Sunday, June 11, 2006

The End Is (Always) Near

Every week, I check on my patient who has been battling cancer and living at home with the help of hospice care and the devotion of his family. At my last visit on Thursday, he was sixteen days without any nutrition, receiving morphine and a few essential medications with a cup of water via g-tube daily. Each visit, I put a hand on his forehead and one on his chest, whispering in his ear that he has been brave and strong, that his wife will be OK without him, and that his time to let go is near. His wife tells me that she gives him permission to go every day, and he has indicated in his obtunded state that he's beginning to see dead relatives in the room. Each visit seems like it may very well be the last, and I keep expecting that call which will tell me he has left this world for the next.

Similarly, my old dog was given two months to live a few months ago, and I pump him with IV fluids every night in an effort to support his slowly failing kidneys. This journey of living and moving towards death is being chronicled on my other blog, Latter Day Sparks. Even as his death seems always around the corner, his continued apparent joy of living is what shines through most clearly. Even as we commemorate his life and memorialize him while he is still with us, we've chosen his burial place and begun to make some plans. Our sweet time with him is so limited, but so cherished.

When I think about it, I can picture the faces of dozens of patients and friends and family members who have passed from this world. How was the quality of their living? What was the quality of their final days, their actual death? Was peace the final sum of their lives' rotations around the sun?

Even as death surrounds us and we prepare for the loss of loved ones near and far, even as death fills the news media and reminds us of the suffering in the world, we embrace each sunrise and live our days in awareness of their numbered reality. As my patient awaits his death, perhaps resisting its inevitable gravitational pull, I understand that each day, each breath, could also be my last, as well. When we know that someone is dying, we of course try to make our moments with that person meaningful, with the thought that we might never see that person again. Carrying that notion forward, each time we see a patient, a friend, a neighbor, a loved one, could also be the last time we lock eyes with that unique individual. May every interaction be informed with that reality, that potential for finality, for a desire for true and honest and authentic discourse.

The end of days is prophesied, but we have no idea what that really means. Global warming, nuclear disaster, pestilence or plague may rob us all of our full lives. A slight miscalculation can send our bicycle into traffic, our car off the road. A lifetime of dietary indiscretion or simple genetic predisposition can block our coronary arteries and send us into arrest at any moment. We may even be struck by lightning.

All of that said, it is only the present, the moment in which we live and breath, that anything real and authentic can occur. As we struggle to save for retirement (a recommended practice, to be sure), pay off debts (also recommended), raise our families and make a living, every moment is truly an opportunity. Working with the ill and disabled, I always try to remember that "there but for the grace of God(dess) go I."

Yes, the end is always near for us all, but each day is also a beginning. Armed with this knowledge, what more can one do but bring this awareness to our days, console the ill, support
the dying, offer succor to the impoverished, and give thanks for another chance to love.

As Mother Teresa said, "I have found the paradox that if I love until it hurts, there is no hurt, only more love."
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