Teach Us to Number Our Days: Health Anxiety and Faithful Anticipation

“Human beings have tried to restrict the river to one course. That’s where the arrogance began. ... Whenever you try to control nature, you’ve got one strike against you.”

John McPhee, The Control of Nature

“The basic mode of vibrant human existence consists not in exerting control over things but in resonating with them...”

Hartmut Rosa, The Uncontrollability of the World

A Season of Control and Denial

January and February mark a time of enhanced attention to health for many, particularly as patients enjoy the fruit of new year’s resolutions or realize they haven’t quite achieved what they’d hoped for by March. It may also be a season characterized by newfound appreciation of death and dying as we consider the losses of those close to us in the past calendar year or years prior, echoing as they often do throughout seasons in which families draw close together.

As a palliative care doctor, I (Frush) constantly speak with patients nearing the end of life who are grappling with the question of what it means to die well. And as a family doctor, I (Eberly) regularly care for patients who are seeking to better learn and practice what it means to live well, even unto a good death. We both inhabit primary care spaces, taking care of patients “cradle to grave,” as we say in family medicine. Through our respective training and practice experiences it has become clear to us that these questions—how to live well and die well—are inextricably bound up with one another.

Recently, we’ve noticed that the way these questions are asked and answered, including by Christians, increasingly suggests a troubling posture of both control and denial—control leading to health anxiety and denial leading to death apathy.

We don’t raise this disturbance in our hearts to claim any more authority than a mere Christian can. As theologian Willie Jennings once quipped, “I’ve never heard so many people tell theology what to be and what to do than when I talk to doctors.” This line haunts, chastens, and constrains us.

At the same time, as the great Methodist minister and ethicist Paul Ramsey wrote of doctors in The Patient as Person:

In the medical literature there are many articles on ethics which are greatly to be admired. Yet I know that these are not part of the daily fare of medical students, or of members of the profession when they gather together as professionals … The Nuremberg Code, The Declaration of Helsinki, various “guidelines” of the American Medical Association, and other “codes” governing medical practice constitute a sort of “catechism” in the ethics of the medical profession. These codes exhibit a professional ethics which ministers and theologians and members of other professions can only profoundly respect and admire. Still, a catechism never sufficed. Unless these principles are constantly pondered and enlivened in their application, they become dead letters. … This is not a personal plea. It is rather a plea that in order to become an ethicist or a moral theologian doctors have only to quit resisting being one.

We write as Christians and clinicians who do not want to tell theology what to be and do, but also want to quit resisting the kind of pondering and enlivening that keeps the catechism and codes of our profession from becoming dead letters.

In that spirit, we want to raise again the perennial tension between living well and dying well, offering what we hope is a just and loving charge for any reader involved in the care of those who claim Christ, especially those who wring their hands to secure their longevity while washing their hands of preparing to die well. We hope the beginning of 2024—particularly here in the lingering light of a new year and yet the ash of Lent—might offer a space for priests, pastors, and church leaders to raise such conversations of longevity and finitude in their local contexts, inspiring not control over health but wonder over it, not denial over death but anticipation of it—and indeed, anticipation for resurrection.

***

Before we say a few things we hope are helpful for patients, pastors, and healers alike, we are moved to say up front that we are acutely aware, on a daily basis, of our suffering patients for whom anxiety and preparation for death are daily features of their experience in this riven world. We do not raise these questions glibly or lightly. Our hearts ache with the patients we have seen die or are dying even as we write these words, and we groan in prayer and in accompaniment with those patients for whom chronic illness, loss, or an uncertain diagnosis with ongoing ambiguity are a daily reality. We have not forgotten those patients who must bear the burden of “having all their bones on display” (Psalms 22:17), “flood their bed with tears” (Psalm 6:6), “sit numb and badly crushed” (Psalm 38:8), or “lie entangled by the ropes of death” (Psalm 116:3).

As brothers and clinicians, we remind ourselves often that, while medicine sometimes has clear and hopeful things to say and real balms to offer, all we can often do is practice presence and prayerful silence in the face of such stories and suffering. We fear pouring salt in any wound. In many ways this essay risks the possibility of just that—especially as we offer an admonition for those who do not number their days. In some ways then, we want to be clear that this essay is largely directed to the healthy and affluent in a North American context and not necessarily to the acutely or chronically sick.

