Life Ending
This service featured a guest reflection from Jeannene Powell.
Story: This story – known as ‘The Appointment in Samarra’ – is an ancient one, but was re-told by Somerset Maugham. It deals with what is considered by some to be the essential human predicament – how shall we live, knowing we must die – such awareness being a peculiarly human trait.
A merchant in Baghdad sends his favourite servant to the marketplace for provisions. Shortly, the servant comes home white and trembling and tells him that in the marketplace he was jostled by a woman, whom he recognized as Death, and she made a threatening gesture. Borrowing the merchant’s fastest horse, he flees at top speed to Samarra, a distance of some 70 miles, where he believes Death will not find him. The merchant then goes to the marketplace and finds Death, and asks why she made the threatening gesture at his beloved servant. She replies, “That was not a threatening gesture, it was only a start of surprise. I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.” (adapted from a version found on Wikipedia)
Some Thoughts from Jeannene Powell:
My reflections on my first impressions and time working at a hospice.
People come to the hospice for all sorts of reasons, not only to live out their last few days on Earth. When I first came to the hospice, it was to have my interview for a clinical volunteer role. A role I started after going through their 3 month training programme. I remember the first time I went to St Christopher’s Hospice. Even though I’d looked at pictures on their website, I didn’t know exactly what to expect, but somewhere in the back of my mind, the childhood memories of visiting old relatives in nursing homes came to mind – the lifeless, stuffy air – darkened rooms and heavy atmosphere. This, coupled with thoughts of hospital visits and the smells associated there, were what I imagined I’d find. To say that I was nervous on my way to the interview is an understatement!
What I found, however, then and subsequently, is a bright, colourful and vibrant place with a peaceful atmosphere. The walls are adorned with the artwork and quilting projects of patients and they’re not all in blacks and greys, but pinks, yellows, violets etc. The Anniversary Centre, where I’m based once a week is often abuzz with patients, visitors and staff. People waiting for appointments and people attending groups. The Wards, one of which I’m also based weekly, are spacious and roomy where people have their own privacy. Hygiene is something that’s attended to scrupulously there, as it is throughout the hospice, and needs to be, but there’s no “hospital disinfectant” smell.
For many on the wards, they are there temporarily, maybe having their pain medication adjusted or experiencing an extra bout of sickness before returning home. People don’t just “come to the hospice to die”, which is what the general mainstream thinking is, and I guess is what I wrongly thought when I first went.
For some both on the ward and in the Anniversary Centre, who’ve been going to the Hospice over many years, the underlying tone is that this is a place where life has ended for others, and the associated thoughts, feelings and related subjects are around. There are tears shed, uncertainties shared, fears faced and wonderings about what happens next – as both a practical and religious/philosophical question.
I’ve found the hospice to be a place where both laughter and sadness, grief and joy co-exist in the same room. Where people are able to talk and plan their wishes and wants about the end of their own life and at the same time have the life that they are still living affirmed and, for some, lived more fully than in their previous decades.
To me, it’s a special kind of place. A very special and welcoming environment.
Dame Cicely Saunders, the founder of St Christopher’s, said, “You matter because you are you and you matter to the last moment of your life.” This philosophy and belief permeates through everything they do and the holistic model of care they provide. From the movement and art courses they run to their choir and regular concerts held – sometimes for, but also by the patients.
Also the hospice has a “pilgrim room” as a quiet room where people can light candles or write messages in a book of remembrance for a loved one who’s died. This and other forms of Pastoral care are all part of their holistic approach.
For me, volunteering at St Christopher’s has shown me that hospices aren’t the scary places that I imagined they were, but a place where death is acknowledged in its natural place side by side with life and where people are valued no matter how near or far from the end of their life they are.
Jeannene Powell
The story we heard earlier on about the servant who had an appointment with death and had borrowed his master’s fastest horse in order to escape that appointment – and yet in his seeming escape was racing only towards his end – that’s a story that has stayed with me ever since I first heard it. That’s perhaps because it’s something I always need reminding of – that we are here on earth but a short time and that, as Forrest Church so eloquently put it in our reading earlier, by being alive we earn the ‘privilege of dying’.
