FINAL GIFTS – Negotiating Life’s Ultimate Transition

Charlotte’s sister had been contending with cancer for some time. Sally and I would ask about her whenever we ran into Charlotte in the neighborhood. After several of those updates—reports of points made and lost—we learned that, after all, she’d lost the argument.

Soon after Charlotte returned from the funeral in Michigan, she gave us a book called Final Gifts. She explained that a friend had given it to her, and that it had helped her and her family get through those last painful months. The book was a blessing, she said, one she wanted to pay forward.

Final Gifts was written by Maggie Callanan and Patricia Kelley, two veteran hospice nurses who not only care for the medical and emotional needs of patients who are dying, but help them and their families understand and grow from the end-of-life experience.

What makes this so relevant to the theme of One Man’s Wonder is that these wishes often aren’t immediately apparent on the surface.

NEARING-DEATH AWARENESS
A Kirkus review of the book says, “The ‘final gifts’ of the title are the comfort and enlightenment offered by the dying to those attending them, and in return, the peace and reassurance offered to the dying by those who hear their needs.”

In one example after another, the authors describe how the fear and grief associated with death are buffered by the dying person’s deep-seated need to reconcile relationships, settle accounts, spare loved ones’ feelings and leave a meaningful legacy.

What makes this so relevant to the theme of One Man’s Wonder is that these wishes often aren’t immediately apparent on the surface. Understanding them involves curiosity and open-mindedness.

Instead of using conventional words or actions, a dying person, especially when they’ve entered the stage the authors call “Nearing Death Awareness,” may describe what they’re going through or ask for things they need using apparently inane symbolism.

THRESHOLD OF FOREVER
A reference to a map or packing a suitcase, for example, might indicate the patient’s fear of the unknown or of not being prepared for death. Talk of a balance sheet or I.O.U. might represent scores to settle or amends to be made. Or the mention of having received an invitation might signal the patient’s peaceful acceptance of death.

In all their cases, Kelley and Callanan help families of the dying to do emotionally and spiritually what many of us already know how to do with our physical sensing: to appreciate the wonder of life, discover new ways of looking and seeing, give voice to deeply-held faith and, ultimately, to embrace the unfathomable.

Like all of Nature, death has more to teach us when we appreciate its many layers. For one dying person it might be the opportunity for caretakers and loved ones to look under the surface of spoken words to discover his or her ultimate needs.

It might compel another patient to reach back through layers of time, asking someone long estranged to come back and share the letting go of resentment, hurt or blame—often for a disagreement whose reasons have long since been forgotten. In many cases, patients are able to hold on just long enough to reconcile with that person before passing away.

Suddenly, he sat bolt upright in his bed, his gaze fixed on a point somewhere
well beyond the upper corner of the room.

WELCOME TO HEAVEN
Sometimes the end of life even enables a dying person to reach across death’s threshold and sense the welcoming spirits of previously-departed loved ones.

Sally and I had no way of knowing how soon the things we learned from reading Final Gifts would apply to our own lives. But within months after Sally finished the book, her friend, Mary, after decades living with recurring cancer, finally was succumbing.

One evening near the end, Sally was sitting with her. Mary’s eyes seemed to drift away from Sally to something in the empty corner of her bedroom. “Who are they?” Mary asked.

Sally admitted later that her normal reaction would have been to try talking Mary out of her “confusion.” But, having read about this behavior in the book, she was able to embrace Mary’s experience and help her make sense of it. “Tell me more about them,” she prompted.

That simple acknowledgment helped Mary realize that the figures were those of her long-departed sister and uncle, and that joining them might not be as fearful as she’d imagined.

THE RAPTURE
Those who experience Nearing Death Awareness often talk about seeing an indescribably beautiful place, one that moves them to wonder and awe. When my dad was dying (at the age of 91), we knew death was imminent. After being knocked to the floor several times by jolts from his defibrillator, he’d decided to have it turned off.

The doctor advised us he’d almost surely die within a couple of days. My brother, Dan, and I decided to keep vigil with him for whatever time remained. We let him know of our sadness and our hope that he’d change his mind. Ultimately, all we could do was to support him, talk with him, advocate for him, and make sure he was comfortable.

It was my shift. Dad was in deep sleep, his breathing so thin that I feared each time his chest rose and fell might be the last. Suddenly, he sat bolt upright in his bed, his eyes wide open, his gaze turned upward, fixed on a point somewhere well beyond the upper corner of the room.

His expression was one of pure rapture. It was as if he were witnessing something stunningly beautiful. Even though the wonder, whatever it was, was visible to me only in his eyes, I too was struck dumb. After about 20 seconds, he lay back down, closed his eyes and resumed his sporadic breathing.

He died the next morning.

SPIRITUAL TRANSFORMATION
Does all of this mean that death’s a wonderful thing? It depends. For my dad, I think it was. He was ready. On the other hand, I can barely imagine what it must be like to lose a child. Or a young family’s loss of a parent. Or anyone dying alone and scared…just the thought brings tears to my eyes.

