A team of nurses and doctors surround an elderly man.
Standing next to his daughter, a woman in her mid-50s, I try to be what we as hospital chaplains are called to be: a non-anxious presence.
With the sounds of alarms and the visualization of a nurse giving chest compressions to stimulate her father’s heart, I know in my own heart the chances of this elderly patient fully recovering, let alone surviving, will be minimal.
A few weeks prior to his cardiac arrest, I recalled visiting him – an older man in his late 80s – and having discussions over his declining health that resulted in frequent hospitalizations.
“I am ready to go,” he told me during one of my visits. “However, my daughter is not, and whenever we or the nurses talk with her about it, she gets upset and says, ‘It’s not time yet for us to have this discussion.’”
For those of us who work as healthcare chaplains and spiritual care providers, we see firsthand the conflict that often arises between family members when it comes to discussing end-of-life care.
While the healthcare industry has made great progress educating the public about end-of-life terminology, such as advanced directives, hospice care and do-not-resuscitate orders, we still, as a society, resist talking about what is an absolute for all of us: We will someday die.
Atul Gawande, a surgeon and author of the book, “Being Mortal: Medicine and What Matters in the End,” which was also featured on PBS “Frontline,” has been working to help individuals begin the conversation about their death by first helping individuals accept their own mortality.
“How we seek to spend our time may depend on how much time we perceive ourselves to have,” Gawande writes.
In my experience working with terminally ill patients or those advancing in age, the majority of patients express an acceptance of their mortality.
For many, the years spent in physical decline, combined with the emotional toil being in failing health takes on them, allows them to accept the inevitable.
While they have anxiety about what happens after death, they also see their death as a liberation from their grief and pain.
However, it’s often their family members who find themselves not only unaware of the wishes of their loved ones for their funerals or memorial services, but unaware of their parents’ or spouses’ desire not to be resuscitated or kept alive through ventilators should their health condition become critical.
So, unfortunately, when their health declines to a point that they need significant medical intervention to sustain life, spouses and children are unaware what to do simply because it’s a conversation they were too afraid to have well before their loved one ever became ill.
Atalanta Beaumont, a former psychotherapist, addressed in Psychology Today the importance of having this conversation with those we love.
“We don’t talk about death,” Beaumont writes. “We talk about sex, drugs and money. We teach our children about these subjects, but we don’t talk about death and dying.”
“Death was so common in the 19th century that it was readily addressed. People wore black if they were in mourning and were treated accordingly,” she says. “If people were dying, they planned their funerals with their family, and everyone knew to express their condolences if they came across someone who was bereaved. It seems we’ve got out of the habit, and the subject has become taboo.”
While our society will continue to make tremendous advancements in medicine and technologies to prolong our lives, we also must be realistic that our lives will still eventually come to an end.
And just as the medical community has made tremendous efforts to help individuals seek quality over longevity when a person’s health issue is deemed terminal, we as a society need to learn how to have these conversations with our loved ones before it happens.
Death Over Dinner, a grassroots movement to introduce the death conversation to Americans, provides information for individuals on how to host conversations with others about the topic of death.
Additionally, the online resource DyingMatters.org and TheConversationProject.org also provide resources and guides for individuals, which can serve as an aid for conversation starters with family members.
And faith communities are starting to introduce the conversation about death as well.
From workshops on the differences in terminology between hospice care and palliative care to ways to complete power of attorneys, advance directives and do-not-resuscitate orders, people know the importance of this conversation and want to find ways to have it with their loved ones from a spiritual faith perspective.
Ira Byock, a palliative care physician and chief medical officer of the Institute for Human Caring of Providence St. Joseph Health, based in Torrance, California, recently wrote an essay for America Magazine about the important role congregations have in this conversation.
“Congregations are a natural milieu for these conversations,” Byock explains. “An innate sense of being part of something larger than ourselves draws us into the company of others with whom we can explore ultimate questions of life and death. Throughout history, when fires and floods have threatened people’s lives, dissolving all pretense of invincibility, we have turned to one another in community. And death is the natural disaster that awaits us all.”
For faith communities wishing to host such conversations, Pew Charitable Trusts, The Conversation Project and other organizations offer resources tailored for faith communities.
For Christians, our belief system is built upon reassurance that our physical deaths do not constitute the end of our existence.
This doesn’t mean we should not express anxiety around our own mortality or not express grief when we lose a loved one.
But if we are willing to have the conversations with our loved ones about our desires and wishes, even though they may not feel comfortable hearing it, we will be able to prepare them for our death.
This way, when that moment comes, those we leave behind will be able to find not just assurance that they are carrying out our desires and wishes, but perhaps they can find healing in their season of grief too.
Christopher L. Schilling is an ordained Christian Church (Disciples of Christ) minister, hospital chaplain, and a chaplain in the Air Force Reserve.
