All That Remains
Page 32
And what of our brand-new mortuary? That was formally opened in 2014 as, to the surprise of nobody, the Val McDermid Mortuary. There was never much doubt, given her massive following and in recognition of her huge drive and commitment to our cause, that Val would win the competition. Because of his enormously significant contributions – make no bones about it, little Skeleton Bob unquestionably left his mark – and because he gained the second-highest number of public votes, we named our dissecting room after Stuart MacBride.
In acknowledgement of the generosity of the other writers who lent us their reputations, time and effort during the campaign, we decided to name individual Thiel submersion tanks after nine of the key players. The tenth is dedicated to my former principal anatomist, Roger Soames, who was a stalwart support throughout, and indeed throughout everything we have done at Dundee. He retired shortly after the mortuary was built, so we christened a Thiel tank after him as a farewell gift. When people see his name on the tank, they assume it is him in there. It is not. Roger is happily and healthily retired, but who knows, maybe one day my favourite anatomist and dearest friend will come home to teach his students again. If he does, he will be welcome, but I hope it will be at a very distant future date.
We have eleven tanks altogether. I quite fancy the idea, when my time comes, of floating peacefully in the Black Tank. How cool would that be?
Epilogue
‘To die will be an awfully big adventure’
J.M. Barrie, Peter Pan
Life’s contemplation.
THROUGH THIS BRIEF exploration of the many faces death has revealed to me, I hope it will have emerged that my relationship with her is one of comfortable camaraderie.
Although I am no scholar of thanatology – the scientific study of death – I think I have experienced enough of her handiwork to have gained a healthy understanding of what might be coming my way. I would, however, never be so bold as to predict with certainty how I might behave at the end of my life. I suspect that someone who muses deeply and often on his or her dying and death bears little resemblance to the person who finally confronts her in the raw. It is the element of the unknown that prompts such philosophising, which tends to increase as the years pass and the edge of our own hole in the ground looms ever nearer. Since nobody has ever returned to tell us what death is really like, no amount of preparation and planning can guarantee the smoothness of the path that lies ahead for us. The only certainty is that we will all have to walk it sooner or later. And although others may walk part of the way with us, it is a journey we must ultimately make with only death herself for company.
The point at which we feel living has stopped and dying has started will, I imagine, be different for all of us. For many, simply not being dead means we are not yet done with living. Is there anything we can do to hold her at bay? Perhaps she is open to some degree of mortal advocacy. Perhaps it is possible to reason or bargain with her, if the debate we place before her is sufficiently compelling and bolstered by a strong attitude of mind. How often have we heard of the terminally ill patient who, determined to see their last Christmas, their child’s wedding or some other significant event, outlives a clinical prognosis to achieve their wish, only to die days afterwards? The trouble with a prognosis – which, after all, can only ever be a guess – is that it has a habit of becoming a self-fulfilling prophecy. Maybe it sometimes strips us of our will to keep fighting beyond the deadline we have set ourselves and thereafter we lose focus, just let go of living and start dying. Or maybe we have invested every ounce of strength we have left in reaching that milestone and are simply spent.
Summoning the will to battle encroaching death constantly and relentlessly, rather than focusing on a specific goal, may be another alternative. The real inspiration in this regard is Norman Cousins, the American political journalist who, on being diagnosed in 1964 with the crippling connective-tissue disease ankylosing spondylitis, was told that he had only a 1 in 500 chance of recovery. Having long believed that human emotions were the key to success in fighting illness, he started to take massive doses of vitamin C, moved into a hotel and bought a movie projector. He found that if he could get a really good belly laugh from watching reruns of Candid Camera episodes or Marx Brothers films, he would have at least two hours of pain-free sleep.
Within six months he was back on his feet, and in two years he had resumed his full-time job. Cousins died of heart failure twenty-six years after his diagnosis – and thirty-six years after first being told he had heart disease. He simply refused to die when the doctors told him he would and his therapy was laughter. There is nothing wrong with letting go of life if that is our choice, but maybe his experience is a lesson to those of us who are not yet ready to do so.
There are many well-known factors that can have either a beneficial or a detrimental effect on our longevity. A healthy diet, exercise, being married and being female are all likely to result in a longer life. The fact that women’s lives will be about 5 per cent longer than those of men is borne out in virtually every country that has been studied. There is a suggestion that this may be because women have two X chromosomes and men only have one, which gives women a spare if something goes wrong. It’s a nice idea, but the inferior longevity of the male is much more likely to be due to the negative side-effects of testosterone.
A research study on the eunuchs of the Imperial Court of the Chosun Dynasty (1392–1910) in Korea showed that they lived on average twenty years longer than non-castrated men. Interestingly, though, this was only true if their testes were removed before the age of fifteen. For individuals sterilised after the onset of puberty, and therefore after the biochemical influences of testosterone had kicked in, the differential was less striking. But it would be somewhat extreme, not to mention significant for the future of the human race, if men were to try to gain themselves another twenty years by getting themselves sterilised.
