Mortality: if you're mortal, this book should help. If you think you're not mortal, seek help....

This man (surgeon, researcher, teacher)

 Atul Gawande, has written a really important book. "Being Mortal" pulls together a lot of what many people have been saying for quite a long time: late and drastic medical interventions in someone's last days can be dreadful failures, in terms of what the dying person has to go through. He says a lot more than that, and he bases what he has to say on detailed accounts, including the last weeks of friends, and of his own father.



It's not always a jolly read; he goes into detail on the sort of ailments that are likely to afflict most of us as we age. One of his aims is to make us think and prepare for future difficulties, ours and those close to us; he wants to change how we view - or try to avoid viewing - the last  stages of life.

The book is about much more than medicine. He finds ways round the usual terrifying conundrums of the terminally ill, with regard to possible treatments. In doing so, he re-defines the role of doctors in such times.

Because a hospice nurse had sat down with Atul and his father and had a direct, careful sort of conversation, his father was able to surprise himself and his son with what he could still do.

"I was almosty oversome just witnessing it. Here was what a different kind of care - a different kind of medicine - makes possible, I thought to myself. Here is what having a hard conversation can do."

The conversation isn't about a menu of marginally effective and deeply horrible treatments; it's about asking the patient what matters to him, what are his fears, what is non-negotiable - all questions that acknowledge that he is going to die, and fairly soon. And then making the medicine serve those ends. 

It is very hard for doctors to do the best for a dying person if the person and those close to him can't acknowledge that they are in the last days, or weeks, or months of a life 

It's easy to say that the quality of a life is more important that it's length, at the end - unless, of course, it's your life. Here is a sensitive, emotionally honest, well-informed guide to a way through and round the horrors of futile (and very expensive) treatments. 

He writes with compassion and clarity, and he wears his learning lightly. It's a very, very good book about dying, so it's also about living.

Contemplating, through this book, the end of life has made my immediate life richer. Can't say fairer than that!

Atul Gawande is giving this year's Reith lectures, BBC Radio 4, 09:00 next Tuesday 25th November. Should be good.

Funerals: Give them what they want?

This is a "funerals" post, so if you'd like to side-step it, that's fine by me, though Andrew Marr's BBC Radio 4 programme this morning made it pretty clear that thinking about death - yours - from time to time is a positive thing to do for your life.

Anyway: as a funeral celebrant, I spend much time ensuring people - families, friends, mourners - get what they want. That is surely a large part of the rationale for a ceremony that does not need to follow the rituals and structures of an organised religion (for better or worse, of course. Come on, own up - which of us does not have a bit of an aching hole where the finer elements of those rituals used to live? Whatever we believe?)

So a while ago, that's what I did. He who had died was a big character, the crematorium was packed twice over. His family wanted to accentuate the positive, celebrate the life, didn't want it too sad and gloomy. 

After my customary warning that it would be sad, but that we would make sure it wasn't too sombre or gloomy, we went ahead and planned it.

It wasn't very sad, that's for sure.

The gathering loved it. Plenty of smiles, some big laughs. Off we went.

And I'm left thinking "was that "right?" There wasn't much mourning there, not much room for grief. Very few signs of grief. Not much acceptance or acknowledgement of the power and mystery of death to enrich our lives and help their grieving. And yet he was a greatly valued man.

Was I helping them to avoid the issue, skate in a superficial way over what had happened to them?

Maybe I still have a model of what a funeral "should" be, instead of letting it be what it is. I was pleased by how it went, but troubled by the thought that it may have lacked what many people see asone important function of a funeral - to help people through a physical loss, however much they want to enjoy memories of his life.

They got what they wanted, but probably not what what I wanted for them. I'm sure that's better than the other way round, but still...


-->

Codicil

Hang about Vicar, let me interrupt.

Having been full of life you say, I'd want a party.

Yes, but I'm full of death now and see things differently.

You say I wouldn't have wanted folk to grieve for long.

No - but with infinite death ahead of me,

a few months being alive and fed up

doesn't seem much to ask of my friends.

