October 1 , 2015 /


Assume you write for an audience consisting solely of terminal patients.  That is, after all, the case.”    Annie Dillard, On Writing, p. 68
At age 41 I had an epiphany about my own mortality. I was leaving my office, driving through a parking lot toward the main street.  I had to stop the car as I had an overwhelming sense of something that I can only call a revelation.  It was as if the world opened up to say “Here is something big.  Pay attention!”  The message was this: “I did not need to fear my own death.  It will come in its own due course.  Others you have known have died and others you know and love will also die but you are now free to live without any worry about when or how you might die.”  I sat there in stunned silence wondering why me, why now, why here?   The other question was all right, what am I to make of that?  Was this a classic mid-life opportunity rather than a crisis?  I am now in my 79th year and living well, at least for now.
I was not aware that I had any deep concern about dying but in there somewhere must have been a residue of wondering, even if out of simple curiosity.  Part of my professional training had included some work in pastoral care and helping others through various life transitions, including dying and death. Being with those people and their families gave me some insight into how we as a culture and society avoided the topic most of the time.  That in itself was fascinating since it’s an experience everyone faces, usually more than once.  I have taken the position that whatever you can’t talk about will come up and bite you in the backside.
My interest in death and dying may stem from early experiences, first with animals and then from watching the adults around me deal with death.  The first death I recall in my own family was my paternal grandmother.  When she died, rather suddenly, I was about 12 years old.  I recall the farmhouse being prepared for a “viewing.”  I did not like the term then and still don’t, but I understand that it may fulfill a need on the part of the immediate family.  My thought then was that my grandmother, lying there, as if she were asleep, had no interest in being stared at by all these people.
The casket was placed in the formal dining room, people came to “pay their respects” and spoke softly in hushed voices as if a normal conversation might be disrespectful.  I couldn’t figure that out.  These practices of viewing the dead vary from culture to culture, often depending on religious traditions and practices.  A viewing (or wake as it is sometimes called) can be for one day or up to three days.  A visitation might just include the immediate family without any public display of the dead body. 
The morning of the funeral 40 to 50 people gathered in the dining room and sat in chairs facing the casket.  I remember my grandfather walking up to the casket and when he was coming back to his seat, I could see that he was crying.  It was the first and only time I saw him with tears in his eyes except when he laughed so hard he cried.  Then the entire group followed the hearse to the church for the service, then to the little cemetery in the country where both my parents and their families are buried.  I have no interest in taking any real estate for my remains and have made that known to my family.
There are enormous differences between a sudden death that is unexpected and one that comes following some illness or disease.  In either case the issues are loss and grief for the “survivors” and coming to terms with living, not dying.  Woody Allen is famous for saying “I am not afraid of death.  I just don’t want to be there when it happens.”    We know intellectually that life can change directions quickly.  We know that life is unpredictable, uncertain, fragile and precious.  We know death is certain, that every living person experiences it and yet we go to extraordinary lengths to avoid it.   We have, until more recently, even avoided having open and honest conversations about death and dying.
Of the 2.5 million deaths in the U.S. in 2012, approximately 175,000 were in the “unnatural” category; 122,000 deaths by accident, 38,200 by suicide and 14,600 by homicide.  Yet accidents ranked as the 5th leading cause of death and suicide 10th.   Numbers can be misleading because over 1.4 million deaths ranked ahead of accidents as a cause of death and these were from heart, cancer, and other diseases.  
The point here is not to draw any conclusions from the aggregated data but to understand that each one of these deaths is personal, regardless of the cause.  Every person faces death, whether you are the dying person or you are among those closest to that person.  And whether the death is anticipated or sudden, it must be dealt with one way or another.
One of my favorite stories is Appointment in Samarra” as re-told by W. Somerset Maugham in 1933. It is an interesting commentary on how some  think they might escape death, even if for awhile.  Death is the speaker.
   “There was a merchant in Bagdad who sent his servant to market to buy provisions and in a little while the servant came back, white and trembling, and said, Master, just now when I was in the marketplace I was jostled by a woman in the crowd and when I turned I saw it was Death that jostled me.  She looked at me and made a threatening gesture, now, lend me your horse, and I will ride away from this city and avoid my fate.  I will go to Samarra and there Death will not find me.  The merchant lent him his horse, and the servant mounted it, and he dug his spurs in its flanks and as fast as the horse could gallop he went.  Then the merchant went down to the marketplace and he saw me standing in the crowd and he came to me and said, ‘Why did you make a threatening gesture to my servant when you saw him this morning?’  That was not a threatening gesture, I said, it was only a start of surprise.  I was astonished to see him in Bagdad, for I had an appointment with him tonight in Samarra.”
There is a tremendous amount of literature on death and dying, some from the medical community that deals with death on a daily basis one way or another; other treatises from writers and poets who try and soften the emotional traumas associated with the inevitable end of life; and only recently have people begun to focus on the choices available not only in the manner they wish to die but how they wish to live.
The medical community seems to be shifting its attitude from one of trying to keep people alive regardless of the physical, emotional and economic costs toward a more humane approach.  Hospice has made its positive presence felt among those families trying to help loved ones live out their last days with more dignity and comfort and several states, Oregon being a pioneer, have laws permitting people to die with dignity.
How each family deals with the loss of a loved one varies greatly. How we are prepared ahead of time will in some measure determine our ability to plan for, accept and embrace the final chapter.  There are now more resources available than ever before. If you or a member of your family are in one of those terminal but uncertain conditions, you can take control. With the help and support from others who have the experience to walk through this valley of the shadow without fear you can have the hope of as good an end as humanly possible.

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