Realistic hoping at the end of life 

[this is the second half of Mountbatten and Me published on October 28, 2022]

What is there to hope for at the end of life? As with all phases of the life cycle, some hopes are more ‘realistic’, and therefore perhaps wiser, than others. Unrealistically, we might hope that we will not ever get ill, perhaps never die, or not even age. More realistically, we might hope for a meaningful and socially connected last phase of life. Moreover, realistic hopes offer a basis for social connection. They are shared realities, not shared fantasies. And as shared realities, whatever ‘the worst’ might be, it is made more bearable. 

*

When we visited my father’s physician for news of his initial biopsy (in company with his closest friend, then very old and previously also treated for cancer) the doctor sat us down, explained what the biopsy and scans had found, and said, ‘you know what? You’re pretty old now and if this thing doesn’t get you, something else might’. While that might sound, out of context, harsh or flippant, it was taken with equanimity; the two old men looked with great respect at the ‘young’ doctor (who was, at a guess, in his early forties) and agreed that he was making a very good point. The ‘worst’ was on the table and being shared and, as a shared weight, also born.

*

Two or three generations ago, death was less of a stranger to culture. It, and even the body of the person who died, was not something hidden from view. For example, the late 19^th century, New England, writer, Sarah Orne Jewett describes the matter-of-fact way that friends, family and neighbours would care the departed through the custom of ‘watching’ or ‘waking’: the dead person was never left on their own but was ‘watched’ by family or friends until the funeral and burial.

Jewett’s short story Miss Tempy’s Watchers, originally published in March 1888 in The Atlantic and is freely available online here describes this custom. Jewett writes of how two characters, Mrs. Crowe and Miss Sarah Anne Binson, friends of the departed Miss Temperance Dent, settle in for a night of watching. They sit in the kitchen, close to the food and the fire rather than the more formal front room. Miss Dent’s corpse is upstairs. The house is by a brook:

‘… which ran down the hillside very near the house, and the sound of it was much louder than usual. When there was silence in the kitchen, the busy stream had a strange insistence in its wild voice, as if it tried to make the watchers understand something that related to the past.

“I declare, I can’t begin to sorry for Tempy yet. I am so glad to have her at rest,” whispered Mrs. Crowe. “It is strange to set here without her, but I can’t make it clear that she has gone. I feel as if she had got easy and dropped off to sleep, and I’m more scared about waking her up than knowing any other feeling.”

“Yes,” said Sarah Ann, “it’s just like that, aint’t it? But I tell you, we are goin’ to miss her worse than we expect. She’s helped me through with many a trial, has Temperance. I ain’t the only one who says the same, neither.”

These words were spoken as if there were a third person listening; somebody beside Mrs. Crowe The watchers could not rid their minds of the feeling that they were being watched themselves.’

*

The two characters speak of Miss Tempy. They reminisce. They take refreshment. They knit and sew until, lulled by the warmth and the food, their talk slows, and they drop off to sleep. The story concludes with the friends looking out to the east and the growing light. Miss Binson observes, “Twill be a beautiful day for the funeral.” She then turns:

‘…with a sigh, to follow Mrs. Crowe up the stairs [to the waiting corpse]. The world seemed more and more empty without the kind face and helpful hands of Tempy Dent’.

*

In Sarah Orne Jewett’s world, what my father’s ‘young’ doctor said to us on the day we got the diagnosis would not have been strange or flippant. It would have been comforting and realistic. It would have been treated with respect, deemed, without undue emotion, as the inevitable if solemn recognition that a point had been reached in the span of a long life. And it would have been a pointer to what, wisely, realistically, might be hoped for.

*

In her wise and realistic consideration of the importance of relationship, and its priority at end of life, Ros Taylor, a palliative care physician, quotes the first line of a poem by Theodore Roethke (‘in a dark time the eye begins to see’ [Taylor 2018: 72]) Taylor describes how, for many people – but not all –  ‘accepting a negative reality, can open new vistas’ (ibid) and suggests that:

“Acceptance of death as a possibility unleashes possibilities for better endings and a different set of hopes: hopes about how to spend time, hopes for the future of the family, hope for a pain-free death, hope to be yourself” (Taylor 2018: 72-3).  

Realistic hoping can, in other words, open up the possibility of ‘control’ over life before death as part of preparation for death. It can keep open spaces for communicating about things that we care about most and for staying connected to the people we love. 

Further Reading:

DeNora, T. (2021). Hope: the dream we carry. London: Palgrave Macmillan.

Taylor, R. (2018) Relationship, Not Intervention: A Palliative Physician’s Perspective. Pp. 57-83 in A. Goodhead and N. Hartley (Eds), Spirituality in Hospice Care: How Staff and Volunteers Can Support the Dying and Their Famiies. London: Jessica Kingsley Publications.