Narrative Medicine

John 12:23-25; 27-28a

What is a good death?

I often taught this poem in a Narrative Medicine course in my role as ethics consultant in a Brooklyn Hospital.

Father
Today you would be ninety-seven
If you had lived, and we would all be
miserable, you and your children,
driving from clinic to clinic,
an ancient, fearful hypochondriac
and his fretful son and daughter,
asking directions, trying to read
the complicated, fading map of cures.
But with your dignity intact
you have been gone for twenty years,
and I am glad for all of us, although
I miss you every day—the heartbeat
under your necktie, the hand cupped
on the back of my neck, Old Spice
in the air, your voice delighted with stories.
On this day each year you loved to relate
that at the moment of your birth
your mother glanced out the window
and saw lilacs in bloom. Well, today
lilacs are blooming in side yards
all over Iowa, still welcoming you.

Ted Kooser in Delights and Shadows (Poet Laureate 2004-2006)

Narrative Medicine is a recent discipline in the field of Medical Humanities and arose out of the work of Rita Charon, Executive Director of the Program in Narrative Medicine, Columbia University. (See her Narrative Medicine: Honoring the Stories of Illness). She defines narrative medicine as “clinical practice fortified by the knowledge of what to do with stories.” The hope is that such a practice, a close reading of literary texts, can foster compassion, imagination and empathy and perhaps reduce the alarming burnout rates for young physicians.

In a process similar to lectio divina, we read the selected text aloud three times, three different readers. After the second reading we discussed various aspects of the poem — voice, form, tone diction, theme … Some expressed their dislike for the poet/speaker: “I don’t think he really loved his father, or he would have wanted him to live.” Often, we talked about the moral distress they experience in their work, especially in intensive care units. “Are we doing the right thing? Are we prolonging life or prolonging death?” Someone spoke about pumping the chest of a frail elderly patient, and feeling her ribs breaking under her hands.

After the third reading the class wrote to a prompt, five minutes without stopping or editing. The prompt in this case arose from the first line of the poem and residents chose between writing about themselves, as in “I would be___if___,” or about someone else, as in “He/She would be___if___.”

Often, residents filled in the blanks with a reflection on their chosen vocation. They wrote something like, “I would be living in a warm place, near my family, not in debt, working as a high school teacher if I had not chosen medicine.” Others might have written about a beloved grandparent who had died, after the manner of the poem. Then, those who wished, shared what they have written. Once, a resident read, “My daughter would be 3 years old if she had lived”… and then he wept and told the story of his daughter’s death.

What is a good death? Jesus says, “Very truly I tell you, unless a grain of wheat falls into the earth and dies, it remains just a single grain; but if it dies, it bears much fruit.” A natural image, a natural death, the kind of death we all want, that opens to the sight and scent of lilacs and Old Spice.

How many times have we heard, I don’t want to be kept alive on a machine.

Pandemic deaths are tragic, not natural. People die hooked up to respirators. People die alone, without their loved ones. This complicates the grief and doesn’t lead so easily to lilacs in bloom. Moreover, the pandemic led immediately to economic hardship that fell most heavily on those already struggling to survive. It was soon apparent that people of color were dying at much great rates than whites. In the midst of this disaster, George Floyd’s violent death made us see yet again (!) the stubborn persistence of systemic racism, of evil.

Jesus didn’t want to die, though he speaks of his death from the very beginning of John’s gospel. Jesus says, “Those who love their life lose it, and those who hate their life in this world will keep it for eternal life.” Jesus loved his life and his soul is troubled by the prospect of death. Still he does not ask to be saved from it. “No, it is for this reason that I have come to this hour. Father, glorify your name.” He hears God’s affirmation: I have glorified it and I will glorify it again.

How is this a good death? In John’s Gospel, no one understands a word that Jesus says about this death — friend or enemy, miracle seekers or disciples.

After this moment, when Jesus surrenders his life to God’s purposes, he turns from his public ministry to be instead with his disciples in the last days, to be with them in great intimacy. Startling physical intimacy. He washes their feet. He tells them again and again that his death is necessary in order for the Spirit, the Advocate, to come. He tells them that he loves them with a love that does not end. And I, when I am lifted up will draw all people to myself. (John 12:32)

The disciples still did not understand. Yet, after he died and appeared to them, after the coming of Jesus’ Spirit, they did understand. Not fully of course. The mystery of the incarnation is not exhausted. Yet they were given the power to love and tell the good news that, in Jesus, God is fully with us and in us.

Back to those machines that failed to keep some five hundred thousand people alive. Yet how many lives were saved by those same machines? We call modern medicine miraculous, and it is. Yet how many moral issues it raises, how much sin is entangled in it. Jesus died for that, too.

I could have told you stories about physician arrogance and lack of compassion. Yet, most often, I was amazed by their dedication and their compassion.

I could have told you about the certified nurse’s aids, unjustly underpaid and overworked. Yet, how often they stopped me in the hallway to share their suffering and ask me, on the spot, to bless and pray for them. Their compassion for patients astounded me.

Mostly, I wanted to tell you this: the Spirit of Jesus Christ is alive in the world. God is alive in the world, grieving with us and in us, opening our eyes to evil and giving us the energy to keep on loving even in the darkest times. A good death indeed.