Reflections on Death and Dying

Someone once said, “Only two things in life are certain: death and taxes.” Interestingly, though death and taxes seem to be completely separate and unique ideas, they have a bit more in common than just their certainty. Both death and taxes seem to evoke a similar emotional response – something that is mine is being taken from me and I really have no control over it. Be it money or even the very life that I have lived, there comes a time when it is demanded back from me. We feel upset or angry, cheated, taken advantage of, maybe hurt, confused, or sad. Consequently, we don’t just go around talking about these things. Furthermore, death tends to be an even more sensitive topic because the pain of loss is felt not only by the dying person, but also potentially by the surrounding friends and family. (I’ve rarely heard of someone weeping over another person’s taxes – well, never.) The questions around the topic of death also tend to eventually lead to a discussion of religion – a conversation many have avoided, chosen not to explore or talk about, or aggressively rejected while proudly marching under the “Shoving It Down My Throat” banner. As a result, death is a difficult issue for everyone that few really choose to sufficiently acknowledge or process. As a physician, however, and maybe even more-so simply as a human being, if I am to fully understand and appreciate life, I feel I must confront this seemingly ominous issue of death. This paper will hopefully serve as a platform to articulate my attitudes and feelings surrounding death and dying.
For most people, exposure to death and dying occurs at a very early age. We attend a funeral with our parents, we read or hear something that causes us to think about death, or we see something on TV or in a movie –each of these mediums carrying with it its own set of connotations or cultural interpretation. In my case, I don’t remember exactly what my first experience with death was. Fortunately, I have still not yet had to endure the death of someone extremely close to me. Nonetheless, throughout the years I have experienced the deaths of a great-grandmother, an aunt, an uncle, a cousin, and even some classmates. Each of their passings mostly served as reminders of the fragility of life – but since I was not especially close with them, I did not feel the deep hurt and loss except sympathetically through those I saw who were genuinely hurting.
The earliest childhood experience that I can remember of dealing with the pain of loss of a friend was in preschool. There was a girl that I had made friends with and even had a little crush on (or whatever you call it at that age) and one day I learned that she and her family had moved to Texas. So, though she didn’t die, I remember coming home and crying – feeling the pain and loss that was much like having her die. I knew I would never see Abby again. And it hurt. I didn’t understand why people couldn’t stay together. Why do we have to have goodbyes that are so permanent? The experience left me mostly hurt and confused.
Similarly, I imagine my first thoughts and questions about death revolved around these issues of loss. It seems unfair. You feel like a part of you has been ripped away and you can no longer continue on in the life that you knew. You have no control. Why is life so fragile? Could I die tonight or this afternoon? Am I guaranteed a certain number of days? If we’re not, then why does everyone act like they are? Would I live my life differently if I actually believed my days were numbered? How would my priorities change? Ultimately, questions of God and what happens after you die arise. Why would God let this happen? What happens to us when we die? Is there actually some purpose to death? Should I be scared of my own death? What if my mom or dad or brother dies? How would that make me feel? Like taxes, we lose something we feel we really shouldn’t have to lose. But, unlike taxes which we know go to our government; the “after life” destinations are a bit less certain. So, in spite of not directly having someone close to me die, as an introspective child, I know that death is an issue that I have thought a great deal about and an issue of which I have had many questions.
In my home death was not a topic that I really ever remember talking about with my parents – save in the context of Christianity – which has been the main influence in developing my thoughts about death. Through learning about Jesus, I learned that all people die, but that eternal life is available through Jesus’ death and resurrection. Death need not be viewed as such the terrifying termination that it is so commonly thought to be. As a result, Christianity slowly began to settle much of my confusion and hurt. As I grew in my faith and wrestled with it – transitioning from it being “my parents’ religion” to my own way of life – death started to make more sense and the hurt of it has been progressively resolving – though there are always questions.
As I mentioned above with the my experience with Abby, most of my separation anxiety has come not from people dying, but from moving and transitioning from one group of close friends to establishing another as school and careers push and pull people in and out of my life. I have been incredibly blessed to have amazing relationships with my friends and family – so each transition has given me insight into appreciating relationships and dealing with separation - all the while, the guiding light has been the teachings of Jesus and a constant desire to live and see the world the way he does. If there is any sense be made about death, it seems logical to me that Jesus, who healed people and raised some from the dead, and who he himself was raised after his death – that this man would be the authority not only on death, but also on life. Perhaps that last statement sounds a bit askew depending on where you’re coming from, but since this is the issue at hand, I must explore it further.
I do not care use this paper to justify why I have chosen to follow Jesus save that he says he is the way, the truth, and the life – three things which I have very much interest in finding in my own life, and that by learning and trusting in him, I feel that I am learning to better love others, not because I’m some nice guy who just wants to be everyone’s buddy, but because love is powerful and it sets us free and because Jesus continues to show his love to me. So, having said that, let me continue by considering some of the answers to these questions surrounding death in light of my relationship with Jesus – and, furthermore, what I believe a “good death” would look like. (I offer these thoughts humbly and with near certainty that my views will more than likely change as I grow and mature.)
Life is fragile. People are dying all the time. My life is fragile. I could be a pessimist… or perhaps a realist, and recognize that I could very well die tonight or this afternoon from a car accident – I’ve had friends die that way, or from an illness – I’ve had family die that way, or from a slip on the ice. I am not guaranteed any certain number of days. This is something that I cannot control. How does that make me feel? Well, I can get angry about it. But, that really doesn’t get me anywhere. So, if I have no choice, I might as well be happy and thankful for the time that I have. This seems to sit best with my heart.
