His wife found him in the garden. He did not awaken to her touch.
When paramedics arrived, they jammed a tube into his windpipe and supported his breathing with a bellows, shoving air into lungs already taut with scars from cigarette smoke and Allied gunpowder. Most people require sedation to tolerate such tubes, however, he neither coughed, nor flinched, nor gagged. His peacefulness was ominous. Although his heart still beat, his brain had receded into stillness.
In the emergency room, a CT scan confirmed a ruptured aneurysm. Blood crowded out his brain and thrust it downward, through the narrow aperture at the base of his skull. The pressure was strangling his brain.
I met his son in the conference room of the intensive care unit (ICU). Through the window behind him, the Boston skyline weaved a starlit backdrop. He faced me with his arms braced across his chest, his jaw set. Only his thumb and forefinger, grimed from the grease of machinery, worried the weave of his sweatshirt and betrayed his heartache.
I explained that his father was dying. We could not save him.
“The best we can do for him now is to ensure he is comfortable and surrounded by those he loves in his last hours.”
He stared at the floor in silence. “No,” he finally whispered. Then, louder: “Nope. It’s not going to happen that way. Dad’s a fighter. He’s also prayed every day of his life. With God, all things are possible.” When he met my gaze, indignation hardened his eyes. “Keep going.”
Such scenarios, which serve as daily fodder for ICU practitioners, penetrate to the core of our understanding of and relationship with God. Loved ones wrestle with grief, doubt, fear, anger, and even guilt as they struggle to reconcile a web of hospital instruments with a mother’s voice, a father’s laughter, or a child’s smile. Doctors agonize over the distinction between measures that salvage life and those that prolong suffering. Nurses fight tears as their patients grimace with yet another turn, yet another dressing change, yet another needle stick. How long, O Lord? we inwardly cry (Ps. 13:1).
Despite their currency in the most fundamental of spiritual issues—life and death—modern medical systems offer scant context for a faithful response. Instead of Scripture, medical professionals navigate these storms with ethics committee consults. We entreat palliative care specialists for help, and rely upon mantras of patient autonomy and quality of life. Leaning forward in our crisp white coats, we discuss resuscitation and feeding tubes, offer a hand squeeze and a sympathetic ear, and ask, “What would your loved one want?”
The question “What is God’s will?”—although it may trouble us privately—never reaches the air of the ICU conference room. We offer chaplaincy services as a conciliatory afterthought, and burden families with the responsibility of “choosing” the course for their loved ones, rather than partnering with them in lifting patients up to the Lord.
The divorce between physical and spiritual care at the end of life unsettles us further when we consider how frequently death occurs in hospitals. In 1908, 86 percent of people in the United States spent their final days at home, Robert Wells writes in his book Facing the “King of Terrors.” By the end of the 20th century, that number had dropped to just 20 percent. In our current era of high-technology critical care, 25 percent of patients over the age of 65 years old die in an ICU, according to the Center for Disease Control. Death has passed from the domain of families, pastors, and the quiet of home, to sterile rooms that resound with alarms.