You would think that if you were nearing death but pain-free and not depressed, you first choice would be to stand anywhere but the head of the checkout line that the Angel of Death was in charge of. If anything, most of my hospice patients jostle to stay at the back of the line or pretend there is no line in the first place.
But every so often, a hospice patient says to me, “When I wake up each day, why am I still here?” Or more generally they will ask, “Why am I still alive?” Or more directly, “I have said all my goodbyes and accomplished everything I wanted. I am at peace with the end. I am ready.” In other words, the spirit is ready before the body. I suppose it is a bit like getting all ready to move out of a home, with the van all packed up to go, but then an unexpected delay at the new locale forces you to stay put indefinitely, and you even have to unpack a few things as you wait in limbo.
Since there is no way I can sneak them ahead in the line, as hospice “neither prolongs life nor hastens death,” what can I tell them? How can I as a chaplain respond to “Why am I still here?” As with any discussion where the answer lies within the individual asking it, all I can do is ponder along with them and wrestle with this existential question together. I may suggest answers I have heard elsewhere, which may in turn help them pull up their own concern. I may open with, “sometimes there are loose ends where something is not resolved. Social workers have told me that you cannot be finished until you have looked back on all the crucial things in your life, or until you have reconciled with someone important.” Usually I get a “no not that” to such remarks, but saying nothing can be even more unsatisfactory to them because I suppose a crummy answer beats nothing at all. So we go on brainstorming. What still gives them meaning now? What memories keep coming back? Is there something else your family needs to hear from you or you need to hear from them?
One time when I was with such a patient, she suddenly reached into herself and came up with her own answer: “Maybe I am still alive because there is some future good news in my family that will fill me with much peace and contentment.” Not only was that a magnificent answer for her, I think it is one that all of us should keep in mind.