FINAL GIFTS – Negotiating Life’s Ultimate Transition

Charlotte’s sister had been contending with cancer for some time. Sally and I would ask about her whenever we ran into Charlotte in the neighborhood. After several of those updates—reports of points made and lost—we learned that, after all, she’d lost the argument.

Soon after Charlotte returned from the funeral in Michigan, she gave us a book called Final Gifts. She explained that a friend had given it to her, and that it had helped her and her family get through those last painful months. The book was a blessing, she said, one she wanted to pay forward.

Final Gifts was written by Maggie Callanan and Patricia Kelley, two veteran hospice nurses who not only care for the medical and emotional needs of patients who are dying, but help them and their families understand and grow from the end-of-life experience.

What makes this so relevant to the theme of One Man’s Wonder is that these wishes often aren’t immediately apparent on the surface.

NEARING-DEATH AWARENESS
A Kirkus review of the book says, “The ‘final gifts’ of the title are the comfort and enlightenment offered by the dying to those attending them, and in return, the peace and reassurance offered to the dying by those who hear their needs.”

In one example after another, the authors describe how the fear and grief associated with death are buffered by the dying person’s deep-seated need to reconcile relationships, settle accounts, spare loved ones’ feelings and leave a meaningful legacy.

What makes this so relevant to the theme of One Man’s Wonder is that these wishes often aren’t immediately apparent on the surface. Understanding them involves curiosity and open-mindedness.

Instead of using conventional words or actions, a dying person, especially when they’ve entered the stage the authors call “Nearing Death Awareness,” may describe what they’re going through or ask for things they need using apparently inane symbolism.

THRESHOLD OF FOREVER
A reference to a map or packing a suitcase, for example, might indicate the patient’s fear of the unknown or of not being prepared for death. Talk of a balance sheet or I.O.U. might represent scores to settle or amends to be made. Or the mention of having received an invitation might signal the patient’s peaceful acceptance of death.

In all their cases, Kelley and Callanan help families of the dying to do emotionally and spiritually what many of us already know how to do with our physical sensing: to appreciate the wonder of life, discover new ways of looking and seeing, give voice to deeply-held faith and, ultimately, to embrace the unfathomable.

Like all of Nature, death has more to teach us when we appreciate its many layers. For one dying person it might be the opportunity for caretakers and loved ones to look under the surface of spoken words to discover his or her ultimate needs.

It might compel another patient to reach back through layers of time, asking someone long estranged to come back and share the letting go of resentment, hurt or blame—often for a disagreement whose reasons have long since been forgotten. In many cases, patients are able to hold on just long enough to reconcile with that person before passing away.

Suddenly, he sat bolt upright in his bed, his gaze fixed on a point somewhere
well beyond the upper corner of the room.

WELCOME TO HEAVEN
Sometimes the end of life even enables a dying person to reach across death’s threshold and sense the welcoming spirits of previously-departed loved ones.

Sally and I had no way of knowing how soon the things we learned from reading Final Gifts would apply to our own lives. But within months after Sally finished the book, her friend, Mary, after decades living with recurring cancer, finally was succumbing.

One evening near the end, Sally was sitting with her. Mary’s eyes seemed to drift away from Sally to something in the empty corner of her bedroom. “Who are they?” Mary asked.

Sally admitted later that her normal reaction would have been to try talking Mary out of her “confusion.” But, having read about this behavior in the book, she was able to embrace Mary’s experience and help her make sense of it. “Tell me more about them,” she prompted.

That simple acknowledgment helped Mary realize that the figures were those of her long-departed sister and uncle, and that joining them might not be as fearful as she’d imagined.

THE RAPTURE
Those who experience Nearing Death Awareness often talk about seeing an indescribably beautiful place, one that moves them to wonder and awe. When my dad was dying (at the age of 91), we knew death was imminent. After being knocked to the floor several times by jolts from his defibrillator, he’d decided to have it turned off.

The doctor advised us he’d almost surely die within a couple of days. My brother, Dan, and I decided to keep vigil with him for whatever time remained. We let him know of our sadness and our hope that he’d change his mind. Ultimately, all we could do was to support him, talk with him, advocate for him, and make sure he was comfortable.

It was my shift. Dad was in deep sleep, his breathing so thin that I feared each time his chest rose and fell might be the last. Suddenly, he sat bolt upright in his bed, his eyes wide open, his gaze turned upward, fixed on a point somewhere well beyond the upper corner of the room.

