A young man is dying. It is clear to everyone that he is dying. However, his family wants just one more test done...
To what end does testing make a difference when someone is dying? How far and how much money do we spend to "confirm" that someone is dying? How much do we think it is appropriate to put a patient through in order for a family to receive confirmation that their loved one is dying? How uncomfortable do we allow the patient to be in order for the family to have "proof" of an impending death? Is a simple needle stick and blood withdrawal appropriate? How about a CAT Scan or EEG or EKG or X-ray that requires that the patient be physically moved in some way when their body is shutting down as they are dying?
Why do we need confirmations that someone is dying when their disease trajectory is clear that death is the result of their disease? And, as human beings, we are going to die at some point anyway, so why do we need to run more tests for confirmation that the person IS dying? Can we be honest with ourselves and our loved ones that we will, one day, die? Are we prepared to have those conversations, to at least name "the horse on the dining room table?"
Dorothy Becvar, in her book, "In the Presence of Grief," includes a story written by Richard Kalish about a man going to see a famous guru, an ancient sage, to find out "what a dying person feels when no one will speak with him, nor be open enough to permit him to speak about his dying." The sage's response is, "It is the horse on the dining room table." Many years later, after the man experiences going to a dinner party where everyone saw the horse on the table but no one dared say anything about it or even acknowledge it, this man returns to the guru who says:
It is a horse that visits every house and sits on every dining-room table -- the tables of the rich and of the poor, of the simple and of the wise. This horse just sits there, but its presence makes you wish to leave without speaking of it. If you leave, you will always fear the presence of the horse. When it sits on your table, you will wish to speak of it, but you may not be able to. However, if you speak about the horse, then you will find that others can also speak about the horse -- most others, at least, if you are gentle and kind as you speak. The horse will remain on the dining room table, but you will not be so distraught. You will enjoy your repast, and ... you will enjoy the presence of your guests. You cannot make magic to have the horse disappear, but you can speak of the horse and thereby render it less powerful. [1]
Are you ready to talk about the horse on your dining room table? Are you ready to acknowledge that no matter how many tests may be done, that your loved one may be dying?
What does God expect you to do when a loved one is clearly dying: to encourage them to let go or to plead with them to "not die"?
[1] Becvar, Dorothy. In the Presence of Grief: Helping family members resolve death, dying and bereavement issues, New York: Guilford Press, 2001, 3-6.
Rev. Dr. Martha R. Jacobs: A Christian Guide to Confronting End of ...
Living wills are one way to bring that horse to the table and for everyone to see that it is not a frightening thing.
Thanks for your comment. Sounds like you have taken control of what will happen to you when your health does decline - which I hope is not for a very long time and will enable you to spend quality time with your great-grandchildren!
I appreciate your comment and think that the horse on the table can be addressed by a conversation about an advance directive like a living will or a health care proxy.
GOOD FOR YOU!!!!!!
Tonight is my night shift and I will talk to her about dying. Thanks for the impetus to do so.
Thanks so much for sharing at what is probably a very difficult time for you and your family - and your mother. You have the right to know exactly what is going on (as long as your mother says it is ok) and she (or her family members) can "request" a meeting with all of her healthcare team to discuss her care. Ask for a Palliative Care consult or a hospice referral because there is no reason that your mother should be in any pain. Pain is now considered a "vital sign" and must be treated appropriately. You all can be her advocate - and if you think you are not getting the straight answers from them, ask for the hospital administrator on duty. You have to be pro-active.
My prayers are with your mother and with you and your family.
Martha
The author really just asks if people are ready to talk about the horse and never addresses the questions raised early in the article about the young man. Never says much about the questions beyond raising them. The questions, as raised, are vague. We obviously would need more information on the circumstances of the young man.
There're two obvious extreme situations to consider. Firstly the parents insist on one more test, from which the doctors discover a misdiagnosis or something, and this young man who was inevitably going to die gets cured and lives. Doctors make mistakes, that's a very good reason to ask for one more test (and I know family members who avoided serious medical issues by asking for one more opinion). We know the other extreme, something like Terri Schiavo, where the parents at great cost and suffering try to save a young man who is effectively dead because they can't deal with his death. Obviously the answer lies somewhere at or between these two situations, the question is where and the challenge is we are uncertain where.
The horse-on-the-table sounds very much like the elephant in the room - same metaphor, different animal. Can't say I'd be scared of a horse in the room, unless it was frightened. People are scared of losing their loved ones, whether they see that as the person ceasing to exist, or whether they have other beliefs. I sometimes wonder how internalised some religous people's belief is, when they profess to believe in an afterlife yet derive no comfort from it.
I think I'd be fairly safe as far as my family goes, if I were to die soon. At least, I trust my sister not to push for me to be kept here, or subjected to tests and so on. She knows my views and my experiences. So does my mother, but she might just wobble and want more done - understandable. This is the sort of thing that calls for a living will!
I think that there is grief because we love them and miss them. It is one of those oddities of love - if you don't love then you miss out on some of the best parts of living, but if you do love, you then have to deal with the pain of separation by death. Even if we believe that our loved one is in a better place, we still miss them and are grieving for the loss of the person in our life.