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Surgeon says Mortality can be a Horror for the Dying

Posted on 25 September 2017, 10:41

In his best-selling book, “Being Mortal: Medicine and What Matters in the End,” Dr. Atul Gawande, a surgeon and a professor at Harvard Medical School, discusses the failure of medicine to effectively deal with the needs of the aging and dying.  “Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need,” he offers in the Introduction.  “Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.”

In effect, the first part of the book is about the needs of the elderly as they struggle with the three plagues of nursing home existence – boredom, loneliness, and helplessness, while the second half of the book deals with the needs of the terminally ill, especially the need for them to face up to their ultimate demise without total despair.  “The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society,” Gawande concludes from his talks with many aging and dying people, including family and patients.  “If you don’t, mortality is only a horror.”

If I am properly interpreting Gawande’s conclusions, it’s the same old plan many others have espoused – live for today, enjoy the grandchildren and the friendships, savor the little pleasures, identify a purpose outside of ourselves, and overall disregard the words of poet Dylan Thomas that we should “not go gentle into the good night.”  In other words, do not rage against death, but accept it as part of life’s journey.

It all sounds so simple and idealistic, but it has been my experience and observation over 80 years of living and seeing many friends and family depart earthly existence that it doesn’t work, at least for a thinking person.  The fact is that nearly all the daily pleasures we experience are for the most part mundane and ordinary, whether reading a novel, painting a landscape, viewing a movie, watching a sporting event, shopping, playing a game of chess or checkers, or just smelling the roses.  So much of our time is spent escaping from reality in fiction and the pretend wars of the athletic arena.  In the great scheme of things, how can any of it really matter to a person on death’s threshold? 

How often can one meet with friends and discuss commonplace things?  What do they talk about – the weather, sports, politics?  As Sophia suggested to her three housemates on the Golden Girls, their best talks had to do with trashing other people. Considering the fact that politics is a means to an end – an end the dying person won’t be around to witness – is such a discussion anything more than a distraction?  And how many grandchildren really want their old-fogey grandparents hanging around and interrupting their more “important” social media discourse? Pray tell, Dr. Gawande, what daily “pleasures” can we truly savor if we believe we will be extinct in a matter of days or weeks?  Let’s be realistic.

As I suspected before reading the book, Gawande avoids the most important subject facing the aging and dying, one that can give hope and a light through the darkness – the survival of consciousness at death, or, for the true skeptic, the possible survival of consciousness at death. The subject is too unscientific and involves too much religious superstition for all except the most courageous men and women of science to even allude to.  It calls for living in the future rather than enjoying the present, seemingly a contraindicated approach.  Gawande’s credibility as a professional man of medicine might very well have been compromised had he dealt with such a “foolish” subject.

To be fair, Gawande does touch upon it in the Epilogue of the book, mentioning that his father, also a physician, wanted some of his ashes spread on the Ganges River in India, which is sacred to all Hindus, as this supposedly assures eternal salvation.  “I was not much of a believer in the idea of gods controlling people’s fates and did not suppose that anything we were doing was going to offer my father a special place in any afterworld,” Gawande states, making it clear that he was simply carrying out his father’s wishes and performing a ritual that both his mother and sister wanted.

I applaud Dr. Gawande’s efforts to effect a change in being more accepting of death and not raging against it as Dylan Thomas would have us do, but I don’t think he said anything more than Dr. Elisabeth Kübler-Ross said in her 1969 classic On Death and Dying, or for that matter as much as Dr. Stephen J. Iacoboni offers in his 2010 book, The Undying Soul.  “Never did we look for or try to save the soul of our patients,” Iacoboni, an oncologist, laments. “We were supposedly among the most brilliant medical investigators in the world, and yet we had no knowledge of or interest in that which mattered most.”

Like Gawande, Iacoboni found that many of his patients had unrealistic expectations and didn’t want their hopes dashed.  They pleaded for or demanded a cure.  While trying not to extinguish what little hope there might have been, Iacoboni tried to be more honest with them than other doctors.  Most of the terminal patients were, however, unable to accept the truth of their condition and lived their remaining days in a state of despair. 

In rating Iacoboni’s book over Gawande’s, I can only conclude that I must not be a very good judge of such books, since Iacoboni’s book never approached the best-seller list and has only 14 reader reviews at, compared with 6,540 reviews for Gawande’s book. 

If I were to have the opportunity and privilege to talk one-on-one with Dr. Gawande, my lack of credentials not withstanding, I would suggest to him that he completely dismiss any ideas he has about the afterlife of orthodox religions and consider all that psychical research, near-death studies, and other consciousness studies have given us over the past 170 years. If he approaches the subject with an open mind and with proper discernment, he should find strong evidence turned up by some very distinguished scientists and scholars that prima facie establish that we all have energy bodies, or spirit bodies, that survive death.  Moreover, he should be able to conclude that we have no a priori reason for believing that the physical world is the only world.  With that in mind, he should be able to see at least the possibility – a strong possibility if the cumulative evidence is fully grasped – of a larger life and the hope that it can give to the dying as they deal with death anxiety. In all that he will find his “coherent view.”   