His expression was one of pure rapture. It was as if he were witnessing something stunningly beautiful. Even though the wonder, whatever it was, was visible to me only in his eyes, I too was struck dumb. After about 20 seconds, he lay back down, closed his eyes and resumed his sporadic breathing.

He died the next morning.

SPIRITUAL TRANSFORMATION
Does all of this mean that death’s a wonderful thing? It depends. For my dad, I think it was. He was ready. On the other hand, I can barely imagine what it must be like to lose a child. Or a young family’s loss of a parent. Or anyone dying alone and scared…just the thought brings tears to my eyes.

Nonetheless, Final Gifts reminded me that the pain, fear and grief surrounding death are not evil; they’re part of the human condition, part of the Creator’s plan. When I view death in that context, through eyes unclouded by all the value judgments and taboos our culture imposes on it, I can’t help feeling that, somewhere under those folds, there’s the potential for it to be an awesome, even beautiful, thing.

The patients and families depicted in the book struggled with the apparent contradiction between that possibility and the stark reality of their own loss.

                                              ~     •        ~     •        ~         
PASS IT ON!
I’ve given away that copy of the Final Gifts that Charlotte gave us, as well as several others I’ve bought. The initial reaction I’ve gotten from some recipients, especially those under 40—from whom thoughts of death and dying are still far removed—has fallen a bit short of gratitude: “What a downer!” “Why such a creepy gift?” “Are you dying?”

Most, nonetheless, have dutifully read it. Everyone who’s done so has thanked me for the discoveries and the comfort it’s brought them. I hope you’ll read it too—and then continue the sequence by passing it forward.

Final Gifts – link to Amazon

(Final Gifts and a few other books and articles I’ve read about death and dying have led me to become a hospice volunteer—with Health Partners Hospice—which has deepened my understanding and appreciation of the end-of-life experience.)

MY BAD – Taking the Rap for Hope

The last month or so here has been laden with what seems like more than its share of death and dying. I’ve lost a former hospice patient and dear friend (He “graduated” from the program five years ago.) and a member of my 40-years-and-running men’s group. Another, current hospice patient is fading. And my long-time shrink has cancer.

What if the outcome I pray for is different from that being invoked by the patient?

WHOSE PRAYER IS IT?
When someone—especially a loved one—is facing a scary diagnosis, naturally I want to do something. I guess we all do.

So, besides the usual nuts-and-bolts support—visiting, offering respite to the care-givers, perhaps dropping off a nice pie or casserole, I put my fondest wishes for the person out there into the Universe to assimilate and perhaps factor into its next rendering of The Big Picture.

In other words, I pray. But for what, exactly? Do I pray for the dying person’s ability to gracefully let go of life and pass away in peace and comfort? Or do I pray for them to beat the odds, kick cancer’s ass and get back to a normal life? It’s a real dilemma. And what if the outcome I’m praying for is different from that being invoked by the patient?

Well, for the hospice patients I volunteer with, the answer’s usually easy. Typically, they’ve lived good, long lives, suffer any number of discomforts and indignities, and in many cases are quite ready to die. It’s when the patient’s younger— chronologically and/or in their attitude—that I’m conflicted.

PROFESSIONAL DETACHMENT
Right now I’m channeling all the positive energy I can marshal into the prospects of the man who’s been my “behavioral health” counselor (I’ll call him Bob). For the past five-plus years Bob’s been the only person in my life whose time I’ve felt I could commandeer to just sit there and listen to my personal problems. He’s helped me cope and hope and grow into a better man.

A couple of months ago, the day after my last appointment with him, Bob had a sudden seizure. Next day, they operated on his brain and confirmed the worst: glioblastoma, the most aggressive form of brain cancer. He was admitted to hospice.

Maybe it’s not typical of such patient-provider relationships, but I love Bob. Though I’m sure any reciprocity on his part has been unintentional, let’s say we’ve come to know each other pretty well. He’s a kind, gentle, compassionate man.

And now, though I want desperately to see him and help him as a friend and supporter, a veil of confidentiality imposed by his employer separates me not just from offering that help, but from even the most basic information about his condition or whereabouts.

So, for Bob, it’s come down to praying. But I’m facing that give-up or give-‘em-hell dilemma. What if what I’m praying for isn’t what he’s praying for? What if he’s decided to commit himself fully to dying with grace?

          I picture every single cancer cell in
          his body as turning a bright, Day-Glo
          red, no longer able to hide.

