The Quality of Dying and Death
Part II of a Life Long Learning Seminar on Death and Dying
It was another beautiful fall day.
For talking about dying and death.
And everyone came back!
If you just added the class today, you can catch up by reading the two previous stories below.
The only prerequisite is that you expect, someday, to die.
The final exam is a take-home.
This seminar, particularly today’s topic, the quality of dying and death, is personal. Everyone had a story. That was clear from today’s discussion. I’ll describe two in a minute, but first, mine.
The best teaching comes from the heart.
My mother died in 2017 at 96. She had been in a memory care unit facility for two years. You can read a fuller account here.
On her final day, she endured two ambulance rides, three rooms, three beds, three gurneys, and three institutions before she drew her last breath. All of this, despite a Do Not Resuscitate order form.
Dying at home was not an option for my mom. My brother Pat, who lived in her city, kept her in the house she had lived in for 60 years for as long as possible. He reluctantly admitted her to a nursing home when she started wandering outside her home, where she lived for two years. Miserable every moment. That’s where she should have died.
Or
Maybe we should have done what Danny, in Wendell Berry’s short story Fidelity, today’s reading assignment, does for his 82-year-old father, Burley.
Burley Coulter “had begun to lose use of himself, his body only falteringly answering to his will.” His immediate family, son Danny, nephew Nathan, and their wives, Hannah and Lyda, reluctantly took him to the hospital in Louisville. They didn’t know what else to do — “he’s going to die.”
Once in the hospital, surrounded by strangers and machines, Burley “slipped away toward death. But the people of the hospital did not call it dying; they called it a coma. They spoke of curing him. They spoke of his recovery.”
Danny and the others felt “like they had abandoned Burley.” So late one night, Danny slipped into the hospital and secreted Burley to an old barn. He looked at Burley's face when he laid the dying man down:
It was, as it had not been in the hospital, unmistakenly the face of the man who for eighty-two years had been Burley Coulter.
Danny asked Burley whether he knew where he was. Burley smiled and said, “Right here.”
We selected Berry’s terrific story to serve as a jumping-off point for our group of forty to tell their own stories of the final journeys of their loved ones. Most of the stories included judgments about medical care.
You’ve read about my mom. Here are two others.
Rebecca’s grandmother went voluntarily into the nursing home when she was 85. At 99, she had surgery for a bleeding ulcer. A year later, she slipped into a coma, and her family — Rebecca’s mom and a sister — OK’d a feeding tube. Her grandmother never came out of the coma, dying at 106. Rebecca said her mother often said she would like to go to the nursing home, kidnap her mom, and remove the feeding tube because her mom’s physician refused to. Of course, she never did.
Mike’s father was on kidney dialysis. After one session, he was so depleted that his physician said he had begun to die. But after a week, he recovered enough for another dialysis a month later. This weakened him enormously, so Mike put his dad in hospice care, where he died a week later. Mike still feels guilt because this meant no extraordinary measures to keep his dad alive, such as a feeding tube.
On my mother’s last day, when she was having trouble breathing — the death certificate listed COPD as the cause — the nursing home should have turned her room into hospice care. That’s what we were told would happen, given our DNR order.
My brothers and I know our mom would have preferred to die in her home, her “old barn” of sixty years. That’s the power of Wendell Berry’s story.
But her mental and physical deterioration made that impossible. Institutional care, in our judgment, was the best loving choice. Yet, Berry’s Fidelity hurdles another possibility at us. Couldn’t you have cared for her in one of your homes? Or took turns — all three brothers were retired when our mother needed nursing home care — in her home?
Most of our seminar group sympathized with Danny’s lawbreaking effort to steal Burley away from strangers and take him to a “good place.”
And a few others joined Rebecca and my stories about things going wrong in hospitals or nursing homes.
But most described skillful and attentive medical care for loved ones dying in institutions.
I’ll end with my teaching colleague Ruth’s story about her friend Martin’s death in a nursing home.
I am grateful I was in the room at a ceremony when my friend Martin died. There were 12 of us, including Martin’s wife Mary Lou, gathered around his bed, with many touching a part of Martin, commenting on how this part had been used in his life. Martin died during this ceremony.
Next week’s topic is the right to die.
