At New York hospital, a friar watches over those dying

‘The miracle is to let go’

Brother Robert Bathe, a Carmelite friar, outside of Bellevue Hospital in Manhattan.

By Kevin Armstrong
The morning after he turned 52 last month, Brother Robert Bathe emerged from the Millennium Hotel on West 44th Street. He ambled half a block into Times Square and reflected on the emptiness. A street cleaner’s whoosh broke the silence.

Dressed in a brown robe, the traditional garb of his Carmelite order, Bathe began his daily walk down Broadway. At 28th Street, he hooked left and continued to Bellevue Hospital, where he is a Roman Catholic chaplain and bereavement coordinator.

“Welcome to ground zero,” he said before a nurse trained a thermometer gun on his forehead and scanned for a reading.

It read 98.6. The nurse nodded.

“Normally,” he said, “the family is there with me bedside at death, and when we say the Our Father it is very emotional. Now I stare at a person that is taking their last breaths. I’m with a doctor and a couple of nurses. We’re saying goodbye.”

Bathe is the friar on the front line of the coronavirus pandemic. A native Tennessean who was a soil scientist before entering religious life at age 27, his Southern accent is the first voice many patients’ family members hear from the city’s oldest hospital when he calls to inquire about special needs.

Each morning, he reviews death logs. He then walks through the emergency department and intensive care unit, where he stands behind glass and cues up music on the smartphone he keeps in his pocket. “Bridge Over Troubled Water” is a favorite selection. On Funky Fridays, as he calls them, Bathe mixes Benedictine chants with James Brown. If patients are awake, he flexes his biceps or pumps a fist — encouragement to stay strong. He takes precautions when praying over the intubated, slipping on an N95 mask and face shield. In all, he ministers to more than 25 patients daily.

“Music gives a little more sense of sacredness so I don’t get distracted by nurses and doctors screaming,” he said. “I am focused on that patient, looking at that face. I know who that person is, imagine what it is like for them to be alive.”

Bathe speaks with a man across the street from Bellevue Hospital. He says he was called to become a friar more than two decades ago after witnessing a man die in North Carolina.
Bathe greets people in the Mount Carmel Place courtyard near the hospital. The coronavirus continues to paralyze New York and stretch the limits of its hospital system.

His pager pulses with death updates. It is programmed to receive alerts for cardiac emergencies, traumas and airway issues. Whenever a coronavirus patient on a ventilator needs attention, it comes across his screen twice. When a nurse who worked in the neonatal ICU died of covid-19 recently, Mary Ann Tsourounakis, Bellevue’s senior associate director of maternal child health, called pastoral care for help. A group of nurses grieved. First to arrive was Bathe, who led them in prayer in a small hallway.

“One of the most healing and loving I’ve heard,” Tsourounakis said. “People think it has to be a big production. Sometimes those moments are the moments.”

The virus continues to paralyze the city and stretch the limits of its hospital system. Confirmed cases have surpassed 185,000 and more than 20,316 deaths had been recorded, according to the New York City Health Department.

Bathe’s path to New York began in Knoxville, Tenn. He grew up around his grandfather’s cattle farm, went on frequent hikes as an Eagle Scout and eyed a career as a forest ranger while a teenager. His mother, Linda, worked at the University of Tennessee, and she consulted with faculty members about her son’s future in forestry. Prospects were slim, and alternate paths — archaeology or agriculture — were suggested.

He didn’t see himself traveling to Egypt to unearth tombs, so he dug into agricultural studies and toiled with botany and geology as well. Following graduation, he worked for the Buncombe County environmental health agency in North Carolina. Hired to protect groundwater, his release was to drop a line in honey holes for catfish, pitch a tent and listen to bluegrass songs after dark.

One day, Bathe was sent to meet a man named Robert Warren to evaluate his soil so he could build a house. When Bathe arrived, he saw Warren slumped over in his truck. As Bathe approached, he said, Warren grabbed his hand and asked, “Would you pray with me?”

They recited the Lord’s Prayer, he said. Moments later, he was dead, Bathe recalled. Bathe accompanied him to the hospital and attended the memorial service and funeral.

Bathe joined the Carmelites soon after, and in 1997 was assigned to Our Lady of the Scapular and St. Stephen’s Church, two blocks from Bellevue. Lessons followed.

One day, he said, a woman fell from her window in a neighboring building and through the church roof. Bathe was sent up to investigate.

“First dead body I ever smelled,” he says. “Life is tender.”

long his almost two-mile walk to work, Bathe’s appearance and demeanor have become well known and appreciated.

Transfers are part of the friar life. He taught in Boca Raton, Fla., and served as the vocation director from Maine to Miami before returning to Manhattan two and a half years ago.

In ordinary times, Bathe receives a monthly allowance of $250, lives in the St. Eliseus Priory in Harrison, N.J., and rides the PATH train. He fell ill in January, experienced the chills, registered a temperature of 101 and lost weight. He believed it was pneumonia then and self-isolated, using a back stairwell to his room. His brothers left meals outside his door, and he returned to Bellevue after convalescing. He has yet to be tested for covid-19.

Since March 30, the hospital has facilitated his participation in a program that provides free or discounted rooms for front-line workers, first at a Comfort Inn on the west side of Manhattan and now at the Millennium, to limit his commute. Along the route to work, his bald head, eager gait and hearty laugh are known to mendicants and administrators alike.

He carries on the tradition of the Carmelites, who have ministered at Bellevue since the 1800s, through periodic epidemics, saying Masses from the psychiatric ward to the prison unit. Colleagues include a new rabbi and a 20-year-old imam.

When a Catholic dies, he performs the commendation of the dead, a seven-minute service. His responsibilities range from distributing Communion to finding prayer books for patients across faiths to leading memorial services for staff. He is “staunchly against” virtual bereavement, which has become common amid the pandemic, insisting on providing a physical presence.

“People are looking for a miracle when the miracle is to let go,” he said. “Call me too practical, but I don’t pray they leap out of the grave like Lazarus. I think we’re meant for better. We’re meant for God.”