We usually measure our life, and its constituent parts, in weeks, months or years. It might be more interesting to measure it in risk. There are credits and debits here that can affect our life expectancy, and choosing how to play them can have some influence on the likely outcome.
In 1978, in a contribution to the book Societal Risk Assessment: How Safe is Safe Enough?, Ronald A. Howard of Stanford University introduced his concept of a unit of risk of death, which he quantified as 1 in 100,000 and named the ‘micromort’. The principle is very straightforward: the higher the value in micromorts of a particular activity, the more dangerous it is and the greater the chance it will result in your demise. It can be applied to both daily tasks and more hazardous enterprises, and to those carrying immediate or cumulative perils. For example, 1 micromort equates to travelling six miles on a motorbike or 6,000 miles by train, the implication being that, as a mode of transport, a train is 1,000 times safer than a motorbike. So this measure allows us to compare the risk inherent in various activities and might, in some instances, make us think twice about whether a particular venture is really worth the gamble. An operation with a general anaesthetic is valued at approximately 10 micromorts, skydiving at around 8 micromorts per jump and running a marathon about 7 per run. The real risk-takers can rack up an impressive number of micromorts – mountaineers may expose themselves to 40,000 with each ascent.
These are all single acts carrying the danger of instant death, defined by Professor Howard as an acute risk. An activity with a cumulative effect, which will take time to become a genuine risk factor, is termed a chronic risk. In this category, drinking half a litre of wine or living for two months with a smoker will earn you 1 micromort.
On a happier note, we can buy back some of our endangered time by acquiring microlives for ourselves. The microlife is a unit quantified by Sir David Spiegelhalter, of Cambridge University, as a daily gain or loss of thirty minutes of our existence. We all know what kind of activities are going to earn or cost us microlives and, to be honest, those on the credit side are rarely fun. Four microlives for men and 3 for
women looks very much like five servings of fruit and vegetables every day. Yep, raw cabbage for lunch again.
I think we should devise a new risk measure: the micromirth. How much more wonderful would our lives be, whether long or short, if we measured them in joy, laughter and utter nonsense? Microlives accumulate, micromorts are fatal but micromirths are priceless. I think Norman Cousins would agree.
◊
So what about my own dying, death and being dead?
I am quite relaxed at the moment about the ‘death’ and ‘being dead’ bits – they hold no fear and actually, I feel almost a slight frisson of excitement at the possibilities of what is to come. I have known the imperfections and strengths of this body all my life and I would really like to see how it copes with the task required of it before the final shutdown. I am no hero, though, so, in common with most people, I would sooner skip through the ‘dying’ part as quickly as possible. In an odd way I am quite intrigued by the threshold that separates dying from being dead, and I would like to experience that when the time comes. Just not for too long. As the Roman philosopher Seneca said: ‘The wise man will live as long as he ought, not as long as he can.’
I have no desire to live to too great an age if that means being a drain on resources needed by younger people, especially if I have nothing of any value left to give and have become a burden to those I love. I want to be independent and mobile right up to my last hours on this earth and for that I would willingly sacrifice quantity for quality. Let me go out with a bang, not a whimper. I am prepared to tolerate some bodily discomfort with advancing age but please don’t addle my mind. Don’t let me languish in a soulless care home or hospital. Don’t let dementia steal my life, my stories and my memories. I do not want my dying to echo my father’s.
I have been asked why I decided to write this book, and why now. The truth is that it is an opportunity to set down some of my stories for our girls, so that they can always hear them in my words and not those of others. My father was a great storyteller and I listened to his tales time and time again as I was growing up. Recently I found a letter Grace and Anna sent him in 1997. As part of his Christmas present they had given him a book and a pen and asked him to write down his stories so that they would not be lost for ever. Sadly, he never did, and most of them died with him. A few more will eventually die with me. So I hope that this book will give Beth, Grace and Anna, and the generations to follow, a little more insight into me, and my life, when I am gone.
My husband and children despair of me because the last time I actively sought out a GP was when I was pregnant with Anna over twenty years ago. I take no prescription medication, although I suspect that if I went for an MOT, I would be put on a regime of tablets to alter my sugar, or my blood pressure, or my cholesterol or my something or other. Once you start down that road, you will be taking tablets for the rest of your life.
And the indignity of an invitation to a ‘poop’ test landing on your doormat on your fiftieth birthday … really! Of course I understand that preventative medicine saves lives, and there will be many who are glad they opted to undergo such tests. We all have a choice in these matters. But for myself, I cannot see the point in going to a doctor so that they can look for something that might be wrong when there is no indication right now of any problem. I have aches and pains that are only to be expected at my age and I don’t need to go to a GP for an in-depth, six-minute consultation to be told I am overweight and should take more exercise. So I let my husband provide me with a single aspirin every day, and that is it.
