Abstract
For many of our patients, the experience of serious illness often brings a sense of deep reckoning and reappraisal of one's life. This opportunity for new reflection can take many forms as people explore various ways of making meaning—through art, relationship, and often through writing. Claire Willis' Lasting Words: A Guide to Finding Meaning Toward the Close of Life accompanies people with life-limiting illness through a series of mindfulness practices with an emphasis on journaling and written reflection. Willis' experiences as a bereavement counselor and writing group leader for seriously ill people appear throughout the book, lending a personal foundation to the concepts. Beautifully illustrated with photography by Marnie Crawford Samuelson and punctuated with poems from greats such as Robert Frost, Denise Levertov, and William Stafford, the book is itself a meditation on life, change, and what really matters in the end.
The book begins with simple instructions for mindfulness meditation focused on the ebb and flow of the patient's breathing. Willis considers brief meditations to be an ideal foundation for the reflective mental state needed to journal about one's most personal values and beliefs. A particular strength of this section is the attention that Willis gives to adjusting a meditation practice for the possible physical limitations that a seriously ill and/or bedbound person may be experiencing. For example, she suggests that persons with spinal problems or back pain may imagine a strong spine holding their body aloft even if they are unable to position in this way.
Throughout the book, Willis demonstrates a compassionate approach that takes seriously the impact of illness and debility on the reflective writer. The majority of the book comprises seven “spiritual issues of common concern—our journey, gratitude, hope, forgiveness, wisdom, prayer, and endings (3).” She does not shy from openly discussing the life-limiting nature of the health problem that has motivated the writer to write, but rather motivates her reader to lovingly document his or her stories, beliefs, and values, ostensibly for future generations to behold. To this end, she suggests the practice of writing an “ethical will” to share one's views with their children and other loved ones. Willis gently guides the writer to focus on offering supportive statements of guidance that are short, simple, and positive. For example, she suggests that a writer advise her child, “Be generous with others,” instead of “Don't hoard your money (83).” As patients and families engage in meaning-making activities toward the end of life, palliative care clinicians often find that some need more guidance than others.
Willis' engagement with faith and spirituality is most evident in the ninth chapter, “On Prayer.” She offers a highly accessible, nondenominational, and inclusive approach to the act of calling out to a force greater than oneself that may surprise some patients who were taught a more rigid approach to the spiritual life in their youth. Willis suggests that “saying yes to your need for help becomes the start of a prayer” and urges her reader to find the divine presence in the swaying of tree branches, calming presence of a caregiver, or quiet sunset through a window (95). Her open-minded approach to the care of the soul involves pithy quotes from Thich Nhat Hanh, St. Teresa of Avila, and Rumi. For the patient of a more well-defined religious orientation, this perspective may not feel as comfortable as a text that overtly used specific theological language. Despite this universal outlook, the chapter on prayer opens up new possibilities of gratitude and connection for everyone, highly observant and less adherent alike.
The final chapter of the book addresses ways to move gracefully and thoughtfully through the end-of-life period. Willis does an excellent job of integrating the poetic with the practical throughout this book, and the pages on “endings” direct readers to consider formalizing their thoughts on advance care planning. She suggests that readers can access materials on the Internet such as “Five Wishes” to assist them in communicating these values, and remarks that such planning is “a gift both to yourself and to the people around you” (105).Willis' belief in the power of the written word shines through as she reprints a letter written by a bereaved man's recently deceased wife as an example of the tremendous gift of such a piece of writing. This slim, yet subtly powerful, guide could be a source of comfort for many of our patients who navigate difficult waters in our care, but yearn to share their stories, songs, and reminiscences with those who are left behind.