Hospital staffers are processing what has happened since the pandemic first gripped New York, and they’re bracing for a potential second wave. Since Lorna Breen, medical director for the emergency department at NewYork-Presbyterian Allen Hospital, died by suicide last month, Bellevue has increased its support services for employees. Questions about closure come from all mourners.

“Families ask, ‘Are we going to be able to have our loved one go to Mexico?’ ” Bathe said. “How are we going to do the next step, to bury our loved ones?”

long his almost two-mile walk to work, Bathe’s appearance and demeanor have become well known and appreciated.

On a recent Sunday, Bathe stepped outside for a breather in what some people call Bedpan Alley, the east side neighborhood that includes hospitals and a shelter on First Avenue. He checked on a homeless woman who sits in a chair facing Bellevue each day, rubbing his thumb against hers as she slept. A shoeless man was prone on the sidewalk. Bathe inquired about a can collector’s economic concerns. Business was slow.

“Are you a priest?” a woman on a bench asked Bathe.

“No, ma’am,” Bathe said. “I’m a friar.”

She introduced herself as Shonda. She was anxious about a meeting with her manager.

“You want to say a prayer for me?” she said.

“Put the phone down,” he said.

Bathe closed his eyes and prayed.

“Breathe,” he said.

“I’m going to breathe,” she said.

As he walked back to the hospital, his pager went off. “Cardiac Arrest,” it read, “10 West 36.”

“Somebody’s dying,” he said.

Bathe makes his way to the hospital from his hotel in midtown Manhattan.

Complete Article HERE!

How to cope with our collective grief:

Psychologist sister offers counsel

On April 23, Michael Neel, funeral director of All Veterans Funeral and Cremation in Denver, looks at the casket of George Trefren, a 90-year-old Korean War veteran who died of the coronavirus in a nursing home.

by Chris Herlinger

Day to day, things remain at a standstill in much of the world. And out of that standstill comes grief, says Australian Mercy Sr. Maryanne Loughry.

In a recent blog, I discussed Loughry’s webinar about how to deal with anxiety and stress during the COVID-19 pandemic. Loughry, a trained psychologist who teaches part-time at the Boston College School of Social Work, has done double duty with another webinar, providing more insight into some of the challenges the pandemic poses.

This time, in an April 21 webinar, also coordinated by the Rome-based International Union of Superiors General, Loughry’s focus was on grief: specifically, personal and social (or collective) grief as well as “anticipatory grief” — waiting for tragedy to unfold.

As she did in the earlier webinar, Loughry made clear that we must respect others’ different experiences and reactions right now, that everyone is dealing with this unsettled moment in different ways and at different paces.

That affirms an insight that New York Times opinion writer Charlie Warzel recently made: “Tragedy and suffering is unevenly distributed and everyone’s lived experience is unique. It feels a bit like we’re living with one foot in two different worlds, or experiencing every outcome of a projection model at once.”

The idea of different “projection models” is a good segue into one of Loughry’s key points. Loughry praised the insights of the late Swiss-American psychiatrist Elisabeth Kübler-Ross, whose seminal 1969 book On Death and Dying laid out the idea of sequential stages of grief: denial, anger, bargaining, depression and, finally, acceptance.

While Kübler-Ross’ insights about grief are still affirmed, the field of psychology has since embraced the idea that the stages are not necessarily always in sequence.

“We grieve differently,” Loughry said. “We move back and forth [between the stages]. We move around the different stages. That’s what emotions are.”

And emotions are very much in flux right now, given that people are experiencing both personal loss and a shared, profound collective loss in communities and societies.

“We’ve lost a lot in this pandemic,” Loughry said. “We’ve not just lost people we’ve known and loved: family, community members, people from our own countries, routines and jobs. But our natural world has been turned upside down. So we’ve lost that sense of what our world is about and what we’re about.”

What people have known and experienced in the past — the basic fiber and texture of life as people experienced it, the pillars “we rested on” — have “now receded,” Loughry said.

“We never thought we wouldn’t be able to bury our dead or visit the sick. But that’s what’s happening right now.”

And in some regions, the situation is exacerbated by already-existing humanitarian and social challenges.

“In some countries, people don’t even get to hospitals,” Loughry said.

But Loughry said at both the collective and personal levels, people have experienced grief before. And that they have, perhaps more than they know, the tools to deal with the situation right now, despite its unprecedented nature.

Noting a string of natural disasters like the 2004 Indian Ocean tsunami and the recent Australian bush fires as well as manmade tragedies like the 1994 Rwandan genocide, Loughry said that, ultimately, people rebuild their lives.

“What we know about collective grief is that we survive. We move on,” Loughry said. “Our world is different, and we know [more] about ourselves and our society.”

That was one affirmation and insight. There were numerous others.

Don’t underestimate collective grief right now.

One of the things many are mourning is “our lack of normalcy.” That’s a shared, collective experience, “a source of grief for us,” Loughry said. But another source of grieving is what we see around us.

“We know our families and the local businesses we deal with are suffering,” she said.

That sadness is accentuated by our day-to-day disconnection from others.

“We’ve also had a profound loss of connection. We can’t physically embrace anybody.” The result? “This can lead us collectively to grieve what we’ve lost.”

Be aware of another kind of grief.

That is “anticipatory grief,” waiting for something to happen. People have “anticipation that this tsunami, or epidemic, is going to overwhelm us.” And that means real worries about mortality, both ours and others’.

“I could be taken by this pandemic. You could be taken by this pandemic. It threatens our very being,” Loughry said. And that results in a feeling of “loss of safety. A lot of us don’t feel safe anymore.”

Now is the time for “naming and claiming” grief.

Specifically, now is the time to share and name what is being lost and what is happening in the world and to ourselves. Loughry noted that people throughout history have established commemorations and memorials for collective tragedies, like the Holocaust. At the root of those is the need for naming.

“To hold it in and not to share it is actually something that can overwhelm us,” Loughry said.

Ask what worked.

At an individual level, this is perhaps the moment to ask what helped us in the past when we grieved.

