The final journey of Arthur Clifton
His good life included a successful career and a loving family.
His death--a universal tale--proved to be a test of faith and love.
November 19, 2006
Arthur Clifton lay in bed in a well-appointed nursing home, looking more elegant in striped pajamas than many men do in dress clothes.
It was a tasteful room in which he was dying. The carpeting was patterned in burnt orange; the wood armoire could have been in a nice hotel, except for the nurse's station across the hall.Clifton, known to everyone as Art, was a pragmatic man. He understood where emphysema, the wages of a smoking habit he kicked too late, was taking him.
Determined to protect his wife and family from any burdens, the retired insurance executive had spent more than a year planning meticulously.
He transferred his finances to a trust. He arranged for a banker to pay the bills, before and after he died. He made to-do lists to be followed posthumously: The alumni association of Mishawaka High School in Indiana was to be notified; his oxygen machine was to be returned; his medications were to be thrown out.
At 81, he had reached a cherished goal--to live long enough to see his wife of 56 years, Nita, surmount her own health problems. Now he had grown too weak to help her, too ill to help himself.
He wanted to be able to get out of bed. He wanted to be able to walk down a hallway. He wanted to be useful. Nita once came to visit and found three words scribbled on a piece of yellow lined paper: "quality of life."
If he couldn't have it, he kept saying, he did not want to live.
Yet Art waited. Death would come on its schedule, not his. He had carefully arranged the move he and Nita had made from the Wilmette home where they raised two sons to Classic Residence by Hyatt, a retirement community in Glenview. But his next move was beyond his control, and his ultimate destination unknowable.
"Something's got to be there," he said. "But what?"
Death is a mystery, not just philosophically but literally. Many Americans have never seen one. Shrouded in medical routine and cultural discomfort, death is universal, but in this country, largely invisible.
And spirituality in the face of death is especially private territory--one's deeply personal reckoning. But it is on the eve of death when people can find themselves confronting the essential questions of life, and their lives in particular.
What has my life meant? What is the purpose of life? What happens after death? For someone who is dying, these questions are not purely theoretical, and the time in which to answer them is short.
The exploration is not necessarily a religious one. Questions about the nature of existence don't require belief in God. They reach into the core of what it means to be human and back to the beginning of thought and reason.
Not every dying person embarks on such a contemplative journey. Some people are not so inclined; some die in too much pain or too abruptly to afford the luxury of introspection.
Sociable and always looking for ways to be of help, Art allowed the curtain to be pulled aside on his own final journey. If this might prove useful to other people facing death, he was willing to share it.
He was known for his optimism; his Boy Scout nickname was Smiley. But although his last months would be warmed by visits with family and friends, the final, slow stages of death would test his upbeat nature and mock his nickname.
He would be tormented by the wall clock in his room that showed as minutes what felt like hours. His Baptist upbringing and his 44 years as a member of Trinity United Methodist Church in Wilmette would not protect him from doubt about his faith.
He would feel abandoned by God. He would pray in vain for a swifter death.
Nita Clifton would pray in the opposite direction--for her husband to live--rejecting reality even as he accepted it. She would castigate herself for her selfishness.
They would not struggle in isolation. Art was receiving hospice care; the services of Midwest Palliative & Hospice CareCenter included regular visits by chaplain Kathleen Foy.
She would be his spiritual companion, a kind of guide into death, a modern echo of the Greek myth that saw Charon ferrying souls into the underworld over the River Styx. But in a larger sense, Art himself would be the guide, leading the way to a death on which he was the only expert.
To the extent that many people think about death, it is often in hopes of experiencing a good one--a death free of pain, eased by acceptance of the inevitable and a deliberate leave-taking of family and friends.
But every death is unique, Foy said. She did not subscribe to the notion of an ideal one.
"There's no such thing," she said. "The death you have is the death you have."
This is the death Art Clifton had.
A WIFE'S DREAD
When Foy prayed for God to bring whatever was best for Art, Nita prayed along with her.
But she didn't really mean it, not if what was best meant his dying.
Slight and soft-voiced, with the delicate presence of a fawn, Nita--no one calls her Juanita--sat with Foy in her living room.
Her hair was white; her demeanor fragile. Art had always taken care of everything.
Nita, then 80, didn't think she could manage without him. "Don't you die before me," she had told him, more than once.
Their apartment was in the independent-living building of the Classic Residence complex, the kind of place where people who have lived well can retire well. The dining rooms were chandeliered. The parking was valet.
Nita's color scheme was white and pink. Her husband's retirement from Washington National Insurance Co., where he was executive vice president and a member of the board of directors, had been her invitation to redecorate.
She had let her inner girl fly; there were pink roses on the sofa, red and blue flowers on the pink ceramic lamps and pink sconces on the wall with little floral lampshades.
She had thought hard about the flowers.
"I thought, `Cripes, what if I die before he does?' " she said, a hint of her native West Virginia playing about the words.
