Sunsets: Reflections on Life's Final Journey by Deborah Howard

It's the beginning of the new year. Places to go. People to meet. Books to read. And what better way to start the year than to read a book titled Sunrises: Reflections on the New Year Ahead. Oh wait... It's titled Sunsets: Reflection on Life's Final Journey. Wait a minute, this is about death? Who thought it was a good idea to start the year by reading a book about death? Well, someone at Faithlife.

Hi, my name is Terence and I'm your host for Reading and Readers, a podcast where I review Christian books for you. Today I review "Sunsets: Reflections on Life's Final Journey" by Deborah Howard. 336 pages, published on August 2017 by Export Press. The book is available in Amazon Kindle for USD8.95 but it is available for free from Faithlife in January.

The author is a Certified Hospice and Palliative Nurse. What is hospice and palliative? If you have cancer and the doctor says there is no more treatment, there is no cure, then hospice becomes an option. As Howard explains in her book, hospices do not speed up or slow down death. They do all they can to provide better quality of life for the patient and for the family.

The foreword was written by the esteemed theologian D.A. Carson, let me read it:

Deborah Howard has managed to link narrative and exposition. Most of the narrative books in this area tell a story, or tell a lot of stories, and nothing more. Many other books provide doctrinal structures, but they are rather abstract. This book combines narrative and doctrinal exposition. Of course, that makes the book a little long; for many readers, however, the combination also makes the book more memorable. And apart from all the little stories, the ongoing narrative of Bachman is not one you are likely to forget.

The ongoing narrative of Bachman is an important part of the book and I'll come back to that. I want to repeat what Carson sees as a unique feature: the book combines narrative and doctrinal exposition. I think the author took a big risk putting it together like this. I can see readers who come for the stories and insights of a hospice nurse find the biblical exposition distracting to the flow of the book. I know I did, and let me show you why.

Overall Flow of the Book
The first three chapters are titled "Denial", "Why Me?" and "Options". Options here referring to hospice care. These three chapters gives you what you can expect from a hospice nurse cum author.

Then we have chapters 4, 5 and 6, chapters which sit more comfortably in a systematic theology textbook. The titles are: "The Sovereignty of God", "The Sovereignty of God in Salvation" and "The Purposes of Suffering".

After that, we return to our regular programming. Chapter 7 is "Preparing for Approaching Death". Chapter 8, 9 and 10 deal with questions on angels and things that go bump in the night, death itself, and Heaven and Hell. All very pertinent to the dying and those who care for the dying.

Lastly, Chapter 11 is titled "Comfort". Comfort to the dying, to the caring and to the mourning. She shows how all comfort ultimately comes from God.

Now that I have given a brief overview of the whole book, I want to show what a typical chapter looks like. Every chapter begins with a snippet of the Bachman story. Howard uses that story as a springboard, a hook, to get into the chapter's topic, whether it's denial, or Heaven and Hell. Every chapter will also include a case study from her experience caring and journeying with the dying.

A Big Guy Story
Remember the Bachman story. Here is how we get introduced to the main character:

Big Bachman McNair III sat in the doctor’s office with his slender wife seated apprehensively on the edge of her chair beside him. He’d always been a big guy—a talented football star in high school and college. But football wasn’t his only claim to fame. He was a big man in the business world as well and had provided a safe and comfortable life for his family.

Then the doctor tells him the news.

“You’re crazy,” he raved. “Cancer. Why, I don’t believe that for a second. I’m healthy as a horse. If it weren’t for this back pain, I’d be as fit as I was in high school. I’ve lost down to my college weight already. I just overdid the exercise and pulled my back. That’s all.”

We follow Bachman through his life's final journey. His wife Penny is a loving partner throughout the trial. And we later get introduced to Paula Shaw, the hospice nurse with "the bright smile and the twinkle in her eyes".

Howard writes:

Bachman McNair is a fictional character but one I created as a composite of several patients I’ve known. The experiences he faces in this book reflect actual situations in the lives of those who have shared their stories, their lives, and their deaths with me.

If there was no Bachman in this book, it can be difficult to see how the chapters come together as a sequence. We were there when Bachman receives the bad news from the doctor and are there when he, spoiler alert?, he dies and his loved ones processed his death. Each chapter is a step in Bachman's move towards death. We experience Bachman's doubts, pain, embarrassment, friendship, joy and hope, which Howard then picks up and elaborates in detail as one who has walked alongside many many deaths.

A Christian's Practical Guide to Dying
So that we get what I call a Christian's Practical Guide to Dying. And she is the only one who can do it in this way.

Any pastor-theologian can tell you about the spiritual side of things: doctrines of Heaven and Hell, Angels and Demons, "the wages of sin is death but the gift of God is eternal life in Christ Jesus our Lord".

