A friend shared with me recently a hospital happening that you may remember having had yourself. She was sound asleep, only to be awakened by a nurse on her rounds. Why? To give my friend a sleeping pill, of course.

Hospitals make a serious mistake in showing little regard for the benefits of sleep. The worst part of this, of course, is the custom of putting medical interns to work when they are groggy from sleep deprivation. Research has shown that the error rate of such medical staffers is far greater than that of interns who have adequate rest.

This I learned from an enlightening article written by Craig Lambert in the current Harvard Magazine. There he draws on the work of experts, most of them Boston-area  physicians, who have studied sleep and have discovered other disturbing facts about its deprivation. Sleeplessness in this country amounts to an epidemic, with consequences the public has failed to recognize.

“Lack of sleep,” Lambert summarizes, “may be related to obesity, diabetes, immune system dysfunction, and many illnesses, as well as to safety issues such as car accidents and medical errors, plus impaired job performance and productivity in many other activities.”

This bad situation, far from improving, has worsened over the last few years. Sixteen percent of Americans now sleep less than six hours on weekday nights, as contrasted with 12 percent in 1998. And only 26 percent of us get eight or more hours of sleep a night.

Americans may not be the most sleep-deprived people on earth. However, we are right down there fighting for the title. Even worse, going without sleep has come to be regarded as highly virtuous. Adults who do not leave the office until late at night are seen as models. Many college students pride themselves on their “all- nighters” before exams, ignoring evidence that this habit may damage their health and actually harm their performance on exam questions that require critical thinking.

Lambert’s article has convinced me of the dangers of getting too little sleep and the advantages of adding more. I have now resolved to increase my nightly ration by another hour, bringing my total number to eight. My hope is for this experiment to relieve some of the fatigue I experience during the day.

My primary care physician wants me to go further. She urges me to take a sleep test, but thus far I am resisting. The prospect of sleeping overnight in a laboratory setting with electrodes attached to my body intimidates me. But, if my current experiment fails, it may come to that.

The older I get, the more I value a good night’s sleep. Shakespeare’s words in Act II of Macbeth often echo in my mind: “Sleep that knits up the ravell’d sleeve of care / The death of each day’s life, sore labour’s bath, / Balm of hurt minds, great nature’s second course, / Chief nourisher in life’s feast.”

The great Elizabethan expressed poetically something of what modern researchers say scientifically. Sleep is not a waste of time; rather it brings us into a therapeutic process. While we are becoming refreshed, our brain is also at work processing information.    

Many studies suggest the folly of trying to get along without sleep. Lambert quotes a Detroit-based researcher who says: “The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero.”

Yet, our culture and our economy both support habits that research shows to be counterproductive and harmful. No matter what the findings of science, hospitals continue to show little regard for the healing powers of sleep. Why do institutions that profess healing as their main purpose place so little value on the therapeutic effects of a good night’s sleep?

During two short hospitalizations this spring, I rediscovered the setting to be sleep aversive. Despite signs on the walls urging staffers to limit noise in the corridors, there was a constant din of chatter coming from areas near the nursing station. Attendants talk loudly at all hours of the night, making it almost impossible for patients to sleep. And, yes, they do wake people for routine procedures that could be done at other times.

“Sleep deprivation doesn’t have any good side effects,” says another Boston researcher.  By contrast, sleeping well promotes good health and may even extend our life span.

The habit of sleeping well, however, requires discipline. Respecting our daily cycles of light and dark counts as part of it. So does sensitivity toward our established patterns of successful sleep. In later life, especially, the opportunity for sustained sleep must be seized if we are to maintain the habit. Research suggests that such opportunities may become narrower the older we get.

Presuming you are with me at this point, I wish you success with your efforts to sleep well. With the zeal of a recent convert, I have a new vision of the world and the gift of sleep looms large in it.

Richard Griffin

July 14, 2005 marked the death of a woman I consider one of the greatest benefactors of our time. She never became a household name in this country, but Cicely Saunders transformed the way many people around the world are cared for as they die.

I learned about this event belatedly, because American news media have been slow to note Cicely Saunder’s passing.

To my mind, this Englishwoman deserves hall of fame recognition. She was the driving force behind the modern hospice movement that provides the dying with medically enlightened and humanly compassionate support as they approach the end of their life. “We think of her as our patron saint,” says Kristina Snyder, a pioneer who led in founding the first hospice house in Massachusetts.

