CHAPTER 2

THE BRICK WALL

I WANT TO DELINEATE for you the boundary between the world of the living and the world of the dying. Through the discovery of the world of the dying, we discover the world of the living. Our primary goal is to discover the spiritual issues that emerge, so that the dying can die well and the living can live better.

How do I understand this world? My patients have been my teachers.

THE IMPORTANCE OF METAPHORS

Metaphors are powerful. They express in symbolic language the depth of raw feeling and emotions that cannot be directly expressed in words. I want to begin with a metaphor often used by patients who find out they have a terminal prognosis. The first time I heard a patient say, “When the doctor told me I had less than six months left to live, it felt like I hit a brick wall,” I didn’t hear it. The second time a patient said that to me, I heard it for the first time. And then I read this metaphor in a hospice nurse-practitioner’s master’s thesis on suffering. The interviewed patient said, “I can be having a good time and it comes slam, like a brick wall, that, well, you’re going to die.”1

I’d like us to look at this metaphor. It is this metaphor that separates us from our patients in the world of the dying.

This particular metaphor is not one you will find in the death and dying literature. So it’s not a metaphor that one dying person has read somewhere and is using. It comes from within—it comes from the experience. New experiences create a new language. New experiences create metaphors. And even though the metaphor is created, that doesn’t mean we who use the metaphor or have the experience know exactly what we mean by it.

For example, the first time you lost a significant person through breakup or death, you may have expressed your pain through the common metaphor “my heart is broken.” It’s a metaphor we use without knowing all the ramifications of what it means to live a broken heart. At the beginning I don’t know what it is to live a broken heart tomorrow, what it will look like a month or a year from now, or how it will transform me in the future. But I use the metaphor because it expresses the depths of a pain that cannot be expressed otherwise.

So when the dying say, “It felt like I hit a brick wall,” they are expressing in a metaphor a reality they have never experienced before and have no other words for. Why? Because they have no other language for what they have never experienced before they were dying. On the other hand, those of us who work with the dying have seen patterns emerge. What I offer you is what patients have taught me: what they have experienced, what I’ve observed over and over and over, and what makes their experience spiritual.

GETTING BENEATH THE METAPHOR

I want to get beneath the metaphor “the brick wall,” because the experience of hitting a brick wall is what separates us in the world of the living from them in the world of the dying. Yes, this is a politically incorrect construct, us and them. But in this world, the world of the dying, there really is a separation between us and them.

DENIAL: NOT YET

I toy with the audience when I present this material. I ask people to raise their hands if they believe that one day they will die. Everyone laughs as they raise their hands (if only to not look foolish). I preface my next question by requesting that people not be philosophical in answering, because of course we all know that we could die today by being struck by a car while crossing the street, and because we all know that we don’t know the future. Then I ask, “How many of you believe that you have at least five more years to live?” Regardless of age, nearly everyone raises their hands. In my experience, ninety-year-olds raise their hands. We know we will someday die—but not yet!

Someone inevitably asks, “But aren’t we all dying the moment we are born?” I try to guess what motivates the asking of this question. Is it a way to dismiss the us versus them by claiming dying as part of the continuity that takes us from birth to death? I counter that we learn in psychology many developmental theories, all espousing that from the moment we are born we are developing, not dying. The simple movement of time forward does not mean we are dying. All of life meets death, but from the moment we are born we are struggling to master developmental tasks. We are becoming, not dying. Death can come at any age, suddenly or forewarned. So, we are still left with our question. If our patients know they will one day die, why do they hit a brick wall? Why don’t they just say, “Oh yes, I have been dying all along anyway,” or “This is what I have been waiting for”?

I did a presentation on this topic for hospice volunteers. The day after my presentation the volunteers wanted to set up an information table about hospice care in the center of their mall, and they asked if I would accompany them. Well, you can imagine! The small kiosks in the center of the mall were filled with the usual products—cell phones, scarves, eyeglasses, stuffed animals, and the like. Hospice information seemed quite incompatible with this environment. It certainly was not the most likely place to give out this information. People started coming over to our table and asking what we were selling. A predictable pattern of response emerged. The first volunteer would say, “We are about palliative care.” The visitor would respond, “What’s that?” The next volunteer would say, “Hospice.” Again, the response was “What’s that?” Finally, another volunteer would say (in exasperation), “This is about death and dying.” Each person, unfailingly, upon hearing this trilogy of responses, would hold up their hands as if pushing something away and, while simultaneously chuckling and backing away from the table, repeat the words “Not yet!”

When I was a younger pastor, before my involvement with hospice, Hans, a seemingly healthy man in my congregation, telephoned in a panic and asked that I come to his house. When I arrived, Hans was visibly angry. His anger quickly mixed with tears as he spoke. He told me that he had just been diagnosed with a terminal illness. “Why me?” he roared, as if a great injustice had crashed in on him. At the time, I was 36. Hans was 93. I found myself carrying on an internal conversation while standing there listening to Hans. I saw myself shaking him by the shoulders, as if to wake him to his senses, and I heard myself say, Why me? You are ninety-three years old, for goodness’ sake! What do you expect—to live forever? Luckily, I didn’t utter a word; I managed a poker face. What I realize now is that if I had asked Hans that question, he would have responded, “No—but not yet!” When someone asks the question, “Why me?” it is not a question we are expected to have an answer to. Rather, it is a crying out from within: I thought I had at least five more years. Why now? Not yet!

DENIAL: NOT ME

I toy with my audience again, this time telling them I have another question but know they will refuse to raise their hands to answer it, out of embarrassment. I ask, “How many of you think that you are more special than the person sitting next to you?” Roaring laughter and movement again acknowledge the commonality of our individual egos’ claim to superiority.

Deep down, I suppose I believe that I’m a little more special than you. I have no problem imagining another person’s death. In fact, I hear about people dying every day, and I have no problem imagining their deaths. But I can’t imagine my own death.

When we are young, we believe we are immortal. For example, when eighteen-year-olds go to war, many don’t believe they will die. During the Gulf War, I saw a young marine interviewed on television after her husband, who was also a marine and who had been missing in Iraq for nearly a week, was found. When she was asked her feelings about the situation, I remember her saying, “All of us here at the fort know that some of us will die, some of us will be wounded, and some of us will be POWs, but not one of us here ever believes it will happen to me.” They go boldly into battle believing, in the beginning at least, that an exciting adventure awaits them and that somehow death is meant for others but not for them. I once heard a mentally and physically healthy seventeen-year-old boy start chuckling because he knew how silly his words were about to sound. He said, “I’m the first person living who will never die.” While we may think he was just joking, and while he also believed that death would be an eventuality, I knew when he said it that he believed it emotionally, even though intellectually he knew it was not true. I remember believing the very same thing about myself when I was young. Even now, when we are middle-aged or elderly, and we know death as a hard-core reality, we cannot imagine death for ourselves. We cannot imagine not existing, not being. Death is far off.

I recently asked my father, who was in the first wave at...