Medicine and the Virtue of Hope

Romans 8:28-39

 

            My mom died three years ago.  It happened rather suddenly, although without surprise. She had CDOP, a cardio-pulmonary disease that weakened her significantly. At the end of her life, my mom struggled to get from the bedroom through the living room to the kitchen.  She would rest in the living room on the way to the kitchen. Still, some folks live for decades with CDOP, and my mom had it only for five years or so. 

 

            As I said, the end came suddenly. On a Friday night as she lay down for bed, my mom turned to my dad and said, “Barrie, I don’t feel well,” and then she collapsed on the floor.  My dad called 911, and the paramedics rushed her to the hospital.  I believe she was gone before she hit the floor, but with medical technology being what it is the medics and then the doctors at the hospital were able to keep her body alive through a ventilator for the lungs and medication for the heart.  I was the last of my siblings to get word of mom’s condition, so it was not until Sunday afternoon that I arrived in Florida to be with my mom and help my dad, my brothers and my sister find the compassion to remove her from medication, to find the courage to let her die.

 

*****

 

            We live in a death obsessed culture, which is ironic for we are also a death avoidant culture.  Many within our culture would rather not confront the reality of our own deaths.  We may make jokes about “death and taxes” being the only two certainties in our world, but most people don’t want to talk about it beyond that.  As a pastor, I am stunned by how few families have any idea what their loved one’s wishes are for their loved one’s funeral.  “Dad” may have had serious heart disease for several years and, at 85, surely the family knew the end would come eventually.  But no discussions ever took place about dad’s impending death. I am stunned by how few families discuss these matters, but even more I am saddened. Too seldom do we take the opportunity to express our love to one another, to say the things that need to be said, to say the things we wish we had said but regret not saying.

 

In our death obsessed, death avoidant culture we encounter two extremes regarding end of life issues. One extreme is the desire to play God by artificially limiting life; Dr. Kevorkian represents this path. Now let me say that I have a fair bit of empathy for Dr. Kevorkian’s goals.  It makes sense to me that we would want to offer people an escape from chronic, debilitating pain and suffering; compassion almost demands that we make such an offer. It makes sense to me that we would want to empower people to make their own informed medical decisions, especially when there is no hope for a physical recovery; such empowerment grants the patient dignity. Again, I empathize with Dr. Kevorkian’s goals: to empower people and relieve suffering are worthy aspirations; however, I cannot accept Dr. Kevorkian’s methods with which he seeks to achieve these goals. The prohibition against murder is absolute; we shall not play God.

 

There is a distinction, however, between using medications to create death versus withdrawing medical care to allow death to come as nature would have it come. In my pastoral ministry I have seen hundreds of examples – not a few, not dozens, hundreds – in which a patient’s suffering was prolonged through various surgeries and medications. One only need go to any nursing home in the country to see people who have lived well past the place where biology and dignity embrace.  How is it that one can justify giving an Alzheimer’s patient with advanced osteoporosis heart medications?  There comes a time when a patient has a right to die according to nature rather than be kept alive artificially through advanced prescriptions.  We recognize this right in extreme cases such as advanced stages of cancer, but such a right should be extended to other, lesser medical situations.

 

The distinction between creating death versus allowing death leads us toward the other extreme position encountered in our death obsessed, death avoidant culture. The other extreme is also a desire to play God, but this time through prolonging life: doctors of the pre-hospice movement medical culture represent this path. Many doctors are narrowly focused solely on saving a patient’s life.  Such a statement may sound strange; after all, saving lives is a doctor’s job, right?  I would argue, however, that saving lives is what doctors often do; their job, however is the same as it is for everyone else: to be fully and truly human.  As fully and truly human beings, the best doctors understand “there is a time to live and a time to die” (Ecclesiastes 3:2).

 

My grandfather-in-law, Tony, was told four years ago, at the age of 86, that he needed heart bypass surgery.  Some members of the family were dismayed by his refusal to walk that path. I personally supported his right to make the decision about his own health as well as the rightness of his decision. For Tony, cracking open his ribs and enduring the difficult, painful recovery from heart bypass surgery was taking medicine too far. Today, at 90, Grandpa Tony is lucid and a bit frail but still his talkative self.

