On Death and Dying

A mini sermon I gave at Church of the Common Table, Vienna, VA on a Sunday honoring All Saints Day:

I’m fascinated with death , always curious about dying. How we die, and the ways we die. How our experiences, and temperaments can shape when we will die, and on what terms. A dying parent usually holds on until that son or daughter from across the country finally makes it to their bed side to say goodbye. Women more commonly die with those around them. Men often will wait until others have left their bedside, left the room..

My interest in death doesn’t means I’m ready to die. I have so much living to do.

I do like to wear black, because I feel it hides my overly ample curves. Not because I have any interest in looking like a mistress of darkness. We don’t take our family photos at a graveyard.

The concrete details of how we die fascinate me. As a physician, I know enough to hope I’ll die suddenly in my sleep from a cardiac arrest. Or maybe I’ll quietly just go to sleep with kidney failure. But I don’t think most would consider me a morbid person. Words like full of life, energetic are my more common descriptors.

And please don’t think me insensitive, or naive. People often die too soon, some, horrifically. Many of us will experience a senseless loss. And death of our dearest loved ones is traumatic, it rocks our very foundations. We fumble afterward and wonder how and if we should go on.

I have the clearest memory of myself close to twenty years ago, as a medical intern, lying in bed, in my blue scrubs, in my sterile on-call room. Most nights on call I got little or no sleep. It didn’t matter how tired I was. Even if my beeper was quiet. I was too anxious, scared of what I might be summoned to do.

One night, I remember, getting a page and walking the long corridors to find the nurse who had paged me. She told me that patient, X’s family had arrived and were ready, Would I please write his order for more morphine. I think I knew how to write the order already. Simply “titrate morphine drip to comfort.”

I can’t remember if Mr. X was even my patient or if he was just among the list of patients I was responsible for tending to that night. I do remember I started my night on call knowing how very sick he was, that he wasn’t going home alive.

When I went to visit the patient, his family was gathered around him. They looked exhausted, their faces red from too much crying. He lay somewhere between life and death. His breathing was labored, so very slow and loud. And he needed comfort. I told them I was going to increase his morphine.
We all understood that meant his body would start to relax. The confusing pain he must have been feeling in his semi conscious state would ease. And that the morphine I had ordered would hasten his death.

I’m not sure if my other interns ever felt uncomfortable writing this familiar order. I would write it several more times during my residency.

As a new intern, I was daunted by the power of my pen that night, but not frightened. After all, it was a privilege to help this man make his final passage.

I have watched patients die many times since then. I hope over the years. I’ve helped my patients die on their own terms whenever that was possible. Good doctoring means walking along side your patient during life’s journeys including when its time to die.

Turns out I am not alone in my comfort with dying. In 2013, The Saturday Evening Post published an illuminating piece by Dr. Ken Murray, a retired family physician and professor at USC. The piece was titled, “How Doctor’s Die.”

“He writes “It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

I have been inspired this year by the death of one of my life’s heroes: Oliver Sachs. The gifted neurologist and prolific writer died this August. Over his years in practice, he wrote brilliant case studies drawn from his work. Some of you might remember one of his more famous books, The man who mistook his wife for a hat. And the movie Awakenings was based on his autobiographical account of working with patients with a special form of encephalopathy.

He wrote three op ed pieces in the New York Times about dying. He wrote about his life, facing his impending death from cancer. In what he estimated to be the months he had left, he said he wanted to “live in the richest, deepest, most productive way I can.”

He chose to face death. And just LIVE before he died He demonstrated a certain rarely discussed form of heroism.
All saints day was not a big part of my religious upbringing But I’ve since embraced it. One day where we formally recognize those who have gone before us, with gratitude. And that they have joined the blessed community of Saints. Where they continue to live on in our lives and on this earth. They continue to teach us, inform us, on how to live our best lives, until the day we too draw our last breath.