In the Midst of Life

by Jennifer Worth

  Christmas is not a good time to have your mind burdened with such thoughts, nor is it a good time for communication. I tried several times to contact Helga by telephone, but the line was always unobtainable. I resolved to do my best to contact Eugen.

  We have a friend, Carole, who speaks German. She agreed to write to Eugen on my behalf, telling him all that I knew, and sending him a copy of her last letter to me. I am sure he had no idea of her intentions. We agreed not to post the letter in the middle of Christmas and New Year festivities, but to send it in early January, three weeks after Helga’s letter of 14 December. I did not know Eugen’s surname, nor his address, so the letter had to be sent to Helga’s apartment, with no more than his Christian name on the envelope in the hope that he would find it. I also wrote to the director of the company for which she had worked for twenty-eight years. Though Helga had retired long since, I felt there might be someone who still knew her. Then I waited.

  I waited, but no reply came.

  After our Paris days, Helga and I seldom met, but our friendship continued through our letters. We both enjoyed sharing news and views, ideas and reflections. Grieving usually involves going back over the past. I could not visit the place where Helga had died, so I found pleasure and relief in writing several letters to her, as we had done over the years, although I knew there could be no reply. Here are some of the thoughts contained in these letters:

  Dearest Helga,

  In your earlier letter you say, ‘I hope you understand, in spite of religious doubts.’ Of course I understand, dear brave Helga, struggling with burdens you no longer have the strength to bear, knowing that things can only get worse. But: ‘in spite of religious doubts’? There I am not so sure. I have doubts aplenty, but they are not based on religion, because there is no religious teaching on the subject. As far as I am aware, none of the world religions – Christian, Muslim, Hindu, Jewish – or any philosophical teachers of any era can help us. What did Socrates or Aristotle have to say? Or Jesus Christ or Mohammed? Nothing. They had plenty to say about death, but not about man’s ability to prevent death. We are entering a new phase of history and we cannot look to the past for guidance. Religious teaching has to adapt and find a new way. No, Helga, I do not have doubts because I am a Christian. And if anyone starts telling me they ‘know the mind of God’, I think I will scream!

  You also said, ‘In my opinion life in age becomes more and more fearful and painful and death is, for me at least, a hopeful aspect.’ These are beautiful and inspiring words, especially as you have always said you do not consider yourself to be a true believer like Eugen (a Catholic) or me (an Anglican). I am sure that your attitude that death is a hopeful prospect is echoed by millions of people worldwide.

  Of course, ten or twelve years ago, when you were around seventy, you could have died of cancer. When we were young girls, no one would have been surprised; after all, threescore years and ten was the span of life for mankind. But medicine saved you and you had ten more years of active and happy life. But now you say, ‘Life in age becomes more and more fearful and painful,’ and this leads to suicide. I hope and pray that all went smoothly for you on your last journey, and that none of my worst imaginings came to pass. I wish you had had someone to accompany you, just to make your journey easier … but…

  Dear, lovely Helga, you have always been an inspiration to me, and I lament your passing and grieve for your suffering, and hold you in my prayers with love and memories of youthful happiness.

  Rest now in peace eternal. Jennifer

  Helga was a very considerate and thoughtful person. She wanted to die and she was determined not to trouble anyone. These desires are entirely understandable, and I have heard many people say something similar. Yet, in acting as she did, she has probably caused more turmoil than she could ever have anticipated. For those left behind, the knowledge of suicide is harder than any other death to get over. Shock, grief, guilt and bewilderment are all mixed up in the mind. An endless cycle of self-reproach is common – ‘What could I have done? Where did I fail?’ Even I, hundreds of miles away, feel this. What must it be like for Eugen? Helga told me that she wanted him to have a new life with a new partner, but, in fact, she may have inflicted a wound that could trouble him for the rest of his days.

