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Another intrusive death is rising in my life, and not just my own. He was a vigorous seventy-eight-year-old until last November. Then he experienced a fall, and another, and swiftly lost his motor skills. In the space of just a few weeks he quickly went from cane to walker to wheelchair to bed.

Doctors thought surgery on his neck arthritis would relieve some of the mobility problems. While he can move his head a bit more, it has done nothing for his legs. He is unable to turn himself or sit up on his own effort. Two months in bed will do that to a person. The nursing home where he was placed after surgery for rehab uses a device to lift him out of bed. Attendants position him over a wheelchair and then lower him into it.

He lost his ability to swallow and a feeding tube was implanted. More heart-rending, he lost his ability to speak, to form words, to communicate beyond thumbs up or thumbs down gestures, and grimaces, groans, and tears. He cannot say the rosary aloud. Once it marked his mornings and his evenings, bracketing his days with a comfort a Lutheran like me would not understand. His mind is slower, slowing, taking longer to process responses to questions, most of which center on his level of comfort. His frustration is sometimes obvious.

I have in my active parish ministry watched parishioners—and their families—go through trials of this sort, patience and hope dried to the breaking with one setback following another. Sometimes only the dulled sense of an imposed but necessary routine remains, one that is recognized as crucially important but finally pointless, the outcome clearly being death.

Were that not enough, exhausted from contending with the sheer spiritual and physical demands placed on the family of a loved one, death itself inevitably leaves a residue of guilt. One should joyfully care for the ailing family member, the burden of the work being the blessing it bears. Yet in the frailty of our humanity, occasional and altogether natural resentments arise. These regrets, I have learned, often linger stronger than any other feeling accompanying a twilight death. It is a potent mix, grief, relief, and regret all mingled together.

What has always struck me most is the loss of personhood. The patient becomes less than him or herself, an object about which decisions must be made. It is inevitable, I suppose. “Real” people have volition and will; they can decide and make choices and express their will. But when they become objects, it is we who make the choices. That happens at the beginning of life as well as at the end. Embryos chosen for their stem cells and the elderly leaning into death cannot do that, make choices. They become “other,” no longer of “us.”

Once I remarked on this to the patient herself, a woman locally renowned for a sharp, sarcastic wit. She had undergone amputation of a leg from circulatory troubles. In my judgment it was unnecessary surgery; administer ample pain medications, comfort, and let her go gentle. But surgeons, well, they have their wiles. She was prone, in bed, the family standing around discussing what to do now. I leaned down to her and said, “They all act like you’re not here.” “Nothing different about that,” she said. “They always act like that.” She died eight days following surgery.

These deaths are painful. I find them excruciating as a pastor. I hardly ever know what to say, what I would want said to me. I rely on a prayer book. It sometimes prevents me from saying stupid things.

I happened once upon a petition from an old, old version of the Great Litany: “From an unprepared and evil death, deliver us good Lord.” I suspect any notion of this has gone out of fashion, a “prepared” death. Most of us would no longer regard an “unprepared” death as evil. Most of us, my guess, would prefer a sudden, relatively painless death, altogether unexpected and unanticipated. Go to bed one night and wake up dead; hardly a problem.

One can avoid lot of troubles that way. We would not, it comes to me, burden our loved ones with pestering questions around the “end of life” choices they may confront. But it was exactly such choices the Great Litany seemingly demanded.

We may pray only as the psalm has it. “Teach us,” the psalmist begs, “to number our days aright, that we may gain a heart of wisdom.” And then, not unnaturally, the very next verse: “Relent, O Lord! How long will it be? Have compassion on your servants.”

Russell E. Saltzman is a dean in the North American Lutheran Church and assistant pastor of St. Matthew’s Church in Riverside, Missouri. His latest book, Speaking of the Dead, is being published this month by ALPB Books. His previous articles can be found here.

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