Tag: Death Meditation

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A Neuroscientist Prepares for Death

Lessons my terminal cancer has taught me about the mind

By David J. Linden

When a routine echocardiogram revealed a large mass next to my heart, the radiologist thought it might be a hiatal hernia—a portion of my stomach poking up through my diaphragm to press against the sac containing my heart.

“Chug this can of Diet Dr. Pepper and then hop up on the table for another echocardiogram before the soda bubbles in your stomach all pop.”

So I did. However, the resulting images showed that the mass did not contain the telltale signature of bursting bubbles in my stomach that would support a hernia diagnosis. A few weeks later, an MRI scan, which has much better resolution, revealed that the mass was actually contained within the pericardial sac and was quite large—about the volume of that soda can. Even with this large invader pressing on my heart, I had no symptoms and could exercise at full capacity. I felt great.

The doctors told me that the mass was most likely to be a teratoma, a clump of cells that is not typically malignant. Their outlook was sunny. Riffing on the musical South Pacific, my cardiologist said, “We’re gonna pop that orange right out of your chest and send you on your way.”

While I was recovering from surgery, the pathology report came back and the news was bad—it wasn’t a benign teratoma after all, but rather a malignant cancer called synovial sarcoma. Because of its location, embedded in my heart wall, the surgeon could not remove all of the cancer cells. Doing so would have rendered my heart unable to pump blood. The oncologist told me to expect to live an additional six to 18 months.

I was absolutely white-hot angry at the universe. Heart cancer? Who the hell gets heart cancer?! Is this some kind of horrible metaphor? This is what’s going to take me away from my beloved family, my cherished friends and colleagues? I simply couldn’t accept it. I was so mad, I could barely see.

[And now comes the part where I’m weeping while I type.]

Five years ago, I met Dena and we fell for each other hard. This wasn’t mere “chemistry”; it was more akin to particle physics—a revelation of the subatomic properties of love. Dena has uplifted me with her pure and unconditional affection, her kindness, beauty, optimism, and keen intelligence. She is the best wife anyone could want, and she is way better than I deserve. Leaving her behind will be the very hardest part of this whole awful situation.

Until the moment of that diagnosis six months ago, I had been the luckiest man in town. My twins, Jacob and Natalie, have been nothing but a delight for 25 years. I’ve been fortunate to have a long career in academic science with the freedom to pursue my own ideas, which is a gift like no other. My good friends are a constant source of joy and amusement. By any reasonable measure, I’ve had a great life, full of love, creativity, and adventure.

I may be dying, but I’m still a science nerd, and so I think about what preparing for death has taught me about the human mind. The first thing, which is obvious to most people but had to be brought home forcefully for me, is that it is possible, even easy, to occupy two seemingly contradictory mental states at the same time. I’m simultaneously furious at my terminal cancer and deeply grateful for all that life has given me. This runs counter to an old idea in neuroscience that we occupy one mental state at a time: We are either curious or fearful—we either “fight or flee” or “rest and digest” based on some overall modulation of the nervous system. But our human brains are more nuanced than that, and so we can easily inhabit multiple complex, even contradictory, cognitive and emotional states.

This leads me to a second insight: The deep truth of being human is that there is no objective experience. Our brains are not built to measure the absolute value of anything. All that we perceive and feel is colored by expectation, comparison, and circumstance. There is no pure sensation, only inference based on sensation. Thirty minutes fly by in a conversation with a good friend, but seem interminable when waiting in line at the DMV. That fat raise you got at work seems nice until you learn that your co-worker got one twice as large as yours. A caress from your sweetheart during a loving, connected time feels warm and delightful, but the very same touch delivered during the middle of a heated argument feels annoying and presumptuous, bordering on violation.

If someone had told me one year ago, when I was 59, that I had five years left to live, I would have been devastated and felt cheated by fate. Now the prospect of five more years strikes me as an impossible gift. With five more years, I could spend good times with all of my people, get some important work done, and still be able to travel and savor life’s sweetness. The point is that, in our minds, there is no such thing as objective value, even for something as fundamental as five years of life.

The final insight of my situation is more subtle, but it’s also the most important. Although I can prepare for death in all sorts of practical ways—getting my financial affairs in order, updating my will, writing reference letters to support the trainees in my lab after I’m gone—I cannot imagine the totality of my death, or the world without me in it, in any deep or meaningful way. My mind skitters across the surface of my impending death without truly engaging. I don’t think this is a personal failing. Rather, it’s a simple result of having a human brain.

The field of neuroscience has changed significantly in the 43 years since I joined it. I was taught that the brain is essentially reactive: Stimuli impinge on the sense organs (eyes, ears, skin, etc.), these signals are conveyed to the brain, a bit of computation happens, some neural decisions are made, and then impulses are sent along nerves to muscles, which contract or relax to produce behavior in the form of movement or speech. Now we know that rather than merely reacting to the external world, the brain spends much of its time and energy actively making predictions about the future—mostly the next few moments. Will that baseball flying through the air hit my head? Am I likely to become hungry soon? Is that approaching stranger a friend or a foe? These predictions are deeply rooted, automatic, and subconscious. They can’t be turned off through mere force of will.