A Sickness of Control and Denial

“We abhor the graves of our bodies, and the body, which in the best vigor thereof was but the grave of the soul, we over-love.”

~John Donne

Or perhaps the healthy are sometimes sick—sick with a kind of overwrought obsession with longevity and control over health. The same patients who dedicate much space in their interior life to health meta-data and body optimization are often those who do not dedicate the same level of concern to preparing to die well. They rationally understand they will die, but do not live as if that were true. Even as I (Eberly) write this sentence from my local library, I am greeted with a billboard highlighting an upcoming “How Not To Age” seminar to ring in the new year.

Such seminars—harmless and practical as they may be—betray a growing culture of “health anxiety” in the United States. Health anxiety is a significant driver of health care utilization and seems to be increasing in prevalence, especially among a younger population interested not merely with avoiding aging but even looking aged. Gone are the days when a grandmother’s wrinkles were found beautiful. Now teenagers are aiming to prevent even “micro-wrinkles” from forming in the first place. As the philosopher Byung-Chul Han argues in Saving Beauty, the aesthetic of the pornographic dominates—seeking to “smooth out” and de-wrinkle all things. Patients desire for their lab values to be “perfect,” forgetting or unlearning that the human creature is a homeostatic organism that lives and issues forth along lines of balance.

It is particularly disheartening to us as Christians in clinical medicine to observe that while many can enjoy untold levels of comfort and bodily health for longer than ever, we continue to expend significant energy and thought life on securing more of that comfort and bodily health. Rather than seeing health as one good among many goods, our culture has primed us to make it the good. Rather than living into our vocations as friends, spouses, and co-laborers—an individualized health security has become a kind of fashionable private vocation for the Christian elite.

As Joel Shuman and Keith Meador argued two decades ago in Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity, modern North American medicine has slowly bowdlerized Christianity into something not just tepid and unpracticed but ultimately unnecessary in the spaces of health care, domesticating the great God of the Scriptures into a rather antiseptic idol who exists mainly to alleviate our fears of sickness and death. The Christ who, when calling a man, bids him come and die, becomes the Great Physician who, when calling a man, bids him live long and prosper.

The second response occurs at the other end of the spectrum, when rather than obsessing over health care details and seeking to control every facet of one’s bodily well-working, patients instead “tune out” and refuse to consider questions of their health, let alone their death.  This can manifest in patients who stubbornly fail to consider their wishes for the end of life and family arrangements, or in those who steadfastly refuse to take seriously the future repercussions of their health habits today. We’ve experienced Christians justify this posture through soft Neo-Platonism—well-meaning descriptions of the body as a shell for the soul that will be blessedly left behind and therefore need not be fretted over in this life—a view that betrays doubt over the incarnation and resurrection, let alone the bodily acts of Christ in his healing ministry and the corporal (bodily) works of mercy. Patients can be wholly unprepared when they experience the inevitable decline in health that faces all of us, expending vast resources to try and secure a few more months or years, proving the principle that people tend to die how they lived.

Again, we do not write this lightly as we think of patients in the midst of difficult decisions or last days. As we have argued in the past, Christians have good reason to be hesitant to allow medicine to set the terms and conditions of our conversations around faithful suffering and death. It can be difficult to overstate just how powerful the momentum of medicine is, especially at the end of life. If one has not practiced for it—made the catechism of preparing to die well a feature of their prayer life, charity, and liturgical practices (especially when they are healthy)—then medicine will offer structures of power and control that are difficult to resist. Indeed, we’ve been shaped to submit to them for some time.

A History of Control and Denial

“Aristotle said that political science is the architectonic science, a ruling science, concerned with the comprehensive good or the best regime. But real science does not talk about good and bad, so that had to be abandoned. However, both medicine and economics really do talk about good and bad, so the abandonment of the old political goods had the effect only of leaving the moral field to health and wealth in the absence of the common good and justice.”

