listening to mortality

Awakening to Death

In 2012, my death looked near. 

For much of my adult life, I'd felt drawn toward ending my life, mainly because my mother died of suicide. I was six at the time, and apart from the devastating loss, many circumstances before and after her death set me up for unhappiness. As I grew into a troubled young adult, her precedent offered a way out. I wasn't sure when my own suicide would happen, but I believed it eventually would.

That changed after I confronted the possibility of a terminal diagnosis. Where suicide had felt inevitable before, it was unimaginable afterward.

I was in my early fifties and under enormous stress. Neck degeneration had ended my work as a surgeon ten years earlier. Since then, I'd made several failed efforts to build a new career. I felt sidelined in a sleepy suburb, deeply unhappy with my decision to move my wife and me away from San Francisco. Other consequential choices haunted me. 

In the weeks prior to the crisis, I was struggling with my latest career effort: a parttime acupuncture practice. The business was losing money and—in just two years—had twice been forced to change locations. Our household finances were kept afloat by disability payments, but the insurance company was working to end my benefits.  They hired a private detective to take pictures of me carrying groceries, and they demanded I undergo a series of humiliating 'skill tests', that proved I could grasp a hammer and crawl through a plastic tube on all fours. I pointed out repeatedly that my main disability was psychiatric, with discouragingly predictable depressive episodes when under stress. I also pointed out that the policy I'd purchased used lost earning potential (not inability to perform any sort of labor) as its criterion for benefits. None of that seemed to matter.

As I battled the insurance company and fought to keep acupuncture practice afloat, I grew increasingly depressed and—once again—contemplated suicide. One evening I felt a vague ache in my belly. Over the next few hours, it escalated to searing pain, beyond anything I'd ever felt or imagined. In the emergency room a CT scan revealed a large internal hemorrhage. Weeks of hospitalization followed. 

I was sent home, briefly, between two hospital stays. There was no firm diagnosis at that point, but pancreatic cancer was a possiblity. A neighbor had recently died of the same illness, just six months after diagnosis. I couldn't get pancreatic cancer out of my mind; I was sure it was going to kill me. 

With all that going on, and knowing my history, a neutral observer might have expected me to give up, to accept a dismal fate and fade away. Hadn't I been planning to cut my life short anyway? But the opposite happened. Life became so precious, it hurt. 

Hanging on a fence outside a window of our tract home was a ceramic sun.  Made in Mexico, it was brightly painted with a serene face. One morning, as I waited to learn whether or not I had terminal cancer, I saw its colorful cheer, shining with dew. Poignant feelings flooded me, until my eyes also shone. Before that morning, I hadn't even noticed that my wife had moved the decoration to a more prominent location. But on this day, it pierced me. I shuddered with waves of remorse, grief, and gratitude. How many times had I looked out the window and not noticed this little sun? How many more chances would I have to gaze upon it? Did my wife have any idea how much I appreciated her for trying to uplift me, trying to save me from depression? 

As the day passed, the world looked different, brighter. Walking from room to room, my usual routine felt novel and magnificent. My wife's worried smile registered in a way it hadn't just days earlier. The dogs, which I had always adored, seemed even more precious than I'd allowed myself to admit. 

You could say death woke me up. I'd been sleepwalking, disappointed with life, letting the days pass as if they didn't matter, as if there were an endless supply, and even as if I wanted them to stop. Now every day—every minute—felt precious. 

The cancer scare passed. The medical issues were serious, but not terminal. After more hospitalization and major surgery, I returned to ordinary life. Death faded from view.

But not entirely.

In some ways, I sank back asleep. Some days I failed to notice the miracle. Yet on others, I stayed awake for it. I began to admit the futility and immaturity of complaining about my situation. I knew the importance of being present, of noticing, of loving. Even if I didn't always act on it.

I didn't become a saint. I still complained sometimes, and I often failed at love. But something in me had shifted and was meeting life with reverence. And rather than fading away, that part gained more influence as years passed. Falling asleep happened less and less often.

Why? Because death—my death—had spoken to me. And so sharp was its truth, it shocked me awake.

The important fact is that my experience was NOT unusual. Countless people have been transformed by death's touch. Mortality is a powerful teacher.

Learning from Death

But let's be clear: death is difficult for humans. Learning from it isn't easy, and often we'd prefer to avoid thinking and talking about it. We'd rather stay asleep.

Death steals loved ones away from us. It mocks our personal importance with its power to bring our entire drama to an abrupt and permanent end. 

Yet the discomfort we feel confronting death is overbalanced by how it clarifies our priorities and makes simple, daily living more meaningful.

