Hospice Chaplain Reflects On Life, Death And The 'Strength Of The Human Soul'

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. My guest has the job of giving spiritual care to the dying. Kerry Egan is a hospice chaplain who has also worked as a hospital chaplain. She's listened to many people's life stories as they died and sat with them as they express their regrets and fears and reflected on the experiences that had brought them joy. Now Egan has written a memoir called "On Living" about her hospice work and the impact it's had on her life. Egan is a graduate of Harvard Divinity School and lives with her husband and two children in South Carolina.

Kerry Egan, welcome to FRESH AIR. I'm going to ask you a question that I know lots of people ask when they meet you, which is, what does a hospice chaplain do? And how are you different from a priest or a rabbi or an imam?

KERRY EGAN: So a priest or a rabbi or imam, I sort of think of it as their primary role is to preach and teach to their parishioners. They're going to say, this is the truth. This is what is real. This is what we believe. A chaplain doesn't do that. A chaplain should never go in and preach to someone. That's not our role. Our role isn't to tell you what to believe. Our role is to say, what is it you believe and how does that help you or not help you in this process, this process of dying, this process of letting go of the life you've loved - or maybe have not loved - and coming to some peaceful place?

The tool has to already be there, right? You know, people are on hospice for six months, ideally, but a lot of people we get on our service are there for five days. You know, some people are there for 24 hours, and I never even get to meet them. So ideally, you have months to do this. You have months to sit down with someone once a week or twice a month and talk with them about their beliefs, religious and otherwise, to make meaning of their lives.

But a lot of times, you just don't have that time. There's no time to preach or teach. You have to use whatever tools that person already has in their spiritual toolbox to help them come to meaning in their lives. And those tools can be religion, but it's also their family and friends, their relationships. It can be literature and music and arts. There's all sorts of tools that people use to make meaning at the ends of their lives.

GROSS: You write about how about one of the things you want to do is hold open a space of prayer or meditation or reflection when someone doesn't have the energy or strength to keep the walls from collapsing. That's such an interesting way of putting it. What do you mean by hold open a space of prayer or meditation or reflection?

EGAN: Well, have you ever tried to meditate or pray when you have overwhelming emotion? Have you ever had that experience...

GROSS: I've tried to do my breathing. It would be too much to call it meditation, I think. But I do try to save a space for breathing and for just kind of emptying my mind of the noise.

EGAN: Yeah. And has it ever been really hard?

GROSS: You bet it has. It is usually hard...

EGAN: Yeah.

GROSS: Yeah.

EGAN: Yeah. And so sometimes when someone - I mean, it's hard on the best of days (laughter). And if you are dealing with or talking about events in a life that 60 years later are still creating just a tsunami of emotion and fear, pain, anxiety, sometimes joy - not usually it can be really hard. So one of the things that...

GROSS: So how do you help a person get to a calmer place of reflection?

EGAN: One of the big things a chaplain does is to model it. And that sounds so simple, right? That sounds so simple. But when you start to learn how to work as a chaplain, you hear people talk all the time about presence. You know, you have to have pastoral presence or sometimes I call it spiritual presence. And I remember thinking, what does that even mean? I don't know what in God's Earth that means.

And what it really means is to model a sense of in the midst of this storm of emotion, you can stay calm, right? It does not have to overtake you. And you would be surprised at how powerful that is for someone else, just to be with someone who is maintaining a sense of presence, of not being in the past, of not being in the future, of literally being present, you know, in the presence. But that has a way of calming people down.

And it's also, you know, as human beings, we're such social creatures. It's easier to do this with someone. It's easier to sort of face the hard things in your life when you're not alone. And that's a big part of what a chaplain does is she stays with you. She stays with you. And, you know - and I'll tell you, sometimes the stories I've heard, sometimes I want to freak out. I really do. Sometimes I, like, get so angry and I, like, want to, you know, throw something (laughter), you know, really. And sometimes I want to cry. I want to burst into tears and say this is this is awful.

But that's not my job, right? That's, like, the key point of the job is, like, you need to keep it together so that the other person can sort of fall apart. And then you're modeling for them what it looks like to come back to a place of peace where you can start to say, OK, what does that all mean? What does that mean?

GROSS: So this means you've had to find a place of peace within yourself, otherwise you're just faking it.

