Last Wishes; Last Reality

Linda Seccaspina’s essay was courageous and thoughtful. I have found that the few people who have the fortitude to ponder death and death-related issues and talk about them occasionally but meaningfully are the people whom I like best to be around. They tend to have some depth.

Determined to demonstrate that I myself have some depth, I launched into the task of drafting my response to her Open Call on the subject.

I first wrote a section on my credentials that license me to comment on the subject. I cut that. I am licensed to comment on the subject purely by reason of the fact that I am a human being and therefore will die myself.

I then wrote a section on the two foundation premises of meaningful thought on the subject as I see them in today’s world:

  • We do not die today in the way that we as a species have historically died. Death is no longer an event. It is a process.
  • Life is not a gift. We pay for our lives with our own deaths. The quality of the payment we give informs that for which we are paying, our lives, in a significant way.

I fleshed out these two points with some nice historical examples and some brief examples of historical thought on the second proposition. I cut all that.

I then wished to make clear what we are up against and offer some blunt, honest talk on the subject through a discussion of an additional three points.

  • Even the very few will suffer, those who die a quicker death than the rest of us. There is no such thing as an instantaneous death. (A couple of literary quotations there originally to spruce the thing up.)
  • We will all be tortured in the end, every single one of us.
  • Since the very essence of torture is the stripping away of the victim’s dignity, there is no such thing as a “death with dignity.”

It was in the context of the second point that I initially parted company with Linda on only one point. To sit on the couch, watch reruns of Green Acres, and fade away is a laudable objective, I thought. I liked the idea of it, but I simply did not see how one would be able to accomplish that while in the grip of physical and mental torture. Then it finally occurred to me, being a bit slow, that she was joking and that I had temporarily misplaced my own sense of humor.

I have edited out the rest of my elaborations on these propositions, which ought to be, it seems to me, self-evident to any observant, thinking person.

I then wrote a section explaining the contrast that I have observed between the way the Mexican people approach the subject and the avoidance strategy that people in the United States employ when they cling to the hope of a “death with dignity,” an oxymoron. As a general statement–a bit of a shaky one as all general statements tend to be– the people of Mexico tend to speak of death with courage. There remain only two questions for them:

  1. How long will my own torture last?
  2. Will my courage hold out until it is done?

I edited away all the extraneous material in that section.

I then hypothesized a person who engages in meaningful thought in an attempt to arrive at some conclusions about the manner in which they themselves wish to negotiate this new process of death. An example of one conclusion they might reach, and only one of many, is that they might wish to do their own death with unfailing courage as I believe most Mexicans do.

Taking death with courage as an example of an objective then, I outlined my ideas on how one might give themselves a real shot at accomplishing that by putting together a plan in advance. I then concluded with a paragraph–one of the best paragraphs that I have ever written in my life, I think–illustrating what I see as a reward for all this. The whole idea was to persuade people who are not sick yet to do what they ought to do anyway.

I absolutely had to edit all of that out of my response to Linda’s Open Call for the simple reason that I am abysmal at telling others what they should do with their lives and by extension their deaths.

I believe so profoundly that each and every one of you is free to do as you will. Freedom that is not exercised is a meaningless abstraction. Each of you is free to avoid thinking about these things at all. Nobody else is bending any of your arms up behind your back in an attempt to force you to fashion some plan regarding your own death and discuss it with the people who need to know, a plan based on your own clear thought about the ins and outs of it when it will be hard upon you. Indeed then, why should I?

Each and every one of you is:

  • Free to be trucked off someday to the nearest medical facility suffering mightily from a life-threatening condition never having previously considered what is going to happen next;
  • Free to delay rational thought and rational decision-making concerning what happens next until that time when rational thought and decisions are perfectly impossible;
  • Free to allow well-meaning people employing every device known to modern medical technology to slowly mold your own natural torture into something so implacable, so relentless, so horrific that is beyond your human ability to imagine in advance;
  • Free to be secure in the knowledge that after your final loss of consciousness this unimaginable torture will continue until the last little brain wave in your head blips its last little blip;
  • Free to maintain your ignorance of hospice services and other alternatives and never discover what these things have to offer until that time when they have nothing of real value left to offer;
  • And free, most importantly, to relish your utter surprise that this all is happening to you.

* * * * * * * * * * * *

For those few who are interested in further reading, I recommend a new offering, “Letting Go,” Atul Gawande, M.D. (and all the rest of the letters), The New Yorker, 2 August 2010, p. 36, available in its entirety on line here–and coming in at considerably more than 1000 words you should know.

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