AGGIORNAMENTO: An Italian word meaning "a spirit of renewal." The word was first used by Saint Pope John XXIII at the beginning of the Second Vatican Council.

Entries by Denise Morency Gannon (106)

Thursday
Apr042024

INVITING THE SACRED INTO THE SECULAR: RITUAL AND GRACE IN THE MARKETPLACE

Southcoast Health©, a community based health delivery system in the Southeastern region of Massachusetts and East Bay, Rhode Island, offers multiple access points within an integrated continuum of health services that allow patients in the South Coast region of the Commonwealth of Massachusetts access to multiple services including Cancer, Heart, Orthopedic, Pediatric, Trauma and the myriad health issues, which afflict not only the sick but the people in their lives.

For the purposes of this post, I will concentrate on the Cancer Care Centers at Southcoast Health, whose protocols align with cancer centers that rank first in the nation - M.D. Anderson Physicians Network in Texas, Sloan Kettering in New York, Dana Faber in Boston, Mayo Clinic in Minnesota, all premiere treatment centers that offer patients the care they need at a critical time in their lives. Southcoast Health Cancer patients are treated in two state of the art cancer care facilities with a defragmented approach to treatment in the South Coast region of and sustained by a non faith-based, not-for-profit health system close to home in their own communities. Additionally, patients have benefited from the protocols integrated with excellent safety and quality measures and compassionate care by clinicians and staff who dedicate their energy and abilities to patient wellness. To these people, death is the enemy.

In creating the dedication ceremony of its newest and largest facility for cancer care, Southcoast Health System administrators wanted to craft an innovative and creative opening event but struggled with the content of the event. Southcoast Health espouses the arts and believes that they impact the wellness of its patients in very real ways. Artists often donate their time and talent Southcoast Health System; the result may be viewed throughout the hallways and corridors of the hospitals, clinics and treatment centers. Two of the three Southcoast’s hospitals house grand pianos in their gathering places, so that patients and visitors may hear live music played by local musicians as they enter the spaces.

As the dedication date crept closer and closer and no one seemed to gain momentum or produce a plan of action, I knew that Southcoast’s administration would welcome a proposal that raised their own bar of artistic conviction and bring it to the next level. I began to imagine a ritual that integrated a narrative with original music and art for the dedication event. Envisioning a ‘liturgy’ for a non faith-based, not-for-profit health system, I imagined a created a ceremonial “rite” that honored not only what the new Center would mean for thousands of people but include art, music and a testimony by a parent whose son had died of leukemia before the Center was built. In short, I invited grace into the marketplace.

Quite by chance, I came upon an original painting called Tree of Life, created by a South Coast artist Joshua Oliveira. The oil painting merged swirling circles of shades and hues that moved colors in vertical and horizontal patterns to surround a bare tree, the dominant figure in the piece. To my eye, the painting alluded that it takes a community of every color and shape to generate one single piece of creation. A cornerstone of my imagined ritual began to shape itself around this painting. I contacted the artist, outlined my idea and persuaded him to tithe Tree of Life to Southcoast Health, which he willingly did, passing up several offers from buyers who wanted to purchase the painting. There really are living saints of God among us.

The arts move hearts to transcend beyond what we intellectualize to stir us in our souls. I asked myself if I possessed the courage to propose and create an encounter with the living God outside of my own comfort zone on behalf of people who suffer. When I am sent forth from the celebration of the Eucharist to love and serve the Lord, do I risk putting myself out there and trust the community of saints to walk with me as I follow the creative breadth of the Spirit when it moves me into unfertilized holy ground?  Well, nothing ventured, nothing gained.

Now my ‘liturgy’ needed a narrative and music.  I called a dear friend and colleague, George Campeau, a South Coast veteran pastoral musician with over 50 years of experience in a plethora of contexts who fully understood the journey that accompanies cancer when it strikes close to home. Both he and his wife Diane, both from the South Coast region lost their son Justin to leukemia. Justin was 21 years old and in his third year as a viola performance major at the Hartt School of Music in Connecticut. His future looked so promising until he became ill; he possessed a beautiful gift. George and Diane’s nomadic journey during Justin’s treatment resembled that of Sarah and Abraham as they pitched their temporary tent with a religious community near the University of Connecticut Medical Center, where Justin’s initial treatment began and where he received the Sacrament of the Sick. Transferring Justin to Boston’s Dana Farber Cancer Institute for a bone marrow transplant added more duress to their odyssey. George and Diane’s took turns traveling 55 miles, back and forth day and night between home and the Boston hospital so that Justin would know the comforting presence of one parent at all times. George summed up the physical exhaustion added to the worry and emotional trauma of the experience: “We were numb.”

The Campeau family experienced the outcome of the Sending Forth of the Eucharist as the Body of Christ outpoured its physical presence, affection and fiscal support to sustain them through Justin’s crisis. Musician friends offered their time and talent to create a benefit string concert, along with a successful bone marrow donor drive and numerous financial contributions to assist George and Diane with Justin’s medical expenses. After exhausting every attempt to rescue Justin from leukemia, he fell out of his hospital bed and severely injured his head. After a 4-hour surgery, Justin was placed on the life support with minimal survival potential. His parents removed him from life support soon thereafter. Justin died. After the death of his son, George, ever the musician, learned to play Justin’s viola, to keep the memory of his son and his music alive.

Real life narratives and well executed music unlock emotion in a way that even the finest rhetoric cannot. As I imagined the marriage of text and tune to reallocate a powerful story from the sacred realm in its spiritual context and shape it into a secular event, I went out on a limb and asked George a question. “If Southcoast Cancer Centers could have treated Justin, would you and Diane have brought Justin home for his treatments rather than undergo the grueling travel and stay between New Bedford and Boston? “Of course,” George responded immediately. “There would have been no need for us to do differently.” I seized the moment and very consciously asked my friend to rake up a wound that never heals. “Would you be willing and able to tell your story to a gathering of people at the dedication of the new center?” George never hesitated. “Yes,” he replied. I mustered more audacity and posed the final and most daring question of all. “If I wrote a piece for string quartet, piano and solo viola and called it Tree of Life, would you tell your story and then play the piece on Justin’s viola? Talk about it with Diane and pray about it. Take your time to decide.”

