How our mortality can define the meaning of our lives

The New York Times concluded (for now) its blog series, Happy Times, about "the pursuit of what matters in troubled times recently. The final entry reflects on the meaning of one's life, especially when facing or reflecting upon one inevitable death. The writer observes two lessons in our mortality: First, that death is terrifying because we are essentially future-focused beings, and we do not know when death will occur for us.

The second, less obvious lesson is that death gives our life purpose by defining our lives in time, with finite boundaries. Developing that thought:

And when there is always time for everything, there is no urgency for anything. It may well be that life is not long enough. But it is equally true that a life without limits would lose the beauty of its moments. It would become boring, but more deeply it would become shapeless. Just one damn thing after another.

This is the paradox death imposes upon us: it grants us the possibility of a meaningful life even as it takes it away.

Religious sisters show dignified and peaceful way to aging and dying

A recent New York Times story describes the peaceful, spiritual nature of an aging community of nuns. Specifically, the story relays the care and introspection that accompanies the ill and infirm sisters who face nearing death.

Here's an excerpt:

Few sisters opt for major surgery, high-tech diagnostic tests or life-sustaining machinery. And nobody can remember the last time anyone died in a hospital . . . .

“There is a time to die and a way to do that with reverence,” said Sister Mary Lou, 56, a former nurse. “ Hospitals should not be meccas for dying. Dying belongs at home, in the community."
. . .

[The primary physician for the sisters,] Dr. McCann said that the sisters’ religious faith insulated them from existential suffering — the “Why me?” refrain commonly heard among those without a belief in an afterlife. Absent that anxiety and fear, Dr. McCann said, there is less pain, less depression, and thus the sisters require only one-third the amount of narcotics he uses to manage end-of-life symptoms among hospitalized patients.

Zen as a dimension of healthcare (reform)

The L.A. Times reported recently that Beth Israel Medical Center in New York City offers Zen chaplains for expanded spiritual care of its patients and employees.

According to the American Hospital Assn., about 68% of public hospitals have a chaplaincy program. But few have Buddhist monks, and none compares with the program at Beth Israel -- where more than 20 Buddhist chaplains and chaplains-in-training offer bedside meditation, interdenominational prayers and other assistance to pregnant women, dying cancer patients and even stressed hospital workers.

. . .

Advocates say the availability of alternative treatments is crucial at a time when millions of Americans are struggling to pay for healthcare. Instead of relying on drugs and hospitalization, the Zen center encourages stress- and pain-relief through meditation, breathing exercises or simple conversation. Even if such methods cannot provide a cure, they can make patients more comfortable. And the Zen chaplains are able to spend more time with patients, time that busy doctors and nurses often cannot spare.

Keep talking about advance directives until everyone has them

Facing a loved one's serious medical condition or end of life is always agonizing. But it approaches being unbearable when there is no way of knowing what the person would want for treatment or care.

Advance health care directives are SO IMPORTANT and can spare families a world of grief. Advance directives and why people tend to avoid them is the topic of a recent post on the New York Times' blog, "The New Old Age."

In light of the recent National Healthcare Decisions Day (April 16), consider this excerpt:

One reason is that advance directives may be misperceived, theorized Nathan Kottkamp, a health care attorney in Richmond, Va., and organizer of this month’s National Healthcare Decisions Day. People may equate such documents with limiting care, with “pulling the plug.” In fact, Mr. Kottkamp said, “Your living will can say you want every medical treatment known to science applied to you at the end of life. Or no treatment. Or anywhere on that spectrum.”

Caregiving lessons from a two-legged friend and from a four-legged friend

Two recent pieces in the New York Times discussed the difference a caring companion makes in coping with serious illness.

First, a medical student reflects on the comfort and companionship a man gave to two patients who faced death and long recovery.

His story, I realized, was a kind of love story, and in some way it evoked all of our stories, whether we are doctor or patient, comforter or comforted, healer or healed. Josh reaffirmed for me what we medical professionals know but all too easily forget: the human story is not a series of illnesses and treatments that we manage, but is an unfolding mystery — a process with which we ourselves are in ongoing communion, both as witnesses and as full participants.

