Becoming: A Book Review

obama bookThis is one of the best books I’ve read in a long time . . .  and I read a LOT of books.

At first, it reads like a long chat with a girlfriend.  No weighty four-syllable words or policy discussions.  A friend curled up at the other end of the couch, pausing occasionally to sip from her glass of wine, and sharing stories of growing up in a close-knit family and vibrant but struggling neighborhood, academic and job successes and challenges, the well-trod paths of career discernment, job changes, marriage, miscarriage and infertility, mothering, daughtering, dreams and losses — all conveyed in a relaxed tone of voice, mostly optimistic about possibilities, and occasionally shaken by tough realities.

Eventually, of course, the path begins to take direction and the focus sharpens.  A husband with political ambitions, gifts, and speed.  One minute Michelle Obama is objecting to a run for the statehouse; the next, she’s negotiating with a Secret Service detail over concerns for her daughters’ safety not compromising their freedom and flexibility as young girls, at least not too much.  (She relates with great humor a hilarious scene in which she and high-school aged Malia make a determined dash for a locked door so that they can escape the confines of the White House and celebrate the Supreme Court marriage equality decision outside, enjoyed the rainbow-hued lights playing across the mansion’s façade in at least some proximity to the crowd gathered to celebrate.)

Of course, it doesn’t all happen in an instant and, as often occurs with such books, many more details emerge with respect to the Obamas’ earlier life in politics than regarding the later, presidential years.  The first years, from the statehouse to the Senate to Iowa, are marked by resistance, mistakes, naivete’, and a developing political eye on her part, helped along by the growth of a dedicated and brilliant support team. But the latter years are fascinating as well, as Mrs. Obama develops the projects that will mark her tenure as first lady, focusing on children’s eating habits and health, a direct response to challenges in her own family; on military families, as she comes to know a world previously hidden from her view; and on girls’ education, a commitment founded in her conviction that the South Side of Chicago as well as the rest of the country are packed with young people as intelligent and gifted as she and her brother, with young people who lack neither brains nor determination, but need the opportunities and support system that paved the path for a young Michelle.

Her thoughtfulness about her choices, and her light but deft touch as she notes the particular challenges she faced as the first black First Lady and as a mother of youngsters and then teens in a political fishbowl, are likely to illumine the way for anyone seeking to clarify her goals for the next stage of life, whatever it might be.  As a 65-year-old white woman trying to sort through what I hope my next ten-to-fifteen years might look like, I find a lot of wisdom in these pages.

And finally — as Michelle Obama reflects on her last day as First Lady and the changes in our country since — well, she brought tears to my eyes.  As the good-byes are said peaceful transition of power occurs, she observes that the joyful diversity that marked her husband’s to inaugural celebrations has been replaced by a stolid, white, male “optic,” (a word that’s often been noted by her team in connection with her own efforts), and gives up on trying to smile.  And as she looks back at the atmosphere which has enveloped our country, she experiences the heartbreak that many of us share.  (On a related note, today’s news includes a report that the Trump administration is rolling back regulations regarding school lunches — legislation on which Michelle Obama quietly worked hard, part of her legacy in promoting healthy lifestyle choices for children.)

I don’t RE-read that many books, but I’m going to start over on this one as soon as I can.  Energy, commitment, determination, humor, and grace.  I am impressed, moved, and inspired.

 

 

 

 

Joy and the Abundant Life

“Joy comes in the morning” (Psalm 30).

When I say that joy is central to abundant living, I do not mean to imply that la-de-da happiness or frivolity is essential to the good life.  Joy refers not so much to a feeling, or even an attitude, as to a deep conviction that life has value and meaning. Joy is often accompanied by energy and overt delight, but I know far too many people (including myself) for whom joy has been a hard-won property to gloss over the challenges that may block its evidence.

