Why Is It So Hard to Let Go?
Death and love are the two wings that bear the good man to heaven. ~Michelangelo
Last week, I learned that my 90-year-old aunt was in the hospital with pneumonia and sepsis. This is her second admission in a little less than six months, and she is not doing well. According to her daughter, she is unable to sit unassisted and can barely speak. And while she does have a DNR order in place, the family has been unable to agree on whether or not to call in hospice. So, like far too many elderly people at the end of their lives, she is at the mercy of a health care team who — in the absence of clear direction from the family to do otherwise — views every hospitalization as a “full court press.”
It’s so terribly sad, and so wasteful. My aunt could be at home in her own bed, cared for by the people who love her and a knowledgeable hospice team. But because some of her children think hospice means “giving up,” she will likely die in the hospital — the very place she doesn’t want to be. And the healthcare system will spend tens of thousands of dollars on care she doesn’t want that will do nothing to improve her quality of life, but will almost certainly prolong her death.
I feel very sad for my aunt and her family. But on a macro level, I am also asking myself, and not for the first time, “How on earth did we get here?” How did our thinking and priorities become so skewed that so many of us — good people with loving hearts — come to think of death as a medical failure rather than a natural part of life? How did we become so convinced that we must do everything we can to prolong every person’s life at any cost? Why do we find it so difficult to let go?
Credit: Liz West via Flickr
I’ve thought about this a lot. And I think the answer traces back to a singular event — the invention in 1960 of cardiopulmonary resuscitation, or CPR. Before then, people who died, either in the hospital or at home, simply died. Drowning victims were sometimes revived with rescue breathing (a technique that was developed only a few years earlier, in 1956). But when a person’s heart stopped, there was no turning back the clock.
But everything changed with the invention of CPR. Suddenly, reviving people after a cardiac arrest became the standard of care. It didn’t even seem to matter that the procedure was a dismal failure the vast majority of the time. (Even today, 60 years later, only about 8 percent of people who receive CPR survive long enough to be discharged from the hospital.) Doctors now had the ability to bring back the dead, and they were determined to use it. And so a whole new branch of medicine and a whole new approach to caring for the very ill was born.
At the time, it must have seemed like miraculous progress. But looking back on it with 20-20 hindsight, it seems like we opened a new and equally horrifying Pandora’s Box. Because now we have entered an era where the medical paradigm has shifted from helping people live to refusing to allow them to die.
Last month, the mother of a dear friend of mine died. I don’t know what was “wrong” with her, other than that she was old and frail and it was her time to go. And, to be honest, I had not talked to my friend in a while. But she posted on Facebook that she was going to Tennessee to be with her mom as her life came to an end. And then she posted many photos of mother on her deathbed, her children gathered around her and her beloved cat snuggled on her lap. And I thought to myself, “What a perfect way to end a life.” It was excruciating for her family, certainly. It always is. But if was beautiful too. They were all working together to help their mom cross over, making the path easier in any way they could.
I wish I could give that gift to my aunt. I wish I could give it to everyone whose well-meaning family simply can’t let go. But I think it is going to take a long time and a major change in the way we think for that wish to come true.
About Kathleen
Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years experience as a registered nurse caring for families and children facing life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.
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I believe one significant aspect of the common current ethos of “keep someone alive” at all costs, is the current mainstream scientific materialism that I suppose is the “spiritual” myth of our day i.e. that consciousness is a byproduct of a strictly material reality, and when death comes, as it will to all of us, it is the end of all that we know and will ever know.
And those of us who love life, who love all that it has to offer, I would imagine would not welcome such an end to it all.
This belief “death is the end” is certainly held by many of our health practitioners and care givers today. Death is viewed as a “fight” and as the “enemy”. How often do we hear that Michele or Frank fought their “Cancer” valiantly until the end. Where life and inevitable death is treated as a war ground to be fought.
I have to admit, even with all my own diverse readings, and even with some of Carl Jung’s testimony in MDR – his own NDE experience he recounts. There is still part of me who cannot shake off the current belief system so prevalent in our time – that this is all there is. We are born out of nothing, and given our fairly brief existence, we then naturally are put away forever, into death. Never to exist again. Because all that there is – is this, this one life, this one material existence. And anything beyond it – many (such as Richard Dawkins, or the late Stephen Hawkings) will claim is just magical thinking.
How to break this belief system so prevalent today? How to not succumb to the sense that one’s individuality, one’s love of life, one’s own, those of others, is not forever buried at one’s last breath. How does one come to terms of those we have loved so much – who have passed away? Are they too obliterated into nothingness? How do we find meaning in this kind of existence?
For me, the puzzle of this mystery does lie in the nature of our consciousness. Are we to believe we are simply products of neuronal actions in our brain? Our thoughts spontaneous productions of chemicals and electricity produced by an extremely complex brain, and nothing more? Is it mere wishful thinking to believe consciousness might be more than this?
I cannot claim to know the answer to these questions. And I admit a fear of death, of being “put away forever” as Frederic Myers once wrote. And our medical health care practitioners, many of them — all they can offer us, is a brief respite from that yawning abyss that may await us. This is indeed – an unresolved problem of our times. The underpinnings of our medical health care system does not resolve the question of death itself. It simply assumes like many of us do, that it is the end of all that we are.
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Hi John,
Those are interesting thoughts, though I tend not to agree entirely. I think many, many people still believe in a hereafter of some sort. Certainly all organized religions hold that there is life after death, and Christianity, which is still the largest religion practiced in the US by far, assures those who believe that they will live on in a “better place.” But that doesn’t seem to affect now fervently many very devout Christians (and their devout physicians) cling to life, even when doing so makes no logical sense. By the same token, many others who don’t believe in an afterlife are able to meet death with far less fear.
I don’t claim to have the answers either. But I believe facing death with some semblance of acceptance starts long before we are on our deathbeds or lying in an ICU. Our culture still denies that death exists. We still look at it as an “enemy” that we can somehow “defeat.” And you are right that as long as we frame our discussions and our thinking that way the really important questions — like, “What happens to me when this body dies?” don’t get asked.
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You could have been talking about me. I will offer my perspective, and we “fought” because I hear so often of medical teams being wrong. If there was anything to do to keep my mom here we were willing to try. If “miracles” happened to others, it was possible for them to happen for us. Maybe it’s because you have the emotional distance of it being your aunt and the “knowledge “ that it truly was her end. For us, we didn’t know it was the end until she passed so we did not accept that in advance. How does one know that the “full court press’ will do nothing to improve quality of life when we often hear the opposite? The difference between your aunt and my mom is that my mom was 64. Maybe if she was 90 we could have been more in the acceptance space than in the save her life space… everything you’re saying makes sense, but until it’s your 64 year old mother who was just fine in October and dead in March, it might be a good idea not to judge and just support. It’s hard for others to fully get another’s emotional perspective and experience if it’s not them who is going through it. I’m sure the people who wouldn’t let go loved her fiercely and are devastated by her physical absence. I would do anything to see my mother’s smile again and I never let go nor will I ever. She’ll always be a part of me.
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