Rev. David Herndon
First Unitarian Church of Pittsburgh
February 21, 2016
When I was in theological school many years ago, I was fortunate to have the opportunity to complete my internship at the First Unitarian Church of Portland, Oregon. Part of what that year a richly satisfying experience was working with my internship supervisor, Rev. Alan Deale, and the wonderful congregation he served. But another attraction was being able to live in the natural beauty of the Pacific Northwest for a year.
From Portland, Oregon, you can see three volcanoes: Mount Hood, Mount Adams, and Mount St. Helens. When I was there during the 1985-1985 church year, local residents were still talking about the enormous volcanic eruption of Mount St. Helens, which had taken place only a few years before on May 18, 1980. Mount St. Helens is just fifty miles from Portland, so the local residents had a front-row seat. They watched the ash cloud climb fourteen miles into the sky. They observed the summit of the mountain drop by thirteen hundred feet. They heard about the destruction of wildlife and natural habitat. They learned about the economic cost of $2.89 billion. They witnessed their neighbors in Washington State digging out from the ash, an arduous process which took months. And they were saddened by the death of approximately fifty-seven people.
One of the more interesting personal stories to emerge from the eruption of Mount St. Helens was that of Harry R. Truman, who was the owner and caretaker of the Mount St. Helens Lodge on the shores of Spirit Lake at the base of Mount St. Helens. He had operated the lodge for fifty-two of his eighty-three years. With a bravado somewhat akin to that of the climate change deniers of today, Truman refused to comply with evacuation orders, claiming that the mountain posed no threat to him. For six weeks, while Mount St. Helens provided unmistakable signs of its impending eruption, Truman became a folk hero, steadfastly standing his ground as the big volcano rumbled nearby. Reporters interviewed him. Schoolchildren sent letters to him. But when the mountain finally exploded, Truman and his lodge were buried under approximately one hundred and fifty feet of ash and rock – about four times the height of our Sanctuary.
One might view Truman as some curmudgeonly stubborn ornery fool who did not have the sense to preserve his own life, not to mention the lives of his sixteen cats. But there is also a more sympathetic way to understand him. One of his friends said, “The mountain and the lake were his life. If he'd left and then saw what the mountain did to his lake, it would have killed him anyway. He always said he wanted to die at Spirit Lake. He went the way he wanted to go.”
Nowadays at the Mount St. Helens National Volcanic Monument, Truman Trail and Harry’s Ridge serve as a kind of memorial to his insistence on being the author of his own life.
What would you have done if you were one of Truman’s children? What would you have done if you were a public safety official responsible for evacuating residents from the area? Would you have forced Truman to get out for his own good? Or would you have just left him there?
Many individuals and families struggle with this kind of question. The context may be less dramatic than a smoldering volcano in the back yard, but the challenge is similar. Is it safe to stay at home? Has the time come for moving out of one’s beloved and familiar home and into an institution of some kind? And if safety is not the highest priority, then what is?
In his book Being Mortal: Medicine and What Matters in the End, surgeon and writer Atul Gawande offers this observation: “We want autonomy for ourselves and safety for those we love.”
Ten days ago I encountered this tug-of-war between competing values when I visited one of our church members in the hospital. I arrived at Carole McNamee’s room at Mercy Hospital at about three thirty in the afternoon. I had previously visited Carole at her home, at Shadyside Hospital, at Mercy Hospital on another occasion, and at the Heritage Rehabilitation Facility in Squirrel Hill. We spoke, and Carole listed off several things she was dissatisfied with. One of them was that twenty-three hours and forty-five minutes each day unhappily enduring her hospital stay while she waited for just fifteen minutes of physical therapy. It made no sense. The benefit seemed hardly worth the discomfort. It was no way to live. And so Carole had given notice that she was checking herself out of the hospital. Yes, checking herself out of the hospital, against medical advice.
I was somewhat taken aback. I had never encountered anyone who had checked herself out of the hospital against medical advice. Can one even do that, I wondered to myself. Carole told me that she had already asked for transport to the hospital lobby, and she was now just waiting. A call came on her cell phone from a family member. Distracted and agitated, Carole announced to the caller that she was indeed going home. The transport hospital staff member arrived, but Carole was still on the phone. After a few moments, the transport hospital staff member left. Eventually the phone call ended. I helped Carole gather up her belongings, and another hospital staff member helped Carole get into a wheel chair. We went out into the hallway to wait for the transport hospital staff member once again. Carole’s physician stopped by and asked Carole if she was sure she wanted to do this. He did not think it would be safe. He asked her to consider the risks. But her mind was made up. So the physician wished her well and went on his way. At that point I felt that I was on safe ground – that is, if even a physician could not force Carole to stay in the hospital, I was probably not going to get in trouble for accompanying and assisting Carole in her ardent quest to go home.