“We need to go back to that again,” she said. “Who did we reach out to? How did we respond? What was helpful, what wasn’t helpful?”

Be conscious of others’ vulnerabilities right now.

That’s especially important in religious communities, where such vulnerabilities may be more visible right now. Perhaps some have not grieved past losses and are doing so now.

Loughry said leaders of communities need to be aware of “what you can do and what you can’t do,” noting that they need to be aware that they and the members of their leadership team are “also impacted” and “are a part of the collective grief and the anticipatory grief.”

Be aware of another dynamic.

Some people — Loughry was speaking specifically of sisters — will be in denial, constantly saying they are fine. But that is often a barrier. Loughry advises not to raise that concern now. This is the time of affirmation, affirming “that people are moving at different stages,” she said. That is especially true at a moment when “people are in confined spaces.”

Loughry added: “It’s a time at the moment for compassion, not for challenge.”

At the same time, don’t be afraid of emotions.

“It’s OK at the moment to be emotional” and allow raw, unfiltered feelings to rise to the surface, Loughry said. That could mean being “teary, because that’s exactly what your body and your emotions need.”

That may be uncomfortable, particularly in a community setting, because it shows your vulnerabilities. But there is no reason to hide such emotions because “it’s not something that can be easily covered up.”

Advice for communities.

When asked how communities should deal with discussing grief and experiences, Loughry said that “each community is different.”

She did suggest that discussion about grief might be better done in small groups “rather than a big setting, where they might be asked to say something they are nervous about saying.”

Another idea is to allow people to write down thoughts and place them in a communal bowl without people being named.

Whatever is decided, it is important to affirm people’s comfort, as “we don’t know how much longer we’ll be in lockdown and you don’t want to increase their vulnerability.”

Loughry also affirmed the need some will feel to remain silent and not to share.

Faith is important.

Sisters’ religious faith is “a real resource” right now, Loughry said. First, there are the biblical and historical anchors: Church forebears experienced drought, famine and other calamities and got through them.

Sisters, who are fortunate “to have an identity, security, and we have supports,” are in a position to offer compassion to those seeking it. And that can help sisters at this difficult moment with their own grief.

“We feel good when we minister to someone.”

A sense of hope.

Loughry noted the pandemic has unfolded during Lent and Easter, with the attendant echoes of death and resurrection.

“We do know that we are going to get out of this, and that there is another side,” she said. “We know this time will pass. We don’t know when, but we know it will.”

Complete Article HERE!

Pastors talk a lot about death around Easter.

Now covid-19 is forcing more to prepare for their own.

The Rev. Michael Curry is the presiding bishop of the Episcopal Church.

By Sarah Pulliam Bailey

The Rev. Barbara Brown Taylor will spend a portion of Good Friday planning her death. The Episcopal priest hopes to outline the music she would like to hear as her life comes to an end, the floral scent she hopes to smell and which of her 12 hand-pieced quilts she intends to hold.

Taylor is not ill, but at 68, she falls squarely into the age range especially vulnerable to covid-19. While the coronavirus has sickened people of every age, 80 percent of those who have died of covid-19 have been over 65.

So before Taylor speaks in virtual gatherings about the death and resurrection, she will add to her list of what she has already prepared: advanced care directives, who has power of attorney over her affairs, and plans to be buried — by her parents and sister.

“Few people are up for this conversation,” she said. “You won’t believe how many people walk away from me when I bring this up.”

Death is ever present in church sermons in the days and weeks that lead up to Easter. On Ash Wednesday, pastors remind parishioners, “Remember you are dust, and to dust you shall return.” On Good Friday, they preach the crucifixion of Jesus.

But even as many pastors lead funerals regularly, many admit they haven’t made end-of-life care decisions or planned for their funerals.

The Rev. Michael Curry, presiding bishop of the Episcopal Church, said he has planned his funeral, but covid-19 has pushed mortality to the forefront. He and his wife have had to make plans for what happens if they get sick with the coronavirus.

“Holy week is about hardship and suffering and death, that Jesus didn’t avoid it and dared to die … to show what love looks like,” said Curry, 67. “This is not a sweet sugarcoated Easter.”

Three weeks ago, a diagnosis for pneumonia prompted the Rev. Tony Evans, a popular megachurch pastor based in Dallas, to think about the details of his own funeral. (He tested negative for covid-19.)

“It’s always hard to hear about death but no better time to deal with it than when it’s staring us in the face right now,” said Evans, 71.

People used to imagine their own deaths more because they witnessed death more regularly, said Lydia Dugdale, director of the Columbia Center for Clinical Medical Ethics and a physician who has spent the past few weeks caring for covid-19 patients in New York City.

And although the church offers comfort to those dealing with the death of a loved one, Dugdale said it hasn’t been at the forefront of helping people face death. In her forthcoming book “The Lost Art of Dying,” she points to a 2013 Harvard University study found that clergy knew little about palliative and other end of life care. It found that pastoral zeal to encourage faith in God enabled congregants to choose treatments associated with more suffering.

Dugdale said laypeople haven’t wanted to hear about death, and clergy have stopped preaching about it. “From my own experience, I can count on one hand the number of sermons I’ve heard on the need to prepare well for death,” she said.

Covid-19 has changed that for some. The Rev. Carrie Call, who provides spiritual care to pastors and parishioners in the Penn Central Conference of the United Church of Christ, said more pastors have been seeking information on end-of-life care and do-not-resuscitate orders in the weeks leading up to Easter this year.

“It’s ironic, because our faith lives and message are about triumph over death and resurrection, but we come face to face with it on this kind of scale, it’s really challenging,” she said. “The challenge for pastors is how they cope with that in their own lives while maintaining a sense of calm to help parishioners in their lives.”

The Rev. James Martin, an editor at-large at America magazine, said he and his fellow Jesuits all have made funeral plans, including the readings, the celebrant and the music.

He said it’s human and natural to fear death, especially now. The way that people have died alone or been unable to hold funerals during the spread of the coronavirus has been especially sad. Still, some people might see it as an opportunity to change their lives.

