Last Chapters

Several months ago I volunteered to spend the night in the hospital with a woman on a respirator, in a palliative care unit awkwardly named "Step Down" for patients who, at least medically, it seemed to me, have nowhere to go but "down." It was a call I received from one of the area's Bikur Cholim (patient aid) groups. The woman's husband refused to leave his wife alone, they explained, and he has collapsed several times from sheer exhaustion. She's been comatose for four months now, and they were looking for people to relieve him.

I said yes immediately, afraid that if I thought about it first, I would lose the courage. The idea of sharing a whole night with someone straddling two worlds seemed awesome to me, so much so that I barely slept the night before, as I lay awake considering this woman and her soul.

Feeling tremendous compassion for the patient, I came to the hospital naively determined to reach her, and coax her to consciousness, if only for a moment. At her bedside, I read the day's Tanya and recited some verses from the Psalms, imagining that the holy letters and words will mysteriously nudge her out of her coma. I brought a charity box and placed it near her bed, and in the early hours of the morning, put in some tzedakah -- a mitzvah said to have life-saving potential.

But my direct encounter with this situation forced certain realizations upon me, and I began to wonder about the absolute views of Halachah (Torah law) on life-extending measures. Is the view that promotes the extension of even one additional moment of life, in its broadest definition, perhaps simplistic, and oblivious to the nuances in cases where all essential life has ebbed?

I was startled to find the patient with her eyes wide open and moving. "Just reflexes" the nurse said to me casually. I peered closely into her vacant eyes wishing to elicit a fleeting sign of the vitality that once animated them. Alas, her spirit or soul, which I had imagined would be more perceptible in the face of a waning physical existence, eluded me entirely.

I wondered at the sustained effort devoted to groom so lifeless a body over so long a stretch of time. Every two hours she is turned to prevent bedsores. She is fed through intravenous tubes and must be suctioned regularly. Her bodily functions are now managed by paid nurses. Once the master of her dignity, she would have recoiled in horror, I thought, to know that when she is no longer here -- when all that defined her as a distinct human being is no more -- her body would not only be allowed to languish, but be cajoled into languishing in an unnatural condition. And I felt deep sadness, convinced that she would not have wanted her body so exhaustively manipulated to keep her tethered to the netherworld of limbo.

So, for the first time I considered with more regard the argument against excessive measures to prolong life where essentially, it is over. It was no longer inconceivable to me that someone anticipating such an end would stipulate against life-extending intervention. And for the first time I realized that family members rejecting this kind of intervention are not necessarily selfish or callous, but may be sincerely motivated by concern for the patient and the desire to dignify their loved one.

Last week, I received another call from the soft-spoken woman at the Bikur Cholim. I wasn't sure what I'd say if asked to give another night, or even just a few hours. The experience was exhausting and seemed almost pointless.

But I am given to understand that we do not, after all, know with any certainty what transpires in the mind or soul of the human being in the absence of normal consciousness. What appears a pointless last chapter of life, may -- if not rushed to premature conclusion -- be its most redeeming episode. While in a coma, the soul may yet do teshuvah and reach fulfillment -- a possibility that is decidedly lost once the soul finally departs the body.

But the lady from the Bikur Cholim wasn't calling to ask me for anything. At the request of the patient's husband, she was contacting the people who had given time, to thank them again and to let them know that the patient had emerged from her coma.