Legacy of Hope June 1st, 2008

Howard Spiro, M.D.

Emeritus Professor of Medicine, Yale
Founder of Yale's Program for Humanities in Medicine

Dying Prolonged?

Good afternoon! Some months ago at the Yale-New Haven Hospital Dr. James Kenney, good friend and colleague, lay in the deep despair of dying.  Tormented  by the failure of his body, he was even more anguished by his search for a medical solution. Before he fell sick, Jim would have called it Angor animi,  in the familiar Latin he so loved. Only a few days later, here in Hospice Jim Kenney, classicist and Catholic,  found the blessing of serenity. His family too found  comfort in the calm consolation of nurses and doctors, his priests, and other watchers in the nights of so many last days.

And that is why I’m honored to be here today.

Whether we regard death as the end or as a portal to a new life, most people hope for a peaceful ending, or one mercifully quick, but we can find still the faithful few who bear their suffering patiently as their lonely sacrifice.  Many want friends and families around, others prefer a quiet exit, but most, one suspects, want to leave a memory of their final days that will comfort  those who remain,  memories that will complete their life story.  Dying brings a time, too we should not forget, to forgive, and to be forgiven.

That alas has not been the fate of so many murdered by their fellow creatures in the last century, and sadly in this new one, as well.  The 20th Century gave lie to the hopes of the 19th that the world was growing ever better and that nations, those lions and lambs the Bible tells us of, would some time soon unite in one great fellowship of love. The slaughter of the First World War, the Holocausts of the Second, the massacres that still follow all over the earth, remind us that evil has never been confined to one group alone, but that it is universal.  Those millions who died in the 20th century have no memorial. Oh yes, there are sculptures and obelisks, other witnesses to the collective millions, but each of those persons, mothers and fathers, children and babies, died alone, unknown, remembered only as a collection of victims, shorn of their family. Memorial like the ones inscribed here are not for them.

When young, I was sure that it was a blessing to die at home. But medical care has had its victories, and now an old physician, I wonder whether it is life that we doctors lengthen or, sometimes, whether it is the act of dying that we  prolong.  Some of you here today must have shared the turmoil that comes from doing all that it is possible to do medically. And you may well have learned to question the purpose of each new medical effort.  “Why?”  is a word not often enough heard at the bedside of those who die in a hospital..   

I am more sure than ever that dying with Hospice care would be my choice, for Death is not welcome in the bright lights of the intensive care units.  For physicians, there is always hope, and for people with cancer the development of controlled clinical trials seems to have brought a duty to participate in them. But there are times, certainly with the elderly, when there may not be enough conversation about the sacrifices that are asked, of chemotherapy, radiation, and mutilation . Modern medical care brings miracles, but not to all. Such studies bring new knowledge, but at such great cost to dying men and women.

For whom are those last months lived?  Few physicians can agree with mercy killing or euthanasia, but more are beginning to ask, once again, whether death is always the enemy that must be fought so hard and so long.  Physicians and patients alike, we need to talk more about these matters, and we need to do something about them.

Most here today have honored your lost loved ones, out of gratitude for the care that Hospice has brought. Words are so important, a peaceful passing, a last goodbye,  can strengthen a family.  The dying shape their memories by their last words, but we who are left also frame that memory by our actions and our attitudes.

Somewhere, somehow, all of us need to recognize in our hearts and in our minds that aging and dying are part of life that society, our society, should welcome --and provide for. We have kindergartens for our children, and we should build refuges for our fathers and mothers. What you have helped to build here will proclaim lasting memories, and   will provide the road for others who come to travel the way we all must go.

In our secular age, many still look for faith in something. In the heavens, some find constellations and others the  Creator, but  humankind yearns for something more than what we can see.  Just so, in the bricks of memory, who knows what messages will be found.

Hospice brings the gift of peace, the blessings of a connection and compassion. The memory of the last days of my friend here in Hospice brings serenity and even joy that overcomes our grief at his loss.

The poet Isaac Watts  wrote,

“Time, like an ever-rolling stream,
   Bears all its sons away;
They fly forgotten, as a dream
   Dies at the opening day."

Hospice keeps that dream alive. Thank you. God bless us all.