dying well, living well

Throughout my start in this field--especially while in grad school--friends and family have seen the books that I read, the journals I research, and the projects for which I volunteer. Invariably, they have responded with the notion that this must be the most depressing, difficult career ever; and they would be hard pressed to want to read the things I read or do the activities I do. Actually, I tell them, it’s emotional, it’s profound, and it’s great. While the concepts of loss and death certainly evoke intense grief and various other emotions (which we, as a culture, typically avoid), it is possible to reframe the experience to find meaning. Death does not have to be viewed as a problem, but rather as an integral, natural part of life. Death is not inherently undignified. Additionally, while the experience of loss and grief is unique to each individual, they are normal aspects of life and emotional wellbeing. The most recent book with which my friends have been uncomfortable is Dying Well: Peace and Possibilities at the End of Life by Ira Byock, M.D., and these are some of the issues he addresses via stories of individual experiences with death.


Regarding his own experience, Dr. Byock discusses death being treated in the medical field, unconditionally, as a problem. Efforts are made in almost every situation to prolong the life of the individual admitted to the hospital, and the stories he cites suggest that it is treated this way out of fear of liability. Even at a sickly ninety-two years old, one woman's distant family did not want to withhold intensive treatments to prolong her life because they would then feel responsible for her death. Our society seems to base its treatment of the terminally ill on the misconception that if we do not prolong life (even in atrocious, painful, or near-death contexts), then we are the ones ending it-—we become murderers. Thus, hospitals and nursing homes, as Byock suggests, are stuck in a precarious situation. Even professionally knowing that someone is about to die, due to any cause, these institutions must be able to prove that they did “everything possible” to keep that person alive, lest the family/friends hold them liable for the death. It is not, therefore, death that is the problem, but perhaps our misguided fear of it.

“I wondered what it was permissible to die from…. even passings that should have been peaceful turned gruesome” (p. 27). As it is fear that is the problem, not death, death does not have to be undignified. It seems that our fear of it and our subsequent reaction to its inevitability are what create any perceived indignity. Byock suggests that by allowing people to reflect on their imminent death, and by opening a safe space for them to experience the emotions that accompany it, people may have a dignified, meaningful, and fulfilling end of life experience. They can confront their fears of being burdensome or of suffering—-he stresses that pain can, in fact, be managed—-as well as fears of solitude and family debt. They can take the opportunity to tie up emotional loose ends and find closure on unfinished business. Some examples: Ira was able to care for his father. Anne Marie reconnected with her sister and daughter. Some of Ira’s patients were able to let go of anger and forgive. Others held on to life long enough to achieve meaningful goals, and all that were mentioned were able to transition out of life peacefully and with dignity.

“‘What would be left undone if I died today?’ and ‘How can I live most fully in whatever time is left?’” (p. 34). These are two very simple, important questions. We take so many things for granted in our daily lives-—especially time. There will always be time to mend that relationship, to apologize, to pay off debt, to quit smoking, to climb that mountain, to learn a skill, to laugh, to cry, to express love. Then, at some point, daily life becomes daily death. It is only when the end and the loss of time becomes almost tangible that so many of us realize that we have a lot of frayed, loose ends to tie.


And with that in mind, I continue to enjoy the spectrum of experience and interactions that constitute life. I will continue to pass go.