The following excerpt is taken from the opening sections of The Promised Landing: A Gateway to Peaceful Dying:
Is This Book for You?
Have you endured, during the demise of a loved one, circumstances so distressing that you are determined to never experience a situation like that again? Are you worried that deaths of loved ones in the foreseeable future may play out contrary to what they, and you, prefer?
Do you wonder if what you have done, or have yet to do, regarding the end of your own life will be sufficient to increase your likelihood of dying in peace?
Do you question how to protect yourself and your family from pressures that escalate dying into a technological battle against death despite its obvious nearness? Are you concerned that you and your loved ones might be among those responsible for such a situation?
Are you confident that the promises you’ve heard, assumed, or made to yourself for a peaceful death will be fulfilled?
Are you certain that spiritual engagement will suffice to protect you from end-of-life outcomes you hope to avoid?
Even if your family has filled out advance directive documents and engaged in conversations about end-of-life matters, do these apprehensions persist?
Are you interested in taking a deep, sustained look at the obstacles arrayed between you and your desire to die in peace?
Are you willing to apply additional effort to learn how to mitigate or even overcome those obstacles?
If you suspect that there’s more to dying than we’ve been told, if you want to make some sense of 21st century impediments, if you discern that wishing won’t really help and are ready for something that will, this book is for you.
The Promised Landing opens a gateway to peaceful dying. It presents a solution for a prevalent yet previously unidentified problem: our inability to differentiate among common dying situations. I’ll name and describe every dying situation we experience in today’s world. We will see all of them combined as our dying territory, where the different dying situations are way stations and destinations that we can learn to aim for, and aim to avoid.
The Promised Landing opens a gateway to peaceful dying. It presents a solution for a prevalent yet previously unidentified problem: our inability to differentiate among common dying situations.
To accomplish this, I have developed a tool that names our dying situations: Windrum’s Matrix of Dying Terms. The Promised Landing presents the Matrix element by element, culminating in a spoken recitation through which we will take a personal tour of our dying territory, imaginatively placing ourselves throughout it. We’ll then locate our dying territory within the larger context of other significant obstacles to peaceful dying which, taken together, comprise a practical end-of-life lexicon, To Die in Peace: Our Rights of Passage. The Matrix and the lexicon will function as a gateway for your further exploration of what is required, of each of us, to die in peace and at peace.
If you have not yet considered dying matters or your own future death, if you have not yet been rattled by a loved one’s troubling demise, this book will still serve you. Depending upon your constitution, you may feel a bit challenged; The Promised Landing is not introductory-level material according to conventionally presented end-of-life discussions, although from my perspective it starts at exactly the right place.
The Promised Landing also offers medical professionals new language to help guide the patients and families they serve toward more peaceful dying.
Getting to Peace
I might experience peaceful dying.
I might experience peace-less dying.
How about you?
How about giving voice to these possibilities? Say out loud, with deliberate emphasis although not over-emphasis:
“I might experience peace-less dying.”
“I might experience peaceful dying.”
Does voicing these possibilities activate any mental response, emotions, or even physical sensations? Does doing so increase or decrease your confidence in achieving the death you want and avoiding the type of death you would prefer not to experience?
If you’ve filled out advance directive documents and assigned a proxy to represent you should the need arise, does having done these things offer clues about how to obtain the outcome you want and avoid the one you don’t want? If you’ve engaged in spiritual development focused on end-of-life outcomes, does it feel sufficient for achieving the kind of death you’d prefer?
The Promised Landing is about identifying and mitigating obstacles to dying in peace. Obstacles peculiar to our time await all of us throughout our dying territory. When we become ensnared by them (most of us do…), we suffer from stressors and risks in addition to those inherent in dying. We can learn to identify, recognize, and plan around these obstacles before we’re upon them and they are upon us. Because the obstacles, by definition, infringe on peace, this is not a book about peace; it’s a book about getting to peace. The Promised Landing: A Gateway to Peaceful Dying points the way toward peaceful end-of-life experiences.
“Toward” means that it will take us all some doing to get there. The first step is to pass through a gateway, stepping through a rarely used gate.
A gateway makes a gate into a statement, imparting importance to the passage, letting us know that something substantial awaits us on the other side.
A gateway is a means toward achieving a state or condition. In the physical world, gateways rise over and frame gates. A gateway makes a gate into a statement, imparting importance to the passage, letting us know that something substantial awaits us on the other side. Metaphorically, the end-of-life gate before us is rusted from disuse. This rusted gate may take some effort to open. It may squeak and squeal, and so may we. We might not like everything we encounter as we step through into a space we’ve purposefully avoided for most, if not all, of our lives. We may need to occasionally take a mental and emotional breath, find our equilibrium, as we traverse the place. It’s a place known by an anti-name: death denial. And traverse it we must; one step doesn’t get us very far.
