This I Believe

Jame - Fort Worth, Texas
Entered on March 1, 2007
Age Group: 30 - 50
Themes: death

This I Believe—Death is Not to Be Feared, not the End

“I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength, and I stand and watch until at last she hangs like a speck of white cloud just where the sea and sky come down to mingle with each other. Then someone at my side says, ‘There she goes!’

Gone where? Gone from my sight … that is all. She is just as large in mast and hull and spar as she was when she left my side and just as able to bear her load of living freight to the place of destination. Her diminished size is in me, not in her. And just at the moment when someone at my side says, ‘There she goes!’ there are other eyes watching her coming and their voices ready to take up the glad shouts ‘Here she comes!’

–Henry Van Dyke, A Parable of Immortality

There is an old cliché that there are only two things inevitable in life: death and taxes. Even though I am a senior Internal Medicine resident and soon-to-be hospice fellow, I can remember as a young child—3-4 years old—playing in the church where my father was the minister, waiting for him to finish his work so we could walk home together. One of my favorite places was the parlor at the far end of the hall from my father’s office. The couches were plush, the curtains heavy and velvet-like, and it was dark and quite.

One particular day, I went to play and wait. While I entertained myself, I came across a large, dark wood box on a stand. I had to climb on a chair to see inside—it was one of the ladies from the adult Sunday school class, and she seemed to be asleep.

I don’t remember being afraid, but curious. I went to Dad and asked him about this unusual finding. He tried, in a valiant effort, to explain to a 4 year old the end of life. But though he was a gifted and great orator, words eventually failed. So he picked me up and took me back to the parlor.

He explained that although it looked like my friend was asleep, she would not ‘wake up.’ Then we talked about heaven and a child’s understanding of the hear-after. Then he took my hand and had me touch her hand. It was waxy and cool. It was at that time that my father began to teach me of life and death. And though I didn’t know it at the time, he also started teaching me about trust and fear. Of course at the age of 4 I had no idea of the concept of hospice or palliative care. But from that time, I knew not to fear the end of this experience.

I believe that the end of this existence does not need to be hard. And I believe the end of this existence is not THE END.

Fear, or guilt, or regret often burden patients and their family. Will death hurt? Will I have dignity at the end of time? You can hold the hand of a patient with cancer and assure them that everything that can be done, will be done to ease their pain. You can sit with the family and tell them you will fiercely protect their loved one’s dignity.

Over the next 25 or so years, my father and I would see many more deaths, attend and serve at many funerals, and sit with countless family members remembering friends and loved ones passed—laughing, hugging, and sometimes crying together. My father and I learned with and from each other: with him I explored the religious and theological paths of death and with me he learned of cellular decay, apoptosis, oncogenesis and how to declare someone clinically dead. But rather than being diametrically opposed, we found a synergy, a harmony, and a yin and yang. For us, religion and science were not mutually exclusive but two ways to look at the same complex issue. And through it all, he continued to give me strength and trust—and to banish my fears as a candle banishes shadows in the night.

I believe that death and the end of life do not have to be painful or fearful for a patient or for their family. The end of life can be peaceful, free of pain and fear and guilt. And I believe beyond the shadow of a doubt that is one of my callings in medicine. My father gave me the strength to ‘be not afraid,’ and as I can be strong, I can talk to those approaching their transition and discuss with them choices, fears and end-of-life issues.

I do this already on the nights when I am the resident on call at my hospital. But I want to know more, to be better, and to more fully understand how this life transitions into the next. To lean to comfort and to ease pain—physical, mental or emotional.

My father is now a part of The Communion of Saints. But I still hear his voice telling me not to fear…not to store too many treasures in this world. Usually I hear him when I am walking to the ICU at 2:00 am to intubate a critically ill person, or running to a code in the wards. Sometimes, I even think I see him standing over the shoulder of the family I have to talk to. Inevitably they are huddled together, looking apprehensive—hopeful, yet fearing the worst.

Sometimes I can hold a daughter’s hand and tell the family that mom is very ill but still alive. Sometimes I hold a wife’s hand as she realizes she is now a widow. Sometimes I shed a tear with them and sometimes I wait to get back to the call room before I feel the grief that the family I just left is feeling.

And all the while, my father and his words, the lessons he taught and the faith he nourished and nurtured, give me strength. To fight aggressively for a patient who is coding, giving ACLS drugs and directing the nurses, interns and all the staff who attend…and to fight for their right to go to sleep in this world and awaken somewhere infinitely more beautiful and glorious.

And this brings forth yet another memory: my father and mother, singing in the community choir when I was in my youth. It is the line from a song…almost too faded to hear the melody; but wait! There it is….

Just think of stepping on shore and finding it Heaven

Of touching a hand, and finding it’s God’s

Of Breathing new air, and finding it’s celestial

Of waking up in Glory, and finding it’s Home.

I do not fear death. I celebrate life and the life to come. This I believe.