And the Last Shall Be Best

Author: Lisa Fortini-Campbell

When I was in graduate school in Seattle, I would take visitors to see the fascinating salmon ladder near the Ballard Locks. The locks were part of an active commercial port, and any fish trying to migrate through them back to the rivers where they were born would have been blocked by high gates and shipping traffic. So the U.S. Army Corps of Engineers built a water ladder for them to climb alongside the locks, complete with huge glass windows below the water line so visitors could watch the salmon on their journey.


I remember watching the fish crowded together in the murky water, some of them gliding back and forth; others treading in place, gathering strength to make their next move; and still others throwing themselves out of the water, trying to leap to the next level.


It was hard to imagine anyone ever wanting to eat one of those fish. They were old and decrepit, their bodies showing a lifetime of wear and tear. The flanks of some were gashed from head to tail, and others were missing a fin, part of their tail or an eye. One had a big hole in its side as if something had taken a bite out of it.


I remember thinking how much human beings were like those fish — how few of us get to the end of our lives intact. As we age, we wrinkle and our hair turns gray, our eyes and ears go bad, our teeth fall out and our legs wobble. We struggle with heart disease or arthritis or cancer, and many of us live long years in dementia. No doubt about it: By the time we get old, the physical glory of our lives is long behind us and it’s all downhill until the end.


For the salmon, though, the best is yet to come. Beneath all that superficial deterioration, an interior revitalization is well underway. Responding to an instinctive call to return home, their old bodies get ready to generate new life. As they move from the salty ocean back to the freshwater river, their skin changes color. Their breathing apparatus morphs and so do their physiques. The long muscles running the length of their bodies, which propelled them for years through the deep ocean, start to atrophy. In their place, the short muscles running across their bodies get stronger to power those great leaps out of the water that will fling them upstream toward home.


Fortini CapmbellIllustrations by Lisk Feng

Finally, nearing home, the salmon stop eating, diverting the energy they would ordinarily have used for digestion into the production of the eggs or sperm they will release in the last great act of their lives — the act of reproduction. And when that is accomplished, they will die just where they were born, and a new generation will begin to grow beside their spent bodies.


For the salmon, with new life springing from an old body, I think you’ll agree that God has saved the best for last. But it seems He has not been similarly kind to us. We hit our reproductive maturity early and live a long time afterward. If the trajectory of a salmon’s life is ever upward, the arc of our physical lives is shaped more like a bell, starting low, rising to a height and then finishing low again. Weakness to strength to weakness again. Dependence to independence back to dependence.


Human memory is a mixed blessing, because as we age our well-remembered youth haunts us, and we rebel against the deterioration of our bodies, the diminution of our minds and depletion of our independence as we fight to hang on to what once was.


Even if we don’t literally rage against aging, how many of us eagerly embrace our last years as potentially full of new life? If you want to know the answer, try asking people who are old and sick which were the best years of their lives and see how many of them say, “Right now.” When I told my 85-year-old mother that I have an 87-year-old friend who truly sees these as the best years of his life, she snorted and said, “Then he’s crazy.”


He is not crazy. Somehow, he is swimming against the conventional experience of old age and moving upward like the salmon. How is he able to do this? Does he see something the rest of us don’t? Is it possible that he realizes the true, God-given trajectory of our lives is also ever upward, and thus he isn’t distracted by the obvious deterioration of his body? And if more of us could see this truth, would we experience the inevitability of age, sickness and death differently? Might we, in fact, live our entire lives differently?


We very well might. Ten years of hospice service has blessed me with a score of teachers and guides, men and women who, although sick and old, have shown me that the best is yet to come — and not just in heaven but while we’re still here. They’ve helped me realize we all swim in a river of God’s grace that carries us ever upward, even in the midst of the dying of the light, until we reach our final home, if only we will let it happen.


A few months after my patient, Guillermo, died, I visited his widow, Maria. On that quiet afternoon she confided to me, “The last five days of my husband’s life were the best five days of our 50-year marriage.”


