A good death

Yong Nie had no papers, no contact with family – and one last wish.

By Kate Legge

[F]or 20 years Yong Nie dodged Australian authorities by lying low, staying out of trouble, earning cash in hand through odd jobs, sleeping rough and keeping to himself. But when he developed an aggressive cancer, the game was up. Gaunt, jaundiced, his once dark hair streaked grey, the 68-year-old illegal immigrant turned up at the emergency department of Sydney’s St Vincent’s Hospital doubled in pain and fearing deportation. But instead of being thrown out, locked up and shipped off, he was welcomed by palliative care staff who took him in as one of our own.

The good death at the heart of this story confirms the generosity of ordinary people performing exceptional acts of compassion without triumphalism or reward because this is what they do every day. Few of those who crossed Nie’s path during the two months he spent at the inner-city hospital founded by the Sisters of Charity will forget him. They couldn’t cure his disease-ridden body but they worked tirelessly to heal a terrible burden in his soul. Those drawn to fulfil his dying wish came from different faiths and countries. There were doctors, nurses and social workers employed in this Catholic health service; monks and volunteers from the Nan Tien Buddhist temple near Wollongong; a Chinese community cancer support agency and Australian Embassy officials in Beijing. Racing against death’s advance, they embraced this fringe dweller who had fallen foul of officialdom with gracious gestures that celebrate the humanity of frontline carers while reminding us how lucky we are to live in a country where goodness thrives.

Yong Nie had not spoken to his wife or ­daughter since leaving the sprawling Chinese port city of Tianjin two decades ago bound for Australia, possibly on a business visa. It was a mission that went awry, humiliation eventually driving him to a flimsy existence with no fixed address, floating on the margins of a society he failed to join. The longer he hid from his family in silence, the harder it was to bridge the distance. He had no Medicare card, no identifying papers, no tax file number, no information about next of kin, and savings of $72.46 when he was admitted to palliative care in May. “There was nowhere else for him to go,” says ­Professor Richard Chye, director of the Sacred Heart palliative care unit at St Vincent’s. “We could not put him on the street. His cancer had spread to his liver; it was too late for treatment.”

Amid grim accounting of refugees around the world as well as those in offshore detention centres closer to our shores, here is an oasis where generosity of spirit is blind to colour, creed and ­citizenship. It doesn’t matter where you’ve come from, since everyone in these wards is contemplating death and energies are focused on journeying comfortably and peacefully to this end. “From a healthcare perspective we were not obliged to report him as an illegal immigrant,” Chye insists. “We provide spiritual care and support and if we reported him to the authorities he would have a lot more emotional angst and worry.”

With only a smattering of English, the patient spent the first week alone, sick and scared as social workers and nurses tried to gently tease out details that would help them look after him. “His biggest fear was that he would be kicked out of hospital,” says Michelle Feng, a Chinese-born nurse who speaks Mandarin. “But I reassured him that was not going to happen.” As luck would have it, her husband emigrated 16 years ago from Nie’s home city, southeast of Beijing. Concerned mainly with alleviating his physical duress, she did not pry. “He told me he’d lost contact with his family, that he had not spoken to them since he came to this country. I was curious,” Feng concedes.

“How can you have a father or husband and no contact? Maybe he was afraid to contact them,” she wonders before dismissing these niggling thoughts. “For me, a patient is a person. They all have their own needs and we have to adapt to them. He is a ­person who has been living underground but I didn’t ask the reason. I don’t know why. At the end of life everyone deserves to be treated as a human being. Really, we don’t have a lot of time.”

Prof Richard Chye with St Vincent’s Hospital palliative care unit staff; at right, Michelle Feng (white shirt) and Trish McKinnon (in black).

Social worker Trish McKinnon arranged for Mandarin-speaking volunteers from the Chinese community support group CanRevive to visit “Mr Nie” so they might better understand his circumstances and needs. Although he had inhabited a shadowland of sorts, he counted a few as friends. He’d helped a single mother in the Chinese community and for many years he’d served as a volunteer at the Nan Tien Buddhist temple, an hour from Sydney. There he got to know Stanley Wong, who came here from China 24 years ago. They cooked together for temple functions. Wong speaks limited English but tells me “we help each other”. Informed of Nie’s rapid decline, he arranged a roster of hospital visits with another Buddhist so that there would be bedside company for him almost every day.

Dr Kate Roberts, a passionate young member of staff, recalls witnessing the turnaround in the patient’s demeanour as the threads of connection were drawn together. “In the first week he had zero visitors. He was severely jaundiced, hardly speaking, and a ­little suicidal. He used to say, ‘Send me back to China or send me to a train station and I’ll sit there until I die’. But then people from the Nan Tien temple began to trickle in and he began to smile. He did a 180-degree switch.”

