Death is Life’s Only Certainty

Direction
Direction

I’m always astounded by the number of conclusions people derive about others based on a few photographs or a few sentences. In my line of work, it’s considered bad practice. Always ask questions. It doesn’t matter if you think you have all the evidence necessary to make what you perceive to be a sound judgement. There might be one crucial detail, that as an outsider you’re not able to perceive that would fundamentally shift the story you’ve created about a person or situation in your head. Whenever someone tries to “tell me” something about someone or a situation, I enter curious interrogator mode. I like to ask people questions that make them think. There are an infinite number of ways for reality to physically manifest. Uncertainty and constant change are my beliefs about my reality.

Here are some statements that I’ve heard in conversation about myself (in direct conversation with another) that have shocked me:

You only care about achievement. What?! What matters to me in a deep core level: survival, personal safety, and freedom. If you perceive me as high-achieving, please know the following: (1) I’m not trying to be “good” or competent at anything. I’ll show up and give 100%. I’m always willing to learn and improve a particular skill set to help and individual or an organization out. However, giving more than 100% doesn’t make sense! I can’t give more than what I have. (2) Promotions, raises, or awards don’t motivate me in any way, shape, or form. I’m intrinsically motivated. When I’m interested in something external, it’s because it aligns with my intrinsic goals.  (3) Acquisition of stuff, degrees, titles, etc. don’t do much for me intrinsically – I don’t necessarily experience a “high” from them. I derive pleasure from plenty of active things, but I also derive pleasure from taking a nap at the beach or laying down in my bed and staring at the empty white ceiling. Trends also don’t mean much to me! Here’s a story: try selling me something. I’m incapable of selling a thing, but I’m also really hard to sell to unless I truly want something. When being sold to, I will not ask about a product or service, instead I will ask the following: Why do I need this? Is this a necessity or are you just using language to attempt to convince me that it’s a necessity? Tell me something, what do you believe humans need to survive? In a conversation with a Verizon rep, when I was upgrading my phone (which I wanted to do – my previous one experienced its end), the conversation ended with me saying the following, “It doesn’t matter to me that you’re selling me this tablet for $1. Bottom line is that I don’t need it!” He was really frustrated with me. I was frustrated with him, too. Pet peeve: Anyone that tries to convince me of anything by some forceful mechanism be it a physically forceful mechanism or a more subtle yet forceful mechanism involving the mind and emotions (using certain language, presenting scenarios in particular frameworks, etc), annoys me.

You only care about money. I only care about money in as much as that in a capitalist society, money is your way to freedom. Freedom is absolutely everything to me. Do I want to amass and hoard large amounts of wealth? No. I don’t need to be a Billionaire + to be free.

That being said, there’s only one thing I’m certain about : death is guaranteed.

On yesterday’s return flight to San Diego, I read an article about death in the context of the end-of-life care – ie. individuals with terminal illness and the elderly. In the New Yorker article below (link in red font below), Atul Gawande (one of my favorite medical writers), beautifully takes the reader on a narrative journey to understand that death is part of the human experience. The long narrative, invites the reader to initiate a process to come to terms with their mortality.  External interventions, whether tried and true or experimental, have limits. Medicine is not an anti-death miracle. It’s an aid to make our lives better into death. There’s a lot of modern day talk about how to live well – “Insert article about 20 tips on how to kickass in some capacity.” If we get to live well, given that we don’t experience an unexpected death, we should also be able to choose how we die.

LETTING GO: What should medicine do when it can’t save your life?

“One basic mistake is conceptual. For doctors, the primary purpose of a discussion about terminal illness is to determine what people want—whether they want chemo or not, whether they want to be resuscitated or not, whether they want hospice or not. They focus on laying out the facts and the options. But that’s a mistake, Block said.

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances,” she explained. “There are many worries and real terrors.” No one conversation can address them all. Arriving at an acceptance of one’s mortality and a clear understanding of the limits and the possibilities of medicine is a process, not an epiphany.”

“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fight to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time— just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.”


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