WE ALL LIVE
At 37 I've watched many acquaintances and friends and much of my family die. I feel like I've seen the gamut, and in everyone from the unborn to the aged: from accidents and old age, to medical complications and DNA transcription errors, to viruses and heart attacks, and a whole range of different cancers too.
Whether it be an accident or a sudden illness, drawing your little personal circles of awareness and memory to a close in such a way, with little or no suffering at all, may be a wish for many. But, let me assure you, this is the worst possible scenario for those who remain. For example, it took me not less than eight years to even be able to talk about my mom disappearing into a hospital with flu-like symptoms one evening, never to be seen again... Was it quick? By all accounts. Did she suffer? Seemingly little. Was it totally fucked up for everyone else? Yup. Something like having your leg torn off by a gorilla while shopping for socks at a department store. Would anyone wish that for their friends and family? I feel, at this point, that doing so would be mad.
The only reasonable alternative to sudden and painless then, we often assume, is old age. While old age may be delightful for some, or even many, of course there's the inevitability of falling apart and not being able to do those things you live for, or losing mobility more generally and finding it difficult just to go for walks or climb the stairs. Or there's not being able to enjoy food or control one's bowels: manageable, yes, but not at all desirable. What about the cruelty of loneliness (and the almost certain depression that results) with the loss of friends and peers? This is no minor loss or struggle, and you are not as immune as you think. Research now shows us such loneliness causes worse health outcomes than smoking a pack of cigarettes daily and, tragically, is alleviated little by socializing with strangers or even family. With all this said now notice that the above old-age scenarios are found on the best-case side of the spectrum of possible experiences. Things can and may degrade swiftly into one's worst nightmare: something unmanageable and inescapable. Indeed, there are terrible foes awaiting many of us in old age. There are those most brutal degenerates, like dementia and Alzheimer's, Parkinson's and many others. And developing some form of neurodegenerative disease, slowly drowning from inside your own body and mind over the span of a year or a decade, can be almost as freightening and horrific for outside observers as for yourself the sufferer. You don't want to watch the wisest, strongest, most capable person you know reduced to excruciating disorientation, recurring panic, and total helplessness. And you want to be that person only slightly less. From what I've seen to date, old age is often quite messy and – despite the leaps and bounds in therapy, medicine, and aged care – is still not something we've learned to do particularly well.
(You're about to read something others before you have described as causing incredulity and, if taken seriously, initially at least, feelings like anxiety or even anger.)
By contrast to the above end-of-life options, cancer can be seen as a gift. (...I know, but just hear me out.) Cancer has a way of destroying barriers. Barriers both psychological and social, and even those normally-intractable institutional ones, can simply crumble to dust before cancer (even with the mere utterance the 'C' word.) And with barriers blown, cancer can actually give you real options. Cancer may provide a critical time frame, a backdrop, and a point of reference; it can give you a reason, a direction, and a mission too. Cancer also has a way of stopping time and focusing the mind (and not just that of the patient.) Like a powerful entheogen, cancer can grab a hold of your guts in one hand and your brain in the other and shake you until something solid, crystalline, and sharp as glass falls loose and out onto the floor. Or it can just kick you out of your habitual stupor, causing you to concentrate on what really matters. Of course, at first, and almost always, the focus is the cancer; yet cancer has a way of not allowing itself to become the focus. In its impenetrability, its quiet and slippery ontogeny, its impossible vindictiveness, it can deflect attention and refract or focus the attention back and onto much more important things: like onto relationships, onto dreams and hopes and ideals, and onto simple living moments.
Yes, it's true, cancer may do none of these, and instead only cause deep sadness and anxiety; but with cancer, unlike so many other ends, there's really much potential. While I've never had cancer myself, and it surely won't seem so for anyone diagnosed at first, I feel like even a terrible cancer – if accompanied by needed, sufficient, and appropriately-timed doses of maple walnut ice cream, opium-derivatives, and love – can be the greatest gift. It may provide you with the peace and determination to end things on your own terms: not alone, afraid, degenerated, slipping in and out of consciousness, and unable to communicate, but present and enveloped in the warmth and love of those you actually care about and not a poor facsimile delivered as best a team of well-meaning nurses possibly can.
