Five Wishes

a sermon preached by Rev. Khleber M. Van Zandt V at First Unitarian Church of Alton, Illinois, October 25, 2009

after a reading of Merritt Malloy’s poem, Epitaph

It’s coming up on Halloween so I want to tell you something that may be very scary.  You see, I know something about you.  Are you squirming yet?  You will be…

I was searching the files of the church this week and I came upon a fact so very personal that it gets right at the heart of who you are and how you live.  I was poking through the folders that we keep on individual members…  Now, they’re not like FBI files – there’s not a whole lot there, only a few newspaper clippings and letters and notes – things a church like ours ought to keep of an historical nature that let us know a little more about our members and their lives and their work out in the wider community.  But in poking through the folders we keep on people, here’s the fact that I found out about you:  you don’t have a health care directive or a living will or any plans for your memorial on file in the church.  [It’s not strictly true – two families have papers in their files…]

I’m sure it’s just an oversight on your part, that when we’ve asked you to fill out the paperwork you’ve been too busy or you forgot or you didn’t get around to it.  It’s not because you don’t believe it’s important.  It’s not because you’re afraid to think about it.  It’s not because you want to put your relatives through a much harder time than they will already have to go through.  It’s not because you’re a less-than-sensitive person.  I know that’s not the case.  But what I’m about today is convincing you to rectify this scary situation by sitting down this week, filling out the forms, and getting them on file so if anything does ever happen, we’ll know what it was you wanted us to do.

 

I don’t know of better ways to convince you than with stories, so here’s one:

The woman arrived at the inner-city hospital unconscious and unresponsive.  She had been helicoptered in from a small nearby town where she lived with her mother.  The mother had left the woman at home while the mother attended church on Sunday morning.  The daughter knew to call the mother in case of an emergency – the daughter was in her late forties, though she lived with profound learning and developmental disabilities. 

The mother had returned home after church and found the daughter unconscious but still breathing on the dining room floor.  Medical personnel had come quickly and had gotten the woman to a local hospital in good time, but there was nothing to be done at that medical facility except transport the woman to a larger hospital in a last-ditch effort to save her life.

So here she was, in an intensive care unit, hooked up to all kinds of gadgets and machines designed to keep her, in some sense, “alive”:  she was alive to the extent that her heart was still beating, but she was not truly alive because her heart was being driven by a machine rather than beating on its own.  Hospital personnel gave the woman two separate and extensive neurological tests to determine the probable level of brain function she would have IF she were ever to wake up.  She failed the tests, and it became the chaplain’s job to help the mother and other family members decide what to do.

As I sat in a hospital consultation room with the mother and family of the woman who was brought in in a vegetative state, I learned that the mother had never felt comfortable discussing death with her daughter.  Now, in this particular case, perhaps she was right – the daughter had been barely functional in society, but very loving and a joy for the whole family to be around and know.  Part of the reason this was so was that she was so innocent. Every moment was new for her - she had been unable to assimilate the idea that what’s happening now won’t last forever, that things end, that people die, that we all die.  Perhaps she was the sort of person who simply could not comprehend what it means to fill out a health care directive, a living will, or a power of attorney.  And because she couldn’t, and because we had nothing in writing, the mother and the family had to make difficult decisions on their own with no help from the woman whose life had actually ended on the dining room floor but whose death was now being extended by the impersonal bells and whistles of an institutional intensive care unit.

We talked in the conference room for a long while about the kind of person the daughter had been, how she had never met a stranger, how she loved everybody she ever met.  She didn’t keep stuff for herself but gave things away to people she thought might need them.  It was in this atmosphere of love and respect and honor and remembrance that the mother finally said, “I can’t do this to my daughter anymore.  Turn the machines off and let her go.” 

A nephew and a cousin went into the ICU room to witness the removal of the machines.  The mother could not force herself to go, realizing that she had said goodbye in her mind when she had gone in for her daughter’s final neurological exam.  She sat instead with her sister and me, talking about the wonderful days of watching her daughter grow up, painting a beautiful picture of a close-knit, rural family that happened to have a developmentally challenged child to love and care for and who loved them back with all her heart.  When the nephew came back and said the daughter’s heart had stopped almost immediately, they knew they had done the right thing – that what had happened was horrible, and dreadful, and not fair, and yet natural.  The daughter had not suffered.  And the family had not forced her to go on without a real chance at life.

 

Scenes such as this play themselves out in hospitals all over this country every day.  It is a commonplace for chaplains and doctors and nurses to walk with families through the emotional, moral, and ethical forests of questions surrounding such tragic events.  It is never easy, and in my experience, it doesn’t get any easier.

