‘I want to stare death in the eye’:

why dying inspires so many writers and artists

By &

It may seem paradoxical, but dying can be a deeply creative process.

Public figures, authors, artists and journalists have long written about their experience of dying. But why do they do it and what do we gain?

Many stories of dying are written to bring an issue or disease to public attention.

For instance, English editor and journalist Ruth Picardie’s description of terminal breast cancer, so poignantly described in Before I say Goodbye, drew attention to the impact of medical negligence, and particularly misdiagnosis, on patients and their families.

American tennis player and social activist Arthur Ashe wrote about his heart disease and subsequent diagnosis and death from AIDS in Days of Grace: A Memoir.

His autobiographical account brought public and political attention to the risks of blood transfusion (he acquired HIV from an infected blood transfusion following heart bypass surgery).

Other accounts of terminal illness lay bare how people navigate uncertainty and healthcare systems, as surgeon Paul Kalanithi did so beautifully in When Breath Becomes Air, his account of dying from lung cancer.

But, perhaps most commonly, for artists, poets, writers, musicians and journalists, dying can provide one last opportunity for creativity.

American writer and illustrator Maurice Sendak drew people he loved as they were dying; founder of psychoanalysis Sigmund Freud, while in great pain, refused pain medication so he could be lucid enough to think clearly about his dying; and author Christopher Hitchens wrote about dying from oesophageal cancer despite increasing symptoms:

I want to stare death in the eye.

Faced with terminal cancer, renowned neurologist Oliver Sacks wrote, if possible, more prolifically than before.

And Australian author Clive James found dying a mine of new material:

Few people read

Poetry any more but I still wish

To write its seedlings down, if only for the lull

Of gathering: no less a harvest season

For being the last time.

Research shows what dying artists have told us for centuries – creative self-expression is core to their sense of self. So, creativity has therapeutic and existential benefits for the dying and their grieving families.

Creativity provides a buffer against anxiety and negative emotions about death.

It may help us make sense of events and experiences, tragedy and misfortune, as a graphic novel did for cartoonist Miriam Engelberg in Cancer Made Me A Shallower Person, and as blogging and online writing does for so many.

Creativity may give voice to our experiences and provide some resilience as we face disintegration. It may also provide agency (an ability to act independently and make our own choices), and a sense of normality.

French doctor Benoit Burucoa wrote art in palliative care allows people to feel physical and emotional relief from dying, and:

[…] to be looked at again and again like someone alive (without which one feels dead before having disappeared).

A way of communicating to loved ones and the public

When someone who is dying creates a work of art or writes a story, this can open up otherwise difficult conversations with people close to them.

But where these works become public, this conversation is also with those they do not know, whose only contact is through that person’s writing, poetry or art.

This public discourse is a means of living while dying, making connections with others, and ultimately, increasing the public’s “death literacy”.

In this way, our conversations about death become more normal, more accessible and much richer.

There is no evidence reading literary works about death and dying fosters rumination (an unhelpful way of dwelling on distressing thoughts) or other forms of psychological harm.

In fact, the evidence we have suggests the opposite is true. There is plenty of evidence for the positive impacts of both making and consuming art (of all kinds) at the end of life, and specifically surrounding palliative care.

Why do we buy these books?

Some people read narratives of dying to gain insight into this mysterious experience, and empathy for those amidst it. Some read it to rehearse their own journeys to come.

But these purpose-oriented explanations miss what is perhaps the most important and unique feature of literature – its delicate, multifaceted capacity to help us become what philosopher Martha Nussbaum described as:

[…] finely aware and richly responsible.

Literature can capture the tragedy in ordinary lives; its depictions of grief, anger and fear help us fine-tune what’s important to us; and it can show the value of a unique person across their whole life’s trajectory.

Not everyone can be creative towards the end

Not everyone, however, has the opportunity for creative self-expression at the end of life. In part, this is because increasingly we die in hospices, hospitals or nursing homes. These are often far removed from the resources, people and spaces that may inspire creative expression.

And in part it is because many people cannot communicate after a stroke or dementia diagnosis, or are delirious, so are incapable of “last wordswhen they die.

