“Your disease has a downward trajectory,” said the doctor to the man. The former was among the best cancer doctors at one of the best cancer hospitals in the world. The latter was a man a few years shy of 60, no longer young but not yet old. An awkward silence opened after his awkward sentence.
What the physician meant to say was: “You are going to die. This disease will kill you, and sooner rather than later.” There are many reasons that sentence was almost unpronounceable in that shiny medical tower. From there death, and the disease that caused it, was a dread enemy to be fought and conquered. The unintended consequence of this view is that death’s eventual arrival on the horizon suggested that someone had failed.
The patient, who was perhaps even more allergic to bullshit than to the cancer in his blood, asked for a clarification: “I don’t understand. What are you saying?”
“I am saying that there is nothing more we can do for you here. I am sorry.”
Later that afternoon, the patient took an ambulance ride from Manhattan to the Bronx, from hospital to hospice. It was not a long trip, but it was the last one he would ever take.
This was not a trip that he had expected to make that day.
We looked like Good Humor men, decked in white from head to toe. White shirt, white pants, white socks, white shoes. Bounce some sunlight off our (mostly) pale skin and looking directly at us became a hazard to retinal health.
It was the springtime of our first year as Jesuits, which for me and my seven classmates meant one thing: “hospital experiment.” From the time of the order’s founding, we Jesuits have often found ourselves ministering in hospitals. This is particularly true of novices – those in their first two years of formation – but not only them. When Ignatius sent several of his first companions to the Council of Trent as theological experts, he instructed them to fill their spare time ministering at a nearby hospital.
The novices of my province have been going to Calvary Hospital, a hospital-scale hospice facility in the Bronx, for over forty years – since the days when nuns in full habits roamed the halls as nurses. For all that has changed at Calvary and in the Church over those forty years, one thing has not: the hospital experiment is one of the most important experiences of a Jesuit’s early formation.
Calvary is a remarkable place. It specializes almost exclusively in palliative medicine, particularly in pain management and end-of-life care for the terminally ill. Most of its patients suffer from various forms of cancer, and they pass through the hospital’s doors knowing that their next bed may well be their deathbed. It is, as I have become fond of saying, a “wonderful terrible place.” Terrible because even the best of care cannot diminish the suffering borne by so many there. Wonderful because patients at Calvary are treated with unrivaled dignity and compassion; cared for not only physically, but spiritually and emotionally as well.
Though we were men seeking to be Jesuit priests, we entered the hospital not to offer spiritual care, at least not in a formal capacity. We were there to serve as orderlies, not chaplains, and this for several weeks. Practically speaking, this meant our days were filled taking care of physical needs. If you were a male patient looking for a bath, a shave, or some help eating your meal, we were your guys. When the bedpan eventually filled, we could help you with that too. And when death came, as it always does, the preparation of a patient’s body became our somber privilege.
It was over eight years ago now that I met “the patient,” just a few days after that fateful conversation took him on a drive to Calvary. The patient and I had arrived at the hospital at just about the same time, albeit for very different purposes, and we had both been assigned to the same floor upon our arrivals. The first thing I noticed, even before the patient and I met, was a poster that hung in his room: publicity for the forthcoming biopic of Julia Child, “Julie & Julia.” It bore the image of an ascot-wearing Meryl Streep, her grinning face framed by two splayed turkey legs.
I remember laughing when I saw it. I remember because laughter was a pretty rare occurrence in those first days at the hospital.
Some days later, I was assigned to help with his care. Only then did I learn that “the patient” was named Tom.1 My assignment to his room meant that each day we would spend a good deal of time together.
Actually accompanying a person in their last days – sharing the experience with them – is an extraordinary thing. Most of us do not inhabit this space very often or very well. This is, in my experience, partially because we do not find ourselves in such positions often. But it is also because we expect this space to be filled with the spectacular, the epiphanic, when in reality the imminent horizon of death draws nearer through the kind of things we don’t pause twice to consider: sleeping, eating, bathing. And talking.
Years later, it is the conversation that I remember most. Not necessarily the topics, which were so ordinary that I have lost many of the details, but rather the time. Initially, we were strangers and so spent a good bit of time getting to know each other. We talked of home and family at first, and then of education and career. We were sketching a roadmap to the present; coming to know one another.