A day later, George called me. “So when I play the coda, I think that I should take it up an octave.” My heart leapt. “Does that mean you’ll do this?” “Yes,” George confirmed. “I’ll give the talk and Diane will stand next to me but she does not feel as though she can speak.” Sometimes the most powerful thing we do is simply to be present and embody a soul whom we loved in this life and sent ahead to God, especially when that person may be one’s own child. I knew that I asked my friends to revisit and reflect upon the most profound and excruciating event of their lives and the ultimate loss and grief for anyone. George and Diane’s response filled me with deep admiration for their faithful valor to act on behalf of some of the least of God’s people – the sick and the suffering. This is our call as the baptized, the reason why we are sent forth week after week from the celebration of Eucharist, to ‘go in peace to love and serve the Lord.” From the celebration of the sacred, do we take that mandate seriously and bring that sacred realm into the secular marketplace to continue the mission of Jesus Christ? How do we cooperate with the creative breadth of gifts that the Spirit of God affords us when we live within God’s grace? Where do we locate and integrate our stories in scriptural ‘real time’?

After composing an original piece for piano, solo viola and string quartet, I could now ‘pitch’ my dedication ritual to the administrators at Southcoast Health. After receiving word that we would move forward, I met with many people over several months to plan and discuss particulars. One of the meetings took place inside a construction trailer at the site of the new center. As we all wore our hard hats as required by law when visiting a construction location, I looked at healthcare providers and staff gathered around the table and familiar words resonated within.

“On the whole, I do not find Christians, outside the catacombs, sufficiently sensible of conditions. Does anyone have the foggiest idea what sort of power we so blithely invoke? Or, as I suspect, does no one believe a word of it? It is madness to wear ladies’ straw hats and velvet hats to church; we should all be wearing crash helmets.”

Annie Dillard, Teaching a Stone to Talk (New York: Harper & Row, 1982).  

 

Moving the sacred into the secular demands a hardhat. It means that we might dodge a few falling live wires and hit a steel beam and bear an injury. If we’re not wearing the bruises, then we’re not doing liturgy. Moving the sacred into the secular means leaving that the ‘safe zone’ with the confidence that God lives not just in our churches but in all people, believers and non believers, in all places, in all of creation. Igniting the combustible gas-soaked rags of ritual means stretching people who may have no idea what or who we invoke but respond, “Yes, we’ll do that your way,” and cooperate with something so much bigger than ourselves. Put your hard hat on when you tread on holy ground. Anything can happen.

At the dedication event, the new center full of South Coast residents eager to see the facility and staff that would act on their behalf, we gathered the assembly. Beginning with a brief introduction by the president of Southcoast Health System, we plunged a death-defying rite of inspired art, heart-wrenching narrative and sonorous original music that actualized the Paschal Mystery within a secular gathering of those who fight death, some who embrace death, other people who accept death or try to delay death. George’s words, “Beauty and pain often coexist,” gave passage to the premiere performance of the piece Tree of Life as Josh’s painting rested on an easel near George, who played Justin’s viola, and my quintet. The water of life poured out of hearts and eyes of all present.

Over the years as we worked together on diocesan conference events or shared experiences within our own pastoral contexts, George and I always noted that when a powerful homily cracked wide and exposed the living Word coupled with a lavish fare of rich music, the feast of grace feeds hungry hearts who yearn to walk with a community of saints that bolster them with unseen but very tangible presence within sacred terrain. We celebrated the victory over death in the living witness of George and Diane in a cancer care center, the very location where death looms on a daily basis. Despite the wide range of believers and non-believers present at that event, the Word dwelt among us and became tangible to all participants. “The bar has been raised on dedications,” one participant commented. I understood. Never again will an event that this health care system issues will be void of the grace of God, even though some will still remain staunchly loyal to their system of disbelief in anything beyond themselves. No matter. ‘Whether we live or die, we are the Lord’s.” (Roman 14:8)

One of the sentences in George’s talk will forever remain in my memory: “We rejoice that Justin was and continues to be our son.” Here stood two parents undergoing the crushing death of loss and standing victorious before us all because of their belief in the Paschal Mystery within a secular non-faith based institution. How much more real does the Sending Forth get? Despite the ultimate loss of their son, George and Diane obdurately believe that ‘the souls of the just are in the hand of God.” (Wisdom 3: 1). They continue to walk with Justin in the land of the living, building the reign of God here and now, in this time and place, in the service of those souls still with us in their bodies and those who walk in the land of the living where we cannot see them but know they live more surely now and only a veil away. Although he died early, Justin is at rest, because “the age that is honorable comes not with the passing of time nor can it be measured in terms of years.” (Wisdom4: 7).

Where, O death, is your victory? Where, O death, is your sting?” (1 Corinthians 15:55-57 New International Version)