My grandmother always warned me to stay away from hospitals. In her experience, going into hospital only increased your chances of coming out feet first in a pine overcoat. I don’t want my life to be hampered by the constraints of a diagnosis or prognosis, to be defined by an illness or to become a medical statistic. Ultimately it is fate that will determine how long I live and when I die. I don’t need my death to be prevented. We all have different opinions and temperaments and how far down the line we go to stave off illness and death must be a personal decision. Mine will probably be to wait until whatever it is that eventually takes me becomes critical. My preference is not to allow my dying and my death to be medicalised.
My life has been full. It has had some purpose. It has been fun. I have met many wonderful people. My husband is my best friend. We have beautiful children and grandchildren. I have outlived my parents. Even if my original, more conservative, life expectancy still holds true, I still have seventeen years to go, and frankly, every single day between now and then I consider a bonus. Of course I would like all this to last as long as possible, but my main desire is for my death to conform to the natural order of the cycle of life – in other words, I want to die before my children and my grandchildren. Having seen the pain and suffering of parents who have lost a child, I would not wish that torment on anyone.
Now that I have less time in front of me than I have behind me, I am starting to focus on that threshold I must cross some time within the next thirty years. I am not afraid to cross it on my own. Indeed, I think I would rather die alone – privately, quietly, on my terms and at my pace. I don’t want to be distracted by having to worry about the pain and grief of my loved ones. I would like to ensure that I have all my ducks in a row. I don’t want to leave work or trouble for anyone else. I want it to be tidy and neat and the next logical step in my life. I don’t want to be any bother.
So how would I like it to happen? If I do not want my dying to be like my father’s, I would welcome the same kind of death: simply turning my face to the wall when I am ready. I don’t believe I would have the bravery to kill myself and I must therefore be prepared to wait with some patience for death to arrive. Might I take the assisted dying pill if it were available? Perhaps, in certain circumstances, but I would not have the same kind of courage as Arthur, my trainee cadaver. I have great faith that society will come to its senses before I shuffle off this mortal coil and allow us to plan our death rather than endure it at the hands of well-meaning medical or care staff. I would like my exit to be natural: I don’t want transplants, or CPR, or drip-feeding, or, in my final moments, a syringe full of opiates. Of course, I may be utterly deluding myself. It’s quite possible that when the first little bit of pain creeps in, I will be shouting for the morphine. I doubt it, though. I don’t like losing sensation or control. And I have always had a very high pain tolerance (three babies, no pain relief). Only time will tell if I am right. When death comes for me, I would like to be properly alive to have my personal conversation with her unencumbered by pharmaceuticals.
While Uncle Willie’s death was pain-free, I think it was just a bit too swift for my liking. I don’t want to die in my sleep, either. I view death as my final adventure and I am reluctant to be cheated out of a moment of it. I am only ever going to experience it once, after all. I want to be able to recognise death, to hear her coming, to see her, to touch her, smell her and taste her; to undergo the assault on all of my senses and, in my last moments, to understand her as completely as is humanly possible. This is the one event that my life has always been leading up to, and I don’t want to miss anything by not having a front-row seat.
Perhaps I will be fortunate enough to die like Sir Thomas Urquhart, the well-travelled seventeenth-century polymath, writer and translator from Cromarty in the north-east of Scotland, who was declared a traitor by Parliament for his part in the royalist uprising at Inverness. He wasn’t subjected to any particularly harsh penalties, although he was later held in the Tower of London and at Windsor for fighting on the royalist side in the Battle of Worcester. Urquhart was eccentric in the extreme. Among his claims was that his 109-times great-grandmother, Termuth, was the woman who found Moses in the bulrushes and his 87-times great-grandmother was the Queen of Sheba. After he was released by Oliver Cromwell, he returned to the Continent. It is said that on receiving news of the restoration of King Charles II to the throne, he laughed himself to death. Micromorts meet mic
romirths – what a way to go.
I doubt that will be my destiny, more’s the pity. But I have a prediction for you. I think I will die before I am seventy-five. I suspect it will be heart-related, and as deaths from myocardial infarction peak on Mondays, at 11am, apparently, I am booking mine in for a Wednesday at noon.
Obviously I don’t actually know how to die, having never done it before. But surely it can’t be that difficult: everyone who has ever lived before me seems to have managed it well enough, with some possible exceptions among the winners of those tongue-in-cheek Darwin awards, who have all succeeded in bringing about their own deaths in ludicrous ways. I can’t rehearse for it and I can’t seek advice from anyone who has done it. So really there is no point in worrying about it. But I know I won’t be alone. Whether or not there are others present, death will be with me, and she has more experience than anybody, so I am certain that she will show me what to do.
I imagine my death as being akin to yielding to permanent general anaesthetic. Everything goes black, you know no more and that is it, you are dead. If all there is beyond death is darkness, I won’t be able to remember it anyway, which is a great shame. But perhaps this is all there is to it: a fugacious moment tacked on to the end of a long story like a final full stop.