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Ann Hamric's "Last Lecture"

Last Lecture Series, 2003 - Ann's Explanation:

Every year for the last 12 years at UVA, undergraduate students invite three professors to give their “Last Lecture”, and this year I was honored to be among the three.  Here was my assignment:  I had 20 minutes to say whatever I wanted to say to the University community if I knew it was the last lecture I could ever give.  Quite a challenging premise, yes?

Also, picture the setting – the University’s largest auditorium, in semi-darkness, with almost 650 students and others there.

The Last Lecture of Ann Baile Hamric

Delivered at “The Last Lecture Series”

University of Virginia, April 14, 2003

It is an honor and a daunting challenge to be asked to give this lecture. I rarely write out my lectures, but I’ve made an exception in this case because I don’t have any PowerPoint slides to hide behind -- and, I expect that you all KNOW how hard it is for professors to only talk for 20 minutes! [Very clever of you guys to limit our time!] Before I begin, there are a few things you need to know about me – I’m a nurse, a breast cancer survivor of 16 years next month (and yes, I am counting!), and I am a Christian. These facts will all be important in different ways as I go through this talk.

The year was 1992. Paul Tsongas, the Senator from Massachusetts, was having some success in the early primaries in challenging Bill Clinton and others to become the Democratic Party’s Presidential nominee. Tsongas was in remission from the cancer that would ultimately take his life, and to all appearances, he was healthy, and many people were very excited by his candidacy. But then he withdrew from the race. In the statement announcing his withdrawal, Tsongas first noted that the issues important to him had been incorporated into the party’s agenda. And then he said this most interesting thing: “The obligation of my survival has been met.”

Not all of the news reports picked up this sentence, but when I read it, this statement, “The obligation of my survival has been met”, hit me like a ton of bricks. In 1992, I was enrolled in a rigorous PhD program 2 states away from my home, traveling weekly on AMTRAK (you can just imagine how much fun THAT was!), trying to be a student again over the outright objection or bewilderment of practically everyone who knew me. [Here’s a typical response: “Let me get this straight – you want to quit your job and go to school for four years so you can make LESS money??!!”] My children thought that I was flat out nuts (some of you may be able to relate to that: CHOOSE to go to school?!). Even I wasn’t sure why I felt compelled to do this “go back to school” thing —until I read Paul Tsongas’ quote. Then I knew in my bones, as a fellow cancer survivor, that I was trying to meet an obligation of my survival.

Probably most of you know that for many persons who are diagnosed with cancer, one of the first questions is, “Why me?” I was 39 years old (yes and it was 16 years ago so the more enterprising among you can do the math and figure out how old I am). I was a very young 39 with no family history of breast cancer, so there was and would be no answer to this question of why me. But what you may not know is that over the course of weeks and months and years, for those of us who recover from cancer, a more profound and haunting question emerges: I call it the “Why not me?” question. Why am I still alive? Why am I surviving? I had terrible odds – even after surgery and aggressive chemotherapy, I had a 70% chance of a recurrence in 3 years (and in those days recurrences were rarely curable). My oncologist was so convinced I would have a recurrence that he talked me into having my bone marrow stored for a transplant, as that was the promising new treatment for recurring breast cancer (which we now know does not work, so I’m grateful I did not have to endure that). I participated in a breast cancer support group with many remarkable women, who did the same things I did to get cured of cancer. We got the same medical care, we tried to follow all the advice we could get our hands on regarding diet, exercise, etc, and we all prayed fervently to the same God. But too many of those women died – I did not. We have all known wonderful people whose lives were ended through fluke accidents or random violence. So Paul Tsongas’ words have resonated in my head for over 10 years now – how am I to understand, much less meet, the obligation of my survival?

Tonight, I’m going to share some reflections on this topic – not my usual subject matter, I assure you. Some of my students say that I push and goad them to think – they don’t always mean this in a positive way. But I choose to view it as a great compliment, and it is my hope tonight that you will be stimulated, pushed, goaded, WHATEVER, to think about and begin reflecting on the obligation of YOUR survival as well. For we are all persons of extraordinary privilege to be alive in this place and in this time. And one is never more acutely aware of this privilege as when they have walked through the valley of the shadow of death.

Now, lest you fear a sermon (which you probably are getting rather worried about after that last statement!), or one of those schmaltzy, over-the-top Internet stories (you know the kind – if you don’t immediately send it to 20 of your closest friends all your teeth will fall out), I need to give a disclaimer, some “truth telling” if you will. I definitely don’t have this “obligation of my survival” all figured out. Gloria Steinem has said,

“We teach what we need to learn.”

