We often talk about what it means to “truly live” or even more simply what it means to be considered “living.” This idea was one of the main points of the Terri Schiavo case and this idea came back to me in the form of a conversation.
A few weeks back, I was talking to one of my best friends about a book she had recently read called When Breath Becomes Air. The book is an autobiography written by Paul Kalanithi. Kalanithi was an outstanding medical student at Stanford who was in the residency stage in his path to becoming a neurosurgeon and all was well in his life. Then one day, his life came crashing down as he was diagnosed with terminal Stage 4 lung cancer. My friend explained to me that Kalanithi wrote the book to not only tell his story but more importantly to discuss how to think of and approach life when diagnosed as terminally ill. Kalanithi talked about how he truly “lived”when he realized he was dying. Although I haven’t read the book (yet), I did a good amount of research and surfing behind Paul’s story to get a better idea of his vision of life.
As the news of the death of Stephen Hawking shook the world, I came across an article on the web, and a particular line caught my attention. “Those who live in the shadow of death often live the most” was the opening line of one of the paragraphs. Although the article was about Stephen Hawking and his life, I immediately thought back to the conversation with my friend about Paul Kalanithi. This is the idea that he so very well embodied in his memoir, and I would like to share a few thoughts on how he did so.
It is obviously a far stretch to claim Paul took his situation “in stride”, but the way he talked about how to approach death with grace makes the reader reconsider what it means to be fully alive. Paul often talked about his experiences in residency, and repeatedly brought up that he didn’t want to be a doctor to “help save lives” as the cliché goes. For Paul, the biggest goal was to help people understand death and illness. Helping save someone’s life wasn’t worth it to Paul if it meant that patient was now bound to a life that he would not find worth living (being severely handicapped, for example). This was a bigger failure to Paul than the patient dying. We often set an ultimatum for those that are ill. We think they must be saved at all costs because in our minds; death is the worst possible scenario.
Kalanithi claims life isn’t about avoiding suffering, because everyone will die. There is not point in worrying about death, because as long as you aren’t dead, you are still living. I will definitely have a much better idea about Paul’s message when I get around to reading the book soon, but the article that I came across reminded me of the conversation with my friend and even further, the Terri Schiavo case. There is of course no one right way to approach death. But Kalanithi’s message is certainly one that can potentially alleviate stress and make this adventure that we call life a little more pleasant.
When Breath Becomes Air by Paul Kalanithi
Following a paradigm shift from infectious to chronic disease, life expectancy rose for individuals, currently at 78.8 years of age (U.S based). The article linked below addresses how the drug rapamycin has been given to dogs in order to prolong life, in which questions as to how this drug might also prolong life for humans are mentioned. It’s interesting to consider that society already takes drugs in order to prolong life, ones that mitigate and help to control threatening symptoms or conditions. But what if there were a pill made specifically with the purpose to extend life beyond the average life expectancy? Perhaps one that slows the natural process of the body ‘shutting down’. For me, this is an acceptable but somewhat strange concept. Firstly, I think the concept can be problematic in terms of the incentive for creating or using such a drug. This is not to say that its use should be thought of as negative, especially considering how many individuals could continue to contribute to society beyond ages that would typically render them otherwise. However, I think this concept doesn’t necessarily stem from a desire to further innovation or even to improve society, I think it stems from a deep rooted fear of death and desire for control.
I also think that the concept of taking a drug to ‘extend’ life, falls into the general nature of western biomedical practices being aggressive, and purposed towards creating a more efficient and acceptable society. It seems within this discourse of integrating something into one’s life in order to enhance or improve the current status quo, questions arise that address why humans might be dissatisfied with a very natural and common phenomenon such as death. Again, I think this relates back to issues of control and fear of the unknown, in which taking a pill to extend the period of coming to terms with the end of life will be furthered. But at what point, if any, is extending life too much? I don’t think this is something that can be quantified in years, but is rather a consideration of the extent that society is willing to go in order to avoid an inevitable process.
Researchers at NYU and Johns Hopkins Universities have found that a single dose of the psychedelic compound in magic mushrooms, psilocybin, can diminish depression and anxiety related to dying in advanced cancer patients. Roland Griffiths (researcher as Hopkins) believes that psychedelic drugs are powerful tools for treating conditions including drug/alcohol abuse, depression and PTSD; they are not just for exploring the human mind.
Volunteers came to doctors with a fear of dying and stress about their illness. People were interviewed and counseled for over 8 hours before they were chosen for the experiment. Griffiths and Stephen Ross (NYU researcher) administered laboratory-synthesized psilocybin to 80 patients with life-threatening cancer. More than 75% of participants reported significant relief from depression and anxiety. Administration of drug was carefully monitored and supported with counseling services.
Overall, the experiment had a healing effect for all those involved. The dose of psilocybin doesn’t result in every participant believing in life after death. However, it was effective in creating a deeper meaning and understanding of the situation. The psilocybin was able to show patients that there is nothing to be fearful of and that everything is going to be okay. Participants were able reassure loved ones that it is okay and they don’t need to worry about what was to come because everything was going to work out. The psilocybin was helpful in relieving the agony of the inevitability of death. Many reported that their experience using psilocybin was one of the most important experiences of their life.
Griffith and Ross found that larger doses of psilocybin were more effective and ‘mystical-type experiences’ showed greater changes in levels of depression and anxiety. There are always concerns and risks that come with experiments. In the case of psilocybin, about 1/3 of patients reported a sense of fear or discomfort. Doctors were there to comfort patients and remind them of where they were and that they were under the influence of psilocybin. However, is almost all cases, the experience was cathartic and resulted in personal understanding.
Find out more: https://www.scientificamerican.com/article/psilocybin-a-journey-beyond-the-fear-of-death/
In the season 8 finale of Grey’s Anatomy, a plane with many of the leading doctors of Seattle Grace crashed in the middle of nowhere. Everyone is injured and scattered throughout the forest they crashed in. Meredith Grey, Mark Sloan, and Cristina Yang are searching for Meredith’s half-sister Lexie. They find her crushed under a piece of the plane. Although Mark, Meredith, and Cristina are injured as well, they try to move the piece of the plane off of Lexie. Realizing that they can’t remove it, Sloan holds her hand while she’s dying. She realizes and understands that she’s going to die and tells him that, but he refuses to believe it. He tells her that she isn’t going to die because they are going to spend the rest of their lives together. Eventually, Lexie passes away while still holding onto Sloan’s hand.
When I watched this season finale in the past, I didn’t think much of it. It was sad that Lexie passed away because she was a major character in the series, but I didn’t realize how she was accepting her death while Sloan was in denial of it. It raises the question of how to console your loved ones when you know that you’re dying and they don’t want to accept it. Are you supposed to attempt to comfort them as much as possible? Or is it okay to pass away knowing that at least you accepted your own death even if your loved ones didn’t? Most people would probably say that being at peace with your death is considered “good,” but I wonder if that is valued more than whether or not your loved ones are at peace with it. I also wonder if people who accept their death feel unsettled if their family or spouses don’t accept it as well.