Perhaps most obviously, it is also because most of us are not artists, musicians, writers, poets or philosophers. We will not come up with elegant prose in our final days and weeks, and lack the skill to paint inspiring or intensely beautiful pictures.

But this does not mean we cannot tell a story, using whatever genre we wish, that captures or at least provides a glimpse of our experience of dying – our fears, goals, hopes and preferences.

Clive James reminded us:

[…] there will still be epic poems, because every human life contains one. It comes out of nowhere and goes somewhere on its way to everywhere – which is nowhere all over again, but leaves a trail of memories. There won’t be many future poets who don’t dip their spoons into all that, even if nobody buys the book.

Complete Article HERE!

How visions, dreams and end-of-life experiences help people prepare for death

By Erin Blakemore

Mary was dying. As her children gathered at her bedside, she began to cradle a nonexistent baby. She cooed and cuddled it in her arms, showing a happiness that was at odds with her physical suffering. Her children turned to the doctor, concerned that their mother was hallucinating. But he encouraged them to let her act out a scene that only made sense to her.

Later, they learned that Mary had delivered a stillborn baby years before she had her other children. What had seemed like a bizarre hallucination actually seemed to help address a trauma she had held inside for years. She died peacefully soon after.

Christopher Kerr, the hospice doctor who witnessed Mary’s actions, credits her with helping change his view on death.

It turns out that similar visions, dreams and end-of-life experiences are common parts of the dying process. Kerr describes what those visions are like and how they help people prepare for the end in “Death Is But a Dream: Finding Hope and Meaning at Life’s End,” written with Carine Mardorossian.

Kerr has interviewed thousands of dying patients about their visions and dreams, which often include dead family members or pets or which recreate past scenes from which patients extract meaning or healing. Patients describe seeing dead family members in the room, feeling a comforting presence nearby, or tying up unfinished emotional business relating to past slights and traumas.

The book is a challenge to doctors, whom Kerr encourages to honor and listen to the dying.

“We need to bring doctors back to the bedside, to their roots as comforters of the dying rather than as mere technicians trying to extend life at all costs,” he writes.

But it beckons to readers, too, encouraging them to open up to how dying patients make meaning of their own lives. By listening to patients, says Kerr, “dying becomes less about death than about life’s resilience.”

Complete Article HERE!

Are we just too busy to grieve?

Do we just not have time to grieve anymore? Not expressing how we feel and holding in our grief affects our wellbeing, jobs, relationships and life. In today’s world, everyone busy- work, social life, family, social media, events.. the to do list is endless! Ask anyone you haven’t seen in a while how they’ve been […]

By

Do we just not have time to grieve anymore?

Not expressing how we feel and holding in our grief affects our wellbeing, jobs, relationships and life.

In today’s world, everyone busy- work, social life, family, social media, events.. the to do list is endless!

Ask anyone you haven’t seen in a while how they’ve been and they’re likely to answer, “okay, busy!”. This isn’t surprising to hear, but something that I didn’t expect in the midst of our very busy lives is how many people who have recently suffered a loss are just too busy to grieve.

Let’s face it, we all have bills, responsibilities and commitments so, for some, taking the time to grieve and heal, to find support may feel like a luxury. Not only from a financial perspective, but also time- they have so much to keep up with.

With life moving so fast and so many things to do, and in a lot of cases, so many people to take care of, do we really give ourselves the chance and time we need to grieve?

There are many reasons we may not allow ourselves time to grieve- and they may not always be what you’d think. Work, responsibilities, being a parent, avoidance, lack of awareness and not realising we need support, sometimes even stubbornness.

We all need to ask ourselves, (and answer honestly!) is it actually about not having the time, space, money or is it a case of not making the time? Some find it easier to throw themselves into a project, to the kids, to work.. as it is “easier” than facing the grief and the emotions that come up. I’m sure “easy” is the last word most people who have experienced a loss would use, but let’s reflect on that. If we are always moving, always busy, and always worried about everyone and everything else, then there just isn’t time to think about our self, our own needs, our emotions or our pain.

