Walking in death valley

Before we talk about the valley, let us hear the voice of the Psalmist. Many of us know the verse from childhood days:

Yea, though I walk in the valley of the shadow of death, I will fear no evil for thou art with me.

These words come in the midst of Psalm 23 that begins by reminding us God leads us through life. As the valley experiences loom, we desperately need this reminder that He is with us.

The valley is full of shadows that terrify us. The unresolved hurts, the failures, the fears that come with every life. But they are only shadows. We can walk through safely in love!

God designed us for love; the valley is the place that helps us learn to let love reign. Do not fear the shadows. Walk into them confident of God's love and love those walking with you. Love never fails.

Not to be harsh, but this is a question that must be kept central. When a loved one is dying, sometimes we forget that the whole event is not just about us. Emotions feel like a torrent tossing us into oblivion. As you walk through the valley, let the person facing their own mortality be the voice that directs the action. Give family members room to struggle and grieve as they need to, but keep them focused on empowering the dying person above all others.

Ideally many of the discussions will have taken place before the journey is far into the valley. Advance Care Directives and living wills are easier topics when death is a distant concept. However, the closer the reality, the sharper the discussion. In fact, opinions may change as the realities become more clear. Such decisions as what type of interventions are acceptable change with prognoses. Most individuals are familiar with the phrase "DNR orders." Resuscitation makes sense at some points in illnesses...and not in others. But the bottom line to remember:

it only needs to make sense to the individual facing their own mortality.

Give your loved one respect enough to allow them to decide what is best for themselves one last time.

End-of-life realities scrape every involved heart raw. Unresolved issues from the past plop like mountains in the valley. Weights deaden some emotions and fire up others. Edginess and sensitivity reach tremulous heights. Communication at such times is necessary but fraught with danger.

Even in this, there is hope. Pressure creates diamonds--and each of those in the valley are in their own jewel-making process. And those great heights being reached? They open up new vistas; you will see life with greater clarity and maturity when you come out of the valley. In the meantime, give one another room enough to keep from being crushed--set gentle boundaries, stay silent sometimes and speak with restraint others.

While it sounds trite, the answer is love. Scripture tells us: Love covers a multitude of wrongs. Every life has a multitude of wrongs that come into and flow out of it. Love covers in both directions.

Love is a verb. There are enough emotions flying around! Just choose the actions that will show love and let love do the work of healing.

• I will get even!
• I will not be patient--I will not suffer long for you!
• I have given enough!
• I don’t want to do anything good for you!
• I want more!
• I am more important than you!
• I am right!
• I don’t care about what you need or think!
• I want you to do it my way! I am mad and you need to know it!
• I have been hurt by you too many times!
• I want you to get what you deserve!
• I don’t care what God says--I’m doing it my way!
• I will say what I want--so what if it hurts you!
• I know you can’t do that--you’re a loser!
• I know you will never be loving to me!
• I give up!

• Patient. I don’t need to get even.
• Kind. I seek to give and to do good.
• Content. I don’t want what others have.
• Humble. I don’t need to make myself look good.
• Peaceable. I don’t always have to be right.
• Courteous. I show respect.
• Serving. I don’t have to get my own way.
• Calm. I don’t blow up and lose my temper.
• Forgetful. I don’t keep a list of ways I’ve been hurt.
• Righteous. I want the best for others.
• Truthful. I love God’s word and try to obey it.
• Protective. I don’t say hurtful things about (or to) others.
• Positive. I believe the best about others.
• Hope. I believe good will come.
• Endure. I will not give up.

Communication with family will not be the only challenging chats in this valley. You will need to effectively communication with many professionals. They are a great source of information...but they are professional in their field of expertise.

The decisions faced in the valley are based on facts AND individual needs/preferences. Ask every question you need to understand what is being presented to you and your loved one. Do not allow your right to decide to fall into the hands of the 'professionals.'

In all of this incredible weight, do not forget to ask your loved one. Research and personal experience indicates that hearing abilities remain far into the dying process. Even those in seemingly semi-conscious states may speak through a hand-squeeze or head nod. Make the questions simple and direct. For example, do you want to keep fighting? Be sure the patient is empowered with a voice as much as possible.

While great strides toward victory have been made in cancer, the reality is that often the valley begins with a cancer diagnosis. Just like the end of life decision, whether to pursue chemo-radiation or not is a personal one. Here are some questions that may help you make that decision:

The Chemo/radiation Decision

Statistics & facts the doctors can help you with.

How much benefit (months/years) can you reasonably expect to get from treatment?

• Life expectancy with NO treatment: ______________
• Life expectancy with treatment: ______________

If cure is not what will result, the doctor may explain that the treatments given will be likely to delay the return of the cancer. If so:

• What do the current tests tell about the level/presence of cancer cells in your system? Are there tests you can take which will tell that?
• If/when the cancer returns, how fast is it likely to grow?

If this a second round of treatment, what kind of changes could be made with the regimen to minimize problems encountered previously?

How much would the doctor’s estimate that the ileostomy contributed to the health crisis during the last attempt at treatment?

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Personal Questions only you can answer.

What is most important to you at this stage in your life—what do you most want to spend your time and energy upon?

How willing/able do you feel to cope with the side effects of chemo & radiation?

Palliative Care doctors, like Hospice workers, enter lives when the patient prognosis is poor. Their expertise is in end-of-life issues such as the extended impact of high oxygen supplementation or feeding tube complications. Their focus will be on keeping the patient comfortable and easing them from this life. This is the doctor who will speak with you on withdrawing life support or providing heavy comfort drugs such as morphine. Ask what you need to know to make the decisions needed. Such questions may be:

• What is the likelihood of a recovery?
• What would recovery look like in terms of physical and mental function?
• How long can we continue as we are...what is happening to my loved one physically and mentally?
• What will be with-held (ie food, drink, oxygen)?
• If we refuse Palliative Care, what will my loved ones care look like?

The valley ends in a field of grief. That field must be walked through. The loss of a loved one is not something you 'prepare for.' Expected or not, the heartache is as much a reality as the hardship of the journey.

Mixed emotions are normal. Sorrow mingled with thankfulness that suffering is over. Tender feelings of love and compassion ebb and flow with slights and offenses. Feel the emotions. Do not try to stuff them away or pretend they do not exist.

Embrace the memories of your loved one even though tears will flow. Legacies are meant to be lived out, so take the memory and live the love you find within it.

Take time to heal; there is not a timetable to follow. Do what you need to to find peace on the other side. Build memorials--plant a garden or a tree; make a memory book; write a story.