Pearls and Irritations

The human experience is haunted by mortality. It is important to encourage deep discussion of the reality of our own individual death from an early age. The potential psycho-spiritual and behavioural benefits of this discussion are immense. 

The incomparable Inga Clendinnen describes her friendship with Death ( 2007): ”Now I know how I want Death to come for me, strolling in the slanting rain of light through eucalyptus leaves, a strip of bark in my fingers, the gurgle of hidden magpies all around. I will say to Death, ‘A moment, friend’. And then: ’I’m ready now’.” Thus death is as natural a part of the landscape as a magpie.

Emily Dickenson also relates to death casually. “Because I could not stop for Death, He kindly stopped for me. The carriage held but ourselves and immortality. We slowly drove, He knew no haste, and I had put away My labour and my leisure too, For His civility”.

In the contemporary world, particularly in the “West” there remains a reluctance to fully embrace and deeply experience the inevitability of our own individual death and the consequent material non-existence. Indeed there remains a taboo in discussing this matter until the grim reaper taps on the window pane or at least turns into the driveway. We are then encouraged to begin open and honest family discussions, ideally mentioning the word “death”, and to consider advanced care directives, limiting futile and often inhumane medical interventions, and to actually believe we are going to die very soon. We may experience a great fear of death (thanatophobia). We should express our love to those we love, audibly forgive those who have offended us, seek forgiveness from those whom we have offended, and consider some meaningful legacy. There may be time to mindfully review our own life. But maybe not.

The transition from life to death is not primarily a medical matter, at least not where medicine is technological and non-engaged, but a timeless, profound personal and relational phenomenon, an existential reality, a termination of delusions of physical immortality and an experience of interconnectedness with all of life. As John Donne wrote (1624): “No man is an island, Entire of itself, Every man is a piece of the continent….: Any man’s death diminishes me, because I am involved in mankind, And therefore never (ask) for whom the bell tolls; It tolls for thee”.  

There may be a great need for support and guidance during this period, as there has been throughout history, in all cultures. Hence the considerable importance of the psychopomp, the death doula and palliative care, but in far greater numbers than available at present. There is talk of a “good death” and “dying with dignity”, both laudable and generally well defined, but not always considered and understood in depth by the dying person and family. We should also consider a “good life” and “living with dignity”, and perhaps contemplate our mortality earlier in life, remembering the Socratic dictum: “An unexamined life is not worth living”, or at least may represent a diminished life, with less autonomy, wonder, freedom and capacity for love.

Not surprisingly children are very interested in “death” if presented in an age-appropriate fashion. In past times they were frequently exposed to the death of others, often family, and often siblings, without evidence of necessarily adverse consequences. It is usually the fears and sensitivities of adults that limit the teaching of “death” to the young, as with the teaching of sex and love. A doctor William Ventres has proposed a “Pedagogy of Dying” whereby adult patients, young and old, well and unwell, are given some anticipatory guidance towards aging, infirmity and death. He avoids glib platitudes such as “Dying – It’s a living thing” proposed by others. Umberto Eco, Leonardo da Vinci and the Buddha have all recommended regular meditation on our own death from early (adult) life, to enable a deeply experienced understanding of and preparation for our death, and also, importantly, to enhance the full enjoyment of our finite life.

In the Zen tradition the Evening Gatha entreaties us: “Let me respectfully remind you, Life and death are of supreme importance. Time swiftly passes by and opportunity is lost. Each of us should strive to awaken. Awaken. Take heed. This night your days are diminished by one. Do not squander your life”.

The powerful myth of the rivers Styx and Acheron dividing the realms of the Living and the Dead and crossed by ferry, still resonates deeply. As a clinical thanatologist I spend much time on the near shore, the Terra Stygiana, a crowded zone, but not one without some happiness and laughter. The accommodation is always comfortable and indeed I met my good friend Charon, the ferry-master, at the three-star Stygian Inn many years ago.

Transport from the distant lands of vitality is reliable: no one is ever late for their ferry trip across the River Styx! Each must pay one Obol to Charon, placed on their tongue, and in return receives smooth passage and much compassion. This currency is said to come from a limitless “black” budget, which is unknown to even the most assiduous Treasurer.

Charon is a kind and ardent fellow with a vast and detailed memory of the 80 billion souls that have crossed over since ancient times. He remembers each one with a smile. He is becoming increasingly busy. There are surges of passengers with the many ongoing wars, destitution and pestilence. He is greatly troubled with the 10 million children under 5 years of age, mostly unaccompanied, who cross over on his ferry each year.

He is also troubled with the numbers of decedents who seem bewildered and even surprised with their new permanent circumstances. Many report nagging regrets and unfinished business. Many fail to leave a legacy and now fear they will be forgotten in the Terra Viviana (land of the living). Many feel they had wisdom to pass on but lost the opportunity. Many report excessive medical intervention with no chance of success (as confirmed by their current decedent status). Unfortunately many doctors do over-treat moribund patients because of dissociation, poor communication and their own thanatophobia, the latter preventing a full and open discussion with their patients about impending death and related matters. Ideally this conversation would be conducted well before the final event.

Dr Elizabeth Kübler-Ross tells us: “Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever”.

Dr Jonathan Page has been a Medical Oncologist in Sydney for 33 years.  

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