For a time, the sequence had been in doubt. Art was dying slowly, but Nita was hit by several swift crises--gastrointestinal surgery, then while recovering, a near-fatal heart attack.
She had rebounded from that as well, though she had been hospitalized several times for dehydration and continued to battle intestinal woes.
Still, it was fairly clear who would be going first. She would not be leaving her husband marooned in flowered fabric.
The prospect of his dying was appalling, devastating. "I don't want him to go," Nita told Foy.
Nita's eyes reddened and filled; she cried.
Behind her delicate appearance, she was raging. "I just won't accept the end. I just won't accept it," she said. "I won't admit he's leaving me."
She didn't know who she was anymore, she said; neither a wife nor a widow, but in some strange limbo.
The memories, though, were so fine. A smile rising on her lips, she padded through the apartment, showing Foy the mementos--the retirement plaque, the needlework, the photographs.
From a frame in her bedroom, young Art grinned, his hair wavy and his World War II infantry uniform pressed. "He was so handsome," Nita sighed, still smitten.
They met just after the war. Art, born in Fair Oaks, Ind., was a fledgling insurance salesman in Washington. Nita was a medical secretary with an apartment in the same complex as his.
One day he spotted her and a girlfriend leaving a restaurant, hurried into his car and offered them a ride home. Maybe Nita rushed for the middle seat and maybe she didn't, but their life together began. They married, he rose at Washington National and after being transferred to several different cities, he was promoted to the home office, then in Evanston.
They raised their sons in a Wilmette house Nita loved so much she had an artist paint it in watercolor. After Art retired in 1987, they bought a condo in Naples, Fla., where they spent winters. He played golf. They watched sunsets over the Gulf of Mexico, sipping glasses of wine.
But illness came calling on the good life. Art's emphysema was worsening and Nita's run of medical problems began. They sold their Wilmette house in 2001 and moved into the Classic Residence. The next year, with Art too ill to go to Florida, they sold the condo, too.
Art got pneumonia 11 times. After his last bout, he entered the nursing home at the complex. His ravaged lungs could no longer put enough oxygen into his bloodstream.
When he began hospice care, he had been virtually bedridden for five months. Once he had traveled frequently to New York on business; now he could barely shuffle a few feet to the washroom.
Nita was agonizing over a decision she could not make. A friend had told her that before her own husband died, she reassured him that she would be OK after he was gone. It was the hardest thing she had ever done, the friend told Nita, but it seemed to ease her husband's mind.
Nita couldn't do it. Wouldn't that be like encouraging him to die? Or implying that she wouldn't mind if he did? Besides, she wasn't sure it was true; she didn't think she really would be OK.
"He's always taken care of me," she told Foy, the injustice of it nearly palpable. "He ought to be here, holding my hand."
A stalwart at Trinity United Methodist Church like her husband, Nita had been searching for comfort in prayer. But prayer itself had become the nexus of her inner conflict.
She knew her husband was praying to die. But Nita, in the twilight of a harmonious marriage, was praying that her husband not get his wish.
"I feel really guilty sometimes," she said. "He wants to die, and I want him to live. Who is God going to listen to?"
Foy sat in her car in the parking lot outside the Glenview nursing center, looking through paperwork on the patients she would visit that day.
She was watchful and calm, with a way of filling a hard silence with a soft murmur.
Her black Prius was her mobile ministry office. She drove from the west suburban home she shared with her husband and college-student son to the hospice's office. From there, the car's global-positioning system guided her to patients' homes. The cargo area held her plastic bottles of holy water and anointing oil, a Bible and a pyx, the small round case that holds communion wafers.
Her mobility reflected the nature of her work. Hospice is not a facility, although Glenview-based Midwest Palliative & Hospice CareCenter has an inpatient unit in Skokie. It is an array of services for people at the end of life. Most hospice patients live at home or in a nursing home.
On this morning, shortly after last Thanksgiving, she put away her papers, got out of the car and walked up the wide drive to the entrance of the nursing center. The hallway to Art's ground-floor room was tasteful and serene. A little past it there was a large dining room with expansive windows and china place settings. In his yearlong stay at the nursing home, Art rarely had the strength to make it there.
Foy knocked on the door to Art's room. "Mr. Clifton? It's Kathi, the hospice chaplain," she said.
He was sitting on the edge of the bed, his feet hanging down. His head was round and smooth, his eyes bright and mildly impish. A handkerchief was folded neatly in his pajama pocket. The skin on his shins was mottled; there was so little oxygen in his body that blood was being shunted away from his extremities and toward his vital organs.
Foy chitchatted. Had he eaten lunch yet? Had he been sleeping a lot lately?
It wasn't idle conversation. Foy was building their relationship and also discreetly gauging Art's condition. Sleep is a clue; the more a disease saps a patient's energy and organ function, the more the patient sleeps.