Does that surprise you? Do you think, “What a lousy marriage they must have had”? We just can’t imagine that the best could come in the very last days before death, but Maria explained, “In those few days, we were together, just the two of us, with nothing to do, nothing to plan for, nothing to worry about, even to say. There was only love and peace.”


Love and peace. Perhaps they came at the moment when Maria and Guillermo realized they had been swimming in a river of grace all along, and so they just rested in the current. God gave them five days of living in heaven, right here on Earth. To my way of thinking, God did save the best for last after all.


My patient, Mary, knew the current was there and prayed hard to be engulfed in it. In the month before she died of colon cancer, she told me she had been reviewing her life — the good and the bad — but mostly she was praying. “I just ask God to help me love Him more,” she said.


Sister Mary Ann has always known exactly how to find the current, but one day she needed a little help to get her bearings again. She is a former missionary to the schools of Honduras, but Parkinson’s, rheumatoid arthritis and congestive heart failure have ended all that, and at age 84 she is confined to her bed, the aides at the convent nursing home turning her body every few hours to prevent bedsores. Still, she is undaunted. “Lisa,” she said to me one day as I sat down next to her, “would you like me to tell you the secret to a happy life?” (Who wouldn’t?) “It’s easy. Simply put yourself in the hands of Jesus and trust in the Lord.”


But when I visited her a week later, she wasn’t happy at all. She said she felt discouraged because, having adjusted herself to being unable to wash, dress or toilet on her own, she now can’t even feed herself anymore. All she can do is press a button and hope someone comes.


So I said, "Sister, now you let me tell you what you taught me. Just let yourself rest in the hands of Jesus; he’s got you. Trust in Our Lord.”


“Did I really say that?” she asked.


“Yes, you did!”


“Well, if I did, maybe it was because Our Lord wanted you to say it back to me when I needed to hear it most. Isn’t it wonderful that He always knows just what we need?”


“Yes it is,” I said, “and God also made us to love and help each other. So it’s time to let the rest of us do what you can’t do for yourself anymore,” and I held the straw while she sipped from her water bottle. “Yes,” she replied after a few swallows. “I like it when you help me, Lisa.”


“And I like it when you let me.” She smiled, her blue, watery eyes twinkling at me.


Yes, I helped her, but she helped me, too, by showing me that when we serve each other in love and kindness, we’re both farther up the river of grace and closer to the Kingdom of God.


But before that can happen, the person who is old or sick has to drop the idea that we have dignity only when we can do everything for ourselves. That facet of pride was the source of the only big argument I’ve ever had with Father Joe, the 79-year-old priest who became my friend during my conversion eight years ago. Soon after I met him in Chicago, he accepted a position to teach at a seminary in New York. We kept in touch, and in early 2012 I started to worry when he told me that for some inexplicable reason he was losing about two pounds a week.


I urged him to get to a doctor. After undergoing many tests, he called me with the results. “It seems there is a problem with the organ that processes my blood,” he said. Now Father Joe can quote chapter and verse of St. Thomas Aquinas, but human anatomy befuddles him.


“Which one?” I said in a panic. “Your liver?”




“Your kidneys?”




“Your gallbladder? Your spleen?” I was running out of organs.


“No, not those either.”


“Is it your pancreas?”


“Yes, that’s it! That’s what the doctor said, something is wrong with my pancreas.”


My heart went straight to my throat and I said, “Father, you cannot go to your doctor’s appointments alone anymore. I’m flying to New York this afternoon.”


“No!” he protested. “I don’t need anyone. I can do this on my own!”


Now, I can count on one hand the number of times I have felt myself speaking words I am certain were put in my mouth by the Holy Spirit. This was one of those times, and that’s why I shouted at him over the phone, “Father, will you please let me grow in grace and charity by serving you?”


Naturally, he capitulated. After all, how can a Catholic priest argue with that? I got on a plane that afternoon.


