JOURNAL: seven things I am learning about dying RICHARD FROUDE

 
In order to protect identities, specific details have been altered or fictionalized.
 

1. For the last year I have volunteered both in the Emergency Department and with the palliative care service at a hospital in the Denver metro area. In the Emergency Department I restock medical supplies, answer patient call lights and assist however I can. With the palliative care service, I help patients to write. This could be a letter of gratitude to a caregiver or employer, a message to an estranged relative, a young or unborn child, or most often a life story or legacy. A common misconception about palliative care is that it is the same as hospice care. Although this is not the case, it may often be offered in conjunction with hospice care just as it may be offered in conjunction with curative treatments. However it is used, the aim of palliative care is the relief of symptoms: physical, psychological, spiritual or otherwise at any stage of illness. As a result, many of the people I meet with are seriously ill. As I write this, I do not mean to suggest that my experience is any more valid or meaningful than that of the nurses, counselors, physicians, social workers, other volunteers, or indeed anyone who has lost someone or something. Nor is this an exhaustive catalog of my emotional reactions to working with this population. Over the last year, these are some of the things that have stuck.
   
   
   

2. On the telephone my mother asks me if I have been with somebody as they have died. I say no. I know it will happen but it has not yet. A few weeks later I go to a training session organized by a local hospice. It is a Saturday morning and the session is led by one of the hospice chaplains. The idea is to prepare us participants for the eventuality my mother had asked about. I don’t know what I am expecting. It isn’t like there is a manual we can all read and discuss. There is a man there who claims to be a hospice volunteer. He sighs or sniggers while the chaplain is talking. He challenges the chaplain on how he knows the things he tells us and the chaplain is very clear – he does not know these things, nobody does. All we have is empathy and a willingness to stand in uncertainty, our presence in the face of absence. As if to compound this, the chaplain leads us on a group meditation. We are guided toward the imagined moment of our own deaths. The challenger sighs throughout, twisting in his chair. We are led to believe that something will endure.
   
   
   

3. After cardiac arrest, a man is rushed to the Emergency Department where I am a volunteer. The ambulance paramedics wheel him into the resuscitation room on a gurney. His lips are already turning purple. His clothes have been cut from his body and his skin is pale and blotchy. The hospital staff takes over chest compressions. This happens on TV all the time but, as I find out later, on TV the CPR survival rate is depicted at around 70%. The actual rate is, at best, 18%. The man is surrounded by doctors, nurses, paramedics, nursing assistants. As instructed, I am watching from the far wall. I am looking at the man’s face. Machines are wheeled in to detect a pulse. The interventions and compressions continue but he is fading. It has simply been too long between the initial cardiac event and his arrival in the hospital. The attending physician makes certain that all on the team are satisfied that nothing more can be done. He announces the time of death. After most have left the room I help the hospital paramedic ‘clean up.’ We pack the body into a white vinyl bag. The skin is rough. We cover the bag with a sheet and wheel it via the shortest route possible to rest in the viewing room.
   
   
   

4. There is a morning in late spring when four patients on the service die on the same day. It is the last heavy snow of the season. I leave the hospital around two in the afternoon and the roads are poor. It is usually a 30 minute drive but today it takes me over an hour. There is little food in the house. I eat two apples and a dry cheese sandwich. I watch a National Geographic special on Netflix instant called The Moment of Death. I don’t know why I do this. I think I want to understand things. “Open your eyes,” says Peter Coyote, voice of the Oscars and part-time poet, “open your eyes and face the moment of death.” The film travels through the various ways in which the body might die, the biological changes that occur, the particular physiological processes. That night I dream I am an inmate in a prison camp along with my best friends from high school. We are running to escape but for some reason I hang back. I am about to be re-captured as I wake. It is early but I cannot sleep. I get up and drive to the gym for their 5:30am spinning class. It is not yet light when the class starts. The instructor plays terrible music and encourages us to “Dig! Dig! Dig!” The day rises slowly through the misted windows of the cycle room. By the end of the class it is morning. The brightness of sun on snow.

