Will the Circle Be Unbroken?: Reflections on Death, Rebirth, and Hunger for a Faith

By Studs Terkel

The renowned oral historian interviews ordinary people about facing mortality: “It’s the unguarded voices he presents that stay with you.” —The New York Times
 
In this book, the Pulitzer Prize winner and National Book Award finalist Studs Terkel, author of the New York Times bestseller Working, turns to the ultimate human experience: death. Here a wide range of people address the unknowable culmination of our lives, the possibilities of an afterlife, and their impact on the way we live, with memorable grace and poignancy. Included in this remarkable treasury are Terkel’s interviews with such famed figures as Kurt Vonnegut and Ira Glass as well as with ordinary people, from policemen and firefighters to emergency health workers and nurses, who confront death in their everyday lives.
 
Whether a Hiroshima survivor, a death-row parolee, or a woman who emerged from a two-year coma, these interviewees offer tremendous eloquence as they deal with a topic many are reluctant to discuss openly and freely. Only Terkel, whom Cornel West called “an American treasure,” could have elicited such honesty from people reflecting on the lives they have led and what lies before them still.
 
“Extraordinary . . . a work of insight, wisdom, and freshness.” —The Seattle Times

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Oct 7, 2014
• ISBN: 9781620970614

Book preview

Part I

Doctors

Dr. Joseph Messer

Chief of cardiology at Rush–St. Luke’s–Presbyterian Hospital in Chicago. Former chairman of the Board of Governors of the American College of Cardiologists.

I WAS BORN in 1931. Watertown, South Dakota, is thirty miles west of the Minnesota border. I lived there until I left to go to college in 1949.

Dad was an undertaker. It had been the family profession for five generations: all the way back to cabinetmakers in Maine. They were the ministers, the circuit riders who marked the trees for molasses. This was the 1600s . . . Their interest in wood led them to become cabinetmakers.

In small towns, the furniture business and the undertaking business were the same people. My father’s father, going back several generations, had been in this business. My dad left it, being more interested in banking and finance. It was while traveling through Watertown that he ran into the town banker, who offered him a job. He married the banker’s daughter. An interesting coincidence: my mother’s side of the family were in the funeral business. My father gave up his banking interests and ended up in the funeral part of it. So I was raised as an undertaker’s son.

We used to play in the chapel where the services were held, run up and down the aisles. I loved to play the piano. When I was about ten, eleven, my dad got a Hammond organ for the funeral chapel—I loved to play that. I was always admonished that I had to play somber music. A few times I would accompany my father—he had a beautiful voice—when he sang the old hymns at funerals.

By the time I was ten, I was working there after school, taking care of the hearses, the limousines. I attended a lot of funerals and, in time, I drove the coaches and the ambulances. In those smaller towns, the funeral directors ran the ambulances because the hearses were convertible. This was before the days of paramedics.

I grew up with grief, though I didn’t experience it because I wasn’t part of the grieving families. Having people die was a part of the life that I lived. I remember the enormous respect my father had for the deceased—he insisted that anyone in the funeral home share that respect. That was one of the important influences in my life. I remember going with my father to farmhouses where people had died. I would help with what we called removals. He was on one end of the stretcher and I would be at the other end. I would watch my father interact with the relatives of the deceased, who were in grief. He treated people of all economic and social classes the same. I’m sure that watching him with people under stress, more than any other lesson, helped me become a good doctor—I hope . . .

I don’t believe that I really felt grief until the boy who lived across the street was killed in World War II. I was about eleven, twelve. He was a wonderful young man. When we learned that he had been killed, it really struck home. It’s my first memory of true grieving.

My father’s real goal in life was to be a physician. He actually started to go to medical school, but had to drop out because his father contracted tuberculosis—not an uncommon disease in those days. That’s what led him into business, supporting the family. He clearly had great respect for physicians.

I think he has lived out that desire vicariously to some extent because my brother and I became physicians; he’s four years older. We were learning the bones of the body when we were six. I knew every bone in the body when I was seven or eight. He had all sorts of medical textbooks. He would teach me about blood vessels and veins and arteries. I saw him embalm many times. Preservative chemicals infused in order to replace the blood lost so that the remains could be preserved.

