On Birthdays and Growing Older

I just celebrated a birthday, my 78th, with my wife and two of our children and their spouses at one of my favorite restaurants, The Marine Room, in LaJolla, California. The restaurant sits directly on the beach and huge spot lights illuminate the waves breaking seemingly just outside the wall of floor-to -ceiling plate glass windows. A Pacific storm, aided by El Niño, had roiled the surf and the view was magnificent. So was the food and service. The Marine Room is elegant but not stuffy and the clientele Saturday night ranged all the way from elegant young people to the table next to ours where four unreformed and unrepentant hippies were seated in appropriate 1960’s Berkely attire, the women in flowing, colorful wraps, granny glasses and lots of beads, the men with long hair in pony tails and big beards. Each of my children and grandchildren telephoned to sing “Happy Birthday” including a Buchanan-only second verse, rough edged, now a part of family ritual sung with gusto at every birthday. In short, it was a perfectly wonderful birthday.

But it was a birthday, marking the passing of another year of my life. In the few days before I received word of the deaths of two high school classmates: Diane, a brilliant student and superb musician, and Bob, an all-state football player and track and field star. So, in addition to celebrating I find myself thinking about a topic we try hard to ignore – mortality. One of my favorite Psalms, Psalm 90, reminds me that I am perilously close to the biblical definition of a life-time, “three score years and ten, or if by reason of strength, four score.”

I also finished a remarkable book last week, Being Mortal, by Atul Gawande. It was a fitting, though totally unplanned, coincidence with my birthday. Gawande, a surgeon at Bringham Women’s Hospital in Boston and professor at Harvard Medical School, is a best-selling author and staff writer for the New Yorker. The subtitle to Being Mortal is Medicine and What Happens in the End. The author uses professional and personal anecdote to document his argument that in spite of near-miraculous advances in medical science and treatment, many physicians do not do well with end-of-life issues. In fact, the medical system in this country, Gawande argues, is skewed toward prolonging life, even when the chances are slim, rather than enhancing quality of life as long as it lasts. “There is almost always a long tail of possibility however thin….The trouble is that we’ve built our medical system and culture around the long tail. We’ve created a multi trillion dollar edifice for dispensing the medical equivalent of a lottery ticket and have only the rudimentary system to prepare patients for the near certainty that those tickets will not win.” His illustrations, including his own surgeon father’s slow decline, are moving, focused on the more human and ultimately more life-enhancing alternatives. Instead of merely extending life, fighting to the bitter end regardless of a patient’s pain and suffering, medicine, Dr. Gawande proposes, should contribute to enhancing the quality of life every day up to and including the final one.

Gawande corrects the common misconception of Hospice as a place to go to die with a new definition as a place or program that helps people live with as much comfort and meaning as possible in the face of terminal illness. He cites a 2010 Massachusetts General Hospital study that came up with unexpected and startling findings. Terminally ill patients who chose palliative care, stopped chemotherapy and entered Hospice sooner than a control group that received traditional oncology care, not only experienced less suffering – but lived 25% longer.

I was struck by Gawande’s description of three models of Doctor-patient relationship; “the priestly Doctor-knows-best” model, the “retail” model – here are your alternatives – choose one, and the “interpretive” model. Here the doctor’s role is to “help patients determine what they want.” The name for it is “shared decision making.”

Dr. Gawande is no fan of nursing homes but has plenty of good things to say about the assisted living movement and life-care programs that simply acknowledge that most people live a relatively long time needing only a little help with daily tasks.

Reading this good book made me grateful that my wife and I decided two years ago to move into a high-rise retirement facility with life care in the middle of the city we love. We are in “Independent Living” which is essentially condominium life that we have been living for twenty years with the addition of some rather nice amenities. Walking with people through their final days, I experienced first hand that when an unexpected health crisis happens, families often do not have many good options. We told our children that we were doing this now so they did not have to make difficult decisions for us, with few options, at some time in the future.

Both the most painful – and most meaningful experiences I had as a minister and parish pastor came at the end of life with my parishioners. Luella, a gracious, always pleasant and cheerful elderly woman who wore the title “lady” proudly, began to experience difficulties. She wandered off and became lost in her neighborhood. The condition of her home deteriorated. She started a small fire by placing a paper grocery bag on a hot stove burner. Her only relative was a nephew who lived in another state. I called him. He came to visit and decided that Luella needed to be somewhere safe and secure. I helped him make arrangements. The institution we chose assured us that they knew how to deal with situations like this. Luella had announced over and over that she would never move into an “old folks home” and that she was determined to die at home in her own bed. Her nephew and I met the team and together we decided that I, her minister, should tell her what was happening, that she was moving into a nice place where she would be cared for, safe and secure. What ensued was the worst experience in my ministry. Luella became adamant, furious, hysterical, profane, calling me a traitor who had betrayed her and finally fighting with all her strength not to leave her home. There has to be a better way than this, I thought, and I have never forgotten that painful day.

On the other hand, I have stood with families around the bedside of a beloved husband/wife, father/mother with compassionate medical personnel providing as much comfort as possible as last breaths were taken. There were prayers, expressions of love and gratitude, sometimes singing. Those were holy moments and always reminded me of the deepest, most profound hope of my faith. Words from the hymn, based on Psalm 90, say it best.

Our God, our help in ages past,
Our hope for years to come,
Our shelter from the stormy blast,
And our eternal home.

Comments

  1. Sounds like the discussions we have all the time. So nicely written, John. That sad bit about high school classmates is too familiar. It’s a scary time of life.

  2. Martha Shrout Brown says:

    Beautiful, John. Conversations with family are so important.

  3. Happy Birthday, JMB!!! I remember when you turned 40. How timely, that I read this today, after being at a friend’s memorial service last night. “Life with dignity” is better than “Death with dignity”.
    This book is on my “must read” list. God’s blessings to you, Sue, and the Buchanan Clan.

  4. David A. Donovan says:

    Happy Birthday, John!!! Thanks for your reflections which have such significance for me as I sneak up on my 81st birthday later this month. As you know, I was not projected to live beyond my teen aged years but the miracles of medical science have proved those earlier projections wrong. Now with the luxury of life in a CCRC, and the recent death of a precious 19 yr old Grandson, Charlie, the road ahead is an adventure of reunion as apposed to a fear-filled ending. Enjoy the sun and surf. Love to you and Sue from Katy and me.

  5. Carole Ogden says:

    John, as has happened so often over the past 16 years your message speaks to what is on my mind. I, too, will be turning 78 on 2/11 and it has, for some reason, caused me lots of thoughts of mortality. I’m not sure why 78 seems so much older than 77, but it does. Glad to know I am not the only one. I, too, have taken steps to secure my physical future and try not to put the burden on my daughter. Mainly on my mind is the knowledge that I am at peace with my life as it has been lived, and trust and faith in the Will of God. You have been so instrumental in that. Happy birthday and God bless you.

  6. jack macmullan says:

    MY MOTHER-IN LAW WILL SOON BE 97, MY MOTHER 98. THANK YOU FOR YOUR PERSPECTIVE ON THESE ADJUSTMENTS IN LIFE AND NEW DECISION MAKING. THANKFUL FOR ONE MAIN FACT—LOVE TRIUMPHS OVER DEATH.

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