Ira Byock — Contemplating Mortality
November 7, 2013

What if we understand death as a developmental stage — like adolescence or mid-life? Dr. Ira Byock is a leading figure in palliative care and hospice in the United States. He says we lose sight of "the remarkable value" of the time of life we call dying if we forget that it's always a personal and human event, and not just a medical one. From his place on this medical frontier, he shares how we can understand dying as a time of learning, repair, and completion of our lives.

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See Mother Teresa: to help people die well. But the other side of dying well, the other side of the human development of virtue at this time, and integration, is the spiritual side: that we prepare to meet God. It's not a preparation for nothingness.

Excellent: dead is not just a medical event, it is a most human event. Pope John Paul II, near his death, said 'I have been preparing for this moment my whole life'.

Or the role of philosophy is to die well.

The atheist Susan Sonntag died like an animal, according to her son.

The relationship between Jesus and Mary and Joseph was perfect.

We can see that the moment of death is the most critical: this is the critical moment in the Life of Jesus. And in the Hail Mary we say 'Pray for us, now and at the hour of our death'.

It does create distance between us and this world, which is healthy. It shows us that we are not immortal in this world. (Jesus: 'My Kingdom is not of this world'.) But it doesn't mean we are not immortal.

Death at any time was the same: an ultimate challenge to the person.

'Being dead a long time' - no, we are immortal souls in dying bodies.

To die well is to die in the arms of God. To look forward in reality to Heaven.

Pope John Paul II showed the world how to die well.

How can we kill the unborn then?

You should be anxious about Heaven: what comes after dying is the question (cf Hamlet). Are we ready to meet God?

Islamic Medical Association of North America - Hofstra Ethics Symposium “End of Life Issues: Ethical and Religious Perspectives”

no reflections per se. just wanted to draw your attention to a conference whose proceedings are published at

http://jima.imana.org/issue/view/811/showToc

and recordings are available at

http://imanaethics2010.wordpress.com/video/

As a Catholic, we look at the Crucifixion of Jesus for understanding about how to die well. Jesus indeed fulfilled his life's purpose with his death. But he also knew he would rise.

To one in the Lord, death is called, in the Bible, 'falling asleep', our brother who has 'fallen asleep'.

But with the aging population, this is topic was very helpful and important.

Death, though is a bad thing, though it can be used for good, as in redemptive suffering.'

What then do you think of the euthanasia people?

No one immortal. Not by medicine. But as we are made, and given by God.

Without God, death is a complete disaster, no matter what. The impossibility of possibility. But we need to use it to be prepared to live more fully with God.

Why is this program assuming atheism?

A relative of mine had a beautiful death. She had fallen at age 88, and broken her hip. In the next two weeks she had two heart attacks, had gone to a nursing home and then back to the ICU unit, it was two weeks later. She had gotten the Last Rights and forgiveness.

On Thursday her cousin, a nun, and I had planned to go to visit her, but she called me and we went on Wednesday instead. We got there at 9:30 in the morning. Our other family members, that live closer, had been in and out, but none were there then. We said hello in her ear, and started to pray the Rosary. She was consious, but not able to respond, and knew we were there. At 9:35 the nurse came in to tell us she was dying.

I saw a man walk by, and he was the deacon, so he came in and we prayed around her. And in ten minutes she had died. As I stood by her bedside, I saw a light come through the wall on the left, it was if the wall wasn't there. It was the softest, gentlest light, and it lasted about two minutes. It was Mary and God taking her soul to Himself.

That is a good death.

'Death lays bare the spiritual condition of man' - very good. Those who fight God all their life have more trouble facing him at that moment.

St. Gianna Molla's life tells us that, to quote a biography, that 'there are joys and loves in life that are so strong that they persist and are stronger than suffering and death'.

As one priest said, 'Who wants more of this?' We hope for a new heavens, and a new earth.

It will, but most of the world dies without medicine, most die the way the people around Mother Teresa died. And she helped them to die well. As one woman said to her, 'I've lived like an animal, but I'm going to die like a saint.' She was prepared for death.

After death, according to Catholic doctrine, one's soul leaves time and space and one stands before God and is judged in the particular judgement.

Philophy has been called the study of how to die well. So in saying we're not prepared for death is to say we're not a wise culture, and need to become more wise.

