Readiness is all

Death has been prominent in my mind these days. Maybe it’s just the winter, and its constant reminder of the coming of the White Walkers which my mind seems to associate with Kamatayan (the Grim Reaper) himself. Or maybe it’s because I am approaching my 47th birthday, and that means I will have beat my parents who both passed at the age of 46. That might sound morbid, but for me it is a milestone to celebrate.

The late Steve Jobs, in that uncharacteristic and much-shared speech he delivered at Stanford University some years ago, said: “Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything—all external expectations, all pride, all fear of embarrassment or failure—these things just fall away in the face of death, leaving only what is truly important.”

Most people tiptoe around death. No one wants to talk about it. It is one of those taboo topics, especially in our culture. Just for fun, I wrote my own eulogy a few years back. Sure, it was unsettling, yet it was also illuminating, as it made me recognize how I needed to recalibrate my life.

If you ask anyone to choose between living a full life to the very end (to say a proper farewell to loved ones, eat ice cream, write something meaningful, watch the sunset, perhaps even travel) and be in hospital during those last few months or weeks, half-dead and connected to all kinds of contrivances, I bet most people would choose the first one. Yet, that is not what happens for most people.

BJ Miller, a doctor and triple amputee who heads the Zen Hospice Center in San Francisco, says that medicine was designed with disease at its center, and not people and life. As a result, hospitals are not equipped to make dying people live their lives fully to their last days. Our modern medical care system totally fails to meet the real needs of human beings, and the cost of this failure goes far beyond the money spent trying to prolong life.

Atul Gawande, a surgeon, writes in The New Yorker magazine that the hard question we face is “how we can build a healthcare system that will actually help dying patients achieve what’s most important to them at the end of their lives.” Gawande writes: “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.”

There are many factors that conspire to make this fight to the bitter end the norm.   Foremost among them is hope, hope on the part of the dying him/herself and his/her family, and the acquiescence of the doctor who does not want to be the one to extinguish that hope. But really, hope is just the other side of fear. Loved ones will choose to sacrifice the quality of a dying person’s existence now, in the desperate hope of gaining more time, maybe even a miracle, and the fear that letting go means giving up.

Hospice, in particular, is a topic that the dying person’s family tries to avoid at all cost, because it means giving up and taking away hope. The natural assumption is that when a person is put in hospice, then it hastens his/her death.   However, there is credible research that shows the opposite. Gawande says: “The lesson seems almost Zen: You live longer only when you stop trying to live longer.”

There is a growing movement in Europe and the United States called the Death Café. In its website, it says that its objective is “to increase awareness of death with a view to helping people make the most of their (finite) lives.” It is a venue for people to talk openly and freely about death. Indeed, we must be able to talk about death, and not when it is too late.

Oliver Sacks, another surgeon, wrote beautifully before he passed: “I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return. … Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

To be coherent enough and be able to say these same words to ourselves when it is our time would be a gift, don’t you think?

Everything is ephemeral, our human lives included. Dying people are living. Dying is part of living.   If we can accept that, and talk about it, it will be for the better.

Joel Villaseca ([email protected]) is a lawyer living in New York City, and a Search Inside Yourself certified teacher (siyli.org). He is a cancer survivor.