A Response to "Please, Please, Let Me Die..."

Friends:

The following post is from a forthcoming article for publication. In it, a member of my congregation (and good friend) Dr. Jim deMaine discusses a situation where he had to make a call for a patient he cared deeply about, and wonders about its implications. You can find the full story on his blog, "End of Life" by clicking in the title. Otherwise, go here - http://www.endoflifeblog.com/

I was given the opportunity to respond with some additional spiritual reflections, hopefully providing a sense of comfort and trust in the eternity of God's care for our lives (in this world and the next).

Following are the articles.

Blessings,
Ethan

"Please, Please Let Me Die..."
By: Jim deMaine, MD

Erik's wife had warned him many times, "Stay off ladders dear, leave it to someone younger." Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn't about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik laid the ladder against the house. He knew that there were both maple and oak leaves in the gutters and that it shouldn't be hard to clean them out. After securing the footing of the ladder and donning rubber gloves he set about tossing the matted leaves toward a yard recycling bin two stories below.

That's about the last thing he remembered other than the crushing chest pain like a mighty force squeezing the life from him. After that it was a daze. He struggled with the restraints, felt like he must pull the tube from his throat, and vaguely recalled Kafka's "Metamorphosis". He was Gregor Samsa awakening as a giant inset trapped lying on his back, struggling with his new existence. Was this real?

Erik's wife, Gerta, had found him unconscious at the foot of the ladder barely breathing. The Medics arrived within two minutes, found Erik to be in ventricular fibrillation and applied CPR, then shocked the heart back into normal rhythm. Circulation returned and Erik's color "pinked up." The medics though were aware of the fall, strapped him safely to a gurney, and rushed him to the trauma center.

Erik woke feeling no pain. In fact he couldn't feel anything. He tried to move his arms and legs, but nothing happened. He saw he Gerta crying at the bedside. All this added to both confusion and anxiety. He still couldn't believe his metamorphosis into a helpless being and wanted to get some answers.

The MRI scan showed that in the fall he had severed his cervical spine at the C1 level. It was explained to him that he was quadriplegic and would likely need to stay on a breathing machine indefinitely. This explanation was gentle at first with some hope attached with a "wait and see" attitude. There was no brain damage because CPR was begun successfully within a few minutes and the heart restarted without delay. It was the fall. Gerta was right, "Why didn't I listen?"

The transition from the ICU to rehabilitation care was gradual. A tracheotomy was done and an intensive program started to get Erik as mobile as possible. Gerta and Erik had been highly successful entrepreneurs in high tech and knew not only how to get things done, but also had the resources to get the best.

A specially equipped wheel chair had a battery powered ventilator to support Erik's breathing. A specially designed breathing tube allowed him to talk in a stutter step way, but it was a big step toward some communication and independence. The electric wheelchair could be controlled by Erik's puffs of air so he became mobile. Gerta had the house remodeled so he could navigate throughout the main floor, out the door, onto a ramp, and go down by the swimming pool (now barricaded)and back. Gerta was expending a huge amount of energy. She wanted Erik to be alive and as happy as possible.

Erik mechanically went though the rehabilitation and body care with some wonderment but progressive discouragement. He hated the daily body massages to prevent sores, tone his muscles, and to try to get his bowels to move. He required a urinary catheter and periodic enemas to handle bodily functions. This was all somewhat tolerable until he began to have recurrent pneumonia. Each time this happened, he would be struggling to breathe and required suctioning from his trachea since he couldn't cough effectively. The first year there were five trips to the ER, two requiring a hospital stay.

In the second year, Erik was having worsening pneumonia with more difficult bacteria and was struggling both physically and emotionally. He let me know that he wanted to talk. Gerta was there when Erik clearly said, "I don't think it's worth it."

Gerta, shocked, said "Erik, you can't mean that. There's so much more that can be done and I can't think of living without you."

Erik backed off, but got me alone one time later. "Look doctor, enough's enough. This isn't living. Do I have to go on this way?"

I asked, "Erik are you down? Are you depressed?"

With more than a touch of scorn, "Wouldn't you be?"

I did have my favorite very practical psychiatrist friend see Erik for assessment. He found that Erik was not clinically depressed and was thinking clearly. He wasn't suicidal per se, but just saw no future in going on.

I asked Erik why he might not want to go on. He said, "First, I'm no longer functioning as a man. I have no chance of recovering. I'm worsening and am a burden to my wife. I'm serious, I should have the right to decide when enough's enough."

Gerta was distraught to hear all of this and pushed Erik to go on. In the third year following the accident, Erik had another severe bout of pneumonia and was in the ICU. We met with Gerta who was struggling, "I just don't want to lose him. He means everything to me."

