“How do I want to die?” is about as profound a question as any you can ask yourself.
This is not about medical diagnosis: that has more to do with circumstances, lifestyle and G-D.
I refer to written instructions and transmitting your legacy. This was the topic of my speech Sunday, Oct. 6, 2019 at the Catholic church of St. Charles Borromeo in Brooklyn Heights, New York City. In a creative attempt to increase attendance at its 9 a.m. and 11:15 a.m. Sunday masses, the church began a series of guest speakers in a program called, “Between the Masses.” I was honored to be the first speaker.
The five documents I introduced were in an order based on an insight I learned from the late Dr. Darcy Sims, Ph.D., who was a frequent speaker to Bereaved Parents, a support group for those who have suffered the loss of a child of any age. Darcy would talk about how a terminal diagnosis is first processed in the head, then in the heart, and then you really know what is happening, when both the head and the heart connect. As we might say, that is when you feel it in your kishkes.
I spoke on the five documents in the order of head-intensive toward heart-intensive, easier to understand that way. Then, I suggested that if you tackle your personal version of these forms in reverse order, heart-intensive back to head-intensive, the documents might be easier.
The first document is the Health Care Surrogate form. Basically, it says that when you can no longer make health care decisions for you, who is designated to make them for you? Like so much of our grief work, this is like an iceberg, much is under the surface. The two states in which I have served as a chaplain, Florida and New York, have a specific order for health care surrogates if they are needed and you did not appoint them, and you might not like the order That is because the law asks if ‘X” is related to “Y? The law does not ask the quality of that relationship. I have assisted at the tragedy of a divorced husband and wife, coming from hundreds of miles way, having to make health care decisions for their teenage son who had just attempted suicide. The couple had not stood net to each other in years. The laws said that since there was no health care surrogate designated, the patient had two parents alive, they had to make decisions equally. The law does not consider the quality of the relationship … unless you do so in your documents. Most importantly, a health care surrogate should know she/he is named, agree to it, and you need to be convinced that she/he will make the same decisions you would, and not be guided by their own spiritual and biological values. I participated in an ethics consult where the patient told several chaplains who documented that she was brought up Catholic, wanted “No Religion” on her chart, and wanted no anointing. When this patient could no longer make her own decisions. two adult daughters took over, both observant Catholics, and insisted on a priest coming to perform anointing.
The second document is called “Health Care Directives.” Basically, it describes the radical measures you want to the medical community to take in an attempt to keep you alive. These options are often phrased in the negative: “DNR” for Do Not Resuscitate, or “DNI” for Do Not Intubate. There are two cautions here. First, research shows the percentage of time heart compressions work on a television medical show are far, far greater than the percentage of time they work in the Hospital Trauma Bay, let alone any medical damage that can result from the compressions. The second caution is that these documents, in their traditional form, are for very specific cases, and they are framed in the negative. I am part of a movement championing an alternative form called “AND,” or Allow Natural Death. Form examples are on the internet, but their applicability may vary by state. I am not lawyer; you may need to ask one. I plan to write a paper on “AND” in 2020.
The third document I ask you to consider is to write down what you want to be surrounded with as your days as we know them begin to fade. If you do not do this, either a musical therapist will guess, or, as Dr. Atal Gawande, M.D., points out in Being Mortal, you will be surrounded by library silence, a white noise punctuated only by, “Dr. Cohen, dial 7049.” Since certain sounds or pictures bring you pleasure, share them with us in advance, so we we may offer them to you. For examples, in my Advance Directives, I have a phrase that says, “These items bring me pleasure. Please try to surround me with the music of Tchaikovsky, especially his Fifth Symphony, and Beethoven’s “Pastoral Symphony,” so appropriate for those of us in Pastoral Care. If you remember the movie, “Philadelphia,” with lawyer Tom Hanks dying of aids, there is a great scene related to this, now available on YouTube, where he is walking with his IV pole to the crescendo-building favorite opera aria of his. (https://www.youtube.com/watch?v=DwRHwKZSu-w)
The fourth step is a Jewish gift to the world, now picked up my many faiths, and is called The Ethical Will. This is a letter or essay to your loved ones on what has been most important to you in the path you chose to live that you want them to know about. The research shows that if you do not write this, your children are likely to guess wrong. The Ethical Will is a Jewish gift to the world, now adapted by many faiths. Rabbi Jack Riemer’s book on Ethical Wills is beautifully entitled, So That Your Values Live On. Shalom Aleichem, whose writings were adapted into “Fiddler on the Roof,” wrote instructions to his children in his Ethical Will on how to remember him on his yahrzeit, the Jewish Calendar anniversary of his death: “ … let my name rather be remembered by them with laughter than not at all.”
The fifth step relates to how you can get the way you describe yourself now a bit close to the way someone will describe you after your death. This is based on the forward and prologue to David Brooks’ book, The Road to Character. Books points out that when we respond to a question, “What are you,” we tend to play back what he calls “resume virtues, e.g., “I am a doctor, Rabbi, engineer.” However, when a person is towering over us, describing us at our funeral, the audience is more apt to hear, phrases like, “She always cooked warm meals for her neighbor when her neighbor was sick.” This speaker is elucidating your “eulogy virtues,” while you were describing yourself by your “resume virtues.” Why can’t we describe ourselves more by our “eulogy virtues” than by our “resume virtues?”
I have a wonderful colleague, Rabbi Elliott Cosgrove, at the Park Avenue Synagogue in Manhattan. On Yom Kippur in 2013, the holy day of sacrifice, introspection and repentance, Rabbi Cosgrove titled his sermon, “The Fate That Awaits Us all.” Rabbi Cosgrove spoke that day, saying, “ … It strikes me that there are really only two things that can be said about death with absolute certainty. First that it will happen, and second that we don’t know when. … But there also exists a third truth about our relationship to death, observed across time and traditions, and that is our disinclination to engage with the aforementioned first two truths. …”
Why do we avoid thinking about our eulogy virtues? Probably because doing so makes us face our mortality, “The fate that awaits us all.” Recently, President Trump used eulogy values as he presented Bob Cousy, the aging basketball star, with the Presidential Medal of Freedom. After hearing President Trump’s praises of him, with his “eulogy virtues,” Bon Cousy replied, “If I had known I was going to be eulogized, I’d have probably done the only decent thing and died for you.”
Please, finish your unfinished business. Thank you.
Barry Pitegoff is a Staff Chaplain at Bon Secours Community Hospital in Port Jervis, New York. Barry enjoyed thousands of hours of volunteer chaplaincy at hospitals, hospices, and prisons while he was vice president of market research for Visit Florida, the state’s tourism board. After retirement, Barry transformed into professional chaplaincy by taking a second Master’s Degree and two years’ of hospital internships. Barry was awarded the title of BCC, Board Certified Chaplain at the May 2019 conference of the NAJC (Neshama: Association of Jewish Chaplains). In 2020, Chaplain Barry was elected to the Board of NAJC, serves on Chaplain Review Committees, and facilitates a monthly national video call of Jewish hospital chaplains.