And because our brains are organized to predict the near future, it presupposes that there will, in fact, be a near future. In this way, our brains are hardwired to prevent us from imagining the totality of death.

If I am allowed to speculate—and I hold that a dying person should be given such dispensation—I would contend that this basic cognitive limitation is not reserved for those of us who are preparing for imminent death, but rather is a widespread glitch that has profound implications for the cross-cultural practice of religious thought. Nearly every religion has the concept of an afterlife (or its cognitive cousin, reincarnation). Why are afterlife/reincarnation stories found all over the world? For the same reason we can’t truly imagine our own deaths: because our brains are built on the faulty premise that there will always be that next moment to predict. We cannot help but imagine that our own consciousness endures.

While not every faith has explicit afterlife/reincarnation stories (Judaism is a notable exception), most of the world’s major religions do, including Islam, Sikhism, Christianity, Daoism, Hinduism, and arguably, even Buddhism. Indeed, much religious thought takes the form of a bargain: Follow these rules in life, and you will be rewarded in the afterlife or with a favorable form of reincarnation or by melding with the divine. What would the world’s religions be like if our brains were not organized to imagine that consciousness endures? And how would this have changed our human cultures, which have been so strongly molded by religions and the conflicts between them?

While I ponder these questions, I am also mulling my own situation. I am not a person of faith, but as I prepare for death, I have a renewed respect for the persistent and broad appeal of afterlife/reincarnation stories and their ultimately neurobiological roots. I’m not sure whether, in the end, faith in afterlife/reincarnation stories is a feature or a bug of human cognition, but if it’s a bug, it’s one for which I have sympathy. After all, how wonderfully strange would it be to return as a manatee or a tapeworm? And what a special delight it would be to see Dena and my children again after I’m gone.

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Joan Didion Wrote About Grief Like No One Else Could

On a patio deck overlooking the ocean, Quintana Roo Dunne leans on a railing with her parents, writers John Gregory Dunne and Joan Didion, in Malibu, Calif., 1976.

By Annabel Gutterman

Joan Didion made sense of the world through words. She was known for them: her cool, exacting prose; her sentences, smooth and spare. But in the aftermath of her husband’s fatal heart attack in 2003, her relationship with words changed. “This is a case in which I need more than words to find the meaning,” she wrote in her 2005 memoir, The Year of Magical Thinking. “This is a case in which I need whatever it is I think or believe to be penetrable, if only for myself.”

Didion, who died on Dec. 23 at 87, was the author of five novels, several works of nonfiction including Slouching Towards Bethlehem and The White Album, screenplays and more. She was a prolific storyteller who ushered in a new style of journalism, combining research and lyrical imagery with cutting moments of humor. In the foreword of the last book she published before her death, Let Me Tell You What I Mean, writer Hilton Als described Didion as “a carver of words in the granite of the specific.” She both dissected the ordinariness of the everyday for its complexities, and broke down the most foreign of situations into familiar, accessible parts. Crucially, Didion also explored the language we use to process loss, and the limitations of that language. Now, as the world mourns her death, we look to her own words for both guidance and solace.

“Grief has no distance. Grief comes in waves, paroxysms, sudden apprehensions that weaken the knees and blind the eyes and obliterate the dailiness of life,” Didion wrote in The Year of Magical Thinking. The book, a finalist for the Pulitzer Prize, chronicled the process of grieving the death of her husband and most trusted collaborator, the writer John Gregory Dunne, a little over a month before their 40th wedding anniversary. (Dunne was writing for TIME when they first met.) When Dunne died, the couple’s adopted daughter, Quintana, was unconscious in the ICU, suffering from pneumonia and septic shock. Didion’s experience with loss continued: A little over a year and a half after Dunne’s death, Quintana died at age 39. The writer examined that second excruciating loss in her 2011 memoir, Blue Nights, detailing a new kind of grief while crafting an aching examination of mortality and aging.

“This book is called ‘Blue Nights’ because at the time I began it I found my mind turning increasingly to illness, to the end of promise, the dwindling of the days, the inevitability of the fading, the dying of the brightness,” she wrote. “Blue nights are the opposite of the dying of the brightness, but they are also its warning.”

Joan Didion, circa 1977

Though both books were rooted in Didion’s agonizing personal tragedies, they were not ones of self-pity or despair. Instead, they sought to understand how memory informs grief and how death shapes life. The title of The Year of Magical Thinking comes from Didion’s experiences reckoning with the finality of death, and the disillusion that exists in its aftermath. In one poignant scene, Didion becomes fixated on her husband’s shoes while going through his clothes.

“I could not give away the rest of his shoes. I stood there for a moment, then realized why: he would need shoes if he was to return. The recognition of this thought by no means eradicated the thought. I have still not tried to determine (say, by giving away the shoes) if the thought has lost its power.”

