The Pain of Choosing

Every bereaved person I know deals with massive amounts of regret.  We have regrets over what we didn't do, say, think, and feel in our relationship with our lost loved one.  We have regrets about our decisions that may have impacted in one way or another the fact that our loved one died.  We have regrets about decisions we have made since our loved one died.  And we have regrets about decisions connected to the actual deaths of our loved ones.

We all know intellectually that we live in a time when we must make choices about the how, the when, and the where of the deaths of our loved ones.  We try to insulate others from such choices by making them ourselves through advance directives, pre-planning of funerals, living wills and other instruments.  Those are wonderful gifts we can give to those who remain alive when we are dying and dead.  I can tell you, however, that those instruments are not inoculations against choice or regret.

I had choices about the how, the when, and the where of Anne's death.  Since those choices existed, I had to make them.  I certainly made those choices in consultation with others.  Nonetheless they were mine to make.  Since I had choices (and a great array of such choices) I now have regrets.  And only slowly do those regrets integrate into a peaceful sense of myself.

In the cognitive psychology of choice, we learn that beyond a certain point the multiplication of choice makes us miserable.  We may have greater personal autonomy and self-determination than every before.  We may have more "freedom."  And we feel worse.  

• When we make choices, we imagine that we might have made better ones.  
• When we make choices, we know we could have made alternative ones.  
• When we have choices, we enter into the bondage of seeking the perfect choice.  
• When we have choices, we are responsible for the outcome.

The morning after Anne became unresponsive, one of the specialists came in and nearly turned into a murder victim.  His first advice was to do nothing and to let her go.  I knew then as I know now that he was right.  And I wanted to kill him for what seemed to be his callous and calculated hopelessness.  I know now that he was a pessimist and therefore had a more accurate perception of reality that did I.  

He was also in the business of giving advice.  I was the one who was forced to make the choices.  When giving advice, talk is cheap.

We did everything we could.  I know that.  We made the best decisions we could at the time.  I know that.  After that, I chose the time, the manner and the location for the removal of all supportive measures.  I knew that within a matter of hours or days Anne would then die.  It has taken many months of reflection and conversation, of prayer and pondering, to let go of the dozens of regrets that I had about it all.  By the way, they are not all gone.  And they don't stay away permanently once managed.

It's not that I made bad choices.  I made good choices.  More than that, I made the best choices I could at the moment.  Part of the problem was simply having the power to choose and then to be responsible. That is the price of having choice.

I don't advocate that we take choice away from folks in our medical practice.  I do urge that practitioners--physicians, pastors, counselors, nurses, social workers and other caregivers--remember as clearly as possible this relationship between regret and the sheer reality of having choices.

I found that the pastors in my life knew this all intuitively.  They did all they could to reduce the number of non-medical choices I needed to make.  They didn't ask me if I needed a visit and when.  They just came.  If it wasn't a good time, they left.  They made the choices for me in that regard.  It may seem like a small thing.  But when you multiply all the small choices we normally make and subtract them from the huge choices needed in a crisis, that subtraction is a marvelous gift.

We must choose.  We will have regrets.  We can find ways to mitigate the pain of these realities.