As a conviction, joy exists as a possibility for us despite our circumstances.  I don’t want to imply that it is something we can achieve with ease, or to shame anyone for whom it remains elusive.  I’ve been hurt and offended by far too many Facebook pull-yourself-up and change-your-attitude quotes for that.  But my experience at this point is that we can open ourselves to an orientation toward joy and that, gradually and sometimes only in fragments, it will direct itself our way after that Psalm 30 long night of weeping.

Insofar as the church goes, joy is foundational to vital congregational life.   Once again, it is only tangentially related to happiness, and largely a function of conviction.  “Behold, I bring you great joy” ~ if we as a church believe that good news, then membership, attendance, budget, building condition, programming ~ all those things we like to measure ~ are essentially irrelevant.  A small congregation whose building has just burned to the ground can evince far more authentic joy than a 3,000 member church with the latest in décor and technology.  Not that I recommend disaster or a lapsed insurance policy as signposts on the road to joyful living.  But when it comes to joy, faith in God’s love for the world trumps a balanced budget.

Abundant Life

What does it mean to have abundant life?

That’s the preliminary question posed to a small group of us attending a retreat for our Presbytery Vitality Committee tomorrow.  It’s been a long time since I’ve blogged, and I’ve made a bit of a promise to myself to write a few times a week ~ and the topic of abundant life seems a good one with which to start.

When you take a look at dictionary definitions of the word “abundance,” you immediately see a focus on quantity.  Abundance means “a great many” or “a large supply” or “a plentiful amount.”  At this point in life, however, I am inclined to understand abundance in terms of quality, rather than quantity.  When Jesus says “I came that you might have abundant life,” the quote (more or less) on which our discussion question is based, I don’t think he was speaking in terms of numbers of years or quantities of financial wealth.

Three things come to mind when I think of abundant living.  Preeminent among them is joy ~ a deep and abiding joy, gladness, gratefulness, in and for life, regardless of one’s circumstances.

The second is care for or service to others.  The richest depths of life are mined when we care about others and act for them ~ whether that care and action involves taking a plate of home-baked cookies to a homebound neighbor, or heading to Congress to advocate for legislation, or something in between.

And finally, abundant living is found when our individual gifts are engaged to the fullest.  It’s not possible to live abundantly, no matter the size of your stock portfolio, if you are miserable in the work you do, or a poor fit for the environment in which you find yourself.

I am pretty sure that these three things apply to abundant life for an individual or an entity, such as a family or a business . . .  or a church.  I think I’ll try to follow through on my writing resolution by exploring them one at a time over the next couple of weeks.

What Will We Say?

A Sermon on Suicide Loss and Prevention for Faith Hope & Life Sunday

What will we say – to ourselves and to others – in times of disaster, of catastrophic loss?  This morning, our readings invite us to consider what we say.  Do we speak for ill or for good, James asks?  We can use our tongues to destroy, he reminds us, but the reverse, of course, is that we can use them for great good.  Who do you say that I am, Jesus asks?  If we say that he is the Messiah, what does that mean for our daily lives?  When we tell the WORST stories of our lives, what do we say as a people of hope?

Here’s my worst story. It’s been ten years since my husband and I, in separate locales that day, received the phone calls that informed us that our lives had been altered forever: That our son Josh had died of suicide the night before.  Our tall, blonde and blue-eyed, brilliant, creative, athletic, and witty son, our beloved son Josh, was gone. I was standing in a small room, cell phone to my ear, and I could literally feel the floor beneath my feet tilting in some new direction I didn’t know existed.

Sometimes, when a person dies of suicide, family and friends perhaps don’t expect it, but they know it’s a possibility lurking out there.  There have been clear indications of mental illness, perhaps years — of suffering, psychiatrists, medications, hospitalizations, perhaps even attempts.  We were in the other broad category of survivors: We had no idea that death was just around the corner.  Later we would learn that our son had probably been struggling with a deep, and deadly, clinical depression for at least a few years.  Sadly, people of great ability and experiencing what appears to be solid progress in life often successfully conceal the despair of mental illness.  People can feel shamed by the discovery that there are challenges in life that they cannot seem to overcome, and fail to seek the help that would be so gladly given.

