A matter of life—and death

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.