- A Thousand Little Deaths
Doctor, just one more thing.”
I marvel every time I hear this, nearly always as I reach for the door. It is as though all patients receive copies of the same instructions, perhaps posted somewhere in the waiting room:
1. Wait until your appointment has run over time.
2. Watch until your doctor stands to leave.
3. Ask a question of grave importance that cannot possibly be answered quickly.
I released the doorknob. “Yes, sir?”
“I was wondering if you had any advice for me on preparing to die. You see, I got a copy of the pathology report and even though my oncologist didn’t tell me the prognosis was bad, I did a little of my own research. I learned that ‘high grade’ and ‘poorly differentiated’ don’t bode well for me. My wife is much younger than I am, and I guess I’m just kind of thinking ahead, you know, for her sake.”
Advice on preparing to die, in one minute or less.
I took a deep breath, and as I did so, a myriad of questions bubbled to the surface. What did he mean, “preparing to die?” Was he talking about managing his estate? Or did he want the name of a good funeral director, someone who could help him plan his ceremony and order his casket? Was he religious? Did he want advice on spiritual preparation for death, a prescription for redemption? Or was he worried about physical suffering and the burden he would be to his wife? Was he interested in hospice or doctor-assisted suicide? Was this some sort of anticipatory grief? Did he understand what he was asking?
In his classic work The Hour of Our Death, French historian Philippe Ariès traces the history of Western attitudes toward death over the past millennium, recounting the evolution in rites, rituals, and cultural values that transformed what he calls a “tame death” into an untame, “invisible death.” He writes that whether tame or not, death “always remains a misfortune, a mal-heur.” He continues:
It is remarkable that in the old Romance languages physical pain, psychological suffering, grief, crime, punishment, and the reverses of fortune were all expressed by the same word, derived from malum, either alone or in combination with other words: in French, malheur, maladie, malchance, le malin (misfortune, illness, mishap, the devil). It was not until later that an attempt was made to distinguish the various meanings. In the beginning there was only one evil that had various aspects: suffering, sin, and death. Christianity explained all of these aspects at once by the doctrine of original sin. There is probably no other myth that has such profound roots in the collective unconscious. It expressed a universal sense of the constant presence of evil.1
Today, even the more religiously inclined may experience philosophical or existential unease when considering the concepts of original sin and pervasive evil. But Ariès argues further that modern death has become increasingly medicalized and invisible, in part because society has grown ashamed of death—a shame that, in his view, is “a direct consequence of the definitive retreat of evil.”2 Has it proven valuable to disassociate death from what Ariès calls the “one evil” of “suffering, sin, and death”?
Indeed, death may be the final inexorable evil, the enemy against which medicine must marshal all its forces. But the truth is that life is shadowed by a thousand little deaths, a thousand evils; and if given proper consideration, these may help prepare us for that final hour. Children seem intuitively to act this out, taming their little deaths by weeping and seeking comfort. The process of mourning enables a certain acceptance of loss, and they move on equipped, at least in part, for the next challenge.
Little deaths are followed by larger evils: pink slips, failed marriages, chronic disease. Some of these misfortunes we rightfully grieve; others we ignore, deny, or fight. Patterns established in early years can become hardwired in adulthood; those who expend the most effort denying tragedy may have the most difficulty accepting death when it calls.
The answer I gave...