Last rites
Several of my friends died recently, under different circumstances. I’ve been pondering death as physical and spiritual loses to both the deceased and their survivors.
I’ve written about my friend, neighbor and fellow physician Ray’s experiences while dying. His journey to death began when he developed heart failure from a brief hospital procedure, and ended a couple of years later with wretched joy.
His heart never fully recovered from the initial insult. His lungs began stiffening with pulmonary fibrosis. He developed painful nerve damage and weakness in his legs. First no more tennis. Then no more golf. Finally no more playing the trumpet. His ever-stiffening lungs controlled his activities.
He became weaker and weaker until he was huffing, puffing and resting after just transferring from a chair to his walker.
Ray was determined to die at home – if possible. His physician made house calls and spent time discussing his condition with him and his “children.” One lives in the Chicago area. The other in Pittsburgh.
He hired aides to help with daily activities. Sliding to the floor one night, he called 911 for help getting back to bed. After that he always had an aide with him.
I regularly visited. We talked about our childhoods, medicine, religion, music, sex and his relationship with his wife. And what dying was like. The visits became shorter as he began nodding off. He was always mentally alert and without pain or shortness of breath when resting.
His son or daughter began visiting more frequently. Finally, one was with him nearly every day. One morning they called and said he had become unresponsive. As he took occasional agonal breaths, the three of us sat around the bed sharing stories and talking to and about him as he terminally rested. After an hour I said goodbye to him and left the family to their private intimacy.
Two hours later they called to say he had stopped breathing.
His family gave Ray prayerful, spiritual last rites. He realized his wish to die peacefully, at home, in the midst of remnants from his rich and full life.
Ironically, a tennis buddy, Bob lived across the street from Ray. He had a different terminal lung disease than Ray, wheezing with activity. Bob was hospitalized several times with pneumonia. Each time was more difficult than the last.
The amount of care Bob required gradually increased beyond what his wife could manage with their in-home hospice’s help, so he was moved to the inpatient hospice. Bob and his wife both liked the home-like environment and were pleased with the excellent and friendly personal and medical care he received. Their miniature Schnauzer, Minnie routinely visited. They snuggled in bed.
At the end, he developed restless legs and other unpleasant symptoms that required additional medication. With his breathing problems and the medicines, he drifted into unconsciousness and died.
Providing palliative care medications that produce coma and death is called “terminal coma.” It’s sometimes referred to as slow euthanasia.
Nick, another tennis buddy, died a very different death. He was mortally injured in an accident at home. Rushed to the hospital, he was rendered unconscious to relieve pain and restlessness and admitted on life support to the ICU. It was soon determined that he could not recover. The machines were kept running until a family member arrived days later, then turned off. His physical death was peaceful.
We can only imagine how terrifyingly painful Nick’s last moments of consciousness were. And we can only imagine the stress his family was under when the medications and machines keeping his lungs working and blood circulating were shut down. But we can be confident that he died among the bright lights and strange sounds of a chaotic corner of the hospital.
I doubt his family had the time and support to bid their previously flamboyant loved one the farewell they would have preferred.
When rescue missions fail, medical personnel often mutter something about the case, turn, and walk away, leaving the human remains and material detritus for nursing assistants and maids to clean up. I wonder if anybody paused to say a prayer over Nick.
Traditional Catholic last rites involve a priest or church official hearing confession, administering communion, praying and anointing with oil to prepare souls for heaven.
Secular last rites of intimate communications and blessings to ease transitions ought to be universally practiced.
Poignant, well-written. Good food for thought.
This article is quite sad but I appreciate the perspective it helps foster in me. The day to day inconveniences of life sure get put in their place when framed by mortality.
As the only child of a 98-year old father who is still strong in mind, but weak in body, I have often pondered how to provide the best quality of life for his remaining time. This is complicated by the fact that we live on opposite coasts. He lives in a senior independent living community in his own apartment with one daily meal and various other services provided by the facility. Gradually his world has narrowed. About a year ago, he stopped composing music. This year, he closed his online stock trading accounts. Recently, after he had a short hospitalization, the physician at his facility rather forcefully suggested that he belonged in assisted living despite the fact that he can handle his own medication and is still handling his own finances. He resisted this idea, and I supported him so he is still in independent living. But this raises a question for me. How , as the end of life approaches, does one balance medical advice, the aging individual’s own wishes, and the responsibilities of his family who only wants the best for him? I would like to hear other people’s thoughts on walking this tightrope.
My perspective is that as the number of things that a person can control in his or her life diminishes, it is important to be able to at least “have a say” in some things. It might be what to eat or when to eat or what TV show to watch or book to read or bigger decisions. However, your father probably can’t objectively judge if he should live in the “independent” or “assisted living” section. Best wishes…..as you begin being more the “parent” and making major decisions for your father.
I have followed Jim’s articles for a number of years, and have been very interested in his concepts of life, and the way he has of cohesion them in pertaining to the medical field. My comments may cause a negative reaction, but I can assure you they can be backed up with references to the K.J.V. 1611. (only a few may understand that) I was particularly interested in his article on “Last Rites”. He mentioned two diverse types. Roman Catholic, and Secular. I mentioned this to him and hence the reason for my coming to this forum. What are the differences in the two? Are either one more likely to afford a place in heaven? Is there a heaven to gain, and a hell to shun? Of his three friends mentioned, would either one of them be at a disadvantage by the particular one he chose? (if he had a chance to choose) It appeared that Ray and Bob had a much better family structure than Nick. It seemed as though Nick’s family was under much more stress than the other two. His article states the problem was somewhat immediate, so time may have played a major role, I don’t know, I am only gleaning what I can from Jim’s article. If I had been one of the three mentioned, I would have regarded Jim’s friendship with very high esteem indeed! Any responses would be appreciated. Falconspath
When writing the article I was thinking of the different kinds of peace afforded the dying and their loved ones. I wanted to contrast secular and non-secular forms of last rites. Unfortunately, my friend Nick’s last conscious moments were painful and fearful. I don’t know what his last moments were like for his loved ones. I would like to see medical care professionals recognize the spiritual significance of death for everyone involved.
I have just finished reading “Mortal Blessings” by Angela Alaimo O’Donnell, a professor at Fordham. It is the intimate story of her mother’s last weeks on earth and what she calls “a sacramental farewell,” in which she and her sisters provide the sacraments to her mother. O’Donnell insists there are not only 7 sacraments but many more, including the sacraments of speech and beauty and even of the wheel chair and cell phone. It’s a wonderful book, both Catholic in its foundation in her Roman Catholic faith and catholic in the sense that it applies universally to all our families. I highly recommend it, especially to those who care for the dying