After a depressing weekend of contemplating the ongoing deterioration of friends and family on an out-of-town trip, I heard these lyrics on the radio while randomly looking for a pop song that I liked: “I’m not afraid of getting older/I’m one less day from dying young.” Crusty old hospice chaplain that I am, I was surprised to hear any pop lyrics at all that would give me a fresh perspective on fear of death. Not only that, the novel way of addressing our mortality in those lyrics actually lifted my mood. The writer of this song, Rob Thomas, should feel highly complimented by that, ha ha. I encourage my readers to hear “One Less Day (Dying Young)” at this You Tube link before continuing with the rest of this post, as viewing the lyrics alone robs them of their impact: https://www.youtube.com/watch?v=gaSoq9FELF8
Perhaps this song is so effective because it directly and openly addresses our fears of aging and of death. He even refers to our dismay when people we know die young. I admire Thomas for outing some of our innermost fears about what remains a taboo subject, at least in popular culture. I have not encountered much popular music on mainstream radio that deals with aging and death head on, and certainly not without platitudes or other sugary coating. (I do, however think of “And When I Die” recorded by the group Peter, Paul and Mary in 1966.)
Beyond that, Thomas gets us to focus on all the time we have had thus far, which grows and grows, rather than the time ahead, which is becoming shorter and shorter. I myself derive comfort from considering how I have enriched and eased the lives of others with all that I have experienced and learned. This song encourages us to have gratitude for all the years that we have lived through thus far, rather than to fret about what has not yet happened. How does his song affect you? If it calms your fears, does it do that for the reasons I have advanced or for some other reason?
“It’s the resistance to feeling that causes a great deal of our suffering.” So says journalist, birth doula, and hospital chaplain Amy Wright Glenn in her most recent book: Holding Space: On Loving, Dying, and Letting Go. Instead, she encourages us to release them, because that is the only way to weaken their grip on us.
We resist our feelings all too often, as if expressing them would make them even worse or more prolonged. And we even encourage others to resist them. I still remember the day when I was standing near my mother’s grave during the funeral for my father I started to cry. After the person standing near me acknowledged my sadness she switched the topic to some trivial matter as if to say, “I better turn off the spigot before any more tears gush out.” And that is exactly what happened; I went into a dulled state. I would have preferred to let as many tears as I wanted go into free fall. I wanted to feel spent.
People do censor their feelings, and part of my job as a chaplain is to remove that destructive inner editor. In her book Amy recounts the story of a patient of hers who was only in her fifties and did not have much time left. She wanted to wail and rage at length about the unfairness of it all. As Amy listened without trying to impede the flow of her anger, her family awkwardly gave the patient and her bed a wide girth. It must have been very draining and even scary for Amy to persevere through the yelling and intensity. Amy not only permitted but encouraged her to go on and on until at last there was a shift: the patient grew quieter and simply wept. The family made the trek back to her bedside. Only at that point did the woman feel free to get at what would make her last days meaningful which was to pass on a legacy to her grandchildren. From there that cleared a path for discussions of how to do so and, although Amy did not specifically mention it, also created a path to the patient and family’s last precious intimate moments with each other instead of alienation and dread.
For more information on her book and about Amy herself, see the following:
Former farmer race horse trainer and bar owner Trisha regaled me with some “stories I swear are the truth.” Who wouldn’t want to listen to a story teller with a triumvirate of careers like that? This is when visits with my hospice patients get entertaining, which in turn feeds this blog. Her first story was about three ducks. “I was in a gardening store and I saw three ducks there, looking like the owner wanted to sell them soon or who knows what might happen to them. So I was worried about them, and I offered to pay whatever he wanted. And when I offered to do that, he said I could have ‘em for free. For free? I couldn’t believe it; I was ready to pay whatever he wanted. So I took ‘em. Well I knew there’d be trouble with my husband when I brought them home, but you see I was worried about what would happen to them. Anyway, when I got home, I put ‘em in the bathtub.” At that point I did become skeptical, so I said, “In the bathtub? Well what about bathing?” Trisha just went right on. I guess she took literally the idea of associating ducks with bathtubs. “My husband wasn’t so pleased with that. Well eventually I got one of those outdoor plastic pools, you know, and I put the ducks there.” I could just picture the cute little darlings splashing around, and the husband (now her “ex” go figure) grunting his displeasure mixed in with resigned tolerance.
She had one more story for me: “I saw this chicken dragging its leg along, and I took it to our farm because I wanted to rescue it. I was so stupid; I put it on the ground to let it do what it wanted. And then nine vultures came down from all around, and then there were feathers all over as they grabbed it and tore at it and hauled it off. They went and killed it,” she said shamefacedly. Maybe after that she stuck with caring for horses.
I wanted to hear more stories, but by now Trisha had run out of energy. Next time, though, and if she is game, I hope to hear about the horses and her bar, and then make you privy to her anecdotes as well.
