Thank you to so many congregants, family members and friends who have responded in phone calls and writing to my Rosh Hashana sermon, anchored by Dr.Atul Gawande’s deeply affecting book, Being Mortal.
In the days since Rosh Hashana, many of you have shared your stories, struggles and experiences of deep understanding. And many more of you have asked for assistance with beginning the difficult conversations about what our lives mean to us. On Rosh Hashana I asked us to consider how we want to face the end of our lives if we are blessed with the opportunity to have choices. I asked us whether we know the true choices of those we love.
I share here a synopsis of my teaching and the links to the resources that I mentioned in the sermon.
In the experience of family members dealing with the inevitable dying of an elderly or seriously ill loved one, there comes a time when they recognize at some level that they are up against the unfixable. If they are blessed or wise or very well versed in matters of life and death, however, the unfixable does not have to be the unmanageable.
Gawande’s transformative book is filled with studies and anecdotal evidence about the astounding intersection of medicine and dying in modern society. He writes that scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. Gawande believes that the medical world has proved alarmingly unprepared for helping people understand death. His book is filled with stories of heartbreak and loss and dying. But each story is most of all about triumph – triumph due to the recognition that we are all mortal. Being mortal means that we are not immortal. It means that all of us will one day die.
As I prepared my sermon, believe me, I understood that mortality can be a treacherous subject. Listeners might be alarmed at my talking about the inevitability of decline and death. No matter how carefully I framed my words; for some, the topic would raise the specter of a society ready to sacrifice its sick and aged. But here are Gawande’s words that encouraged me to take up this topic despite the risks of discomfort or fear. He wrote: What if the sick and aged are already being sacrificed – victims of our refusal to accept the inexorability of our life cycle? And what if there are better approaches, right in front of our eyes, waiting to be recognized?
Gawande’s book, to me, is a very Jewish conversation. Rebbe Nachman of Bratzlav wrote: Kol haolam kulo gesher tzar m’od, v’ha-ikar lo l’fached klal. “All of this world is just a very narrow bridge and the main thing, the essence, is not to be afraid at all.” Perhaps that narrow bridge is meant to teach that between birth and death, there is just a narrow passage, like grass that springs up in the morning but is gone by night and no one can tell where it grew. That bridge is the human condition. We move from birth toward death every moment. So – do not be afraid. Rather, walk confidently and solidly and powerfully on that bridge. Without fear, we can enjoy the view.
Do not be afraid at all.
What is required is courage. We require courage to acknowledge what we all know to be true, and then, most daunting of all, the courage to act on the truth we find. The wisest course is so frequently unclear. In conversations about mortality, it is important to decide whether our fears or our hopes are what should matter most.
There is no right or wrong way for everyone. The only correct way of facing aging, illness and dying is the way required by each individual in his or her unique situation.
The difference between a good death and a hard death hinges on whether someone’s wishes were expressed and respected, whether they’d had a conversation about how they wanted to live toward the end. While 90% of Americans think it’s important to have such conversations, only 30% of us have actually had these conversations. We can change that by bringing the people we love to the kitchen table to have the conversation. And we can do this before there is a crisis rather than in the I.C.U. So what stops us? We don’t talk with our loved ones, we don’t talk about our own desires because “it’s too soon.” But it’s always too soon … until it’s too late.
Throughout the liturgy of this High Holy Day season, we Jews practice thinking about our mortality. Who shall live and who shall die? On Yom Kippur, we will abstain from food and drink, playacting a mini-death in order to understand the necessity of teshuva, repentance. Our rabbis knew what they were doing, insisting that the theology of each new year must address the meaning of our lives which can only be done with an acknowledgment of the finitude of these lives of ours.
The question remains: How do we have these conversations?
If you choose to begin the conversation with your doctor, consider the Dear Doctor letter devised by a team led by Dr. VJ Periyakoil, Director of Palliative Care Education at Stanford University School of Medicine. Here is Dr. Periyakoil’s letter that can help in this conversation.
I advocate that the conversation also take place in your families and in your circles of intimate friendships. Conversation Starter Kit created by The Conversation Project avoids being a technical medical checklist for the dying in favor of a careful discussion guide for the living. The kit asks what matters to you, NOT what’s the matter with you. http://theconversationproject.org/starter-kit/get-ready/.
Rabbi Scheff and I are available to you to help begin the conversations. Contact us at Rabbi.Drill@theojc.org or Rabbi.Scheff@theojc.org. Be in touch if you would like to see the full text of my Rosh Hashana sermon.
If Rabbi Nachman was correct, and all the world is just a narrow bridge, I pray that all of us are able to make meaning of our short walk across it. It begins with acknowledging the bridge, not to diminish life, but rather to value it.
Shana tova tikatevu v’techateimu, May you be written and sealed for a good new year,
Rabbi Paula Mack Drill