Didion detailed how she would convince herself that she could bring her husband back, even though she was well aware he was gone. “Magical Thinking is an act of consummate literary bravery, a writer known for her clarity narrating the loss of that clarity, allowing us to watch her mind as it becomes clouded with grief,” the author Lev Grossman wrote in a review for TIME in 2005. “But the book also reproduces, in its formal progression from those first raw, frenzied impressions to a more composed account of mourning, Didion’s recovery. She literally wrote herself back to sanity.”

The Year of Magical Thinking was Didion’s 13th book. She finished it in 88 days during the year after Dunne’s death. It was the first time in 40 years that Didion did not receive feedback from Dunne on a writing project. Although she wrote the book quickly, she said it was difficult for her to finish because the book “maintained a connection with him.”

Often described as a companion piece to that book, Blue Nights is another gutting look at a writer grasping for words to describe a loss—this time, of a beloved child. While just as candid as its predecessor, Blue Nights is a more raw exploration of grief, less polished in its structure, with Didion moving between fragmented memories. These range from the scenes of Quintana’s adoption and her reunion with her birth family to Quintana losing a tooth as a child. In Blue Nights, the magical thinking that once consumed Didion is gone, instead replaced with her reflections on memory and rumination on growing older and the ways her daughter’s death made her face her own mortality. “When I started writing, I thought it was going to be about attitudes to raising children,” Didion told The Guardian. “Then it became clear to me that, willy-nilly, it was going to be personal. I can’t imagine what I thought it was going to be, if it wasn’t personal.”

The raw emotional weight of both The Year of Magical Thinking and Blue Nights provided an unflinching look inside Didion’s otherwise steely, sophisticated exterior. In letting her guard down, she allowed readers into her grieving process—and provided a roadmap for others navigating their own pain. “I know why we try to keep the dead alive: we try to keep them alive in order to keep them with us,” Didion wrote in The Year of Magical Thinking. “I also know that if we are to live ourselves there comes a point at which we must relinquish the dead, let them go, keep them dead.”

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‘Conversations with those dying are some of the most privileged I have had’

by Matthew Townsend

We are born. We live. We die. That said then, death is the only event in life of which we can be certain: an event that, it could be argued, is implicitly linked to life itself. Without life, there can be no death yet, in order to live, so too must we realise that we will, eventually, die.

The thought of death and dying often provokes discomfort and is a conversation that many prefer not to have. When people ask me what my clinical interests are, my passion for end-of-life care is often greeted with an uncomfortable silence. And for very good reason.

“Should we enjoy these conversations with our patients and their families?”

As Vanderveken et al (2019) observe we, as a species, are both hesitant and reluctant to talk about death. It brings into our conscious stream of thought the very thing that we often consciously attempt to avoid: the reality of our finite existence.

This is confirmed by Doughty (2017) who has coined the phrase ‘death avoidance’ to define the process via which someone refuses to engage in anything to do with death or dying.

Often, such thoughts can provoke death anxiety; a psychophysiological response in reaction to contemplating one’s own finitude or threat to one’s existence.

This is considered in research carried out by Fernandez-Dona ire et al (2019) who report that death anxiety can manifest as panic, fear, upset, and physiologic malaise.

Avoiding these conversations, and the necessary reflection and contemplation that accompanies them, has resulted in the end of life being a chapter of our existence shrouded in taboo and forcibly pushed to the back of our minds.

If we consider our life as a story, the closing chapter is one we shy away from reading, even though it is a necessary one in order to sign the book off as complete.

The fear prompted by the thought of death has not simply resulted in an avoidance of it as a topic: a conscious repression of our fears and anxiety has translated into an almost insurmountable problem.

The harsh reality is though, whether or not we choose to admit, we will, eventually die and, in fact, based upon my experiences in clinical practice, is something rarely feared by those living at the end of their lives.

Through my nursing career so far, I have been privileged to sit at the bedside of many people who are approaching the end of their lives: they may have a chronic condition with no trajected end point or are coming to the end of a terminal illness, with only a matter of days or hours left.

Whether the former or the latter, there has often been a common thread between the two: a beautiful, almost existential, peace. Rarely fear. Rarely panic.

But instead, an inspiring positivity and solemnity that confirms to me that the fear we burden ourselves with through the course of our lives can restrict us in our living and is, in any case, unfounded.

This considered then, how can we condition ourselves to not fear the end of life, and how can we approach death with a positivity that seems almost incongruous with its finite state?

Many of the conversations I have had with those at the end of their lives echo research in the field that regards spirituality as an important aspect of end-of-life care with its acknowledgement significantly reducing fears and anxieties (lnbadas, 2018).

That said, let us not confuse spirituality with religiosity. As Tornoe et al (2017) note, spirituality focuses on factors such as relationships, meaningfulness of life, and feelings of self-worth.

Indeed, the World Health Organization (2017) positions the construct of spirituality central to its definition of quality of life, not only recognising it as key, but acknowledging that it becomes more prevalent as one approaches the end of one’s life.

