REVIEWED By STEVE RYAN

Bruce Bartlow writes out of decades of experience as a nephrologist and critical care physician. He begins with two thought-provoking statements to alert us that this book is about every person’s spiritual challenge to live and die as a person whose core self, or soul, knew and answered life’s essential questions.

His unsettling opening sentence states: “All of us will come to the end of our lives, but few of us will die well.” This is not what we expect a medical doctor to write about the American way of dying in an age of ever-increasing medical technological achievements!

His second statement is that, “Nearly everyone who reads this book will someday care for a friend or family member as they die. Some of us will even make it a profession. Though we offer our help out of love, I believe we will also hope to be nourished by the transcendent experience of participating in the life well lived and released with grace.”

Bartlow maintains that illness and death, if we permit them, can teach us to reshape our lives. They can turn us, if we are willing, toward answering the meaning of life questions we were born to ask about who we are as a unique person, what is or ought to have been my primary goal in life? To what degree did I achieve it? What remains to be done? How can I use this illness and whatever time I have left in my life to achieve this goal?

Examining these questions, he believes, is crucial to every person in order to live and die well. For many of us, however, it is only illness or the approach of death that causes us to put aside other life events and to seriously reflect.

To lead us to do this reflection before or during an illness or as death approaches, Bartlow uses a metaphor of life as a river that is moving serenely through a forest of beauty. Suddenly the waters encounter a large stone and the peaceful flow is disrupted perhaps never to become again the gentle river it was. New adaptations to the environment must be made. However, though the river is different it need not cease to be what it was meant to be.

Bartlow sees our lives moving joyfully, with purpose through events as the original serene river. Unexpectedly, illness -- perhaps terminal illness -- enters and as the stone has changed the river, challenging it to adapt to a new environment and perhaps purposes.

In a similar way, illness becomes our teacher. As dashing against the stone causes the water to become murky and turbulent, so our illness causes us to ask questions we had long silenced within us. How will I live the remaining years of my life? What will I be able to do? How will my family and loved ones relate to me? Will I die peacefully or tied to machines, not being able to communicate my needs and/or desires?

Looking back over the river of his own medical career, Bartlow discovered that the questions he asked patients changed as he found that the medical technology he provided often failed to enable a patient to die well. Rather, 30 years of trying to “save” critically ill patients deprived them of the opportunity to complete the unfinished life goals that our core self needed to pursue in order to die healed.

His experiences taught him he could provide the opportunity for people to die well only if he moved from the technologically centered world into the postmodern world. He learned that rather than being a medical technician with answers about how to heal physical ills, he needed to become a healer, asking the patient to guide him to an understanding of what the patient in his/her deepest self needed so that he/she could die well.

As a technician, he had approached a patient thinking, “What do I need to do to offer this patient a physical cure?”

Today, as a healer, his queries are about the patient’s life goals, his/her hopes for the remainder of her/his life, the quality of life that would be acceptable if cure cannot be achieved.

Knowing the patient’s answers to these questions, as a healer he then outlines whether or not or to what degree the available medical procedures can provide sufficient time and energy for the patient to achieve these goals.

The essential questions become: What is your core self seeking to understand about itself through this illness? Are there unresolved issues that need to be addressed? Are there broken relationships that need to be healed if you are to die well?

The subtitle of this book, A Practical And Healing Guide to End-of-Life Issues for Families, Patients, and Healthcare Providers, can be misleading. A reader may expect a medical ethics book about how to use today’s techniques of medical science, such as pain medication and legal documents such as advance directives to provide for a dignified death.

Rather, the challenge of the book is either to use an existing illness or to imagine one’s dying days to ask questions about the type of person I want to be remembered as being. What have I achieved? What are the life goals that I have not yet accomplished? What is it that I was created to be? How can I achieve that in my remaining years?

The book changes one’s perspective on illness and death as events to be feared and held at bay as long as possible through medical technology into a spiritual guide book about how I must live if I am to die well.

Although, as the subtitle indicates, Bartlow intends a wide audience, I believe that the readers who will benefit most from it are persons in health care. The book presumes experiential knowledge of how the critically ill or the dying are cared for in today’s medical institutions.

Health care personnel will find the book a spiritual guide both for examining their own lives as well as for insights about how they can assist patients in dying well. They will find it valuable to read more than once. There is an excellent table of contents and an extensive index of subjects. These make it easy to find a particular section regarding a specific subject I want to review.

I found that returning to the introduction as I read the chapters enabled me to understand better how each chapter related to the central theme. I’m a Catholic priest and a hospital chaplain and I found that doing the recommended exercises enriched both my own spiritual journey as well as gave me insights into how I can better serve the patients I minister to.

The book is now on my reading table. It is a resource to regularly return to as I reflect on personal issues -- or on how I can more effectively minister to patients with specific needs.

Fr. Steve Ryan is director of chaplaincy services at Queen of Angels-Hollywood Presbyterian Medical Center and QueensCare Pastoral Care. He is immediate past president of the National Association of Catholic Chaplains.

National Catholic Reporter, October 26, 2001

• Top of page