Letters to the Editor

LETTERS TO THE EDITOR Dear Sir: The physician, who has seen so many people going to their deaths, is in a strange and unique position when facing his own. A couple of days before Christmas my doctors informed me that a malignant sarcoma operated and irradiated a few years before had, in fact, recurred and that my chances for surviving diis for more than a few months were no greater than one in five. Being a physician myself, and having seen my own X-rays, I believed them right. An exploratory laparotomy to rule out possible surprises was recommended and I agreed, but for one reason or another I was not operated on until the beginning of February when, fortunately, nothing was found and I was declared, once more, a healthy man. So I had about 6 weeks during which I tried very hard to understand what it is, this thing called death. I failed. No matter how intense my mental gymnastics were, the prospect of one's own extinction kept on being an ungraspable reality. There is something dreamlike in death as contemplated by the brain that is going to do the dying that cannot be equated with simple denial; it isjust that the living mind cannot quite "get it." Death, like this, with a capital D, does not seem to existjust as universale do not exist. The only thing that occurs is my own death, what could be called me-death (forcing the grammar a little bit), and even that has the quality ofa dream. I recalled SamuelJohnson's old saw about how facing the scaffold concentrates one's mind wonderfully. I thought about it often, but the "thing" stayed elusive and slippery, something halfway between reality and unreality, inconclusive. Yet I felt strangely calm often, with the peace of finality, liberated, a pure mind, contemplative, translucid, without demands. Then I realized that if nature "abhors a vacuum," the mind cannot accept a void. Words come to the rescue, not to express understanding but to cover up the absence of clear perception. One speaks then of "meeting my death" as if death were something tangible, there, outside, that one can meet. Or one speaks of "meeting one's Maker," again covering up the unreality with the image of oneself approaching somebody and simply saying "How do you do, Mr. Maker?" There is also a sobering perception that one has grown up at last, that dying is serious business reserved for real adults, and that the verbal consolations of Permission to reprint a letter printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 27, 4 · Summer 1984 \ 657 philosophy (shades of Boetius!), conventional wisdom, and serviceable religion are really sort of childish make-believe, a babble without substance, good only for the adolescent we are and remain throughout our living days. The same applies to what the professionals of terminal diseases call "coping." I found the term devoid of meaning unless it means behaving in such a way as to keep the others around you comfortable and unbothered because they have their lives to live and business to attend to. Yet there were mental exercises that I found consoling in a way. One was the clear perception that millions of humans have died before me and millions would do it after. I saw the grain of my existence as part of a universal continuum and its individual importance diminished by that much. In common parlance, one could almost say "it is not such a big deal." There were, of course, fantasies of suicide because waiting for death to come requires a strength ofcharacter that not everybody has, and one likes a measure ofcontrol in such an important matter. The final diarrhea cannot be prevented but one can make it shorter. Yet fear, in the conventional sense, is hardly there, and self-pity or anger, if it occurs, comes in negligible amounts. As the prospect of death fades into the comfortable sea of uncertainty and seems to recede into the recent past, one sentiment prevails over any other: This experience containspositive aspects that cannot be ignored. I do not regret it at all...