Reading the WHO’s definition of quality-of-life alongside definitions of spirituality, it can be seen how a good quality of life can necessarily translate to a good quality of death.

“I recall with great fondness when I heard roars of laughter from his side-room”

To live in recognition and acknowledgement of death as opposed to in its shadow, will help us remove this taboo and will ultimately improve our relationship with it.

This reinforces my earlier observation: life is inextricably linked to death and to discount the latter negatively impacts the former.

As Lemaster and Moyer (2020) note, our lived experiences and the extent to which we feel we have lived full and meaningful lives removes fear and anxiety of end-of-life issues.

Embracing life will aid us in not just enjoying it but in ensuring that this enjoyment will help remove the fear of death.

Conversations I have had with those who are dying are some of the most privileged and enjoyable I have had in my career.

When I admit this to my family, friends and work colleagues, I am met with the same uncomfortable silence as when people ask me what my clinical interests are. An awkwardness possibly precipitated by using the words ‘enjoyment’ and ‘death’ in the same sentence.

Should we enjoy these conversations with our patients and their families? Should we approach death with a positive optimism?

My answer: absolutely. To acknowledge that someone is dying is not a sign of failure. To acknowledge that someone is dying will not hasten your own death. To acknowledge that death forms an integral part of life should not invoke fear.

Conversely, it should be embraced. It is, after all, our final accomplishment. Conversations I have had are filled with fond memories and often bursting with smiles, happiness, and celebratory nostalgia.

I have recently helped nurse a patient who was at the end of their terminal illness. A similar age to myself, it was a particularly sobering experience. Young people are not supposed to die: it goes against what we are told is the natural order.

We are born, we live, we die and we hope that this last chapter is one that is written many years in the future. Anything that digresses from this catches us off-guard.

Following my patient’s admission to the ward, I soon noticed a common behaviour: an avoidance of talking to him about his death.

Research has shown that nurses are notoriously bad at actively engaging with death (Anderson et al, 2016).

Let us not be too harsh though: we are, after all, only human and to have to deal with it forces us to face our own mortality. That said, my patient was facing his and I was determined that he would not face it alone.

“If we consider our life as a story, the closing chapter is one we shy away from reading”

Over the next few days, we built a strong nurse-patient relationship where we discussed all manner of things.

There were sad moments, but also moments where we both heartedly laughed at, for example, his bucket list and that, in his words, how he was “going to kick the bucket before ticking items off it”.

Through the course of our conversations, there was again a notable absence: fear. He was not afraid of dying, merely sad that he could not have lived a little longer.

This was the significant difference. He also noted that the fact I spoke with him so openly about his death was “refreshing” and “reassuring”.

I recall with great fondness when I heard roars of laughter from his side-room. His mother emerged with an empty teapot and tears in her eyes. Happy tears? Sad tears? A combination of the two? “Are we being too loud?” she asked.

I smiled and shook my head. “Be as loud as you want to be,” I replied. When I checked my patient later, the room was filled with laughter; it was filled with love; it was filled with happiness.

Family and friends had come together to acknowledge what was inevitably happening and to celebrate his life. Fear was nowhere to be seen. Fear would have been out of place. When my patient died, his mother thanked me.

She noted that my positive approach to her son’s death not only helped him, but that she no longer feared death and that she had not realised how simple it was to die.

This woman had witnessed what it actually meant to die and that death is, in fact, usually an incredibly peaceful event.

Kathryn Mannix’s (2015) book, With the End in Mind, aims to remove the taboo of dying and to bring conversations about it into our lived experience.

The observations of my patient’s mother are reinforced in Mannix’s work. As Mannix notes, death, if well managed, is often painless, peaceful and, dare I say, an uncomplicated process?

Significantly, to live in acknowledgement of death is to not live in its shadow. Birth and death are inextricably linked, just sat at different ends of the spectrum of life. We cannot have one without the other.

That said then, to live in fear of death would be a disservice to life. Enjoying life, while simultaneously acknowledging death, will ensure that when the time comes, we approach it not seeing it as something to fear, but instead as a celebration of life.

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‘I Would Give Anything to Hold Their Hands Again’

A husband and wife find a way to talk to their young sons about an unspeakable event.

By Jessica Alexander

It could have been any January day — the air crisp, the sky clear. But that morning in Tokyo, where we lived then, I awoke with the same heaviness I have felt on this day since meeting my husband, Andy, nearly eight years before.

He was already out for a jog.

I pulled our 4-year-old twin boys out of bed, opened a box of crayons and told them we were going to make daddy a card. They didn’t ask why, and I didn’t tell them that it was so he would feel our warmth and affection on this day, the anniversary of the worst day of his life. They drew colorful hearts, and I wrote “We Love You” in big letters.

When Andy returned, one of our boys ran to the door, arm outstretched, proudly handing him our creation.

“Thanks guys,” Andy said with a smile, his eyes asking me: What is this for?

“Because it’s today,” I said.