Armed with that knowledge, the topics deepened. We talked about Tom’s partner, whom he had buried and grieved; struck down like so many others in the first wave of the AIDS epidemic. It was in this way that love and loss, those strange twins, made their appearance in our conversation. And eventually we talked about God, indirectly at least, as a 20-something novice explained why he wanted to be a priest to someone with a complicated relationship to organized religion.
There was also a lot of laughter, and not just the first time I spied the Meryl Streep poster. In fact, I laughed often during the weeks that I spent in that room. (In the end two people, even one dying and one in formation to be a priest, can only spend so much time talking about death and God.) Perhaps that may seem counterintuitive, and maybe even irreverent. I felt awkward the first time we laughed together in his room. I mean, who laughs while tending someone’s hospice bed?
I did. And Tom laughed as well, along with many of his friends who came to visit. It is easy to forget that life in the shadow of death is still life, and that an ordinary part of living – even living with extraordinary suffering – is laughter.
I do not mean to suggest that our time together was all levity. The shadow that Tom’s impending death cast was real, and it was at times difficult for him to bear, as it was for his friends and family – and for me. But I do mean to suggest that it was not all darkness around that deathbed. You have to know that the darkness we felt was tinged by a light, a light that shone from the beauty of his life, even as it neared its end.
I mean to say that there were tears of sadness and tears of joy. I mean to say that to see only darkness when there is also light is a thing worse than simplification. It is humbling reality to fit our emotions. It is selective blindness.
Inhabiting the perimeter of a deathbed, or the space that surrounds someone’s suffering, is not something we regularly elect to do on our own. Most often, as with an illness, it is thrust upon us, arriving without warning or invitation. Perhaps surprisingly, our inner resistance to really “being there” – being present to the person rather than to ourselves – is often directly proportional to our emotional proximity to the person lying in the bed.
Some weeks before his death, before his condition took a final turn for the worse, Tom began contacting friends and colleagues to say goodbye. Several times I witnessed these types of in person encounters between Tom and visiting friends. I could see that it was hard for them to be fully attentive to these sad conversations. I admired those who adopted this attitude; admired that they honored the gravity of what Tom was doing by initiating this kind of a dialogue.
But this response was far from universal. One of his friends, when met with the news that Tom had returned to inpatient care, said blithely: “Oh, I’m sure you’ll beat it.” When, through tears, Tom informed his colleague that in fact he would not “beat it” and would soon die, the person was literally unable to respond. This truth was too hard to look at. The call ended shortly thereafter.
“Nothing in life was as ugly as death,” Graham Greene has written. This is one way to view the reality of suffering and death. It is certainly the most prevalent; the one I saw most often at Calvary. Faced with the death of another, most of us are afraid to meet its gaze – even when the dying person is not. We cannot, or will not, look it in the face, especially when it concerns one we care for.
At the most basic level, we might think of the “downward trajectory” doctor; the one who knows full well what he is saying but cannot say it. Perhaps in contemporary medicine – where death is treated as an enemy, only to be surrendered to reluctantly, at the end of a losing “battle” – this is understandable. Admitting defeat in such a circumstance could weaken one for the combats to come.
But as I walked the halls of Calvary Hospital I realized that Tom’s friend or his doctor weren’t the only people who had difficulty acknowledging the reality before their eyes. The flood of folks who brought “Get Well Soon” cards to friends or relatives who were going to die within days could be included here. And, if I’m being honest, I need to be included here as well. Whether with Tom or with any number of other patients, it was easy for me to overlook the gravity of their illnesses, especially on their “good days.” At some level this was a coping strategy for an assignment that could easily prove oppressive. But in the end, impending death will not be prevented by pretending things are otherwise.
Members of the Society of Jesus make the Spiritual Exercises – a retreat assembled by our founder, Ignatius of Loyola – at least twice in our lives. This retreat takes place over roughly four weeks, and during each week we ask for a particular gift from God. The third of these weeks is spent – jarringly, painfully – meditating on the suffering and death of the man who lies at the center of our life: Jesus. Ignatius asks us to pray a strange prayer as we do this. In his words, we are ask God for “sorrow with Christ in sorrow, anguish with Christ in anguish.” We are called, in other words, to be present to the suffering of someone that we love, to feel it and dwell within its space, all the while knowing that there is nothing (or at least very little) we can do to end that suffering.
We choose to be present at the foot of the cross, to be present when someone we care for is languishing painfully before our eyes. As the late Jesuit peace activist and poet, Daniel Berrigan, was reputedly fond of saying: “Don’t just do something. Stand there.”