Monday
Apr012024

If you want peace, work for justice 

Easter Monday, April 1, 2024
If you want peace, work for justice
Well, we’ve sung Hosanna holding palms, washed one another’s feet, celebrated Eucharist, knelt and prayed at the foot of the Cross, lit the holy fire, shared the light of the Paschal Candle with one another, initiated the Elect in Baptism, Confirmation and Eucharist and anointed those seeking the gifts of the Spirit of God. What a week. Alleluia! 
And yet, we stand on the precipice of one of the most violent times in human history. “What does that have to do with me?” we wonder as we pray for the victims of oligarchs, whose self-interest results in chaos and destruction and wreaks havoc on a world in search of peace? History teaches that the outcome of war produces nothing but more war and the death of innocents, death of peace, death of collaboration between nations that we leave to the generations that follow. 
Pope Francis’ Easter message yesterday included these words: “War is always an absurdity, war is always a defeat!” He added, “Peace is never made with arms, but with outstretched hands and open hearts.” How many private wars between people exist even as we stand together and pray for the victims of war? How many internal wars exists within hearts that have grown hard, weary, sorrowful, even with the promise of new life that we continue to celebrate within these 50 days of Easter and really, all year long? 
I wrote a piece years ago that I never shared and by some coincidence found it in my archives today. I’d like to share it with you on this first day of the Octave of Easter.   
On Oct. 4, 1965, St. Paul XI became the first pope to address the United Nations. What was the essence of his talk? No more war, war never again. (You can read his entire address at link: https://www.ncronline.org/blogs/ncr-today/paul-vi-50-years-ago-no-more-war-war-never-again) 
And yet, here we are again. Ukraine and Russia. Israel and Palestine. The Gaza Strip. No mercy, no compassion, no benevolence for any innocent victims, remorse of any kind but only the use of armament that destroy, steal joy and change the landscape of any community with one fell swoop of destruction. Wars exist. This demonic evil destroys lives, countries, nations.
War in this 21st century includes cyberattacks, assaults on the electric grid, water and oil supply, health care, education, politics, religion and the banking system. War in this day and age may include armaments but there is more than one way to kill, maim and do malevolent devastation that will once again change the course of history. We live on the brink yet again of horrific destruction to millions of people worldwide. 
Perhaps if we stop the petty wars among one another, true global peace will stand a chance.   
St. John XIII who penned Pacem in Terris (Peace on Earth) stated that for world peace to exist, people must "make it imperative that at long last a world-wide community of nations be established." In the decades that followed, alliances between countries and nations were created for that very purpose. Too many innocent lives have been sacrificed in the name of justice, which were the opposite of just. His words resound loudly and clearly what we hear, read and witness daily. https://www.vatican.va/content/john-xxiii/en/encyclicals/documents/hf_j-xxiii_enc_11041963_pacem.html-
Peace is more than the absence of war
Gaudium et Spes (Joy and Hope), the Pastoral Constitution on the Church in the Modern World, is one of the four principle constitutions resulting from the Second Vatican Council in 1965 promulgated by Pope Paul VI on 7 December, 1965. Gaudium et Spes stands as a pillar of many topics but for the purpose of this blog, several of them develop the ideals of culture, economics, politics and peace and war.
More than several quotes ring true almost 60 years later: 
"Peace is more than the absence of war: it cannot be reduced to the maintenance of a balance of power between opposing forces nor does it act out of despotic dominion, but it is appropriately called 'the effect of righteousness' (Isaiah 32:17."(GS78) 
"Peace cannot be achieved on earth unless people's welfare is safeguarded and people freely and in a spirit of mutual trust share with one another the riches of their mind and their talents. A firm determination to respect the dignity of the other individuals and people along with the practice of friendliness are absolutely necessary for the achievement of peace. Accordingly, peace is also the fruit of love, for love goes beyond what justice can achieve." (GS 78)
"War, granted, has not ceased to be part of the human scene. As long as the danger of war persists, and there is no international authority with the necessary competence and power, governments cannot be denied the right of lawful self-defense, once all peaceful effort have failed. State leaders and all who share the burdens of public administration have the duty to defend the interest of their people and to conduct such grave matters, with a deep sense of responsibility. However, it is one thing to wage a war of self-defense; it is quite a different matter to see to conquer another nation. The possession of war potential does not justify the use of force for political or military objectives. Nor does the fact that war has unfortunately broken out mean that all is fair between the warring parties. (GS79) 
My favorite?
“If you want peace, work for justice.” St. Paul VI, Celebration of the Day of Peace, 1972.
To read Gaudium et Spes in its entirety, follow the link: https://www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_const_19651207_gaudium-et-spes_en.html

 

Monday
Feb212022

A question of life or death - weighing in on the Death Penalty

Monday, February 21, 2022

I read a post today (I will not reveal the source) that streamed over 2,200 (so far) comments (with a few exceptions) that affirmed this title: “Killing a police officer should be a mandatory death sentence,” with a by-line “Enough is enough”, a mantra that I’ve used many times since my son was shot and killed in the line of duty in 2018.

I admit that my heart shattered into a fragments when I read these comments. They contained absolutely contained no consideration, no proactive resolutions, no consideration for the killers, the families of the murderers and nowhere to be found was a solution to any of the issues that result in these heinous crimes that we either live or read about every day, thanks to social media, which reports these incidents faster than the speed of sound. I’m beginning to understand “If it bleeds, it reads”. I don’t know who came up with this phrase but really, that’s who we’ve become as a society – vampires thirsty to read who is next on the palate of criminal death is the next best thing to whatever crosses our paths in the virtual world of celebratism. Hands up if I'm wrong. 

I responded to one post that read “Where is the evidence that shows capital punishment is an effective practice? Killing begets killing...”

And the post was correct. Has history not taught us anything at all?

I realize that my stance may not be popular. We back Law Enforcement the same way that we back Heathcare, Education, Social Services - all who deem to assist everyone who has a need, This is who we are, We stand with people, all people, because we are one of the people. 

My husband and I received a glimpse of the crushing blow of people who have lost their souls when we attended a dinner hosted to honor those who had assisted police officers who had assisted and had been themselves victims when their partner, my son died at the hands of a killer and his K-9 wounded in the line of duty, The officers who were with our son at the scene suffered physical and emotional trauma and were honored by thousands of law enforcers present at the event, one of many posthumous events. The crowd at the dinner actually moaned that the criminal had not been shot and died at the scene, which shocked both my husband and me. God bless them: I'm sure that they thought that their hearts were in the right place. Perhaps they knew what was in store for us.  We’re not sure but we knew but this mattered not. The criminal’s life meant very little if nothing to this gathered group, as it mattered not as in the comments on the post that I read throughout today. There was mo mercy, no compassion,no humanity within that moan. No dignity at all for the kiiller. I still think about that room filled with thousands of people wanting death and I admit that the thought keeps me up at night.

Has anyone else noticed that we’ve crossed the Rubicon into a world of cruelty?

