Picking Time: On Being Close to Death

October 22nd, 2011
This article is featured in the Rites of Passage (Nov/Dec/Jan 2011-12) issue of Circuit Rider

In mid-June when the deer move their fawns out of hiding, the wild black raspberries in rural New Jersey ripen to a purple so deep they’re called “blackcaps” by the locals. I’ve been keeping an eye on the berry bushes a mile down the road from our house, and the blackcaps are purple now—it’s picking time. I pull on long pants and hiking shoes, grab a large, empty Cool Whip container and head out the door.

I park on a dirt road alongside a chest-high thicket of multiflora rose, wild grasses, and vines. Thorny branches draw blood as I wade through them, but I’m so transfixed by the blackcaps I barely notice. I grab a handful, stuff them into my mouth and taste their sweet, sun-warmed juice. Tiny seeds crunch as I chew. I stretch for more and soon berries are rhythmically thudding into my makeshift bucket. My thoughts drift.

Brenda’s eighty-six-year-old mother died yesterday. Given her lab results, multiple complications, and underlying heart condition, I wasn’t surprised. Brenda and her brothers had wanted to be sure that everything possible was being done, so they’d had their mother transferred by helicopter to a regional medical center. They weren’t ready to let go. She died two days later.

I learned while serving as a chaplain in a university teaching hospital that death is not a here-one-moment-gone-the-next kind of thing. Death is more often a process like birth, its timing subject to the decisions and actions of any number of people.  

Early in my training I was on call one evening and got paged to the ER. A cab driver had suffered a heart attack while on the job yet had somehow managed to drive himself to the hospital. A passerby found him slumped in his cab outside the emergency room. When I got to the ER, a team of doctors and nurses was administering CPR while wheeling him into the crash room on a gurney. I stood off to the side and watched as the team worked their magic. They restarted his heart and moved him to the cardiac intensive care unit.                                      

Before going off duty I stopped by the CCIU to see how the man was doing. He lay perfectly still in a brightly lit cubicle filled with beeping machines and the rhythmic whoosh of a respirator pumping oxygen into his lungs. His name, a Greek name overflowing with consonants, was written on an index card above the bed. A strip of adhesive tape had been placed over each of his eyelids.  

“What happened to him?” I asked a nurse. “I saw him in the ER. I thought he was doing OK.”

“His heart was stopped too long before the medical team got to him. You can restart a heart but a brain starved of oxygen is rendered lifeless. We’re waiting for his family so we can disconnect him.”

“Why are his eyes taped shut?” I asked.

“To keep them from drying out. His family may want to donate his organs.”

In the ER it had been thrilling to witness a miracle of modern science, the restarting of a heart. Now I was filled with ambivalence. I couldn’t imagine that this man who’d wanted to live so much he’d driven himself to the hospital would have wanted this. “Where is he, God?” I heard the anger in my voice as I prayed. “Is his soul trapped in this body being kept alive by machine? If so, and if he’s not able to ask for release for himself, I ask it now on his behalf.”

In the thicket, the flitter of a monarch butterfly captures my attention. I track its flight to the berry-laden bushes cattycorner from where I stand. I follow, leaving behind the berries that will ripen later this week.

Did Brenda’s mother have a living will? Would it have made a difference? I used to think a living will offered protection from undesired end-of-life medical intervention. Then I attended a patient conference where the doctors, nurses, and a social worker recommended removing all machines from an elderly man in a coma. His daughter demanded he receive a feeding tube even though his living will clearly stated “no life support.” She argued that the document was nonspecific about feeding tubes. So for several weeks the man was fed liquids through a rubber tube inserted into his nose. He never regained consciousness.  

I’ve made my final wishes clear to my husband, Ed. “No feeding tubes. No bone crushing CPR. No extraordinary measures. When it’s time, let me go.” I trust Ed will honor my wishes.

When Ed’s ninety-six–year-old Dutch grandmother, Bappi, was sick with pneumonia, the local rescue squad transported her to the hospital. Bappi yelled, kicked, and tried her best to bite the men lifting her out of her bed at home, and in the hospital she refused to open her eyes or speak. When the nurses and aides weren’t successful in getting her to eat or drink, the attending physician ordered surgery to insert a feeding tube. Ed’s mother and I tried to coax Bappi into eating. I lifted spoonfuls of sweetened tea to her mouth, but she refused to unclench her jaw. A nurse suggested I try a feeding syringe borrowed from the pediatrics department. With the syringe the tea made it past her lips but was blocked by her teeth. The nurse told us Bappi wouldn’t be allowed to remain in the hospital without a feeding tube. Ed’s family made the decision to have Bappi moved to a local nursing home. There she was allowed to die without being force-fed.

As the sun dips toward the horizon, light falls on an especially gorgeous berry. It seems by its very being to announce, “I am ready.” Reaching for it, I wonder who picks the time we die.

Years ago I visited a bed-ridden veteran in a VA hospital. He was paralyzed from the neck down. Twenty some years prior he had put a shotgun into his mouth and pulled the trigger. Is there a reason, as people are wont to say, that he survived? Was he “not ready?” Was God “not ready” for him? Or did this vet just happen to pick the night an especially gifted medical team was working its magic in the ER?

A fifty-seven-year-old man whose family has been keeping nonstop vigil at his hospital bedside dies during the twenty-minute break they take to eat lunch. A mother holds onto life until her son returns on emergency leave from his posting in South Korea. A grandmother squeezes her teenage grandson’s hand as they celebrate her 69th birthday; later that day, after her family is gone, she passes away peacefully. I don’t believe we’re entirely passive participants in regard to the timing of our death. I believe we have some—perhaps limited—choice in the matter.

I’m not ready to die. But I am made aware of my own mortality almost every day when I make pastoral calls. When I read prayers aloud at gravesites, I am keenly aware that I take my life for granted. At a training event a number of years ago, I had to write my own obituary and allow myself to feel my own emotions about my death. I grieved the imagined loss of myself as if I was grieving the loss of my best friend, the only person who knew everything I’d experienced in this lifetime. Now that I’m married, I think about the pain of separation from Ed.

Will I die before him? Will he die before me? I’m older, but he’s truly a more loving soul. Lately I catch myself thinking with more frequency “Only the good die young.” It’s irrational and folksy, but all too often it reflects reality. What about the ornery, vindictive, seemingly heartless souls who live well beyond everyone’s patience and compassion? Sometimes I tell myself God is giving them time to work it out in this lifetime. Time to ripen. I wonder if there’s something invisible to the human eye, discernible only to God, that indicates when we’re ready, when it’s picking time.

comments powered by Disqus