That's why God gave us AIDS, and illnesses: to bring us to truth.

(Those who kill the unborn or the aged are not pro-life.)

"My Kingdom is not of this world." Jesus.

Of course, as your guest states, we don't just blithely say that we look forward to heaven. We have to 'work out our salvation in fear and trembling'. That is, to prepare for death and judgement.

What aout the elderly dieing with dementia, loosing who they are - how do we help them "die well"?

My mom is at the end stage, she is loosing her abilities to speak, to eat, how do I help her? Is it okay to talk about dieing with her? I do read to her, i tell her I love her, I see her as often as I can at her long term care home ....but as she declines....I am not sure how to help her "die well"

I have had a great sense of healing in my time with her in this stage of life, but as I see her becoming less and less connected I am not sure what to do, how can I help her at this stage? Perhaps just being there, holding her hand, reading, I am not sure....how do we address her dieing? Is it okay to talk about it? I don't want her to die without being at peace about it.

Annie- Yes- Do talk with your mother about dying-knowing she is listening and understanding on some level. Talk to her, be with her and just love her where she is now. Being with someone-giving presence- is a comfort. If he found comfort in a religious ritual you may want to arrange that- anointing, blessing etc. You ssid you have had a healing at this stage in her life so good things are happening. Peace to you.

Hi Annie, I think different people will define "dying well" differently. For many, though, I think it means having one's choices honored, and having a loving and compassionate witness for this sacred transition. At the simplest level, it could be thought of as just being present with them: that is the greatest form of love, perhaps?

As the dying shift from connection to others and towards an interior state near the end, it may seem that they're unaware of our presence. Personally I (and many others) feel that at some level they know we;re with them, and it's just as important, I think, that WE know we're with them. You can ask your Mom if she'd like to talk about what's going on, or you can begin to talk about it a little bit and see how she responds. She may want to or she may not need to. Expressions of love and gratitude and peace, and smiles and tears, may be enough.

It's so beautiful that you have been able to heal during this time together, and that you and she get to share this time together. Deep compassionate bows and smiles to you both :) _()_

Yes, Annie, being there, reading aloud to her, holding her hand. Warming her feet.
Yes, by all means share your day. Let her know how her life, well lived, has brought you this far. Lift up her life, glorify it by being determined to live your days in her grace.
Tell her how you continue to do so. Kindest regards, Sara.

I would just suggest that one invite God into this most difficult time. One does not remove any part of it by doing so, except one adds hope. And God wants to be present at these important events (and is there, even if not acknowledged).

Is there any way that we can get the people who accuse President Obama and the Democrats of creating "death panels" to understand the concepts that Dr. Byock presented?

I would really like to send this show to my friends and family, but your website tells me to use a valid email address even after I have done so. Is there something wrong with this function on your site? If not, please
me instructions.

I really appreciated this interview. Dr. Byock mentions the "illusion of immortality" in the interview. If we see an identity for ourselves and others that continues beyond death, might we rather see mortality as the illusion?

Mortality is, indeed, in my view, the illusion, but knowing that death is no more lethal a passage than birth doesn't make it less daunting for most and it cannot be embraced if it's denied.d if it is denied.

As my mother's hospice caregiver, I found myself advocating for her to return to my sister's home and to transition there. Once the doctor agreed and released her to my care, I spent the next week with her, and am writing a book on how much we were able to heal in that time. My mother and I did not have a great, close relationship, but before she flew away, we were able to travel across the tundra of our lives and form a bond. I miss the woman and friend I met that week. I look forward to seeing her again.

