Last week, Monica and I reported for an appointment made for us with a euphemistically-called group of medical practitioners described to us as belonging to the “symptoms management consultation” team. We were surprised to read that our appointment was scheduled for a full 90 minutes, which left us with the impression we might be attending a group class or discussion group. But when our appointment time came we were ushered into a standard patient examination room. When the doctor arrived, the staff position embroidered on his lab coat indicated that our doctor was a member of Kaiser’s Palliative Care team. The time had come for us to talk.
Monica and I arrived for our appointment armed with all sorts of questions. We had experienced a kind of breakthrough dealing with my “sporadic wonkiness” and I wanted confirmation of our hypothesis that incipient dehydration might be at the root of my lightheadedness and dizziness upon standing. Earlier, our oncologist had noticed a slight abberation in my liver function lab results. As a consequence she had proactively ordered a bag of saline solution to be added to my chemo infusion protocol. The Infusion Nurse, meanwhile, had been monitoring my dizziness which continued after I arrived at the Clinic for my chemo infusion. When she saw the order, she exclaimed, “Good. This extra fluid will make you feel like a new man!” And so it did.
Dehydration is a tricky matter to diagnose. If I feel thirsty, it could be a sign that dehydration is near. If I don’t feel thirsty, that could be a signal. If I stop sweating when I should be sweating, it could signal I was lacking in fluids. Obviously, if I experienced a good deal of diahrrea (which is a common side-effect of chemo treatment) the rapid loss of fluids through the gastro-intestinal system could hasten the onset of dehydration. The most reliable indicator of dehydration turns out to be dizziness and lightheadedness upon standing. But those same symptoms can equally be caused by other ailments, so it was easy for both patient and doctor not to immediately realize that my dehydration was the underlying cause cause of my current lightheadedness.
Monica found some statistics that indicate how critical is fluid availability and why fluid balance for the body is so obviously important. She found that up to 60% of the human adult body is water. “According to H.H. Mitchell, Journal of Biological Chemistry 158,” she quoted, “the brain and heart are composed of 73% water, and the lungs are about 83% water. The skin contains 64% water, muscles and kidneys are 79%, and even the bones are a watery 31%.”
The “symptoms management” doctor proceeded to enlighten us about fluid intake and electrolyte balances. He reviewed my experiences to help us corroborate what we suspected to be true about the probable role of dehydration for my most objectionable side effect experience.(1)
Monica and I were both impressed by the patient thoroughness with which our doctor responded to the rest of our numerous questions fully and completely, all the while evaluating, I suspect, our state of mind and my state of health.
After we had exhausted asking questions from our individual lists, our doctor introduced the topic for which our appointment had truly been made, unbeknownst or all unaware to Monica or me.
“You realize, of course,” he began, “that what all of us, here, are doing for you is only treating your symptoms. Ultimately,” he continued, “barring any accidents or unexpected lightning strikes—you will die of this cancer. It might be a good time for you to think about (and discuss with your family) how you wish to die. What kind of care would you choose to have given to you at the end?”
Our doctor asked this question so candidly, directly and respectfully that I was momentarily taken aback.
I wanted to answer glibly, thinking to include in my answer the catch-all pseudo-sophisticated phrase, “After all, we all have to die.” I caught myself, just in time, recognizing that in this context it would have been a cop-out to say so. It would have been a denial that we were discussing a disease from which, I, personally, will most likely die; possibly earlier than later. The doctor was compassionately opening up a chance to confront end-of-life issues.
I have never given much thought about death. As a Roman Catholic, and inspired by my entire educational experience, I’ve considered death as an inexorable part of life; something natural to expect. The formula of the balance of energy suggests that when my body decomposes it will return to the earth certain minerals, chemicals and energy which the earth can utilize for the sustenance of new life. My faith doesn’t forbid my believing that my body is subject to the laws of Nature.
Science and religion, regrettably, are often cast as opposite antagonists. But such an antagonism is not entirely borne out by the historical record which shows how many experiments and scientific discoveries were advanced by church-men and -women. Perhaps it is because at the point of death, with its naturally heavy emotional overload, science and religion have their most electric disagreement about whether there is life after death; whether there exists some spiritual “soul” identified as “me” that persists after my life on this earth is finished.
It is simply non-productive to pursue this regrettable dispute because it distracts us from a better path of inquiry and because neither side will ever be able to prove its hotly debated polarized position on this subject… not in this life, at any rate.
It would seem to me far better to consider how rich and varied are our ways of learning and knowing, and to endeavor to build upon and expand them. Just by carefully observing nature, I can discover animal species that hear better, see beyond human capability, feel (with whiskers, tails or body hairs), and recognize the nature of their surroundings differently than I do. It is increasingly apparent that botanical life has completely different but impressive means of communication and even collaboration.
I share my creation with these other species. It is not unlikely that humans could learn and improve ways of knowing, that are presently only latent in us. The most important realization is that while humans learn through the application of conscious rationality to solve problems we face, we also learn by deepening spiritual sensibilities and relationships, as well… and each provides us with different growth.
Nor is the latter simply a matter of employing our emotions and feelings to achieve a (perhaps, illusory) sense of spirituality. It is, instead, that we should be open to relationship with the world around us, as well as with the world and with its Creator beyond us. That openness can reveal to us another dimension of perception, sharpen our sense of interconnectedness and let us explore our complicated relationship with our Creator. These activities help us peel away the onion layers of fear, self-protection, envy, and all the other consequences of sinfulness with which humans tend to wrap themselves. Openness to our spiritual dimension, relationship with God, and our created nature, throws open the possibility of dialog, self-introspection, humility, altruism, empathy and all the other graces and virtues with which the Creator has imbued each and every one of us.
