What is a “good death”?
A hospital chaplain reflects on the lessons from her patients.
Suffering and death are what initially attracted me to a career in the spiritual care of the sick and dying. I do not say this flippantly. Having accompanied hundreds of people and their families suffering from cancer, heart disease, and traumatic injury, pain and death remain a mystery as well as a challenge. Yet I was drawn to this environment because of what I believed suffering and death could teach me about life in general — and myself in particular. I wanted to learn to become more compassionate and useful. I wanted to learn how to face suffering and use it constructively. I wanted to know why some people appeared to have a “better death” than others, passing from this life with less fear, pain, and resistance than other people. And I also wanted to look at my own worst nightmares about sickness, pain, and the end of life and see what they might show me. What I wound up learning from my patients and their families changed my life.
The Most Generous Teachers
One of my favorite patients was also one of my first patients: an elderly Jewish woman who was dying from lung cancer. She was afraid of the possibility of death by suffocation, and not at all certain as to whether or not there might be anything to “look forward to,” as she put it, after she died. Yet she agreed to my regular chaplaincy visits, not only to have someone with which to process these fears and questions, but specifically because she had somehow learned that I was a brand new chaplain, and felt perhaps my experience of accompanying her through the dying process could be of help to others. She sat with me on a regular basis and with remarkable candor and affection explained all her questions, fears, and details of her physical diminishment — as well as what I was doing that did or didn’t help her! It has been one of my most important lessons as a chaplain to discover how much the sick and dying — and perhaps especially the dying — value feeling useful and generative right up until the end of their lives. I have discovered that my role is not to come in and try to fix people and situations, or play heroine in their time of need, but to humbly accompany my patients as they walk their own unique path and unfold for themselves their own beauty and goodness, even in the face of fear, pain and uncertainty.
The generous spirit that I have so often encountered in my dying patients and their families has taught me that even in times of horrendous pain, we can choose to embrace life and reach out to others. I met one such “teacher” during my very first week at work as a chaplain intern. I was called to the death of a baby, born with a series of horrendous deformities that had made life outside the womb unsustainable, and who had died almost immediately after birth. The distraught mother, knowing she would be giving birth to a deformed child, asked to be heavily sedated during childbirth, and was still unconscious when I arrived, yet the father was very much present and grieving. The couple was from West Africa and Muslim, and had asked for an imam, and somehow wound up with me, a Christian woman of European heritage. Yet rather than being angry or sending me away, the father very tenderly thanked me for coming, and asked me if I could please remain with him while he recited the requisite prayers from the Koran that he explained to me were necessary at the time of death. He told me that he was honored to have me accompany him through such a painful and difficult time, and said that he felt my being with him could help me help other Muslim patients and family members in critical situations dealing with untimely deaths.
The dying and their families have taught me that ultimately the differences we cling to in this life as defining who we are—our beliefs, our ethnicity, our educational and economic backgrounds—all melt away in critical moments and at the time of death. They have taught me that simply being a loving presence is ultimately the most important gift any chaplain, or other individual accompanying the sick and dying, can give to patients and their families no matter what their belief system might be.
What Is a Good Death?
Learning what constitutes a “good death,” or why some people die better than others, wound up being one of my most powerful learning experiences. As medical staff, we are relieved when someone slips away with minimal struggle, surrounded by family. Yet a surprising number of people die during the time when loved ones have stepped into the bathroom or are out in the hall for a quick drink of water. These families were often devastated that their loved ones had died “alone,” despite their best intentions. It was then that medical staff helped them understand that perhaps this was a “kind choice” on the part of the dying — that their loved one may have wanted to spare them the ordeal of witnessing their actual passing. It can certainly be argued that none of us is in control of when or how we die, but anyone who has worked with the dying has seen this phenomenon often enough to ask questions.
I remember an elderly woman who was dying from cancer, whose deepest fear wasn’t facing her own death so much as there being the possibility of her emotionally frail husband, who was starting to show signs of dementia, being alone with her when she passed. She was afraid the shock would be devastating for him, and frankly, the medical staff shared her concern. No amount of pleading could part her husband from her side, where he sat, sobbing pitifully for days on end. Finally he fell asleep from exhaustion, and that’s when his wife passed away. Yet when he woke up, he was calm upon finding out that his wife had died, telling the staff that he had just had a very powerful dream in which his wife assured him that she loved him, and that she was in a wonderful place, waiting for him to join her someday.
When I think of “good death,” I am led to reflect upon how often dying with dignity goes hand in hand with having lived deeply, purposefully, and generously. One of my most memorable teachers was a woman in her mid-seventies, dying of cancer. She had been a secretary and single much of her adult life. In her mid-fifties she met and married a lovely widower, through whom she acquired stepchildren and grandchildren who doted on her. She was a successful oil painter and traveled extensively with her husband. On the wall of her living room was a map with dozens of pushpins marking all the foreign countries she had visited, and she had several shelves and cabinets full of souvenirs which she loved to show me, explaining how and where each piece was acquired.
The funny thing was, whenever I left this elderly dying woman, I felt jealous! Examining that feeling, I realized that my envy was trying to show me something. This woman had managed to accomplish several things in her life that I had not: marrying happily late in life, a career in the arts, and world travel. Were I to be diagnosed with cancer tomorrow, these were the three things I would regret not having done.
One day, while this woman was having a rare but well deserved “pity party,” I admitted to her what a wonderful life I felt she had had, and how envious I was of her. Rather than resenting my intrusion on her own grief, this woman took solace in the fact that someone still saw her as enviable, not pitiful or repugnant, as death began to claim her. My admission gave her a deeper sense of the full life she had been privileged to live, and one of her dying gifts to me was the assurance of her prayers that I would pursue and find those things that would, in my dying moments, give me as sense of having had a full and rich life, deeply lived.
Working with the sick and dying has taught me that each day is precious, that health is not to be taken for granted, and that the most horrendous suffering can contain gifts and life lessons. While I didn’t become a Mother Teresa, working with the sick and dying has taught me how to live. I found that in squarely facing my own fears and daring to ask of myself and others some of life’s most daunting questions, I experienced a profound clarity around my own life’s purpose.
Karen Rushen has worked with the sick and dying, and their caregivers, for over ten years. She ultimately married a fellow chaplain, set up her own artist studio, and has traveled to Bolivia, Ireland, Poland, and Vietnam, among many other places. She credits the unfolding of her own rich life to the love, prayers, and life lessons she has received from her generous and heroic patients and their families.