Thursday, December 5, 2013

Bereavement and a Good-Enough Death

By Rea Ginsberg
Director of Social Work Services and Hospice Coordinator

This article was first published on the blog.

We never know how high we are
Till we are called to rise.
-Emily Dickinson

It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press. It implies an ideal state, one which of course we cannot have. Never agonize over ideals when the problem is as urgent as death. Perhaps it should be renamed “the good-enough death,” one that is sufficient and satisfactory to both the dying person and the caregiver. It is the best that can be achieved at that time, in that place, by those people, with that problem, in their particular situation. Maya Angelou was right to say, “You did then what you knew how to do, and when you know better, you will do better.”  Death and dying are extremely personal.

We believe the term “good death” is a nod to perfection out of human reach.  It is a nod to the impossible.  The “good death” is a tree of dreams.  The “good-enough death” is what we can reasonably pursue and achieve.

An insightful description of a good-enough death is what follows in condensed form here. The author of this description is an emergency physician. She calls it a “good death.” We will take the liberty of renaming it “a good-enough death.”  That changes the intent not at all. (The full case presentation in the book is beautiful, profound, and unforgettable. It should be read in its entirety.)
[Mr. Sharpley was 73 years old. He was rushed to the emergency room in cardiac arrest.  He had a history of lung cancer and cardiac bypass. Effective CPR brought back his heartbeat and he was placed on a ventilator. The doctor wrote,] “No sign of brain life existed, although his heartbeat was strong and sure … I put my hand on Mrs. Sharpley’s shoulder. ‘What we are doing is really complete life support, without that breathing machine, his heart would not continue to beat; he would die.’  She choked back a sob and pressed her clenched hands against her lips … Suddenly… she sat up and dried her eyes. ‘I just need to see him’ she said, rising to her feet … ‘Can you make him comfortable when we remove the tubes?’… … Because she had witnessed the dignified, peaceful and ‘beautiful’ passing of her mother, she wanted the same dignity and peaceful death for her husband. It would be her last and final gift to the man she loved … 
“I had never in all my years of doctoring witnessed such selfless gratitude in the face of death.  I shed tears with her and stated what she already apparently knew, ‘You are right, it is OK for him to go. He is not in any pain, and you are really doing the right thing for him.’  She held his hand tightly to her chest and said, ‘I always want to remember holding his hand.’ … The plastic tubes were removed from his throat and the IVs were disconnected from his neck.  ‘There, that’s better,’ [Mrs. Sharpley] whispered into his ear.  His final breath was the one the ventilator took for him.  Her final word was ‘Goodbye.’ … 
“Although I had read the medical definition of a ‘good death,’ I had not known what the real life meaning of it was until this moment…  This woman had shown me, and now the world, an example of just ‘how’ a death could be good.”
Mrs. Sharpley was lucky to have the emergency physician by her side as she made her decisions and proceeded with a plan. The physician was unusually sensitive, respectful, and compassionate with this caregiver. She was outspoken in her steady reassurance. She was not afraid to allow Mr. Sharpley’s death. She even had the spontaneous good grace to permit herself to cry with the caregiver as the process of dying and letting go unfolded. Certainly the caregiver was aware of the physician’s attitude and appreciated it as completely sincere and supportive. The involved, death-time physician is always remembered and, in this case, will ease the weight of grief work ahead.

This example contains a lesson for other physicians as well: there is a cure beyond saving a life or the curing of an illness. It is a different kind of lifesaving and equally restorative. When all medical technology is rendered useless — by failure or determination — the human touch is everything. True healing is sometimes holding a hand and guiding an elegant, gracious letting go — a good-enough death.

If any of us has a belief in an afterlife, a life after death, it consists first and foremost of healing. The body will be made whole again, perfect, without illness or disability or suffering. Mrs. Sharpley hints at that with her whispered comment, “There, that’s better,” as the tubes and IVs were removed from her husband’s body.

It was better also for Mrs. Sharpley herself. She needed to see that her husband was just as she remembered him to be: alive and healthy. For Mr. Sharpley, it was unfortunately too late.  He had no signs of brain activity and no ability to breathe on his own. The tubes and IVs were no longer his worry.  Now, the focus turned to his wife.

Mrs. Sharpley’s concern for her husband’s healing was highly significant, however. She was the one who would then have to carry on the business of living.  This was the beginning of her bereavement. The unfettered, unencumbered body of her husband would ease her way.

Helen Keller was more direct and specific in her writings about herself and an afterlife. “Death is no more than passing from one room to another. But there is a difference for me, you know. Because in that other room, I shall be able to see.” It is wish fulfillment writ large. It is enormously comforting.

For Mrs. Sharpley, it expressed her deep love, respect, and admiration for her husband. Her letting-go was generous and heroic. It was also an effort to return to what had been “normal” life for her with her husband. If she let him go, would he return as his healthy old self?  In imagination, that possibility does exist.

This is the magical thinking of the survivor who lets go of the loved one, even though that survivor cannot let go yet. The yearning momentarily chokes off all other feelings, all reasoning.  No tears reach deeply enough to wash away the anguish. It is hope against hope. It is a wish of love and longing. It is knowing the impossible dream. It is exquisite psychic pain. It is also thoroughly natural and normal. It is a good-enough death and a good-enough start to grieving and growing.  It is strength and growth.

Rea L. Ginsberg is a social worker and hospice coordinator whose special focus is bereavement and grief work. She can be reached on LinkedIn and on Twitter @rginsberg2.

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