Thirty-odd years later, I work a few days a week in a palliative care program with people who have serious chronic illnesses. I see hardy old people who are doing well and fragile people younger than me. About a fifth of our clients die every year. My clients live all over the city, in apartments and trailers, in memory care units, in sprawling assisted-living complexes, and in adult foster homes, part of the state’s extensive network. People like my clients are everywhere in the world; how could they not be? I forget that this part of life is so hidden, because when I go to work, that’s where I am: in that memory care unit where, really, anything could happen; in that small home where five very old women are cared for by several younger women; in that assisted-living building where every apartment is a microcosm of a long life.
But for many years, I forgot that I was like the man whose hand I had opened like a rose. We do forget such things when we are young, if we are lucky enough to learn them at all. I forgot that I would get old and lose the power that seemed entirely part of me, the power that allowed me to be busy and productive, rear three children, write books in the evening, and still get up and go to work. When I thought about death in those years, I didn’t quite believe in it. Of course patients sometimes died. People I didn’t know died—people on the news, people in the hospital, people on the street. My old relatives began to die, one after the other. But they were, after all, really old.
When I was in my early twenties, just finishing nursing school, I started practicing Soto Zen Buddhism. This is not a book about a Buddhist approach to dying. But my life is deeply informed by Buddhism, and I will return to its vocabulary and guidance throughout. The first story Buddhists learn—the root story—is that of the historical Buddha, Siddhartha. He was a pampered prince who grew up carefully protected from any painful sights. When he grew restless and slipped away from his bodyguards, he saw several things he had never seen before: a sick person, an old person, and then a corpse. His retainer told him that this was inevitable, that such things happen to everyone. What a shock for the young prince. Everyone? Me? Then he saw an ascetic, a religious practitioner who had withdrawn from the world in order to seek knowledge. The prince then knew his life’s task was to understand the meaning of the inevitability of change. (In some versions of the story, these terrible sights are sent by the gods in order to goad him into seeking enlightenment.)
Buddhist practice requires one to confront the blunt facts of life: that we are constantly changing, that we are dissatisfied more or less all the time, that we try desperately to hang on to what we have. That we are mortal, suffering beings. We will change and everything and everyone we love will change. An old Buddhist meditation is simply this: I am of the nature to grow old. I am of the nature to be sick. I am of the nature to die. All that is dear to me and everyone I love are of the nature to change. There is no way to escape being separated from them. The historical Buddha’s story has resonated so deeply with millions of us over thousands of years because it is our own. Sooner or later we each have such an epiphany: sickness, aging, death. Perhaps the sick person gets well and the old person is a stranger and the corpse is carefully made up and lying in an expensive casket in a church, but still. At some point you think, Me? Me too? And you either turn from that thought or start looking for an explanation. Either way, the epiphany has a way of returning.
One of the central ideas of our lives is that there will be a tomorrow. Tomorrow may be when I get the laundry done. Tomorrow may come after I retire. Tomorrow I start summer vacation. But if we are aware of our dangerous situation, there is no tomorrow. No next year. Only this. Of course we plan anyway; there’s no other way to live than to plant seeds and wait for the fruit, whether it’s the laundry or retirement or next summer’s vacation. The trick comes in planning next summer’s vacation while knowing that next summer is not promised to anyone. This impermanence is the key to our pain and our joy. What a radical acceptance of things as they are! “Why should we treat ourselves in a special way?” asked Shunryu Suzuki. “When you understand birth and death as the birth and death of everything—plants, animals and trees—it is not a problem anymore. A problem for everything is not a problem anymore.” A table is a table because of its shape and how we use it, and because there is a chair, and because we call it a table. We can take a table apart, and at some point it is no longer a table. Even if all the parts are there, the table is gone, because no table exists apart from how it fits together. I am like this; you are like this. Everything is like this. Such knowledge can give us a vast space in which to live our lives, a freedom within life. A problem for everyone is no longer a problem. We will break, as all things will; how beautiful, how sweet. How hard.
