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On Being with Krista Tippett is a public radio project delving into the human side of news stories + issues. Curated + edited by senior editor Trent Gilliss.

We publish guest contributions. We edit long; we scrapbook. We do big ideas + deep meaning. We answer questions.

We've even won a couple of Webbys + a Peabody Award.
Being a full human being has a lot to do with suffering.
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BJ Miller, executive director of the Zen Hospice Project at the UCSF Medical Center

A triple amputee, this doctor’s story is one to be read and admired as he brings new approaches to the palliative care field.

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"I would just like people to believe that humility — listening to the other person and trying to understand the other person — and forgiving are important." —David Plant, who reflects on his legacy knowing his skin cancer has spread to other parts of his body
Photo of David Plant with his stepson Frank Lilley courtesy of StoryCorps

"I would just like people to believe that humility — listening to the other person and trying to understand the other person — and forgiving are important."
David Plant, who reflects on his legacy knowing his skin cancer has spread to other parts of his body

Photo of David Plant with his stepson Frank Lilley courtesy of StoryCorps

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Contemplating Mortality: The Need to Remember That Death Is a Human and Personal Event, and Not Just a Medical One

by Krista Tippett, host

Trees and forest.Photo by Long Lim/Flickr, cc by-nc-sa 2.0

It’s difficult to believe these days, when so many of us have had some experience of moving toward death with a loved one in hospice, or even a stranger on the CaringBridge website, how “badly” people died in this country until very recently. That’s the word Dr. Ira Byock uses. He began his life in emergency and family medicine and recalls that when people were deemed to be dying — when what was wrong with them was beyond “fixing” — they too often died in pain in the hospital or were simply sent home. Doctors practicing now still recall their training, implicit and explicit, that death was a failure of the body, and of medicine. We turned away from it, scientifically and culturally.

The palliative care and hospice movement arose first in England and then took hold in the U.S. in the 1970s and 80s to compassionately treat the pain of chronic illness and all the suffering — physical and otherwise — as the end of life approaches. Its spread has converged with the continued advance of medicine. In our lifetimes, many forms of cancer have transformed from fatal diagnoses to chronic illnesses.

As I was preparing for my interview with Dr. Byock, I re-read a gripping New Yorker article by the surgeon Atul Gawande. It chronicles the increasingly blurring boundaries between treating illness, prolonging life, and staving off death. When one woman asks him if her sister is dying, he realizes, “I wasn’t even sure what the word ‘dying’ meant anymore.”

Dr. Ira Byock with PatientsDr. Byock sees this as a human opportunity and challenge. Medicine is remarkable, he knows from the inside, and will continue to get more remarkable with the passage of time. But we must “grow the rest of the way up” and acknowledge that we have yet to make one person immortal. Even while we fight for life with all the tools at our disposal, we have to reckon with the reality of death. The good news, as he tells it, is that there are riches to be gained in that reckoning. That edge of life — which our miraculous medicine allows some to perch on longer than ever before — can be a time of unparalleled repair and celebration. Like it or not, as Dr. Byock says, death completes us. These days more than ever before, we can shape that moment of completion together with those we love.

With this kind of thinking, Dr. Byock is taking the impulse behind hospice to a new place. He goes so far as to suggest that dying can be a developmental stage of human learning and actualization — like adolescence or mid-life accomplishment. He names “the four things that matter most” — words that can be transformatively spoken and enacted — at the end of life: Please forgive me. I forgive you. Thank you. I love you. These are four sentences, a mere eleven words, with a power to call up a lifetime of struggle in so many of our families.

I think here of that phrase attributed to Oliver Wendell Holmes that has recurred so often in my interviews: the “simplicity that lies on the other side of complexity.” For in the time of life we call dying, as Dr. Byock describes, these elemental human capacities like thanks, love, and forgiveness can unfold in their most complex and immediately redemptive power. The Four Things That Matter Most by Ira ByockI love this quote of the theologian Paul Tillich, which he put in the preface of his book The Four Things That Matter Most, and which points at the way being with dying has opened Dr. Byock’s imagination about the word “forgiveness”:

"Forgiving presupposes remembering. And it creates a forgetting not in the natural way we forget yesterday’s weather; but in the way of the great "in spite of" that says: I forget although I remember: Without this kind of forgetting no human relationship can endure healthily."

One difficulty of this conversation is that there are no rules for when, in any life or any course of medical treatment, we can know we have crossed the boundary between fighting death and facing it. Dr. Byock suggests that this is not an either/or but a both/and. Still, there is something fierce and sacred in us that resists the end of our life and the death of those we love. That same impulse resists the kind of contemplation that happens in this conversation as well. One of Dr. Byock’s most basic insights may be his most helpful: we must remember that, even in the 21st century, death is never really a medical event but a human and personal event. Dying is a defining feature, strange and mysterious as it remains, of living.

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Hope at the End of Life

by Judith Leipzig, guest contributor

Waiting Room NapPhoto by John Starnes/Flickr, CC BY-NC-SA 2.0

On my first day as a chaplain at Calvary Hospital, a palliative care facility in the Bronx — a place where every patient was near death — I was overwhelmed. In the other hospitals I had worked in, I had sat by the bedsides of patients who were frightened, lost, conflicted, and alone — whose lives were rife with hardship, and who often had few resources to help them make their way. But there had been — almost always — a future to reference: the possibility that addictions could be overcome, that illness might recede or be cured, that physical pain might be relieved, and certainly that a time would come — in a few days or weeks — when the patient would go home and resume his life. Almost always, hope was an assumption for me and for the patient. No matter how much suffering, hope was implicit in the fact of being alive.

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