As we wend our way through our dying territory, we will become death-literate—knowledgeable about matters pertaining to forces shaping, if not controlling, our dying time. I can promise that you will increase your likelihood of dying in peace by making this journey.
In our death-denying and medicalized culture, only the fortunate few, graced with great luck or good fortune, attain a peaceful demise without arduous effort. For most of us, finding our promised landing will require a new response to how we personally approach and manage dying—through attention, openness, study, and preparation. This is what is meant by death literacy.
Except for the considerable emotional toll extracted by needlessly hard deaths common to those who remain death-illiterate, death denial is easy. All it requires is our refusal to address end-of-life matters. Death literacy requires us to face the end-of-life problems we have made for ourselves—now, well before our dying time, while we’re otherwise busy living our lives. Increasing our likelihood of dying in peace requires us to understand the personal and systemic obstacles between us and our end-of-life promises. It requires us to recognize that by doing nothing now (death denial), we reinforce the likelihood of our last weeks and days on planet Earth being overly stressful and peace-less.
Medicine’s repeated message is that filling out advance directives and appointing an advocate will result in peaceful dying. And many people hope that spiritual engagement will provide a bulwark against the strong socio-medical tide carrying millions of us to protracted, overmedicalized deaths. My experiences have taught me that more is required. We must learn to identify, understand, and manage a range of prevalent obstacles standing between our desire for peaceful deaths and the types of deaths that too many of our loved ones have experienced—deaths which millions of us have witnessed, or participated in, and reject as inhumane.
Our challenges arise largely from opacity around end-of-life matters. Our medical system too often, if not typically, withholds end-of-life information from us and sugar-coats what little it is willing to voice. So we deny and medicine obscures; we’re unused to taking a long and serious look at factors inhibiting a peaceful glide path at the end of our lives. The Promised Landing offers a sustained serious look.
I strive to address the topic in terms of likelihoods, not certainties. One truth I can declare with certainty is this: we who do not deal with matters of how we die while healthy and living will deal with them, for the very first time, while sick and dying. For those who wait, the emotional toll for all involved will be profoundly deeper than for those who choose to become death literate in advance of dying. Doing so may feel disquieting at first but will be gratifying when you know, in your heart and in your bones, that the effort you exert now has resulted in the knowledge and familiarity required to increase your chances of obtaining the dying experience that you or your loved ones would prefer.
Increasing our likelihood of peaceful dying does not guarantee a trouble-free demise, but it’s the best we can do and worth doing well. By minimizing the likelihood of infringement due to obstacles built into our socio-medical system, we open emotional and soul space throughout a demise to make peace with intrinsic aspects of dying—our plain human experiences and relations.
The obstacle to dying in peace that Windrum’s Matrix describes and solves, despite its prevalence, will seem unfamiliar.
Be patient on your journey through The Promised Landing. The obstacle to dying in peace that Windrum’s Matrix describes and solves, despite its prevalence, will seem unfamiliar. It takes some time to explain. Reading this book may feel like making an odyssey. This is a working voyage. As with any long trip, we’ll begin by considering where we’re starting from and imagine where we’re going. We’ll orient ourselves, unfold a new map, learn to read it, and explore the unknown. We’ll see new sights and learn the landmarks; the unfamiliar will become familiar as we name situations that we may have already experienced but haven’t thought to name or formalize. Eventually the stimuli will coalesce into a new way of perceiving our end-of-life experiences. As our death denial fog lifts, our dying territory and obstacles to successfully navigating it will emerge as a new landscape. Viewing that horizon, we’ll be better positioned to chart our glide paths to the peaceful dying experiences we want.
Many potential obstacles, and variations on obstacles, infringe on dying in peace. Considering them all will require engagement beyond this book (see Study Up, Make Some Sense at the end of Appendix C). The Promised Landing focuses on common, ever-present aspects of late-life medical encounters that deliver profound and often unwanted consequences. It does not directly address other obstacles such as insurance coverage shenanigans; religious influences; social inequities; end-of-life politicization; spiritual development; extra-legal self-deliverance; matters of long declines; aging in place; or finding, obtaining, and paying for late-life services. Its lessons will serve as underpinnings for choices you make about these matters.
Welcome to my world… may your visit here improve yours.