This forum is not the place for me to be sharing personal experiences about the experiences that have led me and my family to a different place, a new activism and fresh insights into our own individual personas. However, I do feel a responsibility to encourage those who would be on the wrong (yes, wrong) side of the death penalty and see it with different hearts and minds. The journey to this place of forgiveness is extremely difficult. But the dignity that is due to every living person, without exception (GS27), be the “varieties of crime” “poison civilizations and they debase the perpetrators more than the victims and militate against the honor of the creator.”  (GS27)

In other words, hating those who harm us, hate us, kill us, take those whom we love from us deserve (yes, deserve) our charity, our good will and our forgiveness must be in our hearts, minds and souls.  Mind you that I did not say that the perpetrators should not serve the time due for their deeds. There will never be justice while they live and our loved ones have had their lives stolen. Do the perpetrators deserve death for the deeds? Not on in this world. We will pay the consequences in the next realm if this is our posturing. Death is the enemy; an eye for an eye is not the way through. Forgiveness, difficult as this may be is the only passage open to life, our lives. To bend in the other direction can only lead to more malice, vengeance, cruelty. I, for one, cannot live in that world.

If we really believe in God, meaning that we believe that not only does God exist but really believe in a working, breathing reality in every moment of life, than all things become possible, then hearts and minds must adhere to a different way of thinking, of believing, of existing. A change of heart for the perpetrators, for the victims left behind in this world and for the world in general becomes possible. And let’s not forget that there’s a puddle of muck that runs through every clear river. Those who will want vengeance may not ever be convinced. We do our best; God’s in charge of the rest of things.   

Does anyone really want to see this harsh alliance of forgiveness and severity continue on a daily basis? Hands up who wants to see a kinder world of humanity, even for those who cause us injury?

Open your hearts, friends. God waits for you to listen, change your hearts and believe that redemption is possible, even for those brothers and sisters whom have wounded us to the quick and changed our lives forever seem to be beyond redemption.

Death is not the answer. Only life, even when it sees impossible is the answer. 

 

 

Sunday
Feb132022

Everything Happens for a Reason (NOT) 

February 13, 2022

My brothers and sisters, we believe that all the ties of friendship and affection which knit us together as one throughout our lives do not unravel with death.” Vigil for the Deceased, Order of Christian Funerals, #71

I am the mother of murdered son. On April 12, 2108, K-9 Sergeant Sean McNamee Gannon’s life ended with a bullet through his head when he went with other officers to serve a warrant on a criminal who was guilty of 125 prior offenses. Sean was thirty two years old and happily married for two years to a wonderful girl whom he loved very much. They were a wonderful couple together. He was well-educated, a devoted friend, astute and compassionate in his work and work ethic and dedicated to workouts, health and community service on and off the job. Sean was very close my husband and to me, to his sister and brother, a friend to their spouses and devoted to his grandparents until their deaths. He died months before his first nephew was born and missed all three of our grandchildren’s entrance into the world. To them, he is a face, a story, a name. We will miss him every day for the rest of our lives. His absence to us is palpable always.  

Sean’s K-9 partner, K-9 Nero was also shot. The bullet traveled through his jaw to his esophagus and landed in his shoulder. Sean died on impact and was carried out of the attic by another officer in the attic and a third officer who called in “Officer Down.” They escaped the killer’s illegal gun waiting to shoot them from his hiding place behind some installation in the abandoned attic. The killer was on his cellphone with his ex-girlfriend and mother of his young daughter and told her, “I’m taking out as many as I can.” The crime scene was a nightmare of SWAT, backup officers, ambulances and other law enforcement agencies.

K-9 Nero was bleeding out with no redemption in sight; he was choking on his own blood while negotiators attempted to talk Thomas Latanowich out of his hideout in the attic. Through the collaborative between negotiators and the killer’s former lover and a cell phone between them, Latanowich gave himself up. K-9 handlers went to rescue Nero. Because of an old law, the ambulances on hand were not able to transport a K-9 to the nearest veterinarian for help. A veterinarian surgeon who was at the scene got into a cruiser with several K-9 handlers and used a straw to keep Nero’s airway open until the dying K-9 could be surgically repaired. Several days later, Sean’s wife of only two years took a shirt from Sean’s closet and went to see Nero. Up until then, the wounded animal was lethargic, refusing food and not moving, despite the exquisite care of the veterinarian hospital and experienced K-9 handler. She placed the shirt under his head so Nero could pick up the scent from Sean’s shirt. Nero’s tail began to slowly wag; he recognized his deceased partner’s body scent. After Nero was released, the first thing that he did was go to Sean’s cruiser to find his handler. Nero was placed in the care of an experienced retired K-9 officer who had trained Sean and Nero as a puppy to work together before they went to K-9 training together. Sean, already an experienced K-9 handler because of his work with K-9 Thor in Narcotics Detection, was not only from his family, his department and his community, but also from his two K-9’s who would have died in Sean’s stead. That is the faithfulness, the intimacy, the love and duty between K-9 handlers and their K-9’s, all on behalf of public safety.

Everything happens for a reason.

NOT.

I’ve heard this mantra so many times. I personally believe that someone came up with that prosaic aphorism to make themselves feel better about the difficult things that inevitably occur within the time we spend on this earth. We expect some events to happen; others catch us by surprise and some shock us. Some trials are more caustic than others but whatever they may be, they leave their scars and wounds as the heart markers that life presents to us all, some more than others. That’s the Beatitudes in a nutshell. (Luke 6:20-23)

Nothing happens for a reason. Reasonable people may attempt to find the cause of a terrible things that happen to very good people. I say that it’s all part of life’s learning and may even become a gift (or in Luke’s terms, a blessing) if we allow the abysmal events to take our personhood in directions that we never thought possible. Life, with all of its coils and twines may actually open our hearts a bit wider to understand the travails of our fellow earthlings and turn the vile and appalling events into positive action for others. If I’ve said it once, I’ve said this one thousand times: the grace of God (translated: God’s love) is a powerful entity. When we lean on grace, we lean on love. The ultimate love. The love who became human to show us that we’re never alone. Ever. The trick for Christians is to become that love for one another now. We were born to belong to one another.

I told a friend whose son died at age twenty-one in Afghanistan, a Marine that the heaven-lined streets of good people (Christians call this the community of saints, named and unnamed), along with God's grace help us to act on behalf of others when we cooperate. Not everything happens for a reason. Life is life; there's a good and bad side. We take the bad and turn it into something good. That is the expectation from anyone who is born, lives life and dies.

There. I’ve said it.

I told my friend what I tell myself: our sons, who certainly died too young will never grow old, never experience illness, a broken heart and the myriad things that happen to us all in whatever time we spend on this earth. We can say that our loved ones are always with us and they are, more than we know, just behind a veil where we cannot see. We just wish we could see them one more time. That’s being human.

