He asks:
What brings you meaning at this time in your life?
He hears common threads from distinct perspectives: Thanking people. Giving back. Making sure my family will be okay. Knowing that my kids are launched. Pondering what life was all about.
Gary’s goal is to get people talking so that they can put their life into perspective. He wants to help them find their sources of meaning. He has his own questions about what and why.
What makes people tick?
Why is the world what it is?
He has thought deeply about the questions people have asked him as they confronted death and tried to make sense of it.
What is going to happen to me physically?
Can I atone for what I’ve done?
Can I seek reconciliation?
I drove out to Gary Fink’s office. It was a low, nondescript brick building that could have been mistaken for a suburban strip mall, except that inside on the walls, there were all sorts of drawings from children to their grandparents, letters of appreciation to the staff, and testimonials to loved ones. I wanted to hear more about the questions people ask, and the questions he asks.
He told me that some of the questions are specific to the moment and have tangible answers.
Can I avoid pain?
Others aren’t so easy and ponder the unknowable.
Why is God angry with me?
What will happen to me?
Why is God taking so long?
Gary often replies with a question of his own. “What do you think God might have in mind?” Or, “What thoughts do you have when you ask that question?” A conversation usually follows and becomes a story. “I help people create narratives, each one original, unique, and important,” he explained. “And meaning is embedded in all of their narratives.”
Gary asks about achievements and failures, people and impact. Sometimes religion is part of the dialogue, sometimes not. He does not preach or judge. He includes the patient’s family and friends, inviting them to join the storytelling.
What kinds of things do you think you’ll miss the most?
What are the intangible gifts you have now because of your experience with this person?
The rabbi believes that a properly told life story can capture life’s impact and its meaning. But not all stories have happy endings, and not all lives end with clarity or resolution. A question can prompt a reply brimming with guilt or sadness. Anger and sorrow are not uncommon emotions at the end of life, he explains. Gary hears about broken promises, unfulfilled dreams, hurt feelings—all inevitable parts of the story of life. He presses patients and families alike to confront their sadness. He asks without hesitation and encourages dialogue like this:
What kinds of things will you not miss about your mother?
“Mom was just so difficult. She was bitter. She said terrible things.”
Was there something you learned from that?
“I vowed never to submit my kids to that. To teach them restraint and patience.”
And …?
“If I feel myself losing my temper or getting really angry, I think about what I felt like when my mother turned on me.”
What do you do?
“I stop myself.”
Does that always work?
“Nearly.”
And it’s because of your mother?
“Yes.”
Has it made you a more careful parent?
“I think so.”
Memories of adversity can make a family stronger. In the right context, they can provide comfort. Then, the rabbi says, “you have turned a burden into a blessing.”
Facing Failure
Some burdens may seem insurmountable: feelings of acute failure, a sense of a wasted life. But legacy questions can brighten even those dark places. End-of-life expert and author Ken Doka offers proof. A principal contributor to the hospice training video, Doka has worked with all kinds of people, including patients who expressed wrenching regret at the end of life—about their inability to hold a job, stay in school, or provide for themselves or their families. But Doka has found that even these people often can be guided to a more positive, reassuring place. “Sometimes in framing their lives as lessons that others can learn from, there can be meaning,” Doka says. “The story may be, ‘I made a lot of mistakes. I didn’t learn from them, but others can.’”
He describes a young man we’ll call Martin, who had been a street hustler since he was a kid. When he had just graduated from high school, Martin went to jail for drug possession. After that, he never could hold a job for long. He was estranged from his entire family, except for a brother, who had asked Martin to be godfather to his nephew. Martin agreed, then failed to show up to the baptism. Furious and disappointed, Martin’s brother told him he was “worthless.”
Now, still in his twenties, Martin was dying of AIDS. He told Ken he didn’t have much to be proud of. No family, no job, no legacy beyond the streets. He was sorry he didn’t make it to that baptism. He cared about his nephew.
“What would you say to your nephew?” Ken asked him.
“That I have nothing to give him. That I love him,” Martin said.
Ken said, “Look, Martin, you’ve had some rough times. You’ve learned a lot of lessons about things you shouldn’t do.” He asked:
What do you want to pass along to your nephew?
Martin thought for a minute. “Stay in school. Don’t do drugs.” He spoke softly and paused. Then Martin revealed his secret. He was gay. “I never felt like I belonged while growing up. In my community it was considered a sin.”
Ken listened, then asked, “What advice do you have for your nephew?”
“Be yourself.”
Ken wrote down Martin’s words, went home, and turned them into a letter addressed to Martin’s nephew. The next time they visited, he asked, “What do you want me to do with it?”
“Please give it to my brother—for my nephew.”
Martin had something to pass along after all.
Ken’s questions helped Martin see value in his life story and share it with someone he cared about. Ken believes every life has meaning, though sometimes it takes hard work and persistent questioning to find it. He asks:
How do you put your mistakes in context?
What lessons would you share?
What high points in life would you point to?
End-of-life experts speak in terms of creating a “meaning narrative.” They believe this kind of story makes people feel better about life and more positive about themselves. One approach involves a “question protocol” to help patients recall significant personalities, places, activities and experiences in their lives. In one study by Harvey Chochinov and others, printed in the August 20, 2005, issue of Journal of Clinical Oncology, the researchers asked terminally ill patients to describe when they felt most alive, to recount their most important roles and accomplishments, and to share their hopes and dreams for their loved ones. The researchers edited the responses into a “generativity document” to be given to a family member or friend. When the patients read their document, two-thirds reported a “heightened sense of meaning.” Nearly half said their will to live had increased. “Getting down on paper what I thought was a dull, boring life really opened my eyes to how much I really have done,” a forty-nine-year-old woman said.
In Search of Meaning
Questions of death lead to questions of life. One of the most moving assignments I had when I worked at CNN involved Oregon’s “Death with Dignity” law. The provision permitted people diagnosed with a terminal illness and less than six months to live to obtain a prescription that would end their lives if they decided that’s how they wanted to die. My story revolved around Greg Yaden, a fifty-nine-year-old Oregon man who was dying of leukemia.