“To plan out your own death is not always morbid,” said Martin, 59. “It’s a way to look at the kind of life you want to lead.”

Timothy Keller, the retired pastor of Redeemer Presbyterian Church in New York City, said he does not have his funeral planned. He said he thinks that should be up to his family. He has no burial plot, but he has his eye on a small graveyard in Manhattan surrounded by wire fence and car repair places, describing it as in the middle of things, unpretentious and easy to visit.

Keller said he is less afraid of death now at age 69 than when he was diagnosed with thyroid cancer at 52.

“If we got the virus and died, as sad as it would be, we would both say, ‘We thought we had more to do on earth,’ and it’s God’s way of saying ‘Nope,’ ” he said. “That’s not a bad message for God to say, ‘You’ve done your work.’ ”

Complete Article HERE!

How Does a Buddhist Monk Face Death?

If we learn to celebrate life for its ephemeral beauty, its coming and going, we can make peace with its end.

Geshe Dadul Namgyal

By George Yancy

This is the first in a series of interviews with religious scholars from several faiths — and one atheist — on the meaning of death. This month’s conversation is with Geshe Dadul Namgyal, a Tibetan Buddhist monk who began his Buddhist studies in 1977 at the Institute of Buddhist Dialectics in Dharamsala, India, and went on to earn the prestigious Geshe Lharampa degree in 1992 at Drepung Loseling Monastic University, South India. He also holds a master’s degree in English Literature from Panjab University, Chandigarh, India. He is currently with the Center for Contemplative Science and Compassion-Based Ethics, Emory University. This interview was conducted by email. — George Yancy

George Yancy: I was about 20 years old when I first became intrigued by Eastern thought, especially Buddhism. It was the transformation of Siddhartha Gautama to the Buddha that fascinated me, especially the sense of calmness when faced with competing desires and fears. For so many, death is one of those fears. Can you say why, from a Buddhist perspective, we humans fear death?

Dadul Namgyal: We fear death because we love life, but a little too much, and often look at just the preferred side of it. That is, we cling to a fantasized life, seeing it with colors brighter than it has. Particularly, we insist on seeing life in its incomplete form without death, its inalienable flip side. It’s not that we think death will not come someday, but that it will not happen today, tomorrow, next month, next year, and so on. This biased, selective and incomplete image of life gradually builds in us a strong wish, hope, or even belief in a life with no death associated with it, at least in the foreseeable future. However, reality contradicts this belief. So it is natural for us, as long as we succumb to those inner fragilities, to have this fear of death, to not want to think of it or see it as something that will rip life apart.

We fear death also because we are attached to our comforts of wealth, family, friends, power, and other worldly pleasures. We see death as something that would separate us from the objects to which we cling. In addition, we fear death because of our uncertainty about what follows it. A sense of being not in control, but at the mercy of circumstance, contributes to the fear. It is important to note that fear of death is not the same as knowledge or awareness of death.

Yancy: You point out that most of us embrace life, but fail or refuse to see that death is part of the existential cards dealt, so to speak. It would seem then that our failure to accept the link between life and death is at the root of this fear.

Namgyal: Yes, it is. We fail to see and accept reality as it is — with life in death and death in life. In addition, the habits of self-obsession, the attitude of self-importance and the insistence on a distinct self-identity separate us from the whole of which we are an inalienable part.

Yancy: I really like how you link the idea of self-centeredness with our fear of death. It would seem that part of dealing with death is getting out of the way of ourselves, which is linked, I imagine, to ways of facing death with a peaceful mind.

Namgyal: We can reflect on and contemplate the inevitability of death, and learn to accept it as a part of the gift of life. If we learn to celebrate life for its ephemeral beauty, its coming and going, appearance and disappearance, we can come to terms with and make peace with it. We will then appreciate its message of being in a constant process of renewal and regeneration without holding back, like everything and with everything, including the mountains, stars, and even the universe itself undergoing continual change and renewal. This points to the possibility of being at ease with and accepting the fact of constant change, while at the same time making the most sensible and selfless use of the present moment.

Yancy: That is a beautiful description. Can you say more about how we achieve a peaceful mind?

Namgyal: Try first to gain an unmistaken recognition of what disturbs your mental stability, how those elements of disturbance operate and what fuels them. Then, wonder if something can be done to address them. If the answer to this is no, then what other option do you have than to endure this with acceptance? There is no use for worrying. If, on the other hand, the answer is yes, you may seek those methods and apply them. Again, there is no need for worry.

Obviously, some ways to calm and quiet the mind at the outset will come in handy. Based on that stability or calmness, above all, deepen the insight into the ways things are connected and mutually affect one another, both in negative and positive senses, and integrate them accordingly into your life. We should recognize the destructive elements within us — our afflictive emotions and distorted perspectives — and understand them thoroughly. When do they arise? What measures would counteract them? We should also understand the constructive elements or their potentials within us and strive to learn ways to tap them and enhance them.

Yancy: What do you think that we lose when we fail to look at death for what it is?

Namgyal: When we fail to look at death for what it is — as an inseparable part of life — and do not live our lives accordingly, our thoughts and actions become disconnected from reality and full of conflicting elements, which create unnecessary friction in their wake. We could mess up this wondrous gift or else settle for very shortsighted goals and trivial purposes, which would ultimately mean nothing to us. Eventually we would meet death as though we have never lived in the first place, with no clue as to what life is and how to deal with it.

Yancy: I’m curious about what you called the “gift of life.” In what way is life a gift? And given the link that you’ve described between death and life, might death also be a kind of gift?

Namgyal: I spoke of life as a gift because this is what almost all of us agree on without any second thought, though we may differ in exactly what that gift means for each one of us. I meant to use it as an anchor, a starting point for appreciating life in its wholeness, with death being an inalienable part of it.

