J. Michael Jones

With such a macabre heading, I must quickly state that this topic has nothing to do with me … almost. The only connection is that I find it a bit more comfortable talking about my own death and dying than I did 9 months ago, when the concept was so abstract that it was “out of sight” and “out of mind.”

But this “comfortableness” is a bit more like the strange fellow who decides to lick the tentacles (aka cnidocytes) of a stinging Jellyfish each morning. Yes, over time he might become more “comfortable” with it, but, unless he is really deranged, will never see it as leisure.

Some of you know that I am a movie buff, especially when it comes to deep-thinking, well-acting movies. We had a movie club that met at our house for years, and I do hope to resume it soon and you are invited. There are many famous movies, (and novels too), that have a deathbed confession as a cornerstone to the narrative. There are two movies that quickly come to mind.

The first one is one of my favorite comedies, It’s a Mad, Mad, Mad World. The movie starts with Smiler Grogan (Jimmy Durante) racing down a 2-lane desert highway. He has a spectacular accident and slowly dies beside the road. But just before taking his last breath (and literally kicking the bucket) he confesses that he is a bank robber and has hidden one million dollars in California and he tells the bystanders where it is. The crowd (who have pulled over to help) hear his confession and then, at the same time, get the same idea of racing off to find the money. The race is where the fun really begins.

The second movie has a deathbed confession that is far more solemn. It is from one of my favorites, Braveheart. If you remember the story (and it is based on real events in history) Longshanks – (aka King Edward I) sits on the throne in England and seeks to subdue the Scotts. William Wallace (Braveheart) rises to lead a Scottish rebellion against Longshanks. To say that Wallace is King Edward’s nemesis, is an understatement.

As Longshanks was getting along in his years, and I think he too was suffering from “consumption” (TB), he was becoming quite frail, laying on his deathbed. His daughter-in-law whispers in his ear that the son that she is carrying is not of Edward’s son, but belongs to Wallace. The news—as traumatic as it is—seems to be what finishes off the old king’s life.

I can remember from my youth, a few incidents of death-bed confessions. But some of these, which I will explain in a minute, were more like deathbed interventions than confessions.

One actual confession, that I remember vaguely, happened when I was in middle school. A distant relative of ours (related to my mother’s family, but I can’t remember how) had a family secret to tell her adult daughter as she was old and near the end of her life. She asked her daughter at the hospital, “Do you know that old feather tick (mattress) that I gave you when you got married?”

“Of course, mom, we still sleep on it.”

“Well hon,” her mother said, “it’s not filled with no feathers.”

Her daughter looked surprised and asked, “It’s not? Well, what’s in it?”

Her mother raised up from the bed and grabbed her arm, “Money! The damn thing is stuffed with money!”

“Money?” her daughter asked with her mouth gaped open.

“Yes, money … but Confederate money. After the big war was over, my grandpa got a wagon load because it was cheaper than feathers.”

She paused for a moment and then added, “But I hear now, 100 years later, that Confederate money might be worth something again.”

That is the only family treasure secret story I can think of. I don’t think the money amounted to much, although I heard a lot of people in the family claiming that the mattress was really theirs.

I do remember a couple of what I would call deathbed intervention stories. These are situations where someone is on their deathbed and then, during the deeply emotional situation, someone decides that the person dying must be reconciled to someone he or she has been estranged from for years. Often there was a Baptist preacher in a polyester blazer in the middle of the situation, trying to be the midwife to the resolution.

While living with estrangement within any family is a travesty, I really think that one of the motivating factors for this eleventh-hour attempt to resolve the matter was based on, what I would call colloquial theology. If you go to the grave with unconfessed sin, or in this case, unresolved differences, there is a chance that you might spend all of eternity being tortured by Hell’s fires. This is the same reason that some people believe that those who commit suicide are also, so damned. This was not official Baptist theology, where the central theme is total moral exonerated, past, present and future, though Christ. But, throughout Church history there has often been a disconnect between official Church theology and what people really believe and practice in their everyday lives.

ESTRANGEMENTS

I wanted to say something about this phenomenon of family estrangements, they are far too common. As part of my “Family History” interrogation, when I interview new patients, I ask about each family member (their health and especially their history of migraine or other headache disorders). At least once a day I hear from the patient, in response to my question, something like, “I don’t know if my mother suffered from migraines. I haven’t spoken to the bitch in thirty years.” Then the patient smiles and adds, “I hope she does suffer from migraines.”

While it seems to me that mother-daughter or sister-sister estrangements are most common, the men seem to be more resilient, holding on to their anger to the bitter end. That’s why my memories from childhood were of men being reconciled with their sons or brothers on their deathbeds. But it is a shame that all those years were wasted in broken relationships.

I had a near “deathbed” experience in January. My admitting physician (and we didn’t know what was making me so sick at the time) said that she was just trying to save my life… and she wasn’t sure she could. My kids all flew in. I am so thankful that we have good relationships. Honestly, I can’t imagine anything my kids could do that would cause us to be estranged one from the other. That only thing I needed to do was to remind them how much I loved them and to tell them that I was sorry for any mistakes I had made.

MINDFULNESS AND THE “REGRET”

I’ve said before that I’m not a big fan of fads. I don’t like diet fads, health fads, investment fads or whatever is new and the best thing since sliced bread. Each time a new idea comes around, it comes with promises of solving all our problems and it seems like everyone jumps on the bandwagon.