In the first weeks and months and years, as we tried to figure out how to live again, there didn’t seem to be any reason for us to address suicide as an issue.  As I said, we were in the group of survivors who has no idea that it was coming.  I recall saying to my husband one night, “It’s as if a locomotive came out of nowhere and ran him down.”  We didn’t know much about recent and hopeful strides in mental health care; we didn’t even know that there WAS anything to know.  And certainly most of the people in our circles of friends and colleagues did not go around talking about suicide.

But then, three years later, I was diagnosed with breast cancer.  And I made an interesting discovery.  I had already found that I could clear a room by stating that I had lost a child to suicide.  Seriously, people became silent and moved out of my orbit as fast as they could when they heard that news.  But breast cancer?  People surrounded me with concern and support and information.  All kinds of information and offers of help.

Hmmm, I thought.  I remembered being a little girl and learning about breast cancer via my grandmother’s ladies magazines, and hushed conversations among women as I eavesdropped on the other side of the wall.  Breast cancer was something shameful, and its consequences so horrible that women DIED rather than speaking up or going to the doctor.

Today, two generations later, much has changed.  There’s money, lots of money, available for study and treatment, and lots of research being done on breast cancer.  It’s no longer stigmatized – even football players wear pink jerseys in October.  Public service announcements about mammograms appear everywhere.    Lives are being saved, and a lot of attention these days is being directed to the stubborn cancers that have resisted cure thus far.

All because women dropped the hushed tones, and started speaking out.

Could this happen with suicide, I wondered?  And so I spent some of my cancer recovery time learning new things, and became, in my own very small way, a suicide prevention activist.  Today I volunteer with a couple of national organizations, work which has taken me to Columbus and to DC to meet with legislators and their aides and to speak up for suicide prevention legislation and funding.  Like thousands of others, I participate in walks to raise funds for education, research and advocacy.   Last summer at GA, I presented a suicide prevention resolution that’s been adopted by our national church

But what does this all have to do with faith? Why bring suicide up in the church?  I think that the answer might be summed up in words I heard spoken many years ago by Unitarian pastor Forrest Church in a sermon at Chautauqua: We live, and we die, and our life of faith helps us make sense of those two realities.

Church, the community in which we worship and serve God, is also for many of us the most significant community in which we articulate and absorb realities about life and death.  It’s one of the main communities, sometimes THE main community, in which we meet and share loss.  All kinds of losses, but especially loss as a consequence of death.  We may be people of faith, and we may believe in an afterlife, but those realities don’t prevent us from suffering deeply, or from experiencing anger and bewilderment, in the face of death, and needing a place to go and be with those feelings.

Just last week-end, I conducted a funeral in Euclid for one of my former parishoners from our now closed BPC.  I spent some time there talking with one of her dearest friends, whom I had met years ago at OSC.  She has experienced three suicides in her family, and another recent loss, and is a mental health activist not to be crossed.  She told me that church is the place in which people have checked up on her, asked her how she is, and formed community around her.

It was in church, in a confirmation class a couple of years ago, that an eighth grader asked me, “Do people who die of suicide go to hell?”  He had pulled together various conversations he’d overheard after the death of a beloved uncle, and brought his confusion to his church.

Of course, church is no different from other communities in that we often struggle to discuss or respond to suicide.  It’s such a devastating, traumatic loss.  It so violates everything else we learn in church.  “Choose life!”  says God in the Bible.    How do we even begin address a topic, or a loss in our own small communities of faith, that collides so profoundly with all that we have absorbed and taught together?

That’s why we have days like this: To learn how to do it.  In some ways, it’s like any other horrible loss – but then sometimes we need to learn to respond to those, too.  In other ways, it’s very different.  I’m going to offer you three things today, because maybe three are enough to hang onto:

First, learn the language.  We try not to say anymore that someone “committed suicide.”  Why not?  Because that makes suicide sound like a crime rather than a consequence of mental illness, which science tells us that 90% of suicides are.  We would never say that someone “committed a heart attack,” or “committed cancer.”  We don’t stigmatize physical illness by calling it a crime.  Same with suicide.