Michelle Feng says the presence of the Buddhists calmed him. “He’d been so worried and anxious and not able to sleep. But from the first time the Buddhists came to pray around his bed he told me, ‘The worry is gone’. ” He began to eat, requesting white rice congee — a simple dish of boiled rice with no seasonings — for every meal. Feng brought him pickles from home to flavour his food. Stanley Wong arrived with nourishing broth. Gradually Nie gained the confidence and courage to express his urgent desire to reconcile with the family he’d left behind.

Before coming to hospital he had approached the Red Cross for help in contacting his wife and daughter but the search had drawn a blank. Wong says Nie was “too scared” to approach any other agency. But the longing to make amends troubled him deeply. “He realised he was coming to the end of his life and his final wish was to contact his ­family,” says McKinnon. “He was too ill to travel and he had no passport so everyone went out of their way to achieve the goal of a man who was going to die. A reaffirmation of family began and there was this wonderful confluence of palliative care principles and Buddhist acceptance.”

The notion of “existential resolution” is ­central to the Sacred Heart unit’s philosophy of minimising pain and discomfort in the dance towards death while resolving emotional agitation and distress. “We try to ensure patients are physically and emotionally calm and prepared, ensuring peace at the end of life, so we try to assess appropriate information without being intrusive,” says McKinnon.

Once members of the palliative care team became aware of how much a reconciliation with his family meant to Nie, they enlisted the support of Wong, who had a friend who knew somebody in Tianjin, a vast metropolis with a municipal population of more than 15 million. Feng told Nie the city had grown and developed like topsy since his departure but hopes were pinned on the location of his elder brother, a secondary school physics teacher. Wong’s messenger found him within four hours of posting an alert on a missing person’s site.

This breakthrough led to an exchange of phone numbers for Nie’s wife and daughter, as well as news of a granddaughter, now four years old, and the revelation that Nie’s sister, who is based in Hong Kong, was visiting her son in Melbourne. She tells me through her English-speaking granddaughter that she had no idea of her brother’s whereabouts for the past 20 years: “He disappeared.” Those intent on facilitating a reunion stayed clear of the details that had conspired to keep members of this family apart. Feng set up the Chinese version of Skype so Nie could communicate with his wife and daughter. “It was quite amazing,” she recalls. “His wife and daughter were in tears. Everybody was crying. I didn’t want to intrude.”

A plan took shape for getting them to ­Australia. Wong shared the view of Sacred Heart staff that reconciliation would not only console the patient but also salve the heartache and bitterness of relatives bewildered by his unexplained absence for two decades. “He left his ­family. No contact. No money,” Wong says, still perplexed, even though he knows a little of the gambling problems that beset his friend. “He lost money. He couldn’t face them.” Now was not the time for recriminations. “They were very upset, very angry. It was very difficult. I told his daughter, ‘You should come and see your father otherwise you will never see him again’. ”

Wong collected money to help with the reunion. He pleaded with Nie’s wife and daughter to make the trip, convinced they would feel lighter for this rare chance to say goodbye. “I told them this was a time for forgiveness. Now was the time to put everything away, all the unhappy ­stories to one side so they could feel peace.” As Nie’s health deteriorated, hospital staff wrote to the Immigration Department to hasten visitors’ visas issued by embassy staff in ­Beijing. “It was absolutely amazing,” McKinnon says of the frantic efforts to expedite their journey before Nie took his last breath. Wife and daughter arrived at the hospital and were accommodated in a room near his. “We were so anxious about it. From my point of view this was unfinished business and I was sure that a reaffirmation of the family connection would help enormously … I walked them along the corridor to the room, explaining his physical state to prepare them. It was quite ethereal. When they walked in, he introduced them to us. He said, ‘This is my wife. This is my daughter.’ It was an absolute statement of connection,” she recalls.

“There were tears. They were quite overwhelmed by the face-to-face intimacy but they were pleased this had happened. There was not a lot of discussion about the intervening years. This was not the time to trawl through the past. Obviously there was grief from the missing years but there was no castigation at all, just a real sense of solidarity at the end of life.” Nie’s wife brought with her a yellow cloth inscribed with Chinese characters and laid it under his head. Wong explains this Buddhist tradition encourages serenity in death. “This releases the body and brings peace and silence before people pass away.”