The social worker spent hours supporting Gerta. Somehow slowly she was able to find the strength to support Erik, "He's been suffering so much and it's so hard to see him that way and to try to make him go on."

At the bedside in the ICU, Erik made it very clear, "I'm ready to meet my maker and finally be a peace."

With further conferencing with Gerta, the social worker, and the ICU nurses we sedated Erik with small doses and removed the ventilator. He died peacefully with Gerta at the bedside.

Comment: A case like Erik's continues to haunt me. Did I do the right thing? Didn't people like Steven Hawking live on ventilators? Didn't Christopher Reeves (Superman) struggle more than Erik before succumbing to a similar injury? Being a doctor at the bedside can thrust almost god-like powers in decision making. What's best? Is there a clear right or wrong? My own take is that there isn't a truly right or wrong answer. I felt my obligation was to support the patient's wishes and at times that means not continuing the artificial means of life support. There's a well known quote in medicine from Dr. Francis Peabody: "The secret in caring for the patient is to care for the patient."

EDM RESPONSE:

I was deeply moved by Erik and Gerta's story. Who wouldn't be? Two people that love each other, who want nothing more than to share life together, and who recognize in the depth of their commitment to one another a sense of spiritual purpose for their life. (At least that's what I got from their story). As finite people, we're left with so many questions when we read stories like this. For myself, a leading concern I've always had as a believer in God is: "If God is Love, how could Love allow this?" I don't intend to answer that question for anyone in this response. Enlightenment isn't transferrable. Its a function of each person developing their one to one relationship with God. However, the Heavenly Doctrine for the New Church does give me a profound framework that helps to ground and order my thinking about the eternal nature of God's guidance when temporal reality causes me to question it.

In thinking about this story, I was drawn again to one of the most specific references given in Spiritual Experiences for why people die when they do:

"The reasons why some die as boys and girls, some youths, some adults, some old men and women:

1st, on account of their use in the world to people;
2nd, on account of their use, while a person is in the world, to spirits and angels; for a person, as to his or her interiors, is with spirits and he or she is there as long as they are in the world, in which all things in the spiritual world terminate;
3rd, on account of use to themselves in the world, either that they may be regenerated (spiritually reborn), or that they may be let into their evils lest they lie dormant and afterwards break out, which would result in a person's eternal ruin;
4th, therefore, on account of use afterwards in the other life, after death, to eternity.

Everyone who will be in heaven has his or her place in the Grand Human, or, on the other hand, they have their place in hell: wherever forces fail they are balanced, and, of the Providence of the Lord, people are brought toward that place. So also, the kingdom of the Lord is cared for. The welfare of that kingdom is universal Providence." (Spiritual Experiences # 5003)

So we're given four reasons (all under the umbrella of universal Providence) for why people die when they do. Dr. deMaine usefully commented on the physician's sense of their limitations when "thrust into almost god-like" decision making. I liked the almost. Part of what this passage suggests to me is that although he sought to cooperate with God "as if of himself", the Lord had already foreseen and provided for the time and the means of Erik's transition. As his use in this world drew to a close, his use "to spirits and angels" could come into its fullness. That drew me also to this reflection:

'And God will be with you' means the Lord's Divine Providence. For as the Lord is with someone He leads them and makes provision so that all that happens, whether sad or joyful, may bring him or her what is good. This is Divine Providence. (Heavenly Secrets # 6303)

So believing in the orbit of Providence, by definition, suggests the need for belief in that which we cannot control (and only the Lord can) once we reach the limits of what we perceive as our own power. The irony is, even that which we perceive as our own power only exists because of the Lord's life flowing into us. When I think about things from a perspective like this, I feel I'm brought closer to that state of peace which is experienced by the angels:

Peace holds within itself trust in the Lord, the trust that He governs all things and provides all things, and that He leads towards an end that is good. When a person believes these things about Him they are at peace, since they fear nothing and no anxiety about things to come disturbs them. How far a person comes into this state depends on how far they achieve love to the Lord. (Heavenly Secrets # 8455)

So, any peace I experience in response to situations like this is directly proportionate to how much I love the Lord? I'm not suggesting our difficulty in processing events like this is a shortcoming (or a threat to our spiritual life), but more of an opportunity. An opportunity to recognize we don't need to "do the math" - to make it all make sense for our finite mind.

Jesus said: “You are truly my disciples if you remain faithful to my teachings. And you will know the truth, and the truth will set you free.” (John 8: 31-32)

Maybe we can trust... Perhaps that's as poignant (and uplifting) a thought as is this touching story...

Yours,
Ethan

Not "What Are The Words?" but "What Do They Mean?"

