Judith K. Sullivan, R.N., and Rev. Angelika Zollfrank on a place beyond success and failure

"Where you go, I will go…"

Do not press me to leave you … Where you go, I will go … where you die, I will die...

As I enter the room I see a woman – I will call her Ruth – in her hospital bed. Ruth is breathing with the help of a machine. One tube feeds her body, another drains her body waste. Her kidneys do not function anymore. The dialysis machine washes her blood almost daily. Ruth’s circulation and her heartbeat are maintained by multiple medications. Her lungs are bad and her heart is failing.

With so many parts of her body failing, what keeps her here? I wonder. Ruth has been here for months, supported by medications and machines, plagued by procedures and the suctioning of her lungs, but she is surrounded by her family and her medical team. She is completely alert and visits with her family each day. Do not press me to leave you … Where you go, I will go … where you die, I will die... She is not pressed to leave. Time with family is interrupted by treatments from the many caregivers on her team. Ruth has not eaten for months. She has lost her privacy and most of her control. She is dependent on people and machines. Yet she has hope. She hopes to go home again and to be with her family. Do not press me to leave you … Where you go, I will go … where you die, I will die... She is enduring all of this because she might conquer this illness. She can’t imagine leaving her husband alone. She is convinced that her family can’t live without her, and they believe they can’t live without her.

I get chills walking into this room. Whatever I believe and value, hold dear and draw meaning from, is challenged in this space. Being in the hospital and spending any amount of time at the bedside of those who live their lives here means to encounter suffering previously unimagined. We don’t like suffering, don’t wish it on anyone. We try to avoid it, attempt to alleviate it, do anything to live through it. Yet once we are in it, enter it, and live it, what are we called to do?

Entering into suffering means to dwell in a place beyond success and failure, beyond cure and unrealistic hopes. We bring what we value, our beliefs, what we are afraid to lose, and what we hold dear. We hold on, while letting go. Why can’t Ruth let go? Why can’t her family let go? What are they holding on to? And what am I holding on to?

Let it go, I say to myself as I feel the anger rising in me. My anger is strong and my shame about it makes me want to disappear. Yet it is real and very present in this room: Can’t she see that she will never get better? Can’t the medical team, can’t the family see the folly of pressing on? Even the most sophisticated technologies, procedures, and care will not conquer this illness. Why would this woman want to endure such pain when there is so little hope for recovery? Why doesn’t someone admit defeat? As I am thinking about defeat, I am realizing that I am fighting again. I am wrestling with what I think is right, with what I hold onto, and with what Ruth holds onto. I do not want to press on with this. I do not want this to continue.

Then another family meeting. The entire team paints a bleak picture: it is unlikely that Ruth will get better. She will die in spite of all efforts. Pressing on comes at the cost of more pain and the outcome is not guaranteed. Yet once again I hear Ruth’s voice and her family’s chorus: Do not press me to leave you. Stay the course. I am the last to leave the room. My shame about my anger kept me there. Did she see it? Does she know that I care beyond measure? That I, too, have a husband and a family? That I would want to leave if I were her?

The next morning Ruth is trying to say something. The breathing machine doesn’t allow her to speak, so someone must read her lips. I step forward. Strangely calm and open – my anger is gone. Ruth is my unidentical twin sister. I hold her with my eyes now as she is mouthing: “I’m never going home, am I? How do I stop all of this? I don’t want this anymore.” What follows is a moment of silence that feels like an embrace.

Ruth’s husband is summoned; a call goes out to Palliative Care. We adjust our goals and shift from cure to comfort. Since we spent so much of our energy fighting, acceptance is hard won. After all of this time, all of the operations and procedures, and pain, and loneliness, and deprivation, there is no victory. Now death will come. Where you die, something is dying in me, too. I hadn’t known it was there. I am not sure what it is. But something is dying, as you always said, with you. In the end is this a course of treatment that makes sense? Is this a peaceful death, a meaningful ending? Are we different because we suffered? What have we learned? Have we gained anything? Can we look on suffering as having any merit in and of itself? Is there meaning for the patient? Is the whole family affected by the suffering? What about the medical team?

When we are challenged beyond belief, exhausted beyond anything we ever experienced, stirred up and pained beyond what we thought bearable, we let go. We let go of what was meaningful before. We let go of what was life-giving before. We risk it all. To search for new meaning. To find a new life.

Many empty days later, I heard a new voice: I chose you. I chose you because of your anger, not despite of it. Your anger was your gift to me. It helped me let go. I am at peace, finally. I will be with you always. I will guide you, will see your suffering, and will witness your stories. Do not press me to leave you. Where you will go, I will go....

Rev. Angelika Zollfrank, M.Div., BCC and ACPE Supervisor is the director of Clinical Pastoral Education at Massachusetts General Hospital. She offers s CPE program for healthcare professionals, as well as CPE summer and extended units. She also serves as a chaplain on the MGH inpatient psychiatric unit.

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