Second, remember Jesus.  What does Jesus do when confronted with ill or heartbroken or grieving people?  He doesn’t turn away.  He doesn’t try to pretend he hasn’t seen them.  Jesus always wades right in, walks toward, reaches out.  Jesus is fearless! Jesus is always healing, with hands, and spit, and mud, and food, and drink, and words.  Jesus models for us what to do.  Walk toward, not away.  Listen. Offer help, and then actually give help.  Listen. Write notes.  Show up.  Listen.   You wonder whether people who die by suicide are excluded from eternal joy?  Look at Jesus.  He never condemns those who are in need of healing.  Listen, and then share the good news of hope: We are always, always, surrounded by loved.

Third, learn a little about suicide.  Learn about mental illness. Learn about help and prevention.

Learn, for instance, that suicide is preventable.  You will still hear people say that there’s nothing that can be done; that when a person makes up their mind to end their life, nothing can stop them.  NOT TRUE.  Research and experience continue to show us that when properly treated, people with serious illnesses such as depression and bipolar disorder, and people who have suicidal thoughts, can emerge from the darkness and move into productive and joyful lives.  Nearly everyone who has attempted suicide and lived to tell the story is grateful for whatever interventions restored them to life.  Don’t let yourself be fooled by platitudes which are downright wrong and even dangerous.

Learn the signs of mental illness and of the possibility of suicide.  Learn how to pay attention, and what to notice.  Learn how to respond.  Learn what to ask and what to do.

Church is a place we can do that.  Tonight, in fact, at the Methodist church across the street, there’s a program by a representative from Life Act, the organization I mentioned last week that does the walks at the Zoo and provides extensive education on suicide prevention in the schools.  Go across the street and learn!    Invite trainers in mental health and in suicide prevention to do programs in the church.  There is Mental Health First Aid Training, just as there is Red Cross training for dealing with injuries and for performing CPR.  There are programs specially focused on suicide prevention training. There’s even one  for congregations called Soul Shop, in which I was trained last spring.

Why do all this in church?  Why not leave it to schools, or community groups, or hospital classes?

Because we live, and we die, and the faith community is where we make some sense of those things – and we need to help each other do that in a context of God’s love, taught and practiced.

And because we in the church practice a faith marked by baptism and resurrection.

Do we speak for ill or for good, James asks?  Who do you say that I am, Jesus asks?

What DO we say?  What do we say when confronted by a catastrophic loss of life?  What do we say, and how do we live, when everything in our world is shaken, when the ground tilts beneath us, when nothing will ever be the same?  What are we saying, what are we believing, what are we enacting, when we respond to death by suicide, and when we take it upon ourselves to prevent future deaths?

This is what we say, and believe, and embody:

You, whoever you are, whether “officially” baptized in the church or not, you are a beloved child of God.  That is the name we say at baptism, and it is the name that is irrevocably yours.  Beloved child of God. You have been a beloved child of God since the very beginning of your life and nothing, neither death nor life, nor anything in all creation, can separate you from the love of God in Christ Jesus. (Romans 8:38)  NOTHING.

And you, whoever you are, beloved child of God, your hope lies in the love and resurrection of Jesus Christ, and in the new creation toward which he is leading us, the new creation in which there is no more death or mourning or crying or pain, in which every tear is wiped away.

We live by faith and hope and love.  We have to do a lot of gritty work in between our birth as beloved children of God and our resurrection as beloved participants in God’s new creation.  We do a lot of living, and it isn’t all la-de-da.  Some of it is hard and life-altering and requires way more courage and perseverance than we ever had in mind to practice.

But we are a beloved people of the resurrection.  We are a people who speak out and live out the lives to which God calls us by faith and in hope and for love.  We are called as God’s representatives of a love so recklessly abundant and complete that it embraces us in all circumstances.  And so listen, and share your stories, and learn, and act – out of faith and hope and love. Amen.