Nie died the next morning. A senior monk from the Nan Tien temple was called in to lead prayers and chanting in the room where he lay. “It was very beautiful,” Wong says of his friend’s final hours. “I think we should all become Buddhists,” laughs McKinnon. “It was a wonderful outcome in every way.” Nie’s daughter accompanied the body to the temple for cremation and before their return to China they visited Nie’s sister in Melbourne. Another link mended in this long broken chain.

Complete Article HERE!

Life after death and the fear of dying

By Heidi Anderson

Heidi Anderson, with her Nan and brother, has been thinking about life after death.

[O]n the 16th of August this year, my beautiful 96 year-old Nan passed away. Since then, I have rode one hell of a roller-coaster with my emotions all over the shop.

 
Nan and I always had a pact that if there were something on the other side, that she would come back and tell me about it.

She never believed there was anything else after you die and she would always say to me: “Once you’re dead, you’re dead. That’s it. There is nothing else.”

That is what terrifies me. The thought of “that’s it” petrifies me. I’m seriously scared of dying and for years this has given me anxiety.

I have worked with my psychologist about this fear. Dying is inevitable, but I still find it so hard to comprehend.

I’m not sure any of the sessions have helped, I still think about it a lot.

People constantly say to me: “Why stress about something you have no control of?”

Or, “You won’t know when you’re dead that you’re dead, so chill out.”

Heidi Anderson’s Nan, who passed away in August age 96.

Believe me, if I could switch it off I would but that’s easier said than done. It’s not the thought of how I die that bothers or upsets me, it’s the thought of the unknown. Not knowing what’s next.

This consumes my thoughts far too often and it’s something that I have tried to come to terms with over the past few years with no such luck.

When my Mum told me that Nan was dying and she wouldn’t recover from her fall, I flew straight to her bedside, along with all the family.

Saying goodbye to my Nan was the hardest thing I have ever had to do in my life.

Once Nan knew herself that she was dying and had accepted her fate, she called me into her room to speak. At this stage, she didn’t have much energy but she was putting all her fight into saying goodbye to people individually.

“Heidi, we all die. That’s life,” she said to me. “That’s the one thing are guaranteed in life. We’re born to die.”

Looking back, I think Nan was speaking to herself, as she too was always so afraid of death.

Over the next few days, Nan went downhill and eventually she stopped speaking and just slept.

Family came and went and said their goodbyes, but I stayed around.

I wanted to be with Nan as she exited this world. I wanted to hold her hand as she took her last breath.

Looking back, I think I also wanted to confront my fear of death. If I saw what actually happens, maybe I wouldn’t be so scared.

So I hung around the hospital like a bad smell, rarely leaving Nan’s bedside.

I played her music, told her stories and relived all our good times.

Unfortunately, by that stage she was no longer talking, but she would twitch her lips or flicker her eyes.

I swear she could hear everything, she just couldn’t respond.

In the end, I flew home to Perth. She was holding on and I felt Nan just didn’t want to die in front of any of her grandkids.

12 hours after I got home, Nan took her last breath with her three daughters at her side.

The nurses at the hospital said it was very common for people, when they’re dying, to choose who is with them.

Although I wanted so desperately to be with Nan, I felt she knew it was best that I wasn’t there.

When I arrived home in Bathurst for her funeral, I still felt that I wanted to confront my fear of death and see Nan.

Mum took me to the funeral home the morning of her farewell and I saw Nan for the first time since she passed away.

She was dead and she even looked it. No amount of makeup was hiding the fact that she was gone.

It hit me like a ton of bricks. Nan was dead and she was never coming back.

Thoughts started flooding my brain.

“Where is she? Is there something else out there? Is she with Pop? What happens? Where has she gone?”

Her body was there but that wasn’t my Nan.

My friends asked later if she looked peaceful and I found that hard to explain. She looked like she was gone and that is something I won’t ever really understand.

I’m not sure seeing my Nan in her coffin has helped my fear of dying, but it definitely gave me some kind of closure.

I am still waiting for Nan’s spirit to visit me and let me know if there is anything else out there.

I have had a couple of dreams about her and I talk to her all the time but I am yet to feel her or hear if there is life after death.

Complete Article HERE!

In death reunited: 75 years after Pearl Harbor attack, Anderson brothers of Dilworth, Minn., will rest together in USS Arizona

By Helmut Schmidt

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[J]ohn Anderson somehow survived the bloody mayhem of the Dec. 7, 1941, Japanese attack on Pearl Harbor.

But in that attack, Anderson, a crewman on the USS Arizona, lost his twin brother, Jake.