“What’s today?” he asked, wiping the sweat from his forehead.

“Today. You know — ”

It hit him: This was the day that his first wife and two sons died in the Haiti earthquake 10 years earlier. His body deflated, and his face, still bright from his run, crumpled.

Then the texts began: “Thinking about you.” “Sending love.” With every buzz of his phone, he would look at me with a pleading face, as if to say: “How could all these people remember, except me?”

Of course, he never forgets. He tells me they are with him every day; I imagine their memories like a heavy blanket wrapped around his heart, keeping him warm and grounded.

He rationalized that his slip of the mind that day honored who they were, because they wouldn’t want him to still tear up at the sound of children’s laughter, to still be vacillating between sorrow, anger and emptiness.

“Forgetting” also meant he was present in a way that was once unimaginable — waking up without dread, going for a carefree run, sitting down for toast and eggs with his family.

Our boys didn’t know about Andy’s past. He and I met two years after the earthquake when our work overlapped. In time, Andy and I fell in love, married and had twin sons. As the boys turned 3, then 4, I found myself searching online, “What is the right age to talk to children about death?”

I wondered when they would ask about the other two boys in framed photos on our bookshelves or recognize them on their grandmother’s refrigerator — the pictures that didn’t change with each new baseball season or dance recital like those of the other grandchildren. Those two faces never grow up.

When I looked at my sons — at their baby teeth smiles and wrists still pudgy with baby fat — I could only guess at who they would be years from now. Andy often wondered the same about his first boys. One recent August marked when the eldest, Evan, would have turned 18. Would he be headed off to college? How would his voice sound?

That August afternoon, we had just finished eating lunch next to a lake near our home when Andy turned to me and said, “I’m going to tell them.”

I felt anxious, not knowing how the boys would take it, but also reassured by Andy’s calm. We got up and started walking along the edge of the lake when Andy stopped and said, “Boys, I have something to tell you.”

They loved his stories and ran to him, each grabbing a hand.

“Many years ago,” he said, “when I was working in a country called Haiti, I lived with my two sons and their mom. My sons were just about your age — Baptiste was almost 5, and Evan was 7. Today is Evan’s birthday actually; he would have been 18. One day, there was a big earthquake.” He explained what an earthquake was, tectonic plates and all. “I was at work and Evan, Baptiste and their mom, Laurence, my wife before your mommy, were at home.”

When the shaking started, Andy explained, they couldn’t make it out of the building before it collapsed, and the three of them died.

I tensed to see if the boys would be scared or surprised, or if it would even register.

“What does collapse mean?” one asked.

“Look there’s a fish!” said the other, pointing.

Andy carefully answered all their questions, then took a deep breath and said, “Let’s go for a swim.”

We put on bathing suits and hopped into the cold water, the boys splashing behind rocks and laughing. They didn’t seem to absorb the gravity of the loss, or how brave their father was. It probably struck them as just another story.

Back home, we took the photos of Evan, Baptiste and Laurence from our shelves, introducing the boys to the faces they had always seen around the apartment. In the coming weeks, Andy shared details about them that I realized he had been carrying alone this whole time.

Soon Andy began working memories of his first family into our everyday lives. “Evan and Baptiste loved this book,” he would say before settling in for a bedtime story that he had read our boys countless times. Or as we gathered on the couch to watch a movie, he would tell us that this was Evan and Baptiste’s favorite.

“Did they get scared too?” one of the twins asked.

“Sure they did.”

One summer evening as we walked home from the park, the boys tugged excitedly at our hands, pulling us this way and that, until Andy pulled his hand away from their incessant yanking. Then he immediately flinched and put his hand out again, later saying to me, “I get so mad at myself for doing that.”

“Why?”

“Because I would give anything to hold their hands again.”

As in that instance, I sometimes overlook how his interactions with us are shaped by regret over things he wishes he had done differently, and his sorrow over things he wishes he still could do. But they are also shaped by the realization that today he has another chance.

I often think about Andy’s former wife — I am older than she was when she died at 40 — and how she was robbed of so much life. It shouldn’t have surprised me when the boys did the same about their half brothers.

After losing his first tooth, one of the twins asked, “Did Baptiste ever lose a tooth?” And they would tell their friends over lunch about how Evan pronounced butter “buller.” When they turned 5, they wanted to know if Baptiste ever had a 5th birthday party, and they began asking more often for details about what happened, trying to understand. But so much of what happened isn’t understandable.

“Why did your house break, Daddy?”

“Why were they at home and you weren’t?”

“Why didn’t your office fall down?”

These questions had haunted Andy for years, but when they come from the mouths of his innocently curious children, he tells me that he can face them more easily, which has helped relieve his lingering guilt. One day they may ask about his despair, and perhaps he will explain the many dimensions of his grief. For now, getting through the facts is enough.

One morning after one of the boys’ friends slept over, we all sat down for pancakes when the friend noticed a framed picture of Evan and Baptiste on a seesaw and said, “When were you there?”

