the first person to teach me something Death and Defiance was the mother of a family friend, an older woman who immigrated to the United States from Punjab to be closer to her son. I remember that she was delicate and always wore pastel colored clothes. salwar kameez. Her desire to return to Punjab grew stronger after she was diagnosed with breast cancer, which quickly tried to take away her bones and brain. When my parents told me about the end of her life, it was with a mixture of disbelief and certainty. She survived the several-day journey to her birth village. I struggled to breathe for most of the flight, grimacing as I walked inside. He prayed when the painkillers wore off and died two days after arriving.
I was reminded of her story this week as I read about former President Jimmy Carter’s intentions. live long enough Vote for Kamala Harris. Carter, who has been in hospice care for more than a year, turned 100 on Tuesday, living much longer than many expected. The idea that he rallied to make a final contribution to American democracy raises common questions that arise in my own work with patients and families. That is, do we have some control over when we die, consciously or not? Can one extend the days of one’s life to include one last meaningful act or moment?
As a palliative care physician, I have encountered the phenomenon that people die only after certain circumstances materialize. One gentleman improbably remained alive without ventilator support while his family watched him in the intensive care unit, only passing away after the arrival of his estranged son. Due to her frail constitution, further chemotherapy was not possible, but one woman survived well without chemotherapy and even attended the birth of her first grandchild. There was a woman who died of cirrhosis of the liver after her daughter went out for the night, perhaps to protect her daughter dearly and perhaps to avoid the pain of witnessing her death. Because the unexpected often happens, I tell patients and families that the moment of death is shaped by two timelines. One is the body’s timeline, which is governed by more predictable physiological laws, and the other is the soul’s timeline, which may determine the moment of death. This method violates medical understanding and human expectations. When people wonder about the circumstances of their last heartbeat or last breath, how do they understand the last gestures that reveal and confirm the character and intentions of their loved one? I understand if you keep looking.
Despite widespread talk that humans may have the ability to time their deaths, there is no scientific evidence to support this observation. Decades ago, some the study Researchers have documented a drop in deaths just before Jewish holidays and a drop in deaths immediately after, perhaps indicating that people choose to die after their last holiday celebration. suggests that it is possible. bigger study They then found that specific holidays (in this case Christmas and Thanksgiving) or personally meaningful days (birthdays) did not significantly influence mortality patterns. However, this phenomenon does not easily lend itself to statistical analysis. The importance of holidays, for example, is no substitute for the deeply personal motivations that define the anecdotes shared in hospital break rooms and around dinner tables. And the human truth that many recognize in these stories raises the question of whether we believe them so completely in the absence of evidence.
Palliative care often involves helping people face and develop relationships with the uncertainty that governs so much of their experience of illness. And willpower often comes into play when patients talk about themselves and who they are now with their illness. Many people say that if they focus on the positive, visualize the cancer going away, and fight hard enough, they can win the battle longer. In their words, you can hear echoes of what Nietzsche wrote, words that the psychiatrist Viktor Frankl used to make sense of his years in a German concentration camp. “People who have a reason to live can endure anything.”
And we want to believe that love, desire, devotion, and heroism are possible until the end. As a patient’s condition worsens and death approaches, I talk with them and their families about what they can hope for, even if no cure is possible. That death may, in fact, still contain something generative. Time that seemed to have no further meaning instead becomes an opportunity or an extension of the dying man’s commitment to his country, his family, and his dreams. Soon, President Carter will be able to cast his vote: Georgia’s registrar opens next week Mailing an absentee ballot;Early voting begins the following week. His promise to himself reminds us that even though a person’s life is shortened, death does not completely destroy purpose.
The idea that willpower can be an ally against death is also appealing. Because it offers the possibility of transcendence, the possibility of challenging the limitations that the body or illness may impose. But I’ve found myself being cautious about willpower because I’ve seen the many ways the body doesn’t follow the mind. people They are fighters, but you body Will I no longer be able to fight cancer? With my patients, I wonder if I could take more time and effort without taking personal responsibility for the limitations of biology. Similarly, two people on ventilators may love their family members equally. One may die only after the last beloved family member arrives, and the other may die before rushing across the ocean and returning home. We don’t necessarily know why. If Carter votes and dies shortly thereafter, it may affirm the idea that others can write the last sentence of their own stories. But what would it mean if Carter died before voting? Had he lived another year, or would we have seen Donald Trump become president again and the election be hotly contested? What if we had lived and seen that person?Living with loss involves finding the person we loved and admired not just in the last event, but in the series of events that make up that person’s life. We need to remember that we can.
I imagine a family friend taking a long flight from Los Angeles to Delhi and then taking a taxi back to Punjab. How I found a way to endure what she was told she couldn’t do, all in the only place where I felt the soil I knew best beneath my feet and felt like it was my own. I think about how I found a way to die. What would have happened if the doctors had been right and she had died on the plane? My family may have deplored her single-mindedness and yet admired her defiant attitude. What makes these stories so fascinating is that even if what happens doesn’t end the way we imagined it, death, no matter how greedy, can’t devour hope and possibility. Because it reminds us.
