Do not resuscitate

It was a memorable thing to accompany Mary to Queenstown, to the 50th anniversary reunion of her Otago Medical School “Class of ‘62”. That is the year they graduated MBChB -- they actually assembled in Dunedin in February 1958, having already spent one year doing their Medical Intermediate somewhere, mostly somewhere else. Mary had done hers in Auckland.

Back in 1958 Queenstown was still a small remote Lakeland place, set in those mountains and lakes, with all its history of gold and exploration. I know. I went there that year as a raw divinity student “on supply” in the Queenstown church. The only access to Glenorchy at the head of the lake was by boat. Now it is all a major tourist resort, with a scary alpine international airport and all the concomitants. A sealed highway takes you to Glenorchy. There is furious debate about an extended highway and tunnel onward to Milford Sound. The first time Mary and I went to Milford Sound was in our ancient Austin A4 with bald tires, 70 miles each way on a dirt road from Te Anau. My main memory is sandflies.

Since the Class of ’62 now includes some geriatrics, and because most have made some money along the way, we met in the Crowne Plaza Hotel on the lakeside.

I actually wish I could get to the point here... The point is about life and death. I was one of the attending spouses -- in fact, the only male spouse. Some 120 students began in 1958 in Dunedin. At Queenstown some 54 years later, 50 survivors made it to the reunion. We had also two widows of class members. The total of doctors and spouses at the reunion was 91. Twenty of the original class are known to have died.

They came from all over the world. And I have to say, it was uncommonly pleasant to be at an event sensitively planned for people in their 70s and 80s, with plenty of time and space for chatting and leisure, plenty of fun and good food -- and a ride down the lake on the coal-fired steamer Earnslaw to Walter Peak Station for a sumptuous barbecue.

This blog however was prompted not primarily by the reunion, but by an article I found in the Guardian Weekly by Ken Murray, a professor of family medicine at the University of Southern California. He writes about “the art of dying gracefully”, and about how much end-of-life care is plainly futile, expensive, traumatising and pointless. So, he says, medics tend to refuse it for themselves.

That echoes much that I heard in conversation at the reunion.

Doctors die too. They get sick and struggle. In the Queenstown group there was the whole spectrum of human ailments, joints, tumours, emergencies, skin lesions, neuropathic stuff, blindness, varying degrees of deafness. I think I want to say that this was such an excellent cross-section of the walking wounded. It also covered the gamut of human frailty, with broken marriages and many hidden crises.

One doctor had survived, in a sense, his conviction and imprisonment for child abuse. He showed up. I think that was quite difficult for some of his colleagues, but the fact is, they simply included him at the reunion and there was no crisis.

It occurs to me now that I met no one “in denial”, as we say these days, about life and death. They have long ago learned what happens to people along the way. They have seen it in detail for 50 years. It is no surprise that it happens also to them. If any of them ever thought they would be somehow immune they certainly don’t think it now.

A number of these doctors have done brilliant work over the years, others have faithfully slogged along doing their job, some have pioneered techniques and done much for science and their patients. Yet no one at Queenstown was posturing or performing. Fifty years on, it seemed, there were no prima donnas any more. No one felt they had to prove anything. It was as real and human a bunch as I have ever encountered.

So now it dawns on me that I have had a rare privilege -- meeting with this group of talented and insightful people who have arrived, as it were, on the western slopes, and who can talk gently about what they see from there. Their experiences have generated some wise and good people. I note that any thoughts they may have about religion tend to be produced quietly and one-to-one -- or perhaps not so quietly but with the assistance of Central Otago wine. They have not solved the problems of the universe. But they all know about mortality.

There may be two main pathways to coming to terms with death.

• Death is inevitable, it is going to happen. The doctors who bring life into the world know that death is at their elbow. The only question is how we die. And they tend to reject any strenuous moves (in their own case) to save or prolong life unnecessarily after a terminal diagnosis. CPR, drugs, chemotherapy, radiation therapy, obviously have their uses, but if all it is going to do is buy a few more weeks of sickness, discomfort, dependency and helplessness, forget it. Death should be gentle and dignified, and they seek to make arrangements accordingly.