OK, some of you wear the bright clothes I admired -

but you lot with less taste, give us a break

and wear dark colours please.

No flowers? Donations only? Hold your horses.

I could never have picked one charity

and loved buying and looking at flowers. I'd like to give

my mourners that opportunity.

True I liked food, and would like to see most of you

tucking in. But I'd also like to do some good -

and some of you who could do to lose a pound or two

should surely be too upset to eat.

Smile by all means, remember my gaffes

and share a careful laugh -

but then it's my funeral, fuck it -

some of you ought to go home and WEEP BUCKETS.

                                                             Julie Deakin

  

Harmony, and that Stephen Taberner live magic.

Singing as well as you can, with a goodly number of other non-professional singers who were almost all strangers until the previous morning; singing a simple but powerful little song in the mighty caverns of Liverpool Cathedral; now that's a mindful activity. 

Life-enhancing, nothing to do with the trappings of funerals - it was a lovely change and maybe even a wee bit transformational. 

Harmony seems to me to have the power to carry the beauties and pains of life, to accommodate both being alive and acknowledging life's transience.  Perhaps that's why it fills people up. (Well, me, anyway!)

Your cursor over the title will take you to a YouTube clip of "Soyewela," a South African (Xhosa) freedom song.  Four other songs from the same performance are also on YouTube. The most ambitious is Stephen's arrangement of an Australian rock anthem "Throw Your Arms Around Me,"  by Hunters and Collectors. It's not perfect, but it sure is live. Before we went on, Stephen advised not to worry about ourselves, just to let the song be. It's hard to describe that feeling, but it is very presentmoment, very communal, deeply refeshing.

The man is a magician, no question.

Dying with dignity, funerals with dignity, depend on uniqueness

Your cursor over the title will take you to a BBC "Points of View" transcript of today's broadcast. Don't be misled by the title, it's not part of the assisted dying debate, it's simply about how difficult it is to feel that someone is dying with dignity.

To summarise clumsily: it's difficult for hospital staff, however compassionate and caring they may be, to provide in the environment of a modern hospital, that sense of a unique event happening to one individual. I'll leave you to read the whole thing.

Hospital staff do their best, some do extraordinarily well. But the bed in which she is dying is a bed amongst many; her death is one in a progression of deaths; and perhaps, somewhere in the hospital, someone is looking at spare beds, incoming patients, and thinking, with however much compassion that can be brought to bear, "the lady in no. 20 probably won't last the night, so..."

If you die at home, no-one is going to be waiting for your bed to be ill or die in. (Unless your family is exceptionally unlucky!) There may be one of those wonderful Macmillan people there to help, or someone from Hospice at Home. Hopefully, there will be close relatives there too (as there may well be in a hospital, of course.) But it's a unique event; it's your bed, and you're dying in it.

So if a dignified death depends on a sense of uniqueness, that is surely just as true at a funeral. That's why families hate it when there is another family visibly and sometimes audibly waiting for their turn; when an FD behaves as though this is just another job; when a celebrant minister or priest is doing so many funerals that he hasn't really made himself part of this family's feelings, hasn't done more or other than what he usually does. 

The deathly production line. We must do better.

Of course, if you die in one of the hellish killing fields in the Middle East, or Africa, or... then all this is pretty marginal. We are a fortunate culture still. But I can't imagine there's any bereaved family anywhere that doesn't want, somehow, to feel that the uniqueness of the person they loved has been part of the death, the funeral and the grieving.

 

we are pluralities - meditation and the striving ego

It seems to me that we are not single entities, but pluralities, full of the voices and gestures of people we have known, the places we have lived, and then some. We are unfolding processes, and our present moment, our “now,” is arrived at from “them” and “then” and “there.”

During meditation, it is possible, even for an inconsistent lightweight of a meditator like me, to let go of the trains of thought that usually occupy the mind, and be in the present moment; to drop concepts and judgements, and just be. It doesn't last long before the scripts start running again, and I need to bring the mind back again to the present - often to the breath. 

