A glimpse of dying from literary authors

“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. After I provided clinical and supportive care, I would walk away from their bedside and go on with my work and go home to my family. Now the world has turned around for me. I have widespread metastatic disease to my lungs and bones.”

This was written by the prominent physician educator Roger Bone as he was dying and exploring the classical literature about death and dying. In Bone’s extensive search of classical literature he found little to explain death itself.

“In summary, the great classics, the most significant works in literary history, have had a seminal effect on the behavior and attitudes of our world today, concerning themselves as they do with the issues of love, tragedy, seduction, pride, intrigue, suspense, murder, vanity, fantasy, evil, cruelty, greed, adultery, deceit, depression, fear, brutality, hypocrisy, pride, chivalry, heroism, romance, honor, loyalty, and friendship. But only rarely do they deal with an understanding of death. Notable exceptions include the passages visited above, most memorable in the scene of Beth’s death in Little Women, Emily’s death in Our Town, and Thoreau’s observations in Walden. I examined the classics closely for answers and was left with the conclusion that if you have limited time, read Thoreau, Alcott, and Wilder.”

Perhaps we can get a glimpse about the “D” word from authors.

“Dying is a very dull, dreary affair. And my advice to you is to have nothing whatever to do with it.” (Somerset Maughan) Perhaps the denial that we all have is healthy to some degree, but ultimately harmful when we have to face and plan for the inevitable.

“It’s not that I’m afraid to die, I just don’t want to be there when it happens.” (Woody Allen) The point here is that we really do have some fear, and that denial can be humorous as long as we’re not facing a real crisis.

“Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” (Isaac Asimov) I often heard this from patients, “It’s the dying I’m afraid of!”

Advance planning is something we, as a society, don’t do well. Most of us tend not to save adequately for retirement, don’t execute wills, and don’t complete advance directives. Appropriately we tend to live in the present, “the now”. So how do we deal with educating ourselves, our leaders, and our governments to balance “the now” with “the future”. Ultimately the education about advance planning needs to come from the heath professions, medical societies, communities, states, and the federal government. Viewing this as a public health issue with the rapid aging of the population, the CDC has created a program to educate heath professionals.

None of this, of course, really addresses the mystery of what follows death. Roger Bone found his comfort in the Bible, Helen Keller in Swedenborg’s writings in Heaven and Hell, but the journey remains ours alone, hopefully with our creator gently carrying us.

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

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  • Steallex

    Literary author have there own importance
    but the piratical experience matters lot with the bookish knowledge

    we have to work for the betterment of humanity

    Counselling
    Nottingham

  • drseno

    Thank you for telling your most personal story and for sharing your search and findings. As I studied death and researched clinicians ways of being-with the topic and those experiencing death, dying and grief, I found much more in Thornton Wilder’s Our Town than Emily’s death. The whole play is about something deeper within us that we all know. There’s also much to ponder in Martin Heidegger’s work. He took his work on death and dying to the bedside of his dying parents. How cool is that?

    Well, you also may find many references helpful in my dissertation, available here”
    http://www.esseinstitute.com/about-dr-seno/research/

    “Being-with Dying: Tacit wisdom embedded in the experiences of nurses who attend to dying.”

    I found all of what I studied and learned, came to know very helpful when my husband died with 17 days from diagnosis to death. It’s important we keep talking about this and looking for the meanings to awaken and eliven our awareness.

    Thank you for your story. I hope this response offers some ease.

    • StephenModesto

      …Thanks…I visited your site. I am unable to read it all in one sitting. Heidegger and nursing; who would have thought? More connections for the phenomenology of experiences. I am smiling though…I am imagining myself with a job inerviewer as I am discussinng the relation of Heidegger to nursing palliative/end-of-life perspectives…Like the bureaucratic bean-counter is even gonna’ know.

      • drseno

        Ha, ha! Yes, there are about 31 nurses world wide who get together to study Heidegger once a year. Well, maybe a few more. Others join us too, like engineers and social workers. No docs that I know of. Though some docs I know have read my dissertation. Please keep in touch.

        • James deMaine

          That’s now on my list! Thanks

    • James deMaine

      Thanks. We all need to have “The Conversation” with our loved ones and though it sounds trite, live each day like it’s the last one.

  • chrliechaz

    I realize you are speaking more about excerpts from the classics, but my favorite reflection on death comes from the final Harry Potter novel where Dumbledore says something like: “To the organized mind, death is but the next great adventure.”

    • James deMaine

      Great comment, thanks. Many of my patients would refer to death as “passing”. I’ve always liked the term. It is a leap into the unknown and let’s hope we’re simply passing into that “next great adventure.” Did you ever read Wilson Van Dusen’s “Presence of Other Worlds?” Certainly food for thought.

  • http://www.facebook.com/wendy.hanawalt Wendy Belgard Hanawalt

    Read Tolstoy’s “The Death of Ivan Ilych.” Very powerful.

    • James deMaine

      Agree! Also Mann’s “Magic Mountain” describes the shock of knowing that TB is a death sentence.

  • Don D

    Interesting topic to ponder! I have always been fascinated by Hamlet’s take on Life in his well known solliloquy and especially his last words “The rest is silence. O,o,o,o”.

    • James deMaine

      Also in Jaques’ famous lines from “All’s Well That Ends Well”. It ends with:

      “Last scene of all,
      That ends this strange eventful history,
      Is second childishness and mere oblivion,
      Sans teeth, sans eyes, sans taste, sans everything.”

  • katerinahurd

    Do you think that fear of dying is due to lack of control of ones’ death because the process of dying has been hightly medicalized? If this is the case, do you think that the objective of longevity as a goal of medical care feeds that fear and needs to be reevaluated? How do you think disabled individuals deal with the end of life decissions? Do you believe that the autonomy of an individual needs to be respected when they decide about the quality of their dying process?

    • James deMaine

      You raise lots of important questions. Yes, I think our population in the USA has been highly medicalized through a variety of mechanisms: new technologies and treatments daily touted by the media; ready financing for “doing more” in our medical system; plus a sense that science can solve our problems. Actually with the advent of the hospice movement and palliative care, modern medicine is teaching that quality of life (as assessed by the patient) is more important for many people than quantity of life. At times there is a disconnect when provider and patient have different perspectives. Disabled patients are a special case and their quality of life which may seem impaired to us, is just fine with them. So special protections are needed to protect and respect their autonomy – often easier said than done, because they may not be able to verbalize. As to your last question about autonomy – a resounding “YES”. Medical providers are given special privileges by society, and paternalism used to be taught in the medical schools. But modern medicine and ethics in the USA Is now listening to and respecting the patients wishes about the dying process and their quality of life. For my stories about this please see my blog: http://www.endoflifeblog.com