“That’s not us,” one of the twins said. “That’s Daddy’s other sons, Evan and Baptiste. They died in the earthquake in Haiti when their building fell on them.”

“Oh, like when the bear got smushed by the rocks in that cartoon,” the friend said. He was only 5 — what other reference could he possibly have?

“It’s not a cartoon,” our son said. “It was real. And it’s not funny.”

I had thought the gravity was lost on him and his brother, but he understood. And for the first time, Andy didn’t have to take a deep breath and muster the strength to tell the story yet again. His son had done it for him.

This year, the night before the earthquake anniversary, Andy was feeling low, his attention elsewhere while cooking dinner.

“What’s wrong, Daddy?” asked our older twin.

“Tomorrow is the anniversary of the earthquake,” he said. “So I’m thinking of Baptiste, Evan and Laurence.”

“Tomorrow there will be an earthquake?”

“No baby, tomorrow’s just the anniversary. And I’m sad.”

“Oh,” our son said, then quickly added, “But lucky too, Daddy.”

Andy looked up. “Lucky?”

“Lucky you found us.” His voice was high and his head tilted, as if asking.

Andy looked at me with disbelief. Our boy might not have understood the meaning of an anniversary, but he could comprehend the idea of renewal.

Andy scooped him up in his arms. “Yes, my boy,” he said. “I am the luckiest.”

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A good death: Julie McFadden’s message

McFadden relates that the dying often call out to parents, and report seeing beloved relatives who’ve already passed away, waiting to lead them onward. She has no idea why.

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Have you ever witnessed someone peacefully die? Was it a trauma, a privilege, an intrusion, a wonder? A palliative nurse from Los Angeles has gone viral with her TikTok videos explaining the mysterious process. Julie McFadden’s message:Trust the body. It knows what it’s doing, just as it knows what it’s doing in childbirth. Do not be afraid of what’s unfurling before you so mysteriously and irreversibly – and predictably.

Her aim is to normalise a shielded process. She says death is not, normally, painful; it’s a “peaceful and natural” procedure. “Our bodies are truly built to survive birth, for the most part, and they’re built to die. When someone is in a hospice dying a natural death, the body knows.” She explains: “[It] will start kicking in its regular mechanisms that are built in when someone is getting near death. It will stop eating and drinking for the most part, and sleeping a lot more.”

McFadden believes the less intervention the better, and talks of “the rally” that often occurs near the end, when the patient suddenly seems much better hours or days before death. She says the less we mess with the process, the more peaceful the death usually is. She explains that changes in breathing and skin colour, terminal secretions and fevers are all normal. I could add that the patient’s face takes on the look of a death mask, as if the visage is rehearsing for the skull to come. I saw this with both my father and grandmother as they approached death.

With my father, I was in denial, refused to believe this could be happening. Because what I didn’t get from the hospice, for all their good intentions, was a bracing honesty. I needed the blunt truth, that dad had begun his journey upon the irreversible road into death. In hindsight the staff knew but the family didn’t. We didn’t trust the peaceful process, didn’t surrender to reality, but clung to the wild, stubborn hope of a miraculous turnaround. The head of the palliative unit had said that some people do actually leave their care alive, that it’s not always terminal, and that’s what we gripped on to. Foolishly.

The actual care couldn’t be faulted. The room was large and airy, sliding doors opened to a peaceful courtyard, the dog was allowed onto the bed, there was music and endless cups of tea, as a circuit breaker, in a spacious communal lounge area. So much thought had gone into this compassionate place – it felt like a gift at the end of life. The Australian way of a foreseen death, done very well.

As Ursula Le Guin wrote once, “Let the dying spirit go”. Dad was ready, the staff were ready, but we the family were not. Perhaps it’s just too difficult sometimes to broach the subject; to announce the brutal words “look, they’re dying now, it’s not far off” to a desperately grieving family. I felt like something of a hostage within a death-hesitant culture; needed the truth but hope is easier, a polite and powerful drug.

There are grumblings that our palliative system isn’t good enough, particularly in the fraught arena of arguments around Voluntary Assisted Dying. Yet we felt cradled by support; there was a profound compassion for the dying as well as the living. I just wish there’d been a bit more brutal honesty – it would have lessened the shock. Because we weren’t prepared, mentally, for the process.

McFadden’s TikToks have helped with an understanding of the mysterious state a body succumbs to along its path into death. My relatives were irreversibly lost to us, as a family, yet seemed responsive to love as they underwent a leave-taking that felt beautiful and harrowing all at once. It didn’t feel claustrophobic, but a natural end to things; a slide over days into stillness. McFadden relates that the dying often call out to parents, and report seeing beloved relatives who’ve already passed away, waiting to lead them onward. She has no idea why.

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These Precious Days by Ann Patchett

– a reckoning with loss

‘Having someone who believed in my failure more than my success kept me alert’ … Ann Patchett.