And that is what I’m doing tonight – I’m teaching what I need to learn. Indeed, I will spend my life trying to understand and meet this obligation – I see only glimpses, and this is what I hope to share – so this lecture is really best characterized as one step above random musings, forced upon me by this most challenging assignment. Most of the time I’m as content as the next person to squander my time watching old Star Trek reruns and not think about such profound things.

But not tonight…..after all, this is my Last Lecture.

So, what do I understand thus far in my life journey about the obligation of my survival?

First of all, I would submit that this is a joyful obligation, not ponderous or even necessarily solemn – it is sometimes having the sense to get out and play in the rain (a line from an old Stanford yearbook) – to try to have a little [or a lot of] fun along the way;

to stop to REALLY look at a cherry tree in bloom on a glorious Virginia spring day (did you see the one right outside Clemons Library, next to the big hole where the Special Collections extension on Alderman is being built? A big gorgeous tree just blooming its heart out in the middle of all that construction mess!);

it is getting the great rush that comes from performing or listening to wonderful music (I sang Mozart’s Requiem as part of the “Rolling Requiem” that was held around the world on September 11th this past year in honor and memory of those who died; and that was probably the most important thing I did the entire year);

it is seeing my way clear to laugh and keep laughing in the face of whatever life throws at me. Some of the most joyous people I know have not had easy lives, but they are the first to laugh at life’s absurdities and challenges.

Meeting the obligation of my survival means celebrating small victories as well as large ones (you can tell a lot about people by whether they keep champagne in their refrigerator – I think it is a sign of hope, that there will be something to celebrate any time now and they need to be ready!). I am one of the most obnoxious people you will ever meet on my birthday, because I am so thrilled to be having another one – each is a small victory and absolutely beats the alternative. I have no doubt that I will be a truly obnoxious old person too, if I get so lucky, so you may want to warn my kids!

One obligation of my survival is to love the earth and watch how much I am using up its resources. We are so mindless about that in our country, surrounded by such abundance.

One obligation of my survival is to do my best work as much of the time as I can, and especially to focus my work on the issues that matter AND that I am passionate about – that is what Paul Tsongas helped me to understand in 1992 when I was back in school studying ethics and research. I needed that education to be able to contribute to the conversations about clinical ethics and the place of nurses in those conversations.

My favorite quote of all time about this obligation to do our best work comes from Franny and Zooey by J.D. Salinger – do any of you know this book? Franny and Zooey are brother and sister, and Franny is going through a real crisis of meaning about her life. Zooey phones Franny, and he tells her about a time their brother Seymour was making Zooey shine his shoes before going to his job at a TV station (a job he was really sick of, as you will hear). This is what Zooey said:

“The studio audience were all morons, the announcer was a moron, the sponsors were morons, and I just damn well wasn’t going to shine my shoes for them, I told Seymour. I said they couldn’t see them anyway, where we sat. He said to shine them anyway. He said to shine them for the Fat Lady. I didn’t know what the hell he was talking about, but he had a very Seymour look on his face, and so I did it. He never did tell me who the Fat Lady was, but I shined my shoes for the Fat Lady every time I ever went on the air again…. I’ll tell you a terrible secret – are you listening to me? There isn’t anyone out there who isn’t Seymour’s Fat Lady. There isn’t anyone anywhere that isn’t Seymour’s Fat Lady….And don’t you know – listen to me, now – don’t you know who that Fat Lady really is?....Ah, buddy. Ah, buddy. It’s Christ Himself. Christ Himself, buddy.

For joy, apparently, it was all Franny could do to hold the phone, even with both hands.”

- J.D. Salinger, 1961, Franny and Zooey, pp. 200-202

Regardless of whether you see the source of our being from a Christian perspective as Salinger does, or from any other faith or non-faith perspective, I think that Salinger hits on the head the joyful nature of this obligation to give our best back to the source of all life.

I want to close with a story that I hope will help explain the final, and most central obligation of my survival – and maybe of yours, too. Nurses love stories because much of the meaning of our work occurs when we are privileged to enter into the life world of our patients. Ours is personal and intimate work, most often experienced one person and one family at a time.

