Like many, perhaps most, hospice volunteers, I came to this work through the experience of caring for people I love in their last illnesses.
I helped care for my best friend Jud, as melanoma ravaged him, and his world shrank to the physical comfort given him by his wife Rose and those of us who were there to help them both make this journey as gently as possible. I held my father's hand as he took his last breath and the pulse quivering in his neck slowly disappeared like ripples fading on a pond. Dying is hard work, physically, emotionally, and spiritually—though as Jud taught me those distinctions of the Western mind merge into the body's urgent need to be free of pain and then simply to be free. He was 48 and way too young for this to happen and make any sense, and yet even for Jud there came a point where the only thing to do was to “learn by going where [he had] to go.”
I came to be a hospice volunteer because I wanted to help others, the dying and their loved ones, do the hard and wonderful work of arriving at that moment as gently and mindfully as possible, knowing that to be part of that work would be, for me, a greater gift than anything I gave to them. But there was one uncertainty, one question that none of the volunteer training or my own preparation could answer: It was one thing to care for a family member or a friend, but how would it feel to be at the bedside of a stranger?
The gift of an answer was given to me by my first hospice patient and his family. Peter lay in a light morphine sleep, outwardly unresponsive but aware of our ministrations. I cut away his T-shirt and shorts and helped turn and hold him while his wife Julie and daughter Helen washed him. We changed the bed pads and put fresh clothes on him, and then I rubbed lotion into his right arm and hand, while Helen did the same to his left, and Julie his feet and legs. As I swabbed Peter's lips and gums to keep them moistened, I recalled, more with my hand and heart than my mind, doing the same thing for my father a decade earlier. It wasn't so much a memory as a feeling: I love this man, and we have done this work together before.
My father was 80 years old when he died of congestive heart failure, after a long, full life, thereby avoiding the far worse fate brewing in the carcinoma that had invaded his eye socket and cranial cavity. His heart was his best friend, and my father taught me that a gentle death can be full of grace and beauty. The body in its winding down becomes something greater than itself; mind, feeling, and spirit are distilled, becoming just this body laboring to let go—just this. And to be there helping the body in its becoming is to be present when a window opens briefly on the mystery and power of life itself, streaming through us from our first breath to our last.
Two years before my father died, my daughter Gretchen was born in the front seat of our Toyota Camry stationwagon, on the shoulder of Route 1 at the Brunswick Traffic Circle, eight minutes shy of our destination, the Mercer Medical Center in Trenton, New Jersey. It was rush-hour on a mild Monday morning in September, cars streaming by as I lifted Gretchen off the bucket seat and handed her to Amy, who began to nurse her, saying over and over to calm me as I drove the rest of the way, “It's okay. We have a beautiful baby girl.”
Amy's water had broken a mile and a few minutes before. “Pull over,” she said in the grip of a contraction. And then, “No, keep going.” She repeated this litany as her contractions came and went and we wove through traffic past burger joints and muffler shops, until, in a voice so calm and powerful that the memory of it holds me still, Amy said, “David, stop the car. We are going to have this baby now.”
As she tells it, Amy realized that trying to hold back what was happening would do more harm to her and the baby than going with it, so she gave herself to the power flowing through her. And that was the voice I heard. We learn by going where we have to go.
Gretchen grew up to be a dancer, and once, when I asked her, why she wanted to leave the San Francisco Ballet School and find another company, she said, “Dad, I need to dance.”
Her voice was so calmly passionate, self-assured, and determined that I thought, wow, my little girl is all grown up. And then I realized that I had heard that voice before, eighteen years earlier, when her mother told me to stop the car.
There's a power flowing through us that reveals itself most directly, perhaps, in dancers and athletes, whose bodies are their means of expression. There's a wonderful moment in the film, Chariots of Fire, when Eric Liddell's sister asks him why he wants to compete in the Olympics rather than do God's work as a missionary. He answers, “When I run, I feel His pleasure.” And when I see my daughter's discipline, passion, and grace on the dance floor, I always think of this wonderful passage in a letter from Martha Graham to Agnes De Mille:
It is everyone's business. Mind and body seek those moments where we feel most in tune with the world flowing through us. It might be fly-fishing, throwing clay, playing music, walking the dog— whatever forms of work and play kindle the radiance of our truest selves, joyful and loving, fearless and generous.
There's a power flowing through us from our first breath to our last, and to be present when that window opens–first and last–is to come as close as we can to the mystery of our being here. The labor of birth and the work of dying both entail a letting go, a surrender of self to the flow of things. There was a time when the work of birthing and dying was done at home, with family gathered round, a powerful affirmation of the mystery and fragility of life and of our connectedness to all of nature's comings and goings. Our culture's discomfort with this work, our inclination to hand responsibility for it over to the business of medicine, is a key sign of our dislocation from our own nature and from our place in the community of living things.
It is not mere metaphor to say that birth and death are the same kind of work. They say that all babies look alike. The grain of truth in that observation comes of the fact that we all have to scrunch our way through the birth canal. There are no pointy noses in the nursery.
And just as all of us share one face in the nursery, so we share one face on the deathbed. As the body shuts down, there is a kind of winnowing to essentials— a passage as narrow and demanding, in its own way, as the birth canal. Skin stretches pale and tight over bone, pulling back from the open mouth and leaving features hollowed, translucent, honed to a vanishing point. How ironic that this phenomenon is often called the death mask. It is not a mask at all, but the true face of our mortality revealed in all its beauty.
Perhaps I saw that face coming to Peter as I swabbed his lips and gums, though he would journey two more days with his family by his side. I had been visiting him for several weeks, reading him novels, stories, poems. It came to be that Julie and Helen would sit or lie down next to him and listen, too. And the greatest gift of all was their willingness to let me share with them in Peter's care. This gift of intimacy was not a function of how long I'd known them or how familiar we had become. It came to all of us through Peter— from the place where the body's urgent need for comfort in its final journey meets the simple, human response of a loving touch. There are no strangers there, only loved ones, and love flowing through us first and last.
"There is a vitality, a life force, a quickening that is translated through you into action, and because there is only one of you in all time, this expression is unique. And if you block it, it will never exist through any other medium and be lost. The world will not have it.
It is not your business to determine how good it is, nor how valuable it is, nor how it compares with other expressions. It is your business to keep the channel open."
The Meeting Place