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Scrubbed, gowned and flat on a gurney awaiting the cancer surgeon's knife, Garland Grizell was startled when the head nurse broached a touchy subject. "We have to talk about the Big D," she told him.
" 'The Big D'? You mean death?" Grizell asked incredulously. "What is this, Sesame Street?"
The 61-year-old former Broadway and Las Vegas dancer survived that bout with illness -- and with medicine's often-awkward efforts to avoid confronting death. Now that he's facing terminal emphysema, Grizell is relieved to have found Paradigm, the one-stop shopping center for all your dying needs.
At Paradigm's weekly meetings, experts discuss wills and trusts, spirituality, sexuality and the final stages of life. A specialist from the Hemlock Society explores the euthanasia option. Honest talk about such real-world concerns has proven to be a balm for the anxieties of the terminally ill, who often find they are expected to be unobtrusive "patients," passively awaiting the end. At subsequent meetings without the presence of experts, the afflicted take charge and apply the topics to themselves.
Wresting control from the grim reaper is the concept behind Paradigm, an innovative San Francisco organization that ministers to the dying. The 10-week program is the invention of Richard Wagner, 45, a gay Roman Catholic priest whose inexhaustible humor cushions the constant contact with death. "It's easier to work with people who aren't terminal," he acknowledges. "And it's a lot easier to find funding for programs for the living -- few people are in a position to be grateful when they're dead."
But some are. After a presentation on probate by San Francisco attorney John Goodman, several participants wrote Paradigm into their wills. One man left a car, another a computer. "Getting into the legal aspects of delegating health-care powers and writing an actual last will and testament can be a very self-confrontational step," says Goodman, whose own partner died recently. "It brings the reality of death home to people." Goodman offers pro bono estate planning to Paradigm participants.
Wagner's unapologetic homosexuality has often put him at odds with official church policy, and his own priestly order has censored him in the past. Yet the priest sees no conflict between his role as a cleric and his ministry to the dying. "Paradigm has nothing at all to do with the Catholic Church, nor am I acting in my capacity as a priest," Wagner states.
He also insists that undue influence from the Hemlock Society is a nonissue. "There's an enormous difference between suicide and the informed act we call 'self-deliverance,'" he says. "And we don't advocate anything. Paradigm just dispenses the information -- we allow our intelligent participants to decide for themselves what to do with it."
Wagner's professional experience with death dates from the first wave of AIDS cases in the early '80s, though he stresses that Paradigm is open to persons with any terminal illness. "In those days the kids were so young -- they had no idea of death at all," Wagner recalls. "They'd go, 'You mean ... no more Donna Summer?' Now we're all so used to it, but that doesn't mean we deal with it very well." In his work on the front lines of the AIDS epidemic, Wagner has counseled hundreds of terminal clients. "I feel I've died with them so many times," he reflects, "and yet I breathe and they don't."
After years working with individuals as a therapist, Wagner realized that a common set of fears and confusions apply to most of the dying -- and late last year Paradigm was born. Now, as a kind of death coach, he's often in the strange position of burying his graduates, many of whom first have brief careers as counselors to others near death. Wagner charges nothing for the course, relying on modest donations from friends plus grants from offbeat groups like the Sisters of Perpetual Indulgence who share a sensitivity to good works that are marginal and out of the mainstream. "I sent my eight-page, single-spaced Paradigm prospectus all over the place," Wagner says. "A lot of people said they'd contribute if they didn't have to read it."
Like many, Wagner once regarded death as repulsive and awful. "As a young priest out of seminary I was intimidated and frightened being around the sick and the dying," he recalls. "It's }one reason I asked for a teen ministry -- I figured nobody was going to die in high school."
When friends prevailed on him to perform graveside rites for an acquaintance, Wagner reluctantly complied. As he left the cemetery, an elderly woman told him his words had been beautiful then made him promise to do the same ceremony for her when the time came. Nervously, Wagner asked how old she was. "I'm 81," the woman said.
"Goodness, it hardly pays for you to go home then," he replied without thinking, as they strolled past the tombstones. Though the woman's sons were scandalized by the remark, she found it hilarious -- and Wagner began to realize that many people near death share different values.
"Dying people are wonderful," says Wagner as he prepares for a meeting of his Paradigm participants by baking a pecan pie in his comfortable, plant-filled apartment overlooking the Panhandle. "It's the survivors who tend to be a pain in the ass."