EGAN: Well, sometimes. I'm not peaceful all the time. I mean, I'm just a regular human being. If you knew me personally, you'd be like, wow, that woman's a hot mess (laughter). I think at work, yeah, that's what I do at work. You know, I have a process for getting there. But certainly, I wish I was in a peaceful place all the time. But that's not how I am all the time. But at work I try really hard. Yeah, I try really hard to get there.

But I think that's really key, actually, for everybody to know that you don't have to be, you know, some sort of spiritual heavyweight to do this for other people, right? You can - in the moment - in the moment, you can be that peaceful presence, even if you're not other times in your life. Any of us can do that.

GROSS: Do you find that there are certain common things that most frighten people about dying when they're near death?

EGAN: So when people die in the hospital versus when they die in hospice, it's really different. And I always hesitate to make any sort of blanket statement because people who are dying, of course, are still living. And if you think about how different every single person who's living you know is, well, people are just as different in the dying process, right? They're who they always were, so it's hard to make any sort of blanket statement about people who are dying.

But people who die in hospice hopefully have had a little bit more time to reflect on their lives, to talk about what they think comes next. And ideally, for me - for me, and maybe this is a little selfish, I don't know, I'll have think about that - I would hope that my patients aren't afraid anymore. And I think people would be really surprised to know that a lot of hospice patients aren't nearly as afraid of dying as you think they are.

I think some of us who are like sort of healthy in the middle of life have a real fear and horror of death. And I think a lot of hospice patients don't. They don't anymore. Some of them are downright curious. Some of them are, like, ready. They're ready to do this. They want to know what happens. They want to see what comes next. They're OK.

GROSS: One of the interesting observations you make in the book is that people, when they're dying, often regret that they didn't fully appreciate their bodies, that they were ashamed of their bodies or embarrassed by their bodies because they were too fat or they weren't pretty or handsome enough or they didn't go to the gym enough or, you know, whatever it is that caused them embarrassment or shame about their bodies. Can you talk a little bit about what people have said to you about those regrets?

EGAN: The woman who really shocked me the most was young. She was in her 40s. I'm in my 40s, you know? She was my age. And she was dying. And she had two young children and a husband. And we were in this - she was in the hospital. Some hospice patients if you can't control their symptoms are actually seen in an inpatient unit, so sometimes when people talk about like a hospice house that's an inpatient unit. And sometimes those inpatient units are freestanding, and sometimes they're in a hospital. And this woman - her pain was so bad that that couldn't be controlled at home which that's saying a lot. And that's the kind of pain she - this woman was in. And so she's in the hospital, and the room was dark. The room was dark because she couldn't even stand light.

And she said, you know, more than anything else what I'm going to miss - it's not my children and it's not my husband. It's my own body. She was like I - I remember she was holding up her hands and this like very gray light coming through the screen on the window. And she was holding up her hands looking at her hands, and she said I have to leave it no matter what. No matter what I have to leave this body. Like I can rage against it. I can be angry. I can bargain with God. I can do everything I can, and there's no getting around it. I have to leave my body and this - and remember she's in enormous pain right? She's in like bone cancer pain. I mean, she's in pain.

And she takes her hands, and she just starts like rubbing her arms, you know. And she's like rubbing her chest, and she rubs her face. And she says and I love this body, this body that, you know, went swimming and had sex and made my babies. She was like my body made other human beings. She's like and I have to leave it. And she said I'm just going to miss my body so much. And I never even appreciated it. I never appreciated it until now when I'm in like an excruciating pain and can't even stand the light. And I have to give it up. And, you know, as a young woman myself that kind of changed everything. That changed everything for me.

GROSS: How?

EGAN: Well, you know, it's funny. As a woman, you don't realize in this - or I didn't. I didn't realize just how much pressure there was to look a certain way because I was really skinny. I was really skinny growing up. I was really skinny through my 20s. And I gained an enormous amount of weight after my son was born because of a medication I was on, and I was really embarrassed. I was really - for the first time in my life I was really like ashamed. I had never felt that before.

And then I experienced it. And it's awful. As a woman, the pressure you feel - I feel - to look a certain way, and I had been sort of stewing in that embarrassment about having gained - I'd gained like 60 pounds in three months. And it was just very liberating. And just to think, my God, you know, I still have a body. I have this amazing body that now is, you know, quite a bit pudgier.

