What Matters in the End


And the one who was seated on the throne said, “See, I am making all things new.”  –Revelation 21:5

A few weeks ago, while I was driving, I listened to an episode of the NPR program called “On Being,” hosted by Krista Tippett. This particular episode so engaged me that when I reached my destination, I stayed in my vehicle to listen to the end. Tippett was interviewing Atul Gawande, a medical doctor who has written a book, part of the subtitle from which I’ve borrowed my sermon title.Dr. Gawande described a problem related to patients with terminal disease. He says, “… we have new technologies, and so we’re going to start trying stuff. And then I have so often been there when we said, ‘Let’s try … one more thing.’ And they’re in a bad situation. And we say, ‘Should we try surgery? Well, yes. We have to give it a try,’ and then they never wake up again. And then you see the suffering that has come from that, because we never once talked about the fact that their life might be – is mortal. I didn’t even know how to begin to have that conversation, and they never woke up. They spent the next couple weeks in the ICU, and then we uplugged the machine. They didn’t get to say goodbye. They didn’t get to say, ‘I love you.’ They didn’t get to say, ‘I’m sorry.’”Gawande describes a particularly tragic case that changed his approach to patients. He was working with a woman who finally said to him, “One thing I want to make sure I’m able to do is take my grandchildren to Disney World.” She was telling that to me in the hospital, emaciated …. She would die 48 hours later. And we had missed that. We had failed. We had never asked her, to know that might have mattered to her, because we could have made that possible for her a month before.”[1]One reason I found Dr. Gawande so fascinating is that he was confirming, through his unique clinical perspective, something that pastors and preachers have said for thousands of years. None of us wishes to die prematurely; we all expect the best possible medical care. But, ultimately, avoiding physical death is a meaningless pursuit without spiritual and moral purpose for life. What gives life meaning and purpose, what matters in the end, is the vision we see about where we are going and why.Each time I craft a sermon based on the Book of Revelation I’m reminded about this theme. Why did the early Church editors of the New Testament ultimately place this book at the end of the Bible? Because the Book Revelation casts a poetic and inspired vision about where God is leading us and why. Revelation’s author John dreams of a world in which God’s salvation is known to all nations, and everyone recognizes and worships God. The dream’s magnitude, conveyed through rich symbols, challenges intellectual narrowness, emotional lukewarmness, and theological exclusiveness.John goes on to describe a great “City of God,” which is in this life an unfinished work. And because it is an unfinished work there is always a tension created by voices external and internal that say, “It is only a dream.” But for those who understand such vision is inspired by the Holy Spirit, and who act on the vision, dreams can become reality.  The implied challenge for today’s reader is summed up in a question: “What dream is God calling you to dream?”The work of Dr. Gawande reminds us that purpose can bless and enrich us all the way through the end of life’s journey.  He suggests having conversations to define the dream, breaking down the conversation into five practical questions:

  1. What is your understanding of where you are, and of your illness?
  2. What are your fears or worries for the future?
  3. What are your goals or priorities?
  4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
  5. What would a good day look like?

He says, “What I realized is, we were not really talking about death or dying. We were really talking about how do you live a good life all the way to the very end, with whatever comes?”[2]Gawande’s questions really aren’t all that different from pastoral care rituals used for ages.  The old questions can be just as powerful and valid, questions like “Are you prepared to die?” and “What is your hope for heaven?”  But if those questions feel a little too stilted, then try substituting some of those given by Gawande.  When you or someone you love is approaching the final journey, to the extent that you’re given the ability to do so, ask,

  • “What does a good day look like?”
  • What dream is God calling you to dream today?
  • What beauty can be enjoyed?
  • What relationship can be repaired?
  • What love can be shared?

Questions like that lay the foundation for good things to follow, now, and in the life to come.NOTES[1]Atul Gawande, transcript of “What Matters in End,” On Being with Krista Tippett radio program, 26 Oct. 2017, transcript available at https://onbeing.org/programs/atul-gawande-what-matters-in-the-end/accessed 15 May 2019.[2]As reported by Kristin Lin, “Why We Should Talk More About Death (and How to Get Started), http://onbeing.org/blog/why-we-should-talk-more-about-death-and-how-to-get-started/accessed 14 May 2019.