Thinking about death…

…and other important things.

I am running out of time to listen to all the things I have on my smartphone.  Podcasts, music, audiobooks…and then there’s live radio, which is often gripping.

With all these options, it’s hard to choose what to listen to.

This morning, on my way in to work, I decided, among the many riches available, to listen to the most recent podcast from On Being with Krista Tippett.  The interview was with Dr. B.J. Miller, who I have never heard of, but it turns out that he is the executive director of the Zen Hospice Project, an assistant clinical professor of medicine at the University of California, San Francisco, and an attending specialist for the Symptom Management Service of the Helen Diller Comprehensive Cancer Center at the University of California, San Francisco.  And, by the way, he lost both his legs, and one hand (he’s a “triple amputee”) while in college at Princeton in a freak accident.

It was timely, as our synagogue, Tikvat Israel, had just celebrated “Inclusion Shabbat” – a service celebrating our many members living full lives in the face of various conditions and situations that we broadly categorize as “disabilities”.  So, much of what Dr. Miller said resonated with the insights that we shared on Saturday morning.

But, he also spoke of his work in hospice and palliative care – subjects which have always been very near and dear to me in my own work. I struggle personally, as a physician, with the resistance we have, in America – in the West, with the reality of Death.  Two thoughts expressed struck me:

“Let death be what takes us, not lack of imagination.”


“The fact that we have these bookends of birth and death and in between feels like a guitar solo — in between, all sorts of crazy things can happen. But the song begins and the song ends, at least for this bodily life. And the fact that we share, that 100 percent of us across time and space, across cultures, that all of us share that version of fate is compelling to me.”

I don’t understand why we are so afraid of Death, and pretend that it doesn’t exist for us.  And, as a result, we often lose an opportunity to experience the end of life as fully as we might.

I have an acquaintance and colleague at my workplace, a social worker of many years experience, who I have worked with in cases in the hospital where we have had to introduce the idea of death to a patient, and family members, who often are unwilling to accept the reality of the imminence of Death.  This is particularly true in cases where the patient is relatively young – one woman in her mid-forties, with three kids, comes to my mind.  She was dying, and she didn’t want to see that reality face on.  This lovely social worker met with the patient, and with the two adult daughters, and the patient’s aunt.  And she used the following analogy:

We welcome a baby into this world, and that baby is helpless, and needs the care and love and support of her parents, and her sisters, and brothers, and can’t do anything for herself.  And when we reach the other end of life, and Death is nearing, we again become weak, and need the support of our family and friends.  And that is how it should be.  Our family and loved ones want to help us in the end, and we can accept that help, and allow ourselves to be embraced by that love and support.

The way this social worker described hospice and the dying process was in terms that the patient and her family could cope with.  It made it OK.  I was so impressed.

Just yesterday, I was listening to another radio program, the TED Radio Hour, and heard the following:

In this talk, Amanda Bennett relates the story of her husband’s fight with kidney cancer, and how he lived 7 years beyond the expectations, and she credits “hope” instead of “denial”.  I appreciate her distinction, but my heart bled for her loss of the opportunity to say goodbye.  You have to listen to the story to understand.

As a doctor, I would never want to rob a patient or their family of hope, but I also don’t think that denial of the realities is necessarily helpful.  It’s a fine line.  But, at the end of the day, we all face Death.  We do have a choice as to how we face that reality.