  Helga’s fault was secrecy, but even that is understandable. No one talks about death, and she felt unable to discuss her fears and intentions with Eugen who, she had convinced herself, would be shocked and try to stop her. It is easy to imagine that she could not bring herself to raise the subject, even though, dozens of times, she may have wanted to. She was trapped in the taboo, which is as strong in Germany as it is in England. So she took her last steps alone.

  IN THE MIDST OF LIFE WE ARE IN DEATH

  Much of this book is dark and dreadful, and the reader could be forgiven for thinking I must be a miserable old stick, best avoided. Hotly, I refute the allegation!

  It is true that I have contemplated death throughout my life, but not negatively. In fact, it has been the spur and stimulus of all my many activities and interests – life is short, enjoy it while you may. If you cannot envisage your own death, how can you enjoy life? Or, to put it another way, it is impossible to live life to its very fullest if you fear death, which is our certain end.

  ‘It is finished,’ were Christ’s last words from the cross. His life’s work was done and he could say ‘Into Thy hands I commend my spirit’.

  Old age has been kind to me, so far. The years are short and getting shorter.

  I look at those I love so much and ask nothing more than to enjoy their company and do all the things I enjoy doing whilst I am still able. The very fact that I know that I will soon (how soon? Too soon!) not be able to do so much, gives these activities an added zing.

  2007

  Clonakilty Ballygarven, Skibbereen, the music of the language sings of ancient Celtic peoples. Ballybunnion, Maudawadra, Cap-poquin, Skull. Only in southern Ireland could such names be found, tiny hamlets existing for centuries amidst the hills, valleys, rocks and endless waterways. How much more beauty can the soul sustain, I mused as I cycled alone, every turn in the road revealing a new vista of sea and sky and estuaries and little islands, home only to seabirds. I sang to myself as I cycled amid the silence and awesome beauty of the Kerry coastline.

  It had been a long day, and some of the hills had been daunting. By five o’clock I was getting tired and looking forward to the hotel, a shower, and a good meal. The hotel was beautiful, perched on a cliff overlooking the Atlantic, about as far west as you can go, and it had every facility, including a gym, saunas, a massage room and an open-air swimming pool. I enquired about a massage and was told I would have to wait half an hour. Never mind, thought I in my folly, I will have a lovely cool swim first. The pool gleamed blue in the evening sunlight. I was hot and tired after a long day cycling, and jumped straight in.

  I was dead when they pulled me out.

  Apparently, I had been spotted lying at the bottom of the pool, not moving, and two men had dived in and got me out. They held me upside down by the legs, and shook me vigorously to get the water out of my lungs. Someone rushed into the massage room to alert the therapist, who came immediately. Whilst I was upside down, she thumped my back hard repeatedly. Then they laid me down, and the therapist started manual compression of the rib cage, forcing the heart to beat again. At the same time, someone else started mouth-to-mouth resuscitation, forcing the lungs to function. They continued in this way until a weak pulse could be felt.

  Half the residents and staff of the hotel were now crowded round. I was breathing and coughing, but still unconscious, so someone suggested carrying me into the hot sauna, to raise my blood temperature. This was no doubt a good idea, because the evening air was chilly, and I was wearing only a swimsuit. It was in the sauna that I came to. I remember finding myself lying on a wooden bench, surrounded by steam, and the hazy faces of people around me. A doctor was leaning over me, listening to my chest wit
h a stethoscope.

  ‘Where am I? What happened?’ I enquired.

  ‘You had a lucky escape,’ the doctor said.

  *

  I was indeed lucky, and millions of people can say the same – their lives have been saved by modern medicine, for which we can be deeply grateful.

  Yet life remains finite, and we go through agonies of indecision about whether or not to prolong it. Should drugs and treatments be continued or withheld? Is it futile? To resuscitate, or not? Finally, should euthanasia be legalised? These matters are so complex and so dreadful that they blow the mind. It is like being out at sea in a thick fog, and the compass fails. We don’t know in which direction to steer the boat.