By

At 57, the novelist Ann Patchett is already preparing for death. She isn’t terminally ill, and her decision isn’t as morbid as it sounds at first. She intends from now on to travel light, to empty her house in Nashville of the residues of adulthood: the boxes of clothes and dishes and jewellery that she has accumulated over five decades of living, things that she now believes prevented her from “thinking about what was coming and the beauty that was here now”.

Call it a pandemic house clearance, if you will, for she first had the idea of sorting out her drawers and closets following the death of a friend’s father last year. It took Patchett’s friend the entire summer to tidy up her father’s house for an estate sale: one man living alone had left behind too much. Patchett thought about the boxes in her own basement, all the gifts and possessions she had forgotten about over the years. “I wonder if we could just pretend to move,” she asked her husband: “I could have said: ‘I wonder if we could just pretend to die?’”

Delve deeper into the essays in These Precious Days and you will find that death is more than a pretense. A typical Patchett piece is a eulogy, suitably warm and affectionate, respectful to those who have died, or are about to die. There is her policeman father, who could do a hundred pull-ups in his 70s, but succumbed to Parkinson’s in under two years. There is her nurse mother, who looked so young that people assumed she was Patchett’s sister (and towards the end, Patchett would insist that she was). There is Tom Hanks’s deceased assistant, Sooki Raphael, protagonist of the title essay that went viral a few months ago when it was published by Harper’s, who had gone to Nashville for her chemotherapy and ended up staying with Patchett during the lockdown.

Each time Patchett begins a new novel, she says she is overcome by the fear of dying before finishing the book. But it is in her nonfiction that she has more visibly reckoned with loss, whether it is Truth and Beauty, her memoir of her friendship with the late poet Lucy Grealy, or the pieces in her 2013 essay collection, This Is the Story of a Happy Marriage, about being a caregiver to her grandmother. Why speak of the dead? For Patchett, it’s a tool for living, a salutary reminder of that “beauty that was here now”. You can seldom intuit conflict or ambivalence in her sentences, regardless of the subject; instead they convey a well-adjusted curiosity, mostly about her friends and family. What Patchett lacks in obsession and poetic depth, she makes up for with her raconteuring energy. In the best of these essays – Flight Plan, about her husband’s passion for flying airplanes, and How to Practice, the one about cleaning out her closets – uncomfortable truths are papered over with disarming wit. About her husband she asserts at one point that he is “honest about everything – which should not be confused with being thoughtful about everything”.

The story of becoming a writer is another recurring theme. Patchett’s father would read early drafts of her novels, give her notes, carefully save her publicity materials and reviews. But well after she had been published, he still believed writing was her hobby and not her job: “Having someone who believed in my failure more than my success kept me alert.” Patchett has good advice for younger writers on attitude (“give up on the idea of approval”), on writing v editing (“if you try to do both things at the same time, nothing will be done”), on publishing a book (“never hesitate to rewrite jacket copy or ask to see ad layouts”), and even on the distribution and sale of the printed book, since she is famously the co-owner of an indie bookstore in Nashville. When she was 30, a male author told her that to become “a real writer” one must have children. “I told him I didn’t have children,” Patchett writes. “What I didn’t tell him was that I would never have children, and that I had known this for a very long time.”In an essay on the American writer Eudora Welty, Patchett says that the usually anthologised favourites “fall short of representing the darkness and depth of her work”. I wondered about the remark as I read Patchett’s own essays. Were the decisions on which ones to keep and which to leave out pondered over enough? There are the inevitable repetitions, as with any corpus of pieces originally written for newspapers and magazines; but sometimes the padding conceals the pearls. A more careful selection, for instance, might have let Flight Plan alone sum up Patchett’s rapport with her husband, and left the two other essays on their relationship out.

There are plenty of cringey moments. By buying a stove for a homeless man, Patchett’s friend is apparently sweeping “down the walls of oppression”. She can’t help but talk up her acquaintances on the page – a “bombshell best friend” here, a “force of nature, force of life” there. And does Patchett honestly expect us to believe that Snoopy, the dog from the Peanuts comic strip, was her only role model as a writer? Yet I found myself ignoring the missteps, the saccharine detours, because they stem from the same impulse that enables the more engaging passages: the wish to let the heart “remain open to everyone, everyone, all the time”.

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My dad’s final days

By Ken Dychtwald, Ph.D.

I grew up in the 1950s and ’60s in a mostly blue-collar community in Newark, New Jersey. My father, Seymour, was a fiercely hardworking guy who wanted to be successful. For him, work wasn’t about “finding his bliss,” it was about being a responsible husband and father. His dad had skipped out on him, his siblings and mother for almost 10 years during the Depression. In contrast, my dad was a reliable family man and wanted our family to live the American dream.

Ultimately, Dad rose from selling clothing and home furnishings out of the back of his truck to owning and operating a successful chain of women’s clothing stores. In their mid-60s, my folks retired and relocated to Florida.

Throughout my life, Dad and I had a loving but feisty relationship. He was very opinionated (I guess I am, too) and was skeptical of many of my lifestyle and career moves—from moving to California, from studying physics to the field of psychology and then to gerontology. But he had great love for my family and he eventually developed a deep respect for what I made of myself.