Jake was among 1,177 sailors and Marines from the battleship who died, many of whom were entombed when the ship sank in minutes after a bomb touched off a massive explosion in one of the magazines.

Throughout an active and full life, Anderson carried the guilt of not being able to find his brother.

Now, in death, the brothers from Dilworth, Minn., will be reunited.

Anderson’s cremains, along with those of another man who survived that attack 75 years ago, will be interred by Navy divers in the No. 4 turret of the Arizona on Wednesday, Dec. 7.

Their cremains will join those of about 1,100 sailors and Marines entombed in the wreck.

“When you grow up in the shadow of a hero, you don’t always realize a hero is there,” one of his sons, Terry Anderson, 53, of Roswell, N.M., said Friday, Dec. 2. “We have a great sense of pride.”

Karolyn Anderson, 73, said that it’s been a difficult year since her husband’s death Nov. 14, 2015, at the age of 98.

“This is what John would want. I want to do that for John, and Jake. It’s very sad for me, but I’m honoring his wishes and his memory,” the Roswell woman said of her husband of 47 years.

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“For years, John was hesitant to even talk about Jake, He always carried a guilt burden that he couldn’t get Jake. And finally one day, I said ‘John, you never really mention Jake, why is that?’ And he said. ‘I always felt funny that I lived and he didn’t. I always wondered why I was spared and he wasn’t.’ He just felt like he let himself down, and Jake down as well as the rest of the family.”

John and Jake Anderson were born Aug. 26, 1917, in Verona, N.D. Their family later moved to Dilworth, where the twins grew up and graduated from high school.

Both joined the Navy in March 1937.

John Anderson began his Navy career on the USS Saratoga, then transferred to a destroyer. He was in China when it was attacked by the Japanese.

“That left an impact on him. He had pictures of a Chinese refugee column machine gunned by the Japanese. Pretty graphic stuff,” Terry Anderson said.

Pictured from left are the battleships USS West Virginia, USS Tennessee, and the USS Arizona, after the attack by Japanese aircraft on Pearl Harbor, Hawaii, on Dec. 7, 1941. (U.S. Navy photography provided by the Naval Photographic Center)
Pictured from left are the battleships USS West Virginia, USS Tennessee, and the USS Arizona, after the attack by Japanese aircraft on Pearl Harbor, Hawaii, on Dec. 7, 1941.

In 1940, he was transferred to Hawaii and eventually to the Arizona.

John was a member of a crew manning one of the ship’s 14-inch turret guns, and Jake’s station was an anti-aircraft gun. John Anderson also had the duty of setting up chairs for Sunday morning worship services on the Arizona’s deck. After setting up the chairs on Dec. 7, he went below deck to have breakfast when he heard a “kaplunk,” looked out a porthole and saw planes bombing nearby Ford Island, he told columnist Bob Lind of The Forum of Fargo-Moorhead.

“They started hearing machine gun fire and explosions going off, and Dad went to the porthole of the ship out of the mess hall and that’s when he saw the Japanese planes flying by and he saw the orange balls and he knew the Japanese were there, because he had seen them in China,” said another son, John Anderson Jr., 47 of Carlsbad, N.M..

John Anderson said in accounts after the war that he then headed for his post, all the while looking for his brother, Jake. He made it to his gun turret, but before he could help load it, a bomb hit the turret’s top, bounced off and penetrated the deck. The resulting explosion killed many of the crew.

Shortly after, the forward ammunition magazine with 1.5 million pounds of gunpowder blew up, virtually splitting the Arizona, and leaving dead and dying men everywhere, he told Lind.

As the ship began sinking, a senior officer ordered Anderson onto a barge taking wounded men to Ford Island, and they picked up wounded men on the way.

Once on the island, Anderson commandeered another boat to go back to the Arizona with a shipmate, Chester Rose. On the way, they pulled survivors from the harbor, but then the small craft was hit and wrecked, and all but John perished.

“He talked about this guy Rose many many times, about how he lost his life trying to help, go back to the ship. After (many) years, he was able to locate the family and tell the family what happened to Rose,” John Jr. said.

John Anderson was wounded, but swam to land and grabbed a rifle and two bandoliers of ammunition. He then jumped into a bomb blast crater on Ford Island and told Lind that he thought, “Let ’em come!”

In a 2014 article, he told the Stars and Stripes newspaper that the next day a Marine patrol told him survivors of the Arizona were to gather on a nearby dock for a head count.

“Everybody I saw there had rags around their heads,” Anderson said. Bandages covered their arms, skin was scorched and hair was burned off. “Beat up something awful.”