On a short-term experimental basis the hospice I work for has decided to try out a new system for chaplain visits. It is called “speed visiting” (after the concept of “speed dating”). We know the advantages of speed dating, where we quickly screen out the folks we are not interested in and zero in on the most likely candidates. Why spend lots of time trying to unravel all sorts of deep and convoluted layers of meaning when a truly skilled chaplain can size up a person in a matter of seconds? After all, we know the signs of sadness, anger, disgust, ennui, denial and all the rest. And we know how to instantly respond to their need to be heard. We just have to urge them to express their distress in a sound-bite appropriate length, just as they do in other areas of their life. We just have to reassure them that we get what they are feeling almost as if we were inside their brains, so they don’t have to elaborate. And why waste gobs of time with patients who really are not the least bit interested in seeing a chaplain just to have more to say in our medical record notes? And if we need to vent, we really are desperate if we have to do so in our clinical notes, I mean really!
Really? Speed visiting? April Fools!!
“Do we have to take off our shoes?” “What do we have to wear?” “Are the men and women separate during prayer?” Funny that those were the questions we interfaith leaders of my little Rockwellian town of Kearny in New Jersey preoccupied ourselves with. We were hastening through a conference call to get ready for the New Zealand memorial service at the local mosque. All of a sudden, we Kearny Interfaith Network members felt our lack of knowledge, our fears of inadvertently giving offense, and yes, our curiosity, as we discussed how we could help at a place we were attending for the first time within a day of the Christchurch tragedy.
When we arrived, the mosque members were almost baffled at the number of Jews and Christians suddenly In their midst to offer solace; they have been so used to keeping hidden and quiet out of fear of anti-Muslim sentiment. Even their building, a white home I have passed on the way to work over and over, never gave off a hint that it was a house of worship, let alone a mosque. I never even had noticed it before on this heavily industrialized street. Now, an ample number of polite but watchful policemen stood at the entrance and waited in their cars on the street, and a sign sprouted up along their fence that proclaimed, “New Zealand Candlelight Vigil.” But the Muslim community was glad that a rabbi, priest and pastors along with members of our congregations came to be with them and make speeches of support. And I was comforted when one of their own leaders spoke about the Pittsburgh synagogue and the Texas Baptist church tragedies and how we of all faiths would all stand with each other for peace and freedom. The mosque members are isolated no longer, and they are already planning to invite us to their happier occasions as we prepare to host them at our own houses of worship.
With all of the years of chaplain experience that I have, rare is the book about dying that raises my awareness of how to do my job better. The author Lisa Smartt is a linguist and the essence of the whole book is that the talk of persons who are going to die relatively soon, from a few hours to a few weeks, reflects “consistent patterns that emerge in language at the end of life.” Her data consist of 1,500 English utterances gathered over a period of four years. Some of the patterns she found include paradoxical statements such as, “I understood everything everyone said, but not a word was spoken,” metaphors such as “Yellow bus…lots of angels are driving that bus,” or visions such as seeing ancestors or spiritual figures.
After I read Smartt’s numerous categories and examples, I started to notice this special pre-death talk more often while doing my own hospice work. I then found myself responding to this special way of talking in a much more tuned-in manner than before, letting myself explore what the person was trying to convey. Just the other day a gentleman who only leaves his room in a recliner to relax in the sunroom informed me, “I have to go to a meeting.” I asked, “What is the meeting about?” (Other staff might have tried to “reorient” him by saying there was no meeting he had to attend.) He said, the meeting “is about everything.” I echoed, “Everything?” and then reflected, “That’s going to be a really really long meeting.” Chuckling, he agreed with that. I thought to myself, he might have been referring to what professionals call “life review,” i.e. the kind of run-through of our life story that some people do during the period of time before the very end as well as at other key moments of their lives.
Another characteristic this book includes is intensified language, or what I would call heightened sensitivity. I will never forget the time a patient said to me, hours before dying, that the water I gave her “was the most delicious thing I have ever tasted.”
If you find these examples engaging or touching, you will find anecdote after anecdote in Words At The Threshold, some of which are very poignant. One is about a woman who kept referring to five boxes she had to organize. Her daughter thought maybe the boxes stood for her and her four siblings, and at that her mother got agitated and exclaimed, “I need to find a place for them!” She did not calm down when her daughter mentioned where each one of them lived. Finally when the daughter said to her mother she could keep them in her heart, she became calm and relieved. A lesson here for all of us who may in our personal or professional lives be with someone talking near the end, is to not be too literal and instead get at deeper things such as love and other values.
Besides sensitizing me how to better connect with patients when they engage in “threshold talk”, this book also teaches me to recognize it as an indicator that patients may be nearing the end. So many times, as families struggle with uncertainty, they ask me how long their loved one has. Not even nurses always get this right, and we do not want to increase anyone’s distress by guessing wrong. Especially way wrong. But at least threshold talk can be a guide, and I can let families know that not a whole lot of time may be left. Another benefit of this book is that it shows us how to make the most of a loved one’s end-of-life talk, for example by keeping a journal of all of the utterances to look for patterns of meaning among them, and by thinking of conversing with them as if we were learning a new language in a new land.
My only caveat is that at times, Lisa Smartt thinks that threshold talk hints at an afterlife, partly because the language is like what people who have had near-death experiences use. She thinks of these people as having died and returned, and that the similar language they use is suggestive of consciousness after death. But one could reason the reverse: that since people use such language on other occasions that do not have to do with their actual final death, that this disproves anything about threshold talk pointing to the existence of an afterlife, as comforting and moving as that would be. The author is a poet as well as a linguist, and so I take her comments about consciousness after death in that spirit.