Reflections on Hospice
My aunt died this past weekend. While her health took a sudden and dramatic downturn, the dying process lasted several days after she was admitted to a hospice care facility. It is not the first time I have experienced the loss of a family member. Three years ago, my father died suddenly from a heart attack, and I have visited church members and others in the days leading up to their death. But this was my closest perspective on the hospice process. It led to reflection on the processes of honoring the dignity of life even during the final stages of death.
After a long series of painful injuries and illnesses, my aunt and her family decided to discontinue medical intervention and allow the natural processes to take their course. Last Tuesday she was admitted to a hospice care facility near Pittsburgh. By the next day her health had clearly deteriorated, but she was still conscious and able to communicate. After a prolonged illness her strength had been sapped. As she lingered on the edge of communication she told her family that she was ready to die. Unfortunately, her husband of 59 years was hospitalized at the same time, though he now appears to be recovering physically.
On Wednesday the family gathered at her bedside. Stories were shared from days long passed. Occasionally my aunt would speak out to offer a correction or to share a remembered detail. Speaking was hard for her. As the day went on, she seemed to be less communicative. She was worried about my uncle and worried that she was inconveniencing everyone. I prayed with her and for her.
On Thursday I was occupied, but I visited again on Friday. At this point she had drifted into a semi-conscious dreamlike state. It is often said that hearing is the last to go, so I read the Scriptures to her for an hour. I hoped that she could her the promises of God and the comfort that is offered to those who are in Christ. Later in the day, I received a vivid picture of just how much the human voice was able to penetrate into the deepening veil of her silence. My uncle was rebounding in the hospital and he had been put on speaker phone on a call to my aunt. In a weak voice, he promised to care for her and come to see her as soon as it was possible. He reminded her of his love for her with the words of affection that they had shared for 59 years.
The words seeped down into my aunt’s hazy sleep. After nearly two days of silence, she began to stir. Her eyes remained closed, but her mouth opened. Her lips formed words, but her lungs were too weak to push them into the air. Still, the response was startling. I stood up and walked closer. The bond formed over six decades was visible in her gasping attempts at response. Her words couldn’t break through the air around her lips, let along carry through the speaker back to her husband on the other end of the phone. But we know that she had heard him. In her own way, she was responding. We could assure him of that.
Within a few hours, her breathing slowed and became more labored. The nurses shifted her on pillows to allow better air flow. Eventually, they needed to suction some of the fluid from her lungs. At one point on Friday evening her breathing became labored and it seemed that the end must be near. Family gathered around speaking last words to her. We couldn’t know if she had passed beyond being able to hear anyone. And so she was encouraged to let go… to commit her spirit to God… to slip into an eternal rest. It seemed to clear that she would slip beyond us and into the presence of God. Death was drawing close.
Except that it didn’t. For everyone watching it seemed that it should be over. But it wasn’t. The nurses shifted her. Her breathing returned to a normal rate. She sunk deeper into sleep and her breathing – though shallow – remained steady.
And we waited. The nurses came and went. She was bathed. The pain medication was continued and even increased. She remained asleep. Slow breath coming in little puffs. The vigil continued throughout the night and into Saturday. It was then, after the false climax that the hospice experience really began to impact me.
In hospice we can see both the dignity of human life and its mysterious vitality that lies beyond our grasp. As life slowly slipped from her unconscious body the nurses continued to care for her. This is a reminder that life has value even when it has seemingly low quality. Who knows what could be happening inside her brain as she lay on the bed. Who knows what God could be doing inside a person who has embarked on the slow struggle that we summarize simply with the word: “dying”?
The temptation to end her life prematurely could be strong. As “physician assisted suicide” gains acceptance in western culture, new measures may increasingly be introduced that would alter the way in which this situation was handled. How tempting it would be to play God and seek to intervene definitively once the end seemed certain. How easy it could become for well-meaning friends and family to encourage a poisonous injection that would have hastened the dying process.
But instead, we waited. Our medical process still prohibits doctors and nurses from ending life so no quick fixes were offered. Instead, her pain was treated. Her body was washed. Her family spoke over her in kind words and quiet prayers. Favorite songs where played on an iPad. And we waited.
