Being Mortal, a recent book by Atul Gawande, is an important exploration of the realities we face as we near the end of life. While the first half offers insight into the alternate universe that is the nursing home, it is the second half that is worth the price of admission.
In his description, members of the medical profession are fixers, they are classic problem solvers. Faced with a problem, they:
Determine the nature of the problem
Decide what needs to be done to fix the problem
Describe it to the patient to get commitment to the solution
Execute the solution
Expect the solution to work.
As Gawande eloquently describes it through the story of his father’s death, and the stories of his patients (Gawande is a surgeon), that problem solving approach fails as we approach the end of life. With the multiplications of problems (metastasized cancers, multiple organ failure, overwhelming pain, to name a few) every solution creates a new problem elsewhere. But medical professionals have not been trained for these realities. They have been trained to fix problems. As the end approaches, problem-fixing meets its brick wall. And the professional feels like a failure.
Gawande offers an alternate vision rooted in the practices of palliative care. One of the gifts of this book is watching the author try and fail to do what he knows he wants to do with his patients. The force of habit and training take over, until new habits are formed.
The new habit he has developed asks four simple questions:
What do you hope for in the time left to you?
What do you fear in the time left to you?
In light of those answers, what are you prepared to risk?
In light of that, what do you want to do?
Four simple but transformative questions. As Gawande describes these conversations, they provide guidance for him, even in the midst of surgery, when he cannot ask the patient what to do in light of what he sees. Even more important, they assist the patient in becoming clear about end of life priorities. Amazingly, these conversations can have the seemingly contradictory effects of reducing the cost of end of life care while extending life.
One of the deep lessons of this approach is that of letting go. The physician lets go of the need to solve every problem and is able to engage the patient in all their humanity in the difficult decision making. The patient surrenders to the inevitability of the approaching death and often gains the ability to make connections with loved ones. The death becomes holy instead of hard and miserable.
There are two contexts in the life of a church where Gawande’s questions open new possibilities:
Congregations that are dying
There are congregations that are dying. The doors are closing in the near future. Nothing can change that. Not uncommonly that death is hard, miserable. If the congregation can ask itself these four questions, the possibility of a holy death becomes possible. The doors can be closed with gratitude for the life that the congregation lived. Having let go of what was, those left at the end can move to life in another church in a way that doesn’t drag the leftovers of their previous congregation into the new.
Congregations seeking renewal
For those congregations deciding whether to seek renewal rather than death, the four questions can lead to clarity of what their future might be. Facing their hopes and their fears, they can consciously let go of what was, and choose what risks they are prepared to take in order to seek what is to come.
But most important: in asking these questions, congregations can enter a space where they have let go of the need to fix, to find the one solution to solve all their problems. They can let go their need to make it come out right, and surrender to the life that God is calling them to.
What are you prepared to risk for the new life that God is offering your congregation?
Latest posts by Keith Regehr (see all)
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