There are a number of ways to gain comfort around death. Buddhism suggests spending time with dead bodies, either in charnel grounds (in countries like Tibet, where they are used as final resting places) or in imagination (more accessible for Westerners). We can imagine our own body in a series of post-mortem conditions: recently dead, in advancing stages of moist decay, as a dried skeleton, as dispersed dust. Though this approach can feel harsh at first, it's a potent way to increases comfort with the stark fact of mortality. 

A gentler option is to use biology. Death is, after all, integral to Life. Every animal dies. So do plants. Bacteria divide into daughter cells, so they don't die of old age. But they succumb to other causes and in huge numbers. Heat kills them (eg, in operating room sterilizers), toxins kill them (antiseptic solutions), and they get eaten all the time. 

The potential for new life depends on death. For one thing, aside from organisms that can use sunlight or another inorganic energy source, life must consume life (kill it) in order to grow and propagate. For another, when populations get too large they deplete their resources and spur explosions in predator and parasite numbers. Starvation, predation, and disease bring predictable crashes. Populations can't increase beyond the environment's carrying capacity.  

It's estimated that more than 100 billion humans have lived since our species began. The earth couldn't support a population that large, even with all our technologies. We live today only because tens of billions died before we got here.

Death makes way for life. It is supremely biological. When I look at it in that light, I feel more comfortable with mortality. But concerns remain. Is there an afterlife? Or is death just...the end?

What's After Death?

Life science, loosely applied, can also helps us grapple with the question of what happens when we die. 

Clearly, the world of Life doesn’t end when we die; it continues in new generations. But what about us as individuals? No one has ever been able to answer that question, at least not in a way that convinces everyone. So of course we can't answer it here. But we can speculate about the possibilities.

To many, the idea of possibilities after death sounds like an oxymoron. Surely death is the end of possibility! Yet there are also many people who believe—are convinced—that individual consciousness survives death. Often their convictions from religious texts or teachers, though they may come from direct experiences, as we'll discuss below. The point is, opinions abound and are passionately held. We're entering hazardous territory, with a high risk of offending atheists, spiritualists and, perhaps, everyone. 

But let's keep things playful and start with a simple premise: Suppose every tradition holds glimmer of truth around death, while none possesses exclusive claim. With this as a starting point, we can combine the insights of sages, shamans, skeptics, theologians, and others who grapple with our fate after death. We can add personal experiences we've either had ourselves or heard about. Let's put all those ingredients in the mix, and see what sort of afterlife we cook up.

Afterlife Recipe

It is natural and almost universal for human traditions to form opinions about what happens after bodily death. Yet they point to contradictory fates. Here are some common examples, which we'll use in our recipe:

• Transcendence: Departure to a non-material realm (like Heaven).

• Reincarnation: Return to live in a new body.

• Persistence: Remain nearby to guide or interact with the living.

• Termination: Blinking out of consciousness with the death of the brain.

Faced with these seemingly irreconcilable ideas, I try to imagine what's needed to accommodate the whole spectrum. 

Fluid Soul

Suppose human consciousness behaves less like a permanent identity and more like a turbulent fluid. Perhaps I don't embody a rigid soul named "Will," but rather a temporary aggregate of conscious fluid that sustains a quasi-persistent identity, the way flowing water can sustain a whirlpool. What if, upon death, this fluidic eddy undergoes a recycling process? What if its fate after death allows several paths of flow, and that any or all of them can be followed: 

• Drifting into contact with the greater sea of awareness (transcendence).

• Entering a human soon to be born (reincarnation).

• Staying in close proximity to those held dear (persistence).

• Simply ending when the brain dies (termination). 

This model aligns with biology, at least in analogy. Nature's forms are always impermanent, always constituted of multiple components, with lots of recycling. When a body dies and decomposes, its resources are broken down. Some rise into the sky in a sort of transcendence (for instance, gases like carbon dioxide and water vapor); some enter new life forms right away (eg, when a coyote eats a rabbit); some remains in place (adding to the soil); and some simply ceases to exist (such as the precise DNA sequence in the organism's cells). 

It seems reasonable to imagine the "stuff" of the soul behaving similarly. In this regard it's interesting to note that some Chinese traditions posit multiple souls, including an earthly, material soul and others that are more ethereal. Perhaps different parts of us go different ways.

Directing the Flow

We can speculate further that the soul-aggregate might influence its own path(s) based on its prior habits, inclinations, and momentum. The Tibetan Book of the Dead describes something along those lines. 

• A soul weary of earthly existence might flow into a broader field, one with less density and more radiance  (transcendence).

• A soul wanting or needing another earthly experience might flow into a new human body prior to its birth (reincarnation).

• A soul with strong familial ties might remain concentrated near the living (persistence).