Yet here in the 21st century western world, death has become a private matter, hidden from public view. We have none of the cremations by the riverside of some cultures, nor the almost exuberant public grieving seen in some lands. Improvements in health care have removed from our society the epidemics of previous centuries – when every household would have been visited by death – and far too often would have witnessed the deaths of young children, taken in epidemics such as smallpox and cholera. Consider these statistics taken from a government website:
‘Life expectancy at birth’ estimates indicate how long, on average, an individual born today, could expect to live, if current mortality rates at different ages, applied throughout their life.
There has been a remarkable increase in life expectancy in the United Kingdom over the past century. In 1901 females could expect to live to 49, and men to 45. This compares to the current England & Wales average of 81 years for women and 77 years for men.
Increases in longevity have been accompanied by substantial changes in the main causes of death in the UK, with chronic illnesses such as cancer and cardiovascular disease, generally affecting older age groups, replacing infectious and respiratory diseases as the major killers.
In 1901, almost 40% of deaths occurred amongst those aged under 5. In 1999 less than 1% of deaths were under the age of 5.
The dramatic improvements in life expectancy in this country over recent decades have been brought about through a combination of social and economic policies, improved standards of living, better housing, education and nutrition, preventative approaches to public health, advances in screening, diagnosis, medical treatment and technology, and better access to care.
Our longer lives bring new issues to the fore for society to consider. As a Unitarian congregation we’re affiliated to the General Assembly of Unitarian & Free Christian churches – our GA as it’s affectionately known. Each April we hold our annual meetings and as part of those meetings we discuss motions proposed by congregations such as ours. One such motion last year called for us to support the right of terminally ill people to seek assistance to end their lives if they so wished – assisted dying as it is often called.
After a full debate, the meeting decided to refer the motion back to our congregations for further consideration – recognising that we all needed more time to study and understand the issues raised. A very useful discussion pack was published – we have a copy to lend in the library and it’s also available to read online.
Like many matters in life I think this is one where the deeper we look into it the more we find to explore. And that has certainly been the case for me in the last few weeks as I’ve been talking to people about this issue of life’s ending. And I chose that title of ‘life ending’ with some care because it’s become increasingly apparent to me that whilst death for some people is an understandably frightening subject, for most of us it is the process of moving towards death that is our greatest concern – the quality of our living when our health or cognition is impaired. As we have heard from Jeannene, there is much to be impressed with in our hospice movement in this country. Yet such care is available only to some. Too often our hospital teams remain far too committed to prolonging life – there needs to be greater awareness of the existence of palliative care teams that are orientated to easing the end of life rather than keeping a patient alive at whatever cost – be that financial or, far more importantly, the cost to the individual in terms of dignity and physical comfort.
Those who know about this stage of life always remind me of the value of what used to be called living wills – now known as advance directives, where we as individuals can make clear what level of treatment we want in our last days, when we quite possibly will no longer be able to articulate our needs for ourselves. There is much other practical work for our society to do on the quality of care we offer our elders; an urgent requirement for greater clarity of funding for older people’s care, an understanding that our ability to prolong life may not always seem like a gift to those who endure loss of self through conditions such as dementia, nor for their loved ones.
When we consider the issue of assisted dying, we will all have our own views and it remains to be seen whether or not our next Annual Meetings will attempt to reach a consensus on this matter. It is certainly worth thinking and talking about and I recommend this study pack to you. But for me that issue is merely a stepping stone to something deeper. We need I think to articulate for ourselves our ideas of life and death. We need a theology that works for us. What are we here for? What happens when we die? Some of us have clear and comforting theologies that help us accept the changing seasons of our lives with relative peace. Others have chosen a path of not knowing, of living with uncertainty. Yet that path can also hold much comfort as we consider the great mystery of all that is and imagine ourselves once more part of that unknowing, that swirling star dust of all matter and infinite space. From that perspective, our existence here together at this time and in this place can start to seem quite, quite miraculous. Let me end by celebrating the miracle that is each one of you. Amen.
Rev. Sarah Tinker
Sermon – 13th January 2013