Life, Death, Metamorphosis
People die every second of the day, and I usually know none of them. Recently, however, death and dying have entered my sphere of awareness more than usual. Among the recent incidents are the passing of David Simon, MD, author and co-founder of the Chopra Center for Wellbeing, and Lee Lipsenthal, MD, author and founder of Finding Balance in a Medical Life. Both individuals lived in the world with exceptional curiosity and both had about two years of awareness that their cancers would most certainly take their lives. Additionally, and the reason I am writing about death and dying in the first place, both individuals described those years, in various terms, essentially as the peak of their living experience! This is nothing new, of course. We’ve heard it before, and the death of an acquaintance or friend certainly makes us pause and reflect on life. But do we learn life changing lessons from observing this dying phase of life? Do we change our lives for the better in some way?
Our culture is uncomfortable with dying, and this extends into the medical community as well. Amazingly, medicine, a discipline that is surrounded by dying, attempts to deny it until the last breath. Instead of empowering the dying to experience this part of life, modern medicine distracts itself, and the dying, through an exclusive focus on fighting a disease. A member of my extended family with metastatic cancer was told by one physician “the mass is not any smaller” when in fact it was bigger. This is just one example of the many unconscious attempts in medicine to avoid telling the patient they are dying yet still remain accurate.
One night on call during my internship, I was called to the bedside of a patient that was not under my care and whom I did not know. He was unconscious with a severe fever, critically low blood pressure, and late signs of respiratory failure. The patient had a DNR/DNI (Do Not Resuscitate/Do Not Intubate) order. He was clearly now septic (a widespread infection in the blood) so I jumped into action ordering a full on attack against this sepsis and his organ failure including the most powerful antibiotics, vasopressor agents, oxygen, and various cutting edge anti-sepsis drugs. The nurses rapidly moved to execute these orders, except for one older, more experienced, nurse. She came over close to me and said softly, “doctor, he doesn’t have that much time.” I then knew she was right, but I was only taught how to fight death. I didn’t know what else to do. Helpless, and without thinking, I gently put my hand on the patient’s bare chest. As I did so, the “patient” became human and the room, the equipment, the lights, and the nurses all dissolved away into darkness, along with time itself. It was as if I had some form of tunnel vision, as I was aware of nothing but this man’s breathing body, my seemingly paralyzed hand now connected to his bare chest, and a captivating radiance. This timeless moment lasted no longer than 10 breaths before his chest became motionless. Then the room, the cold florescent lights, the bland cream colored walls and white sheets, all came back into my awareness. The radiance was gone. I checked his heartbeat with my stethoscope and pronounced him dead. But it wasn’t the lack of a heartbeat that convinced me, it was the lack of that radiance, whatever it was.
That experience, and a few others like it, shook me out of a type of slumber. It set my objective and scientific work as a physician in a disconcerting contrast to the mysterious and profound experience of being alive and dying. I realized that I had learned to live life as a series of infinite tasks and scheduled events and to see life as a mechanical event in a world of things. I had been trying to interpret and explain every thing and thus missed it for what it was. I was closed up in my own internal intellectualization of the world, experiencing it only indirectly, and closed off to truly being alive. I realized that there is a phenomenal richness that exists in being alive, and we can choose to open outward into it and experience it directly.
I’m not sure if this is related to what David Simon and Lee Lipsenthal were feeling over the last two years that released their experiences of intense aliveness (both wrote books about their experiences that I’ve yet to read), but I am sure that overcoming our denial of death, and the uncertainty that it entails, can greatly enhance our lives. It is fair to argue that a number of problems would result if we all start living like there is no tomorrow. To do so would be to error equally, but in the opposite direction, to our certainty that there is a tomorrow. I believe that what is needed is not any certainty about when one will die, but the uncertainty about when one will die. It is recognizing the possibility of death and the uncertainty in its timing that keeps us awake and alive. In fact, Lee Lipsenthal often awoke and considered if it was a good day to die. Despite knowing that his death would come sooner than later, he still did not know exactly when. Like the rest of us, he worked, began new endeavors (like writing a book), and participated in typical daily activities but, unlike most of us, he did so with an ever present awareness that life is a temporary gift.
How would we approach each day, each moment, with that uncertainty and awareness? Would our priorities change? Would we treat other people, or ourselves, differently? Would we express our love more? Would commonly dismissed desires, like a work break to get outside, take on greater importance? Would we slow down, take in the experience, and cherish the present moment? How would we answer each morning if we asked ourselves, “Is it a good day to die?”
Perhaps more interesting is the question, how would we perceive life and death if we had the “horizontal” experience of existence that many hunter-gatherer people have? I am careful to use the word “experience” here instead of “view.” They do not view the world and do not view life and death, they are these things. For most religions, life is here on earth but heaven is somewhere else, usually up and “vertical.” Or for modern atheists and most Darwinists, life is a lucky random event and death is its absolute end. For the horizontal eco-spirituality of most hunter-gatherers however, the difference between life and death is a bit more blurry.
Though I’m generalizing, for animistic populations, metamorphosis between human and animal forms is an ordinary event in life. Changing form in rituals and in dreams is experienced as being very real. Further, animals are not so much killed and then dead as they are received (after they give themselves to the hunter) and then transformed into life in another form. For totemic populations, life is an extension of the land with lineages of both human and non-human sharing their origins in certain features of the landscape. The land is imbued with life. In this case, life and death is not so much a here and gone phenomena as it is an emergence from and then return to the land, the reservoir of all life. So, death is clearly not the anti-pole of life but a continuation of life in another form. There is no death in the way most civilized cultures see it, there is only life. And, in the horizontal experience, the life that continues in metamorphosed form is right here, beneath our feet, along the horizon, within the wind, within other life, and within us.
There is only life and we are immersed in it, our sentient animate biosphere. Our bodies are continually rebuilt from this living world (every 4 years on average), and so even our present human form is a flux of living material. And our minds emerge between, or in fact they are, the dynamic body-earth interface. In a sense, we are already dead, which is to be alive-within-the-world, as part of it, sharing one life.
We protect the soil of cemeteries to protect the remains of loved ones, usually humans, long after their souls have flown upward to heaven. We preserve their bodies and buy luxurious caskets to prevent deterioration of their bodies. We feel an impulse to protect them after death. But if death is really life in another form and these forms are the continual revitalization of our living earth, shouldn’t we be protecting more than just cemeteries? It seems that to respect and protect the ongoing process of life itself, the living land, water, and sky that continually transform life into life, would be more appropriate. In fact, respecting and protecting is not enough. Every being that has been loved and lost is still there to love, diffusely and specifically in form. Can one love a tree, an animal, an insect, a mountain, the sky, or even the entire earth? Nature transforms not just life to life but love to love. To truly receive life and love from mother nature is to give life and love in return.
So why am I still afraid to die? Well, it is not a fear of dying. It is a fear that my very young children will not know where to find me and my love after I die, unless I show them before I die. I fear that they will see death when it is really life. I fear that, without the combined influence of myself and their mother, they will learn to disregard nature and, in doing so, truly lose their chance at wholeness.