Friday, September 18, 2009

Dying, we live (Sunday Reflections for September 20, 2009)

Unless you’ve been living in a cave, you are aware we are in the midst of a national argument about health care. I wish I could say it is a national conversation but it rarely has risen to that level—lots of shouting, not much listening. Our health, and our loss of it, is certainly as personal an issue as you’ll find. It’s not surprising we get emotional when the subject comes up, especially when we are talking about what others are going to do to or for us.

Still, as we all know, when important decisions are based on emotion, disaster is usually right around the corner. In this case, the disaster awaiting us is primarily financial. Health care is on course to bankrupt us as a country in the near future if nothing changes. As it is, it is directly or indirectly bankrupting individuals and businesses with increasing frequency. Yet based on the experience of other advanced countries, we know we could be spending a lot less and getting as good and possibly even better care.

The need for medical care can happen at any point in life (my son spent his first three weeks of life in neo-natal intensive care). Not surprising, however, in general our medical needs increase as we grow older. What has become harder to explain, or afford, is the enormous amount of money being spent at life’s end. On average, 80% of medical expenses occur in a person’s last year—much of that often in the last months or even weeks.

This summer there was a great hue-and-cry over the possible creation of “death panels,” government boards that allegedly would decide when people should die. Hopefully we’ve awakened from that nightmare and returned to reality. What was lost in the hysteria, however, is the real topic of how and by whom decisions should be made as a person nears death. What the hysteria did point to was that this is a topic not many of us are ready to talk about, but talk about it is exactly what we need to do.

I am now “middle aged” and so jokingly I can be said to be over-the-hill. The description I like better is one I read a few years ago. At this point in life I am at the top of the hill and can now look down the other side. I’ve done a little mountain climbing and I think that description fits. When you’re going up that’s all you’re aware of—the path just keeps going on and on. When you finally get to the top, however, your perspective suddenly changes. Now you can appreciate the mountain as a whole. You can see where you’ve been and where you’re now about to go.

Being at the summit of life’s mountain makes you somewhat more sober, more reflective but primarily, I think, just more realistic. You are aware that this journey will have an end and you can see it, even if it’s off in the distance. Okay, enough gawking, you say to yourself. Time to move on.

People who reach old age, or younger people who contract a serious and potentially terminal illness, inevitably think about dying. With modern medicine we know that in most such situations there will be a variety of treatments and procedures to decide upon. People have thoughts and opinions about what they want done. None of that will matter, however, if they aren’t shared with family members, friends, and doctors. Everyone, including the patient, has to get over their squeamishness or embarrassment to talk frankly and honestly with one another. It is simply the loving thing to do.

When Gail, a member of my congregation, was diagnosed with cancer, she began a treatment regimen but ended it fairly soon. The prognosis was not good and the treatments were difficult. She decided to opt for quality of life over quantity. What was remarkable was not so much her decision but how straight forward and open she was about it. On more than one visit with her she greeted me saying, “I’m still here. The doctors thought I would be dead by now.” While she lived her last months in a care facility, the life she established there was so “normal” it was almost a surprise when she did finally die.

Gail had difficulties through much of her life, so perhaps she viewed her cancer as just another bump in the road. Perhaps she had been preparing for death for a long time. Yet why should any of us be any different? For better or for worse, doctors will not make end-of-life decisions for us. Their training is to keep people alive. This is fine, normally, except that dying is an inevitable part of life. At that point it is the patient, and the patient’s family and friends, who have to take responsibility and decide what is to be done, and what is not to be done.

Living wills and powers of attorney are very helpful documents to have in such situations. They cannot substitute, however, for open communication and clear verbal statements of our desires and intent. Doctors are human, too, and they need to know we are ready and willing to talk about such matters. They need us to give them the direction in which we want to proceed. Only then can pointless procedures be avoided, our control be maintained, and a dignified ending be assured.

All of this assumes, of course, that we have at some level come to grips with dying. We’re never fully prepared; there’s too much about it that is unknown and unpredictable. Yet, sooner or later, it will happen, it is inevitable. Christianity, like all religions, goes out of its way to make that clear.

The religious response to that reality is also nearly universal, I think, but Jesus gives us one of the best expressions of it: we live by dying. We lose our life to find it. We let go of our life in order to truly live it. We realize nothing belongs to us because the whole world is ours. Paradoxically, we both live each day like it’s our last and like it’s the first day of the rest of our life. We let go of the past and make no assumptions about the future. “This is the day that the Lord has made. Let us be glad and rejoice in it.”

British theologian and author, Don Cupitt, has created an updated metaphor for such a life. He calls it solar living. We live like the sun, which by burning is at the same time burning itself out. We live by using whatever abilities and resources we have, fully and without hesitation, until they are gone. Dying, we live, Paul says. In giving, we receive. It’s only in letting go that we find the happiness we all want.

Our health care dilemma is to a large extent about money. It is also about knowing what we want and what we need, and our being willing to talk frankly about them. And, perhaps most important, it’s about recognizing that our life, whatever its length or quality, is ultimately a gift which we use best by simply giving back and saying, “Thank you.”

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