Any doctor can tell you what happens in the body as it gives up life: the heart, the lungs, the brain, hearing will be the last sense to go.

Anyone who has experienced the death of a loved one can tell you the emotional depth of the days of waiting.

But as I read this book, I am struck by how only a hospice nurse comes to her patient, and begins her assignment by listening to her patient's breathing so that she can listen for the change in rhythm that tells her the end is near and that it's time to call in the family to say their farewells. Most nurses expect or hope their patients to get well. Hospice nurses don't.

And now in this book, we read how a Christian lives out her theology in the days between life and death.

For example, in the first chapter on denial, she doesn't just address the five stages of grief because even unbelievers know and work through the five stages of grief. She tells us where God is in the grief:

I’ve seen over the years that the more we understand the way God works in our lives and the stronger our faith in Christ, the better we are able to find the sweet acceptance that proves so elusive for others without that personal relationship with Him. I’m not saying there is no pain. It always hurts to lose someone you love. I’m saying there is never a reason for despair, bewilderment, or feelings of abandonment when we experience His lovingkindness and understand the truths of His Word.

In speaking about denial, it's not just denial of the inevitable death. She has another denial she wants to address. She writes:

When we say we don’t need a Savior to go to heaven, we are in denial — denying the very Word of God.

Too Theological?
Some reviewers have commented that the book is too pushy in the Christian bits.

In the chapter on "The Sovereignty of God" she presents the sovereignty of God over the earth, over the weather, over Satan and his demons, over governments, over mankind and over life and death. And she dedicates a whole chapter just on the sovereignty of God in salvation.

As I read these Bible-saturated, doctrinally rich chapters, chapters which I would normally love and adore, I must confess my thought was "What's a hospice nurse doing writing on a subject better left to pastors and theologians?"

These chapters are well-written and well-organised. She cites sermons, books and expounds on many dear and familiar Bible verses to tell me things that I already know and have read written by better hands. As I read, I too thought she should cut down or even remove these chapters that interrupt the flow of her book.

But I was wrong. For two reasons.

One, I am being a snob. While there are better books on these themes, as she herself said, she is a student of the Scriptures not a Bible scholar. Here is an everyday Christian who has put together these beautiful truths from the Bible and integrated them into her working life. This is the desire of every pastor for every teaching ministry. I want to be a Christian who can hear the same old truths instead of only searching for a new insight or twist to familiar passages.

Now to the second reason I was wrong to dismiss these doctrinal chapters, and this is the most important reason. We must remember Bachman.

Deborah Howard has written these chapters, and it's not only these God's Sovereignty chapters, all the chapters in this book have a strong biblical flavour to them, because these are important. These are literally, literally, the last words she wants the dying to hear.

There is no hope but Jesus. Call to Jesus. Cry to Jesus. Fly to Jesus. You can hear the urgency of a Christian who has experienced the goodness of God and wants you, before you die, to know Jesus.

More Than A Pastor-Theologian
In my defence, if I am impatient with her biblical exposition of great truths it is because I am so interested in the story of Bachman, the case studies and the practical insights that no pastor or theologian offer so clearly as the humble hospice nurse here.

Pastors accompany and care for many in life's final journey but not in the way that, I've come to realise, hospice nurses do. At one point in the book, a hospice nurse manually removes an impacted stool. Pastors are not in the room for that. It's not something theologians would think or write about. You will never see it shown on TV or movies. It's too embarrassing, impolite and you would never think about the bowel movement of the dying, but here it is in this book.

And it's not written as it would be in a medical textbook: cold, detached, matter of fact, these are the things that happen when dying. She draws us in by describing conversations with anxious loved ones, the reactions of the patient and how a hospice nurse works to preserve dignity when death tries to take even that away.

Let me read a tip she offers in the book:

Don’t be surprised if your loved one begins to have “accidents.” Try to take it in stride, and do what you can to preserve the patient’s dignity as you assist in cleaning her up. Make sure her private parts are covered whenever possible, asking other people to leave the room while you’re working with her and never, never shaming her. Try not to make faces showing revulsion. (If the smell bothers you, here’s a trick I use. Open an alcohol swab and wipe it under your nose. All you’ll be able to smell for a few minutes will be the alcohol.) Many times the patient is already unresponsive at this time or incapable of understanding what she has done. But if she is aware that she has made a mess, it will cause her pain and grief and be a tremendous blow to her already-suffering ego.

Another tip I picked up was "Don't insist that the patient eat." Howard recounts a case where she gives this advice and the daughter of the patient, got furious and asked, "You mean you want us to sit by and watch my father starve to death?" And the answer was yes.

Did you know that as the body nears death, the digestive system shuts down? If the patient eats, he could experience bloating, cramping, vomiting, indigestion, excessive gas production, diarrhea, or constipation, which is why the nurse says, "It could be a cruelty to force food into a gut that has stopped working properly."

