This is Part 2 of a series about Michael, who was 60 years old when he enrolled in hospice services with end-stage cirrhosis of the liver. In Part 1, we learned about how “… dying puts things in perspective,” and about the importance of telling others how we feel “in the living years,” before it’s too late.
Michael and I discovered that we knew many of the same people. I played high school football with and against several guys that Michael knew and worked with. Michael was a West “sider,” an archrival of my alma mater, New Boston, back in the day. Michael and I enjoyed talking about “the Glory Days,” and we drew close as we talked about the glory to come (Psalm 73: 23-26). But life on this earth wasn’t very glorious for Michael at the time.
When Michael enrolled in hospice, he wanted to be a “full code.” If his heart stopped beating or he stopped breathing, he wanted to be resuscitated. He told me, “I’m not giving up; I’m still going to fight this.” In my 24 years as a hospice social worker, I’ve realized that there’s a fine line between “giving up” and “wearing out,” and Michael’s body was wearing out.
Michael’s abdomen filled with fluid because of his liver failure, a condition called ascites. It made it difficult for Michael to breathe, eat and move. Therefore, Michael’s stomach was tapped, a surgical procedure called a paracentesis. The fluid was drained off to make him more comfortable, but it didn’t remedy the problem. And, unfortunately, like most “procedures,” there can be harmful side effects. It can leave you weaker and can trigger more rapid re-buildup of fluid in the abdomen, which for Michael, it did.
As Michael’s body continued to wear out, his abdomen refilled with fluid, and Michael found himself “between a rock and a hard place.” Should he have his stomach tapped again; should he have a “Denver Shunt” implanted to divert the fluid into his blood stream? Michael was paralyzed by indecision, therefore, Michael was admitted to the Hospice Inpatient Center and a family meeting called. Michael, a brother, a sister and the assigned hospice team members were present as Chelsey, Michael’s attending physician, informed Michael of his options. She explained, “Tapping your stomach again or inserting the Denver Shunt are both procedures and the surgery itself might make you even weaker than you are now. And you might not even live through it.” I’ll never forget what Chelsey told Michael next. Chelsey hesitated for a moment and then compassionately explained, “Michael, I don’t mean to squash your hope, but you need to find a different kind of hope. You need to refocus.” Something clicked in Michael’s heart and mind. He looked up at me and asked, “Will you come back over and help me fill out a living will?” Chelsey’s honesty put Michael out of his misery that day. After all, Jesus did say, “And you shall know the truth, and the truth shall make you free” (John 8:32).
I called Chelsey to ask her permission to quote her in this story, and we reflected on that “moment of truth.” Chelsey explained, “Michael was looking death in the face, and was trying to choose life, but life wasn’t an option. The choice that was before him was how he wanted to die. And I wanted to give him some control over that. If he chose to have the procedures, the quantity of life it would have given him, if any, would have been small. And it would have been at the sacrifice of quality.”
I’ve observed that life unfolds in progressive developmental stages with their corresponding tasks or challenges. When there is no going back to what used to be, we are presented with the question, “What else can I do?” We are challenged to refocus and to “find a different kind of hope,” to grieve the loss, reconstruct our lives and reinvest ourselves.
King David understood the importance of placing our ultimate hope in the right place. He wrote, “Why are you cast down, O my soul? And why are you disquieted within me? Hope in God; for I shall yet praise Him, the health of my countenance and my God.” (Psalm 42:11). He also wrote, “When I am overwhelmed, lead me to the Rock that is higher than I” (Psalm 61: 2). Sooner or later we will all find ourselves between “the rock and a hard place,” when physical life in no longer an option. Our final and ultimate developmental task will be to shift our focus from the temporal to the eternal, and our hope from the physical to the spiritual. In conclusion, I have to agree with Edward Mote, the author of “My Hope is built on Nothing Less” (1836).
“My hope is built on nothing less than Jesus’ blood and righteousness. I dare not trust the sweetest frame, but wholly lean on Jesus’ name. On Christ the solid Rock I stand, all other ground is sinking sand. All other ground is sinking sand.”
Loren Hardin is a hospice social worker at Southern Ohio Medical Center, and can be reached at firstname.lastname@example.org or at 740-356-2525