To Know Is To Love: Faith at the End of Life

“Dying, dying in the night. Won’t someone bring the light So I can know which way to go Into the everlasting snow?

And Jesus, where is Jesus gone? They said that Jesus always came. Perhaps he forgot the house this way. Jesus, let him pass.

Somebody run to the great gate To see if Dolly’s coming. Wait, I hear her feet upon the stair. Death won’t hurt now Dolly’s here.”

That poem was written and published in 1861 by Emily Dickinson. And when Emily penned those words, I believe that she put a hidden meaning in there that, to me, causes us to reflect on what a spiritually healthy death looks like.

So when we think about that, there are three things that I believe are hidden in the poem.

One is that the person who’s dying has accepted the fact that they are dying. They said, “Won’t someone bring the light?” They just want to know which way to go, but they know that death is imminent.

The second thing is this: There seems to be a spiritual struggle. With all that they’ve learned, with all that they know about their faith, they’re like, “Jesus was supposed to be here. Where is he?”

And then, finally, there’s an elation that he shows up.

And then, finally, there’s a person, the presence of a person, Dolly. This person is concerned about Dolly coming because why? A spiritually healthy death involves having those around you whom you love.

And the key statement was, “Death won’t hurt now Dolly’s here.”

It got me thinking about a very powerful spiritual movie. It’s very powerful to me. Spiritual principles are all in it. And the movie is called Horton Hears a Who!

For those of you who have never seen this movie, there’s this elephant named Horton who carries around this dust speck, and the people in Whoville are on this dust speck.

Horton says something very grand and very great. And I quote the great Horton when I say this. He said, “There’s a person on this dust speck who needs my help.”

And so the first spiritual principle that I saw, it’s only a couple that I want to bring out today, is the fact that he acknowledged that there was a person present in an atmosphere where no one else would acknowledge that this person existed.

Horton believed that this was a person who existed, and that people existed on this dust speck.

In healthcare, oftentimes we miss the fact that there’s a person there, and we just see the patient. We just see the person who’s hurting, the person who may be dying or the patient who may be dying. But there’s a person who actually exists.

The second thing was that when they were trying to do away with this dust speck, Horton encouraged them to yell as loudly as they could, “We are here! We are here! We are here!”

Why? Because he wanted their voices to be validated and to validate their existence.

You see, when spiritual needs go unacknowledged, when the voices of faith go unheard, we end up dehumanizing individuals. Because many times, their spirituality or their faith defines who they are. So we diminish who they are.

And so I say to you, we don’t have to go too far and try to go overboard to please everybody in every way, for we would find ourselves to be like Katie in the movie Horton Hears a Who!, who said in her world everybody was a pony who ate rainbows and pooped butterflies.

We don’t have to go there.

But where we do have to go is to a place where we can give honor, dignity and respect to each and every person we encounter.

And so I want to share with you, for the first time anywhere, a method that really has incorporated all of the talks that you’ve heard thus far, at least all of the questions that have been put out there as it relates to patient care.

I want to introduce to you something called Waiting to H-EXHALE. Not exhale, H-EXHALE. H-E-X-H-A-L-E.

What does that mean? It’s an acronym for Having a Human Experience at Life’s End.

It helps us to understand the importance of the human experience and how the human experience can lead to a strong spiritual experience.

And there are six questions. Six, not five, six, that actually help us understand how to create this connection that’s necessary for us to have a great human encounter, even with those who are dying.

The first question is who.

I’ll give you the six: who, what, when, where, why and how.

The first question is who.

Who is this person? Who is this individual?

Oftentimes, people come into our care and we fail to see who they are. We fail to recognize that this is a person who is a mother or father, a sister, a brother, a family member, a teacher, a friend, somebody who has functioned in society.

They are far beyond just being a person in the bed, in our care, who may be dying.

And so we need to make sure that we see that person for who they are.

Oftentimes, I’ll ask the family members for a picture of the person at a better time in their life, when they were happy, when maybe they were at the amusement park. Family photos. Just so that we can see and make that connection with the fact that this is a person.