Allan Bloom, The Closing of the American Mind

Christian Scripture and tradition provide important resources that enable us to work toward the health of our bodies in fitting ways, face the reality of our finitude as embodied creatures with courage and steadfastness, and to ultimately lead a life of faith, work, and humility in the face of our creatureliness, neither ignoring our bodily well-working nor discharging undue resources to secure it. For to live well as a human creature and Christian may require letting go of bodily health. A life lived faithfully may mean an earlier death than we might otherwise have enjoyed, had we focused attention away from the call of Christ on our lives and more on our personal longevity.

Before exploring this, it is important to first turn to how we arrived at this cultural moment. Where do these temptations to either obsess over health or ignore death come from?  Such an attitude reflects a deeply entrenched cultural metaphysics that has had four centuries to develop. It is the background radiation of our medicalized culture and therefore can be hard to see, let alone name. As Allan Bloom wrote decades ago, in the absence of the common good and justice, the moral field is left to health and wealth. While we may continue to put our theoretical faith in politics, religion, and education, people tend to put their practical faith in their finance and in their fitness. In many ways the last remnants of enchantment exist in the shadows of Mammon and Mercury—the gods of money, merchants, and medicine—cash and Caduceus in hand. We may roll our eyes in exasperation at politicians, talking head pastors, and YouTube professors, but we listen with deep and abiding intent to our financial advisors and doctors—especially if our investments are under duress or our health is in question.

While we will not speak to money’s enchantments, we can speak to medicine’s. Here we illustrate the rise of health anxiety and death apathy with three historical features of modern medicine: The Baconian Project, The Anticipatory Corpse, and the Confusion of Expertise.

The Baconian Project: Controlling Health and Denying Death

Professor and historian Gerald McKenny coined the term “The Baconian Project” to describe how Francis Bacon ushered in a cultural revolution in the way that society viewed both medical science and the fate of the human body. Operating within a cultural milieu in which suffering, death, and finitude were undeniably present, Bacon was the first to champion the idea that medicine should view, at least in principle, no disease as incurable or outside the scope of its ever-expanding technological promise “to relieve the human condition.” This utopian ethic to cure disease and evade decay was amplified as the West became increasingly detached from a Christian worldview, replacing a vision of the body’s purpose as oriented and subjected to the will of God and the love of neighbor with a newfound purpose of the body as an end in itself, emphasizing survival, progeny, pleasure, and material fortitude above all. As the Baconian ethic continued to progress alongside early medical technologies, this focus on cure broadened to encompass avoidance not only of death, but of suffering itself. Rather than a core element of the human experience, suffering and death came to be viewed as both an aberration from the human condition and something which medicine might be able to relieve and eventually control.

The Anticipatory Corpse: Controlling Death and Denying Health

If McKenny details how we culturally come to view death and suffering as fates to be controlled, there is a concurrent story detailing how clinicians have come to view death in this way, implicitly and powerfully projecting this view on the patients they care for. Orthodox Christian and bioethicist Jeffrey Bishop details this in his 2012 masterpiece The Anticipatory Corpse: Medicine, Power, and the Care of the Dying. Though no longer in medical practice, Bishop writes as a philosopher who has worked as a physician, arguing that contemporary medicine has come to view the dead body as epistemologically normative. The animating metaphysics of medical training is that of material and efficient causation—learning to keep dead matter in motion—to the exclusion of any teleological considerations.

Put simply, medical students are taught to think about matter and efficiency rather than the formal and final realities of human life. As doctors, we have been taught to focus on human function, not human purpose. In so far as we have been taught human purpose, it was almost always taught in subordination and ultimate service to function. The self-assured doctor types “Baptist” in the “Religion & Spirituality” section of an electronic medical record demographic intake, and then happily moves on with the visit, kindly refusing to ever bring up the patient’s spiritual life again.

Much modern dismay and dissatisfaction with medicine from both patients and practitioners can be traced to a health care system that is designed to prioritize material and efficient causes. The metaphysic of modern health care betrays a reductive vision of the human person, only giving a kind of thin layer of attention to the needs raised by recognizing the patient in the fullness of their being as an ensouled creature (sleep, rest, friendship, beauty, hope, good work). By feeding patients through a medical apparatus which treats them as machines (material and efficient beings created for a function) rather than creatures (which are, by definition, created for a purpose), those in medicine learn to constantly grasp at control of the bodies under their care. Indeed, they become machines themselves, formed to attend to the material and efficient causes of the medical industrial complex.