And - but it still does amazing things, and it just, you know - there's very few moments in life where you can say like your consciousness shifted entirely in a second. And that was one for me to realize she's right. Like, what's the point of wishing I hadn't gained 60 pounds? I mean, there's no - that's a stupid thing to be focused on. Instead, I can focus on swimming and dancing and - because someday I'm going to be like her. I'm going to have to give it up.

GROSS: If you're just joining us, my guest is Kerry Egan. She's a hospice chaplain and has written a new memoir about her work called "On Living." We're going to take a short break here then we'll be back. This is FRESH AIR.

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GROSS: This is FRESH AIR, and if you're just joining us my guest is Kerry Egan. She's a hospice chaplain who's written a new memoir called "On Living."

Do you find that people often turn to or turn away from religion as they face the end of life?

EGAN: Both. I mean, they turn to and they turn away - both. Religion can give people so much comfort - such a beautiful structure for understanding what they're going through for making meaning, for reconciliation, for forgiveness, for strength, for peace, for comfort, and religion can also cause a lot of harm. Religion has caused a lot of harm in people's lives - so both.

GROSS: So do people often ask you to read passages from the Bible as they near death?

EGAN: Yes.

GROSS: Are there passages you're most often asked to read?

EGAN: People love the Psalms, and that makes so much sense because they're so beautiful, just so beautiful. And so I have a couple of Psalms like my go-to Psalms, you know, Psalm 23, of course. And actually - and I have a little, like, travel Bible I keep in my bag, and I have those pages dog eared of different really beautiful Psalms.

GROSS: Is Psalm 23 the shadow of death Psalm as I think of it?

EGAN: Yes.

GROSS: So are there other passages from the Bible that have taken on new meaning for you because you've read them to people for whom those passages have a lot of meaning?

EGAN: Well, there was one patient, and I didn't even really know him. I didn't really know him. I actually failed him. I didn't do a very good job with this patient at all - passed early. And he was a man. I only met him once, and he'd had a stroke. And his wife asked me to go in and see him. He was in a nursing home for rehab and was paralyzed on the right side of his body and the left side of his body was very spastic very difficult for him to move. And the nursing home nurses all thought he was a bully, and he hit people. He used to lash out. He would kick and punch and hit people with his left side that he could.

And that's hard. That's really hard on nurses when patients are reacting that way. And she said please go in and see him. Everyone thinks he's a bully, and he's not. So I went in there. And she said he loves the Bible. Give - let him read to you from the Bible, and so I went in and I started to read the Psalms. And I - he wanted the Bible, so I handed it to him. And he starts to page through again with his very, very stiff left hand, and he starts ripping pages out of the Bible. And they're like clumps of them and like individual pages and they're like float - you know, there's tissue paper pages in a Bible and they're floating all around. And I tried to get the Bible back from him, and he hit me. And then I was afraid. I was like, OK, well, I don't know what to do.

And then I thought, well, I can't just get up and leave him here with this Bible he's destroying. And I was - I didn't know what to do. And I was embarrassed, and I was nervous. And finally he stops. He stops at a point in Jeremiah - and the book of Jeremiah if anybody's familiar with it is not an easy read. Jeremiah was a very angry Hebrew prophet who really said some really mean things to the Hebrew people. He was angry. He was very angry. And I remember he holds out the Bible to me in Jeremiah after like 10 minutes of - the Bible's literally destroyed. I mean, I had to throw it away. I mean, there's pages of the Bible all over the floor.

And he holds it out to me in the shaking hand, and I look at it. And I was like what am I supposed to do? Am I - you know, do I like play along and pretend this is all fine and I just read this awful verse from Jeremiah? Because in my head, it was going to be awful. And then I looked at it, and it said I have - at the top of the page because there was no way I thought he could find anything meaningful - it said I have loved you with an everlasting love. I have drawn you with unfailing kindness, and I read that out loud to him.

And I said, is this what you wanted me to read? And he grunted. And then, Terry, I closed the Bible and I stood up and I walked out. I read those two beautiful lines and I was so - all I could think was, like, thank God I've got this wreck of a Bible back and I can now, like, leave. I just wanted to leave. And I stood up and I walked out, and that was it. I didn't read the rest of it to him. And it was only when I got home that I read the rest of that verse, and it's one of the most beautiful verses in the Bible.