That’s the who.

Now the what.

You heard this before from a couple of our great speakers. What matters most?

What matters most to you, to that dying patient, that person, that individual who’s seriously ill? What matters most?

Here’s my take on this.

Oftentimes, from a spiritual standpoint, people of faith will say that their spirituality, their faith, their belief system, is what matters most to them. And that is what oftentimes we gloss over. We go right past it.

Let me give you an example.

The average hospice age in this country is about 73 years of age. And if a person is a person of faith and attends worship services or events an average of about six hours a week, that would mean over a 50-year period they would have invested 15,600 hours of faith-development time.

Let me tell you something. If anybody does something for 15,600 hours, it’s important to them. It means something to them. It’s a part of the fabric of who they are.

And when we miss out on addressing that or talking to someone about that, we strip them of their human dignity.

Who. What. When.

When was the last time they engaged in a meaningful act that was important to them?

That’s the when.

We give people an opportunity to reflect on who they are when we talk about this subject matter, to reflect on that past experience.

There was a person who came into our hospital in Detroit, Michigan. He came into our hospital one time, and he wasn’t doing well. It was about this time of the year.

He was a choir director for his church choir, and they were getting ready for a concert. He had fallen ill, and he came into our care.

As he came into our care, the doctors were concerned because his body was not reacting well to the medications. And he just seemed to be depressed.

So we pressed the issue a little bit. I wanted to find out what was going on with him.

I talked with his wife, and his wife told me about the fact that he was really down because he couldn’t be with his choir.

So what did we do?

We had a closed-circuit television network in our hospital. And what we did was, we asked the choir, because they could not come to the hospital room to sing, we asked the choir to have their rehearsal in our chapel at the hospital.

And we put the choir on his television screen in his room.

From that point, the patient perked up. The patient made that connection.

And lo and behold, a week later, the medications began to work. Because I believe there was a spiritual healing that took place that allowed his physical healing to take place.

At that point, he was able to be back with his choir, and all was well.

The when.

Who. What. When. Where.

Where are they now?

Are they angry? Are they upset? Are they frustrated? Where are they right now?

And how can we show empathy toward a person who may be in a bad place, who may not want to talk about anything, really?

Can we just sit with them? Can we maybe touch their shoulder, hold their hand, just be present?

Being aware of where they are helps us to communicate with them better.

And then, finally, the last two are for clinicians: the why and the how.

When it comes down to why, the question that I ask all of the caregivers, all of the clinicians in the room, is this: Why did you go into the work that you’ve gone into?

Why have you spent all of that money to go to medical school or nursing school, to become a physician? Why is that the case? Why did you do it?

It can’t be just to make money, right? Those loans have to be paid.

It has to be to connect with other human beings in a meaningful way.

I have a friend of mine who happens to be Jewish, and I asked him that question.

He said, “Cory, you know what? The reason why I do what I do is because I believe that God made this beautiful human body, and as a physician, I get the opportunity to take care of what God has made.”

This is why.

What’s your why?

And finally, the how.

How can you connect with someone who’s spiritual?

I had another physician come to me after I wrote an article that appeared in The New York Times dealing with spirituality, medicine and faith.

A couple of people said, “I read your article, and I liked it.”

And so she came to me and she said, “Well, I read your article too.”

Just like that.

Okay. I said, “All right.” I knew where this was going.

She said, “Yeah, I read your article too, and I have a problem.”

I said, “Okay, what’s the problem?”

She said, “Well, I feel like you’re forcing physicians to communicate and engage with their patients spiritually.”

She said, “I’m not a spiritual person.”

I said, “Okay.”

She said, “Well, what do you have to say to that?”

I said, “It’s not about you. It’s about the patient.”

And here’s the thing. I said, “I’m going to give you something. I’m going to give this to you for free, Doc. This is what we’re going to do. I’m going to give this to you for free. Here’s some good advice.”