As Bishop argues, drawing on Foucault and The Birth of the Clinic: An Archaeology of Medical Perception, the ever-expanding reach of the medical system is on fullest display in the ICU (intensive care unit) where patients are treated as mere “matter in motion,” and control is exercised through a comprehensive reliance on medical technology.  Indeed, Bishop argues that this focus on control even extends to the dying process itself in the form of palliative care and bereavement services which function as a powerful—if shrouded—form of controlling death. We realize Bishop’s claim is controversial—perhaps especially demoralizing in a season in which burnout is rampant among the medical community. But we have found his argument compelling both in theory and in practice—especially in conversation with Gerald McKenny and others who have outlined the shift in the way of medicine away from a moral practice and toward a technological product of control.

It is especially telling that Bishop ends his book wondering if only “theology can save medicine.” When the cultural assumptions of the Baconian Project interact with the pervasive, reductive, control-oriented metaphysics that Bishop describes, it is hardly a surprise that medicine’s default posture toward death leaves patients and healers rather bewildered—seeking to control health while denying death or, in this case, controlling death at the expense even of human well-working itself, working toward “some god-like posthuman being.”

A Confusion of Expertise: More Control, More Denial, More Anxiety

An important consequence of the metaphysical and epistemological history we outline here is how this story informs a contemporary tension between two extreme responses to medical information and decision-making: 1) an overexuberant acceptance of perceived medical expertise, imputing to medical process and epistemology the confidence to control what it cannot; and 2) a societal rejection of practitioner expertise in favor of special knowledge. It is easy to look to COVID as the source of this problem, which fed a tension between what philosopher Alasdair MacIntyre called the “cult of expertise,” describing the former extreme, and what professor Tom Nichols called the “death of expertise,” describing the latter extreme.

MacIntyre critiques a cult of expertise in which one follows the work of the expert somewhat blindly, handing over to science a jurisdiction inappropriate to its scope, often anchoring in one area of study rather than tempering that expertise with a constellation of wise experts for a more holistic and contextual vision of the good. As D. C. Shindler, Wendell Berry, and others have argued, the very understanding of a healthy body depends upon an understanding of the world as a whole.

Nichols, on the other hand, worries that in the modern desire to be egalitarian and deferential, wise experts become harder to find and to trust. Experts quiet their voices at the table of discourse while amateurs and autodidacts take advantage of platforms that allow for louder and more public opinions to propagate, thereby creating a strange information environment in which expert opinion is seen as equal to that of the non-expert—indeed, equal to that of the person who truly does not know what they are talking about. This is an old problem with new, sharper teeth. The true philosopher king is unlikely to run for mayor. The good doctors are probably not on Twitter.

There is almost no example of this tension between the “cult of expertise” and “death of expertise” we could give as physicians that would not risk anger and distraction from the point we are trying to make here. Vaccines, statins, supplements, screening—the list is long. Good clinicians will disagree over matters of practical wisdom, which in some ways is the point. Medical epistemology is not as clear as we want it to be.

Put simply, we see patients polarizing to two extremes: obsession with medical science on the one hand or outright rejection of the medication-industrial complex on the other. We have observed a strange irony in which the same patients who reject traditional medicine are often keen to throw themselves upon the altars of alternative medical communities, expensive and dubious functional medicine workshops, or PubMed spelunking for abstracts to support their custom-made health plans, invoking the same non-evidence-based epistemology they so avidly critique among their interlocutors. They are both ultimately forms of clinical gnosticism—the former a claim toward the special knowledge of science, the latter a claim toward the special knowledge of self. Both extremes are particularly troubling as fewer and fewer medical students go into primary care specialties to become the kind of confidant, accompanist, and guide that might serve as a wise wayfarer with a holistic vision of the patient’s health and finitude.