Death, as it naturally occurs, is part of that gift, and together with life makes this thing called existence whole, complete and meaningful. In fact, it is our imminent end that gives life much of its sense of value and purpose. Death also represents renewal, regeneration and continuity, and contemplating it in the proper light imbues us with the transformative qualities of understanding, acceptance, tolerance, hope, responsibility, and generosity. In one of the sutras, the Buddha extols meditation on death as the supreme meditation.

Yancy: You also said that we fear death because of our uncertainty about what follows it. As you know, in Plato’s “Apology,” Socrates suggests that death is a kind of blessing that involves either a “dreamless sleep” or the transmigration of the soul to another place. As a Tibetan Buddhist, do you believe that there is anything after death?

Namgyal: In the Buddhist tradition, particularly at the Vajrayana level, we believe in the continuity of subtle mind and subtle energy into the next life, and the next after that, and so on without end. This subtle mind-energy is eternal; it knows no creation or destruction. For us ordinary beings, this way of transitioning into a new life happens not by choice but under the influence of our past virtuous and non-virtuous actions. This includes the possibility of being born into many forms of life.

Yancy: As a child I would incessantly ask my mother about a possible afterlife. What might we tell our children when they express fear of the afterlife?

Namgyal: We might tell them that an afterlife would be a continuation of themselves, and that their actions in this life, either good or bad, will bear fruit. So if they cultivate compassion and insight in this life by training in positive thinking and properly relating to others, then one would carry those qualities and their potential into the next. They would help them take every situation, including death itself, in stride. So, the sure way to address fear of the afterlife is to live the present life compassionately and wisely which, by the way, also helps us have a happy and meaningful life in the present.

Complete Article HERE!

A Chaplain on How to Talk About the Right to Die and Death With Patients

By Diane Rehm

Martha Kay Nelson has had a long career in hospice work. Rather than choosing hospice work, she believes hospice work chose her. Her training was at Harvard Divinity School. She did a yearlong internship as a hospice chaplain during her graduate work. The year after she graduated, she managed to combine her career as a chaplain with her work in hospice. She is in her mid-forties, with short hair and hazel eyes. Her warm, open face, earnest manner, and easy smile help me understand why she is so good at her work. We sit together in her office at Mission Hospice & Home Care in San Mateo, California.

DIANE: How do you feel about California’s “right to die” law?

MARTHA: Well, I have many feelings, and they could vary depending on the day or the hour. It depends on whom I’m talking to, and what her or his experience is. My overall sense about the law is that people have a right to make their own health-care decisions, whether it’s at the end of life or at any time up to that point. I know people have a hard time having these conversations, particularly early on, before they’re even sick. And then they get sick and it’s crisis time, and those decisions have to be made quickly. The End of Life Option Act to me is part of a spectrum of all those decisions and conversations that come at the end. It’s a new end point on that spectrum.

D: You’ve been in a leadership position here at Mission Hospice, not only learning, but teaching. Tell me what have been the elements of transmitting this information to others.

M: It’s been an interesting learning curve. I think even seasoned hospice professionals have had to adjust to a new option for patients, stepping into that terrain. The elements that have been important in teaching staff members, working with health-care partners, have been to get folks to acknowledge at the outset that this is a challenging topic, this is new terrain, there are profound implications, and not to shy away from it.

Some folks here at Mission Hospice didn’t want to participate, but the majority did, to have their questions answered or share some of their thoughts, their concerns. We’ve done this regularly enough that people felt they could talk freely about the End of Life Option Act. We didn’t want it to be whispered about awkwardly in the corner, that this law is coming and our patients are going to have the right to choose the option. As an agency, we’re not advocates for the law, we’re advocates for our patients, and we won’t abandon them. Having said that, any of our employees, if they’re not comfortable, don’t have to participate. They can opt out if they need to, and they would be fully supported.

D: What kinds of questions did you get from staff? What kinds of issues did they raise?

M: At the outset, a lot of general questions about details of the law, how it works, how are we supposed to communicate with our colleagues around it, what can we say to the patient and what can’t we, those kinds of things. Questions arose about accessibility to the law. If I have patients who are saying they just want to end it all, and they’re saying this a lot, but they’re not specifically asking about the law, then can I bring it up with them or not? We have a policy here at Mission Hospice that we let the patient lead. If a patient is inquiring about his or her options, then we will be there.

That’s one kind of question. Other clinicians have asked about folks who haven’t had the chance to be educated about medical aid in dying, or don’t have access to resources where they might have learned about it. What if it’s something they’d like to avail themselves of ? There’s kind of a social justice question there. There are also questions arising from specific cases. Every case is different.

D: Can you give me an idea of how many patients have actually come forward and asked you about the right to die?

M: We’ve been tracking some of these numbers, and to date, we’ve served around forty-five people since California’s law went into effect, which was a lot more than we anticipated. When back in 2016 we set out to draft our policy and prepare ourselves, we thought maybe we’d have four or five people in the first year. We had twenty-one. And about that same number inquired about the law, but never went all the way through the process. Either they actually died before they had a chance to use the law, or they changed their minds. I would imagine that it was split evenly.

D: Tell me about the process. So a patient comes to you and asks about the process, the law. How do you respond?

M: My initial response as a chaplain would be one of curiosity. I’d be interested in learning more about their thoughts and why they’re asking. It’s a big thing to ask about. Sometimes people are afraid to even inquire. They’re afraid of being shamed or judged. So I’d want to let that person know that I’m glad they’re asking. And then we’d have a conversation, whatever they would wish to say at that time. Next, I would contact the doctor and the rest of my interdisciplinary team members and would let them know the topic had been broached. Then a doctor would probably go and make a direct visit, which would be considered the first formal request, if the decision was made to pursue that course.

We really encourage the other team members to make sure they keep talking to one another—the social worker, the nurse, the spiritual counselor, home health aides, and volunteers who might also be involved. Through a team effort, we would need to have clarity on how much privacy the patient would want. Patients have the right under the law to not tell anyone but the doctors they’re working with, not even family members. Our experience has been that that’s not often the case. Usually there is communication with family.

D: Who makes the initial judgment that the patient has six months or less to live?

