peculiar job. From death to Robert’s Rules of Order in less than one hour.

It’s a somber meeting. Not so many years ago, Bill was one of the elders actively serving on the Session, and sat at this very table. He was well-known and well-loved in our church. We go through our essential business, but there’s not much joy in it.

Cancer has claimed another victim. Bill was 73, but he could otherwise have expected to live much longer. He was in excellent physical shape, having run several New York City Marathons as a younger man. He loved his wife, Jean, his children and his grandchildren. He had a lot to live for.

But, it was not to be. “Death is a mystery,” says the Church of Scotland liturgy I often use at funerals. A mystery, indeed. We can only trust that someday, in some other place very far from this one, it will seem less so.

"Listen, I will tell you a mystery! We will not all die, but we will all be changed..." (1 Corinthians 15:51)


Anonymous said...

I read your description of Bill's passing which brought me right back to my husband, Tom's last weeks. It was so difficult to watch his fight for life and see the process of dying happening anyway. He was not lucid at the end and that was the saddest part of way to finally say our goodbyes. Thank you so much for sharing this experience(and all your others), it means a lot to me

Carl said...

Thanks for saying that, Rosemarie. Those moments in the intensive-care ward, as loved ones pass from this life to the next, are profoundly moving. Such places are holy ground, even as they are places of significant sadness.

As you recall your memories of Tom's last hours, may you find healing.

Anonymous said...

We too wonder if we will face death the way that Bill has - still giving to his family even at the end by sparing them the decision of when to turn off life support.We have had this situation in our immediate family and it is a very difficult decision to make. His courage and his preparedness to go home to our GOD is truly amazing. We have been honored to share part of his life as his friends. Charlene & Harvey

Andy said...

I have CLL.

I fail to see how any death can be a good one, and specifically a death obviously caused by complications of CLL.

I suppose that the way a death is handled by those around the victim can be viewed as "Good", but this death is in fact a terrible thing, like all deaths.

Carl said...

Well, Andy, when I spoke of "a good death," I was understanding it as a relative term. One of the things my wife has learned over and over again, through her ministry as a hospice chaplain - and, which I myself have learned through less-frequent involvement with terminally-ill patients as a parish minister - is that, once it's been established that a person's death is inevitable, there are things that can be done to make it a tolerably good passage.

Dylan Thomas famously wrote,
"Do not go gentle into that good night.
Rage, rage against the dying of the light."
While we can admire the poet's dogged determination to fight on, and see it as a triumph of the human spirit, I think there are times when raging on accomplishes little.

Maybe you're right - no death is truly good. Yet, there are some deaths that are better than others. To choose the moment of one's departure, and to do it with a loving circle of family all around, is about as good as it can get.

Andy said...

Thanks for your reply.

I lived for a couple of years in Uplands, Swansea, Wales. My flat was just down the road from Dylan Thomas' house, and I had a fine view of Swansea Bay.

I love Dylan Thomas' poetry, and I thought you might like a link to the poet himself reading that poem.

I wish you a long remission, and I shall continue to rage.

Anonymous said...

I recall my mother death in 2003 as I read this post. It was similar, her breast cancer had matastecized and the was nothing left to do. She had struggled and seemed to be on a good course until just before Christmas 2002 we found that her cancer returned and gone to her liver. At the end, we did a similar vigil through the night and into the early morning February 6. Her heart was strong. I find the tears return when I read your story of your friend. It was a "good death" in that she was with us and passed quietly into the night.