Tuesday, September 14, 2010

Ashes to Ashes

Cruising into the office after seeing a few patients for home evaluations, I walk into my supervisor's office to pick up some documents from the printer. On her desk, there is a white cardboard box with printing on the top, and I immediately know what it contains: ashes, or what is known euphemistically in the funeral industry as "cremains".

Stopping in my tracks, I approach the box, my mind flashing back to the day when I picked up my step-father's ashes from the funeral home, overwhelmed by the fact that his 72-inch tall body weighing 180 pounds in his prime was now reduced to a box of detritus weighing in at less than 10 pounds. I recall driving home with that box in the passenger seat of my car as I cried in relief for the end of his suffering, despite the surreal notion that all that was left of his physical body now fit in a small container that bounced nonchalantly on the seat as I raced towards home.

Returning to the present, I gently opened the white box bearing my deceased patient's name, and reached in to grasp in my hand a clear, thick plastic bag containing her remains. I lifted the bag out of the box, weighed it in my left hand, and closely examined the small chunks of bone interspersed in the grayish ash. Closing my eyes, I conjured her face in my mind's eye and sent her a prayer of comfort as I returned the bag to the box and closed the flaps tightly.

I had only met this patient once, and although I had heard that she was dying, my next visit was not scheduled quickly enough, and she died before I could make a final visit. Our agency's home health aides knew her well, providing intensive personal care as her illness progressed. An intellectual, writer and retired professor, her body and mind had deteriorated greatly over the last five years, and those who knew her well understood that this mental and physical deterioration had been incredibly difficult for her to accept. Unable to read, write or speak, she was trapped in a body that had become, for all intents and purposes, a vestige of itself, a shell almost entirely incapable of personal expression. Despite having no living family, she did not die alone, and this is a comfort to all who knew and loved her.

Leaving my supervisor's office, I was flooded with memories of my step-father and his final days, especially that last day of his life when we all gathered around his bed to witness his last intake of breath. He never exhaled, and it was as if the six of us expectantly gathered around his bed had exhaled for him, sending his spirit out from his body on its journey into the unknown.

Next, my old dog Sparkey came to mind, and I pictured that day in late summer when the vet came to our house and assisted him to leave his pained and wasted body behind. As the medication entered his veins, he licked each of our faces in turn and a single tear ran down his furry cheek. It was a difficult goodbye, but his suffering was due for a humane and timely end.

Now a dear friend of ours struggles with cancer as she grapples with what treatment regimen will be most effective and least toxic, and her phone messages and our conversations across the country reflect the potential of loss that we are all facing vis-a-vis her mortality.

Recently, another dear friend's sister took her own life, and another acquaintance died after a brief but heroic battle with leukemia.

That little white box and its contents of ash and pulverized bone were a provocative reminder, a physical and unexpected talisman of the final ride that we all must eventually take. Bearing this in mind, I considered my own complaints and their relative pettiness, and was once again reminded of what a brief and wonderful privilege it is to inhabit a human body, walk the earth, and breath in the air of life.

We arrive to this world empty-handed and leave with nothing but our soul. They say you can't take it with you when you go, so we have to make the most of this fleeting earthly sojourn of ours. I am grateful for the time I have, and when it's my turn to take my place in a little white box of ash and bone, I will do so with gratitude and the knowledge that this was a life well lived.

As the saying goes, ashes to ashes.
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