In any circumstance where life finds you, be it illness, grief, poverty, hatred, bullying, hungering for justice, praying to forgive those who hurt you, attempting to make peace with people who have no wish for peace but prefer power – this is life. Depending on how much we want to experience a change of heart because bad things happen to really good people is entirely our decision. Trying to find the reason for everything that happens is a waste of time and energy. Things happen. How will we let what has happened change us into better people for the greater good?  

 

Thursday
Mar052015

Moral Matters

She watches the steady stream of russet refuse flow from his nose through the nasogastric tube into a plastic bag at his bedside, a sewer pipe emitting a cesspool of refuse that his hoary 92-year-old bowels does not permit him to release. “They had to pull it out and start again last night,” he tells her. He looks straight ahead, remembering. “Awful.”

Canary-colored urine streams from a catheter in his bladder. Liquid nutriments run from another bag through a different tube into his veins to correct his dehydrated condition and electrolyte abnormalities. Her fingers touch the purple bruises where the lines sink into the top of his hands that link him to life. “They have a hard time finding a good vein,” he tells her and shrugs. “Whatdaya gonna do?”

She averts her eyes from the tubes and bags and looks through the large picture window of his hospital room. From his bed, he can see a vista of urban dwellings that stretch beyond the clumps of leafy treetops to a view of the seaport that widens from the harbor that give passage to the Cape Cod Islands. He watches the island ferryboats transport the hoard of summer tourists from the mainland to their destinations and relishes the view of the fishing vessels as they leave the port. She marvels at his ability to point out and distinguish the scallop or lobster boats from the trawlers, the difference between the clammers from the longliners and gil netters. “Lots of activity out there,” he comments. “If this weather lasts, they’ll go far out to sea for their catch. How much does a peck of clams sell for now?”

She smiles and remembers the smell of low tide that wafted from the ocean’s edge to cool the family and friends who gathered and broiled under the sun, eating their way through a Sunday afternoon in the backyard as he served them all in a white apron and chef hat. Pecks of fresh steamers and little neck clams, individually wrapped chunks of white fish, husks of sweet corn, Portuguese linguica, steamed hot dogs and red bliss potatoes out of a colossal pot that never seemed to reach the bottom found their way to the picnic tables that held pots of melted butter and empty dishes for the clam and paper spoils. No one ever left hungry.  Anyone who sniffed the tantalizing aromas from the street and “stopped by to say hello” was welcome to dig into the abundant New England feast and drink in the salty scent of ocean where the feast originated. The banquet that he produced not only fed his voracious appetite for good chow: he drew deep pleasure from the joy of feeding others. His present fate now strikes her as cruel.

“About $25.00 a peck,” she tells him. He shakes his head. “Ya gotta be a millionaire to give a clam boil these days.”

His excrement continues to flow from his nose to its own sewage port. She remembers her astonished discovery at the profuse amount of human excrement the colon stores and emits when her mother emptied her bowels as frequently as a new born infant throughout the final week of her life. After ten years of advancing dementia due to a stroke that turned into Alzheimer’s Disease, Type 2 Diabetes, repeated hospitalizations for pneumonia and falls despite the safety of the new in-law apartment attached to her home and round the clock care, a visiting nurse indicted that it might be time to consider other options when her mother became barely responsive. “Let me call Palliative Care; she’s in a really dark place.” Her father attempted to digest the news. Although he had participated in the ongoing care of his wife, he could not believe that she would slide off the mountain before him. “She’s eight years younger than I am,” he wept. “How is this possible?” 

He always chuckled that he had ‘robbed the cradle’ when he married her as a young 21-year-old bride. Four children were born; three survived. Late stage toxemia stole their first son and almost claimed her life as well. But she did recover, caring for her husband and their three children born soon thereafter, managing the household, joining school boards and church auxiliaries as her community service. Later, when more income was needed to pay for all the private school tuitions, she returned to work as an accountant, a field she loved and excelled in because of its precise and exact nature. Although she had no desire to lead, she became a loan accounts manager in her bank until progress merged smaller banks with larger corporate structures and longer travel distances. Still, she loved to ‘crunch those numbers’ and continued to travel long distances on a commuter van that the bank provided. Together, they cared for her widowed mother and unmarried sister.

When a second son died in his early twenties, they buried their broken hearts in the vaulted coffin and helped their son’s young widow to raise their granddaughter. His profound deafness decreased his chances at hearing beyond a one-on-one conversation. She accompanied him twice a week for five years throughout his training period as a permanent deacon, sitting in on the class lectures after a long day of work and returning home to type his notes so that he could study what he had missed in class lectures.

After a debilitating stroke affected her short-term memory, they found the humor within the dire. “What did she say?” he would ask her when he missed someone’s comment. “I don’t know, I can’t remember,” she would answer with a musical laugh that sounded like the sweet tinkling of sleigh bells. But illness staked its claim on her humor; she laughed less frequently and finally not at all. Her sentences became phrases; phrases became words; words turned into grunts and sighs. Medications and a restricted diet altered her taste; food no longer interested her. An icicle melting drip by drip from a snowy roof, she grew more diminished day by day. Still, the question posed by the Hospice nurse during a vitals home check still caught them off guard.  

 “Do you want to stop taking the medications that are keeping you alive and go into comfort measures only?”

The immediacy of her mother’s wordless nod prompted her to think that she didn’t understand the question. “Do you understand what that means?” she asked her mother. Again her mother had nodded, this time adding “Oh, thank God I don’t have to take all those pills anymore. They make me so cloudy.” That was that. Question asked and answered. No fanfare or trepidation, just a neat and tidy decision, so typical of her mother, as though she were putting the last finishing touches on a birthday package and giving it to some lucky recipient. Sign the paperwork and let’s get on with it. Clarity and appetite were last-hurrah gifts that returned for a few weeks until a sudden fall injured her spine and left her in excruciating pain.