Travis Anderson, 45, of Kurtistown, Hawaii, said his father passed on a very memorable lesson learned on that horrible day.

“I don’t remember what we were doing, but he said there’s a reason for rules and doing things the right way, and I kind of smarted off to him and he told me to listen,” Travis Anderson said. “He told me a story about a man locked up on the Arizona. He was in the brig and no one could find the key. Boy, that just hit me like a ton of bricks. That they were trying to get that guy out of there and they didn’t have the key. Pay attention to what you’re doing and do things right. I carried that with me the rest of my life.”

John Anderson joined the destroyer USS Macdonough, and fought in 13 major battles across the Pacific.

After his discharge in 1945, he worked as a movie stuntman and took night classes in meteorology. A friend later convinced him to join the Navy Reserves, where he served for another 23 years.

anderson4

While in Hollywood, he met and worked with John Wayne and also worked on the set of the Jimmy Stewart Christmas staple, “It’s a Wonderful Life.”

Anderson moved to Roswell, where he was “Cactus Jack,” a disc jockey playing mostly country music. He met Elvis Presley and Eddie Arnold in that job.

Anderson later became a television meteorologist and a real estate agent.

“He went after it. He lived life to the fullest. It was like reading a Hollywood book. He really lived. I could just go on and on,” Travis Anderson said.

“He was a wonderful man, very charismatic. He was bigger than life,” Karolyn added.

The interment ceremony on the Arizona is unique in that it is the only ship in the U.S. Navy where the cremated remains of a survivor are returned.

“It will be a chance to say goodbye to dad and a chance to reflect on Dec. 7. A day we should never forget,” John Jr. said. “It will be a time … to thank God for all he did.”

Complete Article HERE!

Grief work can be inspiring and rewarding

By Robin Glantz

children and grief

[F]or many of us, grief from the loss of loved ones can be stronger than ever during the holidays. Hospice by the Bay is here to provide support. The need is great, so we are looking for additional professionals to join our bereavement team.

I hope that my story will inspire others.

For the past few years, I’ve been a member of Hospice by the Bay’s bereavement team. I haven’t always done this kind of work; I used to own a bookkeeping company and had also been a human resources director. People often ask me, “What prompted you to make the change?” “How are you able to do such heart-wrenching work?”

Like many who work in hospice, I have experienced profound loss, in particular the death of my father. Losing him was painful but also life-changing. Before, I had been afraid of death and dying — but something “switched” when I was with him while he was dying; I realized that being with someone at this time is a gift.

I can’t say that I handled my grief very well. I moved too fast and was also grieving the “empty nest” after my daughter left for college.

Ultimately, I sought help, and soon realized that it had been a long time since I had been involved in work that came from my heart.

So I went back to school for my graduate degree in psychology with a vague idea to work in the drug treatment field. But one day it came to me, really as a calling: I wanted to do hospice work.

After completing internships in inpatient hospices, I felt a need to round out my work by helping families and individuals who were grieving. I completed Hospice by the Bay’s Bereavement Internship Program and became a licensed marriage and family therapist.

Today, I work with Hospice by the Bay as a community grief counselor, providing crisis and ongoing counseling to individuals and groups as well as grief education to schools, workplaces and organizations in need. All of these services are available to anyone, whether or not their loved one was our patient.

I get a lot out of my work. Rather than becoming depressed or detached (as some might think), it is uplifting. I get to be a “holder of hope” as I meet people at a critical time of their lives — when they are vulnerable, in pain, and may be all alone with their grief.

No matter how emotional the work is, at the end of the day, it is rewarding to know that I am guiding people when they are rudderless and adrift in an ocean of grief. It is an honor. This work has a positive impact on my personal, day-to-day life as well.

I appreciate life more, because I know that it is short. I make more meaningful choices, treasure “the moments,” and experience an expanded capacity for love.

Bereavement work is not for everyone, but it’s a calling for others.

Hospice by the Bay invites qualified candidates to apply for our Bereavement Internship Program. A part-time and yearlong paid program, it offers highly professional training and supervision.

Candidates must have a master’s degree in mental health, counseling, psychology or social work, and be registered as an intern with the Board of Behavioral Sciences.

If you or someone you know is drawn to this type of work, is mature of heart, respectful, and in search of a meaningful placement, please contact Hospice by the Bay at sohri@hbtb.org.

For the right person, helping others through their grief can be one of the most rewarding experiences you will ever have. It has been for me.

Complete Article HERE!

Against the Dying of the Light

by

Did you know that your patient in 1152 just passed away?