People have been wondering about the nature of death for all the eons we have been able to wonder. The modern literature of death never allows us to forget Cicero, who is otherwise rarely mentioned in conversation: “To philosophize is to get ready to die.” The impulse is to lean on history a little, add context, make a bigger picture. But do we really need to add weight to this conversation? I will do it, too, now and then—depend on another’s words. Perhaps I’m just reminding myself that all of our questions have been asked before. In the workshops I lead, the same questions come up every time: pain, dignity, fear. Old, old questions. How do we prepare for something so mysterious, so unseen? How do we make decisions about the unknown? How can we prepare for the inevitable when we aren’t sure we even believe in it?
We talk about death as a remote idea, imagine what we would like our dying to be like, and do this casually over a few beers, on a summer evening when the air is sweet and our healthy child hums quietly at our feet. We talk about dying when to die seems like a complete impossibility, and so can be considered.
Look around the room—right now. Wherever you are: the office, the subway, your living room. Look around, all around, at everything you can see. You are going to die in one minute. That’s it. There’s no time to find the sweet summer grass or your favorite Adele song. No hand to hold. No time to make a call or write a note. What you see right now, right here—this season, these people, this day, this light, and this room—that’s what you have.
My friend Carol had rarely been sick in her life; she didn’t even catch colds. She was a criminal lawyer in rural Oregon. When she ran for election as county judge, she spent weeks knocking on doors and introducing herself to voters. By the time she was elected—the first woman judge in Yamhill County—her left leg was numb. She assumed she had a pinched nerve, that she’d walked too much, had been wearing the wrong shoes.
Then she called me and said, “I have cancer.” No preamble. Lots of tears. Our bodies are, by any measure, miraculously complex homeostatic systems. But they are also flimsy entropies, and much of what they do is silent: the whispering aneurysm, the invisible embolus, the dying cell, the multiplying cell. Her routine mammogram the summer before had been clean, but now Carol had metastatic breast cancer. The numb leg was caused by an abdominal tumor pressing on her spine.
People with terminal illnesses talk about the knowledge as a kind of border. Life is divided into the time before and the time after one knows one is dying—really knows. The day will come when we cross the border between theory and fact. People are often quite pragmatic in the first days. Paul Kalanithi was a neurosurgeon when he was diagnosed with lung cancer. He and his wife, Lucy, lay in his hospital bed together, talking it out. “I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately.” This temporary acceptance, this willingness, is common; perhaps it is protective, a kind of endorphin buffer to the shock. Carol told me later that she thought she might never leave the hospital. She was calm there, in a private room facing west into her beloved coastal mountains, and the sun fell across her bed and she allowed herself to be what she so suddenly was: not a lawyer, not a judge or wife or dog lover, but a patient with a terminal illness. We talked a little about her biopsy, her options, a
nd a bit more about her dogs and what might happen to them.
Like endorphins, this acceptance wears off. Carol had surgery, recovered, was sworn in as a judge, and took the bench with gusto. She responded well to chemotherapy and lived for several more years. She did anything and everything she could not to die, but she was dying the entire time. She knew it. I knew it. Every day was the day after.
This is a book about preparing for your own death and for the deaths of people close to you. I am talking about both these experiences, so sometimes I am addressing you the visitor, the loved one. And sometimes I am addressing you the dying one. (I am always addressing myself.) Most of us in the West will die in our old age of chronic illnesses, and most of those illnesses cause a decline toward death over months or years. A lot of what I am saying is addressed to this fact: that you and I are likely to die over a period of time from disease, and before that happens, we will see family and friends die this way. But I have seen people die quickly. I’ve seen people die in an instant. I believe that if we are able to consider death, our own death (me? really?)—if we can become familiar with the fact of death—then minutes are enough. We know from a thousand shining moments how time speeds up and slows down. If we are ready to look at it squarely, perhaps five seconds is enough. We spend our lives creating our future, by creating habits, learning from experience, examining our weaknesses and strengths. Our lives as we live them day by day create the person we will be at the moment of death. You see this at the bedside of a dying person. You see it in the way a body rests or fights, in the lines of the face, in the faint shadow of a smile or a scowl, worry or peace. With every passing day, we create the kind of death we will have.
