In the Living of These Days

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Nothing has made me more appreciative of being alive every day than being a hospital chaplain to the sick and dying.

I am now retired. Yet I see it on television – the anxiety and fear of physicians, nurses, respiratory technicians, and others who contend with shortages of essential medical equipment. The Bioethics Committees of medical centers across the country are contending with the need to ration Coronavirus tests. One of my former colleagues now directs the University of Pittsburgh Program on Ethics and Decision Making in Critical Illness. They have created a policy for rationing ventilators. Simply put, the youngest with the best chances of survival will get this life support, while some of the oldest with co-morbidities will not. We must now face that we are rationing health care.

You may consider this to be unthinkable, but we have been rationing healthcare for years. Organ transplant committees have been deciding all along who will receive hearts, lungs, livers, and kidneys – and who will not. There are not enough donated organs for everyone on the transplant lists. That is rationing.

We also see rationing by wallet biopsy. Treatment is sometimes withheld from cancer patients who have no care-givers at home or no health insurance or inadequate coverage, and instead of receiving treatment, they are discharged from the hospital to go home to die. These patients are poor. They cannot afford expensive treatments on their own, and there are only so many beds in public hospitals and not-for-profit hospitals in the U.S. We might have the most expensive healthcare system in the world, but it is not equitable.

In the midst of this pandemic, some of my younger friends are facing their mortality for the first time, as they see reports of people their own ages dying quite suddenly. I understand their disbelief and shock. Yet, if we talk with the Kupuna (Hawaiian word for elders), we can learn about the fragility of this precious life. The Kupuna have known wars and serious illnesses and accidents. They carry the grief of having lost people they love. Some of us do know this tragic side of life. Soon, more of us will know it. 

Hildegard of Bingen, the twelfth-century Christian mystic, said we need to fly with two wings of awareness. One wing is an awareness of life’s glory and beauty. The other is an awareness of life’s pain and suffering. We cannot fly with only one wing. Both are needed for us to appreciate life fully. May we all grow in awareness as we help one another in the living of these days.   ~~~

– Michele Shields is the Director of Spiritual Care Services Emerita and Research Scholar at the University of California San Francisco Medical Center. She is a member of Honolulu Friends Meeting (PYM).

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