I was truly touched and impressed with the ideas, thoughts, and words of Dr. Ira Byock. The subject of death is generally one which most people prefer to avoid—even in the most dire, inevitable situations. I believe this man, and those who support him, have a very honest, honorable, and compassionate message to offer to humanity as a whole. As was mentioned in the interview, death is not something easy that we look forward to in times of quiet introspection and self-assertion. Regardless of who I was or what I’ve done in this life, the moment will eventually be present when I have to come to terms with the inevitable fact that I am going to die, and that is difficult for more reasons than just the journey into the unknown frontier of afterlife. Naturally, people will fight; we will grip tightly to life—all that we have ever known, experienced, learned, and loved. However, at the end of every natural progression of life, is death, and I feel strongly that people would only benefit from a medical staff, a spiritual council, a society that is educated and empathetic—as best they can be, having never actually died—to what we are immediately facing which goes far deeper than just ceasing to exist in this body. I think that there could not be anything more supportive or compassionate than being surrounded by people who are truly thinking about what is important in what could possibly be our last moments. I feel like Dr. Byock could not have chosen a better set of 11 words to sum this up. “Please forgive me. I forgive you. Thank you. I love you.” I cannot think of anything residing in my heart of hearts that would not be expressed satisfactorily in a conversation focused on the meaning behind these 11 words.

Perhaps the most impressive detail about this interview to me was how inclusive the application of these ideas is to all people. When I look at life, and all that separates us and makes us different, only childbirth and death stand out as being events that remain pure and unaffected in their significance by any standards, circumstances, or experiences of human society. Compassion and understanding for others in times of joy and especially sadness are emotions that for some reason have become rare, if not obsolete, for so many. Starting, or rather jumping on board, with a new wave of people in professional or social environments setting the example of how to lovingly guide people to a path—inevitably leading to death—littered with expressions of forgiveness, gratitude, and love could be infectious to the point of pandemic. I cannot imagine anything better than finding peace within my heart and knowing that I left that example behind for those who were there with me on my way out of this world. And that, is the very opportunity I believe people like Dr. Byock are providing and working to establish within the hearts of people everywhere. This interview, and all the ideas therein, is something I am not soon to forget, and I am thankful for having had the opportunity to hear it.

I am a devoted listener to your program. I thank you for your show with guest, Dr. Ira Byock. I am a critical care physician who developed and continue to grow a palliative care program in Lincoln, NE. Your insightful discussions and Dr. Byock's message of promoting appropriate and common sense care are appreciated greatly. Our mission to promote quality and dignity at the end of life is definitely a nationwide mission. Your insight and perspective are deeply appreciated. Lisa I Mansur MD, FCCP

Listening to this broadcast gave me chills. It was a hauntingly beautiful thought that death is a part of life and it should be embraced rather than feared. Hearing how he discovered that he wanted to help people live with death was great to hear. It makes me think that we all could learn from this and that way no one will be devastated when they lose a loved one. The thought of death can be horrifying but this wise man reminds us that it doesn't have to be.

Dear Ms Tippett, After listening today to "Contemplating Mortality," I am moved to express my deep gratitude to you for your show and to share two brief stories. I listened to the show on my way to my dad's 79th birthday party. Since he has been living with lung cancer for the last 2-1/2 years, it is a miracle that he is still with us. We are blessed that he is comfortable at home with my mom, thanks to the local hospice service. I arrived at the party early, to be with my two sisters and our parents before everyone else arrived. During that time, my mother told me of her own recent (and still unfolding) diagnosis of cancer. Your program has given me a feeling of peace and courage to face what's coming. I will share it w/ my sisters and brother � it contains so much wisdom and compassion. I particularly love the insight that dying isn't medical; it's personal. This will help me be present to them as they dance with the unknown. The other story is the origin of a phrase that came to me about your show a while back. I am an avid listener -- particularly enjoyed John O'Donohue, Joanna Macy, Thich Naht Hahn, Ellen Davis, and Sylvia Boorstein. I am an architect and years ago, a colleague related a field trip he took as a student to a small, exquisite Frank Lloyd Wright house that is now a museum. It's called the Pope-Leighey House. At that time, it was a private home, and my friend met the widow Mrs. Leighey who still lived there. She told him, "Living in this house has made me a better person." That's how I feel about your show. Listening to your show has made me a better person. I am always so impressed by the quality of the conversation and your preparation -- and your respect and love for your guests. Bless you. PS The photo is my family at Easter a couple of years ago. My son is now 10.

I decided to listen to the podcast “Contemplating Mortality” and found it very interesting. I feel that many of the points were helpful and interesting. One point talked about death and made a point that people do not look forward to death. Also, they said that when we talk about death it is with a loving intention, rather that ill intentions. We all agree that we don’t want our loved ones to die.