M: The attending physician on the case. And if the patient inquires about the law, and his or her doctor says, “I’m not comfortable being involved with this,” that’s one way we might get involved. Or it might be a hospice patient already on our service.

D: I saw in your waiting room a brochure for Death Cafes. Can you tell me about them?

M: The Death Cafe movement started several years ago in England. It’s basically having a conversation over coffee and cakes in a public venue. Anyone is welcome to attend, and the purpose is open-ended. The goal is to talk about death in any way you wish. There does need to be a facilitator, someone who is able to establish ground rules in etiquette so folks aren’t talking over one another. Folks that host them tend to have some level of experience in end-of- life care, in thanatology, but anyone can sign up. I’ve led a couple of them.

D: How successful do you think Death Cafes are as teaching tools, as comforting elements in the whole discussion of death?

M: I think Death Cafes are successful in meeting the needs of folks who already want to talk about death. If you show up at a Death Cafe, there’s something in you that is already ready to speak and to hear what other people are thinking. It can serve as a cross-pollination of ideas and thoughts, and normalization. The cafes meet a kind of thirst that we have in our culture to speak about these things openly and not be afraid. How you get people to Death Cafes is another question. I’ve had some people say they’re offended by that name, or they don’t want to attend a Death Cafe because it sounds morbid.

D: What is the best way to reach people? How do we get the conversation started even before we’re sick?

M: There’s no one best way. It’s about being creative and really getting to know your community. In my family, I’ve been lucky in that we’ve always talked about death openly. I have ongoing conversations now with my father. He’s about to turn eighty-three, and I really value the kinds of discussions and ruminations we have.

It’s wonderful. We’ve started kind of reflecting theologically, talking about, wondering together, what happens after we die. To be able to have that in a father-daughter kind of way. I’m well aware of what a precious opportunity it is to hear his thoughts. As he comes into the “lean and slippered pantaloon” time of his life, as he might say—some of his last chapters— I feel really blessed that he’s willing to discuss it openly.

D: How do you open that discussion for the general public?

M: I think it takes courage and a conscious decision to ask a question of someone in a moment when you feel there’s an opportunity. Someone speaking about her or his health, some decline, or illness, grief, and you ask, “How would you like things to be?” And perhaps even being a bit persistent if you get an initial brush-off, which often happens, but trying again, and saying, “ Really, I would like to know.”

I also think reaching children is important. I think that in our death-denying culture, children are really shielded from all things involved with death. Things happen at the funeral parlor, no longer at home, and we try to protect children in all kinds of ways. But if you don’t allow children who want to be involved in a loved one’s illness or death, I think you’re doing them a disservice. You’re keeping them from something that is integral to life for all of us. The earlier you can start to have those experiences and wonder about them and ask the questions, the more skills you will have as you age to meet them openly.

D: Have you decided what you want for yourself at the end?

M: I have no idea. I do know that I would like to have the right and the option to choose. I understand that even just knowing that the option is available can bring a lot of comfort to people. I haven’t faced a terminal illness that might cause me great physical pain or suffering, or mental or spiritual suffering. There’s one area that gives me pause, which is when folks choose medical aid in dying because they’re used to being in control in their lives. They might not have physical or mental or spiritual suffering, but they want to have personal agency. I think they entirely have the right to do that. But I also believe we’re in a culture that distorts the degree to which we think we’re in control. So on a soul level, on a much deeper level, I wonder, Are we messing with something there? How is it that we’re making such a profound decision from a place of a distorted need for control? And then I think, Well, what do I know about their journey and what they need? Maybe this is the one time they’ve ever made a strong, solid decision for themselves, and who am I to say what it is they need to learn?

D: But isn’t pain, intractable pain and suffering, and the inability to care for oneself, a sufficient reason to respect someone’s decision in terms of his or her final say?

M: Absolutely. I think clinicians have more trouble when they can’t observe visible intractable pain, when they can’t see physical or emotional suffering. It’s harder for clinicians to get their heads and hearts around that. Why is someone making this choice? And so I do a lot of counseling with staff about that, exploring how to meet the needs of the person when we don’t see them suffering, at least not on the surface. And we have to remind ourselves, clinicians need to express those feelings and concerns, so that when they’re dealing with patients directly, they can be respectful and meet them on their own terms.

Complete Article HERE!

Facing the Fact of My Death

As a child, confronting my mortality was terrifying. Now it is an opportunity.

Mr. Yancy is a philosopher and professor.

By George Yancy

As a young boy, I recall very clearly telling my mother with an innocent defiance that I wished that I had never been born because I will die someday. I can’t recall her response, but I’m sure it worried her and left her feeling hurt. But I was frustrated, angry, afraid. While I knew that people died, it had suddenly dawned on me that I would be among them, that I will die someday. It was an epiphany — one I would rather have not had. I recall thinking, “I didn’t sign up for this. Who is playing this terrible joke on me?”

Strange, I realize, but there I was — a child, elated to be alive, feeling the warmth of the sun on my brown skin, playing with friends in the streets, eating ice cream, celebrating birthdays, enjoying unconditional love shown to me by my mother and my older sister. Why did I have so much joy and shared love just to someday have it all taken away, gone forever? And I understood “gone forever” to mean never ever existing again. Done! Kaput! It made absolutely no sense to me.

I experienced the fact of my death as a cosmic slight. I could not get it out of my head. Even at that young age, I began to feel the heavy weight of my finitude. I couldn’t put it down, even though I wanted to. Death was now too close.

It was dreadful. That sense of unthinking longevity, invulnerability, cavalier confidence — hell, just being a child — gave way to a deep and frightening reality that I could not control. The childlike omnipotence collapsed and left me facing an abyss. The abstract fact of death had become personal. I had come to realize that not a single moment is guaranteed, not another breath, another blink of an eye, another hug from my mother or clash with my sister.

As I grew older this feeling of existential dread stayed with me — of being thrown into existence without any clear sense of why we’re here, of wondering whether or not God exists, whether or not the cosmos has any meaning beyond what we give it, whether or not we have immortal souls, whether there is anything to be discovered after death or whether death is the final absurd moment of our being. I was like the French-Algerian existentialist Albert Camus, who wrote of having “conscious certainty of a death without hope.”