The transport hospital staff member arrived and we went down the elevator and found a courtesy phone where Carole could call for a taxi. She waited for a while, then in frustration hung up the phone and called again. Finally she got through. A taxi would arrive within thirty minutes. We all went down another elevator to the hospital lobby. It was almost four-thirty. The transport hospital staff member’s shift ended at four-thirty, but she dutifully waited for the taxi to arrive. When I saw the taxi’s reflection in a large glass window, I quickly walked outside and called it over. By that time Carole and the transport hospital staff member had also come outside. Carole had no money and no credit cards. Carole did not even have the key to her home. She had said that the taxi driver would simply have to wait while she retrieved the key from its hiding place and then entered her home to find money for the taxi fare. The good-natured taxi driver put Carole’s walker in the trunk and helped her move from her wheel chair into the rear seat of the taxi. I told Carole to call me if she encountered any problems. Then the door closed and the taxi moved away and Carole went back to her beloved and familiar home in Highland Park.
I spoke with Carole that evening and she assured me that she had found the key to her house, that she had paid the taxi driver, and that she was doing just fine.
Two days later Carole had a cardiac arrest and went back to Shadyside Hospital where she died peacefully while surrounded by family and friends from her First Unitarian Church covenant group.
“We want autonomy for ourselves,” wrote Atul Gawande, “and safety for those we love.”
Had I not read these words just days before visiting Carole, I probably would not have understood as clearly her insistence on checking out of the hospital, against medical advice, and going home. I probably would not have understood as clearly that although we want autonomy for ourselves and safety for those we love, those we love also want autonomy. Those we love also want to be the author of their own lives.
As Unitarian Universalists, we promise to one another that we will affirm and promote the inherent worth and dignity of every person. Perhaps one dimension of that inherent worth and dignity is personal autonomy in the later stages of our lives.
In the reading we heard a few moments ago, Atul Gawande wrote that “our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer . . . our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life.”
Among the many helpful insights that Atul Gawande provides in his book is this reasoned insistence that we do not stop being ourselves simply because we have lived for many years. The infirmities that usually accompany aging are not abnormal or unnatural; rather, they are part of the life cycle. Thus, we ourselves do not become abnormal or unnatural in our later years; as the poet Tennyson said,
Though much is taken, much abides; and though
We are not now that strength which in old days
Moved earth and heaven, that which we are, we are.
No matter our age, no matter our infirmities, that which we are, we are, which is to say, still human, and thus still hungry for having meaning or purpose in our lives.
Atul Gawande tells of a nursing home in upstate New York where the medical director had observed a widespread lack of liveliness among the residents. To counteract this, the medical director decided to introduce one hundred parakeets into the nursing home, one for each resident. Dogs and cats and live plants were also introduced. Here is what the medical director said: “People who we had believed weren’t able to speak started speaking. People who had been completely withdrawn and nonambulatory started coming to the nurses’s station and saying, ‘I’ll take the dog for a walk.’” Atul Gawande also reports: “All the parakeets were adopted and named by the residents. The lights turned back on in people’s eyes.”
What had been missing for many of these residents was a sense of meaning or purpose or connection or enjoyment beyond simply going through the motions of living.
In our younger years, we often focus our attention away from where we are, looking toward exploration and achievement and adventure and new experiences for meaning and purpose. In our later years, however, we may find that our attention is drawn closer to where we are, and we may find meaning simply being with familiar people or being in familiar places.
Many of you know that one year ago, my parents moved here to Pittsburgh from their home in the mountains of Virginia. The decision-making process was not simple. My parents themselves had struggled with the autonomy-versus-safety puzzle. My father in particular had also experienced challenges with regard to physical problems interfering with some of the hobbies that he had long enjoyed. They had actually concluded that the time had come for them to move out of their beloved home which they had built themselves forty-seven years earlier and move into some sort of retirement community or assisted living facility. Then my dad got very sick, including a systemic infection. One of his doctors had even gone so far as to write on his chart, “Mr. Herndon is gravely ill.” Cindy and I had numerous conversations about how to proceed, and eventually we decided that it would be best if my parents came to live in Pittsburgh. That decision has had its minor but persistent challenges; no solution is perfect. But that decision has also had many rewards. If we are not three generations living harmoniously under one roof, at least we are three generations living in one city, and we certainly have had more time together than we would have had otherwise. Like Harry Truman on the shores of Spirit Lake at the base of Mount St. Helens, my parents might have prized their autonomy at all costs. But there are many different ways to have a sense of autonomy, a sense that one is the author of one’s own life, and there are many different ways to have a sense that it is worthwhile to keep one’s own life story going.
For all of us, whether we are getting up in years ourselves, or whether we have loved ones who are getting up in years, when it comes time to make decisions about where to live, or about medical treatments, let us place at the center of our decision-making process the importance of having meaning and purpose in one’s life. How that works will be different for different people. For many people, meaning and purpose will mean participating in or contributing to something larger than ourselves, whether that is taking care of a parakeet or advancing some cause. For many others, what makes living worth living may simply be, as Atul Gawande reports, being able to eat chocolate ice cream and watching football on television. But in our world today where we can prolong life almost indefinitely through medical technology, and where we can provide safe environments for those who need assistance in living, let us pay attention to that spark of life, that aim or mission or reason or connection that keeps the little wheel turning in our hearts. And if you would like to see how well that can work out in practice, just look around at the elders in this congregation.
© 2016 by David Herndon