How does the New Church view what some consider the “end times” prophesies in the Bible?

In the New Church we see the Bible as a Divine Allegory. Just like Jesus taught in parables while in the world (stories that held a deeper meaning which would show people how to live), in the New Church we see the Bible itself as one continuous parable. Its important to realize that this doesn’t mean it’s not true, just that it has “layers of meaning” – like us. The outer layer is more literal or historical. A deeper (or more internal) layer reflects our own inner spiritual journey. It describes how we struggle. It describes our ability to overcome with God’s help. It shows us how we can grow through what we face. Just like the stories Jesus told, every story in the Word at its core is concerned with how to love God and how to treat our neighbor. When this becomes the anchor for our study of the Word, the question changes. Instead of just saying: “What are the words?” we start to say, “What does this mean for my life?”

We start to see the whole Bible as a love story, written by God for His Children. Prophesies that seemed at first to talk only about the end of the world (the appearance) start to look more like they’re speaking to us when we’re “at the end of our rope” spiritually (the reality). We start to say: “Yes, I’ve felt like it’s the end of the world!” We think of times when we have little or no love or faith in our hearts, and how the Lord can reach even into the darkest places in our souls and open our eyes to see His presence with us and His work in the lives of all those around us.

This is when our perspective on the Bible starts to be transformed - as we grow spiritually and our awareness develops. But it doesn’t happen overnight. It’s a lifetime of that kind of work that allows us to move from purely natural sight to spiritual insight. An important prayer when we begin again in our study of the Bible becomes: “Lord, open my eyes so that I can see what you’re trying to tell me about my life today.”

Then He can show us that “in itself the Word is nothing but teachings about love to the Lord, and of charity toward the neighbor.” (Heavenly Secrets # 7262)

Who are the 144,000 in Revelation?

Some have taken this statement literally, meaning that only 144,000 people will make it to heaven. Thinking from the principle that the Bible is a Divine Allegory, this wouldn’t make sense, would it? If God is love, then love by definition has to share itself. It can’t keep itself to itself! And only 144,000 people doesn’t seem like all the Love our Creator is capable of, does it? If we run on the assumption that everything we read in the Word is at some level about how to love God and treat our neighbor, we need to think about how that would be possible. What if the numbers in the Word too are also allegorical? What if they mean something about my state of love and faith?

And I heard the number of those who were sealed, one hundred and forty-four thousand. (Rev. 7:4) This symbolizes all people who acknowledge the Lord God of heaven and earth and are governed by teachings about the goodness of love, received from God through the Word.
These are symbolized by the number 144,000 from the twelve tribes of Israel because the twelve tribes of Israel symbolize a church made up of people who possess all love and truth from God. …The number 144,000 means all of those people. For that number has the same symbolism as the number twelve, since it is the product of twelve times twelve, which is then multiplied by 1000; and any number multiplied by itself and then by 10, 100, or 1000, has the same symbolism as the original number. (Apocalypse Revealed # 348)

Ah…so there’s a spiritual numerology to the Word? Again, think about how that transforms our reading of it! The 7 Days of Creation become seven stages we go through in our spiritual development, until we reach the Sabbath (so “7” means “a heavenly state of being”). The 12 disciples mean our possessing “all things of love and faith” from God (just like the “12 tribes of Israel”, right?) As you start reading the Word through this lens of spiritual meaning, the stories literally come alive with application to your state of being.


How would you explain Psalm 137 to people?

O Babylon, you will be destroyed. Happy is the one who pays you back for what you have done to us. Happy is the one who takes your babies and smashes them against the rocks! (Psalm 137: 8-9)

As a father, this one always gets me. How could anyone literally believe that a loving God would advocate hurting innocent babies under any circumstance? Clearly there has to be something else going on here! We know that Israel suffered captivity under the Babylonians, and if we’ve just established that the 12 tribes of Israel mean something so good, Babylon can’t have an equally good representation, can it? If Babylon captured “all things of love and faith”, then the church would be destroyed, right?

Check this out – from a verse by verse “break down” of what’s being described:
7-9 “Those who have devastated the church will perish (spiritually).”
(Prophets and Psalms 387)

Wow! That’s a very different meaning. All of the innocence and love that’s possible for our lives could perish if we’re unwilling to take the guidance offered us in God’s Word? That makes sense!

A New Kind of Sight...

May your reading of the Word be illuminated by this kind of willingness to “look below the surface” for meaning. If we believe the Bible is God talking to us, why wouldn’t we do this? We should do the same thing with the other people in our lives. Imagine how conversations would go with your friends, family, or co-workers if you asked a different question. Not “what are the words?” but “what do they mean?”