My brother and I were really programmed to be doctors. It turns out that my daughter, my dad’s granddaughter, is a physician. [Laughs softly] I tried not to unduly influence her—I didn’t program her.

My father was clearly trying to influence our career choices. I arrived at college with blinders on. There was only one thing I was going to do and that was to be a doctor. I probably missed out on some other things I might have been interested in . . .

Our major medical influence, our citadel, was the Mayo Clinic. That’s where everyone from South Dakota went when they were seriously ill. I made innumerable ambulance trips for my dad from Watertown to Mayo. Lots of long-distance driving, about 375 miles. My dad was very interested in handicapped children. He had the dream that my brother, now deceased, and I would have the Messer Clinic, modeled after Mayo.

My brother was in the army toward the very end of World War II. He had heard of a place on the East Coast called Harvard—it was just a name to us in Watertown. We were going to go to the University of Minnesota, of course. But my brother decided on Harvard, much to my father’s dismay. My mother said, If he wants to go there, let him. I went to Harvard College, too. I stayed there for medical school, for my residency, and for my fellowship in cardiology.

After that, I worked at Wright Patterson Air Force Base. This was in the days of the astronauts—doing studies to get them up into space. Sputnik had gone up, and we were in a race with the Russians. I worked on human centrifuge—gravity and G-force. We would spin people around. That’s how you simulated the tremendous G-forces of a rocket. It was a wonderful experience.

I went back to the Boston City Hospital, one of my favorite institutions in cardiology. Then I came here to Chicago, to be chief of cardiology at Rush.*

During the first eighteen years or so of my life, I looked at death as an objective event that occurs—I didn’t get very emotionally involved. Now, at this end of my life, the other end of my life, I react very personally to the deaths of my patients . . . I sometimes become emotionally involved. I always seek out the families and talk with them and console them and give them my condolences. I’m very much helped by the memory of my father dealing with families in the funeral business. I don’t deal with my patients’ families as though I were an undertaker, but that ability to be empathetic, to share their feelings—I think it’s because I watched my father do it.

As I watch my own colleagues respond to death in their patients, I see quite a variety of responses. A certain ability to separate yourself emotionally from the environment that surrounds a sick and dying patient is important in order to maintain objectivity, to make intelligent decisions about the patient’s care. I think you have to be able to separate yourself in that sense from your patients in order to be a good doctor. In some of us that ability is taken to an extreme. If you become caught up . . . that’s why we don’t take care of our own families, the emotional problem of dealing with illness in your own loved ones. Perhaps it’s a defense mechanism so that we don’t get embroiled. Sometimes it’s absolutely heart-wrenching to see what happens to sick people. If you allow yourself to be subject to that kind of emotional trauma over and over and over again, it becomes a very damaging thing. There has to be a certain amount of insulation—but I think there can still be compassion.

A lot of it is experience. I was blessed in having the experience of watching a true master dealing with grief, my father, and maintaining that necessary separation—he had to do his business, he had to take care of the needs of that family. Dealing with death is a third-rail issue in the United States. We don’t talk about death and dying as a societal problem, but it’s going to become more and more of one . . .

It’s a very delicate issue for many people—it probably conjures up all kinds of fear and anxiety in terms of their own mortality. But we need to do a better job of talking about it, thinking about it, preparing for it. As a result of that, I think the physician–patient relationship will be broadened.

Often when patients die, we know that it’s inevitable. We know the condition they have is incurable, and there’s no self-doubt. It’s always could we have done better in the process of dying, in caring for the patient? But, in some cases, you always wonder: there was a fork in the road in our decisions about a patient—surgery, no surgery. Surgery, we know there are certain risks but greater benefits. No surgery, lesser risks but lesser benefits. Should we have turned the other way? Now, knowing the outcome . . . The retrospectascope—it’s a wonderful tool to learn with, but it’s a vicious mean tool to punish with when you look back and say, We should have gone this way or that way. Of course we use it all the time in medicine and as well we should. You look back at how can we do it better next time—that’s the whole basis of the postmortem examination.