And it talks about how, you know, the Hebrews were in that Babylonian exile and how they were so sad, how they had lost everything. They had lost their homes. They had lost their faith. They had lost it all and that God says, even in the midst of all this loss, I will not abandon you, you know, and that you will be happy again. You will sing again and you will dance again. And young women with babies and old men, you will all get up and dance again in the fields.

I mean, there's no way I ever could have picked a more perfect chapter or verse to have read to him than the one he picked out, and I didn't do it. I didn't do it. I just - I read two verses, which should have clued me in that this was going to be some beautiful poetry, and it just totally went over my head. And I closed the Bible and I walked out. And it's because I was afraid. I wasn't curious, you know? I let my fear get in the way, and that's kind of the - one of the biggest pitfalls as a chaplain is if you let your fear get in the way, all bets are off. Fear is the enemy of spiritual progress.

GROSS: What were you afraid of?

EGAN: I was afraid of him. I was afraid of him. I was afraid of the nurse in the nursing home looking down on me 'cause she had said, you totally - you really don't want to go in there. And I said, no, I'm going to go in there anyway. And I was - it sounds stupid, but that's the truth. I was afraid. I was afraid that I would be embarrassed, that she was, like, told you, which sounds ridiculous. It sounds like I'm in junior high, but that's the truth. I was afraid of him hitting me again. I was - I was just so uncomfortable.

GROSS: You - well, that gets me back to something you say about chaplains. You say a chaplain is the person who doesn't leave.

EGAN: Yeah, and I left (laughter). You know, I - that's why, you know, some - people always say to me, like, oh, you must be so special. You're a chaplain. And it's like, well, if only you knew (laughter). I'm special. Maybe not in a good way. It's really, you know, there - I don't know that I'm a great chaplain, quite frankly. And I mean that honestly. Like - and I say that 'cause I have worked with people who are great chaplains. I try really hard. I think all chaplains try really hard. But, you know, I'm probably - I'm never going to find a job, I imagine, by saying this but (laughter)...

GROSS: (Laughter).

EGAN: ...I'm not - I am not the best chaplain out there (laughter). I try really hard, but I fail a lot.

GROSS: My guest is Kerry Egan. Her new memoir about her work as a hospice chaplain is called "On Living." As part of her work, she's listened to people reflect on life-changing experiences. Coming up, she'll tell us about her own life-changing experience when she had a drug-induced psychosis brought on by a drug she was administered when she was in labor. That's after we take a short break. I'm Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I'm Terry Gross, back with Kerry Egan, a hospice chaplain who has also worked as a hospital chaplain. She helps people spiritually, and in other ways, who are close to death, listening to their life stories and to their thoughts about facing death. She's written a new memoir called "On Living" that's about her hospice work and the impact it's had on her life.

A lot of people, as they're dying, share with you their regrets. You're a kind of a neutral person they can confide in. It's not - you're not a character in their lives in the way that their family and friends and colleagues have been. You're not the aggrieved person. They're not angry at you. You're not angry at them. So they could just confide in you. And you say what you can do is help them reframe or reinterpret the stories of their lives. You can't change what happened, but you can help give what happened a different significance that will just have a more explicable or comforting meaning.

You've had to do that with part of your own life. You had one of those life-changing episodes when you were in childbirth with your first child. You ended up with a postpartum psychosis induced by a drug you were given during childbirth after your epidural failed. What happened with the epidural?

EGAN: So I was hemorrhaging, and I'm now kicking around on the table, and I'm bleeding. And obviously the epidural has failed because you're not supposed be able to move. And I'm, you know, totally aware of having abdominal surgery, feeling every moment of it. And so the anesthesiologist decided to give me ketamine, which is kind of an unusual choice I've been told by other anesthesiologists I've talked to. And what ketamine does - it was invented by the U.S. Army to be a battlefield anesthesia. And it's used when you cannot put someone under general anesthesia, when you can't intubate someone.