A decade after having qualified as a physician at age 38, Dr. Saunders in 1967 established St. Christopher’s, the first hospice institution. From this beginning in London, she was the inspiration for the founding of hospice centers and programs in some 95 other countries. In addition, thousands of professionals were to learn hospice care from her.

It undoubtedly helped that, before becoming a physician, Saunders had first been a nurse and a social worker. Seeing the suffering of people from the vantage point of these professions enabled her in time to grasp better than others the meaning of pain and how best to relieve it.

The hospice approach brought skilled medical care together with emotional, social, and spiritual support for those nearing death. The idea was not to attempt to cure people who are obviously dying, but rather to make their last days as comfortable and meaningful as possible.

The United States can now boast of more than 3,000 hospice programs located in virtually every part of the country. Besides the professional staff attached to these programs, an astounding 400,000 people contribute their time as volunteers who help patients and their families.

Not all patients are reached by the hospice movement, however. Fifty percent of all deaths in America take place in hospitals. Unfortunately, many of the patients who die in these institutions do not receive the pain relief they need.

The need to provide this kind of care now seems obvious to many of us, but it took vision and determination for Cicely Saunders to succeed. In England, people have sometimes thought of her as another Florence Nightingale because of her whole-hearted mission to serve the mortally ill. But she was also a medical scientist who did research and published widely the results of her work.

In the first half of her life, Saunders searched for a faith that would fill the vacuum of the agnosticism with which she had grown up. On her graduation from Oxford she found in Christianity a motivation for her life’s work of relieving suffering. She saw the results of her work as a strong refutation of the euthanasia movement that offered a starkly different approach to the end of life.

This creative woman has made it hard to understand why spirituality could ever have been missing from the care of the dying. Similarly, the emotional needs of people in that situation, and that of their family members and friends, have suffered neglect in so much of the medical practice of our era.

Two facts about Cicely Saunders will find a lasting place in my memory. First, she told an interviewer, in recent years, that she would prefer to die from cancer rather than some other cause. This disease, she explained, would give her the time to prepare for death. As it turned out, she got her wish.

Secondly, this courageous woman said there were five statements that people should be prepared to make before they die: “I forgive you. Please forgive me. Thank you. I love you. Good-bye.”

Of course, this beautiful agenda is not accessible to all those approaching death. Many people are denied the opportunity to share these sentiments with those who are close to them.

It also stands, however, as model for living on the part of those whose death is not yet in sight. If you can bring yourself to say these words or, at least, to subscribe to these sentiments, you have surely achieved something important and you might thank Cicely Saunders for the inspiration.

Fortunately, for people in the Boston area, hospice care is widely available. You can find more information about the programs by calling the Hospice & Palliative Care Federation of Massachusetts at (800) 962-2973. End-of-life services can be provided in one’s home, in a hospice facility, or, if necessary, in a hospital. The service teams are one or more physicians, nurses, social workers, home health aides, chaplains, and volunteers.

Hospice seeks neither to hasten death nor to postpone it. The main idea is to make of dying a human experience with freedom from pain and, to the extent possible, anxiety. It is the vision of Cicely Saunders brought to life, and to death also.

Richard Griffin

A friend, Chuck Colbert, has given me his thesis to read. Written as part of his requirements for a graduate degree in theology, his paper argues the case for the Catholic Church to recognize same-sex marriage, both civilly and sacramentally.

Chuck himself entered into such a marriage last fall in a civil ceremony at our city hall. Later in the year, he and his partner celebrated their union in a religious ceremony presided over by a Jewish woman rabbi, an appropriate ritual because Chuck had recently converted from the Catholic faith to Judaism.

I attended both events and rejoiced at the good fortune of two friends finding one another as life partners. Though gay marriage carries some problems for me, I find values in it that deserve to be celebrated. It’s not as if we have so much love in the world that we should fail to treasure it, even when this love finds a setting unfamiliar to us.

In his thesis, Chuck skillfully draws on the tradition crafted by Catholic theologians of the distant past and the present. Similarly, he discusses two papal encyclicals that express views of marriage different from those that had prevailed earlier. And he finds support in some views of the late John Paul II as they apply to personal relationships.

Many Christians, if not most, see the Bible as condemning homosexuality in all of its expressions. My friend, however, uses the work of the late Yale scholar John Boswell to offer a closer analysis of those biblical passages that have been interpreted as condemning same sex activity. The Jewish and Christian scriptures, the thesis writer concludes, present no obstacles to same-gender sexual unions.

