The idea of death is distressing, but it’s the act of dying that’s most unbearable to think about. And the more experts I consult on the topic of what to expect, the more confused and uncertain I become.
If you haven’t visited The Death Clock, you really must. Enter your date of birth, height, weight and Body Mass Index, and the Death Clock spits out the day and date on which you’ll hear the galloping hooves of the pale horse.
Mine is Tuesday, December 9, 2036.
Until that date, I can step whistling into the paths of vehicles. I can season my steak with asbestos and press my vital organs against the microwave as it cooks.
Unless, here at late-midlife, I absorb the other, far more important, more honest and less entertaining message of the Death Clock: You’re probably not going to Die today, goes that message—but you are certainly, on some actual date in the easily-conceivable future, going to Die.
I wonder what that will be like.
That I even have to wonder is testimony to our modern success in sealing the process and fact of death away from the living, especially in the US. There was a time when dying happened mostly where living happened, at home, and I’d have seen every stage at this point. But now only 1 in 5 Americans die at home, and further eliminating those who are dropped on the spot by heart attack or stroke leaves very little dying to witness.
No wonder I wonder.
The difference between death and ice cream
I am afraid to die. This puts me in the company of most sane people, religious believers included.
As a nonreligious parenting author, I’m often asked how, without benefit of religion, I intend to make the contemplation of death go down my children’s conceptual gullets like ice cream on an August day. Depending on my mood, I either pretend that’s possible, or I don’t, since it isn’t, whether or not you have religious faith. Death is hard to take, and it always will be. Darwin rather insists on it. And honestly, I liked seeing the fear of death in my kids’ eyes once in a while when they were young. It made crossing the street and teaching them to drive much easier.
I can tell by the applause all around me—ancestors behind, descendants ahead—that “I don’t wanna die” is just the sort of thing that I, as the baggie-of-the-moment for my family’s genetic material, am supposed to feel, for their sakes. I’m the keeper of the keys.
Wait a minute.
Come to think of it, that’s no longer true. Between 1994 and 2000, I lent my wife the keys enough times to produce three new bags of DNA, then went under the knife to ensure that, genetically speaking, I would be of no further use. My shift is over. I can clock out any time now.
As a result of completing my sole genetic responsibility, my fear of death no longer serves any real purpose. Maybe vasectomies will eventually engender a population-level selective response in the recipient: the snipping of the vas deferens leads the now-superfluous man to impale himself, thornbirdlike, on the surgeon’s waiting blade, relieving the tribe of 30 additional football seasons of pressure on the supply lines of Cheetos and Bud.
Until then, boys, fear death and eat up.
Doubting (Dylan) Thomas
There are ways to diminish the fear of death and dying. Epicurus may have been the first to formally note that our existence is bounded by symmetrical eternities. We fear the eternity of nonexistence after death without realizing that we’ve already “experienced” nonexistence: the eternity before conception. Will you be scared a hundred years after your death? No. Not even two minutes after. Just as before your conception, there will be no “you” to be frightened. No difference.
Epicurus has now had 2,292 years to test his hypotheses. (No word yet on how it’s going, which tends to support his point.)
It may be possible in a situation like this to not think of Dylan Thomas, raging against the dying of the light, but I can’t help myself. I’d known the last two lines of that poem, the famous lines, for years (“Do not go gentle into that good night / Rage, rage against the dying of the light”) before I learned the rest of it. Those two lines went through my head, usually as a little internal chuckle, every time the lights went down in a theater or a thunderstorm shut the power off. I was about 16 when I finally saw the whole thing and realized it was about dying—and that it was addressed to, though never shown to, his dying father:
Do not go gentle into that good night
Old age should burn and rave at close of day
Rage, rage against the dying of the light.
Though wise men at their end know dark is right
Because their words had forked no lightning they
Do not go gentle into that good night.