The next interesting point was that there is not an example of a perfect relationship in the history of our planet. In relationships we have hurt feelings and make mistakes. Because of this, the relationships have to learn how to heal and become even closer.

The last point talks about the four phrases that are most important in every relationship. These phrases are – please forgive me, I forgive you, thank you, and I love you. I truly believe that these phrases are very important and everyone needs to use them and hear them.

I absolutely loved this conversation with Dr. Ira Byock. He reminds me a lot of a doctor I used to work with at the hospital, he was kind and gentle and did not believe in people dying badly. I worked as a nursing assistant for 10 years on the hospice/oncology ward at the hospital, I started there when I was at the young age of 19. I remember first being terrified of all the death and dying that I saw, but I soon grew to love it. There is something special about Cancer patients, all of them, they always seem to have a positive attitude that rubs off on even the grumpiest of people. My friends used to ask me, "Mag, how do you do it? How can you stand to work with dying people?" I would say, "consider this, the labor and delivery nurses pride themselves on bringing lives into the world, I just happen to enjoy aiding lives out of the world in the most peaceful way I can." My goal in life is to finish up with my nursing degree, I am an LPN now and only allowed to work in clinics, and once I finish I hope to become an important part of the hospice program again. It is my life long dream. It is true what Dr. Byock says that dying is a developmental stage in everyone's life and dying well should be a goal on everyone's list. I have seen many families fight and many come together in these awful times. I have cried with my patients and I have cried with the families trying my best to listen and support them with whatever their needs are. Hospice is the most rewarding program that I feel the medical field has come up with, and I can only hope that it continues on this wonderful path of growing and getting people to go on hospice sooner than the day before they die, because the counseling that is involved with the program, at least the one I worked with, was extremely helpful to patients.

"getting people to go on hospice sooner...." I agree, Maggie. My mom, and I as her primary caregiver, would have benefited if we had gone under hospice care sooner. Instead, we (and all her physicians) remained in "curative mode" which led to a revolving door in and out of the hospital. It was as if no one wanted to be the one to initiate the idea of "palliative care" to us. It took a (well-done) bulletin board display on the floor of my mom's last hospitalization to finally introduce us to the concept (we had never heard the words before). So, my family learned the hard (slow) way, first time around. Next came my Dad five months later, followed by my step-father, another five months later. By then, we knew better how to navigate the "curative" vs "non-curative" tightrope.

As an oncology massage therapist, I find that I too am the type of person who occupies the space of "living on the edge". I am an explorer, and seem to find great meaning and peace when in the company of those who are transitioning from this life to another form. I appreciated what Dr. Byock shared about dying well and dying being another developmental stage. Dying provides opportunity for healing when individuals contemplate the impending "finality" of death as it relates to the physical relationship on earth. It provides an opportunity unlike any other in life. Healing can be tremendous.
Thank you for this beautiful and heart touching interview.
Jacquie

I hit the alarm this morning and lay in bed awakening, becoming aware of how tired I was, when, unbidden, the inner voice spoke up: “I can’t believe I’m going to die, and disappear, and the world
will go on without me, and it will be like I’ve never been. Unbelievable.”

Me, me, me. Stuck in specificity, circumscribed by the narrowest of limits, tightly defined. That’s the whole problem. That’s where the pressure and dissatisfaction come from, and the anxiety, the fear. All your eggs in one basket. Always here, always now. Me, me, me, me, me. That’s the beauty of teaching. I escape into the eyes of my students.

My father was diagnosed with Parkinsons. As his loss of mobility worsened, he and my mother did everything possible to accomodate his situation. When he could no longer drive a car, they got a golf cart to drive around their neighborhood. When he could no longer steady himself, he got a walker. I never heard him complain or blame God for his disease. He faced it with courage. I credit my mother a great deal for his good attitude. She was always encouraging him and finding new ways for them to enjoy the day, even when the day was not so good. Simple things like sitting in a parking lot, enjoying an ice cream and watching the cars go by. She always made him feel as comfortable as possible and made sure that he had things to do; things that gave him a feeling of accomplishment. I watched the love between them grow. Though privately there were tears, she never complained. When he passed in 2008, the family was blessed to be at his bedside. We held hands and prayed the Lord's prayer as he passed from this life to the next. My dad taught me much in this life, but it was through his disease that I learned of his true character. The NY couples comments at the end of this broadcast said it all. The gentleman said "these are not very romantic things to say, but they brighten up my heart". This was his comment to his wife asking him if he wanted more ice cream or reminding him to drink more water.The Valentines Day letter she read was priceless. It really comes down to the simple things in life and small gestures of love that mean the most.