I recognise this dilemma all too well. When I suffered my own loss in life, the loss of a baby, the loss of a parent, the loss of a marriage. The loss of dreams, hopes and a part of me. Grief is both real and measurable, Scientists now know that loss changes us forever. Whether its the death of a parent, or a child- it is one of the most emotional and universal human experiences. Yet, loss is something that we all inevitably face at some point in our lives.

However, ungrieved losses takes it toll on our hearts and can make us feel disconnected from life. We think we can avoid it by being busy but over time, we shut down our emotions, little by little until we are so out of alignment with ourselves, that in some cases we don’t even recognise ourselves anymore.

It’s important to recognise our own needs, asking our self what we really need and recognise how important self care is. Often people suggest grievers eat well, go for walks, get rest, have a cup of tea. Of course, the act of self care itself (whatever it is) can be pleasant in itself, but these quiet activities allow for just that: PEACE and QUIET -and a time to reflect and take that inner journey to allow us to sit with our emotions and heal. It’s something every griever needs, but the busy griever just doesn’t seem to get enough of.

Complete Article HERE!

A Chaplain on How to Talk About the Right to Die and Death With Patients

By Diane Rehm

Martha Kay Nelson has had a long career in hospice work. Rather than choosing hospice work, she believes hospice work chose her. Her training was at Harvard Divinity School. She did a yearlong internship as a hospice chaplain during her graduate work. The year after she graduated, she managed to combine her career as a chaplain with her work in hospice. She is in her mid-forties, with short hair and hazel eyes. Her warm, open face, earnest manner, and easy smile help me understand why she is so good at her work. We sit together in her office at Mission Hospice & Home Care in San Mateo, California.

DIANE: How do you feel about California’s “right to die” law?

MARTHA: Well, I have many feelings, and they could vary depending on the day or the hour. It depends on whom I’m talking to, and what her or his experience is. My overall sense about the law is that people have a right to make their own health-care decisions, whether it’s at the end of life or at any time up to that point. I know people have a hard time having these conversations, particularly early on, before they’re even sick. And then they get sick and it’s crisis time, and those decisions have to be made quickly. The End of Life Option Act to me is part of a spectrum of all those decisions and conversations that come at the end. It’s a new end point on that spectrum.

D: You’ve been in a leadership position here at Mission Hospice, not only learning, but teaching. Tell me what have been the elements of transmitting this information to others.

M: It’s been an interesting learning curve. I think even seasoned hospice professionals have had to adjust to a new option for patients, stepping into that terrain. The elements that have been important in teaching staff members, working with health-care partners, have been to get folks to acknowledge at the outset that this is a challenging topic, this is new terrain, there are profound implications, and not to shy away from it.

Some folks here at Mission Hospice didn’t want to participate, but the majority did, to have their questions answered or share some of their thoughts, their concerns. We’ve done this regularly enough that people felt they could talk freely about the End of Life Option Act. We didn’t want it to be whispered about awkwardly in the corner, that this law is coming and our patients are going to have the right to choose the option. As an agency, we’re not advocates for the law, we’re advocates for our patients, and we won’t abandon them. Having said that, any of our employees, if they’re not comfortable, don’t have to participate. They can opt out if they need to, and they would be fully supported.

D: What kinds of questions did you get from staff? What kinds of issues did they raise?

M: At the outset, a lot of general questions about details of the law, how it works, how are we supposed to communicate with our colleagues around it, what can we say to the patient and what can’t we, those kinds of things. Questions arose about accessibility to the law. If I have patients who are saying they just want to end it all, and they’re saying this a lot, but they’re not specifically asking about the law, then can I bring it up with them or not? We have a policy here at Mission Hospice that we let the patient lead. If a patient is inquiring about his or her options, then we will be there.

That’s one kind of question. Other clinicians have asked about folks who haven’t had the chance to be educated about medical aid in dying, or don’t have access to resources where they might have learned about it. What if it’s something they’d like to avail themselves of ? There’s kind of a social justice question there. There are also questions arising from specific cases. Every case is different.

D: Can you give me an idea of how many patients have actually come forward and asked you about the right to die?

