Our book group had a wrap-up session on our “Aging and Mortality” series last night. We invited everyone to share their own take-aways from our six books. What did we learn? What was comforting? Challenging? How might this effect your planning and decision-making?
Before I share my own take-aways from the series, I would note one general theme in what we read: the more we isolate death and the dying, the more we fear death.
Here my three take-aways from the series and our conversations:
First, the process of dying has some predictable stages and patterns, and can be relatively benign. It is “natural.” It is not always hideous or horrific, though, sadly, some deaths of course are that. The predictable and natural aspects was a big emphasis of the book by Kathryn Mannix, With the End in Mind. Her deeply informed observations as a palliative care physician square with my own experience as a minister and family member.
The availability of good palliative care and pain management can make a big difference in this regard. Moreover, and a related theme of several of the books, is that death need not be hyper-medicalized nor necessarily require hospitalization. It can occur in a setting, whether home or a home-like hospice, that allows for relational connections and interactions with loved ones. Besides Mannix, such themes were also emphasized by Atul Gawande in Being Mortal and Lisa Dugdale in The Lost Art of Dying.
My second take-away makes a distinction between control and agency. What we ought to want when facing our mortality, and which ought to be afforded the dying person, isn’t so much control as agency. Ours is a culture that prizes being in control, which is probably heightened by modern medicine’s great powers. But trying to maintain control in the face of mortality can be both unrealistic and have results that are actually de-humanizing. This came through in several of the books, but especially Wallace Stegner’s novel, Crossing to Safety.
If being in-control is not possible or desirable this doesn’t mean the opposite, that you as a dying person are completely at the mercy of others or the dictates of a medical system, is the only alternative. A better aim than control is agency. How do we maintain and experience agency as we age and as we die?
Here Atul Gawande (Being Mortal) is very helpful. Gawande lists questions that need to be explored, and re-explored, with someone in this time of life. Those questions are, “What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”
To be sure, modern medical science offers great benefits, but it shouldn’t be allowed total control. Talk with the dying, urges Gawande, find out what they understand about their situation and what they want. As I say, the point is for the emphasis to fall less on control (whether by a patient or by doctors) and more on agency for the patient.
My third take-away is that death, or better, the experience of dying, is sacred. I’ve certainly witnessed this, and been a party to it, as a minister. Death is one of life’s “thin places,” where the boundary between the temporal and the eternal becomes thin, even luminous. If possible, it is not an experience to be isolated in the hospital or an ICU, but a human experience to be shared with loved ones and community. We have much to learn, about living, from the dying. Important, even crucial interactions, can take place at this time in a person’s life.
Of course, there are deaths that don’t afford this possibility or experience. Some people die suddenly, whether from a heart attack, accident, or suicide. These, I have observed, are the hardest deaths for those left behind. Or a dying person may be in a coma or in some other way unresponsive. But not always nor even often. Death can be a sacred time for a dying person and for those around them.
These themes were articulated especially in Dugdale’s The Lost Art of Dying, in the aforementioned, With the End in Mind, and in a somewhat different way in Anne Patchett’s book, These Precious Days.
Both the series and our wrap-up session were rich. The members of group, ten guys, have covenanted to be present to for one another as we continue to age and when we ourselves are dying. It’s not control, but connection that we most need in life and in death.
Everyone dies. Kinda scary sometimes. Best to think about living, while we’re here.
Interesting stuff for these days and for those of us of a certain age in particular. Could you please list the six books and authors ? I see names of several here of course….a tidy list would be greatly appreciated! Thanks.
Sure Jeannie, here you are:
The Gift of Aging by Marcy Houle
With the End in Mind by Kathleen Mannix
Being Mortal by Atul Gawande
Crossing to Safety (novel) by Wallace Stegner
The Lost Art of Dying by L. S. Dugdale
These Precious Days by Anne Patchett
Tony
Thank you for this important summary.
The single biggest hurdle is cultural, as expressed above “to think about living.”
If what was meant had focused on those who will remain living then the thought would be spot on.
Our culture fails us by not recognizing the dying is a part of life.
Having just lost a loved one, it is clear that planning for, and discussing as Ton’y group just accomplished is the right, mature and loving thing to do.
Denying the elephant in the room is a mistake.
Sam Sperry
Great article. And I value your perspective. I have experienced the slow and predictable deaths of my family and friends and I agree with your points. For comfort I like Leo Buscaglia and for understanding , Elisabeth Kubler-Ross.
However, regarding my own mortality, i find gallows humor my defense against the inevitable. So far so good (said the man who jumped off the building). BTW i am a healthy, fit septuagenarian who drives fast, eats meat, and doesn’t shower every day.
My guide is Woody Allen:
“I am not afraid of death. I just don’t want to be there when it happens”. And…
There are worse things in life than death. “Have you ever spent an evening with an insurance salesman?”
You can think it’s cool to drive fast but it impacts other people.
If you want to go and do stupid stuff that only impacts you — fine, go ahead and be an idiot. But keep the rest of out of it.
Ouch! What’s your opinion on showering?
All of us will be dead a long time. One might make exceptions for those whose belief system involves reincarnation, but that’s not the point. Of course living involves loss, pain, frustration, disappointment, unhappiness. Sometimes it’s good to reflect on this. But there is a big difference between reflection and fixation. We can be blinded by the inevitability of death, and not see the amazing world we inhabit and our own unique and mysterious part in it. Maurice Chevalier was asked in a late life interview if he was unhappy growing old. His reply: “Consider ze alternative.”
I love the idea of a book group focusing on this important life event. I have read most of the books your group read and discussed. I have come to some conclusions about how I want to face my passage to death. However, I am quite sick about the death industry that puts such high costs on dealing with a dead body. Even cremation is over $1,000 and some closer to $3,000. I would like to be immediately interred, wrapped in a shroud, in a thin wooden casket and on my own private wildernesses property. Sadly, the latter part of a final rest in my own land is not legal in the state of Washington although many other states do allow it. I am pretty sure this “illegality” was initiated and lobbied by that same industry that profits from the emotions of grieving loved ones.