When it came to Ida, I had about ten different feelings.* One was tremendous grief about her death, because I had enormous respect and affection for her. One was a sense of remorse: Had we made the wrong decisions in terms of recommending this particular course of therapy? Going back and doing a retrospect analysis. Did we overlook anything? What had gone wrong? One was: How am I going to confront you? I had learned that I was the one who was going to be telling you she had passed away. How am I going to break the news to you and your son? What words am I going to use? What’s going to be your reaction? How are we going to interact in that terribly difficult period in your life and in my life? How can I help you after I’ve done that? What are the next steps? That’s why I was so grateful to see that your son was there, that you had people with you.

A physician must be honest in dealing with a patient. If the patient senses a lack of integrity, it’ll undermine the whole process. At times being honest means bringing bad news. What I try to do—I’m sure I could do it better—is to tell the patient what the facts are. Then to do my very best to point out that there are ways of dealing with this problem. It may be a palliative type of thing: we’re not going to cure it, but we’re going to lessen the impact. I truly believe that virtually every diagnosis we deal with today holds the hope of some breakthrough in the foreseeable future. I like to bring that to my patients’ attention. Right now we may not have a treatment or a cure for disease X, but so much is happening in the field . . .

My son had Hodgkin’s disease—it’s a cancer of the lymph nodes. When we learned that, I was devastated. The wonderful physician who took care of him pointed out to me that things are changing so quickly in this field that you should have hope—and she was right! He’s now seven or eight years after being treated and no evidence of recurrence. The number-one thing when you’re dealing with an incurable disease is to give the patient a sense of hope without being dishonest.

Grief and guilt are threatening subjects, more so as we get older . . . Because we’re getting nearer and nearer to our own mortality.

I think it’s become more of a problem as our nation has become more secular. I noticed as a child, from experiences with my dad, how much of a role religion plays in dealing with this issue—the belief in the life hereafter, salvation and redemption, that sort of thing . . . The sermons given at funerals, the masses, the expectation of something beyond—these things sustained the grieving family through this terrible period.

My father was very religious, Methodist. He was a regular churchgoer and did all the things that religious people in small communities do in terms of contributions and the like. But his real religious expression was in the way he lived his life.

I raised my children in a religious environment because I’m convinced unless you have experienced this as a child, you cannot recapture a religious belief as an adult. But my science background makes it difficult for me to accept some of the assumptions of organized religion. My experience with some organized religions makes me doubt that they are truly religious in terms of their compassion and their concern for human beings and the needs of human beings. I doubt that there’s a hereafter—and that’s probably the first time I’ve ever said that. [Laughs] But it would be nice if there were. Though I can imagine the enormous complexities if there is a hereafter and all my ancestors are up there!

I think of people who have lost a loved one, as I have—my first wife died ten years ago—and then later remarry. How is that going to work out if we’re all up there together with two wives? Maybe the Mormons were right. [Laughs] I don’t mean to be disrespectful . . . But it does seem a little difficult to put together from a scientific, rational basis that there is a hereafter. I guess I don’t really care. I think the important issue is the way we conduct our lives while we’re here, and the impact we have on other people while we’re here. And if it helps some people to think there’s a reward in the hereafter for being good, Calvinism or the Judeo-Christian ethic, so be it. The motivation isn’t as important to me as the solace it gives survivors.

I’ve always had an internal gut reaction against cremation. My initial experiences with it as the undertaker’s son were emotionally repulsive. I don’t know if I’ve ever gotten over that. When my wife passed away, my children felt very strongly cremation was the appropriate thing, and that my wife had actually told them that’s what she wanted. She and I never discussed it . . . I don’t know that I’ve really decided what I would want. I’ll leave that to my survivors.

I think that we need to take a more active role in deciding about our own terminal care. If you haven’t been able to talk about death and dying with your children, you’ve left them completely in the dark as to what you would like to have done. Most of us aren’t able to do that in the last few months of our lives. Everyone has the right to a graceful death. Unfortunately, we don’t have people die at home anymore, partly because there is this reluctance to engage in the process of dying. Many families don’t want a sick person in the bedroom, dying.

Last week, I attended a play, O’Neill’s Desire Under the Elms. There was talk in that play of the parlor, which no one had entered since the wife’s body was laid out there. From that point on, the parlor was never used by the family. That’s why often it’s called a funeral parlor, as it was in the old days. The service would be in the church, but the remains would be taken back to the home, and the viewing, the wake would be there.