M: We’ve been tracking some of these numbers, and to date, we’ve served around forty-five people since California’s law went into effect, which was a lot more than we anticipated. When back in 2016 we set out to draft our policy and prepare ourselves, we thought maybe we’d have four or five people in the first year. We had twenty-one. And about that same number inquired about the law, but never went all the way through the process. Either they actually died before they had a chance to use the law, or they changed their minds. I would imagine that it was split evenly.

D: Tell me about the process. So a patient comes to you and asks about the process, the law. How do you respond?

M: My initial response as a chaplain would be one of curiosity. I’d be interested in learning more about their thoughts and why they’re asking. It’s a big thing to ask about. Sometimes people are afraid to even inquire. They’re afraid of being shamed or judged. So I’d want to let that person know that I’m glad they’re asking. And then we’d have a conversation, whatever they would wish to say at that time. Next, I would contact the doctor and the rest of my interdisciplinary team members and would let them know the topic had been broached. Then a doctor would probably go and make a direct visit, which would be considered the first formal request, if the decision was made to pursue that course.

We really encourage the other team members to make sure they keep talking to one another—the social worker, the nurse, the spiritual counselor, home health aides, and volunteers who might also be involved. Through a team effort, we would need to have clarity on how much privacy the patient would want. Patients have the right under the law to not tell anyone but the doctors they’re working with, not even family members. Our experience has been that that’s not often the case. Usually there is communication with family.

D: Who makes the initial judgment that the patient has six months or less to live?

M: The attending physician on the case. And if the patient inquires about the law, and his or her doctor says, “I’m not comfortable being involved with this,” that’s one way we might get involved. Or it might be a hospice patient already on our service.

D: I saw in your waiting room a brochure for Death Cafes. Can you tell me about them?

M: The Death Cafe movement started several years ago in England. It’s basically having a conversation over coffee and cakes in a public venue. Anyone is welcome to attend, and the purpose is open-ended. The goal is to talk about death in any way you wish. There does need to be a facilitator, someone who is able to establish ground rules in etiquette so folks aren’t talking over one another. Folks that host them tend to have some level of experience in end-of- life care, in thanatology, but anyone can sign up. I’ve led a couple of them.

D: How successful do you think Death Cafes are as teaching tools, as comforting elements in the whole discussion of death?

M: I think Death Cafes are successful in meeting the needs of folks who already want to talk about death. If you show up at a Death Cafe, there’s something in you that is already ready to speak and to hear what other people are thinking. It can serve as a cross-pollination of ideas and thoughts, and normalization. The cafes meet a kind of thirst that we have in our culture to speak about these things openly and not be afraid. How you get people to Death Cafes is another question. I’ve had some people say they’re offended by that name, or they don’t want to attend a Death Cafe because it sounds morbid.

D: What is the best way to reach people? How do we get the conversation started even before we’re sick?

M: There’s no one best way. It’s about being creative and really getting to know your community. In my family, I’ve been lucky in that we’ve always talked about death openly. I have ongoing conversations now with my father. He’s about to turn eighty-three, and I really value the kinds of discussions and ruminations we have.

It’s wonderful. We’ve started kind of reflecting theologically, talking about, wondering together, what happens after we die. To be able to have that in a father-daughter kind of way. I’m well aware of what a precious opportunity it is to hear his thoughts. As he comes into the “lean and slippered pantaloon” time of his life, as he might say—some of his last chapters— I feel really blessed that he’s willing to discuss it openly.

D: How do you open that discussion for the general public?

M: I think it takes courage and a conscious decision to ask a question of someone in a moment when you feel there’s an opportunity. Someone speaking about her or his health, some decline, or illness, grief, and you ask, “How would you like things to be?” And perhaps even being a bit persistent if you get an initial brush-off, which often happens, but trying again, and saying, “ Really, I would like to know.”

I also think reaching children is important. I think that in our death-denying culture, children are really shielded from all things involved with death. Things happen at the funeral parlor, no longer at home, and we try to protect children in all kinds of ways. But if you don’t allow children who want to be involved in a loved one’s illness or death, I think you’re doing them a disservice. You’re keeping them from something that is integral to life for all of us. The earlier you can start to have those experiences and wonder about them and ask the questions, the more skills you will have as you age to meet them openly.