• The contemplative path, which I embrace, says that death is not our enemy. It is in any case the final defeat of the voracious ego, the victory in which love has finally overcome fear, and all is well.

These doctors at various times in their careers, and some of them frequently, have had to deal with family and friends, and perhaps actually the patients, who were desperate to prolong life when there could not be in fact any quality of life. Expensive science was wheeled in to keep lungs and heart working. Some frantic families resorted to magic to get some miracle cure. Death is seen as an offence for which someone must be to blame. Doctors may be sued if someone thinks they were negligent. A large slice of the health budget gets to be spent on the futile maintenance of life, because people refuse to come to terms with human mortality.

Chemotherapy and radiotherapy are clearly vital parts of the medical weaponry against disease. Some of the doctors in Queenstown had been physicians in these areas. They could reduce pain. They could quite often cure disease. They could buy some months or even years of remission. But they also had to know when to say to a patient, and to the patient’s family, that from now on it is simply palliative. And they formed views on how they would manage their own mortality when it became an issue.

I feel privileged to have met with these people. Other events I sometimes get to tend to be rather more intense, retreats, seminars, quite different in purpose and atmosphere. While there was much thoughtfulness in Queenstown, there was also a wisdom and humour, and a reluctance any more to take oneself too seriously. It was refreshing.

It also made me more confident about my own eventual approach to mortality, frailty and dependence. If there is no further quality of life -- DO NOT RESUSCITATE.

The cathedral

The decision to partly demolish the quake-crippled Christ Church Cathedral will be "heartbreaking" for many Christchurch people, according to mayor Bob Parker.

Good God. Get over it. It will be a huge relief to see it no longer there in pitiful ruins in every photo, and to know that the church is planning something new, different, fresh and relevant.

It was a rather ordinary building anyway, as cathedrals go. No one who has stood in Freiburg Munster or York Minster, could claim that Christ Church Cathedral was great, “iconic”. It was a handsome church of its type -- colonial 19th century English nostalgia, which says nothing much to the world and realities of the 21st century. It was built with manifestly unsuitable material and methods, on unstable land.

Some Christchurch councilor said he would chain himself to the building to prevent demolition. He could organize hundreds of locals to hold hands around the ruins. He actually said they would pull it down over his dead body. Well OK -- two birds with one stone, as it were.

And isn’t it interesting how all these people who in fact have nothing to do with the Anglican church suddenly start claiming some sort of ownership and a say in the matter. “The cathedral belongs to Christchurch…” Well, that would be news to the Anglican Church Property Trustees. “I am by no means religious, but…”

Then this morning, a retired 73-year-old Anglican priest sets out how much the cathedral has always meant to her and her clan, all the events that have happened there, memorials to family members there, ordinations, baptisms there… Wonderful. But it all bespeaks a church that actually doesn’t exist anymore. And if I wanted to know about a proper format for the church of the future I would be unlikely to enquire from this dear lady.

What with care and toil he buildeth,
Tower and temple, fall to dust.

I don’t know whether Bishop Victoria Matthews feels besieged, but TV shows her standing there quite unsupported at media interviews answering silly questions clearly, humbly and succinctly. Where are the cathedral canons and suchlike?

The cathedral dean, Peter Beck, resigned and stood for a vacant Christchurch City Council seat, which he won. I am sure he will do a lot for the city that way. But we have to wonder about what caused a senior Anglican cleric to hand it all in. It may have been what so often happens these days, simply a change of vocation.

Of course Bishop Victoria is not of Canterbury blue blood. She is an import, a foreigner, and she is female. I think there are Christchurch Anglicans and others for whom all that means she starts well behind.

However, there are as we know two cathedrals in Christchurch, not one, and both are more or less in ruins. The Catholic Cathedral of the Blessed Sacrament in Barbadoes Street was in my view a far more interesting and significant building. It impresses me that the Catholics have been much quieter in bearing their anguish and plotting their future.