 

Krishna Constantino
Krishna Constantino

[E]veryone at the nursing station turned silent and looked at the nurse who had delivered the news. I looked at her in disbelief, my brain struggling through a fog of confusion and surprise. I squinted at my patient list trying to remember who was the patient in 1152. Recognition finally hit and I remembered the little old lady that we saw during rounds two hours ago. I remembered gazing at her frail, tiny body and her pale, listless face and how we tried to communicate with her to no avail. We knew she had a Do Not Resuscitate (DNR) status and we knew she was really sick, but we had no idea it would happen so quickly!

Since there was no response from either me or the intern that I was following, she mumbled a hasty, “I’ll go call the family,” and left. I looked at my intern for guidance and I saw that he was staring at the floor, hands resting on top of his knees. It was a surprise for me to see him like this, far removed from his usual confident manner. Death had completely floored us both.

Doctors and other medical professionals have a more frequent and intense contact with death and dying compared to the rest of society creating a need for end-of-life care in medical curricula. However, multiple studies on medical students’ reaction to death show that most medical students feel inadequately prepared by their undergraduate medical curricula for experiences related to end-of-life situations. Death is introduced early in our medical training inside the gross anatomy lab. The absence of any identifying features made those hours spent in anatomy lab easier. Death takes its toll and what is left is an empty husk where a person used to exist. After anatomy lab however, there is very little exposure to the idea of death and dying. A survey of medical students from Duke University showed that the average medical student had experienced fewer than five patient deaths prior to graduation. In addition, few students experienced how to declare a patient dead and none received any formal training on this end-of-life skill.

I, on the other hand was not destined to be part of that statistic. After what seemed like an eternity, my intern rose up from his seat and dashed to another part of the hospital to seek out his senior. After discussing the turn of events and the necessary course of action, our little group convened in front of the door of the patient’s room where I received my first education on the procedure of declaring a patient death.

I lingered close to the door with a bit of trepidation. She was laying in the same position that I had last seen her two hours ago — face to the window, eyes closed. Her mouth was slightly open and for a moment, I merely thought that she was asleep.

First, we need to check for reflexes. In here, we use two: the corneal reflex and the gag reflex.

I watched in silence as both the resident and the intern performed these tests — all without a response. I watched as they both tried to feel a pulse. I watched with bated breath against all hope that there was still life ebbing underneath those veins. I let it out, deflated when both of them shook their head no.

As soon as we walked out of the room, I overheard my intern echo the exact same thought in my head. “Do you think we did anything wrong?” A hundred what-ifs welled up inside me. Was there truly anything we could have done to prevent this death? Modern medicine views death as something that can be resisted, if not avoided. This view of death is further compounded upon by modern society’s view of death which delegates all responsibility to physicians. While it is widely accepted that death is inevitable, it is the physician’s task to ensure that the patient is as far removed from death as possible. As Rudyard Kipling in his address to the medical school of Middlesex Hospital stated, “Death as the senior practitioner, is always bound to win in the long run, but we patients, console ourselves with the idea that it will be your business to make the best terms you can with Death on our behalf; to see how his attacks can best be delayed or diverted.” Little wonder that throughout medical education, death is continually seen as a failure.

Although medical schools are now integrating end-of-life care in its curricula, medical education should also engage students in a frank discussion of death and dying. Only by facing death head-on do we dissipate its power over us. The fear of the unknown has always been part of death’s icy grip over us but what if we learned to “disarm him of his novelty and strangeness, to converse and be familiar with him” as Michel de Montaigne recommended many centuries ago when death was commonplace and lifespans were short. Had I chosen to avoid that room, I would have missed out on one of the most important lessons in my medical education.

Each one of us has ideas surrounding death. I have always imagined death to be more dramatic than what I had experienced. In my mind, I keep seeing an entire healthcare team running back and forth — all working together to snatch the patient away from the jaws of death. However, my patient simply slipped away quietly, almost underhandedly. The way that she passed away seemed natural — as if she were merely falling into an eternal sleep. Gone was the drama, the action, the struggle for life. In its place was peace and acceptance of the inevitable.

This in turn gave me reason to think that perhaps, death is not a failure of medicine but rather a crucial part of being alive. Oftentimes, the best lesson in learning how to live is learning how to die as we see in the works produced by the likes of Oliver Sacks and more recently, Paul Kalanathi. As surgeon and Yale professor Sherwin Nuland wrote, “We die, in turn so that others may live. The tragedy of a single individual becomes, in the balance of natural things, the triumph of ongoing life.”

Complete Article HERE!