 

 

Risk Delight

A few days ago, I listened to this On Being podcast, in which Krista Tippett interviews Elizabeth Gilbert, who quotes a poet named Jack Gilbert (no relation, I presume, as none was mentioned), and a line of his about “risking delight.”  I haven’t found the poem, but the instruction to “risk delight” deems to me to be a good mantra for all of life, but perhaps especially for the third third.

In my personal life, delight is that which evaporated ten years ago, and the road toward its rediscovery is long and rugged and often treacherous.  The potential for deight is found in the small and the vast, of course, from the tiniest of blossoms bursting forth in the springtime woods to the vast canyons and mountains carved out of eons in the American west, and countless other natural  phenomena on this earth and in the universe, and it is the only goal which I can imagine might counter the devastation wrought by natural and human proclivity for disaster.

Too often in the life of the church, my work milieu, delight is precisely that which is missing.  I wonder increasingly, as I observe jaws set in resistance, eyelids drooping with boredom, postures indicative of resistance: Where is the delight?  Delight is a foundational component in every faith tradition of which I know anything.  Today, out for a hike, my daughter and I saw a scarlet tanager.  I am sure that the Creator delights in that bird, as Jesus delights in the play of children, and the Spirit in the dance of the wind.  How have we so reduced that delight to arguments over fire escapes and sound systems?

In our public life, delight seems to be the missing factor.  It’s no wonder that the western world breathed a sigh of relieved anticipation on the morning of the royal wedding — what with Brexit and American politics and Russian misadventures and chaos and violence in the Middle East, we are starved for delight.  I am not the first person to notice that nothing in the way of joy or humor or enchantment emanates from the White House these days ~ quite the opposite, in fact.

Would we not live more abundantly if we risked delight in place of all that we so consistently fall for in its stead?

Ten ~ 1

In a few months, it will be ten years since my son’s death by suicide.  I might have some things to say.

I have a good life; don’t get me wrong.  We live in a beautiful home in a wonderful neighborhood ~ historic houses, walking distance to almost anything you might want, lovely people.  I have work which, at least some of the time, is meaningful and deeply satisfying.  Our living children have done well in the aftermath of trauma. One can survive, and even thrive.

I wonder, all the time, who he would be now.  I imagine whole lives for him.  That MBA from Chicago, a business career, a home in Hyde Park, a cottage on a lake.  The ballerina wife, the adopted Asian children.  Or the loans paid off, the desertion of the corporate world, the worldwide pursuit of photography, the life on the road.  Or the return to summer camp, the job with the farm and maintenance crew, the cabin in the North Carolina mountains, the wife and tow-headed children loving hikes and kayaking. Who knows?  None of it will ever be.

I loved being the mother of three small children.  I thought, at the time, that life could not possibly get better.  It turns out that I was right.  There will always be someone missing.

It hits me like the proverbial ton of bricks sometimes, usually inconvenient times.  A conversation, a glimpse into another life, a scene on the television, an article in the news.  I think I will die, but I never do.

Parts of me are missing.  I see friends losing parents; I see their lostness, their deep grief.  I don’t have access to those feelings anymore.  I have been saddened by my father’s death 18 months ago, and I often miss him, but his death from illness at the age of 85 was not for me an experience that in any way resembled the shock and horror and excruciating pain I felt in every nerve of my body after the death of my son.

I am not an easy person to be around, or to be.  I have no patience for the sentimentality that pervades so much of our culture of death.  I try not to mar others’ experiences of comfort, so a lot of the time I muster a meaningless smile and endure until a conversation or event passes.

I do hope, but it’s hard.

 

 

 

End of Life 3/3

breath air

Earlier this week, as a way of remembering Howard Gray immediately after his death, I flipped through a few of the emails I’ve received from him.  One of the first that popped up, written a couple of years ago, suggested that I read When Breath Becomes Air by Paul Kalanithi, M.D.  It looks as if I didn’t respond to the email, but I think that I had already read the book at that point.