• A skeptical soul might simply blink out, not expecting or needing anything more (termination).

Dissolution

Over time, a continuous separating, diffusing, and mingling means the distinct eddy I call "Will" inevitably becomes less and less identifiable, until it no longer exists. In this sense, the skeptic is right to believe death is the end of personal identity. But perhaps ending takes time. 

Skeptical arguments sounded convincing to me when I was in college. They seem less persuasive now, in part because of numerous reports of consciousness continuing when the body is clinically dead. Taken in aggregate, these reports leave little room for doubt around the fact a substantial number of resuscitated patients experience strange phenomena with rather stereotyped features. Such "near death experiences" don't conclusively prove there's an afterlife. Skeptics insist they must somehow relate to brain function. But there are strong reasons to doubt that a dying, oxygen-depleted brain is capable of generating detailed, vivid, and life-changing experiences. Near death experiences thus pose a serious challenge the materialist assumption that consciousness must end when the brain stops functioning.

If we ask how consciousness might extend beyond the individual brain in time and/or space, we can come up with hypotheses. Many have thought deeply about potential mechanisms. In the past, I read and wrote a lot about what might be going ont, but these days, I'm less interested in mechanisms and more interested in effects. How do brushes with death change us? How—even without medical crisis—can we shift our ideas and attitudes to better learn from mortality? 

Solace

It's tempting to insist on knowing 'the truth', but issues around death and dying mock that temptation. Absent provable answers, we're on safe ground in speculation. This is not a problem, despite our unease with uncertainty. A flexible, imaginative outlook offers comfort. 

Picture a mother who dies. Suppose she and her children are family members. You feel profound grief, of course. But suppose further that you entertain a broad sense of what might be going on with her. 

Imagine that for a time, the main part of her soul stream remains near her young children. Later, a portion moves on to try life again in a new generation, while another eases into an expansive realm, peaceful and buoyant. And some fades away, like a dream upon awakening.

And eventually, eventually, when all that needs doing has been done, her remaining traces dissolve, merging wholly with the cosmic source.

By balancing fixed views and fears with flexible speculations, death ceases to be such a terrifying void. No longer looking like the end of possibilities, it shimmers with an abundance of them. The point isn't to come up with the "right answer", which remains unachievable. Instead, we're adjusting our attitude toward death, honoring the mystery around it, and exploring possibilities—all while accepting mortality. 

Personal Experience

The task gets easier when we've had profound experiences around dying. A great many people experience profound intuitions, visions, and events around the time of a loved one's passing. Near death experiences are not uncommon. With gentle, nonjudgmental questioning, a majority of people report one or more personal experiences along these lines.

I've had experiences of my own, and in helping us feel comfortable with death, one deserves mention.

In 1987, I moved to New York City for one year. I'd just finished medical school and had a residency lined up back in San Francisco. But I needed to complete an internship somewhere, and I chose New York. I fancied myself a top student, but I didn't get my top choice in hospitals. Instead, I ended up at Cabrini Medical Center in lower midtown. It closed years ago, but back then it was a hospital as large as any I'd trained in in San Francisco By New York standards, however, it was only midsized, overshadowed by nearby Bellevue. It was also overshadowed in reputation, being no more than third tier. 

Cabrini, to its credit, reserved a third of its bed for indigent patients. Neither the rooms nor the care were up to par by university healthcare standards, but many of the patients and some of the staff held the hospital in high regard. 

Interns at Cabrini also got to live in large, well-maintained apartments in the building next door. Which is why I'd listed the institution on my match list at all, despite how much less prestigious it was than Cornell Medical Center, which I'd imagined would jump at the chance to accept me. So although I was dismayed by where the matching computer placed me, it fit the bill in important ways. 

One of the most important was how Cabrini forced me to be more independent than was necessary when surrounded by super smart experts. I began to get a sense of how I'd learn more self-reliance during one of my first nights on call.

A nurse paged me some hours after midnight. Upon calling the nurse back, I learned a patient needed help could find out little more. In 1987, AIDS was felling many young people, and the available treatments did little to help. Most of the nurses came from other countries, often Catholic ones, where negative attitudes toward homosexuality and drug users were common. In those early days of the epidemic, fear of contracting the infection was common, even though it was becoming more and more clear that health care workers were safe provided they took precautions and didn't—for instance—get pricked by a needle. But these nurses weren't hearing that, or they didn't believe it. They did their best to minimize contact with AIDS patients.