D: Have you decided what you want for yourself at the end?

M: I have no idea. I do know that I would like to have the right and the option to choose. I understand that even just knowing that the option is available can bring a lot of comfort to people. I haven’t faced a terminal illness that might cause me great physical pain or suffering, or mental or spiritual suffering. There’s one area that gives me pause, which is when folks choose medical aid in dying because they’re used to being in control in their lives. They might not have physical or mental or spiritual suffering, but they want to have personal agency. I think they entirely have the right to do that. But I also believe we’re in a culture that distorts the degree to which we think we’re in control. So on a soul level, on a much deeper level, I wonder, Are we messing with something there? How is it that we’re making such a profound decision from a place of a distorted need for control? And then I think, Well, what do I know about their journey and what they need? Maybe this is the one time they’ve ever made a strong, solid decision for themselves, and who am I to say what it is they need to learn?

D: But isn’t pain, intractable pain and suffering, and the inability to care for oneself, a sufficient reason to respect someone’s decision in terms of his or her final say?

M: Absolutely. I think clinicians have more trouble when they can’t observe visible intractable pain, when they can’t see physical or emotional suffering. It’s harder for clinicians to get their heads and hearts around that. Why is someone making this choice? And so I do a lot of counseling with staff about that, exploring how to meet the needs of the person when we don’t see them suffering, at least not on the surface. And we have to remind ourselves, clinicians need to express those feelings and concerns, so that when they’re dealing with patients directly, they can be respectful and meet them on their own terms.

Complete Article HERE!

There’s No Right Way to Mourn

The ‘grief police’ wield lamentable shaming tactics.

By Sian Beilock

When Kobe Bryant died on Jan. 26, there was an outpouring of grief for the legendary N.B.A. champion. Sports fans placed bouquets of flowers at his high school and held a vigil outside the Staples Center. Shaquille O’Neal, his friend, rival and former Lakers teammate, cried on TV while giving an emotional tribute.

Much of this grieving also took place on social media. His widow, Vanessa Bryant, wrote a powerful tribute on Instagram that was “liked” by more than nine million people. So did Carmelo Anthony and Chris Paul. Grief is no longer private these days, which lets us mourn together. But doing so also allows people to publicly shame how others deal with loss.

“Cancel the games. Cancel the Grammys.,” one person wrote on Twitter. Another criticized those who brought up the rape allegation against Bryant in their commemorations: “Some people have no respect for the dead.” This is part of a broader phenomenon. These “grief police” enforce murky standards of who should be sad, when they’re allowed to be and to what degree. They insist that our grief must be overwhelming and ubiquitous, and for all parts of our lives to be put on hold. This isn’t just problematic in the moment; introducing guilt into the grieving process can negatively impact others’ ability to heal.

Something similar happened at Barnard College where, in December, we were forced to grieve in the media spotlight after one of the newest members of our community, the first-year student Tess Majors, was murdered. I have spent my career researching anxiety and worry, and I was struck by a commonality among people on campus: Amid their feelings of heartbreak, members of our community were worried about how others would perceive their specific form of grieving.

I wasn’t aware of students policing others’ grief, but the perception that this was happening still had an effect, especially given the media attention around the tragedy. One student told me that, in the midst of her deep sorrow, she also felt guilty about feeling eager to write her final papers and was worried she would be judged for not mourning in the “right” way. Another student mentioned that she didn’t know Tess Majors personally and was feeling all right, even looking forward to a long-planned family trip over break, but was going to keep this thought to herself.

I bet some of the N.B.A. players who were eager to play in the wake of Bryant’s death also had mixed feelings — because they are being judged. LeBron James was skewered online for not immediately posting about his friend and mentor: “Why are you not posting Kobe? I never liked LeBron because he is always FULL of himself,” one person wrote on social media.

Public grieving doesn’t happen in a single community where there are shared social norms for how to react, like sitting shiva or walking in a second line. If bereaved players are slow to comment publicly, should we call them out? Must everyone who has ever met Bryant say something in public? When people with vastly different lived experiences come together around a public death, there is no real shared understanding of what is appropriate; this is why the grief police wield such power in calling people out.