As an adult, this uncanniness goes unabated; it has not stopped. There are times when, like the 17th-century thinker Blaise Pascal, I feel trapped between two infinities of meaninglessness. In his unfinished work, “Pensées,” Pascal writes, “When I consider the short duration of my life, swallowed up in an eternity before and after, the small space I fill engulfed in the infinite immensity of spaces whereof I know nothing, and which know nothing of me, I am terrified. The eternal silence of these infinite spaces alarms me. I wonder why I am here rather than there, now rather than then. Who set me here? By whose order and design have this place and time been destined for me?”

The fact of death is like a haunting. It frequents me, entangled in everything I do: It’s just beneath my pillow as I sleep, strolling next to me as I casually walk from one class to the next, inserting its presence between each heart beat in my chest, forcing its way into my consciousness when I say “I love you” to my children each night, assuring me that it can unravel the many promises that I continue to make, threatening the appointments that I need to keep. This sense of haunting is what the Harvard professor Cornel West calls the “death shudder.” Of this “shudder” in the face of death, he writes, “Yes, dread and terror were involved, but also perplexity. Exploration. Where does nonexistence take you? What does it mean to be stripped of your own consciousness? How do we live with the idea that we are always tantalizingly close to death? At any moment the bridge can collapse.”

I continue to shudder. Yet there is something about facing the fact of death that invites us to double back, to see our existence, our lives, differently. The scholar Mark Ralkowski, reflecting on Martin Heidegger’s notion of “being-toward-death,” writes: “In rare moments, we can be returned to ourselves by an experience of anxiety (Angst), which disrupts the tranquillity of the everyday world by emptying it of its usual significance and meaning. In these moments, none of our projects or commitments makes sense to us anymore, and we see that we are committed to roles prescribed to us by das Man” — which means “the they” or “the crowd.”

I want my students to experience one of those “rare moments,” to consider the short duration of their lives. To get them to think differently about our time together, to value their lives differently, I make a resolute effort to remind my students that all of us, at some point, sooner or later, will become rotting corpses. That, I explain, is the great equalizer. No matter how smart, brilliant, wealthy, beautiful and fit you are, no matter how great your MCAT, LSAT or G.P.A. scores, no matter your religious or political orientation, we will all perish.

After hearing this, students will often become completely silent. There is a sudden recognition that something has been haunting our joy, our unquestioned and collective happiness, our sense of “permanence.” It is palpable. No matter how many times I’ve decided to remove the veil, the sting of our collective finitude continues to hit me, along with the reality of bodily decomposition and putrefaction. The unspoken reality of death, which is the haunting background of our lives, shakes my body; I mourn for me and my students, and humanity.

Yet a clarity emerges. My students and I see each other differently, perhaps for the very first time. We are no longer simply students and professor, but fragile creatures and mysterious beings who have been dying from the moment we were born in a universe with no self-evident ultimate meaning. Something as previously uneventful as sitting next to one’s fellow classmate takes on unspeakable value. That shared understanding, vulnerability and mutual recognition of collective destiny makes our time together even more joyful, even more precious.

I’m not sure if the “death shudder” will ever abate while I’m alive. And I am no closer to understanding the fact that I exist or why I must die. I don’t seem to be able to achieve the necessary adjustment, the solace of acceptance. In his “Tractatus Logico-Philosophicus,” Ludwig Wittgenstein writes, “It is not how things are in the world that is mystical, but that it exists.” Wittgenstein helps to give voice to something mysterious about our being: It is that we exist, and that we will die, which is so uncanny. It is that both life and death are inextricably braided together that elicits the shudder. And the shudder and the uncanniness point beyond mere facts. They function, at least for me, as gestures, as intimations of a beyond, that enthrall my soul.

So, sooner or later I will die. I’m assured that it will happen. I know that if you are reading this article 100 years from now, I will no longer exist. I will have paid the debt for the gift of being. Death is our collective fate. Yet so many of us fear to talk about it, fear to face it, terrified by the idea of nonbeing. But we must face our destiny, our rendezvous with death. Indeed, the concept of death is a deep and perennial theme in philosophical and theological-religious thought; it is one of the Big Questions. As the philosopher Todd May writes, “Of course, most religions don’t claim that we don’t die. But there is, for many religions, a particular sense in which we don’t really die.”

It is in this spirit of exploration that I will interview 12 deeply knowledgeable scholars, philosophers and teachers, one each month, about the meaning of death in their respective traditions, including Hinduism, Buddhism, Islam, Christianity, Zoroastrianism, Judaism, Jainism and others. I will be asking questions like: What is death? Why do we fear death? Is death final? Do we have immortal souls? What role does death play in how we ought to live our lives?

The objective is not to find definitive answers to these eternal questions, but to engage, as my students and I try to do in our classes, in a lively discussion about a fact that most of us would rather avoid, and move ourselves a little closer to the truth.

Complete Article HERE!

How Friendship Changes at the End of Life

“People become frightened at the end of life. Sometimes I see them moving away from friends as they get sicker.”


Julie Beck talks with two women who met through the nontheistic religion of Ethical Culture and have spent a significant amount of time ministering to aging and dying members of their congregation. They discuss how friendship changes at the end of life, and how they work to foster connection and community for members of all ages.

The Friends:

Anne Klaeysen, 68, a recently retired clergy leader for the New York Society for Ethical Culture and a humanist chaplain at New York University. She lives in Brooklyn.
Liz Singer, 71, a geriatric-care manager and the president of the New York Society for Ethical Culture. She lives in Fort Lee, New Jersey.

This interview has been edited and condensed for clarity.

Julie Beck: How did you two meet and begin ministering to the dying together?