Despite the admittedly strong negative elements in the official church’s views of homosexual activity, Chuck is not discouraged. “The Roman Catholic tradition is a robust and dynamic one,” he writes. “I believe the kinds of changes that I suggest will eventually come about.” Thus he considers his study one that breathes hope rather than despair.

My appraisal of the case my friend makes is, in many ways, positive. I believe the Catholic Church, along with other religious communities, ought to recognize spiritual values in the love that gay and lesbian couples have for one another. And discrimination against homosexual people should be held abhorrent by people of all faiths.

However, I have three main difficulties with the suggestion that the Catholic Church could and should embrace same-sex unions as its own.

First, there is the multi-national character of the Catholic Church. This church cannot limit its attention to the United States. It must also respect the many diverse cultures, ideologies, traditions, and attitudes of the people who belong to it in other nations. People in many parts of the world remain far from acceptance of homosexuality.

It would take thoroughgoing changes in mentality on the part of these people before they would support same-gender marriage. I don’t think the church could possibly move toward an embrace of such marriage while large sections of its people opposed it.

Secondly, I am convinced that the Catholic Church would first need to change its official position on sexual activity in general before it can move to a different appraisal of gay and lesbian unions. Currently, all sexual activity on the part of unmarried people of any stripe is regarded as immoral. Though not many would seem to think this position still reasonable, the official church continues to hold to it adamantly  

Thirdly, I consider same-gender and male-female marriages as two different realities. I do not deny their similarities but I continue to regard them as distinct. To me, words are vitally important because they signify reality. The word “marriage” signifies a sexual union between male and female persons that differs from the union of male and male, along with female and female. That is the way a well-established tradition has delivered it to us.

A different word should be found for these latter bondings, though I admit not having found an appropriate one. The word “marriage” might be acceptable for gay and lesbian unions if the word were joined with another to distinguish it from heterosexual marriage.

For me as a man, a sexual relationship with a woman is unique. Women differ from me in their physical being, in their emotional life, and in spiritual life. I am not saying that no elements from these spheres of women’s life are present in males, or in some males, but I still find women unique. I value the difference.

And I believe that, for me as a male, entering into a sexual relationship with a woman inevitably differs from what entering into a sexual relationship with someone of my same gender would be.

The Catholic Church needs to find spiritual and human value in the marital unions of homosexual people, but it cannot accept these unions on the same sacramental footing as heterosexual marriage anytime soon.

Richard Griffin

A man in his later years, riding his bicycle, gets slammed by a car. He is rushed to the hospital where doctors decide he must have his right leg amputated. We learn how he enters upon the long process of dealing with this loss as, after a while, he prepares to return to his apartment.

Thus begins “The Blow,” a short story by J. M. Coetzee in the June 27th issue of the New Yorker. The author, winner of the Nobel Prize for literature, is a South African who writes with uncommon sensitivity about what it is like for an aging man, Paul Rayment, to cope with sudden radical disability.

The man’s first home care attendant proves unsuitable. The second woman, a recent immigrant from the Balkans, turns out to be supportive beyond what he could have imagined. Ultimately, this compatibility brings about surprising changes in him.

For fear of giving too much away, I stop the story here. But, if you want to know what’s it’s like to be in new and unexpected need in later life, I recommend reading it. One of the (many) best things about it is the subtle way that the man’s inner feelings shift as time wears on.

This superb fiction has a basis in real life, of course. That’s what makes it so compelling to read. It puts into imaginative form some of the same approach one of my favorite gurus takes when writing about the meaning of frailty in the lives of old people. This writer, Wendy Lustbader, bases her reflections on the work she has done with a wide variety of such men and women..

Envisioning becoming frail, she poses the question: “How will I let my caregivers know who I am?” That is the issue because, if the provider of my care does not go beyond surfaces, I will be for her only another little old lady or old man. I will simply be one more mouth to be fed or body to be pushed back to the bedroom.

But, if my helper does get to know me and allow herself to be known, perhaps I can preserve my real self. Then I will emerge as a real person capable of being known and even loved.

“Are there ways of becoming more as the body becomes less?” asks Lustbader. Answering her own question, she goes on: “There is a further worth awaiting us in remembering and contemplating, in thinking things over, in letting all that has been said and done assemble itself into something we can grasp.”

Although this looking inward may seem daunting, let me suggest that doing it can change your world. Lustbader would encourage anyone who is attracted by this prospect to “embrace our ultimate fragility” now, before it becomes necessary. Doing so will reveal the beauty of human life and its meaning.