In this book, I look at how we grieve, what can be done with the body that remains, and the strange, undeniable fact that the presence of death can be joyful. What exactly are we afraid of ? What is a good death? What really happens in the weeks and months before death? What does it look like when a person dies, and after? There are brief sections of practical advice, a little Buddhism, a few stories of deaths and preparing for death. I want this book to make you think about a few things you don’t really want to think about.
Dying people make symbolic statements. One of the most common images people use is traveling. A dying person may become excited, even frantic, and say he is looking for his passport, must find his luggage, must hurry to catch a train. Human minds share symbols and this one is so apt and easy to understand. How do you get ready to die? The same way you prepare for a trip to a place you’ve never been. Start by realizing you don’t know the way. Read a travel guide: they tell you what to expect, and have maps—large maps of the whole country, maps of small neighborhoods you may visit along the way. A guide will tell you about local customs, how to say hello and ask for help. They give you warnings: what not to say, what to avoid. Study the language. Look at maps, gather any equipment you might need. Find someone to water the plants when you’re gone.
With all this preparation, when we arrive in a place we have never been, perhaps with only a few words in the local language, we are a little lost and a little scared. We are dependent on strangers, relying on kindness and the fact that we are all more alike than different, and the hope that the people in this place will want to know us, too. We walk strange alleys and smell new scents and see a cast of light we’ve never seen before, across a landscape altogether new. Either we relax into this, trust, and look up, or we retreat and turn away. As you are walking the dog, doing the dishes, let your imagination go. What will it be like to go on this trip? What will it be like on the journey? Think about what you want to wear. Pack your bags.
I am comfortable talking about death, and often comfortable even with the fact of my own death, but I didn’t get here in an unbroken line of good experiences. I began to practice Buddhism when I was filled with anxiety, almost agoraphobic. I have at times been really frightened of dying, frightened in an organic, shattering panic. I am comfortable now largely because of the time I’ve spent staring at it, touching it, thinking about it. Experience helps; there’s no way around it. If you want to be more comfortable with death itself, with your death and the death of others, spend time near it. Read this travel guide and follow the maps and find a place where you can see what happens next—what will, like it or not, happen to you in time. One of the goals of my life is to become more congruent—less dissonant—and this is a religious journey to me. But this isn’t a book of inspiration or spiritual guidance. I’m not going to tell you a lot of stories of lovely deaths or suggest meditations for a lonely night. There are plenty of books like that, but none will entirely console you. This isn’t that kind of book. This is just a book about how you can get ready.
Carol and I used to scuba dive together. When I began to dive, I had a revelation: that I only feel wet when I am not completely submerged. Swimming on the surface, I am aware of water and air and the difference between them. I feel wet skin, splashing, damp hair. Underwater, I don’t feel any of these things. “When the time comes for you to die, just die,” the medieval Japanese master Dōgen wrote. “In death, there is nothing but death.” What a mysterious phrase this is: “In death, there is nothing but death.” What this means is that when we engage in anything completely, everything else disappears—not because we’re concentrating on something else, not because we’re looking away. Everything else disappears because it doesn’t exist. This moment is all that exists. Just now is where we live. Life is completely life; death is completely death. Living or dying, this moment is everything if we submerge.
Carol was a great comic, and she would pose for me thirty feet below the surface of the sea. I can see her right now. She is floating weightlessly in clear water, lit by columns of sun. She pretends she is playing the piano. She pretends she is sleeping, curled up on her side like a cat. She pretends she is sitting in court, pounding her gavel. We laugh and laugh in this silly, free, perfect moment, and it is as though there is no water around us at all.