Assuming that Gawande had the patience to hear me this far, I would anticipate that he is aware of the usual theories offered by the fundamentalists of science to debunk the evidence as resulting from either trickery, unconscious deception, or not-well understood workings of the subconscious mind, and that he would then excuse himself and return to his important work.  If, however, he remained and showed any interest, I would quote the words of the great physicist Sir Oliver Lodge: “Science is incompetent to make comprehensive denials about anything.  It should not deal in negatives.  Denial is no more fallible than assertion.  There are cheap and easy kinds of skepticism, just as there are cheap and easy kinds of dogmatism.” 
I would tell Gawande that if he is able to remove the mental blocks of scientific fundamentalism, he should be able to see that our consciousness is attached to those energy bodies and that it survives death in a much more meaningful way than that suggested by orthodox religions.  He will have to recognize that much of it is beyond modern mainstream science and look for a preponderance of evidence rather than absolute certainty.  If he really digs into it and closely examines the arguments of the debunkers rather than just accepting them because they more easily fit into a materialistic paradigm, he might even find evidence that goes beyond a reasonable doubt, more than enough to give hope to all those patients in despair who expect obliteration of the personality or, even worse, an eternity of floating around on clouds, strumming harps, and singing praises to a self-centered, cruel and capricious god. 

If Dr. Gawande thinks that is all too much for him to accept, I would urge him to carefully consider how inadequate his recommendation for dealing with death anxiety are, something he might not fully appreciate until he is a little older, and I would once more point to the advice of pioneering psychiatrist Carl Gustav Jung, who said that “a man should be able to say he has done his best to form a conception of life after death, or to create some image of it – even if he must confess his failure.”  Not to do so, Jung added, is “a vital loss.”  I would further ask that he also carefully consider Dr. Jung’s words that “while the man who despairs marches toward nothingness, the one who has placed his faith in the [survival] archetype follows the tracks of life and lives right into his death.  Both, to be sure, remain in uncertainty, but the one lives against his instincts, the other with them.”  I’d ask Gawande to explain why he thinks Jung was wrong in making such proclamations, but he would likely shrug it off and say it is a matter of opinion, not a matter of science. 

If Gawande really believes that “living in the moment” and savoring all those mundane activities is an effective way to deal with death anxiety and its concomitant despair, there would be no point in going on with the discussion. Perhaps there are some out there who have mastered the ability to repress all ideas of death as they march toward what they see as an abyss of nothingness, but I don’t recall having met any such person.  I have met some who claim they have no fears of falling into that abyss, but, although I can’t be certain, it does come across to me as nothing more than bravado, i.e., false courage.  And if the good doctor were to further suggest that discussing the larger life is best left to ministers and hospital chaplains, I would take issue with him on that and point out that orthodox religions are stuck in the muck and mire of dogmatism and therefore have for the most part not been open to the discoveries of valid scientific research relating to an energy or spirit body.  I’d admit that such science is not exact science, but neither is medicine anywhere close to being an exact science.  Why accept the inexactitudes of medicine and not of controlled research in psychic matters?  Is it simply hubris?

I’d argue that “meaning” is not the strict domain of religion, that religion arises out of the existential search for meaning, and that science can make its own search in that regard, which it has done, even if not fully appreciated by the masses.  I’d end my discussion by calling upon another Harvard professor of some reputation, a pioneer in the field of psychology, William James. 

To quote Professor James:  “Let sanguine healthy-mindedness do its best with its strange power of living in the moment and ignoring and forgetting, still the evil background is really there to be thought of, and the skull will grin in at the banquet. In the practical life of the individual, we know how his whole gloom or glee about any present fact depends on the remoter schemes and hopes of which it stands related.  Its significance and framing give it the chief part of its value.  Let it be known to lead nowhere, and however agreeable it may be in its immediacy, its glow and guilding vanish.  The old man, sick with an insidious internal disease, may laugh and quaff his wine at first as well as ever, but he knows his fate now, for the doctors have revealed it, and the knowledge knocks the satisfaction out of all these functions.  They are partners of death and the worm is their brother, and they turn to a mere flatness.” 

Michael Tymn is the author of The Afterlife Revealed: What Happens After We Die, Resurrecting Leonora Piper: How Science Discovered the Afterlife, and Dead Men Talking: Afterlife Communication from World War I.

Next blog post: October 9


Don’t be to hard on yourself Michael. 

Meaning and understanding come from within an individual.  Nothing you can say or do will ‘make’ a person understand if they are not open to such understanding.  Consciousness provides the meaning and understanding and maybe to a greater or lesser extent the reality of life.  If consciousness is not ready for the enlightenment, no one can force it to understand.  You accomplished your task when you offered another way to look at things.