  The great and good of the professions debate these issues endlessly. But that is not enough. Everyone must enter the debate, because we are all involved; and this is where most people fall lamentably short. It is well nigh impossible to talk to anyone about death, I find. Most people seem deeply embarrassed. It is like when I was a girl and nobody could talk about sex. We all did it, but nobody talked about it! We have now grown out of that silly taboo, and we must grow out of our inhibitions surrounding death. They have arisen largely because so few people see death any more, even though it is quite obviously in our midst. A cultural change must come, a new atmosphere of freedom, which will only happen if we open our closed minds.

  I have the impression that things are already changing. Around 1975 I spoke at a sixth form college. The subject was, ‘Should drugs and advanced medical treatment be given to an old person who is dying?’ When it came to questions and debate, there was an ominous silence. Twenty boys and girls gave me some very suspicious looks, making me feel uncomfortable. When it came to a response, every one of those young people said that, of course, all available treatment should be given, no question about it, there was nothing to debate. I remembered my matron’s words: ‘This is a dangerous subject,’ and her caution not to be too free in what I said and to whom, because I would be misunderstood.

  Last year, 2009, my granddaughter, who is doing A-level philosophy, religion and ethics at school, asked her course teacher if I could address the class on the same subject. Afterwards, about twenty-five young people couldn’t stop talking. Debate, opinions, examples were thrown back and forth. The bell went, it was the last lesson on Friday, and still they couldn’t stop. I seem to remember we overran by about twenty minutes, until the caretaker came in to say he was locking up. This is the healthy attitude, and our hope is in the young. My thanks to staff and pupils of Townsend C of E School, St Albans.

  However, the dilemma remains. Life used to be so much simpler, as it still is in many parts of the world. Birth, life and death were seen as part of a great whole, ordained by God. This has largely been eroded by the steady decline in faith. But it seems that Man is a believing animal; we absolutely must believe in something outside ourselves, and preferably something beyond our understanding. Having lost faith in God, we place it uncritically elsewhere. Huge numbers of people now cling to faith in science, which, it is thought, can be controlled.

  This is the root cause of all our problems. The dilemma has not come upon us through science or medicine, per se, nor even from social attitudes to death. It has crept up on us through lack of faith, and hidden between the lines of this book is a plea for a return to the simple understanding that life and death are in God’s hands, not ours.

  Reverence at the time of death used to be accepted without question. All religions require it. ‘A peace beyond understanding’, the Christian church calls for; Buddhists see death as the gateway to Enlightenment, and demand calmness in death; reincarnation is central to Hinduism, and the laws of Karma teach death as a step towards Nirvana; ancient Jewish law has described death as ‘God’s kiss’; Moslems see death as part of Allah’s plan for mankind, against which it is wrong to struggle. Death and religion are closely linked.

  In the secular, and increasingly atheistic age, in which we now live, this ancient teaching has, to a large extent, been denied and discarded, and we find ourselves with a medical dilemma beyond parallel.

  I find it hard to understand the mind of the true atheist, who believes that life is nothing more than a series of electrical impulses and biochemical reactions to chemical stimuli. Presumably, such thinkers see death as the worst thing that can occur, because it means the end of everything. Therefore (logically), maintaining the continuance of physical existence, under any circumstances, is entirely justifiable.

  But I do not see things that way. Death may be the end of what we presently call ‘life’, but it is not the end. There is another dimension, a spiritual life that we are all caught up in and cannot escape, which is eternal. I believe that we come from God, and return to God. The awesome mystery of birth and death, both of which I have handled, convinces me of this truth. As the physical body grows weaker and draws near to death, the soul yearns, with unspeakable longing, to return to God, the source of life.

  I have seen this many times, and one cannot say that it is consciously ‘longing for God’. It is yearning for the peace and contentment that enfolds the dying body and calms the dying mind, and, in my view, this comes from, and is part of, God. It is ‘a peace beyond all understanding’, to which we, as human beings, are all entitled.

