In the previous part of this article, we discussed some ways to find purpose and peace even, or especially, when one has come face to face with the end of life. In this second part, we will offer a few more suggestions of meaningful activities to pursue. As a conclusion, we will suggest a way to rethink our attitude towards the end of life.
Words that Matter
The “conversation on the deathbed” is perhaps the most clichéd of images when it comes to the end of life. It is, however, important and meaningful, and, as we have seen of other activities, it can be carried out effectively a long time before a person is actually at the end. The fact is that many of us are not good at talking about what is most valuable to us or sharing the feelings we really want to share. There is something about facing the end that gives us both the courage and the impetus to make sure that these things do not go unsaid.
Ira Byock is a palliative care doctor who speaks and writes frequently about the end of life. One of his most famous books is called The Four Things that Matter Most. In his telling, the four things that matter most are expressing gratitude, love, and forgiveness, and asking for forgiveness. We might add our own statements to this list, but what these have in common is that they are simple words that go straight to the heart – and to the heart of the matter. Because of this, they can be the hardest to say and the most meaningful to hear.
The conversations we have and the words we say and hear at the end of life always have a magnified impact, aside from the fact that it will be our last chance to say or hear them. Relationships can be healed or broken; memories can be shaped forever. We can say things we have always felt but had a difficult time expressing. In this case, simplest is best: Words that are straightforward have the most power.
We have all heard stories of people whose parent said “I’m proud of you” for the first time at the very end, and we have heard stories of people waiting for a reconciliation that never came. The nature of the end of life is such that people are often more amenable to being open and understanding. It might be foolish to imagine that we can simply erase a lifetime of difficulty just by asking for forgiveness. But it would also be foolish to underestimate what we can accomplish.
Changing Our Expectations: What Is Important?
What constitutes good quality of life? When we are healthy, we might have very definite ideas about what makes our lives productive. When we encounter someone who is mentally or physically infirm, we might decide that we could not imagine living that way. But the truth is that our definition of what brings us joy has a way of changing with our circumstances.
One patient who joined Seasons Hospice recently had fairly advanced dementia. When she was younger, she had been a vibrant, active, and witty personality; now, she had significant physical limitations and very little of her old personality left. In a conversation I had with her children, they agreed that their mother was a shell of her former self and that she would certainly not choose to live this way. I asked them to consider what she did still have in her life that brought her pleasure or joy: She was calm and pleasant with the people who took care of her; she enjoyed being fed food that she liked by her children; her face lit up when her grandchildren came to visit, even if she was not always sure who they were. Life changes, and our sense of its quality can change with it.
In the previous article, we wrote about the many possibilities that exist when the end of life gets closer. But it is also important to remember that the time comes when the most meaningful things we do are the simplest things. There is nothing as powerful as just being present, nothing as reassuring and supportive as giving someone the sense that he or she can rely on us to care for them and stay by their side. To mean the world to someone, we do not need to give all that we can give; we need to give all that they can receive.
A Perspective on Transition: An End and a Beginning
As a concluding thought to this series, I want to bring to light a new way of thinking about this inevitable part of life. As we have discussed over the course of this series, we value life and go to great lengths to value and preserve it. When someone passes away, the halacha mandates that we treat it as the irreplaceable loss that it is. Death was not part of Hashem’s original plan for mankind. But let us ask a more complex question: Should we be afraid of reaching the end?
One would assume intuitively that someone who works with people facing terminal illness would encounter a lot of fear. It is true that families of those who are ill are often fearful of what will come. But people who work in hospice report that the patients themselves are hardly ever afraid of leaving this world. Often, they have made their peace with their situation and have accepted what will come. Sometimes they are excited about the idea of reuniting with relatives who have passed on, and sometimes they are simply intrigued by the idea of going to the next world. I recall reading that when Rabbi Noach Weinberg, z”l, was diagnosed with what would turn out to be his final illness, a doctor spent some time with him discussing his condition and what he should expect. After their conversation, Rav Weinberg’s family asked how he had taken the news. The doctor paused before saying that Rav Weinberg had taken it with more than equanimity. “I think that your father is curious to find out what it’s like in the next world,” he told them.