The issue of dying is a very sensitive one in our country. I think it’s caused a lot of emotional stress, a lot of financial problems for people who haven’t planned in advance. It’s placed a lot of unnecessary burden on families because they don’t know what the wishes of the parent might have been.

When I was a kid my mother said, There’s certain things, Joseph, you don’t talk about in polite company. You don’t talk about politics, you don’t talk about religion, you don’t talk about sex. She never said death, but I would add that—because there’s a fear that you’re going to touch a sensitive raw surface on the other person, that you’re going to remind them of a recent death or stimulate their anxiety and fear about their own illness. I don’t mean that’s the next thing, but I think it is a topic that needs to be discussed so that we can get our fears and our anxieties out in front of us, take a look at them, and then begin to deal with them.

*Rush–St. Luke’s–Presbyterian Hospital.

*Ida was my wife. She died after undergoing heart surgery.—S.T.

Dr. Sharon Sandell

We’re in a high-rise on Chicago’s near North Side. Her one companion is Juliet, a little Pomeranian. She’s seen both sides of doctoring. I seldom go outside now. I have spinal problems, both neck and the low back. I’ve had repetitive spinal cord compression for three years. I’ve moved here because it’s not safe for me to drive anymore. I don’t have enough neck movement. Ten pounds is as much as I can lift, even and that’s pushing it . . . She moves about as carefully and gracefully as she can, but with obvious difficulty and discomfort.

I GREW UP in a part of Phoenix that was surrounded by wealthy people, but we were very poor, blue-collar poor. My parents were against education: they thought it was a waste of time for a female especially, and of course they didn’t want to pay for it. My father actually set up my getting married when I was very young. He picked out a guy and arranged the first date. If I dated anyone else I had a curfew, and then there were a million questions—it was difficult. With this guy, I could stay out all hours, no questions asked. I married right out of high school, I was seventeen. It didn’t last very long.

My goal was to get a college education. I just knew that there was more to life than being married. I wanted to know all I could know. I was very good in school. I excelled at everything. I didn’t find out until I was in my thirties that I had been tested in kindergarten and my parents were told I should have been put in classes for very bright children. But that was kept from me—they didn’t want me to excel in any way. I really do believe that they didn’t want to have a child that didn’t know her place. They knew their place . . .

When I started college, gee, it was one surprise after another for me. I was majoring in engineering after I found out how good I was at math. I was the only female in any of my engineering classes. I got national recognition for our project in engineering design. But I couldn’t find work that I could do around the scheduled classes. That’s when I started working through one of the nursing registries as a sitter, a baby-sitter for sick adults. That was good, ’cause I could stay up all night and study.

Then I found out I could make more money if I got six months of training as a nurse’s aide—changing bedpans, getting vital signs, giving people bed baths. I had to decide whether I was going to finish engineering. I decided to stick with nursing because I was enjoying working with people more than with things and because there was still an incredible amount of prejudice against women in engineering back in the early seventies. I got a Bachelor of Science in nursing—that was in December of ’78.

As soon as I graduated, I went to work for Maricopa County Hospital in the neonatal intensive care in Phoenix. I wanted to continue on to become a neonatal nurse practitioner—but, in order to do that, I needed a master’s degree in nursing. I had to go down to Tucson to the University of Arizona. When I interviewed for the position in the master’s program, they told me I had to have two years of medical-surgical floor nursing before they would let me in. Which meant I would have had to quit working in the nursery, which I loved doing, work with adults, and then apply to the master’s program. I got angry.

The college of nursing was sitting right perpendicular to the college of medicine. After all I had been through I was so angry that a straight-A student wouldn’t be accepted in their master’s program without two years of nursing, that I marched over to the College of Medicine. I found the dean of students and knocked on his door—I said, What do I have to do to get in here? I was thirty years old at the time. When I was twenty-three, I had been told I was too old to apply to medical school . . .