Lucy Kalanithi, M.D. was the other main speaker at the Dayton conference a  few weeks ago.  The book (which I am not going to review here) details her husband’s experience with lung cancer; Lucy finished it after he died.  Paul Kalanithi was a brilliant young neurosurgeon when his diagnosis disrupted his life, and forced him to shift from physician delivering bad news to patient on the receiving end of a devastating report.  It’s a must-read for anyone whose life has jolted from one of ordinary dailiness (not that Paul Kalanithi was ever ordinary in the sense of the word which most of us understand) to the high drama of end-stage cancer.

Lucy spoke about the challenges she and Paul faced after his diagnosis, including

  • facing one’s own mortality
  • questions of identity ~ who am I now?
  • facing death and uncertainty
  • and the tension between living and dying.

That last one I remember so well from my stepmother’s stage 4 lung cancer diagnosis.  How do you deal with in-your-face issues of serious illness and likely imminent death and simultaneously forge a life among your family and friends?

Lucy left us with two poignant reflections, the latter emerging from the Q-and-A period and much discussed at out table.

The first had to do with Paul’s statement of desire: “I want everyone else to take care of Lucy so that she can take care of me.”  What a powerful recognition of, on the one hand, the needs of the primary caregiver, and on the other, the need of the patient for someone who can focus her life entirely on his need for care and support, to which everyone else can contribute by providing for the caregiver.

The second had to do with their conscious decision to have a child whose father would probably not live to see her grow up, whose father might not live to see her at all.  For the Kalanithis, their daughter was, and is, a life-giving source of joy and, while some shuddered at the thought of the courage required of her mother, most at our table could appreciate the powerful desire for love to break forth in the form of the birth of a child, even, or perhaps especially, in the heart of a sojourn toward death.

Please read this important book.  It illuminates an all-too-common experience, and may be the trigger you need to start a much-needed conversation with a loved one.

 

Rev. Howard Gray, S.J. (1930 – 2018)

HJG

As a middle and high school teacher (my second career) fifteen years ago, I was in need of a graduate course in literature or history, which I could not find.  Hmmmm . . .  Spirituality and Narrative sounded interesting.  “Who is this Gray professor?” I asked the department secretary.  “He’s new,” she responded.  “But people seem to like him.”  He was out of town for our first two classes, and a friend and I wondered distractedly about missing the date for a course refund.  What if we didn’t like him?

We did.  In fact,  I was mesmerized by the eloquent, well-read, humorous, and delightful 70-something Father Gray.  I took another course in literature from him.  And then a third, on Ignatian spirituality.  It was early in that semester that I asked him if he would serve as my spiritual director and help me make the Spiritual Exercises – a long adventure in prayer and one-on-one conversation.  I knew that my request would mean an hour of his time every week or so for months, so I was sure that he would turn me down.  But I so wanted whatever it was that filled this brilliant and elfin-like man with such an infectious joy.  “Oops,” I thought, when he said, “Sure,” and pulled out his calendar,  “Now I have to do this!”

That “Sure” changed my life.

As it tuned out, that was a year of relative peace and lack of drama for me, a leader in my local PC(USA) congregation, a teacher in a Jewish school, and the mother of three college students.  A perfect time to spend hours on a practice of prayer devised by a Catholic saint nearly 500 years earlier.  A couple of months in, it occurred to me to google Howard’s name and I discovered, to my astonishment, that this gentle and unassuming man was known across the globe as one of the foremost scholars and teachers of Ignatian spirituality.  Oops again.  What should I do?  How could I continue to take up so much of his time?  Eventually I concluded that, since he didn’t seem to mind, I would press on.  A few months later, I threw all caution to the wind and announced that I was going to seminary.  Howard, who was not supposed to say much of anything beyond a few suggestions as I made my way through the Exercises, exclaimed, “Will you get going?!”

Months later, I finally made it to seminary in Pittsburgh, and also started a program here in Cleveland for would-be spiritual directors.  Howard moved on to Georgetown, but we stayed in touch via email — I mostly complained about my courses in Greek, and he offered encouragement and witty commentary.

