Longing to Live

Life doesn’t last forever. But our quest to extend it has raised some vital questions—and obscured some others.

The pain is killing his wife, and John is knotted up with grief over it.

“One of the greatest difficulties of any human being I think is to watch another who you love suffer,” he says.

His wife isn’t sick. John is the one with cancer. He’s the one with constricted breathing, erratic sleep, diarrhea, nausea, exhaustion. He’s the one in pain. Incessant, almost incomprehensible pain. He takes just enough medication to manage the misery without befogging his mind or building his body’s resistance to the treatment more than necessary.

But all the while, his wife is right there waiting on him, feeding him, cleaning him, praying with him, weeping with him. As strong and as loyal as she is, John can see the suffering consuming her life along with his own.

“In some ways this absolutely rips and tears at the very chords of your marriage,” John says. “The marriage is a team. When one is sick, you have more trials—and only half the team. It devastates you.”

The questions and trials surrounding dying and death are among the most excruciating that human beings face. For both the victims and their families.

“Nobody wants to die. And nobody wants to die badly,” says Judith Nelson.

Nelson has wrestled death firsthand like few people. She specializes in end-of-life care. A doctor in the intensive care unit of one of America’s most highly regarded hospitals, she regularly serves people on the edge of life, grappling with the unknown beyond.

Nelson recently appeared in a heart-rending Frontline episode called “Facing Death,” about doctors and families at New York City’s Mount Sinai Medical Center struggling with the raw, painful decisions involved in treating terminal patients.

How much have you thought about it? There is something remarkable, even noble, in this near-universal quality among people and all living things. We want to preserve the spark of life we possess.

Inhabiting perishable bodies, living in an ephemeral world, we pretend life is permanent. Then, rude reality intrudes. Our bodies age and fail. Our friends pass away. Our families suffer loss. And still we are loath to face it. Even in intensive care, where it hangs in the air, the words die,dying and death are almost never uttered.

Dr. Nelson’s profession peddles hope. To patients stricken with fatal conditions, it offers an ever growing menu of treatments. A chance of escaping the inescapable.

At the same time, it also creates some gut-wrenching conundrums, and raises questions that are deeply important for each one of us to consider.

A “Fiction” in Modern Medicine

Medicinal and therapeutic innovation expands the decision-making capacity and responsibility for people facing death. “[T]here’s almost always something else that we can do to put off the inevitable—another course of chemotherapy, a little bit more radiation,” says David Muller, dean of medical education at the Mount Sinai School of Medicine. “What if we got one more cat scan? What if we explored this person’s belly one more time? There’s always the nagging concern in the back of your mind, ‘Have I really left no stone unturned?’”

In addition to the treatments available, machinery makes it possible to keep a body’s vital functions operating—heart beating, blood flowing, lungs pumping—almost indefinitely.

The gritty drive to use any means necessary to preserve life is understandable—some would even say heroic. But these advancements also have a downside. While offering promise to sick patients, the range of possible treatments also creates a formidable set of expectations for modern medicine to live up to. And in most cases, it is simply not equal to the task.

“[T]he availability of the therapies has created this fiction that we can orchestrate this one way or the other, when the truth of it is that, for all of this magnificent technology, the underlying illness and the medical condition of the patient are far and away the most important factors in determining the outcome,” Dr. Nelson says. “But it feels like, when you have the technology available, that your decisions to use or not use it are like the decisions to allow life or not allow life. And that’s not a position that any of us want to be in.”

This moral dilemma is a striking by-product of contemporary health care. Nobody wants to die. Death is an intimidating enemy; it has never been easy to confront. But accepting the reality of a body succumbing to a fatal disease becomes more difficult when accompanied by the notion—however false—that it was a choice. I choose death. Do not resuscitate.