She had dealt with bigger questions on her first visit. Matters of faith and God are vast and profound, but Foy had a down-to-earth tool to establish a patient's beliefs: a spiritual-assessment form. Many hospices use such forms to help chart patients' needs.
The form used by Foy and her colleagues seeks to bring the ineffable down to the specific. There are boxes to be checked off. Does the patient have eternal life beliefs? A sense of peace? Feelings of guilt or loss? Unfinished business? Loss of faith?
The idea, she said, is to see how patients make sense of their lives, the world and whatever may lie beyond it.
At 53, Foy had come to hospice work after her own journey. Raised Roman Catholic, she found herself moving away from a faith centered on scriptures and a concept of God in which she did not literally believe.
Her new spiritual home was in Ethical Culture. Founded in the late 19th Century by Felix Adler, Ethical Culture is a humanistic religious fellowship of people who believe that the highest purpose of life is to create a better society and that the source of ethics is not God, but the human condition.
Foy became an Ethical Culture leader, as the movement's clergy are called, and then a chaplain. Some of her Ethical Culture colleagues have asked how she can in good conscience pray with patients to a God in whom she does not believe. But she sees no conflict. Her agnosticism does not dismiss divine possibilities.
"For me, God is a concept that helps people find meaning out of life, to try to make sense out of the world and our place in it," she said. God is "that essential place you reach when you just don't know. ... My leap of faith is mostly into acknowledging that I am comfortable with not knowing."
She saw her chaplain's role as traveling with patients wherever they led her. Some people wanted to pray; some wanted to talk; some were comatose, in which case she simply sat, offering her prayerful presence.
There were those who accepted their approaching death, and those who fiercely rejected it. One young woman vowed to beat cancer, right up to the day she died of it.
"She died in denial," Foy said. But she taught Foy a lesson. Denial was a choice, and a chaplain had to respect it.
Art was looking straight at his death and not blinking. He figured it was up to God.
"I'm willing for him to take me any time he wants to take me," he once told Foy. "I only hope he doesn't wait too long."
Foy's spiritual assessment was that Art was ending his life comforted by significant strengths.
He had accepted that he was going to die soon. He had a sense of his life's meaning and purpose. He had close ties to his church in Wilmette, where he had once served as treasurer; the pastor visited him regularly.
The spiritual-assessment form, though, only hinted at the richness of his life. He and Nita thrilled to their sons' successes. Richard Clifton, 55, is a federal appeals court judge who lives with his wife, son and daughter in Hawaii. Kevin Clifton, 49, is a partner in a commercial real estate firm. He and his wife have raised their three sons--the older two are in college--in Winnetka, where proximity gave the boys a particularly close relationship with their grandparents.
Art adored his grandchildren and was deeply devoted to Nita. They shared a ritual at each parting: "Love you," one of them would say. "Love you best," the other would reply.
His business life had brought accomplishment and pride. He had been "a 100 percent straight shooter" at Washington National, said his closest friend, Kendall Carver, 69, also a longtime executive there. Art spoke frankly at work even when it was impolitic to do so, Carver said, and would not tailor his views to make them more acceptable: "Art wasn't that kind of guy."
He was the kind of guy who called an ailing colleague every day to ask how he was.
He was the kind of guy who did not mention that he was wounded by shrapnel twice while serving in the infantry in Europe during World War II and was awarded the Purple Heart with Oak Leaf Cluster. He did not speak of the time in France when he rescued wounded members of his platoon from an enemy minefield, or the resulting Bronze Star.
For all his strengths, he was not immune to despair. He found waiting to die agonizing. He told a startled friend who was visiting that if he had a gun, he would shoot himself. He was taking anti-depressants.
He was not afraid of death, he had told Foy at one of their meetings. He had grown up believing in heaven, although youthful certainty had yielded to some adult skepticism.
As his life waned, however, he found himself wondering if his belief "was as strong as I originally thought it would be."
He would find out the truth, he figured, when he died.
"If there's something after, I'll know about it," he said.
A lifelong churchgoer, Art still wasn't a man for a lot of God-talk. God was a given, a presence, a fundamental fact of his eight-decade life.
Until the facts seemed to shift beneath his feet.
One day Foy encountered Art in uncharacteristic anguish. He told her, she recalls, that waiting for death was unbearable. He had sinned in his life, and God must be punishing him. He was in tears.
While the details of their conversation would remain private, Foy later characterized it not as a confession to a particular sin, but a universally human look back on life with some regret.
They talked about how to ask God for forgiveness. Art was so exhausted that Foy pushed no further. She urged him to get some rest.
She returned the next day, and pulled a chair close to his bed.
"I know yesterday was a rough day for you," she said.
"The last few days," he said quietly.
He was lying in bed, one hand behind his head. He was thinking about God.
"Sometimes I wonder if he's still there," Art said.
He stared at the ceiling.
"I'm there, but where is he?"
