What's Tony Thinking

Being Mortal

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 you 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.