Joe Rogan, Peter Attia, Bryan Johnson, Jeff Bezos, Andrew Huberman (all—it should be said—white and wealthy men with abundant resources to pursue idiosyncratic longevity practices) are folks we have been asked about directly by patients, with enough frequency that we wonder what other voices in the Christian life have compelling confessions to offer patients in their local church contexts about what it means to live and die well as an ensouled creature. We hope for a community that can lean on both Sirach 38 (“Give doctors the honor they deserve, for the Lord gave them their work to do. ... Their skill came from the Most High. ... The Lord created medicines from the earth, and a sensible person will not hesitate to use them.”) and 2 Chronicles 16:12 (“In the thirty-ninth year of his reign Asa was afflicted with a disease in his feet. Though his disease was severe, even in his illness he did not seek help from the Lord, but only from the physicians.”)

We hope such church communities might imagine and be able to convey a reality in which the body is both a temple and a constellation of dust that will, in fact, return to dust. Is that not a more adventurous and compelling vision of the human person? Not a machine to be fine-tuned but a creation to be stewarded unto death, until that day when the Creator breathes new life into his beloved again in the absurd and beautiful resurrection life that Christians claim. It is to that future hope we turn in conclusion:

Christian Counterformation to Control and Denial: Wonder, Renunciation, & Anticipation

As Christians, what alternative responses do we have to our creaturely health besides control and denial?

Wondering at Life and Health

“I think it is right, as long as I am in this bodily tent, to wake you up with a reminder, since I know that I will soon lay aside my tent, as our Lord Jesus Christ has indeed made clear to me. …For we did not follow cleverly contrived myths when we made known to you the power and coming of our Lord Jesus Christ; instead, we were eyewitnesses of his majesty.”

2 Peter 1:13-14, 16

Christians might consider that their health is not something to be controlled but something to wonder at. One of our colleagues and friends, bioethicist Devan Stahl, once said that “those who are prone to wonder are slow to fix, and those who are quick to fix are slow to wonder.” She was describing an inverse link between our capacity as Christians to be still in awe and the predisposition we have to fix and control what we behold.

Philosopher Ashley Moyse argues another version of this in his book Resourcing Hope for Ageing and Dying in a Broken World: Wayfaring through Despair, where he draws upon Gabriel Marcel to describe how contemporary society tends to render as “problems” those wonders that would be better understood as “mysteries.” Marcel argues that to render something a “problem”—as contemporary medicine does by its very nature through clinical “problem lists”—is to intentionally make it an object of control. A mystery, on the other hand, is something we ought to behold and wonder at. That’s not to say medicine does wrong when it seeks to name and alleviate problems, only that its default position is to see only problems that need fixing.

What would it look like to temper our obsession of control of health by resting in the glory of life’s reality as gift—unasked for, unearned—such gift which can only be received and held lightly rather than wielded, shielded, or coerced? That truth might allow the health-anxious patient to admit both that strength is the glory of the young and a gray head is a splendor (Proverbs 20:29).

And it is not just life and health that is a gift and mystery. A physician colleague reminded me (Eberly) recently that death is also a wonder and even a kind of gift. God could have made the curse of death from the Garden of Eden like the one Zeus curses upon Tithonus, who is gifted with immortality but not eternal youth, and therefore never dies but also never stops aging. In that sense, even in the curse of death there exists the difficult gift of release from limitless decay and suffering. Christians are not cursed with that fate, and beginning the year with that in mind might help us wonder at the bodies that we have, marked as they are by both fitness and finitude.

Renunciating Anxiety and Denial

“When anxiety was great within me, your consolation brought me joy.”

Psalm 94:19

Our colleague, friend, and fellow physician Farr Curlin recently argued in “‘Sufficient for the day is its own trouble’: Medicalizing Risk and the Way of Jesus,” that modern preventative medicine has not only essentially become a form of risk management, but that it should be more controversial for Christians than it is: “Preventative medicine...is motivated by, depends on, and encourages anxiety about the future body. It calls us to give attention today to strategies that have no rationale apart from worry about what tomorrow will bring.”