The middle of the poem doesn’t stick in my memory—something about wild men, and grave men, all of them enraged at the coming darkness. But the end I know by heart:
And you, my father, there on the sad height,
Curse, bless me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
Though I don’t want or expect my kids to ever find death delicious, I’d like to keep their concerns about it manageable, and I’ve always found understanding to be the best path away from fear. In this case, I was able to draw on another in my arsenal of death-softeners—the fact that most people, by most accounts, don’t go out kicking and screaming, but do, in spite of Dylan Thomas, go gentle.
Here’s another Thomas—doctor, biologist and essayist Lewis Thomas—writing in one of the most wonderful popular science books of the past century, Lives of a Cell:
In a nineteenth-century memoir on an expedition in Africa, there is a story by David Livingstone about his own experience of near-death. He was caught by a lion, crushed across the chest in the animal’s great jaws, and saved in the instant by a lucky shot from a friend. Later, he remembered the episode in clear detail. He was so amazed by the extraordinary sense of peace, calm, and total painlessness associated with being killed that he constructed a theory that all creatures are provided with a protective physiologic mechanism, switched on at the verge of death, carrying them through in a haze of tranquillity.
I have seen agony in death only once, in a patient with rabies; he remained acutely aware of every stage in the process of his own disintegration over a twenty-four-hour period, right up to his final moment. It was as though, in the special neuropathology of rabies, the switch had been prevented from turning.
Lewis isn’t the only witness against Dylan. There are countless testimonies suggesting that the process of dying is more often a peaceful, tranquil one than not. And that’s some darn useful consolation — since Epicurus really (truly) cured me of the worst of my fears of death itself, only the fear of dying remains to be dealt with.
“A sleep and a forgetting”
It is not death, it is dying that alarms me.MICHEL de MONTAIGNE, dead person
Death is distressing, but it’s the act of dying that’s most unbearable to think about for me—the minutes in which you realize your conscious existence is really ending. Though it takes some effort, we can neutralize our fear of death by realizing, with Epicurus, that we will never experience it.
But dying is different. Dying, not death, is the horror. Dying is real, individual, personal, because you know you will indeed experience it someday. That’s why coming upon a dying bird, or dog, or person, is a hundred times harder to take than coming upon a dead one.
I might, before I die, come to terms with death, but I still tend to see myself kicking and screaming during the dy-ing portion of our program. In a strange way, that realization can turn death itself into a friend, since it represents the end of the thing that is really feared: dying. The testimony of Lewis Thomas—that most people die quite peacefully and without apparent fear — ought to help, but I’d like to hear someone second that before I go grabbing at consolation.
In addition to being born on my birthday, the 16th-century philosopher Michel de Montaigne invented the personal essay, then used the form to write about anything that popped into his head. That’s right—he was a blogger. Fortunately, fascinating and worthwhile things popped into his head, including the nature of greatness, human vanity, lies, laziness, thumbs, birth defects, the passing of gas, smelliness, anger, cruelty, cannibals, laughter, solitude, drunkenness, and how it could be that children resemble their fathers. He also wrote extensively about death, since he thought himself on the brink of it many, many times from kidney and bladder stones.
One time he nearly went over that brink, but lived to write about it—and to soundly renounce the earlier alarm he had about dying.
During one of the series of religious civil wars that convulsed 16th-century France, Montaigne went riding near his house with friends. One of his servants, a strong man riding a powerful horse, was nearby with his own companions. The servant decided to show off and spurred his horse at full speed, coming up behind Montaigne unintentionally. He lost control, and horse and rider came down on Montaigne and his much smaller horse, sending them both flying. Montaigne’s horse lay bowled over and stunned, while Montaigne, 20 feet further on, lay unconscious on his back, bruised and skinned, his entire body, as he put it, “having no more sensation than a log”:
My own companions tried everything to revive me, deciding at last, and for good reason, that I was dead. With heavy hearts, my friends bore me up and carried me to my house, more than a mile away.