My patient was alone when I went to see him. It was the middle of the night, so the lack of family wasn't surprising. But the lack of nurses was. The most obvious thing about the patient was how terribly sick he looked. He'd kicked off the bedclothes and his hospital gone was askew. I could see most of his skin and all of it looked terrible: red, blistered, weeping, and sliding off his body in sheets. My first thought, as I remember it, was, "why isn't this patient in the Intensive Care Unit?!" At the hospital where I'd trained, he'd have been on a dedicated burn service, with a team of specialists working to stabilize the massive loss of fluids and heat that follows severe skin damage. Here, at Cabrini, this tragedy was unfolding in a regular hospital bed, unobserved. Why didn't anyone care? What was I supposed to do? 

This was four decades ago, and I've replayed the memory so many times I no longer know for sure when I noticed background details. Yet as I revisit the scene now, I'm struck with how the room looked shadowy despite the glare of fluorescent tubes. Partly this was down to the dull beige walls, smudged and in need of fresh paint. The late hour no doubt played a role. But the room also lacked any hint of cheer to dispel shadow. There were no cards, photos, flowers, or balloons from family and friends. There wasn't a single personal touch on view for this terminally ill patient. The scene was as emotionally bleak as any I've ever witnessed.

From looking at his chart, I knew my patient suffered from pneumocystis pneumonia, the most common killer of AIDS patients back then. I also knew an experimental drug had triggered a severe side effect: toxic epidermal necrolysis—that's why his skin looked so scary. I also knew there was little I could do to help him. 

I said his name, but he lay still, barely breathing, eyes closed. I did the next thing that came to mind: I touched his shoulder to see if he'd respond. This was harder than you'd think. Protective gloves weren't available in every room at Cabrini, and I hadn't yet learned to carry a handful with me. So gently touched an an area of intact skin with my bare hand. It slid sideways under my fingers, sloughing off. My heart lurched but the patient responded.

He did more than respond. His eyes opened and looked into mine with focus and purpose. His face shone with a broad smile. "I know the answer everyone seeks!" As he said these surprising words, the room seemed to fill with golden light; it seemed to open, as if the dingy walls slid open or grew transparent. My heart, which had been lurching, now soared, uplifted by something I had no belief system to explain. My atheist upbringing and scientific materialism were useless in this space of grace.

It closed quickly. The shine faded from the patient's face. His eyes closed. His body stopped breathing. He died.

What now? My training allowed only one option: I yelled "Code Blue" out the door. and started CPR, dead skin sliding sickeningly beneath my hands. A team showed up with a crash cart. An Ambu Bag was placed over the corpse's face. Medications were pushed in, electric shocks applied. And before long, the leader of the Code pronounced a time of death.

Of course, the patient had died before the team arrived. I knew that—not because of my medical knowledge, but because of my human heart. He was gone. The Code Blue was pointless, doomed, a disgrace even. 

I live with many regrets. Thankfully, I've learned to release the shame the once plagued me. I had much to learn back then. I didn't know to trust my heart, to consider taking a stand against meaningless and harmful medical rituals. I also didn't know to let myself off the hook for obeying my training rather than respecting the mystery of the moment.

It was good the patient had someone with him when he died. It would have been better if he'd gotten someone braver. But however much or little value I was to him, he gave me a massive gift. 

Listening

Human connection is hard for me. If I outlive my wife, the future may find me alone in a dreary nursing home room, with no cards or flowers by my bed, dying while no one cares and few notice. And although I'd prefer a future like this to leaving my wife alone, it would be a nightmare. 

Or would it? On the surface, that AIDS patient's life ended in one of the worst ways I can imagine: alone in a dingy third rate hospital, forgotten by friends and family, shunned by nurses, skin sliding off in wet shreds. And yet, and yet...

What happened as he died? 

Wait—don't try to answer. Forget what I wrote about about afterlife possibilities. If they help you, return to them later. For now, try to imagine the glory my patient glimpsed, however briefly and for whatever reason. 

Could it mean we don't understand enough to judge one death as better than another? Is there a deep mystery in our dying? Is life, perhaps, about more than battling for comfort, resources, and position? You may think not. But I believe so. Why? Because that's what I've heard when death is near. 

Maybe everyone hears something different, but we all hear something when we get close to death, close to the dying, close to dying. Maybe some hear only a cold, empty echo in a meaningless, uncaring cosmos. But it appears many people hear a message to fear death less and savor Life more. 

What if we've never been close to death or dying in ways that seem instructive? That's where contemplative practice helps. We don't need profound stories; we only need connection with the fact of death. We can try Buddhist meditations on dead bodies. We can reflect on the biological need for mortality. We can read about near death experiences. We can talk to others. We can be curious about death rather than avoidant. We can discover what countless people have discovered before us: death need not be feared. 

It's a powerful teacher and a rich source of meaning.