In the 1990s, my father started to lose his vision and with it, control over much of his life. Sadly, Alzheimer’s was also chiseling away at my mother’s mind. Dad loved Mom so much that he railed against the dissolution of her memory and her mind. He got depressed and angry.

“If I die before Mom, she’ll struggle terribly, and if she dies before me, I’ll go crazy. Just as we’ve lived together, we want to die together,” he said. That was quite a lot for me to digest.

One night, he asked me, “If I take my own life and Mom’s, would that be brave or cowardly?”

I said, “I don’t know, Dad. If I was in your situation, I can’t imagine what I’d think or do.”

So, for almost a year, every night I’d go to sleep not knowing if my parents would be alive in the morning.

In 2013, my brother Alan called me in a state of distress to report that our dad’s blood sugar was going haywire. And to make things worse, he’d lost his balance and fallen on his face, giving himself a big gash on his forehead. Alan was already on his way to Florida. I packed my bags and headed east.

Dad’s doctor admitted him to intensive care. He had internal bleeding and had suffered a heart attack. When he realized that his boys were there for him, he called out to us: “What’s going on? Get me out of here!”

Dad settled down a bit, and Alan and I went to see our mom. Later that night, the phone rang. It was Dad pleading with us to rescue him. 

We shot back to the hospital and went into our anguished father’s room. His arms, chest, face and hair were covered with blood because he kept pulling out his IV lines. In the morning, after a torturous night for both my dad and brother, and a sad night for me and for my confused mother, I returned to the hospital. Alan and I asked: “Dad, what do you want?”

“I’m scared,” he said, “but I know this: I’ve lived my whole life on my own two feet, and I’m not going out on my hands and knees. Please help me bring this to an end.”

Shortly after, Alan and I met with Dad’s physician. He was a kind and decent man who asked us if we wanted our dad to remain in intensive care or if we preferred to shift him to hospice car
Were we going to battle to keep Dad alive for a few more days, albeit in a ghastly, ghoulish fashion? Or were we prepared to make him comfortable and allow him to die a good death? 

What would he want us to do?

We had Dad transferred to the hospice floor, where the nurses and aides removed all the wires and tubes, lovingly sponged all of the blood off him and even gave him a shave and combed his hair. They asked him what his favorite music was and then put on Frank Sinatra.

Next, they began a low dose of morphine to ease his anxiety. My wife and kids all dropped what they were doing to fly to Florida and be with him.

As I contemplated the end of my father’s life, I reflected that even though we had often butted heads, there was not one instance in my entire life when he wasn’t there for me when I truly needed him.

I wanted to show Dad proper respect and kindness, but not knowing how I should handle the situation with my dad nearing his death, I called one of my closest friends, Stuart Pellman, who had already dealt with the death of both of his parents.

He wisely told me, “Get one-on-one time with your dad. Even if he’s unconscious, tell him you love him, ask him to forgive you for anything you may have ever done to trouble him. Tell him you forgive him for anything he might have ever done to upset you, and then tell him you’ll always remember him.”

And that’s what I did.

Dad and I held each other for a long while, and then I left the room and allowed my brother some privacy to do the same.

Later that night, after the other members of my family had gone home, I joined my dad for a very intense and private conversation.

I said, “Dad, you’ve never asked me what I think happens when a person dies.”

“I’d like to know what you think about that, Kenny,” he responded. “Because I’ve begun to see my brothers and sister and they’re reaching out to me.”

My dad had no religious beliefs, but I had some. So I said, “Dad, I don’t know this for sure, but I believe when a person passes, there is another plane that presents itself. In that place are all the people you have known and loved.”

As I began to describe this, he started to cry. Then he turned toward me and told me he was ready.

I asked him if I could record the rest of our exchange on my phone so I could always have it to watch when I missed him. He said okay, and this is what transpired:

Ken: “Dad, you know that what’s going to be next is going to be beautiful and your vision’s going to be back and you’re going to be a young man again.”

Dad: “I’m ready for that, Kenny.”

Ken: “And you know we all love you, and you’ve always loved us.”

Dad: “I know it, Kenny.”

Ken: “So, what you’ll need to do is let go and not worry about anything because everything is going to be looked after. All we need is for you to be relaxed and calm and just drift off into the white light. Can you do that, Dad?”

Dad: “Absolutely.”

Ken: “I love you, Pops.”

Dad: “I love you, Kenny.”

My father died peacefully that night. With help from all of us, he went out on his own two feet.

Ultimately, even with all his frustration and anger, my dad died a good death. At the end, his pain was minimal. His mind was calm. He found a way to think about leaving his body as not being frightening. And although he had been blind for years, at the very end, he began to describe beautiful waterfalls, flowers, birds and castles.

When my time comes, I hope that my wife Maddy will kiss me goodbye and at least one of my kids—maybe even both—will be there to lovingly guide me out of my body.

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