Unfortunately, introducing blame into the grieving process causes people to question whether they are dealing with loss the right way and to feel guilty about what they do, say and feel. Recent research has linked guilt in bereavement to a wide range of mental and physical difficulties, including depression. So how, in the age of communal and public mourning, do we grieve and not let the grief police undercut how we feel? How do we continue to perform at our best with heavy hearts?

Everyone responds to death differently, and it’s psychologically healthy to focus on parts of our identity that are not touched by tragedy. It is O.K. for a grieving athlete to play an important game; the same goes for a student who wants to take her finals in the wake of a campus tragedy. Research on resiliency shows quite clearly that people who express (and value) different aspects of who they are tend to be psychologically stronger. For example, their role as an athlete, student or parent provides another outlet to express themselves if they experience a setback or loss in one aspect of their life, or if one of the ways they identify themselves is called into doubt.

Embracing the fullness of our identities in no way represents a lack of respect or a blindness to the gravity of a tragedy. Quite the opposite: It is only through this process that we can effectively take care of one another, including those who have been most affected.

Despite my expertise in this subject, I have had to force myself over the last month to realize that, even in mourning, I have to juggle life as a college president, a researcher, a mother, an athlete and a friend — not only for my own health and mind-set, but also for the well-being of those around me. When the grief police arrive, we need to give ourselves license to express positive emotions and affirm other aspects of ourselves that we value outside of the tragedy. Doing so means we will feel more in control and cope better down the line.

Complete Article HERE!

Dates With Death

When My Time Comes

Diane Rehm poses for a portrait at her home in January. After more than three decades and thousands of programs, she’s stepping away from the broadcast microphone.

By Amy Kepferle

“My mother begged to die,” Diane Rehm writes in the preface of her new book, When My Time Comes: Conversations about Whether Those Who Are Dying Should Have the Right to Determine When Life Should End.

“There was no hope of recovery,” she continues. “There was nothing more they could do to ease her pain or to keep her comfortable. She died suffering.”

Rehm, a beloved National Public Radio talk show host and bestselling author, wondered why she’d had to watch her mother endure the horrific effects of non-alcohol-related cirrhosis for so long, and why she didn’t have the right to choose when she’d had enough.

The subject again became personal in 2014 when her husband of 55 years, John Rehm, decided to end his life when the side effects of Parkinson’s disease became overwhelming. He couldn’t use his hands, could no longer feed himself or use the bathroom on his own, and slept for most of the day.

“Because John could not receive medical aid in dying, he had to starve himself and go without medication for 10 days, until he died,” she relates during a chapter focusing on an interview with palliative care physician, internist and geriatrician Christina Puchalski. “I as his wife could do nothing but watch him suffer.”

Puchalski’s take on Rehm’s story is an interesting one. Although she has plenty of compassion for those who are facing their final journey, she has concern that in states where assisted suicide is legal—like Washington, Oregon, Maine, Vermont, California, New Jersey, and Colorado—people might be too quick to seek medical aid to quicken their deaths. She believes palliative care and hospice care can help with pain and symptom management, and can also be done with dignity.

“Are we giving a message that when you get to that point, there’s not a lot of opportunity for meaning and purpose and joy?” Puchalski asks.

At 83 years old, Rehm is a clear proponent of the right-to-die movement. But in When My Time Comes, she uses her interviewing prowess to explore the topic in ways that go beyond a simple “yes” or “no.” She questions terminal cancer patients—one of whom moved to Oregon so she’d be able to end her life on her own terms—and widowed spouses, doctors, death educators, reverends and Roman Catholic priests, constitutional law professors, attorneys and politicians for their opinions.

It’s heady reading, especially when hearing from those who know they’re running out of time. But it’s also a reminder that life is fleeting, and that it’s better to let your family and loved ones know what you want before its final chapter.

At the end of the book, Rehm even talks to her grandson, asking him to record their conversation on his iPhone for posterity. She then tells him that if she’s terminally ill and there is no reasonable expectation of her recovery from mental or physical disability, to let her die and not be kept alive by artificial means and heroic measures.