The oxygen machine hummed. A life's faith wavered.
"Have you asked him?" Foy said softly.
"I tried to," Art said, still staring up. "I didn't hear him."
"It's a rough, rough place to be," Foy said.
"I know," Art said. "And I've been here a long time. Bobbin' up and down like a bobber."
Foy looked at him, adrift. Then she carefully waded in.
"When you felt him there before, how did you know he was there?" she said.
"Well, that's what I'm wondering," Art said. "I wish I knew."
"It's hard to remember how that felt," Foy said. "It's like, `Was that real, or was that a fantasy?' That's a hard place to be."
"Nowhere," Art said.
The painful assessment hung in the air.
"When you think about your children, what's that like?" Foy asked.
"I love them very much," Art said. "When they were little tykes, they were just so loving. And my grandchildren--they were there all the time."
"Was God around those times, when you think of those memories?"
"Oh, yeah," Art said. "We fixed up a bedroom into ... our make-believe room. We pretended we had canoes and go up and down the sides of the beds. We'd get umbrellas, open them up and jump off the bed like a parachute."
He had conquered the bitter present with the sweet past. Back then, he was not a bedridden patient, but Papaw, the adored grandfather who eagerly took to the floor to play with his grandchildren. He was strong, Nita was healthy and everything felt happy and alive.
Foy asked if Art could try to recreate those moments in his mind, searching for God by summoning times when his presence had been so strong.
"I wish you could, but you can't," he said. "You can't just tap into any moment."
Foy offered him a cup of water. He took it, his hand shaking.
He forced himself back into good humor when Nita peered into the room.
The hospice offered bereavement services, Foy told the Cliftons. "After your death," she said to Art, "we will be following Nita for a year."
It was a matter-of-fact acknowledgement that did not faze Art. Lest it hurt Nita, he protectively batted it away with a quip.
"Well, if you're going to be following me, I hope I'm going up that way," he joked, nodding upwards.
Nita was not laughing.
"I don't know what we're talking about," she said. "Idle chatter."
"Do you have any questions?" Foy asked her. "It's not an easy subject; it's not an easy time."
Nita hesitated. "I guess I don't know the kind of thing you're supposed to talk about," she said.
Foy turned back to Art with a discreet acknowledgement of their earlier conversation.
These were hard times, she said: "Nobody's planned this; nobody asked for it."
"And we don't get too many answers," Art said.
Kevin Clifton leaned over from his considerable height to kiss his father. He sat on the window ledge, squeezing into the space between the bed and window.
It was a sunny day, but the blinds were drawn. The room overlooked a patch of grass, a thin tree and a wall. Nita, sitting on a wing chair in the corner, had wanted Art to transfer to a room with a better view, but he was not interested. The time for him to care about views had passed.
Kevin goaded his father to talk about the war. "Didn't the shrapnel hit your Bible?" he prompted.
"Yes; I was carrying a Bible in my shirt pocket and it hit the pocket," Art said. "It was just luck."
"The Bible kind of helped, though," Nita said dryly.
Art had told his sons a few things about the war. He and one of his best friends had been smoking cigarettes when shots rang out. His friend had been shot in the head and killed.
"They were this close," Kevin said outside his father's room, gesturing to his side. The experience, Kevin thought, had helped make his father grateful for life and shaped his thoughts about death: It could come at any time.
Kevin had been measuring his father's decline by his shrinking interest in the things he had always loved. An Indiana University alumnus, Art stopped caring about basketball games. Even news of an upcoming visit by his grandchildren didn't always rally him.
Art's older son, Richard, was visiting every few weeks--a remarkable schedule considering that he was flying in every time from Hawaii.
The sons knew their father was hoping to die.
"The hardest struggle for me is wishing for something different," Kevin said. "I want to be able to call him tomorrow."
IN THE WILDERNESS
Something strange often happened to Foy when she was around death or felt an intense connection with a patient at the end of life: The top of her head would start to tingle and itch.
"I call it my crown chakra," she said, the center of energy at the top of her head reacting to something spiritually electric.
Art was coming ever closer to the end of his life. He still ate his meals, but did little else. He had stopped reading the newspapers that he once devoured daily from front to back. He no longer read books, though he had previously finished as many as five a week. He was too weak now to hold them up.
Sometimes he was too tired to talk with Foy. But one day she arrived to find him strong enough to confront pain.
He wasn't sure he was doing what God wanted of him, he told her. He wasn't sure what God did want of him. And how could he serve God if he wasn't strong enough to help his wife?
"When you don't feel that you're helping God, you try to proceed and help your fellow man," he said. "But when you get to the point where you don't feel you're helping them, you feel lost."
The clock, his tormenting reminder of the slow crawl of time, ticked.
"You're in unfamiliar territory, aren't you, Art?" Foy said gently.
"Yes," he said. "Still not certain who I am or should be."
He coughed wetly.
