There was a time, no more than a few generations ago, when the concept of death was not as far removed from American lives as it has become today. It was a time when family members died at home instead of in hospitals or nursing homes, when family members witnessed and better understood the dying process, watching it unfold in front of their eyes. Today, death is a taboo subject, much as sex was in the Victorian era. Our language reflects the unease we have developed with dying, as though it’s no longer an integral part of this thing we call life. We speak in euphemisms. People no longer die; they pass away, become the “dearly departed”, move on to their eternal reward. We no longer have cemeteries but have developed memorial parks. In Southern California, the land where eternal youth is worshiped above all, Forest Lawn is the prototypical cemetery, where the dead are placed in a Disneyland like world of reproductions of classic sculptures and art. We have more plastic surgeons ply their trade here than anywhere else in the world. The gravest sin in Hollywood is not theft or lying but being old.
Though we know better, we have managed to delude ourselves into believing that as long we eat right, exercise regularly, control our cholesterol, we can somehow avoid the fate that is part of life – dying. The following is a true story. One of my patients came to my office for a follow up on the results of one of his tests. Unfortunately, his test revealed that he had an advanced form of cancer. After I shared the life changing news with him, and explained to him the limited treatment options and the expected outcome of his disease, he turned to me and asked, “OK, doc, but what was my cholesterol?” Sadly, he didn’t ask his question in jest.
Throughout the middle Ages and extending to modern times, the Catholic Church inspired the culture of “Memento Mori”, Latin for “Remember Death.” Usually depicted as a skeleton with a scythe, the figure adorned tombstones, churches, and appeared in religious art to remind man of his ultimate fate. Lawrence Durrell wrote that “if art has any message it must be this: to remind us that we are dying without having properly lived.”
The Covid pandemic that has been with us since the beginning of the year has claimed over 350,000 lives in our country alone, and that number is increasing exponentially. To put that in context, it is more than 6 times the number of American lives lost during the entire Vietnam War. Despite this carnage, there are still some who try to minimize the magnitude of this number. Part of the reason is to keep the idea of death at bay, that this is something that may be happening to other people, but will not be happening to us.
Irrespective of the implications of Covid on our own mortality, we as a society need to change our superstitious avoidance of speaking of death openly, and learn to accept the essential truth which death entails. The French philosopher Montaigne wrote: “To philosophize is to learn how to die. To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness; let us frequent it, let us get used to it; let us have nothing more often in mind than death.”
As a physician who works in a hospital, I see how terribly uncomfortable and fearful the lay public is about death, which is understandable, given our social strictures regarding this topic. What is harder for me to grasp is the fact that many of my own colleagues feel just as uncomfortable, and as a result establish barriers to communication between themselves, their patients, and their patient’s families. Even before Covid, I’ve witnessed many patients who sadly died alone because those who should have been closest to them were too uncomfortable to be in the presence of the dying, as if death itself was a contagious disease. Studies have shown that both doctors and nurses spend progressively less time in a patient’s room once a fatal diagnosis has been established. In talking with dying patients, their biggest fear, besides the fear of pain which today can be controlled with medication, is the fear of dying alone, without the presence of those they have loved by their side. We as a profession and we as a society need to do a much better job of educating ourselves about what happens as a person dies. In four year of medical school, I learned a lot about the mechanisms and the treatment of disease, but I cannot recall a single lecture about the process of dying, and how to best care for the dying patient. With the advent of the hospice movement, some of this is changing, but not nearly fast enough. Too many people I know have trouble even talking of illness with family members, and some remain unable to even set foot in a hospital or funeral home. We have a lot of work ahead of us to bring our culture to face the basic reality of life being irretrievably bound to death.