Dying with purpose

A patient arrives at the Emergency Department complaining of abdominal discomfort and flu-like symptoms.  But subsequent laboratory testing and x-rays reveals that the patient has cancer of the pancreas that has metastasized to both lungs.  She has never been diagnosed with cancer before, so this is quite a shock to her and her husband.  Her faith is very strong but this is still a major surprise.  Our conversation mainly focused on how she can make her dying one with purpose.  Such an idea is strange to most people.  Few people imagine how their dying can be filled with deep meaning, uncharted depths of love and hope.
There are several things that we can do to make our dying a process that minimizes anxiety and conflict.  The one thing everyone must do is declare a durable power of medical attorney.  This designates someone to make medical decisions for you if you are incapacitated.  And hopefully you and your DPOA have discussed what your wishes would be for issues like CPR, ventilation, and artificial nutrition.  You can use a living will that identify your wishes and will help guide your DPOA.  Both of these documents have to be notarized.  I can help you with these forms and notarize for you.  I am at the hospital Monday through Friday, 8:00 to 4:30.  There is no fee for this.
Another document is the Do Not Resuscitate.  There is even a Do Not Ventilate.  I can also help you with this, but this must be signed by your physician.  We also have a form, TPOPPs, which is a combined form that takes care of issues like resuscitation, ventilation, nutrition, and comfort care.  I can also help you with this, but it must also be signed by your physician.  TPOPPs is for people who imagine that they will not live more than a year.  It is very clear and one of the most helpful tools I know of.
OK – that’s the legal nuts and bolts, but let’s talk about the deep issues.  Think about what you would want your children and grandchildren to learn from your dying.  What are the life lessons you can teach them in the last chapter of your life?  What can you teach them about dignity, respect, courage, ethical resolution, and keeping your identity that is not your diagnosis?  What are the spiritual depths that will sustain you?  By that I do not mean the name of the church you attend, but the center of your being that resonates with the Eternal?  
One of the best ways that we can do that is by telling stories.  Tell the stories of your life, the events that changed you or the direction of your life.  Talk about the people who shaped your values and strengthened your moral compass.  When were the times that you were the most challenged and how did you resolve that.  Don’t be afraid to speak of your failures or moral lapses and what brought you back from the brink of moral catastrophe.  And if it didn’t, what transformed you?  Make sure you tell the comical stories.  Even death has a funny bone.
Talk about your dying.  What are you experiencing?  What worries do you have?  What is your vision of where the Life Force takes you next?  
I have known many people who have special gifts, even simple ones, which they want to give to their loved ones.  Do this while you are alive.  For example, I collect fountain pens, pocket watches, and pocket knives.  I already know which ones I want to give to my children and grandchildren.  I have my grandfather’s pocket watch that I will give to my son, Jeremy, whose middle name is my grandfather’s last name.  There is a tale to tell about that watch which will make the gift more meaningful to him.
Write letters.  Keep a journal, either a written one or a video one.  Send letters to your friends and family.  Give thanks, offer forgiveness, say “I love you,” and say goodbye.
Finally, think about and plan the celebration of your life.  Talk with your minister, priest, or rabbi about the service.  Pick out your music and readings.  They do not have to be “religious” but most importantly the ones that reflect who you are what you cherished.  My memorial readings will include Psalms, Ralph Waldo Emerson, and Henry David Thoreau.  There can certainly be hymns but think about music that swells your soul and blesses all who sing them.
Chaplain Gary Blaine, D.Min., provides Pastoral Care at Susan B. Allen Memorial Hospital.  He received his Doctorate of Ministry from Emory University, and holds certifications as a grief counselor and a grief group facilitator.  He can be reached via e-mail at jblaine@sbamh.org.