So, recognizing that my days are finite and not guaranteed, should I live these days of life differently? Should my priorities change? This has been a difficult question lately. Is medical school the thing that gives me so much joy that if I die at the end of the semester, I would be happy with how I spent my last months? I am trying to realign my life so that I can say YES! This has involved putting my relationships with family and friends and with God above my academic “at-a-boys.” It has meant letting go of all the things that seem so important, but in the end everyone says they wish they wouldn’t have chased after so hard. I am starting to choose going to church or visiting my grandma or my friends over spending that last 4 or 5 hours studying. It has been exhilarating! I study to pass, and I cram the rest of my time into the lives of others. I believe Jesus says that we should be responsible with what we have, but we should always keep our eyes focused on that which is most important.
My grandma is currently not doing very well. She is 96, I believe. She fell out of her wheelchair, and for the first time, she is really having a hard time getting around. It is becoming a very difficult challenge for my mom and her sisters. I was helping my mom take care of her the other night and I did a couple tests to try to figure out what was going on with her leg: some muscle strength grading, some testing of sensation. In the midst of listening to my grandma talk about what she was feeling, not only the pain, but the feelings she had about being helpless, her feelings of guilt for falling out of her chair and being a burden, the frustration with dealing with my tired uncle – I found myself torn between two worlds: my academic mind wanted to help her by making the right diagnosis, but my grandson mind just wanted to listen and love her. What is really important here? That which is important is the latter. As my grandmother reaches the end of her days, more than anything else, she wants to know me and to have me know her. In the end, the right diagnosis is wonderful, but it really just delays death. I don’t say this lightly, but I feel that medicine sometimes wars against our ability to see what is truly needed – especially as we deal with end of life issues. The temptation is to become so consumed with the science that we neglect that which makes life worth living in the first place.
Furthermore, as my life with Jesus continues to grow, I realize that death is not to be feared. Not only is it is just as much a normal part of life as being born, or breathing, or eating, but Jesus – according to the testimony of many witnesses who were willing to die for this testimony – was killed and rose again as he had predicted. The great part is that he says the same is available to us. If I don’t want to be afraid of death, I just need to try to live like he did – love God, love others and hunger for the truth. In other words, I invert my priorities from living for me, to living for God and for others. The issue then becomes not so much a matter of living to die, but dying to live. Instead of focusing my life on what I can gain and how much more time I can spend getting a better degree or better this or that, it becomes the opposite where I am more interested in serving others and loving others and helping them reach their dreams – not because it is easier (because sometimes it isn’t) – but because Jesus says that in dying to myself, I will actually find that I am more alive than I ever thought I could be. I am finding this to be absolutely true. If I pass an exam by only one point because I spent time talking with my sister about her difficulties at school, that is time perfectly spent. I love my sister far more than my car or my apartment or my grades, and as I choose to model my life after that which I know to be true in my heart, this semester is becoming the exact way I would live my life even if I knew the I only had until the end of the semester.
So, in essence, a “good death” to me has very little to do with death, and everything to do with living. A good death is what I am trying to do all the time – kill the selfish priorities that I have for myself and learn to live for others. It’s actually the best death because it leads to life. Maybe when we think of a “good death” we think of issues of pain and suffering. These things are not desirable by any means, and I believe they should be minimized as much as possible. But these are minor issues of death and dying. The good death is the death of someone who chose to rightly live and because they loved truth and others, they have no fear of dying, but welcome it as just another transition – like waking up after a good night’s sleep. Additionally, it may seem like a good death would be a nice peaceful death with friends and family all around. It does sound nice. But, again, we don’t always have those options… and if friends and family are around, how often are their faces not smiley and happy, but scared or disheartening as they deal with the medicine, the legalities, and the loss? Again, priorities get contorted. The good death, then, is probably a death free of lawyers, doctors, and wills – but time with the family enjoying each other and celebrating the life shared with each other.
Finally, I know that there will be challenges and issues that I face as a physician that no amount of training will prepare me for. I think this is good, though. As with the story of my grandma, we need times of academic foolishness to remind us that we are firstly human beings and that a dying patient might very well not need a diagnosis, but someone to listen and love. As fluffy as it sounds, it’s the truth – and it’s not fluffy, either, it’s often the very most potent, efficacious drug known to man – and it carries no side effects! So, if I find myself working with terminally ill patients or children with cancer, though it seems sad, since I believe that death is normal and not something to be afraid of, I feel that I could be very satisfied being given the honor of sharing the last few moments with a dying patient. Even when dealing with an ornery or obnoxious dying patient – by loving Jesus, I am becoming more patient and learning to not to ask myself, “why does this patient annoy me?” or “why doesn’t this patient just chill out and get off my back?” but rather to ask myself, “how can I really love this person?” “How can I flip their world upside-down by loving them when they really expect me to treat them the way everyone else treats them?” See, Jesus teaches me to even love my enemies and to cast my burdens on him. So, I believe my priorities as a physician are first, to love the patient, then, to do my best as a trained physician, and finally, trust the Lord for the rest – whatever it might be.
Though this paper has seemed to me a little more disjointed than papers I typically have tried to produce, it has been a good exercise of exploring my thoughts and attitudes about death and dying. Death is a normal part of living, but rather than concern myself with fears of losing my life, I have found that the more I loosen my grip on my own life, the more abundant and refreshing life seems to be. And through my faith in Jesus I’ve come to question if the only certainties of life are death and taxes… maybe it’s just taxes. Ultimately, I hope that through my interactions with patients – even more than simply making the right diagnosis – I am able to let this abundance of life overflow into them simply by loving them.