When in life does one come to confront the tough truth that each of us will eventually die? In my years as an internist caring for young and old alike, some people understand this early, and some people never get it. In denying death, we intensify our fear of it. Usually, however, it is sometime during their 50’s that people first look into the eyes of death. Put it off as we may, the hard certainty is that we are all aging and one day an end will come. Shakespeare described advanced age in his play As You Like It, Act II, Scene VII (All the world’s a stage):
“... Last scene of all, That ends this strange eventful history, Is second childishness and mere oblivion, Sans (without) teeth, sans eyes, sans taste, sans everything.”
Shakespeare’s description of advanced age during the 1600s is rather bleak and scary. I think, with modern medicine and the support of a loving family, we could do better. I clearly believe that advanced age and facing our own death should not fill us with dread. The following is a more hopeful version to end Shakespeare’s excerpt:
“... He did not have to end his life alone; If over time he’d shared his caring, raised the worth of others, fed the love he’d sown. His death would find him kindly prized and praised, While kin sang festive songs of joy, amazed.”
Fear comes from the oldest reptilian part of our brain. Fear helps us run from attackers but can also make us run from making important choices about our health. Fear can even bring us to push forward with treatment that may cause significant suffering, even when we are very old and even when treatment is futile and it’s time to quit.
Fear of dying can prevent us from making plans about end-of-life care and, most importantly, prevent us from talking to our families about those wishes. How do we want to be cared for if we should lose mental capacity from a stroke or dementia? Do we wish to have a feeding tube, resuscitation, antibiotics when there is no quality of life left, when one doesn’t recognize family and when the only option will be residing in a bed somewhere “sans everything.”
I would rather die and be: “... kindly prized and praised, While kin sing festive songs of joy, amazed.”
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.organd follow Prairie Doc on Facebook.