My darling Josh, my tall and blonde and blue-eyed and funny and brilliant son, died of suicide just before the beginning of my second year of seminary.  Howard was one of the first people I emailed, and he became one of what would eventually be a group of three Jesuits who encircled me with listening hearts and occasional words and hours and hours of presence.  It’s no exaggeration to say that I would not have survived those early years without Howard and his brother Jesuits, my personal lifesavers.

As I’ve written on FB, some months, maybe a couple of years, after Josh died, I was  ready to give up on everything – quit seminary, quit ministry, go live in Greenland or someplace. “Well, of course you can quit,” said Howard. “Or you can keep going for what may turn out to be the most productive years of your life.” I don’t know yet whether or not he was right. But he inspired me to try.

That’s the thing about those Jesuits.  They seem to be under the impression that one can do impossible things where God is concerned, and they don’t make a big deal about it.  Most especially, they don’t tell you that you can’t move forward just because your life is a mess.  They think that you can.

It’s been nearly 15 years since that first class with Howard, nearly ten years since Josh died, seven and one-half years since I was ordained in the PC(USA).   I have a stack of emails, most of them offering counsel and encouragement after my son died, but many others filled with humor and recommendations for poetry and other reading.  I often preach and teach things I learned from Howard, and I hope that when I am with people who are suffering or dying, I remember what he taught me, mostly through example, about presence.

I know that, with his death two days ago from injuries sustained in a car accident on Friday, the accolades will pour in.  He held positions of enormous responsibility and influenced thousands of people.  But to me, Howard Gray is that white-haired man with the gleam in his eye, the wicked sense of humor, and the capacity to be present to any experience of faith, from the highest mountaintop of exuberance to the most vast desert of desolation.

I will miss him very much.

 

Image:  Georgetown University, 2014.

End of Life 2/3

Steve Pantilat, M.D. was the keynote speaker for the conference entitled Soul Work on Living and Dying that friends and I attended a few weeks ago.  Dr. Pantilat is a renowned expert on palliative care — care which he describes as “focused on improving the quality of life for people with serious medical illness.”

I’m going to offer a few highlights of his presentation (any errors are mine, straight from my notes), and suggest that you read his book, Life After the Diagnosis.

life after cover

One: We tend to think that we must choose between quality and quantity of life: we must choose either every treatment offered us to prolong life, or refuse treatment and die. This is a false and damaging dichotomy, as much care is available to make life in the face of illness more palatable — and often longer.  Dr. Pantilat advocates for everyone receiving palliative care from a team of caregivers within six weeks of a diagnosis of metastatic cancer.

Two: A terrible question: “Would you like us to do everything possible?”  Of course; who is going to sat “no” to  question like that?  I have been with both parishoners and family when that question has been asked, and it has been very difficult to walk the conversation back with what is always my next question: “Could you please explain the likely consequences of a ‘yes’ answer?”

A good question: “How are you hoping we might help?”  People may have very specific goals related to pain management, surviving until a family event takes place, travel plans, where they want to be when they die — but an open-ended question is needed for those hopes to surface.  My own commentary: People are often too intimidated by the presence of a physician at a hospital beside, or too frightened by the death they have not discussed with anyone, to say, “I know I’m going to die soon, so I think I’ll skip the clinical trial, and go home to be with my family instead.”  We have to ask, not assume, what someone’s priorities are.

Three: People are fearful that talking about these issues will destroy hope.  In fact, talking about the questions increases hope.  Other good questions include, “What are you hoping for in your future?” “What worries you most about what lies ahead?”

Four: A most unfortunate statement: “There’s nothing more we can do.”  In fact, there is always something that we can do in terms of helping someone address their concerns, companioning them, and alleviating their feelings of abandonment.

Five: It’s a myth that the goal is to have a “good death.” I would take issue with his statement that “grief is not mitigated by age and a ‘good death,” but his overall point is a good one:  The goal is to live a good life.

Next post: Another of our speakers.

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