Also, from the "Well" health blog, Dana Jennings tells Life Lessons from the Family Dog--the author's struggle with agressive prostate cancer and the contemporaneous age-related decline in his dog's health.

Even so, as I face my own profound health issues, it is my dog’s poor health that is piercing me to the heart. I’m dreading that morning when I walk downstairs and … well, those of us who love dogs understand that all dog stories end the same way.

. . .

Dogs also tell us – especially when we’re sick – of our own finitude. And, partly, that’s why we cry when they die, because we also know that all human-being stories end the same way, too.

Reasons for paying attention to the healthcare system

If you don't have your own personal reasons for considering the immediate and long-term concerns of the American healthcare system, consider these from an interview in the New York Times. A notable and accomplished physician discusses the current medical culture, the President's proposals for change, and aspects of our healthcare that all of us should think about. A prominent topic of the interview is the discussion of advance directives for medical treatment at the end of life.

If you missed the Dallas Morning News series on end of life issues, check out my post on it here.

(Photo by Erica Marshall; used by permission.)

End of life series from the Dallas Morning News

The Dallas Morning News ran an excellent five-part series on end of life decisions and difficulties. The "Edge of Life" series follows a palliative care team at Baylor University Medical Center. Nurse Min Patel and several of her patients discuss, prepare for, and address the family, health, and spiritual dimensions of dealing with death in the face of modern medical technology.

My nut-shell summary:
Old way: "Aversion to their own mortality was at the core of doctors' inhibitions in helping patients at the end of life . . . . It made physicians hide behind stiff white coats, rush from room to room, and turn clinical and cold when they couldn't fix or rescue."

New way: Palliative care professionals address all relevant issues head-on. "[They] can't fix everything, but [the patients] don't have to go it alone." The outcomes are better for all those involved when they realize "that using more drugs and devices wasn't always the best way to show love."

The stories in this series are so touching it makes you wish all death and grieving could be as good as this featured approach aspires to.

Also, check out my previous post on hospice care.

(Photo by blueskygirl; used by permission.)

End of life decisions

Jane Gross of the New York Times, continues her excellent blog on aging, with which she frequently reflects on her own mother's aging, final illness, and death. This entry is indicative of her series, both in its personal dimension and in the useful information provided.

Gross shares the process of her mother's decisions and actions just before her death:

She often longed for the oblivion of Alzheimer’s disease. But her sharp mind — she never skipped a beat — entitled her to organize her own death, within legal limits, which she did by deciding to stop food and hydration. We had discussed and researched this option, and we had read enough to be reasonably confident this manner of dying was not a frightful ordeal but rather a gentle death. We trusted that an enlightened nursing home like the one she was in wouldn’t force her to eat and drink. They had readily accepted earlier decisions to forgo diagnostic tests or hospitalizations, and later antibiotics for pneumonia.

Our study of what is known as V.S.E.D., or “voluntarily stopping eating and drinking,” was impressive for amateurs, if I do say so myself. My mother had a pretty good death, on her own terms, and we had the nursing home’s full support. I’m proud and grateful to have been able to advocate for her and to have been by her side.

The end of life process will only continue to get more attention as hospice and palliative care programs expand and become better known. Also, advance directives for health care and good powers of attorney for health care can undergird a person's decisions, even when the person is not capable of expressing his or her wishes at the time.

(Photo by mike 23; used by permission.)

Hospice care with expansive options

Hospice care has become more familiar as we as a society acknowledge the natural last stages of dying. Along with the physical stages of death, a patient frequently reflects on relationships, personal accomplishments, and spirituality. Now, even when a person is not necessarily religious, chaplains and similar advisors offer comfort and companionship on the final journey of life. The New York Times recently reported on the nonsectarian dimension emerging in hospice chaplaincy.

In the Madison, Wisconsin region, HospiceCare offers in-home and hospice facility care options. It also offers family services, medical information, and other assistance. You can check out their excellent website for more information.

(Photo by tiarescott; used by permission.)