Given that choice, fewer and fewer take it. Per person, Americans spend more on health care than any other people worldwide; the bill totaled $2.5 trillion in 2009. More Americans now die in hospitals than anywhere else, often after significant medical intervention. According to Dr. Nelson, there are about 100,000 critical patients on artificial respirators at any given moment in America. Their treatments generate a bill of $20 billion to $25 billion per year. But there is another, more intangible cost.

“[T]hese are the broken survivors of intensive care,” Nelson says. “And the better intensive care gets, the more of these broken survivors we have.”

“We Have His Body”

One of these broken survivors is Ryan. He is 21 years old and has been in an “eyes-open coma” for over a year after receiving a horrendous beating. He must be fed through a tube attached to his stomach. He has received nine surgeries, and his heart stopped beating at least twice. Doctors estimate he has a 10 to 20 percent chance of waking up, probably into “basic consciousness, closer to being an infant than an adult.” A year of Ryan’s medical care costs half a million dollars.

Ryan is tended to around the clock by his father. Ken quit his job so he could remain with his son, brushing his teeth, bathing him, administering his medications (50 of them), changing his catheter, stretching his limbs.

Concerned family and friends have formed a prayer group for Ryan. But Ken no longer believes in prayer. “What kind of God would allow this to happen?” he asks. “What kind of God wouldn’t correct it?”

A Washington Post article about these two shattered lives quotes Ken testifying at a court hearing for Austin, the 19-year-old boy who kicked his son in the head in a parking lot fight and is now serving time for malicious assault. “My fantasy is to have two minutes in a locked room with a baseball bat,” Ken says ominously. Austin, he promises, “won’t come out in any worse condition than my son.”

Then he relays a bitter fact: that, though losing a child is said to be life’s worst experience, this is worse. “We have his body,” he says, “but we don’t have his mind” (Dec. 2, 2010).

Ken and his family ask themselves whether it would have been better for Ryan if he had died the night he was beaten. You may think you know the answer. But had it been your son, and had you been offered the hope—however slim—that with the right treatment, he could still have a future, would you have decided differently?

Putting Off the Big Questions

At the heart of the issue is a painful paradox.

Doctors are applying the utmost of their intellectual and creative powers to pursue the fundamentally benevolent goal of giving individuals a valuable, albeit fleeting gift: more years of precious life. More years to deepen relationships, to create memories, to share wisdom, to dare exploits, to fulfill dreams.

At the same time, they recognize that it is impossible to indefinitely defy human mortality. They have no power to heal. And in many cases, their treatments actually harm patients, diminishing quality of life and hastening death. Thus they, along with patients and their families, confront agonizing choices about how much therapy to administer, treading uncertain ground, guided by probabilities and feelings.

“There’s no question that the technology has saved, in a meaningful way, hundreds of thousands, if not millions of lives,” Dr. Muller says. By “lives,” of course, he is referring to years, since the most successful treatment can only put off the date of one’s death. He continues, “But with those advances and all of that progress comes an ultimate tradeoff. And the toll is sometimes devastating on the patients themselves, on their family, their loved ones, and on the health care system.”

Three in four Americans say they believe in life after death. But just what that might be remains shrouded in mystery for most people. They simply have never closely examined the subject. Maybe they’re afraid to.

Modern medical advances have clearly given years—of varying degrees of quality—to many people. At the same time, these advances have enabled us to put off the fundamental questions that our mortality raises. With death looming, we become preoccupied with essentially material concerns—options, treatments, schedules, odds. For so many, the last days of life are spent not in peace, but in warfare, armed only with faith in the frail weapons of science. We pour what little life we have into fighting the enemy that will end it. And ultimately, that “rage against the dying of the light” always ends in defeat.

Modern medicine promises a kind of immortality. It suggests that our energies are best put toward employing every means to extend physical existence as long as possible. If we are not careful, this “fiction,” as Dr. Nelson termed it, can preempt the important spiritual concerns that should dominate our thinking, even our decision-making, as we contemplate the inescapability of death.

