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How Do You Prepare For Death?

I often think about death. I don’t want to: I just do.

It’s a recurring subject that always comes to me as a question: what happens when you die? Is it all nothingness? Do we really have to leave everyone behind, going quietly or loudly, softly or roughly, onto the next stage? I have a lot of trouble answering the question, making sense of the subject, because it’s so unknown. I hate the unknown. I don’t fear many things but I do fear the unknown, the unanswerable—and that question is the epitome of that.

I try to surround myself with stories about that inevitable slide out of life. Yes, it’s morbid but I want to know as much as I can. I want to stare at that question as long as I can before looking away, watery eyed. I don’t like to be idle in the face of my fear: I want to challenge it, to try to solve it, even though I know that is impossible. There is no answer to that question until you or I are answering it for ourselves.

That question is backhandedly addressed in a recent New Yorker article about hospice care, the realm of nursing exclusively for people approaching their answer. The story follows nurse Heather Meyerend, a New York based hospice nurse as she tends to various patients, sharing stories and interactions with people as they prepare to pass. Some are scared, some are empowered by faith, and others are lost. It’s an absorbing read and, although dawdling at points, it’s well crafted by Larissa MacFarquhar.

The main focus is obviously on why hospice is important, framed by how we prepare for death through other people. I’ve never considered that work as “important” until now although, growing up in the Catholic church, you hear about hospice all the time and grow to ignore such an alien term. In Heather’s story, you see it is worth paying attention to.

Dying can be long and bewildering, lonely and painful, frequently undignified, and consumed by pressing and unpredictable and constantly changing and multiplying needs. It’s a relief to have someone around who understands what’s going on and what may happen next. On the other hand, when dying is long it becomes ordinary, just another kind of living, but one in which your friends may be gone and your children busy, or not busy enough. In that case, it can be a good thing to see someone who is not a member of your family; who comes from the world outside your illness; who has known you long enough to be familiar but not long enough to have heard your stories already; who wants to know where your pain is but doesn’t need you to explain everything; and who is there to take your vital signs but who behaves as though she might have come over to borrow a snow shovel or a couple of eggs.

“Just another kind of living” is so striking and so devastating: the act of dying can be a way of life. Who wants to do that alone? That seems so cold and foreign, the opposite of the human experience.

Hospice helps with that, obviously, but also these nurses, care workers, and volunteers are also signals for more to look at death and life. They’re gatekeepers, able to see when the body is changing, transitioning from life to death. In a grim (Or bright?) sort of way, a hospice worker knows when death is near.

When death is imminent, the breathing changes, and discoloration begins. The skin under the nails starts to get cyanotic, to turn blue. The legs grow dusky and cool. When Heather sees these signs, she calls family members who aren’t there and tells them, If you want to be here, this is the time. But she has seen, many times, that the patient seems to choose whom he wants there at the moment of death. Sometimes he waits for someone to arrive; but just as often he waits for someone to leave. Heather would see a husband or a wife or a child sit by the bedside day after day, hour after hour, and then he or she would say to the patient, I’m just running out to the market for ten minutes to get lunch, or I’m just going to take a shower, and that would be the time the patient would go. This happened over and over again. She wasn’t sure why. Maybe the dying person wanted to spare his spouse or his child the grief, or maybe it was harder to let go with that particular person around. Maybe dying was just easier to do alone.

Unf. That stabs deep. “Maybe dying was just easier to do alone” is one of those thoughts or questions that we often wonder about when animals remove themselves to pass, to be a relief of a burden to anyone around them. Maybe we try to rise to the occasion as much as we can and then, at the most mundane of moments, pass. There’s something poetic about that.

Prepare as we might, death is not something we’re ready for. It comes and it takes and, those left in our wake, must fill the emptiness. This feels especially pronounced for those in long relationships, in love, in a life intertwined. I find it very hard to imagine being by the side of your loved one as they slowly die even though I’ve seen it happen multiple times in my life.

People react differently to a death. Some cry, some are calm. Some are frightened to be left alone with a body. Some fear that the body may come back to life. Wives sometimes throw themselves on the body, weeping and grasping it, especially when the couple have been married forty, fifty, sixty years. “The Bible says, And two shall become one,” Heather says. “It’s a wrenching that happens, a tearing, like a garment that’s being pulled apart.” But fairly often a former spouse is taking care of the patient, because there is no one else to do it, and that person may not feel too much.

In all of our lives, we will feel all of those reactions to death. We will experience the gamut and, hopefully, each moment will teach us something about what it means to die. In someone else’s dying, we can only hope to learn something from them and their living and their departing.

Something to think about. If you, like me, want to dig into what it means to prepare for death, you can read the story here. It’s a long one (taking roughly forty minutes to an hour to complete). If you want to keep the playlist of sad going, might I recommend this story about the death of Sandy Bem.

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