Through the next day her closest family alternated in their vigil to assure that she would not be alone. When I wasn’t obligated to other ministry services I sat there as well. It had been days since eating or drinking, her IV offering only a regular supply of pain medication. For the entire next day, her breathing did not change. Life continued to flow within her silent body. But as we waited, we were changed. As we waited before the awesome and unpredictable shadow of death, I was changed. The dignity and wonder of life was impressed more deeply on my mind. Our fragility and dependence upon God was highlighted. Against the steady beat of modern technological control, the glow of life throbbed just beyond the edges of our control.
And then, late on Saturday evening, my aunt’s breathing slowed. In the presence of her only sister, her shallow breaths stopped. And her heart beat no more. Then she was gone.
I will miss her. My mom will grieve the loss of this last link to her nuclear family. My uncle will have to sit beneath the shadow of this loss for his remaining days. I am reminded why death is called an “enemy” in the Bible. It robs and it destroys.
But I am also thankful for this experience of death. Until God intervenes in human history to fully establish his kingdom - death will reign. Broken only by the resurrection of Jesus and the promise of a great future restoration. In Christ our grief is rimmed with hope. Until God sets all things new, death will continue to bookend the final days of all our lives. Some of us will die quickly. Some will die slowly. Some will be surrounded by friends and family and some will slip into darkness in the quiet of our own beds.
If I have my say, I would like to die with my closest friends and family nearby. I would hope for a process that upholds the dignity of human life made in the image of God. I would also hope for a process that leaves the final contours of life firmly in God’s hands and refuses to grasp for abrupt control at the end of life. I am thankful that the process of hospice, as I experienced it, continues to guard those two important principles.
(A quick work of explanation for the blog. I couldn't update the blog at our last hotel spot, so I had to save the posts and put them up all at once.)
We are not yet fully home, but we landed in Philadelphia last evening. Slept the night at my sister’s house and we are preparing to go to church with them this morning. Afterward, we’ll drive to Clearfield where I will drop of my mom and then catch up with my family at a nearby cabin for two nights away before returning to work on Tuesday morning. I am eager to see my family and looking forward to being with my church family again for the Easter week.
Mom did a great job on the trip. She was determined to see it all and she did just that. At times she needed a little boost, but she made it to the end of the road. I really admire her courage to go and her perseverance. It was not an easy trip, but it was a wonderful one. It was an incredible privilege to see Israel -to view the ancient ruins of Biblical cities and to immerse ourselves in the modern country that is making fertile lands out of the desert. We caught a glimpse of the conflict that mires the region and have renewed concern for complexity of the issues there. We are led to pray for the ministry of the Prince of Peace. May his gracious rule bring true “Shalom” to this troubled land.
The Empty Tomb
Our tour concluded with visits to both the Church of the Holy Sepulcher and the Garden Tomb. Visitors to Jerusalem know that they represent two very different options for locating Golgotha and the tomb of Christ. Of course, neither site can be confirmed. The first cathedral was built by Constantine in the 4th century, apparently on the location of a former chapel which commemorated the supposed location of the crucifixion of Christ. It was destroyed and rebuilt many times over the years, but is still a magnificent structure. Archaeologists have shown that there are tombs in the area which date to the first century, but beyond that nothing is certain. It is difficult to locate anything in a city that has been destroyed and rebuilt so many times.
By contrast, the Garden Tomb is a more recent discovery. British archaeologists in the 19th century noticed a rock structure that looked suspiciously like a skull. Since the Gospel accounts speak of the location of the crucifixion as the “place of the skull” (Golgotha) it was an intriguing find. The proximity to the road and the city gate fits the Biblical description and nearby excavation revealed an ancient vineyard. Further excavation uncovered an tomb that was cut into the rock and closed by a rolling stone. Unfortunately, the tomb has been determined to be from earlier than the first century. It is too old to be the tomb of Joseph of Arimathea.