"You don't have the energy you had," she said. "And your role is changing. It's like, `Who is Art now?' "
Art was quiet for a moment.
"To tell you the truth, right now I'm just a little bit lost," he said.
But in Foy's eyes, he was also deeply courageous.
Outside his room, in a quiet corner of the nursing home, she paid tribute.
"He's going out to the absolute edge of not knowing anything," she said. "It's like, `Who am I now as I'm dying?' ... He was really crying out in the wilderness."
And the veteran chaplain, professional companion to the dying, cried.
Foy would offer support, but not false comfort. "This is his only death," she said. "You don't jolly him out of it and say, `Everything's going to be OK.' You say, `I'm going to go there with you, as much as I can.' "
Before she left his room that day, Foy stood next to Art's bed to pray with him. She looked directly into his eyes; he looked back, just as directly.
Foy's head was tingling.
They grasped hands and bent their heads.
"Even though it's unfamiliar territory and there's none of us who can say how you feel and it's hard for you to say some things, God is with you," Foy said. "He may look different from the God you knew before; it may be changing.
"My prayer is that you have everything you need and that you have no fear and that it's peaceful, even if it's unfamiliar territory. And we call upon the words Jesus taught us: `Our Father Who art in Heaven ...' "
Art Clifton joined in, praying to the Father whose presence he no longer sensed, in the heaven he was not certain existed.
Facing the end, with faith
November 20, 2006
Arthur Clifton was slipping away.
The emphysema that had choked off his life was now poised to end it. One morning last April, his blood pressure plummeted. His breathing turned labored. A hospice nurse advised his wife, Nita, to call their sons.
The nurse told Nita that Art was close to death, but Nita didn't believe it. And to see him that afternoon, neither would most people.
He was a man transformed.
He was wide awake, completely lucid and eager to talk about God, sports and anything else. He was sharp, he was reflective, he was joking, he was serious.
Nita was dumbfounded. But those in hospice care see the phenomenon too often to be surprised.
Just before death, people sometimes rally to a degree that families can mistake for a recovery. A patient who had seemed nearly comatose may sit up in bed, ask for food or hold complex conversations.
In hospice, they call it the "power surge."
It is one of the signposts of dying that are clear to those familiar with the process, and astonishing to those who are not.
Another sign had come four days earlier, when Kathleen Foy, Art's hospice chaplain, arrived for her regular visit. Art had been confused that morning, a nurse told her, and he had said something odd:
My car is waiting.
With that, Foy knew.
It was no random expression of befuddlement to her ear, but a harbinger. When patients start talking about taking a trip, packing their bags or some mode of transportation, she had found, they were close to dying.
When she entered Art's room, the evidence mounted. Art, 81, was agitated and seemed unaware of his surroundings. His schedule was too full for them to talk, he told her. "The time is bad," he said briskly. "I have a lot going on today."
It was a businessman's approach to his final meeting, she thought, in which the language of his life became symbols for his death.
"People die the way they live, only more so," said Foy, who worked for Midwest Palliative & Hospice CareCenter. "He lived by the schedule; now he was scheduling himself for death, in a metaphorical way."
Art, a retired insurance executive from Wilmette, had been in hospice care for six months, dying by degrees in the nursing center of the Classic Residence by Hyatt, the Glenview retirement community where he and Nita, 80, lived.
He had struggled with his faith; he had faced his doubts. He had told his friends and family he was ready to die. He despaired that it was taking so long, as he was reminded by every glance at the large clock on the wall, ticking off the passage of time.
That particular anguish, Foy suspected, would end. "There will be a time when he looks at the clock and doesn't know it's a clock," she said.
Now Art would say--and receive--final goodbyes. Now his thoughts about spirituality would become his last. Now would come his last chance to say anything that needed saying.
Dr. Ira Byock in his influential book, "Dying Well: Peace and Possibilities at the End of Life," suggested that people find some way to tell their loved ones five things before they die:
I forgive you. Forgive me. Thank you. I love you. Goodbye.
Science has yet to explain the power surge at the end of life. It could be the result of hormones and adrenaline released by the body, but no one knows whether it is the body's reaction, the mind's or both.
Whatever the cause, the effect on Art was striking.
He was lying in bed, as always. Purple blotches bloomed on his hands, a common marker of impending death.
For months, steroids and morphine had spared him the agonies of emphysema.
Now even that wasn't enough; he was struggling to breathe.
But he was alert, aware of his precarious condition and eager to talk. And for one remarkable hour, with Nita by his side, he did. He wasn't feeling too well, he conceded.
"If I want to go to the men's room, they said I should take one of the nurses with me because I'm losing my balance a bit," he said.
"See, things aren't always as pleasant as we would like," he added, his eyes steady and intent. "You make plans, but you don't know how they're going to turn out."
But he knew now.
"Right now I'm on the loser side," he said. "But I'm still waiting for the Lord to do what he's going to do."