Patience Worth said something about her writing to the effect that her words were as crumbs which she scattered for birds to eat; that is, as she expressed it, her writing “be eat”, for whoever chose to take it up.  Whether or not anyone read her words or understood them was not her concern.  Her work was done when she offered them for “eat”. - AOD

Amos Oliver Doyle, Sat 30 Sep, 20:51

Not only do I agree with your assessment of the book and the orientation it radiates, to me the author’s blinders are glued in place by his personal and professional experiences with cancer. The book is filled with lingering tortuous goodbyes, but he never addresses the anguish attendant to dementia, sudden catastrophic illness or accident, locked-in syndromes and so much more. Each chapter felt to me like a hedge grown up defensively around larger issues, the principal one being (as you point out) the existence of the soul and its needs. Until doctors humbly and bravely learn to address - nay, embrace - his elephant in the room, they might as well remain silent.

Bonnie, Sat 30 Sep, 16:28

My local library book club discussed Dr. Gawande’s book last night, so I thought I’d attend. I expressed my views as above, and while one of the 16 other people attending agreed with me, the others seemed to shrug it off and didn’t seem to see the relationship between what we believe relative to survival and how we live our final days.  I tried to get them to understand, but I apparently failed.

I had intended to use this quote as an epigraph to the blog, but I forgot about it. I’ll add it in here:

  “Neither a person nor a nation can exist without some higher idea. And there is only one higher idea on earth, and it is the idea of the immortality of the human soul, for all other “higher” ideas of life by which humans might live derive from that idea alone.         
            ~ Fyodor Dostoyevsky

Michael Tymn, Sat 30 Sep, 02:47

I think Mr. Gawande is right about finding meaning in life by being part of something bigger than ourselves. If we’re on Earth to accomplish a spiritual goal, what better way to live than by trying to make that goal a success, especially if it can be used to make the world a better place? The artist can create works that move and inspire, doctors and medical researchers create new treatments, and politicians help to bring stability to millions. Even if these goals ultimitely don’t succeed, There is still value in trying; If I were to die tonight, my life’s goals wouldn’t be completed, but I’d be proud that I tried to see them through.

With regards to enjoying little things in life, I think the problem is that many people make them the sole purpose of their life. It’s fine to have fun, but not at the expense of the all-important work of contributing to the human race in a meaningful and lasting way. And these little pleasures can be as meaningful as our big goals: even years after they’ve happened, I still cherish going to movie premieres with friends, enjoying lunch with them, going on vacations with loved ones, and other events where I knew I was helping others have a good time. And moments where I was by myself having a good meal in a new city, reading a spellbinding book, or finding inspiration still mean much to me, because they helped shape me in important ways.

In my opinion, the little things are like sightseeing opportunities on a road trip: enjoying them isn’t required to reach your goal, but they make the journey more fun… just as long as you don’t stop at each and every one.

Ian, Fri 29 Sep, 07:18

Mike a wonderful, thoughtful, knowledgeable blog on a very difficult subject.  Thank you.

Karen Herrick PhD, Tue 26 Sep, 10:39

Good piece Mike. I agree - medicine needs to get into the 21st cnetury and recognize the solid evidence for the survival of consciouness.

Mike Schmicker, Mon 25 Sep, 23:34

First-rate review. I suggest you send a copy of it to him by way of his publisher, though I suspect there is no hope for him, at least until the skull grins in at his banquet.

Stafford Betty, Mon 25 Sep, 23:12

Dr. Gawande is still, relatively speaking, a young man.  He is 51 years old. He apparently is an energetic mainstream ‘by-the-book’ physician which assures his success, provided his energies and interests continue to propel him.  In a few more years he will be at the point where family members begin to pass away—-he has already lost his father.  His own health will begin to deteriorate and he will loose his looks, his eyesight, is hair, his teeth and his potency, all things he takes for granted now.  His vitality will be compromised and eventually he will not care much about those things that used to interest him.  If he is fortunate he will have loving children to care for him when his dotage knocks, unsummoned, at his doorstep.

He is very naive if he thinks that the three plagues of nursing home existence are boredom, loneliness and helplessness.  What he forgot in this trilogy was “sickness” with it’s accompanying physical and mental deterioration, aches, pain, and loss of function, all forerunners of helplessness, loneliness and boredom. If only it were easy to address boredom, loneliness and helplessness in the elderly.

Sometimes people just have no wish to go on when everything and everyone they have ever loved is gone, everything they ever wished for is no longer possible, all the activities they once participated in they can no longer do and all of their dreams have faded quietly away.  People get tired of fighting and would rather just let go.  I think we all need to honor that in the elderly.

I no longer waste time trying to discuss with anyone topics related to a spiritual existence (except on a couple of blogs).  The truth is, that I really don’t know much about it myself.  I used to be part of something greater—- family, a community, a society, as Dr. Gawande suggests but those things are not so easily available to me now and I find myself not in agreement with most of them anyway.  Upon reflection I sometimes think that although those things may have been available to me in the past, for some reason I didn’t relate to any of them then either.

Do your thing, Dr. Gawande while you can; write your books, give your conferences, direct your TV shows and teach your students.  Perhaps its your role in life but then again,—-maybe not!  - AOD

P.S. With all of those 6,540 book reviews, maybe his book was required reading with a review for his classes and others at Harvard Medical School. - AOD

Amos Oliver Doyle, Mon 25 Sep, 22:21

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