Understanding Demises as Destinations Within Our Dying Territory
The following stories of three demises introduce and set the context for exploring our dying territory. My parents’ unexpected terminal hospitalizations exemplify two of the harder end-of-life landings. How one doctor adapted this work’s message when counseling a dying patient’s family exemplifies its utility for medical professionals.
At the end of each story, I will introduce new terms that name the situations described. These new terms may make sense, or they may raise questions. In either case, know that chapters 1–9 will fully explain the terms, their meaning, and what they represent in our lives, our deaths, and our memories.
[…]
Promises, Promises
For sentient beings here on planet Earth, dying may be painful enough in and of itself, and losing loved ones is existentially painful. Medicine has blessed us with beneficence over the past several generations, yet left unchecked, our medical system too often adds a second, unnecessary level of pain. Many families’ experience of modern dying leaves bitterness about their experiences in the medical domain. The recent emergence of a social movement to relieve both levels of pain by learning how to prepare for and accept dying ironically adds the potential for a third level of pain.
The recent emergence of a social movement to relieve both levels of pain by learning how to prepare for and accept dying ironically adds the potential for a third level of pain.
The deaths I’ve experienced—my parents’ sudden-onset, multi-week, error-filled hospitalized demises—revealed the distinction between intrinsic and extrinsic pain. Intrinsic pain is part of living and dying, plain and simple. Regarding the end of life, extrinsic pain is additional, unnecessary distress resulting from the nature and machinations of our technologically rich and relationship-poor medical system, abetted by our collective naiveté and willfully ignorant approach to dying. And now the likelihood looms for additional suffering emanating from unfulfilled promises.
The promises come from three sources. One source is medicine, through its wise guidance to execute advance directive documents and to assign a proxy to assist and/or represent us medically. (Advance directives are meant to specify what medical treatments people will allow and disallow. A proxy—also referred to as a surrogate or a healthcare agent—is a person authorized to act on our behalf, according to our instructions, when we cannot speak for ourselves.) Another source of promises is spiritual guidance intended to both calm us and reinforce our inner fortitude.
Although both are useful, each, I believe, implies that following the offered guidance will significantly increase our likelihood of dying peacefully rather than connected to unwanted life supports—a decidedly non-peaceful experience for many patient-families.
The third source of promises is us. Having collectively experienced millions of overmedicalized deaths, many of us, individually and collectively, are striving to become death-literate and death-accepting, promising ourselves “never again in my family or among my loved ones.” We believe this promise will be fulfilled because we filled out legal directives and/or engaged in spiritual practice, certain that we have received enough information and knowledge to succeed.
We have not. And should these promises fail, whether they were implied from sources outside ourselves or emanating from within, and we end up landing in the types of dying situations we’ve vowed never to experience again, we add a new, third level of end-of-life pain: promise pain. Imagine for a long moment looking back on a loved one’s demise in which all three levels of pain were part of your experience. As one who has experienced intrinsic and extrinsic end-of-life pain combined, I can tell you that I do not want promise pain added to future deaths in my family—nor to our memories. Nor to yours.
Why might we experience promise pain? My 14-year examination of end-of-life matters leads me to see clearly that practical education in identifying and learning how to mitigate obstacles to peaceful dying is crucially important—and virtually absent from civil and medical conversations. Given how medicalized, death-denying, and controlling our society is, I do not believe that directives and novice proxies and enriched spirit can, alone or together, act as a bulwark against inevitable and multiple obstacles to dying in peace.
I do not believe that directives and novice proxies and enriched spirit can, alone or together, act as a bulwark against inevitable and multiple obstacles to dying in peace.
Obstacles may develop slowly or arise instantaneously. They are linked, appearing simultaneously or in predictable sequence. They are persistent and shocking, ambushing us deep within our dying territory. We enter our dying realm with insufficient knowledge to plot our course through it, with no sense of impending obstacles and no map of its contours or way stations.
Our practical unpreparedness overwhelms the promise implied by directives, spiritual activation, and our own awakened longing.
I’m aware of a proliferation of offerings and enterprises to help people ponder, make, store, and access advance directives. I’ve read of many (and experienced several) spiritual teachings intended to enrich our inner selves, to instill both an open heart and a firm, if abstract, resolve. Yet I’ve seen no map of our dying territory with which to orient ourselves; no map naming well-known dying situations and showing their existence; no map with legends stimulating us to learn to identify, understand, and mitigate the range of everyday practical obstacles that await us throughout our dying territory.
The Promised Landing maps that territory. We will explore all its contours, ending our tour with a deepened appreciation of obstacles ahead and perhaps a resolve to learn what we must do, beyond directives and inner work, to overcome them so that we might increase our likelihood of dying in peace, and of dying at peace.