Nita looked at her husband.
"Are you comfortable with that, waiting for the Lord to do what he's going to do?"
"Yes, I am," he said firmly. "Anytime he wants, he can take me, and the sooner he takes me the better it will be. I've done what I can for other people. I've served the life I wanted."
Nita stroked his hand. "You mean you don't want me to keep talking to the Lord?" she said, her voice teasing but her intent serious.
"I don't know what you're saying," Art said. "You can keep talking to him."
"I've been giving him a different message," Nita confessed.
"What message have you been giving him?" Art asked.
"Oh, about being with you," she murmured. "Being selfish."
While Art had been praying to die, his wife had been praying for him to live.
"No, that's OK," he told her.
I forgive you.
"I'd be with you if I could be helpful," he said. "But if there isn't anything you can do for other people, that is just a mere existence. I know it's hard to say, but that's how I feel."
He told Nita he was ready to join the soldiers who died by his side in World War II. "Everything is in fairly proper order. ..." he said. "I would be happy to go with them down that path."
And the spiritual pain that had sometimes darkened his last months? Did he still feel abandoned by God?
In a sense, he did.
"For some reason, he's not talking to me right now," Art said.
But it was a simple acknowledgment, not a lonely cry. He had circled back to the pragmatism with which he had begun.
"I have faith; I've had faith all my life. But whether my belief is completely and 100 percent true, I can't know," he said. "When I go, if I see Jesus Christ our Lord and Savior, I will know the Book is correct. If not, the Book is incorrect."
"But you don't believe that," Nita said, half statement and half question.
"I believe," Art said.
"You believe in the hereafter?" she pressed.
"I do," he said, and his voice now expressed no doubt. "I'll be there."
"I'll be there too," she said.
"I'll be waiting," he said.
And yet he was not taking entry to heaven for granted. In his last opportunity to look back, he did so soberly, even regretfully.
"Maybe in my life I was not good enough," he said to Nita.
"Oh, you were," she assured him. "You were always a good guy."
"Oh, I've been bad, many times," he said.
It was Nita's turn to deflect pain with a joke.
"I didn't know you then," she said, fliply.
"No--what's your name?" Art said, equally flip.
They both laughed.
Then they turned serious.
Nita, who had tried so hard to avoid the reality coming at her, addressed it head-on.
"You've been a wonderful husband, father, grandpa," she told Art. "Can't get any better than that."
Art knew how uncertainly he was perched. Twice that day, he said, he had thought death was moments away. The first time, he had felt so ill that he wanted to die.
But the second time, he had felt strong and almost euphoric.
"That's right now," he said. And then the man who for so long had been praying to die said: "I wish I could go on for years."
Suddenly, it was on to the Cubs. "I've been a Cub fan since 1934," he remarked as Nita balanced a stuffed Cubby bear on his chest. "But I don't pray for the Cubs to win. That's not a prayable object for me."
Still, he was happy when the White Sox won the World Series.
"Why root against my sport's enemies? When I can't win, I still root for them," he said. "People say they never root for the Yankees, but they're out there, trying their best."
Nita was goggle-eyed.
"You haven't talked this much for a month," she said.
Art knew. And he knew more.
"Being this spirited, I still may not live through the night," he said, with a laugh. "But I would not object; really, I would not. I think it would be nice not to go out on a sour note, but to go out on a good one."
It was a breathtaking final act, a blazing last soliloquy. In swift succession, he expressed his gratitude for his family, his love for his children and grandchildren, his delight in the world of people and his sadness at how much he would miss that world when he was gone.
Thank you. I love you. Goodbye.
Then he stopped talking.
"I think I'm finished," he said.
And he was.
Two days later, he was barely responsive.
His eyes were unfocused. His body was twitching with an involuntary jerking movement called myoclonus, a type of anxiety sometimes seen just before death. When he spoke, it was an incomprehensible mumble.
His body was closing down.
"Think of it like a domino effect," said Dr. Jason Sobel, Art's hospice doctor and the CareCenter's associate medical director. "The lungs have the job of getting oxygen into blood circulation and taking away carbon dioxide. When the lungs decline, you lose the ability to give nutrients to the organs."
Art's kidneys were starting to fail. Morphine had been helping him breathe; the drug eases the sensation of breathlessness and lowers the respiratory rate by reducing pain and anxiety.
But now that Art's kidneys were no longer able to process it, the morphine was building up in his body, possibly contributing to the twitching.
The rest of his organs also were shutting down; he would soon be in a coma. The brain, a particularly voracious consumer of oxygen, was being starved. The last to go, Sobel said, was usually the heart.
"The heart is an organ of incredible resilience," he said.
Art's spiritual grappling was over, at least on a conscious level.
He had faced painful doubts and lonely moments. And though the questions he had asked were personal, they also were universal.
His yearning for God reflected millennia of similar human hopes. His wondering why God was making him suffer had echoes reaching back to Job. His concern about the afterlife has been shared by every civilization throughout history.