EXPANSIVE THOUGHTS FOR A SHRINK
I thought about it for several days, simply wishing him peace and comfort. And then it hit me. So what if I wish for a recovery he can no longer envision? Could that be any worse than cheering for an athlete who’s resigned to losing a race, or for that matter any underdog who doesn’t believe they can beat the odds?

So I’ve taken part of my daily meditation—the one visualizing my own body as healthy and pain free—and turned that biofeedback toward Bob. Maybe I’ll call it tele-biofeedback.

I picture every single cancer cell in his body as turning a bright, Day-Glo red, no longer able to hide from his body’s natural defenses and the search-and-destroy raids of chemo drugs. I see all those pinpoints of red getting zapped, darkening to burgundy, then dark gray, and finally blowing away as so much lifeless ash.

There’s a chance I’ll never, ever know what happens to Bob. But whatever it is, at least I’ll know I did my best by him. I think that’s what I would want from my friends and loved ones. Cheer for me even if I cannot cheer for myself. Even if it turned out to be an outcome I couldn’t have, I think I’d forgive them for their misplaced hope. Wouldn’t you?

And Bob? What if he just happens to end up among the five percent of patients who survive this cancer…do you think he’ll blame me?

A HOLE IN TOMORROW – Seeing Right Through Mortality

You may have noticed the gradually increasing frequency of my posts touching on aging, death and dying. This is partly due to my perspective, which I can no longer pretend is anything but that of a senior citizen. It’s also inspired by my experiences as a hospice volunteer. (I spend a few hours every week with people whose days are numbered.)

Despite my long predisposition to the present moment, the older I get, the more often I seem to stray to thoughts of the ever-more-precious future. Like imagining how, when the time comes for me to face my own life’s end, I might do so with half as much grace as my patients do.

       In just the past couple of years, five of my 
       family members and friends have faced a 
       cancer diagnosis.

TOMORROW…AND TOMORROW
I know, I know…worrying about tomorrow is pointless. While it’s probably more useful than worrying about the past, either way there’s little any of us can do to affect the consequences of time.

But there’s tomorrow…and then there’s TOMORROW. For someone simply living out their last days or one facing a grave health crisis, the term could mean, literally, the next day; one might not dare look ahead much further.

But for those of us still fortunate enough to still gaze out on an indeterminate horizon, the view is quite different.

Yes, there’s still that sense—especially if gratitude is part of your daily spiritual practice—of each tomorrow being a precious gift, one you should appreciate as if it were your last. But even that self-imposed filter doesn’t keep those of us in reasonably good health from fully expecting another tomorrow after that…and another…and another...

How cruelly that expectation must change when one receives, say, a cancer diagnosis. These days, I find myself thinking about that all the time, because in just the past couple of years five of my family members and friends have faced that reality.
        It’s an opportunity to introduce ourselves 
        to our faith—or at least an aspect of that 
        faith we may never have been in the same 
        room with before.

CLOSER STILL TO HOME 
Even as I’ve been writing this post, one of those loved ones dealing with cancer—a dear old friend—has experienced a dramatic change in his condition. Steve had been responding quite well to cutting-edge treatment which aimed to seek out and destroy cancer cells no matter where in his body they lurked.

But now, quite suddenly, the cancer has gained the upper hand throughout his body. There’s nothing left to do for him—at least in terms of cure-oriented medical treatment. He’s entered hospice, and doctors advise him and his family not to think in terms of months, but weeks…or maybe even days.

What a fickle friend hope can be. I can only imagine what he and his family must be going through, given that initial ebbing of the disease’s leaden horizon and then its abrupt rushing in and imminently crashing over them.

PERMEABLE PERMANENCE
I guess this is one positive effect of death—a silver lining, if one thinks broadly enough—in the whole human scheme of things. It causes those left behind to confront the reality of our own mortality.

It’s also an opportunity to introduce ourselves to our faith—or at least an aspect of that faith we may never have been in the same room with before.

It’s that faith that renders the dreadful, absolute finality of death somewhat more forgiving. As if that barrier to yet another tomorrow becomes, rather than a dark, impenetrable, tombstone-granite wall, perhaps more like a fine-mesh screen which, while it certainly inhibits our free, physical movement from one dimension to the other, at least allows the free flow of air and sunshine and spirit between the two.

As death becomes an ever-more-frequent visitor to my aging circle of loved ones, I’m asking myself if my faith is up to the task. Can I, as with any other aspect of wonder, learn to be fully present with my mortality? Might I, if faced with a terminal diagnosis, be able somehow to see beyond—if not right through—death’s dark curtain?

Could you?