[Here is a contribution we feel our pastors, doctors, nurses, and Bible instructors will appreciate. The author, who expresses himself out of a wealth of experience, opens up a theme very close to the human heart.
In the same issue of Pastoral Psychology, from which we obtained permission to reprint Dr. Beatty's article, is an interesting discussion in "The Consultation Clinic" section. To the question, "What is the role of the minister or chaplain in telling a parishioner that his illness is hopeless and death is imminent?" a number of answers are given. Two of these have been selected because they are typical—one by a minister and the other by a physician. These appear at the end of this article. —Editors.]
"Now while they rested and waited for the good hour, there was a noise in the town that there was a post come from the Celestial City, with a matter of great importance to one Christiana, the wife of Christian the pilgrim. So inquiry was made for her, and the house was found out where she was. So the post presented her with a letter, the contents whereof were: 'Hail, good woman. I bring thee tidings that the Master calleth for thee and expectest that thou shouldst stand in his presence, in clothes of immortality, within this ten days.'
"When Christiana saw that her time was come, and that she was the first of this company to go over, she called for Mr. Great-heart her guide, and told him how matters were. So he told her he was heartily glad of the news, and could have been glad had the post come for him. Then she bid that he should give advice how all things should be prepared for her journey. So he told her saying: 'Thus and thus it must be, and we that survive will accompany you to the river-side.'
"Then she called for her children and gave them her blessing, and told them that she yet read with comfort the mark that was set in their foreheads, and was glad to see them with her there, and that they had kept their garments so white. Lastly, she bequeathed to the poor that little she had and commanded her sons and daughters to be ready against the messenger should come for them. . . ." —JOHN BUNYAN in Pilgrim's Progress
It is not likely that the modern-day Christiana would find as ready an acceptance of the approach of the end of her earthly life as did the Christiana of John Bunyan's story. We do not want to face the fact of death. We do not want to talk about it. There is real evidence to support the idea that many people do not want even to think about it. And so we use subterfuge. We encourage ourselves to think: "It will be better for the patient if he does not realize how sick he is." Even when the best medical judgment indicates that the end is near, it is usual rather than unusual to maintain the pretense that the situation is serious but not critical. Many a patient slips into a coma from which he does not recover without ever having had the opportunity to communicate with his loved ones. The normal good-bys of a short trip are often denied the one who makes the long journey. There is a hardened convention, a conspiracy of silence, that makes it difficult if not impossible for the critically ill person to talk about his impending death.
After the funeral service for an eighty-oneyear-old woman (at which, incidentally, the story of Christiana's passing was read), one of her daughters who had been with her constantly during her last illness was heard to say: "That last week mother thought she wasn't going to get well; but I didn't let her talk about it." The daughter felt that she had done the proper thing. She expected that her stifling of the mother's desire to talk about the end of her life would be applauded by her hearers. There was, in fact, a considerable nodding of heads as though her action had been both natural and wise.
A hospital chaplain, in a report of his experiences with the dying, says that it is the accepted procedure at his hospital never to acknowledge to critically ill patients that the end of life is probably near. Doctors in his hospital, he says, never indicate to patients that they may not get well. Nurses are instructed not to answer questions, or at least to dissemble when asked questions, about the seriousness of the illness. Even the chaplain, when he allows patients to discuss the possibility of impending death, is considered to have done the wrong thing.
These are not isolated or unusual situations. The very general evasion of any frank facing of the probable end of earthly existence seems to be more the rule than the exception.
Why Should It Be Talked About?
It would seem that the idea of the impermanence of life should by now have worked its way into the thinking and feeling of all people. We know that death comes to all of us. The younger we are, of course, the more likely we are to think that it comes to others, not to us. But we all know that sometime or other death comes. This knowledge, however, seems to be in the category of those things that we "know about" rather than those we "know." It is accepted by our intelligence but has not worked its way into our feeling knowledge. We know in theory, but we have little actual feeling that it applies to us. Perhaps this accounts in part for the ease with which we avoid any talking or even thinking about the matter.
Are we right in the avoidance of any discussion of the end of life? Is it true, as some think, that honest recognition of the probable outcome of a critical illness is likely to precipitate a death that would not otherwise occur? Is that physician right who holds that no patient in any circumstances should be told that he probably will not recover?