His acknowledgment that he had sinned in his life reflected a central doctrine of Christianity and Art's spiritual maturity, said his pastor, Rev. Kirk Reed of Trinity United Methodist Church.
"If you are a human being, I would hope that you would be humble enough to realize that all have sinned before God," he said.
And his doubt? It is an inextricable element of most people's spiritual lives.
Art's doubts and suffering spoke to his courage and honesty, Reed said. "If you don't go through some of that," he said, "you've probably got some pseudo, shallow faith that has never been tested."
Art's testing was over; the worst for his family was about to begin.
Kevin Clifton thought he was prepared. Still, as he sat in a chair next to his father's bed, he was shaken.
Art's power surge had come on a Friday, and he had been lucid Saturday night. When Nita had said the traditional, "Love you" upon leaving for the night, he had replied with the ritual, "Love you best."
Now, on Sunday, Art's eyes fell on the wall where the clock--his nemesis--hung.
He did not seem to know what a clock was.
He pulled at his oxygen tube. He reached his hand into the air. Kevin took it.
Nita sat on the bed. Art thrashed; his arms pulled at his bedclothes. It was agony to watch. Sobel prescribed anti-anxiety medicine, more for the family's benefit than Art's. He didn't think Art was suffering, but he knew Nita was.
Nita, who had worried she was not strong enough to manage without her husband, found it in herself to hold him firmly in her arms as he flailed at the air.
"I love you," she said softly. "I wish I knew what you were trying to tell me."
She leaned her elbow against the bedrail and cried.
Brenda Kitchka, a chaplain from the hospice, arrived.
Kathleen Foy, Art's spiritual companion through his monthslong journey toward death, was out of town visiting family.
She had suspected that Art was near the end and had wanted to be there, but professional guidelines discourage hospice workers from rearranging their personal lives in case a patient dies. If a chaplain insisted on being present for every patient's death, she would neither rest nor sleep. The Clifton family understood.
Kitchka sat next to Nita, took her hand and told her she shouldn't be afraid to leave out of fear that Art would die alone.
"Sometimes they wait until you leave, and then they die. They consider that their gift to you," Kitchka said. "So if you leave some time and it should happen, it's nothing you should feel guilty about; it's something he intended."
"Hi, Mr. Clifton," Kitchka said.
He mumbled what could have been a reply.
"You hanging in? It's hard work, isn't it?" she said.
"This is one of the hardest things you are ever going to have to do," she said to Nita. "But you are not alone."
Nita wept. "I feel so empty without him," she said.
Kitchka turned again to Art.
"It's OK, Mr. Clifton," she said. "You are safe. ... And you are dearly loved. We are going to take good care of you. And we are going to sit here and share this journey with you for however long it takes."
Arthur Clifton died shortly after 9:30 p.m. the next day, April 24, drawing his last breath in the presence of two nurse's aides who had come in to make sure his feet were covered.
Kevin Clifton and Nita had left for the night just five minutes earlier.
Nita Clifton sat in the front row of Trinity United Methodist Church, an elegant stone Gothic building in Wilmette, not far from the lake. Her eyes were red-rimmed, but she smiled gamely at a church full of well-dressed friends, Art's legacy of a lifetime.
The family had just buried his ashes in the church's memorial garden, and Nita was numb. Behind eight huge vases of brilliant flowers, Rev. Reed spoke of Art's graciousness and modesty.
"He never told me about his combat medals; instead he told me about trying to enlist in [an Army Air Corps training program] and getting rejected because in his right eye he couldn't tell the difference between green and red," Reed said. "He never talked about how cool he was; he talked about how thankful he was that Nita loved him."
As for Art's despair as he approached death, Reed quoted Rabbi Harold Kushner, pointing out that the 23rd Psalm speaks of going through the valley of the shadow of death, not around it. Only by going through the painful valley of grief at his death, Reed said, could Art emerge from the other side.
"Yes, he did struggle with his faith at times, as all of us do at times if we're honest. I'm grateful to his hospice chaplain, Kathi Foy," he said, nodding to her.
From her seat in a pew, Foy, who had learned of Art's death upon her return from vacation, smiled back.
"But through it all, his faith was strong when it mattered," Reed said.
Art's sons offered eulogies. Kevin's, in the form of a letter to his father, honored his upbeat disposition, his eagerness to help others, his defense of the chair-throwing Bobby Knight on the grounds that the basketball coach was "just having a bad day."
"The characteristic I treasure you most for is your unconditional love," Kevin said. "I am comforted by your faith in the Lord. ... I will see you soon in heaven. Rest easy, and we will take care of Mom."
Richard Clifton spoke of his father's good cheer despite his awareness of the dark sides of life, the fatherly guidance that never strayed into control and the way he valued fairness, hard work and humility.
"He was an amazing person," he said. "... I've lost so much because he gave me so much."