So it worked the way it's supposed to in that it creates a psychotic break. It creates a dissociative break where your mind and your body are now split. And it's supposed to last for, you know, maybe 24 to 48 hours. And in my really unlucky case, it lasted longer. And I had what's called drug-induced psychotic disorder. So sometimes, depending on the psychiatrist - I saw a lot of psychiatrists - some would say it was, you know, postpartum psychosis caused by anesthesia and some would diagnose me with drug-induced psychotic disorder. I don't know what the details between those two diagnoses are. I don't know what the differences are, but I - I'd heard both.

Here's the really awful thing is that it wasn't picked up for about six months, and I kept telling all the doctors, like, there's something wrong with my brain. I knew there was something wrong, and they all kept saying you have postpartum depression or you have the baby blues or, you know, it cannot be the ketamine. The half life of ketamine is 48 hours or whatever it is. And so I wasn't diagnosed for six months, so I spent six months in that really awful psychotic state.

GROSS: What got you out of it?

EGAN: My mother.

GROSS: How?

EGAN: So Jimmy was - oh, I might - I might get upset (laughter). I love my mom a lot. She's - she's really awesome. So Jimmy was born in June, and so my mom at Christmas - my mom is a public health nurse. And she's lived, like, the most amazing life. Like, she was, like, on the frontlines of the AIDS crisis, you know, in New York and and, you know, babies addicted to crack cocaine. I mean, she's lived this incredible life. And one of the things she did - she was a psychiatric public health nurse in New York. When they closed all the big psychiatric hospitals and the patients went to live in the community, she was the nurse who followed them. So she knew - she knew her symptoms.

And she said at Christmas to me finally, and I think she was so nervous - I'll never forget - I was in my childhood bedroom and she said Kerry - she said, I know what postpartum depression looks like. And this is not what postpartum depression looks like. And she never said what she thought it was. She just said I don't think this is postpartum depression. Can I call your psychiatrist in Iowa? Do I have your permission to call her and speak with her about what I have observed? And I said, yes, yes, please, of course. And so I don't know what that conversation she had with the psychiatrist was like. But when I got back in January, I had an appointment and we went through, I guess, a screening of sorts.

And she said I think you have - I remember her words. She said just a little bit of psychosis, which of course there's no such thing (laughter) as a little bit of psychosis. But I think she was - and I wasn't upset. I wasn't - I mean, I was upset (laughter) but at the same time, I was also really relieved. I was like, oh, thank goodness. Thank goodness someone is now taking me seriously. Someone is listening to me, that there is something wrong with my brain. When there's something wrong with your brain, you know it. And so I started on that antipsychotic medication called Zyprexa, and it worked almost immediately.

GROSS: You also had some really bad side effects from it.

EGAN: I did - well, it's a difficult drug to be on. I mean, not just me. I think those side effects are pretty well known. I mean, if you look at the box, it's - they're all listed right there. It's a really difficult drug to be on actually. And my heart - you know, my heart really goes out to people who have to take that drug every day for the rest of their lives. I'm no longer on it. But there are some people who are, who live taking that. It causes enormous weight gain. It makes - for me, at least, it makes you sleep. And I've actually heard people say that they were prescribed it as a sleeping pill. I mean, it made me sleep like 18 hours a day. I was exhausted all the time. I gained an enormous amount of weight. I had terrible pain in my legs and in my feet. And I don't know if it's related, but to this day, my left foot still sort of just randomly twitches. It's kind of amazing. I can watch it. Like, the toes move around and I'm not moving them. They - and that all started with that. It's a difficult drug to be on, not just for me but for everybody.

GROSS: But it...

EGAN: But it also - it also saved my life. I have no regrets. Believe me. It saved my life. I will be forever grateful to Zyprexa (laughter).

GROSS: So you had a lot of hallucinations and delusions during the period when you had that drug-induced psychosis.

EGAN: Right.

GROSS: Being a religious person, did any of those delusions and hallucinations take on a religious significance? Did you think that they were religious visions?

