At the first notice of death, Muslims are taught to utter a verse from the Quran, ‘To Allah we belong and truly, to Him we shall return.’ The dead are usually buried within twenty-four hours after being washed and shrouded in modest cloth without seams or stitches. They are remembered through a special prayer where the congregation remains standing, but there are no formal ceremonies held after the funeral.
Buddhists believe the body is merely a vessel for the mind, which never ceases to exist. For up to a month after death, the body may exist in an intermediate state between birth and death and prayers during this time are open to everyone, including the recently bereaved and those who may be caring for the dying. The prayers are not to an entity, rather they’re meant to produce clarity and purity of the mind.
Judaism also calls for an early burial of the deceased, following which Jews enter a period of deep mourning. For seven days after a person’s death, they sit shiva, the Hebrew word for seven. Mourners sit low on the ground and share stories of the dead, wearing clothes that have been torn to symbolise a person torn from their lives. Friends and colleagues may visit at designated times to make a shiva call.
Christians have a strong belief in the afterlife and their funerals focus on the entry of the deceased into heaven. Hymns and prayers are offered for the soul of the deceased, hoping for their reawakening or believing that they have transcended into another life.
Some cultures mourn in private, while others require grief to be ostentatious in order to placate the deceased.
In contrast to the restraint shown in European cultures, the Congolese deem it shameful for a relative not to cry loudly at a funeral.
We can’t say if the deceased are comforted, saddened or unmoved by the actions of those left behind but it’s enough that we perform them to comfort us and grant us peace and reconciliation. The dead don’t resent us for being alive nor do they wish us to grieve any more than we have. The dead are finally at rest – they’d be happy for us if our rituals helped us arrive at a place of peace.
Every Christmas, my family remembers this as we feel our grief anew. My husband’s sister died unexpectedly at a young age and there was no time to say goodbye. The dinner table is not the same without her. Instead of setting a plate, we light a candle in her remembrance. Amidst the joy and bustle of Christmas, the flickering flame always evinces tears, but through this small but important gesture, we acknowledge our permanent sadness and teach our children that grief does not have an expiration date.
At a time when the consolations of religion have waned, there is a growing emphasis on seeking professional help during bereavement. This can help us navigate the worst parts of the grieving process, but I have learnt from the accounts of many patients that the passage of time and the togetherness of family are often the best healers.
Not everyone needs grief counselling – it’s possible to hurt and recover on one’s own. Upon the loss of my twin pregnancy, I was inundated with well-wishers and offers of help but all I needed was some time alone. Time, tears, quiet walks and writing all helped me right my topsy-turvy world. If they hadn’t, I hope I’d have had the insight to seek help – sometimes, the value of professional help lies in reassuring us that our experience is normal.
When I meet relatives of my deceased patients, I always ask how they’re coping. I’m reassured to hear that they have discovered themselves to be more resilient than they ever imagined, which speaks to the human capacity to endure and to recover. They tell me that their lives have been eased by making a new friend, finding fresh love, adopting a pet or trying a new hobby. Many emphasise the value of a routine in the aftermath of grief. This includes getting enough sleep, regular exercise, gentle socialisation and timely meals. One of the kindest gestures towards the bereaved is to be there for them as they face the future.
I always tell surviving relatives to return with their questions and concerns, knowing that this is one way of addressing the myths that occupy the minds of the bereaved long after everyone else has moved on. Every year, a handful of people accept the invitation and their stories are a poignant reminder of the regrets and fears that can accompany us in the aftermath of death. Other people turn to a longstanding family doctor, a social worker or palliative care professionals to make sense of their loss. Knowing that such thoughts are natural and common might empower us to ask questions long after we might think it irrelevant or impolite.
Almost no one experiences the death of a loved one without coming face to face with the subject of one’s own mortality. We cannot be a close confidant, a constant carer or an involved friend at death without investing a large part of ourselves, hence it’s only natural for death to prompt questions about our own destiny.
We need not be overwhelmed by them, but we cannot afford to banish them either. Rather, we would do well to invite an abundance of thoughts and ideas about dying as essential to a meaningful life. By reminding ourselves that we are mortal, we are treating ourselves with respect and being thoughtful towards those who will survive us.
Epilogue
ONE OF THE HARDEST parts of being a doctor, in particular an oncologist, is to constantly run up against mortality. Death spares no one – neither the frail and elderly grandfather nor the beautiful and vibrant mother; neither the accomplished, urbane executive nor the hardworking, humble factory hand. Death is indeed the ultimate levelling experience. But instead of being limiting, this realisation has taught me to live each day meaningfully – to be grateful, mindful and useful. It’s important to accept our mortality and live peacefully with it. The certainty of dying shouldn’t dissuade us from living a full life and doing all we can to ensure it is healthy and long.
It is impossible to do my job without contemplating my legacy and reminding myself of the role I have in actively shaping it, whether it involves mentoring doctors, helping patients, or being a caring mother and a loyal friend. Most of all, it consists of being true to myself.
Even for someone who routinely cares for the dying, it is testing to imagine my own footprint erased from the world. I regard the fate of my young patients with heartache and dread, wondering how their children will cope. I am sobered by the loss of my oldest patients, especially when they still held an infectious enthusiasm for life. If I had a magic wand for a day, I think I might use it to erase loss that crops up in more ways than I can count.