Immortal prose: how writers deal with death

Julian Barnes, Joan Didion, Jenny Diski, Christopher Hitchens, Meghan O’Rourke and more address life’s ultimate question

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By

[W]oody Allen famously quipped “I’m not afraid to die, I just don’t want to be there when it happens.” This resonates with all of us who live in a culture that promotes eternal youth through scalpel or scientific miracle and cold shoulders the icy certainty of death.

Kafka stated that “the meaning of life is that it stops” while Anaïs Nin, a daily diarist, wrote that “people living deeply have no fear of death”. Freud recognised that people sometimes did express fear of death, a condition referred to as thanatophobia. Freud felt that it was not actual death that people feared as our own death is quite unimaginable, and in our unconscious we are all convinced of our own immortality. Beckett wrote that “they give birth astride of a grave, the light gleams an instant, then it’s night once more”. Joan Didion wrote that “we tell ourselves stories in order to live”.

Lately there has been much written about death, narratives and stories that aim to help us negotiate the emotional landscape of grief and death. The novelist Julian Barnes is a self-confessed thanatophobe who sometimes is “roared awake” and “pitched from sleep into darkness, panic and a vicious awareness that this is a rented world”. In his memoir on the fear of non-existence, Nothing to Be Frightened Of, Barnes writes an elegant meditation on death and attempts to address his thanophobia. As an agnostic Barnes doesn’t believe in an afterlife and writes that “I don’t believe in God but I miss him”. He believes that the Christian religion has lasted because it is a “beautiful lie… a tragedy with a happy ending”, and yet he misses the sense of purpose and belief that he finds in a Mozart Requiem or the sculptures of Donatello.

There is a trend over the last few years for a new type of fiction, a genre that moulds memoir with biography to form a literature that feels fresh and hyper-real, a type of reality fiction for the modern reader. David Shields presaged this new trend when in his 2010 publication Reality Hunger he advocated a return to the “real” in literature and he railed against conventional plot-driven fiction in favour of the lyric essay and the memoir.

A memoir of illness and dying is always an emotional read and the pages pulse with life, strife and the emotional intensity of the author’s feelings and predicament. None more so than In Gratitude by Jenny Diski, who died earlier this year of inoperable lung cancer. Diski wrote a series of essays in the London Review of Books about life after her diagnosis with its frailties and sudden fragilities which have been published as this memoir. She writes that she feared the oncologist would find her response cliched after he gave her the prognosis and she turned to her husband and suggested that they’d better get cooking the meth like Heisenberg in the television series Breaking Bad.

Diski’s talon-sharp prose has never harboured a platitude and this memoir touches on her peripatetic early life, abandoned by neglectful parents and in and out of psychiatric hospitals, “rattling from bin to bin”. She was adopted by the writer Doris Lessing for four years as a teenager and shared family dinners with Alan Sillitoe, RD Laing and Arnold Wesker and listened to late-night intellectual discussions about philosophy and psychotherapy which she describes as “a dream come true, but I had to work out how to live it”.

Diski with her unique sense of directness and humour writes that she makes an ideal candidate to play the role of a cancer patient as her lifelong favourite places are bed and sofa and she lives like one of those secondary characters in Victorian literature who constantly languish on the fainting couch. Diski described herself as being “contrary-minded”, delighted at breaking taboos and pushing boundaries. Controversial to the end, she likens having cancer to “an act in a pantomime in which my participation is guaranteed, I have been given this role ….I have no choice but to perform and to be embarrassed to death.”

Christopher Hitchens was on a book tour for Hitch 22 when he experienced the first health crisis that was the beginning of his demise. However, this pugnacious and witty writer was able to channel his experiences into his end of life memoir Mortality, which begins with the line “I have more than once in my time woken up feeling like death”. When the emergency services arrive to collect him Hitchens feels a psychogeographical shift taking him “from the country of the well to the stark frontier that marks off the land of malady”. Hitchens concedes that he has become a finalist in the race of life and quotes from TS Eliot’s Prufrock:

I have seen the moment of my greatness flicker / And I have seen the eternal footman hold my coat / and snicker / And in short / I was afraid

Hitch decided to live dyingly and extolled the consolation of friends who came to eat, drink and converse with him even as these earthly delights become impossible for him as the cancer progressed. His memoir is life affirming, punchy and rich with morbid humour, noting that when one falls ill people tend to send Leonard Cohen CDs. He doesn’t experience rage at a terminal diagnosis as he feels that he has been taunting the Reaper into “taking a free scythe in my direction” and that he has now succumbed to “something so predictable and banal that it bores me”. His wife Carol Blue in the afterword to this memoir writes of the man she admired and loved and ends with the lines that in death as in life Hitch still has the last word.