EGAN: What happened, at least for me on the Ketamine, is I thought I had died and that - this was the big, main hallucination when I was really, like, floridly out of it, like knocked unconscious on the ketamine, which I remember that I was going down - anybody who's taken ketamine is going to recognize this. I was going down this long tunnel of swirling pink hexagons. And I was talking to God and I was saying I want to go back to the world. I want - like, this isn't - you know, I want - I want to go back to the real world. And God was saying, I'm the only thing that's real. And I said, no, no the world is real. I've been there. I want to go back. And God said, no, totally not real. You people just made all that up to make yourselves feel better. I'm the only real thing. And so - (laughter) so it was a very religious delusion, hallucination, whatever you - dream, whatever you want to call that. So my brother Dan, like, a couple days later - they kept me in the hospital for a long time after all this, obviously. He called me in my room and he said, hey, Ker (ph), I heard you had a really bad time on the ketamine. And I said, yeah, and he said, OK, tell me what you saw. And I said, OK, well, Dan, I was going down this big swirling pink tunnel and there was a light at the end, and I met God. And he goes, OK, so you went down the k-hole. And I said...

GROSS: (Laughter).

EGAN: I did - I did what? And he goes you went down the k-hole. And I said, oh, my god, it has a name? And he goes, yeah, yeah, of course it does. Haven't you ever been at some party and there's some dude lying on the floor screaming I'm dying, I'm dying? And I said, no, I've never been to parties like that (laughter). I don't know about this K-hole. And he's like, yeah. That's what happens when you take ketamine. It's totally normal. People think they're dying, and they meet angels and God. And that's why people take it.

And I have to tell you. It was the single most reassuring and comforting thing anybody had said to me the entire, you know - five days after the birth was my brother Dan being like you went down K-hole. That's what it's called. So, yes, they were very religious in nature.

GROSS: We're going to take a short break here, and then we'll be right back. My guest is Kerry Egan. She's a hospice chaplain who's written a new memoir, and her memoir is called "On Living." This is FRESH AIR.

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GROSS: This is FRESH AIR, and if you're just joining us, my guest is Kerry Egan. She's a hospice chaplain who's written a new memoir called "On Living." So you have patients who are dying. They're in various stages of dying, and I'm sure some of them have hallucinations or visions of various sorts or dreams - good bad dreams of various sorts - that seem real and probably some of them have a kind of religious or spiritual dimension. What are some of the things you've heard from people that you have to respond to, you know, about that kind of experience?

EGAN: So it's - anybody who works in hospice will tell you - anybody - that it's really common for people who are dying to see their mothers. It's not a necessary step. It's not - everybody doesn't experience it, but it happens a lot.

GROSS: To see mothers who have - who are dead?

EGAN: Already died, yeah.

GROSS: Yeah.

EGAN: And they come. They come to them, and they wave at them and sometimes they talk to them. And it's really, really comforting to people. And is that real, not real? You know, I've come to this place where it's - I don't know, and I'm OK with that. I'm really OK not fully understanding. And I wasn't like that before. I think they are going to be a lot of things in life, whether you've experienced them yet or not, that we cannot fully understand, that we can't fully make meaning of. We can try and that at some point, you have to be OK saying, you know, I don't know that I really know what that means. But it's part of my experience that I need to accept it.

GROSS: We face a lot of significance in a dying person's last words in that final bedside conversation - too much weight you think we put on that. And you say most people have no idea what is going to be their last words. Often people are in a coma for the last hours or days of their life.

EGAN: Right.

GROSS: So what does the whole last words thing mean to you?

EGAN: I think that a lot of people don't have a lot of experience with someone who's dying and that a lot of our understanding of what dying looks like comes from television and movies. It makes for really good drama to have these last words. And so I understand. I completely understand. I'm a writer, too. I get it (laughter). I get why you would write that, but it's not really accurate. And so, you know, maybe hundreds of years ago when people had more experience with death, when more people died at younger ages, when children died, when women died in childbirth, when people died of infectious diseases maybe they didn't have this importance on last words. I don't know.

But nowadays people have this idea that death is going to be this this peaceful process where someone is going to say something very wise at the end, and I think that's - I think it does a disservice to people. That's not typically how people die. And so if there's something you want to say, you should say it now, right? You shouldn't wait until you have these last words. If there's something you want to say to someone who's dying, you should say it now because you really don't know when they're going to die.

And if you are dying or even if you're not, I mean, we should say whatever we want to say right now. If we want to ask for forgiveness, we should do that now because there's a lot of work that goes into forgiveness, into really reconciling with someone. If you want to tell someone that you really love them, like, why would you hold that back? Why wouldn't you tell them right now? Why wouldn't you give them that joy right now? And then you can sort of celebrate together how much you love each other.