There is a remarkable description of the way a tzadik leaves this world that is found in the introduction to the sefer Gesher Hachaim, written by Rav Yechiel Michel Tukachinsky. The sefer itself is a classic masterpiece about the end of life: It is both a halachic work, encapsulating the many laws of a funeral and mourning, and a profound work of hashkafa, exploring the Torah perspective on death and the World to Come. Rav Tukachinsky himself lived in Yerushalayim and was both the head of a school and a prolific talmid chacham, whose sefarim are masterfully researched and organized. Rav Tukachinsky passed away in 1955 at the age of 83.
In the introduction to the second edition of Gesher Hachaim, in a section entitled simply, “That Day,” Rav Tukachinsky’s son relates the gripping account of his father’s final day in this world. It is well worth reading in its entirety. What follows here are some excerpts:
In his final days...he would ask his doctor not to give him injections for pain if they would make him drowsy. As he would explain, it was better for him to suffer pain as long as he could remain awake during his last moments, so he could leave this world in a state of contemplation. … [On the day he passed away, he suddenly asked that the doctors leave the room.] He said, “My son, the time is here! It is ninety-nine percent! We do not need doctors anymore.” … When a friend started to tell him something that was happening in the world at large, he said, “Now, this does not interest me anymore...”…Several times, he said to me...pointing to a chair that was next to his bed, “My master and teacher R’ Shmuel, my master and teacher R’ Shmuel!” [referring to Rav Shmuel Salant, the rav of Yerushalayim, who was not alive but had apparently come to accompany him on his final journey.]
He asked for a cup of water. I wanted to feed it to him with a spoon because he had not been able to drink very much in the previous days. But my father strengthened himself, took the cup in both hands, asked for an extra pillow to support his head, said the bracha of Shehakol, drank the first half of the cup and then the second, to everyone’s astonishment, and made the bracha of Borei Nefashos. Then he asked for water and washed his hands, dried them and tied his belt, preparing for his journey....Without emotion, he said, “[Turn my] face towards the west.”…He suddenly held out his hands and held my two hands for a while as his lips moved silently.
[As his breathing grew weaker, we were unsure whether it was time to recite Viduy.] All of a sudden, he slowly took his hand out from under the blanket and started beating his chest, without any sign of emotion: Viduy... When he finished saying Viduy, he straightened his hand and continued speaking quietly…. At seven in the evening, on Wednesday night, the eighth of Nissan, my father’s soul left in purity.
He goes on to relate that his father would often quote the Zohar: What is death? A person takes off one garment and puts on another garment! It is a natural transition from life in this world to life in the next; it is not going away but traveling from one place to another.
Not all of us will merit the peace, holiness, and focus of Rav Tukachinsky. But all of us can take this lesson to heart.
We have spent much time in this series talking about thinking ahead: considering our wishes, writing down what is important to us, and leaving a legacy behind. One of the most important reasons we avoid tackling these tasks is simply that thinking about our own mortality is too frightening. In a certain sense, we have been conditioned to look the other way and postpone any thought of it until it has met us face to face.
What we should realize, instead, is that placing infinite value on every moment spent in this world is no contradiction to a positive outlook on our transition to the next world. Our role is to appreciate life in all its expressions, to treat it with sanctity and dignity, to seek the Torah’s guidance in valuing it properly, and to make it as meaningful and holy as we can. Man was created, Rashi says, with two existences in mind: one in this world and one in the next world. Putting ourselves in the hands of Hashem, the Source of all life, we can hope to live our lives to their fullest to the very end.
Rabbi Daniel Rose is the rabbi for Jewish Hospice Services for Seasons Hospice and Palliative Care. He is also the Assistant Rabbi at Congregation Bnai Jacob Shaarei Zion. All four articles in this series are available at www.wherewhatwhen.com.
] It should be noted that this is the exceptional request of a tzadik and should not to be taken as normative practice. As we have discussed, halacha considers it vitally important to control pain at all stages, and it is certainly permitted even when it will compromise other faculties.