Her mother’s last week of life taught her more than she cared to know about human excrement. Comfort measures included doses of pain-killing narcotics. The days of constipation were more painful than the injured spine relegating her mother to vomit refuse in a mouth basin while she sat on the toilet trying to push concrete through the colon.  “Why don’t you just kill me?” her mother asked her in between heaves of black defecation. When laxatives forced what seemed like an endless evacuation of poop, she found herself cheering for diarrhea that relieved her mother’s discomfort while the colon emptied faster than the speed of sound. Once the volcanic eruption began, so did the frequent bed changes. Lifting her mother’s death weight to change the chucks became an added challenge on her own broken spine. Her physical pain grew as intense as the emotional throb of caring for her dying mother in her home while simultaneously caring for her old dad. Exhaustion crept in like fog during a bad weather front, not to mention the malodourous smell of shit.

The stink reeked from the in-law apartment, seeping into her house and remained for days. She used salt on her hands to wash the scent that crept into her skin as she changed chucks and hospital bedding. Eventually, the odious scent disappeared from her hands but not from her memory. After her mother died and her father’s prostate and bowel problems required diaper changes with hand cloth washes, she remembered to wear latex gloves. We really do return to our childhood, she thinks as she surveys her father’s tubing. Suddenly, life is all about bodily functions.

She knows that she should eat but watching his pipeline dials her appetite down. “I’m hungry,” he tells her. “How long has it been since I’ve eaten?” he inquires. “You declined food for four days at home because you were all backed up, remember?” she answers him. She can tell that he’s beginning to short circuit by how many times she needs to answer the same question as he keeps reviewing his event. “That’s why I called 911. You felt really sick and you weren’t eating.” He looks at her. “I thought I signed all that paperwork,” he tells her. His advanced directives included DNR paperwork; he had put them into place when he and his wife had assigned her as the executor of their will and appointed her as their health care proxy. “That paperwork means that we can’t revive you if you’re heart stops but that doesn’t mean that we should let you suffer while you’re still here,” she tells him. “There’s a difference.” He nods. He understands. He sways begin regret and gratitude. The question looms in the not far off distance.

“How long have I been in the hospital?” he continues, trying to measure his appetite against the duration of his illness. “You’ve been here for four days,” she tells him. “You haven’t eaten anything in eight days.”  His eyebrows lift. “Long time,” he counters. “No wonder I’m hungry.” He pauses for a moment and asks, “I’ve had a lot of tests in the last few days. Has anyone said why can’t I move my bowels? Has my prostate cancer moved into my bowels?” She tells him that there could be a lot of reasons for his current back up but no one has given them an answer just yet. She doesn’t have the heart to tell him that she thinks that years of inactivity and his old age are huge contributing factors. “If you start to eat again before you’re colon is empty and you still can’t move your bowels, you’re just going to back up again and be in the same situation that you’re in now. One step at a time; we’ll figure this out.” He sighs and nods. “Are you still cleaning out the house?” he asks.

His 85-year old sister-in-law died several months earlier. Clinically depressed with a narcissistic nature, her inability to eat and persistent cough turned out to be congestive heart failure resulting in a two-week hospital stay in the Progressive Care Unit, where patients normally stay for only several days before they’re moved to a regular floor. The series of events that led to the two-week stay could be described as a norm for people who deny their mortality, refuse to face realities that have everything to do with them but in their minds, nothing to do with them and try to stave off the inevitable.

When the cardiologist suggested open heart surgery, her 85 year old aunt felt a surge of hope that she might live to be 105. Because the physician had privileges within this particular health system but was actually aligned with another, he recommended that the surgery take place where his own health system was aligned and a long distance away rather than the health system that she knew and was local to the patient and family. Mustering the hutzpah to face the dragon, she invited the cardiologist into the corridor outside the room and dared to question the acumen of his decision. “Do you really think that putting an 85 year old woman through this kind of surgery and then months of rehabilitation with a doubtful outcome is wise?” He looked at her with disdain. “This is fatal,” he sneered in a terse, laconic kind of way. She was dumbfounded at his insipid perspective. Is this guy for real? Was he honestly encouraging this sick old woman to undergo a surgery that she probably would not even survive? Was it a power issue? Maybe he just expects that his patients will never die, no matter how sick and frail they become, she thought. Talk about costly denial and then realizes that she’s been persuaded into the camp of natural outcomes with dignity verses alteration of human life. What about post-op outcomes, the possibility of infection, grueling physical therapy, not to mention where she would live upon release from skilled care? She was fairly certain that the cardiologist had no idea about his patient’s Hoarder Hell home; her aunt was as secretive as an animal in the African Bushveld. She wondered if the cardiologist really even cared about anything beyond the science of his patient’s personhood and knew that any further dialogue was pointless.

She invited a surgeon that she knew and respected and assigned to her aunt’s case into a frank conversation regarding the state of his patient’s mental health. She came clean about her aunt’s mental health, Hoarder Hell and the menagerie of potential disasters that would face her aunt if she decided to go through with the surgery. She beseeched him to persuade her aunt not to have surgery, to not to be afraid to ask the question. Everyone else seemed to be in denial; she needed an advocate on the side of common sense. He agreed; she took her first deep breath in very long time. He spoke candidly to his patient. “If you were my mother, I would tell you not to have this surgery,” and counseled her in that direction, kindly, sitting on her bed and holding her hand. Her aunt had sent him away with a polite “Thank you for your opinion” and called her back to her bedside. “I trust the cardiologist; he’s the one that I’ve seen since this problem started and he’s the one that has my best interests at heart. I just keep worrying where I’ll go if I can’t go back home after the surgery. It’s quite a mess in there,” she mused, casting a sidelong glance her way as the first-ever admittance that there might be a bit of problem in Hoarder Hell.

No one had been permitted into the first floor of the home for years, including her parents who owned the house and occupied two floors above Hoarder Hell. “You can’t even get into the house,” her parents told her before they moved into the safety zone of their new in-law apartment. “She has to push her way through a ten-inch crack between the door and the house to get in. We have no idea what’s in there; we just know that it’s a mess.” They accepted some of the responsibility for Hoarder Hell, caving under her aunt’s infamous tantrums and enabled her behavior until it was out of control. Even if her aunt did recover from surgery, social services would never let her return to those living conditions. She would die of an infection from filth and trash that filled the house. Moreover, services for the elderly would claim that the family was not providing good care and threaten to report them to the state. The family had learned that lesson from one her husband’s widowed aunts for whom they had cared for many years.