GROSS: There's something that I think another chaplain had said to you early in your career about being a chaplain and what you were told was in most of life, you can be weak inside and get through by putting on a tough outer shell. But if you work in hospice you have to stay soft on the outside. So in order to stand up straight, you have to have a spine of steel. What does that mean to you now?

EGAN: I think it's just the nature of living that there's a lot that's so beautiful and so wonderful and so joyful and so fun. And - but there's also so much loss and pain, right? Everybody dies. I mean, that's just the nature of life. And so you're going to have to deal with those losses and that sadness. And there's two ways to do it. And in hospice, you're really going to deal with a lot of loss because all of your patients die, and you do come to love them. You come to love them and their families.

And so you can put on this hard outer shell and not let it affect you, just be like I'm not - I don't feel it. I don't feel you. I don't love you. I don't have no connection to you. I mean, that's one way, and, unfortunately, sometimes a really common way that people deal with the barrage of loss. But to be effective as a chaplain to create that peaceful place, that presence that I talked about, you have to be very open to them.

You have to be willing to enter into their world, to engage with them, to walk with them in that journey of meaning-making. If you're not willing to be soft on the outside, you're not going to get any work done. And if you have to be soft on the outside to be an effective chaplain, well, then something's got to hold you up. And the only thing that can hold you up is sort of an interior strength. That's it. You got to do it.

GROSS: So you find the work very fulfilling is the impression I get.

EGAN: Yes. Very fulfilling. Yeah. I'm a happier person when I'm working as a chaplain.

GROSS: Why is that?

EGAN: It makes me happier. I really tried to figure that out.

GROSS: People would probably think the opposite. It would make you feel terrible because you're surrounded by death all the time. And who wants to be surrounded by death?

EGAN: I mean, death is really sad. When someone dies, it's really sad. But there's also like enormous joy to be had and funny times and happy times and everything. I mean, it's life right? Dying is part of living. And so everything that you have in the course of a life you have in the course of dying. I think it makes me a happier person because I'm constantly reminded of the strength of the human soul. I'm constantly reminded of what people can do and accomplish and get through. I am constantly reminded of of love and the power of how much love people have for each other and the love that's all around us that we just don't necessarily take a moment to see.

I think when people are dying, they can't necessarily do a lot physically. And so they they are in their minds a lot. They remember a lot. They remember their lives. They talk about what they did in their lives, and they find so much happiness and joy in the memory, but oftentimes they'll say, you know, I was so happy. And I didn't appreciate it then. And so that's a constant reminder for me to stop and say, wow, I've got some really good stuff going on in my life right now. I'm really happy. I think a lot of people go around happy, and they don't even know they're happy. It's such a joy to be aware of it.

GROSS: Well, thank you so much for talking with us and for reflecting with us on your work and your life.

EGAN: Thank you for having me.

GROSS: Kerry Egan's memoir about her work as a hospice chaplain is called "On Living." After we take a short break, Ken Tucker will review Leonard Cohen's new album "You Want It Darker." This is FRESH AIR.
TERRY GROSS, HOST:

This is FRESH AIR. Leonard Cohen has just released an album of new songs called "You Want It Darker." Cohen, who is now 82, writes frequently about the fragility of life. Rock critic Ken Tucker has a review.

(SOUNDBITE OF SONG, "TRAVELING LIGHT")

UNIDENTIFIED SINGERS: (Vocalizing).

LEONARD COHEN: (Singing) I'm traveling light. It's au revoir. My once so bright. My fallen star. I'm running late. They'll close the bar. I used to play one mean guitar. I guess I'm just...

KEN TUCKER, BYLINE: In a certain sense, Leonard Cohen's talents qualify him supremely to be a chronicler of oncoming death. His voice sounds as though it is emerging from a tomb, most often now a ghostly whisper, offering serious contemplation, wry observations and sly taunts to friends, fans and whoever may be waiting for him on the other side. The tendency of the melodies to fall into a stately cadence has never seemed more appropriate to the lyrics he's now writing.

(SOUNDBITE OF SONG, "LEAVING THE TABLE")

COHEN: (Singing) I'm leaving the table. I'm out of the game. I don't know the people in your picture frame. If I ever loved you, oh, no, no, it's a crying shame if I ever loved you, if I knew your name.