What's really worth considering in advance is the important distinction between a fear of death and the fear of dying. And most people I know express some of the latter while very little of the former. (And I think this is partly because they've had no problem willingly submitting to timeless, senseless eternity of sleep each night of their life; and even do with delight, without any sort of gripping terror that they may not awake again.) So what about dying then? Having cancer or not, in my experience, there are two elements of dying that people wish to avoid, and these inform many of their choices at the end. Both are so obvious and purely logical that they may be close to inevitable; but I wish to argue here as strongly as is reasonable against both. Whatever your end looks like, almost everyone hopes to avoid pain and suffering and along with this have their life last as long as possible. Today I feel all of this thinking is pure misery-making confusion. I appreciate how that sounds and how unavoidable these feelings may seem. But I think these can and should be overcome.
On the suffering front, I'm convinced that your deepest dread should not be feeling too much but feeling too little, not pain but painlessness, not anxiety but an alien fog of disconnection and dispassion. Feeling nothing at all, being achelessly bed-bound, tethered to a tank of oxygen, degrading slowly and incorrigibly in a tolerably, drug-induced anguishlessness (as I've observed weeks of with three family members winding up in hospice [which, by the way, I think should be renamed "hell-space"]) is far more brutal and inhumane up close than it appears at a distance – and must surely be about as far from bliss as one can get. I've watched folks on maximal legal human dosages of painkillers, anti-anxiety meds, and sleeping pills drowning for days in seemingly unaddressed discomfort and anxiety, all paired with an inability to sleep. This is one of the places you can go. And I've been in the excruciating position of asking for more drugs or alternatives for a loved one and having nurses insist that it isn't possible and there aren't any alternatives.Pain, that clear and reliable visitor, that agent you've known your whole life who signifies when action must be taken, can really be your friend. While there certainly are reasons to mute this bodily call to action, doing so may put you (and everyone around you) in a terrible position. You can slip into a place where you are unable to decide, to perceive or articulate, between the tolerable and the intolerable. And once there not only are others unable to know what's going on for you or even to choose what happens, but this may also be a lasting, multi-dimensional experience.
This brings us to time and your life's length. Having seen what I have of death, up close and at a distance, I can say with some certainty that any fear of pulling the pin, as it were, too early is profoundly misguided. I understand that may sound harsh, unreasonable, even brutal to some. Even I wasn't convinced of this until the latest death in my life. I found myself laying beside my father in his hospice bed, with my arms around him, watching a third parent disappear. There it felt something beyond obvious that the real worry, very likely your only worry, should be not acting soon enough. This is something you really want and need to avoid. In case it's not immediately intelligible, the trouble here really is that the transition point between able and unable, tolerable and intolerable, is often imperceptibly discrete (and acutely more so if you've imbibed of the "compassionate", needle-based, feel-reduction program.) It's something like a dark line on the horizon that, at a distance, appears sharp and clear with a definite edge. As it's approached, however, that clear distinction is seen as an illusion. Yes, at ground level it appeared a narrow line, but from a different perspective, from above, that line is obviously a gradient. As you're navigating the terrain things shift gradually and over some distance, so that by the time you notice how drastically things have changed you find yourself so deep into it that the only way out is through and not back. Once there, unable, what remains of a life – whether it is measured in hours, days, weeks, or otherwise – is likely to last a very long time indeed. As a matter of fact, it could be the closest thing to forever you are ever likely to experience. I encourage you to read this as a warning and maybe even as a kind of threat. If you've ever experienced real suffering, whether it's serious physical pain or something like a full-blown panic attack, you know how long a minute or an hour can last. And if you know or can imagine that your end could be far worse than that, and that things could extend out across what for observers is a week but for you could be a truly immeasurable abyss of cosmic space-time, then you're beginning to see what I see.
But I think there's an even more important reason for making the choice yourself, while you are able. It's that it really should be your choice. Gifting your family with the choice or preventing them from being able to (legally) do so is an especially brutal form of neglect. We live in a very strange time and place where you could be left in a state that you would never want for yourself, in which your loved ones are certain of this but are unable to intervene on your behalf. And, as you can imagine, if this situation persists long enough it will undoubtedly cause any compassionate, rational person in your proximity to consider taking matters into their own hands. And, however humane and well-reasoned it is, that's actually a pretty horrible thing even to consider nevermind carry out and have to live with. But worse still, I think, is to allow such a situation to manifest in the first place. I can't imagine why you would put your friends or spouse or children in such a position.
From where I sit, choosing how and where, when and with whom to die should fell like a tremendous personal obligation (far more than buying life insurance or drawing up a will), but also an honour and gift (more potent and meaningful than a funeral) for everyone involved.
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