When her husband’s old auntie’s health became more than they could manage, her husband suggested that she move into a comfortable assisted living facility. His aunt refused. Despite their frequent visits when she needed food or rides to her appointments or someone to help clean the house, the aunt grew senile and began to wander from her apartment in a state of growing confusion, roaming the streets and becoming disoriented and confused. Neighbors reported his auntie’s wanderings to a local senior agency who called her husband. He hired a private nurse to stay with his aunt during the day; the aunt’s went to bed early and slept all night. During the day, the nurse took a nap when she thought her patient snoozed. Elder foolery taught her otherwise. Auntie escaped while the day nurse slept and continued her vagabonding until the police would find her and return her to the distraught caregiver. The local senior care services threatened to file a report against her and her husband for elder abuse. Completely worn out from his auntie’s demanding ways, her husband activated his legal guardianship, deemed his aunt incompetent to make her own decisions and admitted her into a nursing home facility. She had ranted and raged, wept and pleaded to come and live in their basement but finally acclimated to her new environment with the help of the facility’s competent staff. After several hospitalizations for elder issues, the auntie simply stopped eating. No one could induce her to even sip water. Her will to live ceased. She died about a month later of natural causes without anyone ever having to ask the question. Now they braced for another attack as another single aunt faced the firing squad.

 “They just told me that now I have renal failure,” her aunt told her when she walked into the room. “What does that mean, exactly?” Had no one from the hospital staff explained the severity to her or had her aunt pretended to understand the severity of this new development? She decided to steer the ship straight into the harbor. “If you have heart surgery and survive it, your recovery will be very hard and include an extensive stay in a long-term care facility.” She did not add that Hoarder Hell would not pass health inspection for a post-operative patient. No one would approve sending her aunt back to four floors of the magpie mansion that included five generations of stuff that had never been cleaned out.

She forged on. “Even if you recover after a long haul, you’ll be on dialysis for the rest of your life.” A furrowed brow appeared between her aunt’s anxious eyes. “Dialysis….what is that?” she asked. Her aunt’s ignorance about the severity of her own condition caught her off guard. For years, her aunt had worked closely with health care providers in her job and volunteered for several hospital systems over the past fifty years. I guess we’re really never are too old to learn, she thought.

“Dialysis means that you’ll be hooked up to a machine to empty your kidneys because they no longer function on their own.”

White noise followed for what seemed an interminable amount of time. Her aunt broke the silence. “If I decide not to have the surgery, that means I’m going to die. Is that right?” A nod confirmed her aunt’s mounting and visible panic. “Well why can’t I die here? I like the people, it’s comfortable and everyone has been so wonderful. Why do I have to move? That means that I have to get used to another new place all over again? Oh my God…” Her vocal crescendo rose with each sentence. Rule adjustment served her as a lifelong cornerstone; she honestly believed that she was beyond most laws and regulations. Hell’s bells, she thought. Why should this day be different than any other?

“Well, this is hospital, where people come to get well. This is not a hotel. You’ve been here in a cardiac unit for two weeks when the usual stay is only several days. You’re holding up a bed because you can’t make up your mind about what to do on your own behalf.” Carpe diem, she thought. What better time to pose the question. “You have to make a decision. No one can make it for you. What do you want to do?”

Her aunt selected a nursing home facility that included Hospice Care and signed the hospital release forms within the next hour. Ten minutes later, a team of nurses arrived to pack the aunt up and load her onto a transport that would free them of their exasperating patient. Their expeditious confiscation stunned her aunt. “My God, I just signed the paperwork and they’re here throwing me out,” she declared. “Don’t I get a few more days to digest all this?” Aghast with a look that said, “How can anyone treat me this way?” she arrived at the nursing home in a state of such deep anxiety that she clung to a night nurse for most of his night shift, terrified of her impending fate. Renal failure caused her to break out into a histamine rash from the roots of her hair to her toes. She continued to cough up mucus and tried to push food down her throat that she immediately vomited in a swash bucket at her side. “I have to try,” she insisted. She declined all comfort medications because “I want to know what’s going on,” clinging to a minute to minute face off with death with her fist up and ready for a knock down draw to the end.  

She watched the horror mount as this tiny pugilist fought against the inevitable. At the end of her life, her aunt was sleeping with the enemy of her own self-absorbed existence. “No one knows what this is like until you get here. I’m so afraid. I haven’t been perfect,” she said with terrified eyes that defined the underbelly of her entire psychotic existence. Several days later, she went down for the count, allowing comfort medication for the last 24 hours until she went into a coma and died in the presence of a caregiver.

After following her aunt’s instructions for her prearranged wake and burial (“I gave myself a really gorgeous funeral. Order the best food for lunch.”), she began the attack on Hoarder Hell and ended up with cellulites in her right leg from standing in filth and mountains of debris for hours at a time. Weeks turned into months. The episode catapulted her over the precipice of thirty-some-odd years as a care giver for a procession of aging relatives. Together with her husband, they had tended failing bodies and diminishing minds with the plethora of medical services that accompany the elderly, the sick and the dying. They attended to their spiritual and religious needs, moved them into care facilities, renovated their own home, altered their lives and their children’s lives to accommodate the needs and cares of a community of their elders who relied on them for everything. They cleaned out all the clutter from a plethora of their houses and bore the responsibility for the tangled web of business transactions and mounds of paperwork that surfaced even after dandelions grew on the graves of the dead.  

A tick of bitterness sticks its nasty tentacles into her skin that kicks off a rolling river of emotions. For the first time in her life, she understands burn out. On some days, exhaustion morphs into depression; she feels as though she will die before her father. She wonders if Ponce de Leon ever imagined that a copious desire for a fountain of youth could cause such a tsunami of questionable ethical accountability and inevitable fallout of philosophical disparity within the practice of American health care. Moonstruck’s famous line “Because they fear death” becomes her favorite mantra and motto. “Thank you for answering my question,” Olympia Dukakis exclaims. Four months into the task of purging Hoarder Hell, she answers her father’s question about Hoarder Hell.