At Peace With Death

Harry has a tumor in his left lung. Nine months ago, doctors said he would live another six months to a year. He is gradually adapting to new inconveniences and discomforts: soreness that forces him to sleep only on his right side; a couple of hours each day sucking oxygen from a machine; upset stomach; numbness and unresponsiveness in his left foot.

Doctors have tried to sell him on getting radiation and chemotherapy treatments, but he has refused. “I’m 80 years old, and I didn’t want to spend all that time in the hospital,” he says with a smile. He has chosen instead to address his condition through a restricted diet, some simple natural treatments—and faith.

“I’ve placed it in God’s hands. Whether I live or die, He can control that,” Harry says. “I want to do everything I can that’s logical and makes sense to help myself, and leave the rest to Him.”

Harry wants to live. But he is frank, clear-headed and unafraid about death. “If God says it’s time to go, okay. I do feel I’m learning some lessons from this trial which are good for me—and I’m thankful for that.” He is focused less on his physical health than on his spiritual health.

John has taken the same approach, but the advanced state of his cancer makes it more difficult. “I wish I would have known how fatiguing this would be,” he says, “so that I would have prepared myself spiritually more for it in advance.”

Even with faith in God, facing death can be exceedingly difficult, particularly when ongoing pain is involved. “It drives you beyond what you think you can possibly stand, in every way—mentally, physically, spiritually, emotionally, financially,” John says. “These things wreak havoc on your emotions, your motivation, your desire to live.”

Even Jesus Christ, who was perfect in faith, struggled mightily as He faced His own death, praying with penetrating emotion that He could avoid the suffering He faced (read Matthew 26:36-44 and Luke 22:41-44).

Still, though, there is a serenity that comes from saying, as Jesus did, “Nevertheless not my will, but thine, be done.”

And there is tremendous peace in recognizing and understanding the value of the spiritual over and above the physical. What, after all, is the real purpose for life? Using every possible means to stretch it for a few more years does nothing to answer that fundamental question.

And what happens after death?

Real Hope

“If in this lifeonly we have hope in Christ, we are of all men most miserable,” wrote the Apostle Paul.

This was a man who faced death with confidence. “For I am now ready to be offered, and the time of my departure is at hand,” he wrote. “I have fought a good fight, I have finished my course, I have kept the faith: Henceforth there is laid up for me a crown of righteousness, which the Lord, the righteous judge, shall give me at that day: and not to me only, but unto all them also that love his appearing.”

Paul longed to live, just as we all do. But what he alluded to was not an empty hope of extending his physical life—but the true hope expounded in Scripture.

It is a hope founded in understanding God’s wonderful purpose in creating man mortal, subjecting us to the trials of the flesh—an experience that, in order to fulfill that purpose, He even put His only begotten Son through (e.g. Hebrews 2:9).

Many people believe that men possess immortal souls, and that when they die, depending on their choices in life, they go to either heaven or hell. The Bible is clear, however, that souls are not immortal—they can die (e.g. Matthew 10:28; Ezekiel 18:4, 20; Romans 6:23). Scripture says that when we die, our “thoughts perish” and that “the dead know not anything” (Psalm 146:3-4; Ecclesiastes 9:5; see also Psalms 6:5; 115:17). Jesus Christ Himself said that “no man hath ascended up to heaven, but he that came down from heaven, even the Son of man which is in heaven” (John 3:13).

The true hope of Scripture is not about our possessing an “immortal soul,” or about the “miracles” of medical intervention. It is the promise of resurrection. It is the promise that, “as in Adam all die, even so in Christ shall all be made alive”—and that ultimately, “The last enemy that shall be destroyed is death” (1 Corinthians 15:22, 26). Human death means nothing to God except a temporary sleep (verses 51-55), because God can resurrect humans from the grave!

There is a reason—a wonderful, inspiring reason—that something within us clings to life. A reason we crave permanence, even as our physical existence passes like a shadow. We were, in fact, created to inherit eternity.

How much have you thought about it?