Interview

Discussing Death

A Conversation with Hal and Carole Stoneking

by Sarah Stoneking

Some families discuss sports, politics or weekend plans around the dinner table. While my family does all of that, we sometimes find ourselves discussing other challenging issues. Both of my parents work professionally with issues of death and dying and they have had their own poignant experiences with death. So, this is not a rare topic in our house. My mother, Carole Stoneking, is a professor of Christian Ethics and has co-authored Growing Old in Christ. My father, Hal Stoneking, has spent much of his life practicing geriatric medicine. As I prepare to begin medical school, I sat down to talk with them about their collective wisdom surrounding death. Here’s a snippet of that conversation.

Sarah: Mom, how would you define a good death?

Carole: In the company of fellow Christians. Death is an experience that we all fear because we fear being alone, and what we can do for one another at the end of life is to be present. That’s the most significant thing that we can do. I think a good death is a death experienced in the presence of others. Sadly, I don’t think that’s experienced widely. People are afraid to be present even with the ones that they love when they are near death. Death is often romanticized or, on the other hand, it’s fictionalized to the point that we don’t really know what to expect. And when we don’t know what to expect, we fear.

Hal: One of the things that modern medicine has done, unfortunately, is create the idea that we can cure and save everyone. We can’t. We cannot. So because this idea permeates the way people view medicine and death, people should be taught how to have conversations about death—clergy, physicians, patients, everyone. What I run into most often is that family members have never had the conversation. They never talk about that topic so when the time comes, there’s no history of that conversation between them and that time becomes even more pressured.

Carole: Part of the reason I think we don’t have those conversations is because we’ve created this interesting phenomenon called retirement and retirement homes. The intergenerational family is more the exception than the rule in terms of the way most Americans live. People are much more mobile, and families are separated not only by years but by distance. So suddenly grandma’s sick and everybody flies in and these conversations haven’t happened and there are unresolved family issues and nobody’s talked about it up until this point and the physician walks through the door and they want to do everything. Do it all.

From personal experience, as well as theological conviction, I’d say that when my mother died, the greatest gift that she gave us and that we gave her was our presence with one another– her presence with us as she died and her willingness to be dependent upon us and to let us carry that load. That was what we wanted to do and that was all we could do, and it was one of the most profound experiences of my life. I don’t want to paint a rosy picture. It was very, very hard, but it was profoundly life-changing for me to be able to be with her during that time and I would not trade that time for anything in the world.

I think this is the challenge for medicine, for the church, and for our society—to try to understand how we can be present to one another at the end of life. This is a complex and difficult thing, but it’s part of what we do and part of what we’re called to do as Christians. The church has to figure out a way to recreate that multi-generational family, and while there is much biblical precedent for that, and we can do that, it won’t be easy. In the absence of that, medicine has been called upon to do many things that it was never intended to do.

Sarah: You said “biblical precedent.” Can you think of places in the Bible where you see this?

Carole: Jesus talked a lot about “Who is my brother? Who is my sister?” And you know he certainly was not assuming a biological definition. That’s why I said it’s a great challenge for the church. We need to have serious conversations about what family means. Theologically, what is family? I think that we assume a biological definition of family. But that’s not all that a family is or can be.

Sarah: Dad, what have you learned from personal experience in your own practice? What is a good death to you?

Hal: A good death takes into account the individual experiences of the person who is dying. I just can’t emphasize enough the incredible variability of every person’s unique experience when they’re dying. A good death is a combination of your personality, your relationships, your faith, your illness. You know, why are you dying? Was it falling out of a bed and hitting your head? Or a slow-growing mass in your lungs that is taking you away in inches? Or an illness that’s taking your brain away? None of them are the same. So health professionals have to learn how we can support the process of death rather than using a one-size-fits-all approach.

I had a family whose mother I’ve worked with for over fifteen years. She’s 98 years old, has multi-system organ failure, can no longer eat, and the family wants to put in a feeding tube. They had not had any conversations on end-of-life planning and quality of life, and they adamantly refused to consider hospice. Juxtaposed to her, I had a family whose father was young, independent, and doing well and who had just been diagnosed with a lung mass. He immediately wanted to call hospice, to throw in the towel and forget chemo. So now it’s my job to step in and say “What have you heard about chemotherapy? Where are the barriers here? Do you know that there are some chemotherapies now for lung cancer that are taking a pill a day? You need to talk to an oncologist, someone who treats this day in and day out, to give you the information—and then we can make the decision about if you want to do it or not.” Every situation is intricately different. Not only do families need to be having these conversations, but health care workers need to be trained to know how to handle them. That’s not something I see our medical schools doing.

Carole: That’s very true: what becomes an extraordinary measure for one could be a sort of ordinary treatment for another person. It is very different from one case to another and I think that this is a conversation that should be happening more in congregations. It would be extremely helpful to a lot of families to have a safe space to start having those conversations and thinking about those issues before they’re in the midst of a crisis. What would be appropriate for my 99-year-old grandmother under certain circumstances and what wouldn’t be? What would be more in keeping with her life story and how she understands who she is and how we understand what it means to be in life together in this community?

Our lives are narratives, they have a beginning, a middle, and they have an end. We should honor that narrative. I think those are the kinds of conversations that should be happening with parish nurses and pastors and family members. People should be encouraged to have open, honest, informative conversations about death. Maybe that’s what churches, what families, should be encouraging: a forum for these conversations to take place.

 

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