5. My first trip to an inpatient hospice center is to visit a woman I have come to know well. It is a one story building set away from the street with large windows. Outside each of the windows is a birdfeeder. Some of the blinds are closed. It is mid morning. In a training session months ago the presenter had described a paradigm scenario for a ‘good death.’ In this scenario, an elderly man is lying in a serene cabin in the woods. It is the cabin where he was born, where his children were born, where his mother and wife had died. From a bed at the window, covered by a quilt sewn by his grandmother, he watches the birds. At the care center, I am buzzed in by the receptionist who tells me which room to go to. I have met with the woman there several times over the past two months, listened to her and written the story of her life into thousands of words that she hopes her children will one day read. It is strange to see her, not only because I have witnessed the progress of her disease, but because I feel like I have already said goodbye, at the front door of her house two weeks earlier. I had not expected to see her again. I had imagined how her intellect would diminish. I am not sure what we mean when we use the word ‘dignity.’

6. One of the first people I talked to at the hospital was a woman in her late fifties with advanced cancer. It had been nearly ten years since her initial diagnosis, during which she had spent a great deal of time considering her own death. I asked her if she was scared. She said she had been, absolutely terrified, but not anymore. She said she knew what would happen and that it would be OK. She told me about an afternoon two or three years ago when she rose translucent and perpendicular above the bed in which her body lay. And when she returned to her body, so she let go her fear. Although this is not an isolated presentation, I have not found it to be the norm. Many of the people I have met with have been consumed by fear, the anxiety of waiting, of dying without knowing they have permission from loved ones. I am writing this paragraph in a crowded coffee shop. I am wearing headphones, listening to Swedish death metal named for the Grey-elvish translation of Tolkien’s Mount Doom (yes, I know). Most of the lyrics concern bloody battles between various factions of Norsemen and the glory of dying on the battlefield. The moment of death features prominently. I am telling you this because the juxtaposition seems not only completely absurd but shockingly commonplace: the way it feels for me to think about my own death.
   
   
   

7. All of this is to say that the title I have given this writing is maybe misleading. I do not have seven things to tell you that I can define and categorize like days of the week or habits of highly effective people. I am learning things that bleed into each other. And I am learning that the things I would most like to know are not things that can be learned. Sometimes I want to be able to say everything that has been said to me however insignificant it may have seemed at the time. I think that if I could do that, then I could voice my own personal protest against the obtuse and crushing inevitability of mortality. Because I cannot, I sit in hospital rooms. I sit in hospice rooms. I sit in the homes of discharged patients and I write about the one thing that will give their deaths meaning: their lives. I sit in training sessions and coffee shops trying to understand. I sit here with open eyes.

_____________

Richard Froude was born in London, grew up in Bristol, and came to the US in 2002. He is the author of FABRIC (Horse Less Press, 2011). Other writing can be found in Witness and Birkensnake. He lives in Denver with his wife Rohini. You can learn more about Rich and his thoughts on writing by checking out his recent interview with fellow writer Rob Mclennan.

 _____________

A native of Alabama, Mary Rachel Fanning currently resides in Chicago where she teaches photography and advises students at Columbia College. She is also co-founder of 6+: a women’s art collective. Fanning’s influences and motivations are derived from her upbringing:  

Over the last six years I have used myself, the artist, and my family as the primary story and storyteller. My maternal grandmother, Marybelle, began slipping into Alzheimer’s disease in 2005. She and I made quiet images of our changing relationship until she left us in the summer two years later. For myself, the challenge to visually find spots of dignity and lightness in a natural process perceived by the majority of the public as painful and morose is often overwhelming.  However, through this process, I am able to see what parts of her, besides her name, are a part me, and as she gradually, and I believe naturally, slips away, I am able to hold those parts in these photographs.    —- Mary Rachel Fanning

This particular series, titled “Namesake,” accompanies Richard’s writing throughout.