I was a 20-something nurse, working as a clinical nurse specialist in neurosurgery, when I had the most extraordinary experience of my career. I will call this patient “Peter”, and he is the reason I got involved in ethics and ultimately felt the need to return to school for my PhD. Peter was a high school junior, a star gymnast, basketball player and swimmer who was admitted to my hospital with a devastating injury – a C1 quadriplegia [he was paralyzed from the base of his neck down – like Christopher Reeve’s injury. Basically what this means is that he could not move any part of his body but his face: he could not turn his head, move or feel his arms or legs, or even breathe on his own. He needed a respirator to breathe; a breathing tube was inserted in his neck that connected to the respirator]. Once Peter realized he would never recover in the sense of being able to move again, he for whom sports was THE meaning in his life, he began asking to die. Now to communicate with Peter, you had to read his lips, because he could not make the sounds needed to talk. It was hard work. No one could stand to talk with him about dying – not his parents, who were beyond heartbroken about Peter’s injury, not his neurosurgeon, who told Peter “I am proud you are alive”, in fact, hardly anyone but me. Over the course of months, Peter explored many possible avenues to end his life, many quite creative (for example, he wanted to become a Christian Scientist [he was a Southern Baptist], so he could refuse treatment on religious grounds) but none of these avenues were possible. Finally, he worked out an elaborate plan that involved his working the respirator hose off of his breathing tube with his chin, and being left alone long enough for the resulting anoxia [lack of oxygen to his brain] to kill him. He needed someone’s help to carry out this plan to end his life [I was to turn off the respirator alarm and keep everyone out of his room long enough for the plan to work] – it was an assisted suicide request before we in health care had “invented” that term. When Peter asked me to help him, he said, “You are my last hope”, and we both knew that was true. It was one of the most excruciating ethical dilemmas of my life.

I did not help him. In the end, while I truly believed that Peter had a right to end his life, I wanted to keep being a nurse and I feared that his family would realize that I had assisted him to die. I will never know if I did the right thing in refusing Peter’s request – it is one of my questions for God. Do you all have a list yet? Some of my questions, like whether I did the right thing to not help Peter, are profound. Others are quite trivial, like “Why is it that thinking really hard doesn’t use up as many calories as running a marathon?” (I would have lost 10 pounds preparing this lecture alone!) If you don’t have a list for God, my guess is you will by the time you’re my age.

I did not help Peter die. What I DID do was redouble my efforts to help him have the fullest and most meaningful life he could possibly have. I broke every rule in the book in getting him outside, ventilator and all (and he developed a great tan); in arranging for him to see his baby niece in our nursery right after she was born. I got him home, on a ventilator but home to his room after 1 year of living at our hospital. I got him flown to one of the best rehab centers in the country where he was able to have a procedure that helped him breathe without the ventilator. I continued to see him weekly at his home after his discharge (the home health nurse came once and wouldn’t come back because his care was so complex). I stayed in touch with Peter even after I moved to a different state, and was an honorary pallbearer at his funeral (he died in his sleep 5 years after he was injured). I still am in touch with his family, who I love as if they were my own.

The day he left the hospital, Peter gave me a record by Cat Stevens called “Foreigner”. Do any of you know Cat Stevens? This record? Peter said he had many things he wanted to say to me but he didn’t know how to say them – that I should listen to the “Foreigner Suite”. There are many wonderful lyrics in this song, but the most important one that has stayed with me all these years is this:

“Won’t you give me your word that you won’t laugh

Cos you’ve been a saving grace to me”

- Cat Stevens, 1973, Foreigner Suite

Now why have I told you this long involved story? I have at very few times in my life, and Peter was one of the first of those times, been privileged to be a saving grace to another person. There have been other times when I depended for my very life on the saving grace of others to see me through a hard time. So, I think that this is the final obligation of my survival – not to shy away from those times, but to give AND receive help as it is needed and as I am able.

There are times in our lives when we need to give grace, whether it be hot soup or homemade bread, just being present with someone (I’ve learned it doesn’t matter so much what you say – what matters is that you are willing to be there). Sometimes grace IS saying or doing something that shows we really understand what another person is going through – grace takes many forms. As Anna Quindlen says, “I show up. I listen. I try to laugh” (p. 15, A Short Guide to a Happy Life). And equally important, there are other times when we need to accept the saving grace of others. It seems to me that BOTH are profoundly important for the human family, though as a culture I think we Americans are more comfortable helping others than we are asking for help for ourselves. We have this vaunted idea of our independence and autonomy that belies the reality that we are all interdependent and connected.

So this finally, at the center of it all, seems the core obligation of my and maybe even our survival – to be a saving grace for one another.

Thank you for this invitation and for your kind attention.

Ann left us suddenly last Sunday evening. She sang with the altos that morning as she always did when not traveling to lecture, visit grandchildren, or encounter places in the world near and far. She was beloved by everyone who spent at least five minutes with her.

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