During Father Joe’s three-month-long, harrowing ordeal with pancreatic cancer, I did grow in grace and charity and, remarkably, so did he. While the 1,000 stitches inside his body tried to hold his digestive system together, his heart raced out of control. The blood thinners the doctors gave him to reduce the risk of a stroke caused an abdominal bleed, which promptly became so infected that the doctors gave him a less than 50 percent chance of surviving. The antibiotics meant to help his body fight the infection destroyed his appetite, and his weight dropped to 135 pounds. Despite his fragile state, lots of people stopped by his room — nurses, hospital staff, other patients and their families. Some brought their rosaries for him to bless, others came for confession or simply to visit. That’s how we got to meet Melanie, and how I got to watch grace magnify grace.


NewYork-Presbyterian Hospital keeps all of its extreme surgery patients together on one floor — those undergoing heart transplants, lung transplants or, like Father Joe, Whipple procedures. People are there for a long time, and their families get to know one another a bit. Across the hall from Father Joe was a young patient named Melanie. Just 17 years old, she had a life-threatening lymphatic condition. Her mother and I would chat occasionally in the family lounge, and after hearing Father Joe’s story, her mother came one day to meet him. They had a nice talk, and she said she wanted to bring Melanie by when her daughter was well enough to get out of bed.


The next day Melanie came into the room, tall, dark-haired, slender and graceful. Her dark brown eyes set in her pale white face looked otherworldly. When Father Joe talks about her now, he remembers she looked like an angel.


She walked over to his bed, and Father Joe took her hand. “You are my model!” he exclaimed. She smiled and clasped his hand in both of hers. Eventually her mother asked, “Can you tell us, Father, about hope?”


They did not know that Father Joe’s doctoral dissertation was on hope, that he is a master of the theology of hope and that every homily, conference or retreat he ever gives ends with a message about hope. But he just said to them, “St. Thomas Aquinas tells us that hope is a future good, difficult but possible.”


We were all quiet for a bit. Then this dreadfully sick young girl, still smiling and still holding the hand of this dreadfully sick old man, said, “Then I hope you get well.”


In the end, Father Joe did get well. Melanie did not. Regardless, these two healed each other with the balm of hope as they swam together in a river of grace in a hospital room at NewYork-Presbyterian.

“Yes, Dahlink, we heal each other.” Those were exactly the words my patient, Annie, long lost in dementia, used while we were watching a movie together one day. How I wish I could tell you her whole life’s story — teaching the Jewish children in her German hometown after Hitler forbade them to go to school; escaping through France after life in Germany became too dangerous; questioned by the French border police for three days, after which one of the guards asked to marry her; taking a boat to New York to stay with her distant cousin, Albert Einstein, until he threw her out because she used the $100 he gave her for tuition on a car; getting an offer of marriage in the mail at the age of 70 from a man from home who’d carried a torch for her all those years. I heard all of this from her daughter.


When I met her, she was 88, and all those memories were gone, as was the memory of the previous few minutes. Somehow Annie seemed to recognize me anyway, because every time I walked into her room at the Memory Care unit, she would exclaim in delight, “Dahlink! Dahlink! I am so happy to see you!” in her adorable German accent.


One afternoon, we sat with the rest of the residents, holding hands, watching the movie Seabiscuit. The ending is exciting as the injured and recovered Seabiscuit and his injured and recovered jockey, Red Pollard, win the race at Santa Anita. Seabiscuit’s owner is overcome with emotion as he tells Red how grateful he is for everything Red did to help to heal his precious horse and bring him on to victory. Red says simply, “You know, everybody thinks we found this broken-down horse and fixed him, but we didn't. He fixed us. Every one of us. And I guess in a way we kinda fixed each other, too.”


It’s a teary scene, and when we two wet-eyed women looked at each other, I said, “I love you, Annie.” And this woman who knew neither my name nor hers, nor time, nor place replied, “Yes, Dahlink, he’s right. We heal each other.”


Yes, loving one another, serving one another, trusting in Him and committing that His will, not ours, be done, the action of grace will move our souls ever onward and upward, no matter what’s happening to our bodies or minds. Grace lifted Mary and Sister Mary Ann, Melanie, Father Joe and Annie, as it will you and me, just as surely as biology is taking the salmon up the river home, but only if we don’t prevent it. The salmon cannot thwart the call, but unfortunately, we can.