I would expect the profound loneliness would be as bad as the pain. BUT, let's get our bucket-lists ready and make the best we can of this next part of our journey through life.

The end of life for me is the beginning of life . Knowing that as a Christian, I know there is more then this, a belief in Heaven, where there are no more tears, only joy! To celebrate life daily is a gift! Living and enjoying each day! Yes, I miss my Mom, but knowing she is finally at peace, no more pain! What a gift!

Anyone interested in this topic who wants more would do well to check out Stephen Jenkinson's work. His website is orphanwisdom.com, and he is best know for the documentary Griefwalker. His work will take you deep; it has much in common with what Dr. Byock has said here and I dare say it goes even further. Here is a taste: http://www.youtube.com/watch?v=d2IhwsTtXzA&feature=player_embedded

I worry about us becoming perfectionistic about death when I hear "die well". Us aging boomers got quite perfectionistic about the way we gave birth and I can see us becoming the same way about death. I do understand what Dr. Byock is talking about as I was a witness to some awful hospital deaths back in the 70's. I wonder if perhaps we should look forwards to having " singular deaths". Deaths that represent the singular lives which we have led.

When KPCC in Los Angeles area broadcast your program on Sunday at 3 p.m. I would listen faithfully. Then time was switched to 0 pm. and I don't listen to you at that time. Do you broadcast the program on your web site? I could then listen at my convenience.I miss hearing your beautiful voice and comments and the amazing guests with whom you interact.
Thank you so much. Caroline

Trent Gilliss's picture

Hi Caroline. We hear you loud and clear. Unfortunately, we don't have much say in local public radio programming schedules. There are several ways you can listen to our shows at your convenience and availability: our website offers streaming + downloadable audio, and so does our email newsletter. And, in December we'll have a mobile app for your smartphone that will make it convenient and super-easy to listen to any show you'd like!

it's sad that people are put thru dreadful "heroic" measures because family members and the docs want them - when family member's paramount goal - perhaps unconscious - is "we did everything we could" - clearly needs to sensitize more to how much they are torturing the person who is really the one in crisis.

My mother 'relocated to heaven' 5 yrs ago. She'd suffered a massive stroke and she had a Living Will which clearly stated she did not want to be kept alive by extraordary means/resuscitated. I am the youngest of 3 sisters- one of my sisters decided she would violate our Mom's wishes and kept her alive, ignoring her Living Will and her rights. Our Mom lingered for 9 long agonizing months until she (sister) felt it was ok to let Mom go. I knew my Mom did not want the inhumane way she was forced to remain 'alive'-She was a woman of faith and knew her ultimate desination would be heaven. Why would someone who also claims to be a believer, feel entitled to play God? The bottom line is that it is wrong for anyone to decide what is best for the person who is dying on the best way or the time to let go. It is simply selfish.

Work for an insurance company where we are expanding Hospice and Compassionate Carre. I went through the dying process with a professor who was terminally ill with Breast Cancer over 20 years ago and it changed by like forever. Someone told me it was a privilege to have someone allow you to become close to them when they are dying it really was a privilege

Today's show reminded me of my mother and how she died. Just as Frank Lilley said on the show, I wanted to learn from my mother how to handle the process of dying and death. As I listened to and observed her in the weeks before she died, I took note of things she said. One night, I wrote a poem incorporating some of her words and phrases from poems that she and I remembered during that time. I read the poem to her as a way of letting her know what I was learning from her. I also read it at her memorial services.

Recommendation

Emily, like you, I did not stop for death
until it, kindly, stopped for me.
Six months to two years, the doctors said.
I opted for the latter
thank you very much.
For I had promises to keep
and miles to go before I went to sleep.
I did not rage against the dying of the light
(although, to be honest, at times I did.)
Courage and dignity and grace, like Papa
was my mantra.
At times, that cough kept aggravating me.
Teresa, do I have a cold?
You smiled, ruefully.
Lung cancer, I answered
to spare your having to reply.
Other than that, Mrs. Lincoln
how were things?
Children, you pampered me
with strong coffee, fruit cobblers, and hugs.
Peavine, you raced in
and lay beside my bed.
Friends, family, you sent cards, flowers, paintings
and a song written just for me.
Julia, you called and told me to wait for you, up there.
Where else did you think I’d be?

