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.
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.