After I had been thought dead for over two full hours, I began to move and breathe. With much excitement my companions helped me to a sitting position. I vomited great clots of blood, blood enough for filling buckets. It amazes me still that any remained in my small body. We would move a hundred yards, and I would vomit blood again. We continued so for a long stretch of time, during which my feelings were at first much closer to death than to life.
When at last I began to see anything, it was with vision blurred and weak. I could perceive only light. I did not have any idea what had happened. When at last I could focus enough to see my doublet – covered in blood I had thrown up – I thought I had been shot by a musket. We had heard skirmishes nearby – our immediate region was always in dispute during times of war – including many gunshots, so a musket shot seemed the most likely explanation.
I had a sensation for a time of my very life hanging at the tip of my lips. A strange idea floated into my head: I had a choice to breathe my life back in or to push it out and away. Most strange, that feeling. And I chose, quite without distress, to push it out. I tried to do so, coaxed by that sweet sensation one feels when about to drift into sleep.
It seems to me that what I describe must be the common feeling one has on death’s door, a feeling of naturalness and repose. We fear death because we view it from a condition of vigor and strength, a condition we cannot bear to relinquish. But the act of dying, I now believe, must be most often a gradual one, a gentle resignation, proceeding by stages so incremental that each seems a more natural, even a more desirable step than a jolting return to the full vigor of life.
This recollection of Death’s true face, so strongly implanted in my mind, has reconciled me to it a good deal. Philosophy cured me of my fear of death, while Experience cured me of my fear of dying. What else then is left for me to fear?
It’s Livingstone again, peaceful in the jaws of the lion.
William Osler, one of the founding physicians of Johns Hopkins, sharing my curiosity about the final moments of life, examined the death records of 500 patients with special attention to “the sensations of the dying.” Of the 500, he found that “the great majority gave no sign one way or the other; like their birth, their death was a sleep and a forgetting.”
I’d like nothing more than to end on that note, to walk away reassured. But Sherwin Nuland won’t allow it.
In a lifetime transfixed by the study and contemplation of death, I’ve encountered nothing more gripping and thorough on the subject than Nuland’s 1994 book How We Die. It was there that I learned about Livingstone’s and Osler’s equanimity. But it would be malpractice to pretend that Nuland himself, a physician and bioethicist of long experience, didn’t shatter that equanimity a few paragraphs later.
“And yet I am puzzled,” he wrote, damn him:
I have seen too many people die in suffering, too many families tormented by the deathwatch they must helplessly keep, to think that my clinical observation is somehow a misapprehension of reality. The last weeks and days of far more of my patients than Osler’s one in five have been overfull with a plethora of purgatory, and I have been there to see it.
He notes that Lewis Thomas spent most of his career in laboratories, and that Osler was examining not 500 patients, but 500 records, and was suffused with “a well-known optimism that the world is really a much better place than we take it to be,” and a zeal to “transmit that rosy philosophy” to the world.
I don’t want rosy philosophy. I want to know what dying is like. So I turned at last to the living.
Dr. Eve Makoff is a palliative care physician, someone highly and intimately familiar with life’s final moments. She has written movingly here at OnlySky about her experiences. So as someone hermetically sealed away from the deaths around me, I asked her: Do people in their final hours or minutes tend to experience a peaceful transition or a difficult one?
Her answer was pragmatic: it depends.
“Those lucky enough to have a skilled hospice team will die peacefully,” she said. “Otherwise it depends on what they die of, and whether they have access to comfort medications.”
She added that my question had come at a tragically opportune moment: Just days earlier, a close friend’s husband who was also a doctor had died of a heart attack while hiking.
“I keep imagining what he went through at the end,” she said. He was not lucky enough to be in the presence of a hospice team or comfort meds, so she can’t know for sure.
If even someone of Dr. Makoff’s experience can only imagine, what hope is there for the rest of us wonderers?