I have been especially graced by continuing to be involved in a decade-long project that is just coming to a close. It involves the digitization of, and the making of a facsimile printed edition of a three-volume Bible once owned and annotated by the hand of Johann Sebastian Bach, himself.
Bach produced what most agree is among the most sublime music to enhance scripture and enrich the liturgical seasons of the Church calendar. Observing in the pages of Bach’s Bible the detailed attentiveness to the selection of readings Bach annotated by hand, one gains a deeper respect for how carefully Bach sought to combine his intellectual rational mind and his musically-sensitive creativity in presenting the words recorded in his Bible in an unforgettable and moving way.
Bach’s music adds a dimension of knowledge about the words. Scripture gives greater concreteness to his music.
On the recommendation of the principal leader of the Calov Bible facsimile project, I recently signed up, online, to receive notices from an impressive effort spearheaded by the Netherlands Bach Society. The Society aspires to produce new recordings of each of Bach’s thousands of compositions, long or short, published or fragmentary. They attempt to release one composition each week. Each composition is impeccably recorded and videographed. The releases are typically accompanied by a short commentary on the composition, a live interview with a performer or conductor, and a libretto in both Bach’s original language and in English translation. One can read the words while listening to the performance of each piece.
This week’s new release brought a Christmas dual-chorus motet(2) that seemed perfectly timed for my reflections. The first quotation is from one of the few places in the Bible where we hear God using direct address to speak directly to us. God could be facing me in the Infusion Clinic.(3) Bach’s music underscores the dynamic between trepidation and comfort.
First, God says, directly to me, “Fear not”.
Immediately thereafter He embraces me, the listener, with a bear hug: “for I am thy God.”
And again, in case we’ve missed the point, He says, “be not dismayed” (because God knows that we are truly distressed when confronting illness or being unable to comprehend the answer to our “Why?”).
Following immediately is the prompt explanation for why we should be at peace. It is a mild chiding and an instruction: “for I am thy God… I will strengthen thee and help thee; I will uphold thee…”
It is the interplay of fear and confidence that Bach underscores with his joyous music.(4) The short motet is joyous because of the inspirational message of the text, just as the announcement to the shepherds at Bethlehem opens similarly with the words “Be not afraid…” but announces the birth of the Christ-child. The joy in the motet is in the personal relationship with God that the prophet writes about, and in the confidence that, however low we may feel, God will support us through it. The motet, is known as the “Christmas motet”. But it may have been composed as a funeral melody. It works just as well in both circumstances.
Note the concluding words chosen by Bach for this motet. They are a sigh of relief and a (re)commitment of love for our Creator. The last verses are overlaid with mystery (for it is true that one thing Bach is not, is superficial or simple). This time Bach explores the mystery of the loving entanglement of Creator with creature, as in the last lines of the motet: “Let me… let me attain to where thou me and I thee may lovingly embrace.”
Following are the complete words of the motet. Following the words, is a link to the online performance(5):
Fear not, for I am with thee,
be not dismayed, for I am thy God.
I will strengthen thee and help thee,
I will uphold thee with the right hand
of my righteousness.
for I have redeemed thee,
I have called thee by thy name;
thou art mine.
Lord, my shepherd, fount of all joys!
Thou art mine, I am thine,
no one can part us.
I am thine, for thou hast given
thy life and thy blood
for my sake in death.
Thou art mine, for I embrace thee,
and will not, O my light,
let thee from my heart!
Let me, let me attain
to where thou me and I thee
may lovingly embrace.
Monica and have not answered the Palliative Care doctor’s specific question (for which question I am entirely grateful). But I know that the components to answering his question will have more to do with relationships than with medical interventions. I will hope, of course, to receive sufficient medical assistance not to struggle unnecessarily with death. But I have great confidence that as I die I will be surrounded by those whom I love and those who love me—whether they be physically present nearby or whether they will be physically distant and only spiritually by my side. We will experience death together. That will comfort me immeasurably.
I hope to meet my Creator infused with gratitude for every day of my life, for each person I have met—especially those closest to me. I wish to be humbly thankful for everything I have experienced and learned through generous teachers and friends. I want to be aware of the Creator’s bounteous generosity to me. I will long for His comforting embrace.
Let me, let me attain
to where thou me and I thee
may lovingly embrace.
(1) Since our meeting, I have been on a self-imposed fluid intake regimen. (In truth, the regimen is enforced by Monica rather than being mainly self-imposed.) Monica has researched and provides me with liters of enriched coconut water, and has stationed water bottles at all the spots in the house where I typically read, rest or play with Gracie. This makes it unlikely that I will forget drinking my allotted volume of liquids. In the meantime, my sporadic wonkiness has abated, as has slightly, a persistent and annoying dry cough. Subduing the cough may require some more work. So, All is Well. I am tolerating the mild (thus far) common side effects, and am happy for the cessation of one of my more troubling items of concern.
(2) BWV 228 Fürchte Dich Nicht, Ich Bin Bei Dir
(3) I realize that, theologically, “God” has no gender. It is awkward to use some grammatical circumlocution to replace the masculine pronoun, so I have just kept it, with apologies.
(4) The website includes a conversation with the conductor as well as the principal soprano, in which they both discuss the need to vocalize the differences when singing the words of fear as contrasted with the words of comfort.
(5) According to the “All of Bach” website, the source of the text is as follows: “Verses 1 and 2 are taken from Isaiah 41:10 and 43:1; verses 3 and 4 are taken from Paul Gerhardt’s chorale ‘Warum solt ich mich denn grämen’ (1653)”.