The Pope's Final Amen
He bounded from continent to continent as God's athlete, speaking the international language of love, compassion, and respect for life, an energy unquieted by later years of frailty and disability from Parkinson's disease. But it was during the final days of his life, weak and nearly mute from an influenza-triggered tracheotomy, that Pope John Paul II showed us all how to die. A message sorely needed as his dying time coincided with the earth-quaking brawl over the court-imposed withdrawal of water and food from the severely brain-damaged 41-year-old woman, Terri Schiavo, who had been languishing for 15 years in a zone of limited if not absent consciousness.
To be sure, we have endured a heavy-duty deathwatch of late. A polarized nation and world witnessed the final saga of Schiavo's life in public discord between her husband, who insisted on her right to die, and parents who believed in her will to live. With no written directive and no truly independent medical specialist to call her own, Schiavo's wishes, level of consciousness, and state of suffering were left unresolved by her death. Living in a hospice for five years, where five weeks is closer to average, reinforced the notion that she was overextending her stay on Earth. And the image of a "vegetable" on a feeding tube enabled normally bleeding-heart America to accept the ugliness of her 13-day dehydration and the loneliness of her final moments without her parents and siblings at her side, and lawyers, rather than doctors, in attendance.
Blessedly, the eyes of the world promptly shifted to the pope, who lay dying at the Vatican from a blood infection. Septic shock is a common way to cross the "finish line": In idiom we call it "natural causes," but in medical lingo, it means that toxic pathogens seep into the bloodstream, usually from infections in places like the lung, urinary tract, or skin, and run wild. The blood poisoning triggers a cascade of signaling molecules produced by the body's own tissues and defending white blood cells, which blast the body with friendly fire. The lungs fill with fluid, choking off oxygen; the heart weakens; kidneys fail, and consciousness blurs. As organ failures pile up, the body faces a point of no return, despite the most advanced medical support. Sepsis is a common ending among those suffering with chronic diseases like cancer, heart failure, HIV, or failing old age. And in that the pope's was a rather typical way to die.
A frequent fear about death among the healthy is that they might linger in a high-tech nightmare of artificial life support when they should have been let to die. In my experience, however, it's the compulsion to live that's palpable among the ill and disabled. I have seen how the once hardy suddenly see things differently when stricken with disease or cling to the last threads of life. The recognition of this shifting perspective--and the trust of a good doctor to integrate a patient's values and wishes with sound medical advice--should be part of any written advanced medical directive. Advice will change as knowledge and circumstances change.
A good death. Though his last will and testament released by the Vatican cites no medical directive, the pontiff made his views crystal clear through his many teachings that were as much religious as they were common sense and humane: Doctors are not "lords of life" but "skilled and generous servants" caring for the sick and dying, offering treatments to cure their patients if possible but always enabling them to bear their sufferings with ease and dignity. He preached that doctors not embark on futile treatment or extraordinary measures when death is imminent and inevitable. But at the same time they should not hasten death. And to him a good death was one in the comfort of family, doctors and nurses, and loving friends.
He lived his words. The 84-year-old holy father made his choices as his health rapidly declined. He accepted antibiotics, a tracheotomy, a feeding tube, and two hospitalizations over his last five weeks, but as things grew bleaker, he rejected an intensive care unit, kidney dialysis, or organ resuscitation. Without this, his life faded softly to a final amen. And, perhaps with a wink, he lasted for a time well beyond what Vatican doctors had been predicting.
Heaven only knows the moment of birthing and dying, the eternal bookends of all our lives. But we do know they are neither pain free nor predictable. And control of the final moments are unlikely to be in our hands, however high-tech or directive we mortals become.
This story appears in the April 18, 2005 print edition of U.S. News & World Report.