In eighth grade we had to do a paper on what we wanted to be when we grew up. I wanted to be a doctor. So here I was, turning down a good-paying job in nursing and struggling with putting myself through medical school? I worked as a nurse for the first two years of medical school, at night. Medical school was much easier than nursing school. I loved emergency medicine. Northwestern had the only residency program at the time where you could get board-certified in both internal medicine and emergency medicine. Now I’m ten years older or more than most of the students. At Northwestern there were eight hundred applicants for eight positions. I have no idea how I made it, but I was one of the eight. I’m really bright. I know that now, but I didn’t know it for a long time.

I herniated the disk above one that had already been operated on in my senior year in medical school, in ’83. I was working as the admitting resident at Columbus Hospital in the intensive care unit. And I got called down for a woman who was having massive rectal bleeding. They had put MAST* trousers on her. It was a procedure that called for all kinds of pressure on the abdomen, on the theory that it would save that blood for the brain and the heart. They don’t use it anymore because it didn’t work, but one of the cardinal rules was that once you pumped it up, you couldn’t just let it down—it had to be let down very gradually or you’d kill the person.

I pulled the curtain back and I could see these MAST trousers on her, and she was just as blue as the sky. What I discovered was that while they pumped up the trousers, they were getting people in from another accident, so they were doing everything very quickly. They had caught the patient’s gown in the trousers, so that when the nurse pumped up fast, it was strangling her. I tried to get the neckline free, and I was calling out for someone with scissors—I couldn’t find anything. The only way I could make sure this woman didn’t strangle was to actually tear that neckline, and that’s how I herniated the disk. I worked my fingers under there and ripped as hard as I could. I knew something was wrong within minutes of having done that. I just about passed out from the pain.

It turned out that she should have never even been brought into the hospital. She came in from a nursing home with no code written all over her chart. So they never should have brought her to the emergency room in the first place. I saved her life for no good reason. She probably died within a week or two.

What really did me in, though, happened in 1993 in Mesa, Arizona. I’m working in the ER, all these years later. A man had had a very severe heart attack and had been given thrombolitic therapy to thin the blood. Something that he was on caused his tongue to swell massively. The ER doc there for the night shift, who was trying to resuscitate him, couldn’t get an airway in. She couldn’t do a tracheotomy because of the thrombolitic. He would have bled to death. So I offered to help, to try to get a tube through this massively swollen tongue. I was pulling on that instrument; it’s called a ringoscope. You get the tongue out of the way so you can see the vocal cords and put the tube through. I was pulling on it for all I was worth and my neck blew apart. I didn’t know that the surgeon in ’87 took out most of the joint at five–six to get rid of the disk material. So I had one joint holding it together. That blew apart. It was misdiagnosed for fifteen months. If I’d not been a physician, this would have killed me. I diagnosed myself. Finally, at Scripps Clinic I got referred to a surgeon who could fix it.

My biggest grief is the loss of a profession that I spent my whole life working for. It’s years of my life down the tubes. Now it’s a love–hate relationship. I’m not so sure I love medicine so much anymore. Maybe two months ago, when I went to see my doctor who’s treating me now, I looked at the X-ray view box and I realized, I’m not a doctor anymore, and I just broke into tears. The loss of my true love. It surprised me. I’ve had some people say things like, Oh, what a waste, all those years and you’re wasting all that knowledge. But if I hadn’t been a doctor, I wouldn’t be alive today—I’m the one who finally figured out what was going on with my neck.

Medicine is a big business now. It’s not Marcus Welby, MD, anymore. HMOs and managed care don’t let physicians work from their heart. I hate to see what’s happening to it. There are a thousand things wrong, a million things wrong. Our priorities are so messed up. When you look at us spending thousands, millions of dollars on trying to save infants that are born way too premature and we torture these little beings for several months, and then they’re either brain-damaged and have horrible, institutionalized lives or they die, and you look at hungry children out on the street who could have half a chance with the money that we’re throwing away. When I was in residency, a lot of times we would see people we knew were going to die. I remember in particular one woman with terminal breast cancer who required almost daily blood transfusions. If she did not have insurance, she would not have gotten the transfusions. And what did we do for her, other than padding the pockets of the hospital? We kept her going for as long as the insurance kept paying.