It’s striking how much death feels like a rebuke to modern medicine – a personal or professional failure rather than an assured thing. And I know all too well how easy it is to dismiss death as something that happens to others – in this, we are all given to magical thinking. But it’s okay to be a work in progress. Indeed, we are all works in progress, coming to terms with the death of a loved one, contemplating our own mortality.
For most of us, death will come by way of a visible and gradual decline that’s unlikely to be capped by going to sleep and never waking up. Our dying will involve months, sometimes years, of fluctuating health and a few near-misses. There will be visits to emergency, close calls in intensive care, and an overwhelming parade of doctors interested in a part of us. Therefore, it will really fall to us to regard ourselves as more than the sum of our parts, as complex and unique individuals with dreams and desires and goals that matter. In order to honour them, we will need to actively shape our lives, knowing that a life well-lived is a stepping stone to a better death. How we do this is up to us, but the aim must be to keep at it.
I want to thank you for accompanying me on a difficult but important journey. I hope that some stories have inspired you, while others prompted you to think about who you are and where you are going. These are questions that face each and every one of us – we can answer them by being true to ourselves and by making space in our noisy and overexposed world for periods of silence and introspection.
Here’s to your peace and fulfilment as you explore the makings of a good life and, ultimately, a better death.
Acknowledgements
I STA
RT BY REPRISING MY dedication. This book would not have been possible without the generosity of countless patients and their families, who have allowed me to care for them and shared their stories so that we may all learn from their experiences. To navigate one of life’s most challenging events, the process of dying, and still retain the capacity and the will to care about others is extraordinary and I owe these selfless people a mountain of debt. They teach me how to be a better doctor and a more thoughtful person and I am confident that their stories will illuminate the lives of others.
Any creative process begins with someone believing in a vague idea. I thank my agent, Clare Forster, for reconnecting me with the wonderful Dan Ruffino of Simon & Schuster Australia, who could have said maybe, but chose to say yes and quietly empowered me to write this book. Claire de Medici, Katie Stackhouse, Shannon Kelly, Mark Evans and Lisa White have painstakingly transformed a disbanded draft into a real book, which always seems impossible until it isn’t. The lovely Anna O’Grady and the sales team deserve praise for working tirelessly behind the scenes. As do Chris Lemoh, Irene Wagner, Kate Richards and Andrea McNamara and the team at The Guardian for helping me see further.
I reserve my greatest thanks for my publisher, Roberta Ivers, for two things – her diligent attention to my writing and her steadfast confidence in me. One cannot contemplate the weighty issue of what it means to live and die well without feeling uncertain and, sometimes, hopelessly lost. The task of an able publisher might be to simply redirect an author, but I’ve been enriched by Roberta’s decency and friendship.
It’s amazing that the love and support of my family has stayed constant through the demands of writing another book. For this, I thank my wonderful parents, Urmila and Kaushal, and my brother, Rajesh, for believing in me. I also thank Rosemary, Geoff, Taru and Helen for their support.
I would be a lesser writer without my husband, Declan, who specialises in conjuring ideas when he can’t sleep and jotting them down for me while I sleep. To Rohan, Anjali and Sachin, thank you for your help in big and small ways. I’m lucky to have you and you know that there is no greater joy in my life than being your mother.
Ranjana Srivastava
About the Author
Author photo © Declan Green
Dr Ranjana Srivastava OAM is a practising oncologist, internationally published and award-winning author, broadcaster and Fulbright scholar.
She is a fellow of the Royal Australasian College of Physicians and works in the public hospital system. In 2017, Ranjana was awarded the Medal of the Order of Australia for her contribution to doctor–patient communication and was recognised by Monash University as a Distinguished Alumni of the Year.
Her writing has been published worldwide, including in Time magazine and The Week, and in prominent medical journals such as The New England Journal of Medicine, Lancet, and Journal of the American Medical Association. In 2018 she was a finalist in the Walkley Awards for her work as a regular columnist for The Guardian newspaper. Her acclaimed non-fiction books include Tell Me the Truth: Conversations with My Patients about Life and Death (shortlisted, NSW Premier’s Literary Awards), Dying for a Chat: The Communication Breakdown Between Doctors and Patients (winner, Human Rights Literature Prize) and What It Takes to Be a Doctor (finalist, Australian Career Book Award). She lives in Victoria.
See www.ranjanasrivastava.com
simonandschuster.com.au
Authors.SimonandSchuster.com.au/Dr-Ranjana-Srivastava
Simon & Schuster
Also by Dr Ranjana Srivastava
What It Takes to Be a Doctor
A Cancer Companion: An oncologist’s advice on diagnosis, treatment and recovery
After Cancer: A guide to living well
So It’s Cancer: Now What? An expert’s guide to what you need to know
Dying for a Chat: The communication breakdown between doctors and patients
Tell Me the Truth: Conversations with my patients about life and death
A BETTER DEATH: CONVERSATIONS ABOUT THE ART OF LIVING AND DYING WELL
First published in Australia in 2019 by
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Visit our website at www.simonandschuster.com.au
© Ranjana Srivastava 2019
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of the publisher.
Cover design and illustration by Lisa White
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ISBN 978-1-9257-5096-6 (ebook)
A Better Death Page 18