  LAST THOUGHTS

  Only six months after this book was first published, I was diagnosed with cancer of the oesophagus and with secondaries in the bones. I want anyone reading the book to know that I am completely at ease with the diagnosis. I have no fears, no worries, no regrets. I do not try to struggle against this – I accept it as part of life. I shall be sorry to leave my dear husband and this beautiful world, but I do not fear what is to come. In fact, I am grateful, very grateful, because we all have to die, and it could be so very much worse. As it is, my family will see probably only a brief period as the cancer takes over. At the moment, I feel only weakness. I can see death coming, but if it is to be no more than weakness increasing day by day, then it is no bad thing.

  I feel that everything is slipping away from the periphery, which is rather nice. There are, I am sure, hundreds of things I could, or should, or must be doing, but they become less relevant as the days go by. They just slide away. As everything slides away, what I am left with is faith and love. Faith, which has been the cornerstone of my life, and love, which has been always with me. Love of my husband; our love for each other; love of my daughters and my grandchildren, and their surpassing care of me. And overall, and around all, the love of God. Thanks be to God.

  Jennifer Worth, April 2011

  ‘Lord, grant us a quiet night and a perfect end,

  so that we who are wearied by the changes and chances

  of this fleeting world

  may rest upon Thy eternal changelessness’

  — The Anglican office of Compline from the Book of Common Worship

  APPENDICES

  Appendix I: Medical aspects of cardio-pulmonary resuscitation, David Hackett

  Appendix II: The Paramedic’s Tale, Louise Massen

  Appendix III: Should patients at the end of life be given the option of receiving CPR?, Madeline Bass

  Appendix IV: Principles of Palliative Care,

  Madeline Bass

  APPENDIX I

  Medical aspects of cardio-pulmonary resuscitation DavidHackett, MD, FRCP, FESC.

  Consultant Cardiologist, West Hertfordshire Hospitals NHS Trust, and Imperial College Healthcare NHS Trust; former Chairman of the Resuscitation Committee, West Hertfordshire Hospitals NHS Trust; and former Vice-President of the British Cardiovascular Society.

  During the Second World War and in the Korean War the severe injuries inflicted led to surgeons having to extract bullets and shrapnel from many locations in the body including the heart. Previous medical teaching had assumed that any cardiac surgery would be fatal, but many foreign bodies were successfully extracted from the heart without mishap. This led to the dawn of modern heart surgery, and the re
cognition that many serious heart conditions could be treated. Doctors observed that ventricular fibrillation, a fatal abnormality in cardiac rhythm, could occur in certain circumstances such as during induction of anaesthesia or in the early stages of heart attacks in hearts that were otherwise healthy, ‘hearts that were too good to die’. It was also known that accidental electrocution could induce ventricular fibrillation, and that powerful electric shocks could reverse it. In 1947, the first successful internal defibrillation was performed during an open chest surgical procedure. The first successful external defibrillation was performed in 1955, and in the early 1960s portable defibrillators were developed. In 1967 mobile coronary care units were introduced in Belfast, with successful out-of-hospital defibrillation in patients with acute heart attacks. These developments led to the concept of Emergency Medical Services, to bring medical care to resuscitate the victim at the scene, rather than ‘scoop and run’ to the hospital.

  It has been known since the late 19th century that open chest cardiac massage could maintain an effective circulation. Closed chest cardiac massage by compressing the front of the chest against the vertebral spine resulting in compression of the heart and ejection of blood into the arteries was rediscovered in 1960. Mouth-to-mouth ventilation, often used to initiate breathing in a newborn, was shown to maintain oxygenation, and resulted in a switch from more cumbersome manual ventilation techniques. The combination of chest compression and mouth-to-mouth ventilation, or cardio-pulmonary resuscitation, became known as basic life support; this could maintain life for a short time until defibrillation or another definitive procedure was performed.