 

Contrast Tony’s situation with a woman in one of my former churches who at 90 had a pacemaker implanted at the insistence of her daughter.  The woman was frail before the surgery, and the doctor insisted that it would perk her up.  The daughter, with full love and the best of intentions, desired for her mother to have more energy and vitality and so pressured her into having the surgery.  What neither the doctor nor the daughter looked at was the total life situation of the patient: a woman of declining health, alone in an assisted care facility, her spouse of over fifty years having died several years before, yet also a woman of deep faith and abiding hope in eternal life. She was ready to go when it was “her time.”  The surgery happened, her heart arrhythmias diminished, but the recovery required too much energy for her frail, old body.  The woman spent the next year of her life sleeping 14-18 hours a day, until she finally passed from this life into the next to meet her Creator and be reunited with her beloved. 

 

Soldiers teach us that there are some things more valuable than life: duty, honor and freedom to name three.  I would add to this list: dignity.  In the pursuit of saving the patient at all costs we are in danger of losing our Christian identity by forgetting our ultimate hope.

*****

 

The Heidelberg Catechism, the most beautiful of all Reformation era confessions, asks the question, “What is your only comfort in life and in death?”  And the answer is given: “That I belong – body and soul, in life and in death – not to myself but to my faithful Savior, Jesus Christ.” “A Brief Confession of Faith,” which was written at the time of reunion between the northern and southern Presbyterian churches following the Civil War, or in other words in 1983, echoes this phrase from the Heidelberg Catechism, although I wish they had added an extra phrase: “In life and in death and in life beyond death, we belong to God.” Either way, the truth remains that our belonging to God stands as the foundation for all our thinking, believing, acting and hoping in the face of the onslaught of modern medicine and the vagaries of human life. We do not control our own destinies, nor are we controlled by doctors and their desire to save at all costs.  Rather we belong to a God whose ways at times appear mysterious but whose purposes are always for the good.

 

In Romans 8, the most beautiful of all of Paul’s writings, we learn important lessons for how we as Christians may live out our faith in today’s world. In Romans 8:28 Paul teaches that “In all things, God is at work for the good of those who love him, who have been called according to his purpose.” This verse does not mean, as some have mistakenly argued, that all things are good.  No!  The death of a child is never good.  Getting cancer is not good.  No amount of casuistry can make a valid argument otherwise; some situations are bad, pure and simple.  But even in the midst of bad situations, the death of a child or the on set of cancer, God is present; God is at work; God is bringing his loving, redeeming grace into our lives. No situation is beyond the reach of God’s providence.

 

Four years ago I woke up in the ICU from being in a coma for ten days. My fist thought was that I had what I considered to be a fire hose down my throat and a garden hose up my nose, although in truth they were not nearly that large.  I looked around at my room in ICU and recognized immediately where I was, for I had visited many patients in ICU units at various hospitals.  I realized where I was but was surprised because I had gone into the hospital with what I thought was the flu and don’t remember going to the ICU.  I do remember my reaction upon waking up, however: “Hmmp, this is a bit excessive for the flu!”  It was not a good situation, but God was present.

 

The night the doctor took me off the ventilator was a most miserable night.  My lungs were weak from having the ventilator breathe for them, and I felt as if I could not get any air. It was late, so all visitors had gone home, and dark, so I could sleep; I felt alone.  Alone and I could not breathe.  I became very anxious without breath and cried out in prayer, “God, help me!”  And I heard a voice in the back of my head say, “Breathe….”  So I relaxed myself and allowed myself to breathe.  “Okay,” I prayed again, “what next?”  And the voice told me, “Breathe again.”  And as I breathed a second time, I drifted off to sleep.  When I awoke in the morning my lungs were strong enough to breathe on their own without difficulty, without anxiety.  It was not a good situation, but God was present.

 

As we continue in Romans 8 we hear Paul ask the question, “If God is for us, who shall be against us” (Romans 8:31)?  This question is, of course, rhetorical, for no one can be against us if God is for us.  We may doubt this at times, for it often seems as if there is much against us: illness and death ranking near the top of the list of foes.  Yet we must recognize that no ultimate harm ever comes to those whom God has chosen, that even when we do not receive a cure God always provides healing.

 

The first funeral at which I participated as a pastor was for a 60 year old man in our church in San Antonio.  At the time (I was 25) I thought to myself, “At least he lived a good, long life.”  As I have aged I have adjusted my definition of a “good, long life.”  In any case, this gentleman died after a long battle with cancer.  Near the end, the gentleman lingered for quite a while in a state very close to death.  I wondered out loud to my colleague, Duncan, what was keeping our parishioner alive, and, by the way, why didn’t God answer our constant prayers for healing.  Duncan, with 40 years of pastoral experience, suggested that our parishioner was waiting for his family to come to a place of peace and acceptance.  After several heart wrenching days on the brink, the man’s wife was finally able to say to her beloved, “It’s okay to go.  I’ll be fine.”  Her husband died within twenty minutes.  I submit to you that God’s healing, although not a cure, was granted, for both the patient and the family knew God’s peace in life and in death and, presumably, in life beyond death.