There’s a condition called a dissecting aortic aneurysm. The aorta is the first big, heavy vessel off your heart. An aneurysm is a ballooning out, a weak spot. If it ruptures it doesn’t take too many heartbeats before you pump out all your blood and you’re dead. Saving someone in the emergency room with a dissecting aortic aneurysm is a real coup. It’s a very difficult thing to do. You’re so proud of yourself as the physician who can make the diagnosis fast enough and get everybody doing the right thing at the right time. I did that.

When I was working in Mesa, I had a gentleman come in. I diagnosed him right away. Everything just clicked fine and I knew he’d made it, we’d saved him, and I was so proud of myself. About three weeks later, I was the ER doctor and suddenly got called up to reinsert the nasal-gastric tube in someone. It turned out to be this guy I’d saved. The minute he saw me he goes, You’re the bitch that did this to me. He was furious that I had saved his life, absolutely furious. He just didn’t want to be alive, and he was mad I’d saved his life—he’d been robbed of dying a nice, fast, natural death. [Laughs]

Ultimately the patient, not the doctor, may decide life or death. Ultimately, who decides when you die is you. A colleague of mine had a patient in the emergency room on Christmas day saying she was sure she was going to die. The ER doctor did a complete workup on her and couldn’t find anything wrong in the chemistries, blood gases, X rays, you name it . . . She still insisted she was going to die, but she really had no medical problems. The doctor called her attending physician who said this woman was not a hypochondriac. He knew her very well, had taken care of her for years. Even though it was Christmas, he was going to go in and see her. He looked at all of the workup that had been done, examined her, and there was nothing wrong with her. As he was in his car, starting to drive out, he got the page to come back. She was getting dressed to leave, had been discharged, and she died. Nobody ever knew why. She knew she was going to die. We don’t know what she died of, but she died.

*Manually Adjustable Sphygmomanometric Trousers—a medical article long out of use.

ER

Dr. John Barrett

He is Chief of the Trauma Unit at Cook County Hospital, Chicago. He still has an Irish brogue.

In 1966, the Trauma Unit here was actually the first of its kind in the nation. It’s dedicated to people who, more than being sick, are injured—patients who have been subjected to what we call intentional injury, violence. It’s gunshot wounds, stabbings, personal assaults. Other trauma centers see patients who predominantly are victims of unintentional injury: automotive wrecks and falls. Our experience here has been inner-urban, lower-socioeconomic groupings; predominantly young, predominantly male, and predominantly penetrating trauma: gunshot wounds and stabbings.

I AM THE THIRD of four sons. My father was a mail carrier, my mother was a dressmaker in Cork. The family really struggled to make sure that all of the sons went to university. My two elder brothers did science—chemistry and physics. I wanted to do something that was scientific in nature but more people-oriented. There was really no family tradition of medicine, but medicine seemed to fill my criteria. I can recall my eldest brother, Frank, saying, This is a terrible waste of time—you don’t have to be intelligent to be a doctor.

It’s not as if it’s rocket science. There’s nothing terribly difficult to understand in medicine, there’s just an awful lot of it that you have to remember. I always wanted to be a general practitioner. In my final year of medical school, I did a rotation with the then-professor of surgery, and I loved it. At the end of the rotation he said, Well, Barrett, what are you going to do? I said, Well, Mr. Kiley, sir, I’m going to be a general practitioner. He looked at me and said, Barrett, there’s the makings of a great surgeon lost in you. So that’s why I decided to do surgery. I realized that what I really, really enjoyed was the injured patient. It’s such an acute event: the patient is perfectly healthy, then something traumatic happens, and within a matter of seconds they are injured. They’re a great surgical challenge because they’re bleeding, they generally need surgical intervention. The epitome of those patients is the gunshot wound. Despite all the terrible things you hear about Northern Ireland and all the violence, where I was in the South we saw no gunshot wounds. I actually had to come to this country to see gunshot

Reviews for Will the Circle Be Unbroken?

[mikerees-1 · Rating: 4 out of 5 stars]

This author does the simple things, asks questions and allows people to answer.Amazing, ordinary people, like you and me

[chriswise_1 · Rating: 4 out of 5 stars]

Not as strong as others he's put together. Considerable insight into effects of the AIDS crisis that seems to be forgotten now.