Discussion Post for THE LOST ART OF DYING, Chapter 4 Art, Pages 226-227

In different ways, this image seems both realistic and unrealistic. The man, the wheelchair, and the sign are depicted is realistic ways. In this respect, our chapter four image is unlike the flower image for chapter two, which was clearly symbolic, or the windows image for chapter three, which was both spatially and temporally ambiguous. On the other hand, I am pretty sure that none of us has every seen someone really doing what this man is doing, whereas we have seen flowers and neighbors in windows. He appears to be straining upward like a healthy man calling for a taxi. He looks alert. Yet he is unambiguously signaling his desire to be taken to a hospital. What is going on here?

Dr. Dugdale says this man “provides a visual representation of the many people who grow increasingly dependent on the mechanisms of health-care institutions” (page 226). That reliance, she says, “is partly responsible for the fact that only a minority of people die at home, contradicting their own strongly expressed wishes” (page 226). This man doesn’t appear to be dying (though appearances can deceive). Perhaps his present desire to go to the hospital will lead to his dying there later in life. Or perhaps the eager desire expressed by his body is a symbol of the inward desires of those who suffer terminal illness.

These observations make me think about the meanings of works like wish and want. Dr. Dugdale refers to people’s “strongly expressed wishes” to die at home. Like the man in this image, however, people who die in hospitals in some sense wanted to be there. Otherwise they wouldn’t have gone. This disconnect between what people want and what actually happens seems to come down, at lease in part, to the difference between what they previously wished and what they want when the time comes. That previous wish might just be a general, all-things-being-equal kind of desire. When decisions really have to be made, all things are not equal and there are often practical challenges that make dying at home less desirable.

I find in this disconnect, between what people want in a general way and what they want when confronted by the particular circumstances of dying, similar difficulties to those that pertain to making advance directives. (Here is an article I wrote about that.) In both cases, desires people have about their futures are more or less uninformed. We can’t fully anticipate the circumstances of our future illnesses, whether those circumstances have to do with where we will die or whether we will choose this or that treatment option. To an extent, however, we can anticipate. We can consider many possibilities ahead of time so that our wishes are less general and more informed, less like daydreamy fantasies and more like practical wants that inspire real preparation.

Perhaps we can draw two conclusions about this disparity between wishes and reality. First, that this disparity should be expected. Because we aren’t comparing apples to apples, but apples to oranges. People’s general wishes to die at home are not contradicted by their later decisions to go to or stay in a hospital, nursing home, or hospice. It is not as though they were performing the same activity in contradictory ways, like donating money to the Democratic candidate one day and to her Republican opponent the next day. Wishing and deciding are, in the sense in which we are considering them, two very different activities. As a second conclusion, we might say that our general advanced wishes would be more similar to our specific in-the-moment decisions if we considered beforehand the practical circumstances of our future dying.

People’s “strongly expressed wishes” to die at home are often at odds with the kind of desire that is expressed in this image. Advanced consideration about practical possibilities could have the desirable effect of partially bridging that divide. Dr. Dugdale is clearly interested in that. But I think she is more interested in the effects that could result from advanced consideration of cultural, existential, and personal aspects of human death and dying. I think she will attend more to those subjects in the remaining chapters of this book.

8 thoughts on “Discussion Post for THE LOST ART OF DYING, Chapter 4 Art, Pages 226-227”

  1. I agree with Christopher; the sign the man holds up to me indicates he wish to be saved–his hope for care. And, as Jacqueline has said, if we are alone when we are ill, we hope that the hospital will care for us in a way that we cannot care for ourselves. There is a place for hospital care; it may help us to come back to a place of health. The challenge, however, is for each of us to know when it will no longer serve our lives on this earth. As with so many things, it is the letting go of a long-held hope that is so hard.

  2. The man holding up the sign seems hopeful that his life will be extended. I don’t think that he is changing his mind about the preference to die at home. He is hopeful that the hospital will extend his life. People don’t always realize or are not told that going to the hospital means that they will die in the hospital and not at home. We always hope that the doctor will help us get well. Perhaps better communications with our doctors would let us know when it is time for hospice care. This idea of hope reminds me one of Father Jonah’s articles where he talked about two different kinds of hope. Sometimes there are real reasons to hope when we go to the hospital.

  3. Appearances can be deceptive. This robust healthy-looking man ‘s sign shouts out to us that he wants to go to the hospital. Wheelchair bound, he is unable to move about and care for himself and this has negatively impacted his quality of life. His world has become small – his life revolves around his caretakers. Are they weary of the daily task of lifting him out of his wheelchair and caring for his needs? Has it become an arduous unpleasant task? I surmise , it is not financially possible to hire surrogates to help with these tasks? The man in the wheelchair views the hospital as a hopeful alternative He seems to have faith that a health care institution will offer him a way out- relief from duress or maybe even healing.

  4. Susan, I love your interpretation about this man being the “picture boy” for modern medicine coupled with the outcome of increasing (not limiting) his independence. That makes great sense and shines a positive light on why we seek such help–especially when we are not necessarily at the end of our lives. Brilliant!