Many patients, it is true, do not need to be told in so many words. 'I'hey have a surprisingly accurate way of estimating the situation. Sometimes they enter quite willingly into a little drama of deceit, pretending to friends and loved ones that they consider the illness only a temporary setback, while at the same time convinced in their own minds that death is near. Should we fall into line with this attempted evasion of one of life's great realities?
A quick answer one is likely to get is a return question. Why should it be talked about? What is to be gained by talk at a time like this? If a person dies, he dies; if he gets well, what was the value of the talking?
There are, of course, many answers to that. Take just one, for illustration. Ben and Alice had lived together for twenty-seven years. Their older children were married and had moved away. The younger ones were still in school. Alice took sick and was for several weeks in the local hospital. One day Ben came to his minister to pour out a heart full of anguish. Alice, he said, was probably not going to get well. The doctors had talked to him about her condition. "But," he said, "she doesn't know how serious it is!"
A short time later the minister called on Alice. In the quiet but serious way of the critically ill, she told of her feeling that she was not getting along well and that if things didn't change she wouldn't get well at all. She felt, she said, so sorry for Ben. "He doesn't know how bad it is!"
The minister's response was somewhat in this fashion. "We all hope that you will recover. I know that the doctors are giving you very special attention. But if you feel this way, why not talk to Ben about it? At any rate, if he gives some indication of his concern, don't shut him off." Returning to Ben he made much the same sort of suggestion. If Alice wanted to talk he should not discourage her.
Two days later Ben reported with tears in his eyes but with a face that glowed with inner light. He and Alice had been re-living their life together. They had talked about the children and their hopes and plans for them. They had recalled, together, their early life and the little incidents, both sad and gay, that had stuck in their memories. A part of the time they had just held hands and been silent. Alice was in a coma now. She didn't seem to know when he came or went in the room. But it was "all right"!
Death need not be unrelieved calamity. Sometimes, of course, it appalls us with its cutting short of a promising life. Often it comes as the culmination or coronation of a life well lived. In such circumstances it seems wasteful, if not almost cruel, not to allow the person to summarize, to take stock of the past, to express love and affection for those who will remain to carry on the living of life when this one steps out into a new dimension. Indeed, some of the most significant living can be lived in the shadow of the imminence of death. Should this hallowed experience not be the accepted rather than the unusual happening?
It may come as a surprise to many people to find how often those who live in the valley of the shadow of death appreciate an opportunity to talk freely about the great event. One such was a woman of mature years who, dying of cancer, was being cared for in the home of her son and daughter-in-law. Friends and neighbors who had known her through the years were very faithful and gracious in visiting her as she lay in bed. They all wanted to be helpful. Many of them spoke words of encouragement —or so they thought! They talked about what she would do when she got well. They tried to have her feel that they were much encouraged to find her looking so well, in spite of the fact that she had and used a hand-mirror that lay on her bedside table.
A clergyman from a distant city, apprised of the seriousness of the condition and correctly intuiting that she was as aware as anyone of the actual situation, brashly introduced the subject by saying: "Well, Bella, I understand that you're not going to get well." Her response was instant. "Oh, do come in and sit down," she said. "You're the first person I've been able to talk to in the longest time! They keep telling me how much I'll enjoy my garden in the spring. But I'm not going to be here in the spring!"
They went on then to talk of other matters having to do with her final days. Quite without prompting, she talked of her satisfaction in her children; of her regret that she would not be able to see her grandchildren grow up; of her feeling that, perhaps, her contribution had been made and that her final days would be free of responsibilities. She talked too of her thoughts of life after death and of her concern lest when the actual time of death should come she might not be able to face it well.
Since she had lived courageously, the minister indicated, it would be quite probable that she would die the same way. He would expect that her last acts in this world would be of a piece with her living all along. If she should be so weakened in body that she should be tearfully tired, that would certainly be understandable to her friends and loved ones. Did she want to talk to the children about all these matters? Yes, she did if it would not be too difficult for them.
When the children learned of her desire to tell them of her feelings, they took the attitude that if that was what Mother wanted that was what she should have. The last weeks that she was conscious were full of subdued satisfactions both for her and for her family. They have never stopped being grateful for those last intimate days together.
Shall we talk about death?
