Saturday, May 31, 2008

Bad Death

From Plainviews a journal about pastoral care and practice within Canada.

Bad Death

I could have done without the juicy comments about your sex lives.
Please know that it has nothing to do with my role as chaplain.
On the other hand I liked seeing the greeting on your door:
“Religious people go away!” each time I arrived.

Looking at life through your grey-colored glasses
required all I had to give
And little of what I was trained to provide.
I was always on notice, on borrowed time, on Holy Ground.

You see I’m called to be with people I wouldn’t invite to dinner;
It’s my job to just show up for a conversation.
So we talked nothing of religion but lots culture:
New York, Cape Cod, Las Vegas, security detail and prize fights you worked,
anything but the estrangement you felt so deep in your bones.
You wanted it to end, and cleverly.

After my visits I smelled like a tavern.
It took a plentiful misting of Febreze
and a night hanging outside
to put my clothes right.
Residue of my time with you came out of pants and shirts
but not out of my mind and spirit.

You smoked like a machine, and smoked near one, too.
We both knew that it was reckless; O2 and white ash don’t mix.
Now your memory is part of me
Your burning house and then your legitimate cremation
Refining fires for my ministry of understanding.

Who would have thought final healing would cost so much?
Neither Saul nor Judas had it in them to choose ice or fire
But your goal may have been the same,
to end despair and sadness, the tragic cargo which can erode any
but the most stubborn embrace of gratitude, faith, hope.

I confess now that I wanted for you
a kind of reformation called “good” death
I may have let you down.
Sorry for getting religious.

Recently I had one of the toughest pastoral encounters of my ministry: the disturbing death of an at-home hospice patient. I’ve worked as a chaplain in many settings including an inner city ER, an industrial workplace and pediatric oncology. After this death, however, I found myself challenged by a series of feelings: distress, guilt, failure, and also longing.

I’d met with the hospice patient in his home for six months. “Mike” was outspoken in his distaste for religion and the people who speak of it. Nonetheless, he let me “in the door,” both literally and figuratively; our contact was weekly for the last six weeks before he died. He was an intriguing personality and younger than most hospice patients. More complex, too! Time with Mike was different than with many of the more routine patients on my census. He was a challenge to engage but over time we built trust. I looked forward to seeing him then and long to see him since his death. I wonder about Mike’s choices, his pain, and now, his peace. Whether his was an intentional or accidental death is very much a question in my mind. That is what prompts my feelings of distress, guilt, and failure. I think Mike’s was a “bad” death, but I am still processing this conclusion.

I want to know more about “bad” death. What is it exactly? Are there certain key components? Is there more than one kind of bad death (other than those ending in “cide”) and most importantly, what makes us think that our definition is accurate? Might the dying person (should he or she be able to tell us) have another view? The above poem was my attempt to get to the heart of my feelings on the matter. I am still unpacking the event and its poetic record. I want to balance my bias with some of the genuine affection and self-definition that were clearly part of our encounters.

I had an investment in promoting Mike’s “good” death. It wasn’t apparent just how much investment until after the fact. I hold out hope for and try to promote the best deaths that my patients and their circumstances allow. This is hardly unique; what’s more most of us have thought about what constitutes a “good” death. One of my colleagues speaks of a dying whereby a person leaves this world “at peace and in love.”[1] Hospice stresses the engagement of “the four things that matter most”[2] or a patient’s display of “final gifts”[3] as indicators of a better death. Recently I heard an artist who creates portraits of the dying refer to death as “the final healing.”[4] I like that. I hope I can muster such self-perception as I take my last breaths. But what constitutes a good death isn’t what interests me just now.

I’d be interested in hearing from my professional colleagues about their take on a so-called “bad”death. I’d like to put the following questions to PlainViews readers: If you have witnessed a “bad” death what did it look like and how did it leave you feeling? How clear are you in your distinctions of “bad” and “good” deaths? What are your projections and judgments, be they doctrinal, cultural or political? I look forward to your feedback as is convenient and HIPPA appropriate.


[1] This phrase is courtesy of my friend and colleague, Tim Ledbetter, D. Min, BCC.

[2] Byock, Ira, The Four Things that Matter Most, proposes four areas of engagement between a patient and her/his loved ones that might ensure a good death: forgiveness (I forgive you, do you forgive me?), gratitude (thank you), affection (I love you) and farewell (good-bye)

[3] Callahan, Maggie and Kelley, Patricia, Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying, suggests that a host of psychological, physical and metaphysical traits are exhibited by terminally ill patients in the weeks and days preceding death. While neither “good” or “bad” in nature these traits together constitute a “near death awareness,” (NDA) and perhaps a more predictable, less frightening death. (see

Rev. Kirk M. Ruehl, BCC, is a chaplain with Hospice at the Chaplaincy in Kennewick, WA, where he has served for five years. Prior to this he was a chaplain at Deaconess Medical Center in Spokane, WA; Seamen's Church Institute in Port Newark, NJ and Eger Health Care Center in Staten Island, NY. He has a wife and two boys, enjoys poetry and hiking around the Northwest with the Boy Scouts.

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