Accepting Death in Medicine

   As a 19-year-old pre-medical student, I thought that chemotherapy was barbaric and medicine was doing more harm than good keeping people alive at all costs. Medicine did not accept death, a completely natural and normal part of our existence. I thought that if we as a culture could better accept death as a natural and normal part of the human condition, then we could practice better medicine. 

    That was some thirty years ago. This summer,  my 77-year-old mother-in-law directed me to an article in the April 2014 issue of the Sun (The Art of Dying, by Katy Butler). And this fall, my 83-year-old aunt Kathy told me about a book she was going to read, which I instantly knew I wanted to read too (Being Mortal by Atul Gawande). I am so thankful to these experts who are bringing this topic into the limelight. 

    It can be hard to die in America. Harder still to stay in command of our personal dignity as we age and the medical system intervenes. Like the zombies our teenager’s are so fixated with, some of our elders have become like the living dead.

   Albert Einstein thought that the chief objective of all technology must be concern for humankind, and that if applied science is not bringing us happiness, then we have not yet learned to make proper use of it. 

    Our elders are such treasures. And yet when you talk to them, they will often tell you that they feel like such burdens. Our elders are the wisdom of our society. We can do much better than isolating and institutionalizing them.  When we hear their life stories, the resiliency and courage of the human condition is sparked within us all. 

      Arthur Kleinman’s pioneering work in cultural competency became central to my doctorate. Finding out how we understand our illness, our chief problems, feelings, hope and fears, helps us in our healing, that is, in making our hearts more comfortable. These same questions may also help us in our dying.

    As Dr. Atul Gawande MD suggests, when we ask, “What is living a life you'd find worthwhile?”, we are practicing good medicine. What we need are honest conversations and honest choices. To find out what is most important, and consider how procedures may or may not actually be in alignment with what we actually want. 

   Einstein regarded our science, measured against reality, to be primitive and childlike, yet also considered it the most precious thing we have.  I no longer have such a radical view of chemotherapy, or of medical care at the end of life. I am grateful to my many colleagues who work to better cancer therapies, to those who care for cancer patients, and to those who administer to the dying. I am thankful that America is a free country, and that we have the freedom to choose what we want, in living and in dying. 

      My hope is that all Americans have access to healthcare professionals, such as hospice nurses, who attend home deaths, as we have midwives who attend home births. It can take a long time to come into this world, or to leave this world, or we may birth or die very quickly. My grandmother sat with dying people in their homes. She was a nurse in St. Louis during the Great Depression. My aunt describes her as patient and kind, and as a brilliant woman. When she came home from work, she would take a bath and then go play the piano, before going into the kitchen to make dinner. 

   We are all heroes on our own journeys, stars of our own lives. And as authors of our own lives, how do we want our stories to end?

   Do I want dialysis, open-heart surgery, antibiotics, feeding tubes, respirator, or any other technology assisted living at the end? No. I rather may want assisted dying if I were suffering in excruciating pain. Will I be able to accept my own death when the time comes? I can only aspire to. Knowing the beauty of home birth, I would choose to die at home with my children and loved ones at my side. With flowers and candles and song and fresh air coming in through my bedroom window. Yes, and have cake.