This is where Coetzee’s short story ultimately leads. The man makes discoveries about himself that turn him into a different kind of person. The life that seemed at a dead end as a result of the sudden catastrophe now takes on new meaning.

Thus literary art succeeds in revealing something not commonly perceived or appreciated. It shows what can happen when people are thrown into unfamiliar circumstances that appear only dire. With an effort on both sides, the direness can become transformed into one of the most valuable experiences of one’s whole life.

But the situation is not without challenges. When, as happens most of the time, family members are the ones who care for those who are frail, they may need to improve relationships that have been marred by remoteness or tension. Lustbader tells of a son who was pressed into service lifting his father from bed to wheelchair. They had not been on speaking terms for years, but when he had to embrace his father to make the transfer, the son broke into tears and so did his father, too.

When care comes from professionals outside the family, then the challenge may be different. Hired caregivers often differ in ethic origin or social class in ways that make it necessary for the frail person to adapt to unfamiliar styles of doing things. However, it is vitally important to break through toward respect for personal identity.

Some people, like the man in the story, have frailty thrust upon them suddenly, without warning. They have to adapt sooner than they ever expected.

By contrast, those of us in at least relatively good health have time to prepare ourselves for changes in our status. The best preparation, experience suggests, is to cultivate in ourselves an inner life that enables us to find meaning for what we may be called upon to go through.

Making time, in advance, for assembling within ourselves the various elements of our life can prepare us for diminishment to come. It is the old adventure of finding ourselves in new ways, much to our surprise and, perhaps, relief.

Richard

On the Fourth of July, four American soldiers, veterans of the war in Iraq, discussed their experiences. Appearing on public television, these young men offered a sober account of where things now stand.

“Two years into this war, this situation hasn’t improved,” said Specialist Patrick Resta.. Another, Sgt. Gregg Bumgardner, referring to the Iraqis, added: “They didn’t really want us there.”

Back home, when they meet civilians, the latter sometimes say: “Thank you for defending our country.” This sentiment has Bumgardner scratching his head in confusion because it can come from people opposed to the war.

These four men made a highly favorable impression on me. Their intelligence, obvious sincerity, and balanced realistic judgments suggest that the number of smart and capable non-commissioned officers in the American forces may be high.

That so many other soldiers like these have been killed or terribly wounded in body and/or soul continues to trouble me. I grieve when I see the names of the dead several times each week. My heart goes out to those families who have lost sons and daughters fighting in this war.

Equally afflicting is the fact that casualties are much greater among innocent Iraqis. It is one thing to die for a good cause; to fall victim to the lethal violence unleashed by modern weapons in a misbegotten war is something else.

An old friend, a native-born Iraqi Jesuit, provides a personal perspective on the agonizing warfare that continues to devastate his people and their land. Talking about it, he shakes his head in dismay at what is happening to his former countrymen, and to us.

Length of life provokes comparisons, I discover. Iraq drives me back in memory to Vietnam. Granted, these comparisons do not work exactly. You cannot easily apply the lessons of one complicated situation to another quite different one.

However, when it comes to war, what the comparisons do teach is the unexpected complications of armed conflict. You cannot count on things turning out as you expect: you are quite likely to be fooled, as the authors of the Iraqi invasion have been.

In my later life, I feel constant concern about what is happening to our country. Naiveté about the people of the world and ignorance of history, along with lack of interest in the subject, strike me as disabling handicaps for our nation. All too often our federal government adopts policies that embroil us in warfare, harming us as well as people of other countries. Anyone who has lived for more than a few decades knows that willful blindness can lead into dark and disastrous places.

War spawns the telling of lies, and our federal government has become accomplished at this activity. We are all suffering from repressive changes in our society that harm our national values without making us more safe. A constant barrage of propaganda is necessary to make us believe in the myths that are foisted on us for political advantage.

For my money, the journalist Chris Hedges has written more tellingly about contemporary war than anyone else. After covering warfare in at least ten different countries in the last three decades, he knows the subject at first hand.

In an interview published online by the Public Broadcasting System, Hedges speaks about the hidden costs of war:  “I'm not a pacifist. Wars are always tragic, but probably inevitable; I would think they are inevitable .  .   .  But I also understand what war can do, especially when you fall into the dark intoxication that war brings.

“That process of dehumanizing the other,” he continues, “that ecstatic euphoria in wartime, that use of patriotism as a form of self-glorification, that worshiping of the capacity to inflict violence — especially in a society that possesses a military as advanced as ours — all of those things I wanted to expose in the book, so that people would at least understand war for the poison that it is.”