To their credit, the guides at the Garden Tomb don’t over-sell their case. Our tour was led by an Arab Christian from the nearby Palestinian village of Bethlehem. He not only shared information about the location and about first century practice, but he read to us from the Scripture. “The important thing,” he said, “is not where the tomb was, exactly. The important thing is what it means. The tomb means that God so loved the world that he gave his only Son, so that whosoever should believe in him would not perish but have eternal life.” I think that the words of Scripture spoken by the mouth of our Arab brother meant more to me than anything I saw at that location.
In a similar way, my thoughts on the tomb of Jesus were shaped by an offhand comment from our tour guide. Our guide for the week was a Messianic Jew that grew up in the Soviet Union before immigrating to Israel. He clearly loved Israel and was fiercely proud of his people. But he had come to know Messiah Jesus while in Russia and brought his faith with him to the Holy Land. His encyclopedic knowledge was paired with wit and love for the Lord. Sometimes his off-hand comments were more memorable than anything else. At one point he tried to describe what we would see when we entered the Church of the Holy Sepulcher. He was animated by the details, but he knew that this historic location touched on the heart of the Christian faith. I will end with his words.
“Inside the large dome of the church is a small dome. It is like Russians dolls – one inside the other. The people wait in a long line for hours to enter the smaller chapel. And inside the chapel what they think is the tomb. And the people wait for hours to go in and when they do, they look around and see that Jesus is not there.” And in a moment, his voice rose as he progressed from the technical description to proclaim his faith. “Jesus is not in the tomb… He is Risen!”
That alone was worth a trip to Israel.
My former post was about diversity among Christians, but that is only part of the story. Jerusalem is a 5,000 year old city and it contains layer upon layer of religious expression. Today it is still a very important religious city for the worlds three largest monotheistic religions. Jews, Christians and Muslims consider it to be a place of great importance. The Old City of Jerusalem is divided into sections of Jews, Muslims and Christians - all of whom trace their lineage back for hundreds of years in the city. Currently, the city is under Jewish control, but that has only been the case since the 6 Days War in 1967. In the tentative balance of Middle Easter politics, the local people navigate the delicate relationships which characterize their daily life.
At the Western Wall, the Muslim call to prayer, the Christian church bells and the groaning prayers of the Jewish people rise together into the air of this contested city.
First a quick review. On Wednesday we saw Masada and En Gedi as we made our way to Jerusalem. Upon entry we went to the City of David and sloshed through Hezekiah’s Tunnel. Yesterday we started at the Western Wall, viewed the excavations under the city, then crossed the border into Palestinian controlled Bethlehem. We returned to see the traditional locations of Caiaphas’s house and the upper room. Today we did a walking tour of Jerusalem, starting with the Mount of Olives, into Jerusalem and the pool of Bethsaida and then along several stops of the historic Via Dolorosa, all the way to the Church of the Holy Sepulcher. We then concluded with a tour of the Garden Tomb and walked back to the hotel.
A couple of stories from this time demonstrates the tense nature of inter-religious balance.
On Thursday we closed our day today with a visit to an old site that commemorates the last supper. It is highly doubtful that this marks the actual location of the last supper, but the building has been venerated for that purpose since at least the time of the crusaders and maybe before. Almost unbelievably, it is located on top of what the Jewish people recognize as the tomb of King David. The small building which contains the purported sarcophagus of David is filled with praying rabbis and is considered to be the second holiest Jewish site in the city. During the time of Turkish rule, the hostilities surrounding the use of this location created enough tension that the local Muslim ruler attempted to solve the problem by turning the building into a Mosque. That was not a great plan. After the city returned to Jewish control in 1967, you can imagine the problems that ensued. One location is considered a significantly important holy site by three religions. As we entered, our tour guide warned us: "The rules are very strict here. You cannot pray out loud, you cannot sing. You must be careful. We do not want to start a fight."
On Friday I was struck by a vivid picture of these converging and conflicting religious streams. The Via Dolorosa is the supposed route that Jesus took as he endured suffering and rejection on the way to the cross. Some of the sites reflect Biblical stories and some are extra-biblical. Given that the city was so often destroyed and rebuilt, it is hard to know with any certainty where particular things were located. It is also interesting that the route progresses through the Muslim quarter of the city. The street vendors and narrow corridors make the route feel both foreign and ancient.
