When to keep living
We deserve WICHITA, KAN. — to die in peace, Father Tom Welk says.
He’s the chaplain at Harry Hynes Memorial Hospice in Wichita, Kan.
You could say he counsels the dying.
He says he counsels the living.
We should talk about death more, he says. We should help each other die in peace.
Here’s how he does it.
Some patients with a terminal illness fight desperately to stay alive.
“I’ve had many a patient where you wonder why are they hanging on so hard,” Welk said. “And nearly always, you find out there is some unfinished business in their lives.”
“I’ve seen this may times,” said Sarah Yoder, a longtime registered nurse who was trained in hospice care recently by Welk.
“Some patients do things that defy medical explanations,” Yoder said. “Why does this person even have a heart rate at all now?
“And then you figure out, even with those who are unconscious – they want to hear that their wife is going to be taken care of. They need to hear it from one of their children. So as soon as they hear that, as soon as that conversation happens, they’ll finally let go.”
“We learned a long time ago to explore this with all new patients,” Welk said. “Is there someone you need to talk to?”
Welk remembers what one dying woman said the first time he walked into her hospice room. “Thank God for cancer.” “What do you mean?” he asked her.
She’d alienated many people, she told him. Family included. She’d made a list of people. So Welk took the list and, with the help of a social worker, made phone calls and arranged several last meetings.
One by one, people came to see her — people who had refused to see her for years. “Thank God for cancer” meant that people who had avoided her would come to her now because she wanted to make amends.
She apologized, reconciled, made peace, Welk said.
Shortly after that last person left, she died.
She did more than give herself peace, Welk said.
“Those people who had some reconciliation with her — they also ended up being in a better place for that.”
People don’t want to get out of bed when they think they have nothing to live for.
That’s true of the dying, Welk said. It’s true also of the healthy.
So recently when Welk coached Yoder and five other new hospice employees about how to work in hospice care, he told them: Some hospice patients begin that last journey feeling utter despair — at dying, at how their passing will leave loved ones in financial trouble. Most frequently and most urgently of all, he said, patients worry about “leaving relationships at loose ends.” They want their loved ones cared for emotionally, spiritually, socially.
So hospice care is not only about giving comfort. It’s about giving purpose.
“Human beings crave meaning,” Welk told the hospice employees. “So give them meaning.”
The Washington Post reported recently that 111 people had killed themselves in the six months under California’s new End of Life option law. California is the fifth state to allow assisted deaths, the Post reported.
One misconception some people have is that the Catholic Church in which Welk serves as a priest always insists on preserving all life, no matter what. Not quite true, he said. He’s not only a chaplain but also a doctoral scholar in medical ethics and is Harry Hynes Memorial Hospice’s director of education and pastoral care.
“Any kind of hastening of death is considered immoral,” he said. “Bullets, knives, ropes, lethal drugs — anything that would appear on a death certificate as a cause of death — no.
“But allowing death is a whole different ballgame.”
It’s a tricky challenge to work through, he said, but the church does not always oppose discontinuing treatments when suffering is present and when the patient is terminal. This is such tricky territory for the church that bishops insist on saying that it’s OK under some circumstances to discontinue “medically assisted nutrition and hydration.” Most people would say “feeding tubes,” but those two words, Welk said, imply a moral obligation, while the larger phrase does not.
Bottom line, Welk said: “We make it clear here that while we never advocate hastening death, we’re not going to prolong it unnecessarily, either.”
People who are considering assisted suicide, like those in California, do so for a variety of reasons, Welk said. One is to alleviate pain and suffering.
“But hospitals and hospices do a much better job of alleviating pain now than they did when I started 35 years ago,” he said. The meds alleviate pain, even from the slow suffocation characteristic of some lung cancer or emphysema cases. “Believe it or not, morphine relieves it without hastening death.”
Other reasons are to exert control by choosing the time of their deaths.
To avoid being a burden to their families. To end despair. Welk always tries to gently remind the patients that they are not dying in isolation – that their deaths, if they occur too early, can have consequences to loved ones or to themselves that should give them pause.
“I look deep in the eyes of these people, and I still see the spark of life.”
We are all dying, Welk told the new hospice employees, but we are also all living – and those last days spent in hospice, knowing death is near, can sometimes produce some of the more meaningful days of our lives. No one should end those days early if there’s still purpose to be fulfilled.
Sometimes people refuse to reconcile. Years ago, Welk said, he tried to help a man, “a salty old sailor,” dying of nose cancer. The affliction made his last days miserable, but he hung on far longer than Welk thought he could.
“It got to the point where we asked what he was hanging on for? ‘It’s OK to let go and die.’ He was a skeleton by then.
“He finally told us: He had two sons and had been estranged from them for 20 years. He wanted to talk with them.
“I got ahold of them. One of them didn’t return messages. The other said, ‘I’ll call you back.’ He never did.
“That’s a failure story,” Welk said. “That man did not die as peacefully as we’d hoped.
“To this day, I wonder if those sons are still alive — and what unfinished business did they still have to deal with?”
People sometimes stay alive for the wrong reasons. Like the son of Welk’s own niece.
Ryan was only 7, dying of cancer.
“I still get emotional, talking about it,” Welk said.
Ryan one day asked to talk with Welk alone.
He felt despair, he told him — not so much about his death but how it would traumatize his parents. They had fought hard to keep him alive. The little boy was fighting to stay alive.
Welk quickly met with the parents.
“You need to tell Ryan it’s OK to let go,” he told them. “You need to tell him you will be OK after he’s gone.”
“Giving permission,” Welk called it.
So they told their boy, consoled him and gave permission.
Ryan died quickly after that, with his parents’ last reassurances in his ears.