Nonetheless, Final Gifts reminded me that the pain, fear and grief surrounding death are not evil; they’re part of the human condition, part of the Creator’s plan. When I view death in that context, through eyes unclouded by all the value judgments and taboos our culture imposes on it, I can’t help feeling that, somewhere under those folds, there’s the potential for it to be an awesome, even beautiful, thing.

The patients and families depicted in the book struggled with the apparent contradiction between that possibility and the stark reality of their own loss.

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PASS IT ON!
I’ve given away that copy of the Final Gifts that Charlotte gave us, as well as several others I’ve bought. The initial reaction I’ve gotten from some recipients, especially those under 40—from whom thoughts of death and dying are still far removed—has fallen a bit short of gratitude: “What a downer!” “Why such a creepy gift?” “Are you dying?”

Most, nonetheless, have dutifully read it. Everyone who’s done so has thanked me for the discoveries and the comfort it’s brought them. I hope you’ll read it too—and then continue the sequence by passing it forward.

Final Gifts – link to Amazon

(Final Gifts and a few other books and articles I’ve read about death and dying have led me to become a hospice volunteer—with Health Partners Hospice—which has deepened my understanding and appreciation of the end-of-life experience.)

AS IF FOR THE FIRST TIME: Balance

In my As If For the First Time series I pick some common observation or activity—one so ubiquitous as to easily escape one’s full appreciation—and describe it as if I’d never seen or done it before.
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I toddled before my first birthday, and I’ve been on my feet ever since. Never doubting my ability to stand up, put one foot in front of the other and walk across the room.

Until late last summer.

That morning—it was September 13—I’d gotten up as usual, brushed my teeth, done my stretches. I’d just opened the refrigerator door to grab the orange juice when I felt a twinge of wooziness. Odd, I thought, as possible causes sifted through my mind.

Stroke? Heart attack? Brain tumor? Before entertaining any of these awful prospects, I decided just to sit down, relax and see if the dizziness might pass. But ten minutes later, as the dog barked to go outside, I just knew I wouldn’t be able to stand up. I tried, and I was right.

WHAT IT’S NOT
Quite the saga unfolded from there. Staggering to the door, vomiting, an ambulance ride, and an eye-opening night in the ER where they did every imaginable image and test to rule out the obvious culprits. Thank God, about 24 hours after whatever it was stole my balance, I was finally able to walk out of there.

The diagnosis after all that: dehydration. Ha! I knew that wasn’t the case. (Ever since having passed a couple of kidney stones years ago I’ve been quite conscientious about my water intake.) So if that wasn’t it, what was it, this mysterious, vertigo-like case of the swirlies? I just hoped and prayed it would be a one-and-done.

Then, just over three months later, while I was visiting my daughter and her family in Maine for Christmas, it happened again. Roughly the same time of day, same circumstances, same debilitation. Only this time, realizing that all the most dire causes had been ruled out, I worried less.

Sure enough, twenty-four hours later it was gone. But not without leaving me mystified again and feeling more vulnerable than ever.

           As far as walking, you might as well
           be aboard a tiny boat on rough seas.

ON ROUGH SEAS
While researching my new disorder, I’ve been reminded of the fascinating workings of the human body’s balance center, the inner ear. Among its components are thousands of little calcium carbonate crystals that sit on a gelatinous bed inlaid with tiny vertical hairs.

Normally, the crystals' condition and position signal to the brain where your body is in space. And they coordinate with your muscles to keep you…well…vertical.

But if those little crystals get jostled and some get tipped into the semicircular canals, that can be a problem. The errant crystals are supposed to dissolve, but certain positions can hinder that process, and then all bets are off. As far as walking, you might as well be trying to stand in a tiny boat on rough seas.

If it is vertigo there’s a remedy. The Epley Maneuver—a series of specific head and torso movements—can help satisfy the inner ear that you’re not really aboard a storm-tossed dinghy. I tried it three or four times without success.

LIKE FATHER…
This is one of those junctures in my life where I wish I could talk to my dad. He was a good-natured stickler for good posture. He’d see my brother or me slouched over our oatmeal and, without saying a word, demonstrate what sitting up straight looks like. Robot-like, he’d lift a spoonful straight up to the level of his face and then execute the precise 90-degree turn into his mouth.

Dad must have been taught the same thing growing up, that posture’s not just good for one’s spine, but is also an expression of one’s character. He walked steadily—and even played cartless golf—until just a couple of weeks before his death at age 91. No one would have been more profoundly bothered by the inability to stand.

Maybe that’s why this vertigo thing has hit me so hard. I’d like to ask my dad if he ever had an episode of this vertigo-like disorder. And if so, how he felt and what he might have learned about it.

From here on out, I guess all I can do is keep exploring possible causes…and hope it doesn’t happen again. I’ve made an appointment at the National Center For Dizziness and Balance, located here in Minneapolis, so maybe I can get some answers about causes, prevention and, I hope, a remedy.

And I’ll never again take simply standing for granted.