The Hardest Question


Months have passed, and I still remember the hardest question I’ve faced in my professional career as a nurse.

It was the kind of moment you’re hit with a ton of bricks, your breath sort of disappears, and sometime later you walk away stunned. I sat in a beautiful living room, glancing from him to the cultured decorations. Occassionally I pet the cat. He was calm and we spoke about his extracurricular clubs and meetings. As we transitioned from small-talk to health, he earnestly asked, “So what do you know about this Death with Dignity thing in California?”

I wasn’t expecting that.

The Death with Dignity Act is legislature allowing the prescription of fatal medication to pass from physician to patient. The patient must meet specific criteria — residency in California (similar laws also exist in Oregan, Colorado, Vermont and Washington), life expectancy less than 6 months, legal adulthood, and mental competency. Death with Dignity is modeled after Oregon’s similar act, made famous in 2014 by 29 year-old Brittany Maynard, who moved to Oregon for the purpose of choosing Death with Dignity after initial treatments of her rapidly progressing brain cancer were unsuccessful. Those in favor the Act affirm that by ending one’s life before the natural occurrence of death, the person also maintains their dignity as to not lose physical, mental and emotional capacity with the dying process. As of June 9, 2016 the End of Life Option Act became legal in California.

Before I go any further you should know this is not an opinion piece. This is a processing piece. A teacher I highly admire, Mike Erre, puts it simply: “The goal is never to get you to think what I think. The goal is to provoke thought.”

We had a long conversation. He expressed his goals and his desires, clearly and plainly. I committed to getting him more information on the topic. After the visit I got in my car. Then I cried.

I cried for death in general. I cried for the immense pain people experience, to choose ending life rather than prolonging the pain in their existence. I cried for the families of loved ones who choose Death with Dignity — the anger or the questions or the sorrow even in the midst of acceptance.

I cried because working in hospice forces you to consider your own mortality from time to time. What if it were me with a terminal diagnosis? What if I knew I had to leave behind my husband and family? Would they look at me differently and remember me differently after I became too frail to care for myself? When I put on the shoes of another who is suffering, the thought of leaving the pain behind and exiting before the (sometimes gruesome) end makes a little more sense. I’m not saying I would. I’m not saying I agree. I’m simply given some perspective.

All of this makes me think of what God hates. God hates for his children to cry, to be in pain, to feel hopeless, to feel scared, to experience death and darkness.

God is a God who loves light, who loves to heal his children, who turns ugly things into beautiful things. Who offers strength, courage and peace. Who is making a new heaven and a new earth where death no longer holds any power.

But all of God’s redemptive work doesn’t diminish the depth of despair and anguish we experience this side of heaven. Actually, all of the deep despair and pain show God’s love and God’s light even brighter simply because of the contrasting shades — imagine a single candle light in a large dark room. The small flame becomes the brightest thing.

How does that play out now? How does that take shape this side of heaven, when I’m holding someone’s hand who stands at the door of death? I care immensely for my patients’ dignity, integrity, and autonomy. I always tell them, “Your goals for you are my goals for you.” The end of life is a vastly universal but vastly personal experience. Our relationship is sacred and special — people trust you when they know you love and care for them just as they are, no strings attached.

The palliative and hospice industry will become more interesting as policies surrounding the Death with Dignity Act take shape. Usually I have the ability to turn a blind eye and ignore heavily political issues [mostly due to lack of brain power and attention span after a particularly long day] until I feel equipped to deal with them. Last week this was not the case. I will continue rubbing shoulders with uncomfortable changes, all the while loving and honoring my patients. So for now I am a learner.

Over the past few months I’ve been reminded that when my heart breaks, it means my heart lives. When my heart breaks for these things it’s because God has given me a piece of himself, because he mourns and grieves our pain also. I don’t always know what to say in these sticky situations, but that doesn’t have to stop me from being present.


| Valuable Resources |

Being Mortal by Atul Gawande – this book is an incredible introduction to the processes and decisions we all face before the end of life. The auther writes from the perspective of a surgeon, but also highlights the non-fiction work with memoir of his own father’s dying process. You get the objective and subjective thoughts, intertwined and complimentary.

Photo Credit: John Rocha

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