Bishop Fulton Sheen said, “Grace will move you only when you want it to move you, and only when you let it move you.” Therein lies the key to an upward spiritual journey: Grace is always ready to act on us, but only if we will welcome it. So why won’t we relax and go with the flow, trusting in the grace-filled water around us, confident in the love of God, willingly serving and humbly willing to be served?


I think that’s why it’s been so easy for me to see grace at work in my hospice patients — they have all let go. In humility, they’ve agreed to forgo any treatment for their conditions, knowing that, very likely, they will die within the next six months. More than that, they’ve let go of the idea that to be happy you must be young and healthy, to be valuable you must be working and productive, and to have dignity you must be independent and do everything on your own.


With pride dissolved, the dying rest in a childlike trust in God. They let God’s will be done in them and so grace blooms, visible for anyone to see. But the rest of us don’t easily see. I think it’s because our natural love of life can blind us to this kind of grace. We want to live. It is a powerful urge and hard to resist. In the end, even Christ struggled. In his agony, he pleaded the way we all might plead in the face of impending suffering and death: “Father, if you are willing, take this cup from me.” But, then, in abject humility, he sacrificed this last remnant of human pride: “Yet not my will, but yours be done." 


When I volunteered to serve in hospice, our instructors told our class that while we have come forward to serve and comfort the dying, it is actually they who will teach and serve us. It was hard for me to believe at first, but it is absolutely true.


Six years ago, to help me learn how to minister to patients, Father Frank, the chaplain in our residential hospice unit, took me under his wing. One day we visited a woman dying of cancer. Marilyn was just 66 years old, and her bald head was covered with a scarf. She lay in the bed with her eyes closed. The chart said she was Lutheran, so Father Frank asked if he might offer prayers.


She nodded, and Father Frank stood beside her bed and prayed. Then he introduced me and asked if I also might offer a prayer. Eyes still closed, she nodded.


I told her that I had been the reader at Mass that day and asked if I could read her the Gospel passage — from John 15 — that I had read that day. She agreed. "Remain in me, as I remain in you. As the Father loves me, so I also love you. Remain in my love. If you keep my commandments, you will remain in my love, just as I have kept my Father's commandments and remain in his love. I have told you this so that my joy may be in you and your joy may be complete. This is my commandment: love one another as I love you."


She was silent and then, with her eyes still closed and in a voice full of emotion, said, “I can see it! I can see it! And it’s so different than it is here. So very, very different. And I’m looking forward to it.”


Then still without opening her eyes, she cried out, “You are beautiful! You are so beautiful!” And again, more quietly this time. “You are so beautiful!” After a brief pause, she said, “Now, what can I do for you?”


I was stunned. After all, I was there to serve her, not tell her how to serve me. I didn’t know what to do or what to say. I started crying, but Father Frank said gently, “Marilyn, please pray for us.”


When we left the room, Father Frank said, “The next time this happens to you, and it will happen to you, just ask her to pray for us all. People like Marilyn are very close to God.”


Like Marilyn, Kathy let me swim close to God with her, too. She died two years ago, just short of 72 years of age, of heart failure after living more than 10 years in ever-worsening dementia. By the time I met her, language had essentially abandoned her, but she had two phrases left — “thank you” and “I love you” — as well as a dazzling smile.


As her volunteer, sometimes I sat at home with her so her husband could have a break, but mostly I helped him to take her to Mass every Sunday. The three of us would sit in the front pew, Kathy between us, and it was obvious she loved being there. She knew when to stand up and sit down, and sometimes she would mouth a few words of the creed or of a hymn and she would beam at everyone around her.


We were all together at Mass for the last time two weeks before she died. She was weaker, but her smile was as glorious as ever. The Mass started, and we rose for the entrance hymn and opening prayer. Then it was time for the Gloria, and Kathy turned away from the sanctuary to face me and sang every word directly to me — perfect words, perfect sound — tears running down her face. In that moment, I saw her silvery soul throw itself high out of the water and leap toward Home, as it splashed me with her grace.


Lisa Fortini-Campbell is an adjunct professor at the Kellogg School of Management at Northwestern University. She is a midlife Catholic convert and lives in Evanston, Illinois. The names of all hospice patients have been changed.