That business of dying
I recommend it
but not highly.

Deborah Cromer
July 2009
based on the words of Pamelia Sale Cromer, Emily Dickinson, Robert Frost and Dylan Thomas

I'd like to get a copy of the Franz Kafka poem that Ira Byock recited this morning. Do you have it available? Thank you.

You do not need to leave your room. Remain sitting at your table and listen. Do not even listen, simply wait, be quiet still and solitary. The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet.
- Franz Kafka

Did anyone get that Lily Tomlin Quote mentioned on the show. It was great but I can't remember enough of it to use google since the inaccurate rumors of her death overwhelm the search results.

Forgiveness is hope in the future even in the face of our past, true hope in God, for whom all things are possible.

The 4 sentences you quote - reminds me of the last words of Jesus on the Cross. Also, at the end of each Hail Mary we pray 'pray for us now, and at the hour of our death'. The moment of our death is important and is a moment of grace, as Cardinal Cooke said. It is a time to find peace, to hand ourselves over to God.

"We'll be dead a long time" - at the moment of death we stand before God to be judged. And then we have the opportunity to live with God, forever, to have overcome death.

We have found someone who is immortal - Jesus. And Mary. And the saints, who rise to life, not to death.

You might look at the child Matty Stepanovich, who died at 14 or so of an illness, and who wrote a book called 'Heart songs'.

This show describes why I love my job being a social worker in hospice - helping people to die well and helping families to navigate the coinciding process of grieving and healing. Being invited into families at this tender time - to hold space for memories and honor their lives and their choices moving forward - is such a privilege. It is often in dying that people learn about living.
Thank you for bringing awareness to something we will all experience, but so often do not want to delve into. Some listeners may also like this awareness campaign: http://www.wakeuptodyingproject.org

There are those of us who are going to die alone without having anyone who loves them intimately, without ever having received the kind of love your Story Corps stories celebrate, without family in the room wanting them to live or grieving them when they die. I came extremely close to dying a few years ago, and there was no one to say "Please forgive me" to, nor "Thank you", nor "I love you". One can die very well without any of that. I will die well, as I would have died then, because I love, not because I have been loved.
I see that I am commenting about a re-run. Well, I have listened to myself at least.

Trent Gilliss's picture

Mary, this show remains very much an active conversation. And I'd like thank you for adding to this discussion with your personal story, which, for me, carries a pang of truth and a host of delight. To love means action, and that is a deed all of us are capable of.

This was, again, another wonderful, thought-provoking program. Ira Byock is a voice of reason urging us to maintain a balanced view between our faith in science and medicine and faith. There are times when I feel as if the medical/scientific communities are trying to put death to death. As much as we hate death and all that it does, undoes and takes away, it serves a purpose. Could we realistically live in a world where there were no death?

As a Christian, I must daily remind myself of what it so clearly and beautifully says in Ecclesiastes, that to everything there is a season, "a time to be born, and a time to die." Also, as it says in the Wisdom of Solomon, "The souls of the righteous are in the hand of God, and there shall no torment touch them."

I have a good hunch that the ancients were on to something.

I have been the beneficiary of the "profound opportunity" associated with facing the death of my partner.
It was transformative and dare say I, spiritual, as well.

Please read The Grace in Dying. It has been called a landmark in the field and it would be an act of service to refer people to it. Thanks for your good work in creating this site.

A beautiful and provocative segment. Life and death are indeed 'both sides now."

Thank you for this gift.

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Voices on the Radio

is former director of Palliative Medicine at Dartmouth-Hitchcock Medical Center and a Professor at Dartmouth Medical School. His books include Dying Well and The Best Care Possible.

Production Credits

Host/Producer: Krista Tippett

Senior Editor: Trent Gilliss

Technical Director/Producer: Chris Heagle

Senior Producer: Lily Percy