Jack Kevorkian died several months ago, in a hospital bed, hooked to machines, suffering from chronic illness, a frequent flier in the same hospital where he died. He could have ended his life prior to going to the hospital one last time, but he did not.
On first glance, we may be tempted to infer that his choices at the end of his life call into question the validity of his life-long crusade for the right to die. Maybe. Or maybe his choice gives us a glimpse of how knowing and following what we believe about life, and hence about death, is far more complicated than a checked box on an Advanced Directives document.
In my more than 10 years of serving in hospice I have known only one patient to actively end his life. By gun. Was his home, like most of our hospice patient's as well as our own, full of medicines and methods that could have killed him in a less bloody and traumatic fashion? Yes. This patient's death reminded me that although we all have the means to end our existence, most of us don't. However, most of our patients and their caregivers talk about how they would like to die. And most of us on the hospice team know that the conversation is less about death than it is about control.
We like to have control. Amen.
In hospice we use the term "self-determined life closure." Those are just fancy, psycho-social words for control.
Even our most primitive responses to challenge or conflict, the urge to fight or flight, are rooted in a desire for control. When faced with an illness, a common first response is battle. It is often our first response because healthcare professionals naturally train to be Four Star Body Generals, at least in their own minds. We gird ourselves with chemicals, pharmaceuticals, laser or knife to fight the tumor, the virus, the infection, and eventually we turn to fighting the symptoms of sources that can no longer be vanquished. We become survivors. We show our battle scars, lift our wigs, rattle our pill boxes. Like Dylan Thomas impassioned, we "do not go gentle into that good night," we "rage, rage against the dying of the light."
Yin to fight's yang is of course flight. As quickly as our hands can close into a tight fist, they can release in open submission, to cover our eyes or ears in denial. We can plan our end, imagining snifters of brandy and a library, like author Terry Pratchett, or moments of music and memory spent with loving friends, like Dudley Clendinen. And why not? What a beautiful picture of hope for a life lived fully. But we will be wise to take comfort from the hope of a full life, and not from the illusion of control.
I've been reading Thomas Lynch's "The Undertaking: Life Studies from the Dismal Trade." As a poet and an undertaker, he reflects on the art and ministry of embalming, graves and death in general. Early in the preface to the book, he paints a picture of how the baby boomers will face aging and death, which offers a humorous and pointed statement about the limits of control.
"My generation, those boomers ... we age with the grace of polar bears on roller skates. Wary of being caught unawares, we planned our parenthood, committed to trial marriages with pre-nuptials, and pre-arranged our parents' funerals -- convinced we could pre-feel the feelings that we have heard attend new life, true love, and death. And for all our planning, for all our micro-management, for all our yammering about our parents' mistakes, we abort more, divorce more, and soon will kevork, more than any twenty generations on the globe before us."
Yes, Lynch turns Kevorkian's name into a verb, and he is right. In the next 20 years, I imagine we will witness the options for end of life choice and control expand for those facing chronic or terminal illness, chronic or terminal pain, chronic or terminal malaise and meaninglessness, even chronic or terminal boredom. We all have a right to personal agency, just choosing honestly and choosing wisely may not be the same thing.
"The king put Daniel in the lion's den,
the lion's den, oh the lion's den...
He thought Daniel'd be crying,
Because he'd be afraid of dying,
On account of that lion,
But the king, instead, he heard him sing...
Here kitty, kitty, kitty, kitty, kitty...
Won't you come, kitty, kitty, kitty, kitty
I am not afraid, no, I am not afraid,
Here kitty, kitty, kitty, kitty...
Won't you come kitty, kitty, kitty...
The Lord is with me, and the Lord is with you..."
At some point, a diagnosis or deed will place us in the lion's den. As we face the complex mystery of death in the midst of life, whether we choose to fight or flight or something in between, I pray that we know no fear. The Lord is with you, and, as hard as it can be to believe, the Lord is with the lion too.
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