The final hymn was "The Old Rugged Cross," Art's favorite from his Baptist youth. The stone church rang with the organ and voices:
To the old rugged cross I will ever be true/Its shame and reproach gladly bear/ Then He'll call me some day to my home far away/ Where His glory forever I'll share.
Nita took her husband's pillow home from the nursing home and put it in her bed. It smelled like him.
At first, she talked to his picture on the wall. She told him what she was going to do that day and who had asked about him. She upbraided him for leaving her. She dreamed about him, so vividly that she would wake up and stare at the ceiling, waiting for him.
She was hospitalized several times, for dehydration and a brain hemorrhage after a fall.
But she recovered. And as time passed, she found herself talking to her husband a little less. She stopped telling him she was angry that he had left her; he deserved, she thought, to rest in peace. He had taken care of her, to the very end. "He even waited until we left to die," said Nita, now 81.
Art had been in good spirits at the end. The anti-depressants he was taking, Sobel said, had helped him return to the customary cheeriness that had earned him the childhood nickname Smiley. The drugs had not cut short his spiritual questioning, the doctor said; on the contrary, they had enabled him to pursue it.
"When people feel a sense of despair, they can't communicate with anybody, even themselves," he said. "I think helping the depression helped him to communicate with God."
Shortly after Art died, hospice chaplain Kathleen Foy moved to Albuquerque to be near her daughter and sister, taking a job as bereavement coordinator with a hospice there.
She regretted that circumstances had kept her from being with Art when he died; she felt a certain lack of closure herself. Their conversations remained on her mind.
"In some ways, I was amazed he went so far," she said. "There's a lot of stuff at the end of life that can be very scary for people. It can rattle some people. But it's also very freeing and energizing."
He had died without certainty, but he hadn't needed it.
"That is the essence of the `leap of faith' that believers take," Foy said. "Art was a man of faith, and doubt was an ingredient of his faith."
Arthur Clifton died looking back on his life with gratitude, and forward with acceptance.
He had arranged for Nita's ease and security. He had accepted Foy's invitation to confront hard questions. He had asked forgiveness; he had expressed love; he had said goodbye.
He had said he would find out the truth about his beliefs when he died.
His waiting was over.
Understanding fear of death
November 20, 2006
Arthur Clifton did not fear death, but many do.
So widespread is fear of death that it is the subject of an academic discipline--the study of death anxiety--producing a substantial amount of literature in the last four decades.
Researchers have divided it into various types of fears: fear of pain, fear of the unknown, fear of non-existence and fear of eternal punishment.
They have developed tools such as the Death Anxiety Scale and the Hoelter Multidimensional Fear of Death Scale to examine them.
There are those who dismiss such attempts to measure the unmeasurable, but some of the research findings are intriguing.
Women report more fear of death than men, for example, which some researchers theorize is a result of women's greater willingness to express fear. And young people are more fearful of death than the elderly.
Religious faith is no guarantor of peace at the end of life. Nitza Rosario, a chaplain with Rainbow Hospice in Park Ridge, recalled a patient who was a pious woman, but in facing death was terrified.
"She was a pillar of her church, but in talking to her, I saw this look of fear in her eyes," Rosario said. "She said, `There are so many religions; how do you know which is the right one?'"
Faith also can mask fear. One study found that some people who say they believe in an afterlife may actually dread there is none. When college students were hypnotized and asked to rate their fears, they expressed greater fear of non-existence than when they were awake.
If belief does not guarantee a serene death, non-belief doesn't necessarily lead to a fearful one. There are plenty of atheists in these foxholes, and many approach death resolutely.
"It's the ones who are in the middle ... they're the ones who have trouble," said Kathleen Foy, Clifton's hospice chaplain. "If they haven't worked it out by the end of life, they have a hard time. They have to work it out now--or not."
Fear may be exacerbated by the way death unfolds in modern America. Over the last several generations, death's place in society has changed radically.
"Death was always public," wrote Philippe Aries in "The Hour of Our Death," his landmark 1981 history of Western civilization's changing attitudes over the last thousand years. "Death was not a personal drama but an ordeal for the community."
For centuries, friends, family and even passersby would gather in the bedroom while the dying person said final goodbyes, asked forgiveness and received sacraments. After death, bodies were laid out in parlors while people visited.
In the 19th Century, that began to change in the United States.
The modern hospital came into being. Caring for the dying at home began to seem dirty and unpleasant.
In prosperous Western societies, medicine and hygiene largely eliminated childhood death, once mankind's most common encounter with mortality. Death disappeared into medical institutions.
As far as the community is concerned, "You don't see anything," said Daniel Callahan, director of the International Program at The Hastings Center, a bioethics think tank.
But privacy has come at a price.
"We lost something as a culture," said Beth Burbank, who trains chaplains for Vitas Innovative Hospice Care. "We got less and less comfortable with death."
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