This is hard. Like the apostles who had followed Jesus until the moment that it mattered most, we also face the temptation to flee. There are multiple ways to do so, and actually running away is just one of them.
As Tom’s condition gradually deteriorated, two forces competed within me. I recognized them both from the experience of making the Exercises months earlier. One was the urge to stay, to be fully present to this person and to the full breadth of his life – including his death. The other was to bolt, in one way or another. In other words, I know all too well that we search, even unwittingly, for reasons to be absent from one in need and therefore from our discomfort. Sometimes we may be physically present, but still elude the reality before our eyes until death removes all possible denial. In the same vein, we face the temptation (and that is precisely the word) to make the suffering of our loved one about us rather than about them.
The most common way that this happens is the effort to “make sense” of what the other person is going through. “Why?” is a beautiful human question. It is a natural question when we face suffering and death. Patients go through this, too, but often emerge from this stage of grief long before their friends and families. Our search for an answer, to glean sense from the senseless, can keep us from being present to the reality, to the person, that is actually before our eyes. Even these many years later, I cannot – or, better still, will not – suggest a “reason” for the suffering I saw at Calvary. I am afraid that in addition to making the experience about me, this would blind me to the light – actual, abundant light – on display there.
On the face of it, the work at Calvary might seem rather dark. We cared for the dying. We washed the bodies of the dead. There were days that it actually was dark, no question. And yet those who dwell in darkness are often most sensitive to the presence of light.
Not long before I arrived at Calvary, a friend passed me a copy of the Jane Kenyon’s Otherwise: New and Selected Poems. Kenyon herself was no stranger to sufferings: hers included both a long battle with depression and her eventual, untimely death from leukemia in 1995. One evening before mass, when Tom’s suffering grew more acute and the end of his life came squarely into view, I found myself alone in a Jesuit community chapel, with Kenyon’s poem “Let Evening Come”2:
Let the light of late afternoon
shine through chinks in the barn, moving
up the bales as the sun moves down.
Let the cricket take up chafing
as a woman takes up her needles
and her yarn. Let evening come.
Let dew collect on the hoe abandoned
in long grass. Let the stars appear
and the moon disclose her silver horn.
Let the fox go back to its sandy den.
Let the wind die down. Let the shed
go black inside. Let evening come.
To the bottle in the ditch, to the scoop
in the oats, to air in the lung
let evening come.
Let it come, as it will, and don’t
be afraid. God does not leave us
comfortless, so let evening come.
As evening came in Tom’s life, I found myself having to check my own resistance to that twilight. I did not want to let it come. This man, who had been a stranger weeks before, was no longer that. Now I looked forward to our conversations – looked forward to going to the hospital each day – and was not prepared for it all to end. Perhaps I had temporarily forgotten that he had come to Calvary to die. The only choice available to me was rather stark: either stay with him to the end or flee, in whatever form that might take.
The end came abruptly. His rather consistent pain level spiked one day, and managing the pain quickly required doses of medication that, while keeping him more comfortable, also left him hovering just below the border of consciousness. As with all medicines, this effect also had side-effects, and the latter complicated Tom’s underlying medical conditions. It was a Passion; one he bore with courage.
Tom died on a Friday, right before I arrived at work. My first task on that last day was to help prepare his body for burial. It was a tremendous honor, and a sad one.
I first arrived at the hospital for work on Easter Thursday, when the liturgy of the Church is still delirious with joy that Jesus of Nazareth rose from the dead and thereby destroyed its power forever. In fact, our presence at Calvary coincided almost exactly with the fifty days of the Easter season. During my first days at the hospital, I remember feeling a kind of whiplash between the bright joy of the Easter season and the dark realities we witnessed at the hospital. It was jarring to sing our Easter “alleluias” each evening after the pain and death and sorrow of Good Friday each morning and afternoon.
Fittingly the liturgical color for the Easter season is white – the same color in which we were clad from head to toe as we walked the dark hallways. It took some time, but a few of us took to calling our blinding uniforms our “Resurrection Whites.” It seemed, and seems, appropriate.
Then as now, it is light – not darkness – that I see at the heart of my time at Calvary. It is light, not darkness, that the suffering and dying offer to bring into our lives. It is light, not darkness, that they offer to leave in our busy hearts. The least we can do is stand there.
Cover image courtesy FlickrCC user Jo Naylor, found here.