2
Resistance
It is a fine Thursday in September. My brother is visiting. We are about to go out for breakfast, when a friend from my Zen temple calls.
“What’s up?” I ask as I pull on my shoes and look for my jacket. But his voice is serious; the words instantly fade out of reach. I hear only Kyogen and heart attack before I yelp. “What! No!” and then I am coping: “Okay, I’m coming, which hospital?” Kyogen has been my religious teacher for more than thirty years. For his birthday once, I gave him a small statue of Ganesha, a Hindu god who represents both removing and creating obstacles. Such is the nature of the challenging relationship between a religious teacher and a student. But deep, abiding love is part of it, too. He has been many things to me over the years, but as time passed, we became friends, traveling companions, and, finally, family.
Which hospital? I ask, because I am already on my way.
And then my friend says, Wait.
And then he says, He died.
No. I say it, or shout it, and then I find myself on the floor. No. When I look up, my brother is hovering beside me, confused. I try to explain, crying, gasping, even while I am ticking off the list of what I need to bring, even while a tsunami washes over me. NO. The dog? What should I do with the dog? My brother shifts from foot to foot: What happened? Tell me what happened. And then I just crumple and weep while he pats me awkwardly, saying, Breathe.
I get lost driving to a hospital I’ve been to many times before, park in the wrong lot, go to the wrong building, get lost twice more before I find the room. And when I walk in, I am walking into a new world where he lies in a hospital bed, so clearly himself and so clearly not alive. He is wearing a gown he would joke about if he could still joke. His wife sits in a chair beside him. She is crying; she has been crying for quite a while; I am crying, too, and it feels like I have been crying for hours. I love him more than my own hands. There is nothing to say, so I say, Oh. Oh. I think, He died, and the wave of disbelief breaks over
me again. Decades of Zen practice, many hours at the bedsides of the dying, the loss of other people I loved—what these give me now is not acceptance but awareness of denial. A chance to not resist my resistance. To see my disbelief for what it is.
Other people arrive, and we bathe his limp, cooling body and dress him in a clean kimono. Several of us divide up a list of names and start making calls. I send urgent texts and leave voice messages telegraphing an unexplained disaster. I suddenly remember that tonight is a meeting of the death-and-dying study group I am leading, and I send an email to everyone to cancel the meeting.
In the vocabulary of grief, a grieving person has tasks: one must accept the reality of the death, feel its pain, adjust to the new world. But in the stark early hours and days, there are also chores. So many chores. I take on the funeral home. I call from the hallway, surrounded by visitors coming and going and sitting against the wall and pacing about. My chest feels as though it has been struck with a mallet, but I slide into the ordinary world again, where I say “Hello” and explain the situation and get put on hold and listen to bland music and then explain the special requirements—no embalming; a group to go into the crematorium and start the fire; the bones to be left alone—and get put on hold again and then agree on a price and say goodbye.
His body is in the last room on the cardiovascular unit, which is half-empty today. We fill the room and the hallway all day, supported by graceful, efficient nurses. One person after the other peeks in the unit’s double doors: Is this the place? Some are crying, others look numb and barren. One marches straight into the room while another veers away, steps dragging. A few walk as though they are injured. In the room, people cry quietly or whisper and then lapse into silence. In the hallway, laughter and stories and hugs and more crying. There are people who cannot get away from work or must find a babysitter. One person is 150 miles away and begs us to wait, to keep the body there until she can reach us. We have forgotten to eat. A bereavement cart arrives with coffee and tea, and I buy cottage cheese and celery sticks and yogurt at the little café down the hall. We poke at everything. I go for a walk. Now and then a fog settles over me, a kind of numb confusion. Then another friend comes through the doors and we start over. We do this for fourteen hours.
Advice for Future Corpses_and Those Who Love Them Page 2