The purpose of this letter is to help you look clearly and sensitively at the possibility that –if you become seriously ill with this virus – it might prove to be the end of your earthly life. If that is not something you wish to consider at the moment, and you would rather leave it aside until the time feels right, by all means do. There is no right or wrong choice, no “ought” or “should”, simply the opportunity to consider this if you choose.
A part of the church’s ministry is to prepare the dying for their death, and being prepared starts well before the event. It would be wrong for the Christian message to only be about doing what we must to save lives, important though that is; it is also about accepting and facing the reality that our life on this earth has a beginning and an end, as God planned it to have. Facing that end with faith, hope and love is actually more important than extending the length of it at whatever cost.
I’m grateful to our daughter Katie who is a medic in an A & E department in London and has helped me with the accuracy of the information included here.
The choices if I need to go to hospital
If the time comes that I feel that I am displaying symptoms, I will of course be asked to stay at home and not go to a hospital. All the guidance about what I should do is on the NHS111 webpage. It’s most likely of course, even if I’m advanced in years, that I will recover without any intervention. If the infection is in my throat alone, it will follow the course of a bad cold; I don’t need antibiotics or anything more than paracetamol, and I will recover. But if the infection is in my lungs and I am starting to have difficulty breathing and my oxygen levels become low, I will be advised to call an ambulance and go to hospital. There, I will likely be given a chest x-ray which would show the extent of infection in my lungs and confirm or rule out whether pneumonia is also present. This is the point at which I should be ready to make decisions, supported by family or those close to me. In hospital these days, the choice will very much be my own. The medical professionals will assess my situation, offering me their expertise and setting out the treatment options, but ultimately, I will decide the level of care I wish to receive. These will be the three main decisions I will need to consider:
The decision whether or not a ventilator is appropriate may be made by the hospital if they judge my chances of recovery to be low, or if they have to make the difficult decision of who has priority (thankfully, not currently the case in any of our local hospitals). Ventilators are the main tool that doctors have that can help me fight serious infection, and of course they save lives. My chances of recovery may well be rated as good, in which case I will be encouraged to accept one, but I need to be aware that I will be under heavy sedation, and will not regain consciousness if I do die in the intensive care ward. My family will not be allowed to enter the Covid 19 intensive care ward, so my time to say farewell in case I die will be at the point that they bring me to the hospital. I might choose not to go on a ventilator whatever the advice or prognosis – either because the demand for intensive care beds becomes critically high, or because I do not wish to be unconscious when my life might potentially end. If I am not to be ventilated, I will most likely be offered care on an isolation ward with other, less invasive, options for breathing support and treatment.
a) If the doctors do not think I require a ventilator because my case is only moderate, not severe, I may be offered alternative treatments and admission to a general isolation ward (not intensive care). Alternative treatments may be needed to help my chance of survival, like antibiotics if I have a pneumonia as well as coronavirus. But I will be on an isolation ward, without my family being able to visit. If, whilst I am on the ward, my situation deteriorates, some hospitals will allow one family member to visit me on the ward.
b) If I am offered a ventilator but choose not to have one, or if a ventilator is not an option for me because my chance of survival is very low, I might choose “palliative care” on the ward, meaning no active treatment will be given, but treatment just to make me comfortable for the time I have left to live. In most hospitals, if I choose palliative care only, I will be allowed just one relative to visit my bedside to say farewell near the end of my life.
3. Returning Home.
If I don’t have pneumonia and am not being ventilated, I might consider opting to return home, if appropriate pain relief and an oxygen supply can be arranged. This is the best way to ensure that at least one of my loved ones can be with me if I do not recover – as long as they accept the risk, and are totally committed to 14 days of strict quarantine for themselves as a result of being with me.
The doctors or medics will certainly discuss these options with me when I arrive at hospital, but clearly it would be very good to have considered them ahead of time and, if I am able, to discuss with my family or inform them, or someone close, of my thoughts.
As a Christian, the most important preparation for death that I can make is to acknowledge it as a gift from God. Life is, of course a deeply precious gift, and to die before what I might consider to be my time is heart-breaking and very hard to bear. But death is also a gift, and it must come to us all, because our life in this world was never intended to last forever. A verse from the Canticle of St Francis “All Creatures of our God and King” puts it well:
O thou, most kind and gentle death, waiting to hush our latest breath,
O praise him, alleluia!
Thou leadest home the child of God, and Christ out Lord thy way hast trod
O praise him, alleluia, alleluia!
So here are three things I need to do:
I can give my loved ones the gift of reassurance, by letting them know that I may be anxious and afraid, but I’m willing to talk about it with them and let them be close to where I am. Planning my funeral or my end-of-life care might well feel an odd thing to do, but it gives those close to me access to me, and helps them express their thoughts and concerns too. I might think about the sentence, “In case I don’t recover from this, I want you to know …..,” and how I might complete it. I might especially think if I want to say sorry to anyone about anything. One of the effects of an infection on my lungs is that speech will become difficult, so it’s good for me to say these things early rather than late.
2. My library.
As a priest, it’s been my privilege to be with many people at their time of death, and I know how valuable it will be for me to sing a hymn or recite a prayer in my final hours. This may have to happen in my head rather than with my voice, so the time to learn a few prayers and hymns, or maybe a psalm by heart is now. “Just as I am” and “The King of Love” are easy to learn, as are “Be Still” and “There is a Redeemer”. For prayers, I might learn “Father of all,” from the end of the Eucharist. The Lord’s Prayer is of course my foundation at such a time, but I don’t want it to be my only prayer. My selection of course won’t be yours, but to have some resources to call on will be good.
Above all, I will need to place myself in God’s hands at the end of my life, reaching out my hand to him and let go of everything else. I imagine that this “letting go” will be the hardest part for me, especially when it comes to those I love, so I need to consciously entrust them into God’s keeping, and have faith that he will watch over them with a love even greater than my own.
It will help me greatly to visualise this trust in God, and I will be choosing Mother Julian’s little hazelnut in the palm of God’s hand, and her words, “All shall be well, and all shall be well, and all manner of things shall be well.” Or the image of a child in its mother’s arms from psalm 131, or Paul’s words in 2 Timothy 4, “the time for my departure is near, I have run the race, I have kept the faith…”. But the words of Jesus on the cross are the best prayer of trust I can offer when I die, “Into your hands O Lord, I commend my spirit.”
I can also visualize God’s hand reaching out to me in welcome, forgiveness and healing. The father running to meet his prodigal son in the parable might give me this picture, or the lovely words from Isaiah 43, “Do not be afraid, for I have redeemed you, I have called you by your name and you are mine.”
As I said, as a priest I have hugely valued the experience of being with someone when they die. Even when this has been a struggle for someone physically, I have seen on every occasion the courage people find for that final letting go, and the peace which descends on them at the last. Dying is a deeply spiritual moment which words cannot express, and everything I have experienced of that moment leads me to believe it is indeed a gift, the path that leads home a child of God.
If there’s any of the content of this letter that you feel uncertain about, or if you would like to talk any of it through with me, please don’t hesitate to call me.