Production vs Purpose
By JIM NICHOLS
Once again I wish to take you into an area of my indecision and wondering. I hope I am not alone in having many more questions than solutions. Perhaps by writing some of this to you, it will help me think and clarify my thoughts.
It happened again just this week. I was visiting with a hospice patient in her home and she was troubled as to why she was still alive. For those of us in presumably good health, this is a jarring question. It almost does not make sense to us because we (naively) believe tomorrow and next week and next year will come for us and we will have many more opportunities to learn, grow, and produce.
You and I are clearly caught in a trap of living in a world in which we must always be producing rather than just being. As children, most of us watched our parents perform multiple duties day and night; many of those were selling, building, trading, and consuming. Part of that constant activity was for our benefits as children in the household. It taught us, however, that much of life consisted of generating some types of products. What does that mean when we are no longer capable physically, emotionally, or intellectually to be a “producer?”
People enrolled in hospice programs qualify by having what appears to be a clearly limited future lifespan; their family knows that, we know that, and they know that. I have found that hospice patients frequently respond to that knowledge by seriously wondering why they still exist on earth.
They will say, “I feel so weak all the time. My nausea is severe and I cannot believe I am unable to go to the toilet by myself. I feel dirty and ugly and am dependent on others for care just as if I am a baby again. Why can’t I just pass away?” Patients who are religious will often add that they are ready to go to heaven now, not later.
These are difficult statements and questions for me. I consistently feel that any response I make is superficial and poorly helpful. The best I can do is address two truths for me.
The first is to suggest to the patient that he or she has a purpose even without an obvious product. This distinction is important for all of us, not just those serving their last weeks or days of life. Even in weakness, others can teach us serious aspects of life. We learn from them what is important and what is not. The world for someone dying becomes much narrower and most of the junk of life falls away. This should cause those of us remaining to ask important questions about how we are spending our energy and time. I have found that the first minutes after such a patient encounter are times of some of my clearest thinking about who loves me and how I return that love. Even if the patient is non-verbal or wildly incoherent, we are learning from that patient. We need to tell them that.
Family members frequently fill the home or room of someone dying. The array of behavior is always striking to me. Some are in deep sadness and grief, whereas others seem hopeful. Some are almost boisterous in their denial. I suggest, however, that every person in that space is learning something that cannot be learned in any other way than by their presence there. I certainly have found that when I take care of somebody, I learn things about myself.
Second, we need to remind someone at the end that God’s love continues. Even in what may be significant physical struggle, God has promised that He will not abandon us. One translation of Psalm 121 reflects, “May the Lord watch over your entrance and your exit.” This is not just talking about our daily life; God was watching our physical birth and will watch our physical death.
I read to the patient from Romans 14:7-9. “We do not live to ourselves, and we do not die to ourselves. If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord’s. For to this end Christ died and lived again, so that he might be Lord of both the dead and the living.”
As I finished reading, her eyes brightened and she said, “Even when we die, we belong to God.”
Jim Nichols is a retired Abilene Christian University biology professor and current medical chaplain