Sometimes what we offer is not enough. We can offer all sorts of modalities to manage decline and we can do it well. But we cannot medicate away gripping existential anxiety; we cannot fix death.
These are the tough cases, the ones where the patient or family or both do not accept death. Because death is our concrete reality, when it presents itself it is non-negotiable. We may want more time, more health, we may think it’s unfair but nothing we say or do will change the fact that each organism has a finality and that this finality has divine timing.
It is true that there has been changing mortality over time. What killed us years ago, doesn’t kill us now. And what kills us now may not kill us in the future. But as long as we, simple humans, hope to live, we are still not destined for immortality – at least not in physical form. We may push the boundaries, the limits of our existences, but ultimately, by something new or something old, we will succumb. That is our current destiny.
It is also true that miracles do occur. And in hospice it is not our place to deny them. I pray for the miraculous in every patient I encounter. But miracles are tricky. Our fixation on our version of a miracle may prevent us from accepting our reality, and thereby achieving the miracle of transcendent transformation that death is, the blessing of acceptance and true inner peace.
Sometimes - if our patients wishing to refute death could only see - sometimes the miracle is the gift of superlative hospice care, steeped in agile readiness to manage symptoms, to compassionately placate cavernous grief, and to show that dying isn’t the untamable monster we think it is. In hospice we try to offer the peace of a good death, a miraculous thing, but for those who are tormented by the grief of losing life, it simply is not enough.