We ate lunch on a corner where the Via Dolorosa turned onto a larger thoroughfare. The corner had one of many outposts of soldiers with the Israeli Defense Force. Military service is mandatory for all citizens (male and female) and many of the soldiers are in the late teens and early twenties. The larger street (by Old City Jerusalem standards) in front of our café was a major passageway for Muslim worshippers to access the Mosque on the Temple Mount.
At the beginning of our lunch the call to prayer echoed through the streets as Muslims streamed down to the mosque. Throughout the meal, Christian pilgrims continued to pour down the Via Dolorosa. Eastern European women with their heads covered in scarves, and priests in long flowing black robes trekked in the ancient pathway of Jesus. During the meal, several young Palestinian men were pulled from the street, questioned and searched. A reminder of the continued police presence in this conflicted land.
At the end of the meal, the flow of Muslim worshippers reversed course and moved backward, away from the Mosque. Now the two streams were moving in opposition. In front of our tables, the throngs of Christian pilgrims jostled with Muslim worshippers, under the watchful eye of the Israeli police. Distinct clothing marked the contrast in these great monotheistic religions. M-16’s and police baracades were a reminder of the ongoing hostilities. It was a picture of the conflict and the struggle to coexist in this ancient land.
The Mountain of the Lord
One of the most surprising aspects of this trip is the incredible diversity of life here in Jerusalem. That is happening on so many levels.
First, there is an remarkable diversity of Christian pilgrims in the city. Tour buses full of African Christians and Europeans from the former soviet block countries jockey for position in the park lots of the ancient churches. Tonight, as I write in the lobby of our hotel I watched a group of Italian priests receive an introduction to the hotel. After their departure the room fills with Korean women in the 50's and 60's.
This morning I was asked to give a short devotional during our bus ride and I read from Isaiah 2:2-3. City Reformed people will know that we did a 6 week blog series based around those verses last year. Today I saw the most vivid depiction of God's people as we toured the Holy sites of the city.
It shall come to pass in the latter days that the mountain of the house of the LORD shall be established as the highest of the mountains, and shall be lifted up above the hills; and all the nations shall flow to it,
and many peoples shall come, and say: "Come, let us go up to the mountain of the LORD, to the house of the God of Jacob, that he may teach us his ways and that we may walk in his paths." (Isa. 2:2-3)
Today I saw people from every continent flowing to the mountain of the house of the Lord. Literally.
But diversity among Christians is only part of the story. Jerusalem is a 5000 year old city and it contains layer upon layer of religious expression. It is a very important religious city for the worlds three largest monotheistic religions. Jews, Christians and Muslims consider it to be a place of great importance. And that is not an easy arrangement. The Old City of Jerusalem is divided into sections of Jews, Muslims and Christians - all of whom trace their lineage back for hundreds of years in the city. Currently, the city is under Jewish control, but that has only been the case since the 6 days war in 1967. In the tentative balance of Middle Easter politics, the local people navigate the delicate relationships which characterize their daily life. At the Western Wall, the Muslim call to prayer, the Christian church bells and the groaning prayers of the Jewish people rise together into the air above this contested city.
One particular story demonstrates the tense nature of this balance. We closed our day today with a visit to an old site that commemorates the last supper. It is highly doubtful that this marks the actual site of the last supper, but the building has been venerated for that purpose since at least the time of the crusaders and maybe before. Almost unbelievably, it is located on top of what the Jewish people recognize as the tomb of King David. The small building which contains the purported sarcophagus of David is filled with praying rabbis and is considered to be the second holiest Jewish site in the city. During the time of Turkish rule, the hostilities surrounding the use of this location created enough tension that the local Muslim ruler attempted to solve the problem by turning the building into a Mosque. That only made it worse. After the city returned to Jewish control in 1967, you can imagine the challenge of balancing these three different expectations. This one location is considered a significantly important holy site by three religions - with a long history of conflict. As we entered our tour guide warned us: "The rules are very strict here. You cannot pray out loud, you cannot sing. You must be careful. We do not want to start a fight."
This sign was on the wall:
Matt Koerber is the senior pastor at City Reformed Presbyterian church. This is his personal blog that he also asks guest writers to participate on.