 

Paul continues his teaching by reminding us that we are those “whom God has chosen” (Romans 8:34).  One of the reasons I remain a Calvinist is this sense that our salvation does not depend upon what we do but upon what God has done already.  It brings me great comfort to believe that God knew us before the beginning of time and will hold us until after the end of all things, that the God who knew us also claimed us as his own and called us to himself.  God, who claims and calls, will not abandon us to our devices; we are not on our own as we face the great challenge of illness and the greater mystery of death.

 

I recall being present in a nursing home when one of my parishioners in Brenham, Texas died.  The gentleman was in his late 80’s and of declining health, so there was no surprise in his death; indeed, his wife had been expecting death “sometime soon.”  My presence in the room was greatly appreciated by the wife; indeed, she told many, many other parishioners what a fine pastor I was, how I was right there when she needed me, and on and on.  Now I appreciated the compliments; ministers are never harmed when parishioners think of them as good, caring pastors. However, the truth of the matter is that the only reason I was at the nursing home that morning was because I had writer’s block and could not finish my sermon.  Yes, I had planned to visit the man at some point during the day, probably in the afternoon, but had changed my plans only because I was so frustrated in not being able to accomplish anything in the office.  I hope you know, as I know for certain, that my presence at that man’s death was not my doing but God’s.

 

 

Paul concludes his teaching in Romans 8 with the soaring heights that remind us “Neither death nor life…nor anything else in all creation can separate us from the love of God found in Christ Jesus our Lord” (Romans 8:38-39).  How can this be? Why is this true? Is this a truth we can trust? Yes, I believe it is a truth we can trust, for we are not our own: in life and in death and in life beyond death, we belong not to ourselves but our faithful savior, Jesus Christ.

 

Louise was an early ninety-something (she never would divulge her age!), young at heart even as she became more aged in outward form.  My earliest memory of Louise was as an upper eighty-something on the carpet in our fellowship hall playing with my toddler son as he climbed all over her. Louise had no children and her only family was her “Little Brother,” who was five years her junior.  “Little Brother” was something of a playboy who had never truly settled down.  Church was not his thing; he was having too much fun chasing the ladies, even well into his retirement. 

 

When Little Brother was diagnosed with cancer, it was a blow to Louise.  She was concerned about her brother’s health but even more about his salvation.  She ordered him to move in with her so that she could take care of him, although Louise could barely care for herself.  Together they made quite a pair. Slowly, gradually, a miracle happened in that household.  No, Little Brother was not cured, but he came to understand his sister in ways he had never been able to see before, to appreciate the subtle but unbending strength of her faith.  And in his moment of need Little Brother gave his life to Jesus.

 

I was not present the morning of his death, for the moment was too sacred to be intruded upon by a pastor, but Louise shared with me the story.  Louise and Little Brother were on his bed together, Louise sitting on the edge while Little Brother lay prone.  They were talking about the day when Little Brother looked away from Louise to something in the ceiling.  Louise followed his gaze but saw nothing herself.  “What is it, Little Brother,” she asked?  Little Brother turned to Louise and said, “It’s the angels, my dear Louise, they are coming to take me to Jesus.”  And then he laid his head on his pillow and passed into the life beyond death.

 

This is a rare, extraordinary story.  Death almost never happens this way.  I say almost, for such stories, although uncommon, are known.  Of course the psychologist in me wonders why death happens this way for some but not for others, and the answer is that I do not know.  As a pastor, I suspect that God, according to his gentle grace, knowing the delicate nature of Little Brother’ faith and the fierce concern of Louise’s love for him, granted to them both this glimpse beyond the veil, beyond the mystery, into the lightness of dawn’s new life, in order to reassure them both that “Neither death nor life…nor anything else in all creation can separate us from the love of God found in Christ Jesus our Lord.”

 

*****

 

            Some people have asked me about my mom: is my mom in heaven?  The Bible scholar in me says, “Probably not.” The theologian in me says, “Possibly.” The son in me says, “Trust in God’s love.” 

 

Ultimately it is not up to me: thank God!  Ultimately it is up to Jesus to say where my mom lives in life beyond death.  And the Son says, “Trust in God’s love.  Trust in my Father’s love. For your own life.  For the lives of all whom you hold beloved.  For the lives of all whom he has created.”

 

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future nor any powers, neither height nor depth nor anything else in all creation can separate us from the love of God that is found in Christ Jesus our Lord.