Anne Klaeysen: Liz became a member of the New York society maybe seven years ago. I am always at the monthly newcomer reception, so we met there. She just dove right in, and shortly became the president of the board. I have to confess, Liz, I get a little worried when people dive in so quickly. I’m thinking, Oh dear, is she going to drown? Liz did not drown; she’s a strong swimmer. Liz came at a time when we really needed strong leadership. And she wasn’t afraid to take on a couple of the old boys. So I think there was certainly a feminist bond there. [We became] partners in crime, or [rather] partners in good works.strong>Liz Singer: We have a strong aging population. I think 30 percent of our members are probably over 70. And we started to see things like dementia. As Anne and I developed our friendship, we began having conversations on the very delicate process of aging and navigating our roles with the members.

Anne: Liz is a geriatric-care manager. Her expertise in this field was invaluable, but I was a little concerned because I didn’t want to take advantage of her. Members don’t mean to take advantage, but sometimes they do.

Also, our members are humanists. We’re a nontheistic religion of ethics. So most of our members don’t believe in a supernatural deity, nor in an afterlife. And they’re fiercely independent. One of our challenges has been to get them to tell us when they’re going through something. Very often we find out about things after they’re in the hospital. It’s not that they don’t trust us; they have a real fear of losing their dignity.

Another society member, Barbara Simpson, runs something called the Death Café. That’s an opportunity for folks to come and really speak about living. We know that we are mortal, and the gift of that is we can live life more completely and in connection with each other. It’s really a joyful experience for [our members]. Barbara has said that very often people are comfortable talking about [mortality], but their children aren’t. [They’ll say], “No, Mom, you’re never going to die; you’re not going to die yet.” People may have their life in order, their papers in order, but their children are in denial.

Anne Klaeysen (left) and Liz Singer (right) sharing a meal together.

Beck: Was there a turning point where you went from having a collegial relationship to more of a friendship?

Liz: The turning point was probably our first serious case, five or six years ago. There was a woman who was estranged from her daughter. Very stubborn. We were trying to bring the daughter back into the picture and make that relationship communicative. Because it was so difficult, Anne and I had to talk about it all the time. The trick was for Anne and I to work together very closely. Anne was having lunch with [the older woman], and gaining her trust. And I was trying to bring in oversight without activating her stubbornness.

Anne: [The woman] left the society for a while because she didn’t get along with people. People didn’t quite come up to her standards. When she came back I was thinking, How can we help her to fit in? How can we help her not be so judgmental? One really good connection was with the children [in our congregation]. I suggested that she come meet with the children, and tell them about her experience. She was a Holocaust survivor; she was on the kindertransport train from Germany to England. I wanted her to be connected with the children, because she was estranged from her own daughter. And she was kind of prickly around some of the adults. The children were so appreciative, and so affectionate with her. They wrote to her when she wasn’t well. They drew her pictures. That’s another thing that a community can do when it’s intergenerational: connect at all ages of one’s life.

Beck: Being with people at the end of life is very intense work. You are regularly seeing a part of life that a lot of people don’t see, or see very rarely. How do you feel that affects your relationships generally and your friendship specifically?

Anne: Generally I have a great appreciation for what the elderly are going through. A big challenge with one of our members was the lack of understanding among hospice and health-care staff for people who are humanists, who don’t believe in God, and don’t believe in an afterlife. It was really difficult for this person when others around her were saying, “Oh, don’t be afraid. God loves you.”

I’ve been on different panels to try to train people not to assume that they are caring for God-fearing people. Just listen to these people. Even when they have dementia. They may not know where they are, they may not remember things, but you’ve got to listen.

Liz: How does it affect my personal life? Number one, it [gives me] an appreciation for life. Number two, I have a reputation when I go to dinner parties. Don’t bring up any questions about aging or I’ll get on a soapbox.

Beck: You mentioned that sometimes you are ministering to people who are your friends, which I imagine is very special, but at the same time could make the balance harder.

Anne: It does. Keeping our work separate from [our personal lives] is a challenge. Where do you draw the line for someone who’s a friend and someone that you’re pastoring to in a professional capacity? But there’s a part of me that wants my life to be integrated. You don’t want to compartmentalize, but you also don’t want to become so involved that you lose perspective. One thing Liz and I do in our friendship is try to help each other keep that balance.

Beck: Is there anything that you’ve observed about how friendship changes at the end of life?

Liz: People become frightened at the end of life. Sometimes I see them moving away from friends as they get sicker. Once people get past that fear of what’s going on, they can be friends again.

Anne: Partly, [what changes is] a sense of loss. My dad died at 101. He was hale and hearty up until the end, and very sound of mind. I remember him saying that all of his friends had died on him. But because he was hard of hearing, it was difficult for him to make new friends. I think a lot of the infirmities that are experienced in advanced age make it difficult to make new friends. Often at the New York society, I see people who become a member after a spouse has died. They’re grateful to have a group of people with whom they can socialize.

I don’t want to sound stereotypical here, but women have been raised to develop those social skills. Men have very often relied on women to do that for them. What we find is that, in the aging population, women are able to cope better. Men who have relied on a spouse or a girlfriend lack those skills. They prefer to have a woman in their lives who can do that for them. That’s the way they were raised. It’s really difficult for them.

Beck: Because of this work, are there things you’re able to talk about with each other that are harder to talk about with your other friends?

Liz: [Anne and I have] skills around dealing with very deep conversations, where a lot of people don’t want to go.

Anne: Of course we’ve also had a lot of challenges in this political atmosphere of, How do you hear somebody with whom you profoundly disagree? We’ve seen that with members who may not be on speaking terms with family or friends. A lot of the work that we do is about—no matter what age somebody is—having respect for human worth, and seeing the other person as a full person.

Liz, you and I had a little rocky time when we weren’t really understanding each other.

Liz: It had to do with some organizational issues at the society. It was very political.

Anne: I thought, I’m going to assume that this is a misunderstanding. We just really need to go back and listen more carefully. What I really appreciated about Liz was that she not only listened to me but she also checked in with other Ethical Culture clergy. I really appreciated not only the deep listening, but also her checking to see, What’s the bigger story here? I think that comes back to being a religion of ethics. Friendships take work. And a lot of people aren’t willing to do that.

Complete Article HERE!