Joan Didion’s memoir The Year of Magical Thinking begins with the death of her husband of 44 years, the writer John Dunne, and brings the reader on a journey through the land of grief that she entered in the aftermath of his loss. In the opening lines of this poised but passionate memoir she writes that “life changes fast. Life changes in the instant. The ordinary instant.” She writes about the ordinary nature of everything preceding the event and writes that when we are confronted with sudden disaster we all focus on how “unremarkable the circumstances were in which the unthinkable occurred, the clear blue sky from which the plane fell.’’

Didion gives the reader an unflinching account of grief in the year when the shock of Dunne’s death “was obliterative, dislocating to both body and mind”. Despite the unshakeable reality of her husband’s death Joan’s thinking enters the realm of the magical and she writes that “we do not expect to be crazy, cool customers who believe that their husband is about to return and need his shoes”.

Zadie Smith wrote that Didion is essential reading on the subject of death and I have bought many copies over the years for grieving friends who have found comfort in its reading, recognition of their suffering in its pages.

The Long Goodbye by Meghan O’Rourke is an unstintingly honest memoir about the loss of her mother Barbara to colorectal cancer. O’Rourke is an award-winning poet and she writes about the consolation that she finds in reading Hamlet. Shakespeare’s hero holds up a mirror to O’Rourke’s own duality of emotion; emptiness and anger, despair and longing for relief. O’Rourke can understand why Hamlet, who has just lost his father, is angry and cagey. He is told that how he feels is unmanly and unseemly, his uncle greeting him with the worst question to ask a grieving person “How is it that that the cloud still hang on you?”

O’Rourke felt a resonance with Hamlet in her grief state when she felt that to descend to the deepest fathom of it would be unseemly and was somehow taboo. She writes that nothing prepared her for the death of her mother, even knowing that she had terminal cancer did not prepare her. There is a stark unearthing of truths in this memoir. “A mother, after all, is your entry into the world. She is the shell in which you divide and become a life. Waking up in a world without her is like waking up in a world without sky, unimaginable.”

Doctors face death daily and Dr Paul Kalanithi became a neurosurgeon because with its unforgiving call to “perfection, it seemed to present the most challenging and direct confrontation with meaning, identity and death”. When Breath Becomes Air opens with a description by the author of a CT scan that he was examining where the lungs were matted with innumerable tumours, the spine deformed and a full lobe of the liver obliterated. This scan, though similar to scores of others that he had examined over the previous six years, was different, different because it was his own. Kalanithi wrote his memoir in the aftermath of this discovery, fusing his medical knowledge with his love of literature to produce a work that is more than a memoir: it is a philosophical reflection on life and purpose. Kalanithi and his wife have a baby Cady who was eight months old when her father died. His memoir will be his legacy to his little girl as “words”, he writes, “have a longevity I do not”.

The Iceberg: A Memoir by Marion Coutts tells of Coutts’ partner Tom Lubbock’s death from a malignant brain tumour. This account of illness and decline is told with an artist’s eye and in poetic prose that is both razor sharp and suffused with emotion. Coutts writes that there is a filmic quality to their life. A friend suggests that the director is Bergman, “shot flat without affect but deeply charged, with a fondness for long shots, no cuts, ensemble scenes, dark comedy and the action geared always to the man in the bed even though he is frequently off camera.”

Death is the inevitable full stop in the essay of life. Christopher Hitchens quotes this poem by Kingsley Amis in his memoir Mortality: Death has this much to be said for it/ You don’t have to get out of bed for it/Wherever you happen to be/ They bring it to you – free.

The writer Katie Roiphe wrote The Violet Hour: Great Writers at the End in part to sate her curiosity about death and dying. It is an account of how the writer found beauty and comfort in the stories of how her literary heroes faced up to dying. For Roiphe religion has never been consoling and feels like a foreign language. She, like many book lovers finds comfort in novels and poems. As a child recovering from serious illness Yeats’s Sailing to Byzantium resonated with her. She becomes ambushed by the beauty in the deaths of her literary heroes, Dylan Thomas, Susan Sontag, Freud and Maurice Sendak. Sontag “fought her death to the end, believing on some deep irrational level she would be the one exception”.

Roiphe feels that writers and artists are more attuned to death, that they can put the confrontation with mortality into words in a way that most of us can’t or won’t. The last taboo has been dealt with by memoirists, essayists and poets. If, according to FR Leavis, literature is the supreme means by which you renew your sensuous and emotional life and learn a new awareness, then these publications are a gateway to enlightenment.

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