This to and fro motion is, of course, what a meditation is, for most of us. The Balance is never static, as a tightrope walker might tell us.

For those moments of presentness,  them then and there fall away. When I return to my plural self, it is with more calmness and a better balance. Perhaps for a while I am more fully a plurality, and happy with it; I am not struggling so much to sustain one single "I," worrying about claiming things for my ego. It's easier then to accept change, uncertainty, provisionality.

Meditation, like exercise, can be addictive! 

Serenade - a poem by John Fuller

This poem links in my mind with my post about the fear of death, 02:10:14; I hope Mr Fuller doesn't mind my reprinting in full his fine poem, which I found in The Spectator, 4th October 2014, page 24.


Come to the garden, that familiar place
Where life renews itself against all odds.
Untightening buds act out their memory,
And dying seems a momentray pause.

Our star that took an afternoon to sink
Hangs in reluctance from the darkening tree
Like an amused and philosophic eye
Penning his treatise of the out-of-doors.

We are the topics of his arguments,
Enduring his extemporised revisions.
We are reminded of our natural ends
And of our origins and of their laws.

The knotted plum has dared at last to bloom:
Its blossom has no other mind but yours.

The yellow spray will lean down just for you
And though its petals scatter, they are yours.

Twisted wistaria unfolds and falls:
Its violet is a passing thought of yours.

The carved magnolia tilts its head and lifts a cheek
That mimics the expressiveness of yours.

The visited and swooning clematis
Climbs like a conscious eagerness of yours.

Yours are the flowers dimmer than their air,
Whose perfume lingers like an old desire.

Come to the garden, where two glasses wait
And there's a chair beside another chair.
The liquid lifts and widens as it pours,
And evening has no other end but night.

                                      John Fuller

The psychological appeal of polarised views: adolescence, The Process, jihadism - ?

I had two good friends at school who became heavily inolved in what became a full-blown cult. This cult, originally called The Process, and later the Process Church of the Final Judgement, was why I lost touch with them both. At one point, I was quite interested in The Process myself. 

I realise now it was feeding on the common adolescent uncertainty about personal identity, and the longing to belong to Something - and of course in 1967 that Something had better be strange and exciting. It mustn't be part of what Processeans charmingly called "the Grey." (i.e. you and me.)

Well, that was a long time ago. Here's something more recent; from "The Spectator," 4th October, page 17. It's a woman describing how her stepson became a radical Islamist, and how he is now beginning to return to his family, leaving behind the influence of his frightening friends:

"He is maturing. He no longer needs the support of a tribe, which is what attractes Muslims from all backgrounds and nations to the idea of jihad. I've come to think that it is youth, not presecution or poverty, that these Islamic State groupies have in common, an embryonic sense of identity. For them, blaming America for the world's problems is the equivalent of shouting at their parents that they 'never asked to be born.'"

I think that my young friends back then in the mid-1960s felt that at last they had an identity that had nothing to do with their parents, that simplified their lives, gave them a new identity and a tribe. Thus were they pulled into the vortex of The Process.

It provided absolute and polarised answers to the frustrating complexities of life, it broke down their previous sense of who they were and where they belonged, it made them vulnerable to manipulative people. And as usual with such cults, guess what? There was, allegedly (!), sex and money in it for the leaders.

Would that Western jihadists had fallen for something so ultimately ludicrous and relatively harmless as the Process Church, rather than the terrifying simplicities of jihadism. The Process had its nasty side, in my opinion, but it didn't involve hacking people's heads off and it had no power base in regional religious sectarian conflict.

So when desperate parents tell us that they can't understand why their middle-class privileged children start to talk in scary slogans and attack everything their family stands for, I think that, unlikely though it may at first seem, there may be something in common with my two schoolfriends, both from comfortable, apparently stable middle-class backgrounds. 

They both became relatively suddenly alienated, energised, very strange, and figuratively and then literally, distanced from all they had known, all who knew them. They had a tribe. Than God it wasn't Charles Manson's tribe, or Jim Jones down in Guyana.