One wish I’ve had for the people I’ve met in these situations is that they would be able to make these most private of decisions in peaceful surroundings – not in crowded waiting rooms, not when they’re crippled by grief, but rather I wish people would be able to make these decisions calmly and thoughtfully, reflecting on their lives and on their loved ones and on their most deeply held values.  But I find that too often we don’t take the time, when we seem to have the most of it, to consider end-of-life questions.

You’ve heard it said that Time heals all wounds.  But sometimes time works against us, especially when we put important things off because we’re afraid or because we’re too busy to bother.  I don’t know anyone whose body has gotten better and better and better over eighty or a hundred years, though some of you look pretty good. – Rather, as the years roll on, our aches and pains and trials and tribulations teach us to celebrate a good day when we have one. 

 

It’s a beautiful autumn day here in the Riverbend, the trees aglow in fall shades of yellow and red.  Even though we’re coming up on Halloween, it’s time to celebrate life, not to be consumed with death.  I don’t tell you these stories about death to lower your spirits but rather to raise your awareness that we have responsibilities to those around us:  the responsibility to tell others what it is we want, to make the hard decisions and to have the hard discussions about our wishes for our last days.  On the one hand, if we don’t tell anyone what our wishes are, then maybe we deserve what we get.  But much more importantly, if we don’t tell anyone, then we are leaving our most intimate friends and family members – the ones we love the most - to make the hardest decisions they could ever possibly make, without any guidance from the one that ought to know the most about what we want – ourselves.

Financial issues are one thing.  I knew a man who ran a business worth a couple of hundred million dollars.  He had three children by his first marriage, and after he was widowed late in life, married again.  When he died after a protracted illness, it was learned he had made no provision for the division of his assets among his new wife and grown children.  They are still fighting about it all these years later, and it’s affecting all his employees, the entire community, and then some.

I know another family in which the patriarch passed away and the matriarch moved into a retirement center and after several months died there, leaving no hint of her wishes.  The grown children of that family are still fighting over their inheritance, which was a grand total of about $4,000.

So maybe it doesn’t matter whether you have money or not, the financial issues will always be a problem.   This morning, though, I’m most interested in having you consider the family members who are left to make care decisions on their own, who are left to decide whether or not to continue treatments, who are left to consider tissue and organ donation questions.  Without guidance from a loved one, these can be excruciating decisions to have to make for someone you love. I’ve heard some national spokespeople in the health care reform debate characterize a team approach to counseling people about end-of-life care as “death panels for killing grandmas” – it’s bizarre. 

They accuse us of being a “culture of death” rather than a culture that honors life.  But I would say that a culture that worships life at any cost is an idolatrous culture.  It’s a culture that hasn’t seen or paid attention to those situations when death might be preferable to life.

But a culture that honors life recognizes that those of us who can make our own choices should do so – that we have a responsibility to decide and to make choices and to let our loved ones know what we choose. 

If you already have a living will or a health care directive, I invite you to send the church a copy so we will know what to do if we are ever asked.  If you haven’t filled out a health care directive and a power of attorney, I brought a few forms with me today.  They carry the title Five Wishes and will walk you through thinking about some end-of-life issues that you may never have considered.  And this will give your loved ones something to go on when the time comes.

[read the five topics]

I told you I know something about you.  It’s about all of us, and that is that we’re all going to die.  We are.  I take it as part of my calling to remind people of their mortality every so often.  And I think by doing that, it might make it all a little less scary.  Sometimes I think it’s the denial of death that makes death itself so God-awful.  In my experience, once you’ve considered it, once you’ve sat with it for awhile, once you’ve faced it down and spent time reflecting on your own impermanence, the fear tends to dissipate and be replaced by the recognition that each day is a gift, and that love is stronger than death.

 

At this point, I need to admit that this has not been the sermon I wished to present to you this week.  I had chosen the title, Five Wishes, to correspond to these forms before I realized they are a registered trademark of the non-profit agency, Aging with Dignity.  You can have the ones I brought this morning or you can purchase them yourself online.  They’re very good, and I think they’re terribly important, and I think the work that Aging with Dignity does is incredible.

I do urge you to fill out a health care directive and a living will today, whether one of these Five Wishes forms or some other legal instrument.  Let your wishes be known.  Give the gift of life to your loved ones.  Then, quit thinking about death.  Our days are short enough without robbing ourselves with worry and obsessing over things we can do nothing about.  The universe does not demand that we suffer.  The universe is our sustenance, and life here is a gift.

If the forms ask you to say what your five wishes are, I’ve thought about the five wishes I have for you today, and here they are:

--  I wish you peace.

--  I wish you wholeness.

--  I wish you relief from suffering.

--  I wish you to know that you are loved.

--  and I wish you the courage to act accordingly.

So go.  Live now, with gratitude.  While you have the chance, act compassionately toward yourself and toward others.  And revel in the gift that is this day. 

So may it be.