Like Hedges, I am not a pacifist either. But, in my book, war can only be a last resort for the most pressing of reasons.

I will never forget the words of the British poet Wilfred Owen, killed in France one week before the armistice of 1918. Writing from the trenches, he bitterly quoted the Latin slogan “Dulce et Decorum Est Pro Patria Mori” (It is sweet and proper to die for one’s country). He called this saying “the old lie.”  

These are the concerns of an aging columnist who increasingly worries about what is happening to our beloved country. When our government leads us into an unjustifiable war, it inflicts damage, boomerang-like, on ourselves as well as other people. I could wish for greater confidence that we will find our way out of this morass and reclaim the moral stature that we Americans have had at our best.

Richard Griffin

Contrasting news reports about two young men, one report astonishingly joyful, the other inexpressibly tragic, have moved me to ponder yet again some of the big issues in life.

The first young man, a 21-year-old named Patrick, was swept out to sea off Maui and feared lost. After some 15 hours of bobbing up and down in a life jacket, he was spotted by the crew of a Coast Guard helicopter and racheted up to safety. Patrick’s father heard the good news from the pilot of an airliner as he flew towards the Hawaiian Islands. There are no words to express the ecstatic relief that marked that day.

Paul, the second young man, graduated from Harvard College in June where he was celebrated for his intellectual gifts and vibrant personality. Late last month, he fell out of the sixth floor window of a New York City apartment where he had been sleeping. His death has devastated family and friends who loved and admired him. Like them, I find his loss cause for tears.

This unexpected rescue and this bizarre death draw from me amazement at the unequal outcomes in life. Why do some of us live so long while others disappear early on? It is enough to tempt me to endorse Shakespearean lines from King Lear memorized in college: “As flies to wanton boys, are we to the gods / They kill us for their sport.”

But this grim sentiment does not come close to my considered philosophy. Even in the face of the world’s daily horrors, I continue to place great value on human life and believe in the ultimate power of love. Nor does my wonder at the great adventure dry up as the years accumulate.

In fact, the question, “Why am I still alive?” takes on renewed relevance with increased age. Already, I have been given 20 years more than my father had at his death. And many classmates in school and college have already died, while I still live.

The mystery of unequal lifespans urges further thought. When you find yourself outliving friends and family members, you sort out the reasons why it is worth living longer. As answers, it is tempting to offer various abstractions, in the manner of the philosophers.

Instead, let me suggest a much more simple and direct approach: You, like me, may be a spouse, parent, sibling, aunt or uncle, cousin, friend, neighbor, colleague. These roles count for more than we usually allow. When we depart finally, many of those on the other end of these relationships will miss us, thus affirming the value of these ties and the value of our life.

During a public dialogue with me four years ago, the scholar and writer Catherine Bateson gave a striking illustration of how important even one of these roles can be. Her mother, the anthropologist Margaret Mead, was one of the first people to write a living will. In it, she stipulated that, if she had suffered mental impairment or lost her mobility, she did not want anything done to extend her life.

This provision for her future angered Catherine, then a teenager, because her mother was saying that “it was not worth her while to be alive when she was no longer the famous Margaret Mead.” Catherine’s sharp response was: “But you’d still be my mother.”

You do not need to exercise all of the roles listed above to find meaning in your life.  Even one of them can make a vital difference to you and to others. Parenthood, for instance: even when children have become fully adult, the relationship continues to be a support for sons and daughters, and ourselves.

Ideally, ties to family members and friends take on greater meaning as we age. Maturity has brought many of us to realize the value in being connected to others. Though they would no doubt retort that they do not need my pity, I tend to feel badly for the few misanthropic figures encountered in my neighborhood. Almost inevitably, as I see it, old age will leave them exposed to soulful melancholy, if not acute vulnerability.

Let me mention the neighbor’s role, one that is commonly undervalued. I do not blush to ask my own neighbors for favors that compensate for my deficiencies of body and mind. These chores range from screwing in a new light bulb in a porch roof, to advice about how to get my computer back online after some mysterious failure of connections.

By the same token, I take pleasure in offering to neighbors whatever talents might help them. Several times a year, I publish a neighborhood newsletter that is enriched by the varied talents of local residents. More significant, perhaps, when neighbors are away, I am ready to move their cars on our city’s dreaded street cleaning days.

Serving as spouse, parent, sibling, uncle or aunt, cousin, friend, neighbor, colleague ──not the worst of responses to life’s unsolvable mysteries.

Richard Griffin