I don't want you to misunderstand, the book is more than tips and tricks on caring for the dying. By giving you these examples, I show you that Howard deals with things as it is, this is real, and it's not just real physically and emotionally, she gives it to you, spiritually.

Integrating Theology and Life
When I talk with people about angels and demons, it's a topic of a conversation. "Do angels exist?" We discuss, debate, take a position, study the Bible, preach, and so on. But in this book, when she asks "Do angels exist?", it's because... let me read to you from the story of Bachman. The family are in the den. When...

Looking away from her again, Bachman said weakly, “What do you want?” “What, Daddy?” “Okay. But what did Mama say? Is she going too?” With wide eyes Laura looked back over her shoulder at Sarah and John, who were sitting in stunned silence, watching Bachman. Laura shrugged and softly spoke to Bachman again. “Daddy, what are you talking about?” “I wasn’t talking to you,” he said curtly. “Then who were you talking to?” “To him.” He nodded his head toward the space between the fireplace and the leather chair, pointing one thin finger. They all looked but saw nothing. “You were talking to whom, Daddy? John?” Laura strained her ears to hear his muffled reply. “To ... the angel,” he managed to explain.

Howard tells of a real incident where a woman saw an angel everyday for several days before she died. She writes:

This is not an isolated incident. It happens fairly frequently. I’m not saying absolutely that an angel is there. I’m just saying that’s what people sometimes report. What do the Scriptures teach about this?

So that's what I mean by the theology is integrated with real life. In answering questions like angels and demons, heaven and hell, she does not speculate. She does Scripture.

Recommending books

After completing this book, I was struck that we should all read a book before we go on a trip.

You have travel books, travel blogs, travel vlogs, describing every possible holiday destination and what you can see, hear and experience. The travel guide is full of descriptions, warnings and tips and tricks.

But there is that one place everybody will go. A place where everybody should be ready for. Have you read a travel book for your final journey?

I don't have any personal recommendations to make but Howard does. She regularly quotes from these books: "One Minute After You Die" by Erwin Lutzer and another favourite of hers is "Trusting God Even When Life Hurts" by Jerry Bridges. From this Jerry Bridges book she quotes, "We must embrace three truths if we are really to trust God: God is completely sovereign, God is infinite in wisdom and God is perfect in love."

When I read this, I remember a podcast episode, of a father breaking the news he has late-stage cancer to his children. I went looking for the episode and found it.

It's from Truth in Love, a podcast from the Association of Certified Biblical Counsellors. In episode 37, "Talking to Your Kids about Your Cancer", Tim Keeter tells the story:

Tim asks, "We talk a lot about God is perfect in his love for us, right? What does that mean?" "That means, he always wants what is best for us." "Not just that, not only does he want what is best for us but he is perfect in his infinite wisdom. So boys what does that mean?" "It means that not only that he wants what is best for us but he knows what is best for us." "That's great. That's exactly right. I got one more." "We also talk about God is completely sovereign. So what does that mean?" "Well dad, it means that not only does God always want what is best for us, not only does he always know what is best for us, he will always bring it about." "When?" "Always." "No matter how severe the situation?" "Yes dad, always." "Good. Because I'm going to give you a chance to practise that right now."

You can hear Tim break off in tears. I recommend you listen to the full episode in the podcast, Truth in Love. It's episode 37 and there are many good episodes in that podcast from the Association of Certified Biblical Counsellors.

This Jerry Bridges book which has helped Tim Keeter and Deborah Howard and many others proves how books can offer real help, real comfort.

In her concluding chapter titled "Comfort", Howard shares that when she wrote this book, she wrote it to comfort people. But as she wrote the book, she realised even more deeply that the only source of comfort is God.

Deborah Howard's book has helped me reflect on my own life's final journey. And also those of my loved ones. What a great way to start the year. The whole year is ahead of you. Will what you do this way prepare you for the journey you and your loved ones will take?

This is a Reading and Readers review of "Sunsets: Reflections on Life's Final Journey" by Deborah Howard. Foreword by D.A. Carson. Available in Amazon Kindle for USD8.95 but free from Faithlife for January.

After reading this book, I have gained a newfound appreciation for the work of hospices and palliative care. So much so that I'm going to make a contribution to the local palliative care centre. I ask that you join me to support hospices. And if you are not sure why you should, just read the book. Or visit a hospice. Thank you for listening.

Book List

"Sunsets: Reflections on Life's Final Journey" by Deborah Howard. Amazon. Faithlife.
"One Minute After You Die" by Erwin Lutzer. Amazon. Faithlife.
"Trusting God Even When Life Hurts" by Jerry Bridges. Amazon. Faithlife.
Truth in Love (Podcast) by Association of Certified Biblical Counsellors. Link.