By medicalizing risk, medicine claims a temporal jurisdiction that produces much anxiety about tomorrow—a health anxiety in contradiction with the truth of God’s care for us and medicine’s limits to secure a future in the first place. Health anxiety becomes a kind of vocation itself, distracting and hindering one’s true vocations. Curlin’s remedy is fourfold:

1. Focus on the present. Sufficient for the day is its own trouble. In medical training there is a saying: “don’t look for a fever that isn’t there.” Sufficient for the day’s work is focusing on the symptoms at hand, not looking for symptoms that have yet to manifest.
2. Cooperate with God’s care for the body. Far from arguing against a relationship with good medicine, make fitting choices in relationship with a trusted primary care doctor to honor the body without unduly obsessing over it. Far from arguing against attention to health or screening, for example, temper attention to the body in community and in right relationship with neighbor and with God. Resist that which does not restore you to self, neighbor, God, and good work. As Wendell Berry writes in “The Body and the Earth,” “A medical doctor uninterested in nutrition, in agriculture, in the wholesomeness of mind and spirit is as absurd as a farmer who is uninterested in health. Our fragmentation of this subject cannot be our cure, because it is our disease. The body cannot be whole alone. Persons cannot be whole alone.”
3. Respect the limits of medicine. Recognize that medicine cannot control death or guarantee health. Ask clinicians what reasonably can be expected from a medical intervention being considered. The “number needed to treat” and “absolute risk reduction” are two helpful biostatical concepts to know about, but we would also say that knowing these terms is less important than knowing and trusting that the physician caring for you respects the limits of medicine herself.
4. Emphasize vocation as a clinical standard. The standard of care for good medicine might include the extent to which we are equipped to put medicine out of our minds and simply live as creatures living into our respective vocations. A clinical standard then might not focus on perfect labs, for example, but on a race well run. As Curlin writes, ““Jesus asked, ‘Is not life more than food, and the body more than clothing?’ One can imagine him asking also, ‘Is not living well more than trying to avoid dying in the future?’”

Curlin points out that sick people are emphasized in the Christian tradition not necessarily because they are promised future healing or relief from their disease but because they emphasize Christianity’s commitment to the sick, pushing the affluent and healthy to practice the radical acts of hospitality, visitation, and forbearance with their neighbors who are in pain—rather than securing more of their own painless state. As we mentioned earlier, this may mean letting go of bodily optimization in obedience to the faith.

It is intriguing that “sufficient for the day” is found directly after “You cannot serve God and mammon.” In Luke 12 the same lesson is bookended by two clams about “where your treasure is, there your heart will be also” (Luke 12:13–34). We see in this the relationship between Mammon and health anxiety—the “health and wealth” Allan Bloom named decades ago. There is much money to be made by weaponizing and profiting upon the health scruples of the most anxious generation in history.

One can imagine a new year’s resolution or Lenten practice that is motivated not by more yoga or experimenting with athletic greens but by a commitment to the sick—following the imperative found in Matthew 25: “I was sick and you visited me.” We wonder if Christians showing up at the bedside of the sick will not only help them wake up from themselves and heal from health anxiety, but teach them the practices necessary to die well by having first accompanied the dying themselves. We don’t claim this simply because we are in health care and therefore enjoy projecting our vocations onto the whole church. We would go so far as to say this is one of the foremost ways the church can recover her witness in a season of de-churching and deep loneliness.

Anticipating Death and Resurrection

 “They kept this word to themselves, questioning what ‘rising from the dead’ meant.”

Mark 9:10

Likewise, we would offer that death should not be denied nor controlled but rather faithfully anticipated. Considering good health and acknowledging finitude go hand in hand. In my practice (Eberly), I open a conversation about health and finitude once a year with all my patients. I ask them to explore the Blue Zones and read the American Heart Association’s “Life’s Essential 8,” because I find these concepts accessible, evidence-based, and succinct enough to cut through the chatter of how much ashwagandha one should take or how many cold showers or fitness rings will add one day to a patient’s life.

It only takes one elderly farmer who has never heard or had interest (or time) for Crossfit to teach us that human longevity is not only a mystery but a gift, often bound to common-sense practices for a flourishing creaturely life that have been more or less known for centuries: a diet abundant in fruits and vegetables, walking, avoiding a sedentary lifestyle, little or no alcohol, low cholesterol, low sugar, low salt, good sleep, thick community, refusing workism, and a spiritual life. And even with those great habits, the simple fact of the matter is that health is received more than achieved—sheer gift dependent on genetics, location, access, and providence.

These basics have been known for a long time, and outside of chronic disease, trauma, new diagnoses, or other sufferings that make daily demands of patients, this is more than enough for most healthy people.