  5. The man in this picture appears physically strong, alert, and healthy. My impression was not that he is waving a sign “Hospital” in an attempt to hitch a ride there, but that he is a human billboard, a poster boy, if you will, on behalf of the healthcare system. The way a man in a spiffy suit and new shoes holding up an “Armani” sign would be advertising himself as a consumer/product of Armani, the man in this picture is a product/consumer of the hospital system.

    While the author describes “a gentleman in a wheelchair” as representing people “who grow increasingly dependent on the mechanisms of health-care institutions”, which she sees as being responsible for only a minority of people dying at home, to me the man in the wheelchair is a visual representation of hope. And gratitude. He is almost smiling; he seems proud.

    Whatever physical, psychological or sociological limitations or circumstances which may have made this man unable to ambulate, the wheelchair has given him the opportunity to become mobile, to go out and interact with other people and not be isolated in a room, waiting for a meal to be delivered. The mechanisms of the health-care institution have given him freedom and made him less dependent, not more — he is now mobile. Isn’t that a good thing?

    Although the author laments the movement from the “coffin and cradle-equipped farmhouse to death in the hospital” (p. 84), the industrial revolution and the changes it brought about in society, as well as in the development of hospitals as outlined in this chapter, is a reality. Hospitals offer care. Hospitals offer a place to die when one does not have a home or a family; or when one is afraid to die. Hospitals offer hope.

    While it is popular to criticize big institutions, they each serve a purpose. As stewards of God’s creation, we share in the responsibility of making them serve God’s plan and our neighbor’s good. Advances in research, treatment options, medication, vaccines, and even wheelchairs, are different ways man uses the gifts God has given him.

  6. Vera O –
    I appreciate your comments so eloquently explaining the difference between “want and wishes”…Advance directives speak as of a “time” specific. My soon to be 93 yr old uncle, my mom’s youngest and only remaining sibling of six, cared for his wife, worked her through brutal cancer tratments..some 20 + years ago…quite different options…when we approached him with his thoughts for wants and wishes…He said and continues to say “I want nothing” Please give me some meds and leave me alone…He saw it all up close and personal…he wants nothing. He has diminished capacity at this time, in a facility non NY, and continues to say “nothing”…Conversely, my sister struggled through her 40s through early 70s…”saving” her leg…from sarcoma..? pre-prosthetics..and the years needd to raise her children. She “always: wanted Hospital and “help” as she saw it, like the sign. Toward the end, having not been hospitalized for several years, she was unable to make a decision and her family chose Hospital.. eventually, leg amputation…for nought….spreading to the brain…interventions to reduce swelling …for nought….and so forth…until finally her major organs /kidneys gave out…Had she known…maybe she would have chosen to “Stay home” . My final thought about the picture reminds me of today’s covid sufferers “leaving” the hospital ….ushered out by the cheering heroic medical professionals and staff…clapping…balloons…etc. in wheelchairs….finally “going HOME” …reversed of “Hospital”

  7. Best wishes to everyone for a happy and healthy new year!

    The man depicted looks like he could be hitch-hiking a ride to the E.R. The situation seems more enthusiastic than urgent; he appears to be more healthy than infirm. It is an unusual picture, because “healthy” people generally wish to avoid hospitals. But when we are really sick, we embrace the hospital to alleviate our suffering and cure our ills. In today’s society, we are conditioned to place our faith in modern medicine and look to the hospital for our hope. If we are alone, we know the hospital will provide us with care when we can no longer care for ourselves. As wonderful as it is to have that luxury, it is also sad that so many of us no longer appreciate true faith, hope and love as gifts from God.

    Until we are actually face-to-face with death, we simply do not know how we will react. Thus, we are not fully prepared to state our wishes for life and death. Healthy people often sign their advance directives before any indications of their eventual demise are evident. They imagine all sorts of circumstances that seem unpleasant, and they opt out. As a healthy woman, my Mother used to say, “if I ever ____ (fill in the blank with pretty much anything), just let me die.” The first time I brought her to the hospital with a serious condition, she was petrified. She grabbed my arm, stared in my eyes and begged me not to let her die. When she recovered, the first thing she did was tear up her advance directives. After my Father died, I found old advance directives he signed as a younger, healthier man. They were in direct opposition to the interventions he consented to during his numerous late-life hospitalizations. On some level, we simply can’t underestimate the very powerful human will to survive. Perhaps it is that very will that raises this man up in his chair when he feels he has exhausted his alternatives.

  8. The enthusiasm with which this man holds up his sign is indicative to me of the idea of hope. He has the strength, wherewithal, and confidence to sit up so straight because he believes – whether at all truthfully – that getting to the hospital will fix whatever it is that ails him. I find the wheelchair is symbolic of this one, as a chronically ill/injured person, and two as someone who cannot reach the object of their hope on their own. It is interesting because we, the viewer, do not know why he is in the wheelchair: it could be a very temporary need, or it could be a lifelong dependence. I find myself assuming the former, which makes his hope that the hospital will provide salvation seem clearly misplaced. But the enthusiasm remains. I cannot decide if this is admirable or naive of our subject; probably both.

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