Landmarks and Taskwork for End of Life

This blog is the fourth in a series of reflections from the 3^rd annual Symposium with Dr. Ira Byock on October 12, 2018, Abundant Aging Through the End of Life.

For many, the thought that someone may be developing as a person at the end of life might seem preposterous. Too often, we think about a slow decline and winding down into the end of life. Dr. Ira Byock, however, has some different observations that he frames as landmarks and taskwork.

In the paper, “Developmental Landmarks and Taskwork for the End of Life”, Ira outlines helpful tasks that he has observed over his career of working with individuals as they come to the end of their life. I appreciate that these are landmarks and not “stages.” Each person will touch upon them in their own order and time. And with each landmark he suggests taskwork that is indicated. As I heard him speak on Oct. 12 and as I reread his paper, I was vividly reminded of the journey of my father following the diagnosis of an aggressive cancer.

Sense of Completion

Sense of completion with worldly affairs is the first of the three landmarks related to completion.

This refers to the transfer of legal, financial and larger responsibilities. It is one thing to name who your power of attorney will be and to engage the person who would make medical decisions when you are no longer able to do so. It is another thing to know when it is time for this transfer of choice needs to happen. For some, this decision is made for them because they are not able to do so. For others it can be more challenging as the letting go of these responsibilities indicates a significant shift in their self-understanding.

There can also be a sense of completion in relationships with community.

This happens when people are able to close social relationships and roles. When my father understood that all curative measures were exhausted for his cancer, we asked him what he needed. He formed his list quickly.

Dad’s 40-year vocation in parish ministry ended abruptly when the ambulance took him from the sanctuary to the hospital. He didn’t have closure with his congregation. So, first on the list, he wanted to lead worship one more time. Eight months into his medical leave and three weeks following the realization that there would be no cure, he led a farewell worship service from his wheelchair on a Sunday afternoon. There were members from three of the four churches he had served in the congregation that day. He had some completion to a faithful career.

The sense of completion is in relationships with family and friends.

As my father’s energy waned and as his heart weakened and it was evident that his life was coming to a close, he was able to say goodbye to his close friends. One by one and two by two, they came to his hospital room. Together, they shared expressions of gratitude and appreciation, affection and saying goodbye. He was unable, however, to have these conversations as explicitly with his family. How, I wish we had known about Byock’s “The Four Things that Matter Most.” We knew that we were loved. We had shared these things through our lives. He was just unable to share the last goodbye.

The Landmarks Unfulfilled

There are several landmarks that I am unable to identify in reference to my father’s death. I hope that he was able to acknowledge self-forgiveness and the he knew that he was worthy. I don’t think that he was fully able to accept the finality of life. He fought to the last breath. His last night was challenging, not because of pain, but because we all had the sense that he was trying to stay with us. He had not felt that he was ready for hospice care and did not speak to his grown children about his own death once the cancer had been diagnosed.

Sense of Meaning

Besides leading worship, there were several other items on my father’s list. He wanted to travel to Florida with Mom, her sister and husband for their annual November trip. We helped to make that possible. My parents had dreamed about taking their two grandchildren on a train trip and were waiting for them to be old enough to appreciate the journey. With 10-days’ notice, the eight members of our family went by overnight train to Washington, D.C. A part of that trip was a reunion and last visit with his half-brother. He was able to ask for forgiveness from his brother and they shared in honest reflection together. The family remembered stories through Dad’s life. And in those days, we made new memories. Even our children sensed the poignancy of the time during that family trip.

A close friend from Germany came to spend a week his father-figure and mentor, Dad, who was able to reflect on meaning about his life and to share wisdom about ministry and family.

Surrender to the Transcendent

In this landmark, Byock shares that “the doer and the taskwork are one.” Indeed, with my father’s death and the many others that I have had the privilege to accompany, this is the case. For many, like Dad, it is in the final moments that the letting go is achieved. For others the desire to let go does not bring immediate release, but death finally comes, even if not at the time of our own choosing.

In all of the landmarks, Byock frames the taskwork in helpful positive terms: Developing self-awareness, achieving a sense of awe, acknowledgment of one thing or acceptance of another. These are not marks of diminishment, but of growth. These are not marks of hopeless loss, but of hopeful fullness. May we all find ways to reframe the way we look at what is happening at the end of life. May we all anticipate and encourage others to engage in the taskwork. And may we create the sacred spaces for these conversations and reflections to bring fulfillment and a sense of dying well.

11/22/18 12:30