Accepting the end

The hospice patient, an innovative leader in his profession, was in his last moments of life. His eyes rolled back into his head, and his breath began to catch in his throat. His devoted wife was not ready for him to go. She climbed up onto his bed, grabbed him by the lapels of his pajamas and shook him, screaming “No! Do not leave me!”

The patient’s gaze returned, and, as his wife later described it, she could see through his eyes into eternity. They held each other’s gaze for several minutes, and then his eyes closed for good. He was gone.

The wife told this story at the patient’s funeral, feeling that it captured something important about her beloved. She was pleased. But our ancient rabbis and commentators, I thought to myself, would have been shocked. For them, this is not the proper way to treat someone as they die.

Judaism is very clear about the precious, holy time of transitioning from this world into the next. Known in medical circles as “actively dying,” it is characterized by raspy breathing, slowing vital signs, and a lack of interest in food and water. It can last from a few hours to several days. 

Judaism has a name for this important stage of life: goses (rhymes with “no less”). As it says in the Talmud (Shabbat 151b), when someone is a goses, they are like a candle whose flame is flickering — if you reach out to touch it, you may put it out. 

So many people today die in hospital rooms, surrounded by beeping machines, yammering televisions, and teams of medical professionals that flood in to administer electric shocks and break bones. This all flies in the face of what Judaism says God wants us to be doing for the dying patient. 

Of course, there are times when modern medical interventions are appropriate to “save” a patient from death, but suffice it to say there are times when it can do no one any good. It is in the latter situation, when the end of life is nigh, that Jewish teachings want caregivers to adopt a very specific attitude: Keep at the forefront of your mind the idea that any action could either hasten or delay death, so it should not be taken. This is a time for self-restraint. Be tender and quiet, and let the death follow its natural trajectory. Let go, so that the patient can as well. 

The rules of goses, and how I suggest the Jewish families I work with observe them (when they are open to them), are as follows:

• Minimize sound. Turn off machines and televisions. Speak quietly. Play only quiet, gentle music or sing sweetly to the patient.

• Minimize touch. Gentle kisses and strokes are fine, as is dabbing the patient’s mouth with a wet sponge to keep it moist. But do not shake, jab, squeeze or move them. Don’t call 911 and rush them to the emergency room, nor rush them home from the hospital (lest they die in the ambulance). Don’t even change their pillow or their diaper — unless you are confident that it is an impediment to comfort and ease that needs to be removed.

• Do nothing bracing. Do not wipe the patient with a wet washcloth or put an ice cube in their mouth. Do not squeeze or pinch them, such as with a blood pressure cuff or an IV needle. It is clear that they are dying; it is not necessary to track each step of it on a medical chart. Hospice nurses should be amenable once you explain that this is a religious preference. But if the patient is in a hospital, it may take stationing someone in the room to negotiate and actively refuse interruptions to the patient’s peace.

• Speak gently. Offer words of reassurance. Do not order the patient not to die, nor to die today. Tell them everything is fine with you, and that they are safe, and that death will be the right thing for them to do, when they are ready to do it. All is well.

I have known people who held on long after they should have died — for months — even though they were being tortured by their health condition. It seemed they were fulfilling a demand, telegraphed to them by their families, not to leave. It’s just not a fair thing to ask.

Dying is not inconceivable or bizarre. We have made it a taboo in our culture, but dying is just as normal and normative as having sex, giving birth or even going to the bathroom. It is something we need to relax and let our bodies do. We need not fear it. It will come when the time is right, and then it will be up to everyone to face it with respect, and let it unfold with grace.

The Talmud (Ketubot 104a) tells the story of Rabbi Judah, who was dying and in pain, but who was so beloved by the community that the rabbis declared a public fast and offered prayers, day and night, to keep him among the living. His housekeeper saw his suffering, however, and interceded. She threw a jar off the roof, and the praying rabbis paused in unison. In the silence, the rabbi died. 

The story is told in praise of the housekeeper. The commotion and pleading of the rabbis was in its own way torture to Rabbi Judah’s soul. It just needed some peace and quiet so it could move on.

The rabbis of old may have had it easy, believing as they did that even reaching out and closing the eyes of a goses could be punished in the afterlife as murder. Today, it takes real bravery to contain one’s inclination to interfere.

Perhaps remembering the rules of goses, and the needs of the soul to return to That From Which We Came, can help give us this strength.

Rabbi Avivah W. Erlick is a board-certified health care chaplain working in home hospice and institutional settings. She owns a referral agency for clergy in private practice (lacommunitychaplaincy.com), and is a provider of creative Jewish after-death ritual (sacred-waters.com).