I said, “The next time you go into a patient’s room, and they’re your patient, and you know that they are spiritually inclined, that they have a faith preference, you go into that room. You don’t have to be spiritually inclined.

“But if you go into that room and you let them know, ‘Hey, look, I’m your physician. I really care about you as a whole person. My job is to care for you medically, but I also care about you as a whole person.

“‘So if you don’t mind, we have a wonderful spiritual care team, a pastoral care team, and if you don’t mind, we can have them come and talk with you. And I would like to do that for you because I care about you as a person.’”

Trust me. If that’s my physician, anything else they say to me medically, they’ve got me. I trust them.

Why? Because they care about me as a person.

You’re welcome.

Finally, I just want to share this quick story with you. It’s about a gift. The gift of spirituality, and the gift that our patients give to us each and every day.

There was a young man who was getting ready to graduate from high school. And as he was preparing to graduate, he went to his father and he said, “Dad, in two weeks it’s my graduation, and I’m excited about it. I would like for you to give me a gift.”

His dad said, “Okay. All right.”

And so he said, “You know what? Here’s the gift that I want. I went down to the new Corvette dealership, and there was a beautiful, shiny red Corvette, tan interior, drop-top. That’s what I want.”

And so his father kind of nodded his head and walked away.

His father walked away knowing that he could well afford to buy this gift for his son, and his son knew it too.

Two weeks passed by.

His son jumped up out of bed. He ran to his father’s room.

He said, “Dad, you know what today is, right?”

His dad said, “I know.”

He said, “It’s my graduation. Where is my gift?”

The father looked at him, reached over and handed him a cardboard box. A plain box.

The son looked at the box. He looked at his father. He looked at the box. He looked at his father. He looked at the box and looked at his father, like, “What is this?”

So he opened the box, and in it he saw a neatly wrapped Bible.

He looked at the Bible. He looked at his father. He looked at the Bible. He looked at his father.

And he threw the box with the Bible in it on the floor.

He said, “With all of your money, all you could get me was this Bible?”

And he stormed out of his father’s room, vowing never to speak to his father again.

The son held true to that promise.

Thirty years later, after he had moved away, become very successful as a businessman, gotten married and had children, he got a phone call one day saying that his father was seriously ill and that he needed to come home.

The son thought, “I need to go make amends with my father.”

He bought a plane ticket, went to the airport and got another phone call.

The person who called him said, “You’re too late. Your father has passed away.”

So he flew home.

He got to his father’s house, and the person who had called him was sitting there on the steps waiting for him.

He said, “I know what happened. And your father loved you so much that he left everything to you.”

The son walked into the house. He walked into his father’s bedroom. He sat down on his father’s bed, and he began to cry uncontrollably.

As the tears were flowing, he looked through the tears and saw, in the corner, the box.

This time, he picked up the box again. He opened it. He unwrapped the Bible.

He saw a place in it that his father had marked for him to read. It was Matthew 7:11, which says, “If you, being evil, know how to give good gifts to your children, how much more will your heavenly Father give you good gifts?”

And at that moment, a car key dropped from the back of the Bible.

On that car key was inscribed the date of his graduation and the words, “Paid in full.”

You see, he had missed all along the gift that he wanted because he didn’t like what it was wrapped in.

And far too often, we miss a beautiful gift that our dying patients can give us because we don’t like what the situation may be wrapped in.

It may be wrapped in their spirituality or their faith. It may be wrapped in their willingness to fight. It may be wrapped in something that we may not feel comfortable discussing or talking about.

But, my friends, we can miss out on a great gift that our patients can give us, and that we can give them, by making that human connection, by answering those six questions: who, what, when, where, why and how.

And then, ultimately, we can say as I close, like the great narrator from my great spiritual movie, Horton Hears a Who!

At the end, he said:

“And all ended well With Horton and the Whos, For all in the jungle, Even the kangaroos.

So let that be a lesson To one and to all, That a person is a person, No matter how small.”

That includes people of faith who may be dying.

God bless you.