Teaching Death to Nursing Students with Leo Tolstoy
By Richard Becker
“As though I had been going steadily downhill, imagining that I was going uphill. So it was in fact. In public opinion I was going uphill, and steadily as I got up it, life was ebbing away from me....And now the work's done, there's only death.” Leo Tolstoy, The Death of Ivan Ilych And Other Stories
We’ve come to the close of our annual month-long reminder of the obvious: We’re all going to die. It’s a truism that we learned as kids in Sunday school and CCD—the first of the four Last Things: death, followed by judgment, and then heaven and (rather, or) hell—although we Catholics are reminded of death year-round. It’s front and center in our liturgy, our creed, and even our routine devotional prayers. “Pray for us sinners,” we repeatedly implore the Blessed Mother in our rosaries, “now and at the hour of our death.”
Even so, the reality of death—the actual dying part—makes us all … well, squirm. “Can’t we talk about something more pleasant?” is how Roz Chast’s aging parents deflected the topic, and we frequently do the same—that includes my nursing students. They’re mostly young, and prone to delusions of invincibility (remember those days?) Plus, they’ve grown up with television dramas that feature doctors and nurses rushing in at the last moment to successfully resuscitate patients on the verge of oblivion. The patients recover, the sub-plots are resolved, and all the loose ends are tied up by the time the credits roll.
Such tidy packaging of complicated and dire healthcare situations is great marketing for nursing school—who wouldn’t want to be the hero and save lives, right? Yet, there’s a downside as well, for it conditions those future nurses to expect unrealistic routine outcomes. The truth is, despite winning plenty of battles at the bedside, we’re always bound to lose the war against physical death, and that’s not easy to hear when you’re a budding life-saver.
Consequently, I put death and dying at the very beginning of my introductory medical-surgical nursing course—it puts everything else in context. “All the pathologies, diseases, and chronic illnesses we’ll be studying the rest of the semester,” I tell them, “are merely hints of what we’ll all face sooner or later—yes, you included!” Our cancers, our heart disease and diabetes, even our mild colds and bouts of indigestion are experiences in miniature of everyone’s inevitable final ailment. In temporal terms, physical death is the end game, and I’m inclined to deal with it up front.
So, what is there to say about physical death? Less than you’d think. Regardless of cause, death is pretty simple, and has been traditionally defined by common sense observations: We need air to breathe and blood to circulate in order to live, and so it has long been understood that their absence is the best indication that life has ceased. In medical terms, this is what we call a lack of vital signs: heartbeat, breathing, blood pressure, temperature. Once these are completely and irrevocably gone, we can be certain that physical life is gone as well—a natural conclusion to biological existence in scientific terms.
For Christians, however, and particularly for Christian healthcare workers, that’s just the beginning. To start with, we vehemently reject the widespread notion that “death is just a part of life”—nonsense! Instead, with the Catechism we affirm that death is a “departure” in which the “soul is separated from the body” and the “end of earthly life,”not a part of it. Furthermore, it’s a “consequence of sin,” and the “last enemy of man left to be conquered” (CCC 1008).