During “A Conversation with Diane Rehm” Tues., Feb. 11 at Sehome High School, the retired radio personality will be in conversation with local author Phyllis Shacter, who—like Rehm—watched her spouse choose to die via Voluntary Stopping Eating and Drinking (VSED) rather than live into the late stages of Alzheimer’s. The discussion is sure to be a fascinating one, and may help give attendees a clearer look at the bigger picture.

Complete Article HERE!

The Pitfalls Of Extending Life And Prolonging Death

Humans have had to face death and mortality since since the beginning of time, but our experience of the dying process has changed dramatically in recent history.

Haider Warraich, a fellow in cardiology at Duke University Medical Center, tells Fresh Air‘s Terry Gross that death used to be sudden, unexpected and relatively swift — the result of a violent cause, or perhaps an infection. But, he says, modern medicines and medical technologies have lead to a “dramatic extension” of life — and a more prolonged dying processes.

“We’ve now … introduced a phase of our life, which can be considered as ‘dying,’ in which patients have terminal diseases in which they are in and out of the hospital, they are dependent in nursing homes,” Warraich says. “That is something that is a very, very recent development in our history as a species.”

Prolonging life might sound like a good thing, but Warraich notes that medical technologies often force patients, their loved ones and their doctors to make difficult, painful decisions. In his new book, Modern Death, he writes about a patient with end-stage dementia who screamed “kill me” as a feeding tube was inserted into his nose.

“This is probably one of the encounters that I had in residency that I have been unable to shake from my memory,” Warraich says. “I think if you ask any physician, any nurse, any paramedic, they’ll have many such stories to tell you.”

Interview Highlights

On the importance of having a healthcare proxy, living will and advanced directive

One of the biggest problems that we face in not only modern society, but in societies of olden times as well, is that people have always been very afraid to talk about death. In many cultures it is considered bad luck to talk about death and it is thought to be a bad omen. I think to some extent that extends to this very day. But … I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you’re not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.

On giving CPR and knowing when to stop giving CPR

One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. …

I was actually working in the hospital last night and it was about 3 in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, “Haider, I need your help. I have a patient that we are doing CPR on,” and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. … There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. …

At the same time while this CPR was ongoing, the patient’s family member, her daughter, was outside the room, and she was crying. … Even though we could give her all the information … that wasn’t perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, “Do you want us to stop CPR?” And that’s the type of thing that I don’t think any of us can ever prepare for, especially when it’s our parent that’s involved.

On why he wrote a book about dying

I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient’s religion but a physician’s religion when it comes to dealing with the end of life? How is social media affecting how people experience the end of life? …

So many times I’ve found myself in the room where there are people who were so much more experienced in life than I was, yet knew so little about death and dying. And so I wanted to write a book so that people could go into those really, really difficult places and feel like they’re armed with information, that this isn’t a completely foreign territory for them and that in some way could help them navigate and deal with the sort of difficult situations that lay ahead for them.

On the possible repeal of the Affordable Care Act

It is very unfortunate that health is so politicized in this country, because it doesn’t have to be. Health and wellness aren’t red or blue, and they shouldn’t be, but unfortunately that is where we are. I hope that when policies are being enacted in DC, patient’s voices, those who have benefited from the ACA, those who have gained insurance, those voices are not lost in the midst of all of this political activity.

On immigrating to the U.S. from Pakistan

Dr. Haider Warraich has written medical and opinion pieces for The New York Times, The Wall Street Journal and The Atlantic.

I came to the United States in 2010 and [until now] have only lived in an America in which Barack Obama was the president. I think in some ways Trump’s victory has really shaken me, because of how invested I was in the idea that America is a special place, it’s a truly multicultural society. And I’m still trying to understand, I think like so many others, just exactly what happened. Especially as a writer and as a physician I’ve tried to separate myself from my identity as a Muslim. I’d rather be known as a physician/scientist/writer who happens to be Pakistani, rather than a young Pakistani Muslim immigrant who happens to be a doctor and a writer, but I don’t know. Given how things are changing, I’m not even sure if I’ll be able to set that narrative for myself. That’s a scary thought — to live an identity that is so politicized even when you wish for it to not be.