I think I learned my lesson about this when I was a college student and preparing (for 2 years before switching to premed) to be a clinical psychologist. One or my professors was so enthralled by B.F. Skinner (the father of Behavior Modification) that he could not contain himself. He was giddy over the man. I remember him telling us that by the time we reached clinical practice, there would be no more mental illness, no more addiction, and the prisons would be empty. Behavior Modification was a panacea that would solve all our societal problems. I was skeptical even then as a 19-year-old. Behavior Modification is hardly on the radar anymore, except in the area of animal training.

I’ve been hearing about “Mindfulness” for at least a decade. It is everywhere. I see it too as just the latest craze in mental health work. I am sure that it will not solve all our mental health problems and it will evolve over time and then, eventually, be replaced by the next big thing.

While I, as a medical provider, I had plenty exposure to Mindfulness, however, I got a double or triple dose as a patient at the Seattle Cancer Care Alliance, in preparation for my stem-cell transplant. This was my fault for mis-reading a question on a mental health survey. It asked the question, “Have you had any thoughts that you would be better off dead than going through this treatment, within the past two weeks.” I didn’t notice the “past two weeks” part and answered yes. But it had been almost two months since I had a very bad day, feeling overwhelmed by the suffering, and having serious thoughts that my death, by my own hands, might be my only way out of this nightmare. Yet, when I tried to explain my misunderstanding of the question, it was too late and, as they say, the damage was done. I was labeled as having “active suicidal ideation” and was fast-tracked to follow with a social worker, then a psychologist and then a referral to a psychiatrist. In summary, our weeks of work was all focused on “Mindfulness.”

Now, with my criticism clearly voiced, I will pause to give some credit to the concept and how it does have some value (but still not the panacea). Mindfulness, in my over-simplified explanation, is living in the moment, where our lives intersect with the present. Its roots are based in some of the teachings of Buddhism (I will not try to explain here). So, it is being more aware of the sights, sounds, conversations, feelings, tastes, and other senses that is right before us at any given moment. But here is why I think it has some merit. These present senses are helpful because they replace the temptation to think about the past or the future.

It is true that when we think about the past, it tends to make us depressed. We feel depressed because we miss the “good-ole-days” and we have regrets of our past mistakes. When we think about the future, we tend to become anxious, because the future is loaded with the “what ifs.” What if the treatment fails? What if I suffer more? What if one of about a possible 100 bad outcomes happens to me? While it is a Buddhist concept, even Jesus advised us not to worry about tomorrow because tomorrow with take care of itself.

This now brings me back to the topic of “regrets” and the deathbed confessional. I think regrets is the most common form of such confessionals. If I were to ask you, and I am, what are some of your biggest regrets in life, I’m sure things would start popping into your mind. Now, you may or may not want to share those, but they are real. I think when most people face the end of life, these regrets start to work their way back to the surface. Some people live with the thoughts of these regrets during their every waking moment.

I will mention that the only people who do not have regrets, in my opinion, are the narcissists. They believe every decision that they have ever made in life, was perfect. Any bad thing that has happened to them had to be the results of other people’s poor choices. But for the rest of us, we have regrets and must find ways to manage them or live less fully with them.

I think that regrets come in major categories. In my life I can think of about ten stories, from associates, patients, and family, that I would call profound regrets. In these situations, it is often the accidental death of a child, by the parent’s (or grandparent’s) mistake. Leaving the gate to the pool open. Not looking behind the SUV before backing down the driveway. Not taking the child to the hospital when they seemed very sick. These moments are lived over and over to infinitude within the minds of those who made such a mistake. These are all horrible circumstances and the one who must carry the regret, will never be the same for the rest of their lives. The sad thing, and I’ve spent some time counselling such people over this, is that most of them … maybe all of them, are very good people. They weren’t stupid or just bad parents. We all make mistakes and it is but, for the grace of God, that we didn’t have such a terrible regret in our own lives. It is very hard to help these people because the emotional damage, the guilt (false guilt) it just dreadful.

The second level of regret are the big things, but not of the previous magnitude. Most of us have at least one or two. With these regrets, it is still black and white. We made a very bad choice that caused a lot of trouble and suffering. We are fully culpable. We do have a responsibility toward this regret, to ask for forgiveness, to take responsibility, and to promise to never make such a mistake again. Then, if we are lucky enough to be granted the forgiveness, we must find a way to move on and to “let it go” or it will start to haunt us, almost as bad as the profound regrets haunt those people.

The last category are the frivolous regrets. At this level, it is not so black and white. For example, “I regret that I didn’t take job B instead of job A.” However, we don’t know if things would have been better… as it could have turned out even worst. Another frivolous type of regret is where the solution is not so obvious. I personally regret that I did not find a way to support myself by writing. But so are 50 million other people. There is no easy fix for this. I don’t know what I could have done differently. This level of regret is not worth a moment’s thought.

It seems that most people, as they approach the ends of their lives, pass back through this regret-rumination valley once again. Some get hung up in those narrow places. There is no benefit to anyone for someone to spend their last days wallowing in regret. Mindfulness certainly has much to offer in this situation.

I fortunately don’t feel that I am having to deal so much with regrets right now. I don’t know why this topic came to my mind. However, for the past six weeks I’ve been on high dose steroids, trying to tame a host Vs graft syndrome. The steroids render most of my nights as sleepless. I wander through the dark house, looking out the windows, listening to MP3 books, watching science documentaries, and trying to find a few minutes, now and then, to nap. It is during these moments that a variety of topics seem to get caught in my mind, like a moth in a spider’s web. I give them much thought and then I find myself having to put some of these thoughts down before they are lost forever.  Mike