In addition to discussing these habits, I (Eberly) then ask my patients to also read physician and ethicist Lydia Dugdale’s The Lost Art of Dying: Reviving Forgotten Wisdom and to choose a “death day”—a day once a year where they sit down with family and close friends to talk about dying well. Lydia is a friend and colleague to both of us, but we believe her book is the best public-facing work on this topic, particularly in so far as her focus on community and dependency holds a critical counterbalance to popular works on death and dying like Atul Gawande’s On Being Mortal.

By “death day,” I don’t mean just a focus on power of attorney, living will, or estate planning. These preparations are important in their own way, and I don’t mean to belittle them. But I’ve observed that, when I bring up death and the importance of meditating on finitude, patients are quick and keen to assure me that they have their affairs in order. It takes some time for patients to realize that I don’t mean just their financial, medical, and legal affairs, but rather the affairs of the community, spirit, and soul.

Yes, it is important to have a funeral planning packet set aside and so forth, but it is far more important to revisit the reality of death and dying yearly, with close friends and loved ones. Indeed, there is even an app called “WeCroak” that sends multiple reminders each day that we will die, motivated by the Bhutanese folk saying “to be a happy person, one must contemplate death five times daily.”

While modern medicine already emphasizes advanced care planning, the results are often overpromising and underdelivering. It takes intentional preparation and habits forged in community to focus on the spiritual, moral, emotional, and ecclesial work of dying well that is so often outsourced to the legal, financial, technical, and medical powers and principalities. As Lydia argues so beautifully, dying well is practiced. Our friends and colleagues with the Living Well and Dying Faithfully program provide one such resource. For Christians, the season of Lent is a natural time to explore and enact something like this, and our hope is that more and more churches might resurrect the Christian ars moriendi (art of dying well) tradition that was popular in the past and is being revived by physicians and sisters like Dr. Dugdale.

Conclusions: A Closing Prescription for The New Year & Lent

One of our physician colleagues and fellow brothers in Christ shared with us that each evening as he lets go of thought in bed and welcomes sleep, he tries to make his final conscience act to pray Psalm 31:5 and Luke 23:46 “Father, into your hands I commit my spirit.” He does this because he sees each evening as a little death—a chance to practice dying well.

As King’s Kaleidoscope’s reimagines in their song “All Glory Be to Christ,” sung to the tune of the New Year’s Eve hymn Auld Lang Syne, “Oh you who boast tomorrow’s gain, tell me, what is your life? A mist that vanishes at dawn. All glory be to Christ.” Here in a new year and in the middle  of Lent, we join the Psalmist by crying out against a posture of control and denial and toward a spirit of wonder and anticipation, on behalf of ourselves and our patients, teaching us to number our days with wisdom and grace:

¹ Lord, you have been our dwelling place
    throughout all generations.
² Before the mountains were born
    or you brought forth the whole world,
    from everlasting to everlasting you are God.

³ You turn people back to dust,
    saying, “Return to dust, you mortals.”
⁴ A thousand years in your sight
    are like a day that has just gone by,
    or like a watch in the night.
⁵ Yet you sweep people away in the sleep of death—
    they are like the new grass of the morning:
⁶ In the morning it springs up new,
    but by evening it is dry and withered.

⁷ We are consumed by your anger
    and terrified by your indignation.
⁸ You have set our iniquities before you,
    our secret sins in the light of your presence.
⁹ All our days pass away under your wrath;
    we finish our years with a moan.
¹⁰ Our days may come to seventy years,
    or eighty, if our strength endures;
yet the best of them are but trouble and sorrow,
    for they quickly pass, and we fly away.
¹¹ If only we knew the power of your anger!
    Your wrath is as great as the fear that is your due.
¹² Teach us to number our days,
    that we may gain a heart of wisdom.

¹³ Relent, Lord! How long will it be?
    Have compassion on your servants.
¹⁴ Satisfy us in the morning with your unfailing love,
    that we may sing for joy and be glad all our days.
¹⁵ Make us glad for as many days as you have afflicted us,
    for as many years as we have seen trouble.
¹⁶ May your deeds be shown to your servants,
    your splendor to their children.

¹⁷ May the favor of the Lord our God rest on us;
    establish the work of our hands for us—
    yes, establish the work of our hands.