Death on Your Own Accord

Reclaiming the End of Life for Ourselves

“If your heart were to stop beating, would you want us to do everything in our power to restart it?”

“Yes, of course,” you reply as you can not imagine a life in which you do not exist. 

But despite our minimal ability to view the world as if our beam of consciousness is not the only one, we must shine a light on life as that of the eternal. Our temporal concerns with finitude detract from living through the passion of totality. We clamber to hold onto the present as it is the fear of uncertainty that binds us to anxiety. 

It is this anxiety for the unknown that we hide away from the one truth of our lives; Our conscious experience as we understand it, will end. Death. Finality. The last page, paragraph, and sentence. Given death’s verity, is it not strange how we broach it?

We treat death as happenstance. A random occurrence that will strike us when we least expect. But we all beat Death’s drum long before our wake. We view death as the result of disease. And disease hears our praise. We have identified all the ways in which disease will bring our final breath; we credit disease as the robber of our lives. 

But your death belongs to you, not a disease. Your death does not belong to cancer, atherosclerosis, or complications due to diabetes. Death is ours to process and possess. We should rightfully take back what was ours from the beginning. Death is to be realized; for you are not going to be selected at random, but will bear it, no matter what. 

Our approach to life and death is much like how a college student treats a term paper assigned at the beginning of the semester. We formulate ideas of how the paper will be written, what topics will fill the page, and what resources we will gleam to provide support to our paper. But the semester carries on and we do very little to formulate the paper into what we set it out to be. The due date approaches and we must now put pen to paper. The paper starts out strong with the potential to become what you envisioned. But you have procrastinated far too long. You wait until the twenty-third hour. And now you must haphazardly conclude the essay, barely hanging onto any coherence. As you finish the paper and send it over to your professor just in time before the deadline, you can’t help but feel uneasy about the whole thing. 

What remains, is a potentially strong essay with an incoherent conclusion. A conclusion that did not live up to your potential. It was not Your conclusion, but Time’s conclusion. This is how we treat death. It resides in our periphery for most of our life, but is not addressed until it arrives. This poses a problem as it allows death to occur without your consent. 

You might say, “I could get hit by a bus tomorrow. I did not consent to that!” And while you do not pick the exact moment of conclusion, you can vitally prepare for its arrival. In some sense, you must undergo an extraction of yourself prior to when the bell tolls. A metaphorical death will meet the physical death when the time is right.

I am not here. I will die. I will one day leave. How do I feel about this? Am I one with this moment of passing? Can we undergo self-realization in the absence of our perspective? Death is the ultimate self realization as your life has been fulfilled. 

You see, when death is swept under the rug for your entire life, it rears its head as if you have never met it before. It shows up as a novelty, one which is deeply unsettling, especially if we have mentally rejected it. But death lurks around all corners of reality and encroaches beyond physical decay. We are dying everyday. We die a thousand deaths before our physical one. We are not the same person we were 5 minutes ago. A metaphorical death occurs through all wrinkles in time.

But the one death that gets the most attention is physical death. And for the sake of brevity, we will focus mainly on this type of death.  

As a larger percentage of people are dying in hospitals, many of us have come to accept an institutionalized death. An institutionalized death is a death in whichever hospital system you are a part of. Death in most hospital systems are similar. Often patients opt for a ‘full-code status;’ In the event your heart stops beating, the team of Drs. and nurses will do everything in their power to achieve a “return of spontaneous circulation (ROSC).” When patients are asked upon admission, “in the event your heart would stop or you are unable to breathe adequately on your own, would you like us to perform CPR and/or intubation?”  Most people answer with an emphatic, yes!

Our indifference to death demonstrates how little respect we have for the last few pages of our story. But perhaps we should consider how we would like the end to look and feel. This requires a contemplation of an existence in which you have no part. Consider your death as a moment of meaning beyond yourself. And in this moment all of those intertwined in your life can watch on with love and perhaps, even, admiration on how you faced it. 

Institutionalized death is on someone else’s terms. This does not mean the hospital has no respect for the dying. It just means it occurs based on their preferences. When someone dies in an institutional setting, the patient and family are often at the whim of the system's resources, staff, décor, noise, aesthetics, and so on.

An often overlooked price to pay for institutionalized death is the barbarism of Advanced Cardiac Life Support, particularly on frail or sick individuals. There is no peace during a code in a hospital setting. And even if the code runs smoothly; with efficient communication, minimized interruptions, and is effective, the aftermath is not a return to life as it was.  

CPR may be more about the optics of heroics than it is a restoration of quality of life. The patient “fought until the end.” But the patient does little fighting in these scenarios. They seem to be passive observers to what is often brutal and chaotic. If resuscitation goes on unabated with no sign of ROSC, the doctor will eventually turn to the family and let them know, “we have done everything we can.” A family member will subsequently cry out in anguish as Death is the robber of justice here. This was our first and last meet and greet with Death. 

Is it that we just want to feel like we did not go quiet? Is to die on your own accord to accept death? Would a natural death be to go to bed without objection when your parents told you to? Or should we kick and scream all the way? Must we scream out: "Cease, eternal adversary! I am Human! The progenitor of art, the maestro of culture. From the symphonies of creation to the canvas of life, I craft the narrative of existence. Death, your elegy cannot claim me, for I am yet to compose the magnum opus that defines the very essence of being. I am the author of progress. My endeavors span the epochs, and my intellect shapes the fabric of reality. Grant me a reprieve, for I am on the verge of unlocking the universe's ultimate secrets."

But an ideal death is one on the person’s terms, with nature. One in which we are surrounded by those we love. A bit if sunshine and fresh air. Perhaps some reflections, aphorisms, or wisdom is spread. One’s last words present an opportune moment of profundity, emotion, or even levity. 

How we reach moments like these is addressing your conclusion before 11:45PM on the day the term paper is due. It is through contemplation and an openness with those you love about your feelings on death. Addressing your hopes and fears prior to an institutional admission. [*Places order for palliative care consult*]

We do not speak of death in regular conversation as if it is superstition. We act as if to mention Death is to confirm its arrival. Or maybe we do not wish to affirm its promise.

I can recall a dying patient who was in comfort care waiting for a hospice bed. He had been sleeping on and off for 2 days. On the third day he woke up during one of my rounds. All of his children were sitting around him, reminiscing about his life and its imprint on them. He opened his eyes and took a sip of water. He then turned to his daughter, smiled wryly and told her, “I have lived a good life,” and went back to sleep for the final time. I think about this moment often.