TUCKER: In a recent profile in The New Yorker, David Remnick quotes Leonard Cohen as saying of his current life "the big change is the proximity to death." I've got some work to do, Cohen tells Remnick, take care of business. I am ready to die. I hope it's not too uncomfortable. The sentiments would be unbearably sad were they not uttered in the context of such vital creativity.

The New Yorker profile is, among other things, a promotional item for this new album, which features some of Cohen's simplest yet most effective lyrics. His mordant sense of humor mixes with religious righteousness on the title song in which Cohen's vocal slithers through the music like a serpent.

(SOUNDBITE OF SONG, "YOU WANT IT DARKER")

COHEN: (Singing) If you are the dealer, I'm out of the game. If you are the healer, it means I'm broken and lame. If thine is the glory, then mine must be the shame. You want it darker. We kill the flame. Magnified, sanctified, be thy holy name. Vilified, crucified in the human frame. A million candles burning for the help that never came. You want it darker. Hineni, hineni, I'm ready, my Lord.

TUCKER: I recently re-listened to some of Cohen's earlier work, particularly my favorite album of his, 1988's "I'm Your Man," and I was struck by how much his voice has changed slowly, steadily, without my realizing the extent of the change. Yes, the process of aging has further constricted his always limited range and added a sandpapery wear on his vocal cords. Nevertheless, he's still singing about, thinking about, one of his eternal topics - the difficulties of romance - on a song such as "Treaty."

(SOUNDBITE OF SONG, "TREATY")

COHEN: (Singing) I've seen you change the water into wine. I've seen you change it back to water too. I sit at your table every night. I try but I just don't get high with you. I wish there was a treaty we could sign. And I do not care who takes the bloody hill. I'm angry and I'm tired all the time. I wish there was a treaty - I wish there was a treaty between your love and mine.

TUCKER: Aging has also added something to Cohen's performances here, a quietness that comes across as intimacy as the musical complement to the confidences he's offering in his words.

I love one of these new songs called "On The Level" for a couple of reasons. The first is the aching couplet you smiled at me like I was young, it took my breath away. The second is the arrangement of the song, the way a rhythm and blues chorus of female voices joins Cohen's, giving the song an added touch of reality, of being on the level with the listener.

(SOUNDBITE OF SONG, "ON THE LEVEL")

COHEN: (Singing) I knew that it was wrong. I didn't have a doubt. I was dying to get back home, and you were starting out. I said I'd best be moving on. You said we have all day. You smiled at me like I was young. It took my breath away. Your crazy fragrance all around. Your secrets all in view. My lost, my lost was saying found, my don't was saying do.

LEONARD COHEN AND UNIDENTIFIED SINGERS: (Singing) Let's keep it on the level when I walked away from you. I turned my back on the devil, turned my back on the angel too.

TUCKER: This album, "You Want It Darker," is filled with an array of metaphors for death. Cohen sings of leaving the table or being out of the game, a phrase that appears in two songs. He picks up the notion of death as the final journey when he sings, I'm traveling light. It's au revoir. And on the title song, he speaks directly to God, using the Hebrew word for here I am - hineni, hineni. I'm ready, my Lord.

Among recent albums about facing down final moments, this album finds its only equal with the last recordings of Johnny Cash, who made tremendous music with a voice that was almost escaping his body. What Leonard Cohen is doing here is less a summing up than a living will, complete with gifts for how to negotiate a life for maximum passion.

GROSS: Ken Tucker is critic at large for Yahoo TV. He reviewed Leonard Cohen's new album "You Want It Darker." Tomorrow on FRESH AIR, my guest will be Donald Glover, who created the FX series "Atlanta" in which he stars as a Princeton dropout who's broke and wants to manage the career of his cousin, who's a rapper. Glover wrote for "30 Rock," played Troy Barnes on the series "Community," raps under the name Childish Gambino - he was nominated for two Grammys - and he also does standup. I hope you'll join us.

(SOUNDBITE OF MUSIC)

GROSS: FRESH AIR's executive producer is Danny Miller. Our senior producer is Roberta Shorrock. Our engineer today is Adam Stanishevski (ph). Our associate producer for online media is Molly Seavy-Nesper. Therese Madden directed today's show. I'm Terry Gross.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.