“Yes, I’m still cleaning. Unless I’m here visiting you, I’m cleaning out years of stuff in suffocating heat. The windows haven’t been opened in so long that they’re sealed shut. They’re no air so I have to wear a mask to breathe because the dust is really bad for my asthma.” He looks at her as though she has five heads.” She forges on. “Her attorney wants me to move the process along so he can sell the property and close her estate.” She wonders how he can be so obtuse; he enabled some of this havoc by not putting his foot down with his incorrigible sister-in-law. “She ruined our lives,” he admits. She wants to tell him that now he was ruining hers but kicking the horse while it’s down seems cruel. A nurse checks his vital signs. “I miss food,” he grins. He rubs his whiskers. “I should be careful how much I eat; I need to lose weight. Maybe I’ll drop a few pounds when this is over.” She laughs with the nurse. The battle of the bulge isn’t over until it’s over. “Dad, I think that you should just eat whatever you want and not worry about that anymore,” she laughs. “That sounds good to me!” cheers the nurse with a wink. The corners of his mouth twist into a small grin. Permission to cheat granted.

A hospitalist enters the room. He reviews test findings on his computer. “He’s quite debilitated and will require skilled care upon release,” the physician murmurs quietly to her. “Someone will be in to talk to you about choosing a facility.”

“What did he say? Can I eat soon? When can I go home?”

He relies on her to interpret everything that his profound deafness prohibits him from hearing. She tells him the truth: he will require an unanticipated detour upon release from the hospital. Her candor takes him off guard; he wants to return to the apartment that adjoins her home, where he helped to care for her mother through dementia, where she died 10 feet away from him in a hospital bed placed near the double bed that they shared for 60 years of marriage. He had so hoped to follow her soon thereafter. The card on his flowers that sat on the top of her casket read, “I’ll see you soon.” Four years later, he may have his chance to join her soon.

The physician now faces his patient. “Sir, now that your colon is empty, you can begin to eat food again. We’ll pull that line out and we’ll bring you a meal.” Her father’s toothless smile that beams across his face reminds her of the man in the moon when he understands that this nasal tube torture will soon end. “Great!” He chuckles with the delight of a young child who has just been told that he can have ice cream for dinner.

The physician pauses and weighs his words before he speaks his next words like a prophet heralding the end of an era. He sits directly in front of her father. “None of the tests indicate a specific medical issue that’s causing your bowel obstruction. Perhaps the condition is caused by others – declining heart function, perhaps prostate cancer, advanced years --- it’s difficult to say at this point. The main thing is that we want to keep you comfortable so this will not happen again when you begin to eat food. We will try a new bowel protocol to keep everything moving along.” The physician looks satisfied. He has covered all his bases.

She looks directly into her father’s face and speaks slowly. “Do you understand what the doctor is saying?” she asks him. He nods but she can tell from his absent look that he will ask her to interpret what he has just pretended to hear in his profound deafness. He can only focus on his taste for real food and the promised meal that will arrive very soon. She knows that he does not comprehend the physician’s words.

She mentally checks off the growing list of his illnesses. Bowel failure. Kidney failure. Advancing prostate cancer. Congestive heart failure. An aneurism behind the left temple. Although he has three different hearing aide devices, he must read lips to hear anything out of his partial good ear. She suspects that the big dark brown warts on his forehead that remind her of broiled skin on a plump rotisserie chicken will soon rear its ugly head and turn into squamous cell carcinoma. His wife and two sons have died and his youngest son lives on the other side of the country. ”Vous serez le porte à ma vieillesse,” he used to tell her as a child. She wonders how he knew that she would be the only one available to serve in the capacity of the doorway to his old age. Now they stand together in front of two portals; he will elect to walk through one of them. The elephant has officially entered the room.

She waits for the physician to pose the question that evinces on a marquis in bold block letters behind her eyelids. Her father’s choice of doors will decide his fate; who will ask what only he can determine? The question percolates inside her mouth. She wonders at her own motives. Is the question a ruse to jump-start his spiral downhill? Will he choose to be a turtle or a hare to the end of the finish line? She shakes off the guilt; the question is ethical and humane. Does she want the physician to ask the question to get her off the hook and ease her conscience, like a get-out-of-jail-free card?  The elephant in the room swings its trunk like a pendulum while she waits for the physician to ask the question.

It comes as no surprise to her that the question never emerges from the doctor’s lips. She’s weary from venturing where many physicians do not seem willing to fly. She knows that she must chart the course yet again.

 “Dad, you’re too sick to go home. You need to go to a nursing facility for rehabilitation. We’ll have to wait and see how you do little by little. Your body seems to be shutting down.” She pauses as he processes the information and then dives into the deep end of the pool. “Do you want to go off of your medications and go into comfort measures, the way Mom did?”

The question detonates like a silent explosive in the middle of the room.

The physician appears flustered. Her curve ball knocks him off base and she knows immediately that she stands on the opposite side of the physician’s invisible fence. Science and ethics in conflict create problems for patients and their families. The thought charges through her head like a horse galloping through a copse of trees. She almost expects someone from offstage to call out “Lights! Curtain!” to close this scene of the play that the actors script as the drama continues to unfold.  

 The question causes her father’s expression to turn from the fear of what lies beyond the portal of one door to resignation of what lies beyond the other. She waits. The elephant’s trunk stops its pendulum sway as she waits for his reply. 

“I’ll stay on my medications,” he answers.

She places her hand on his shoulder to brace herself for the road that he chooses for both them both.

*** 

Dignity of Moral Conscience

"Deep within their consciences men and women discover a law which they have not laid upon themselves and which they must obey."

"Conscience is the most secret core and the sanctuary of the human person. There they are alone with God whose voice echoes in their depths."

"By conscience, in a wonderful way, that law is made known which is fulfilled int he love of God and of one's neighbor."

"Through loyalty to conscience, Christians are joined to others in the search for truth and for the right solution to so many moral problems which arise both in the life of individuals and from social relationships." 

"The more a conscience prevails, the more do persons and groups trun aside from blind choice and endeavor to conform to the objective stadards of moral conduct."

from Church in the Modern World ((Gaudium et Spes), #16