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Til death do us part

Edward A. Larkin | Tuesday, February 15, 2011

Some phrases sear themselves into our cultural consciousness, and, rightfully or not, define events. “Death panels” will certainly represent the health care debate of 2009-10 for future historians. In retrospect, the life cycle of these two words seems bizarre. Sarah Palin introduced the term on her Facebook, objecting to a provision in the healthcare bill that subsidized conversations between ill patients and their private doctors about their intentions for the end of life. Palin saw the provision as code language for faceless government bureaucrats making simple decisions on who lives and who dies.

News outlets latched on to the idea, and policy makers caved accordingly. In a memorable comment, Senator Chuck Grassley said that no one would be “pulling the plug on grandma” and the provision was summarily removed. More than a year later, death panels mean different things to different people: the denigration of the national conversation; an irresponsible media; the feverish pitch of the health care debate itself. However, a more interesting question is why these two words touched a national nerve, a collective insecurity. The answer is that we as a society have a death problem.

That same summer the phrase was introduced, I was shadowing a neurosurgeon at a local hospital in Michigan. After he had scraped part of a tumor out of the head of an 89-year old patient, we discussed the case in his office.

“Unfortunately, there was no way to remove all of that tumor. We were able to buy her more time, but she will still die,” he said. The words were matter-of-fact, but there was a longing in his eyes that gave me the distinct impression of regret, a sadness that he couldn’t do anything more.

“How much time did we give her?”

“Probably about a year. She would have died in three months, and we gave her another year. That year will cost about a million dollars when it is all said and done. That’s the essential difficulty in health care reform.”

A million dollars for one year. A grand sum, no doubt. But those nine months were certainly no less significant — more time for that woman to spend with her loved ones, to relish the joyfulness of being; to hold hands and get her affairs in order. Whether this woman knew these aspects of the situation, I don’t know. But imagine if she had chosen to let the disease run its course and forego the surgery. It seems strange to us. We as a culture can not wrap our minds around a surrender like this. When approaching disease — cancer, Alzheimer’s, AIDS — we march unthinkingly into battle. It’s a cost-benefit analysis minus the cost.

Earlier this year, Atul Gawande wrote an exquisite article in the New Yorker, “Letting Go.” It deals with the difficulty of dying; the unsatisfying nature of the medical struggle until the end. It was a beautiful, heart-wrenching article, and it asked the difficult questions about death that we as a society have trouble answering. Would I rather have a month of relative health, or five months of misery? Do I want my loved ones to sit at my bedside for a month, while I am unresponsive, chemotherapy coursing through my veins; fighting an unwinnable battle?

He was a fighter until the very end.

She took advantage of every option.

We’re using the most aggressive therapy possible.

These are the refrains we hear in hospitals. And they are not inappropriate — anyone who has seen the strength and dignity of the severely ill gains such an appreciation for their fight. In our zeal for battle, however, we lose recognition of the grace of approaching death with a placid demeanor, head held high. It’s a fight, the fight against cancer, and we as a society will be damned if every last person doesn’t go kicking and screaming until the very end.

In 2011, we are oddly removed from our mortality. Movies and video games are saturated with exotic scenarios of “death.” Note the quotation marks — death in the movies is about as close to reality as The Sims. Notice how easily people die. Someone gets stabbed, shot, hit by a car and 10 seconds later they are dead. The illusion hardly registers; the struggle is never shown.

Real death, by contrast, is bizarrely absent from the modern world. We rarely see dead people. We don’t see scenes of the process of dying on the news — it is considered too graphic. Football is humane compared to the gladiatorial bouts of ancient Rome. Our religions preach eternal life. We all have doubts about that, and we don’t ask ourselves what real, never-ending eternity would be like. Rather, we accept and cling to it with desperation. Not long ago, the average age of death in even advanced areas of the world was about 25. The psychological effects of this cannot be overstated — imagine if many of your siblings and friends had died before the age of 10. In the 21st century, death is something to be shut away in the recesses of our mind for most of our life, brought out under compulsion during sickness or old age.

Behind the humming of biomedical research laboratories, the rapturous proclamations of futurists like Ray Kurzweil, the philanthropic foundations to fight against cancer, is the desire to fend off death for as long as possible. We may eventually learn to survive for lengths of time that aren’t even currently comprehensible. Indeed, researchers at Harvard Medical School recently demonstrated in a much-hyped paper in Nature that they could reverse aging in genetically modified mice. Others claim that future humans will be able to download their consciousness to computers and fuse with robots, and therefore last into eternity. Extending life is a noble quest, no doubt. However, by denying it so violently, we fail to understand the inevitability. When we are confronted with death, it’s no wonder we are completely ill equipped to cope.

As Atul Gawande says at the end of Letting Go, “there is no prettifying death.” This is true — the final exhalation will be forever shocking in its finality, a defeat. However, there is prettifying life — it’s what each of us strives for, every day. An ultimate acceptance cannot make death any more beautiful. Not so for the end of life.

Edward Larkin is a senior majoring in biological sciences and classical civilization. He can be reached at [email protected]

The views expressed in this column are those of the author and not necessarily those of The Observer.