We Need to Talk About Death
Popular depictions of birth often go like this: first kiss, pregnancy, dramatic water breakage, fade to black, and– voilà– a pink and clean baby appears in someone’s arms. It is blissful and cinematically-induced amnesia of a universal fact. The feces, fluids, and bodily expulsion of a whole organ are details that we simply need not think about and we go to great lengths to shield ourselves against the full image of life. From hyper-private delivery protocol to vague general education, we have refined barriers to ensure that the living do not have to look life in the eyes. Predictably, even greater measures are taken to censor death.
A majority of Americans die in hospitals and a majority of America‘s experience with the imagery of death comes from news excerpts and media. Learning of a familiar’s death happens over telephone, from the mouth of doctor, or, more currently, a post. The loss of life is largely left to the imagination. By the time someone’s passing is reported, the greased gears of our institutions have already scrubbed the scene clean. The body is sheltered from view, embalmed, and pipelined into the ground or furnace. The sentimental fallout is carefully procured obituary or memorialization. Perhaps this is why most of us– according to polls– do not really think about death.
We’re not meant to.
Three weeks ago (before social distancing was introduced) I was leaving my house to go to brunch and noticed a car idling in front of my house. The driver appeared to be sleeping, but, as I went to retrieve my bicycle from my backyard, I reassessed the situation and decided that it was odd that someone would leave their engine running for a nap on a seventy-degree afternoon. Upon further investigation, I realized that this person’s body was stiff. Her mouth was agape and her eyes were completely open but unblinking. “Yes,” I had to intentionally confirm with myself. “She is either dying or already dead.” Everything told me that it was a classic opiate overdose, but I didn’t stick around long enough after the first responders arrived to confirm.
I have seen a handful of dead or dying strangers during my travels and brief stint with photojournalism and/or emergency medicine. It is not something I dwell on, but it’s also not something I want to forget. Each time, it has forced me to reckon with a hard truth: for the majority, death is excruciatingly painful, lonesome, and ugly. There is no fade to black. It’s fentanyl-induced organ failure at the dashboard or heart explosion on the concrete tiling of a public park. “Went peacefully” is the equivalent of “effortlessly gave birth to a beautiful baby.” The latter, of course, procures witnesses who can contest such a gross misrepresentation.
In How we Die by Sherwin B. Nuland, Dr. Nuland writes about an encounter with a patient:
“Dr. Nuland, there was no dignity in my mother’s death!” My patient needed a great deal of reassurance that there had been nothing unusual about the way her mother died, that she had not done something wrong to prevent her mother from experiencing that “spiritual” death with dignity that she had anticipated… I tried to make clear to her that the belief in the probability of death with dignity is our, and society’s, attempt to deal with the reality of what is all too frequently a series of destructive events that involve by their very nature the disintegration of the dying person’s humanity. I have not often seen much dignity in the process by which we die. The quest to achieve true dignity fails when our bodies fail.”
You might ask why I’ve chosen to spend my afternoon mulling on the most terrifying part of our shared reality. Why, my dear and concerned acquaintance, it’s because, in the throws of a severe pandemic, we’re going to have to talk about death sooner or later. Should it not be on our terms?
Right now, refrigerated eighteen-wheelers are parked outside of New York City hospitals because the shear volume of death is overwhelming our discrete protocol of dealing with bodies. This morning, a good friend read a mourners kaddish for the 500+ New Yorkers who passed away yesterday. The majority of these individuals died alone and cordoned off from their loved ones. Somewhere off the coast of Florida, a cruise ship with dead passengers onboard is floating in indefinite limbo. All this to say, the core terror of Coronavirus is death, yet, in our conversations about the crisis, it is seldom the centerpiece.
My favorite Rebecca Solnit essay is “The Separating Sickness.” It is a harrowing account and recollection of leper colonies, but it is also an exploration of our society-wide defense mechanisms against feeling– and processing– pain.
Brand concluded that “shared pain is central to what it means to be a human being,” but we are a society that values the anesthetic over pain. We hide our prisons, our sick, our mad, and our poor; we expend colossal resources to live in padded, temperature-controlled environments that make few demands on our bodies or our minds. We come up with elaborate means of not knowing about the suffering of others and of blaming them when we do.
Choosing not to feel pain is choosing a sort of death, a withering away of the expansive self.
Gazing off in the opposite direction of horror is, in fact, a form of violence against groups who are repeatedly exposed to death. It’s how we talk about war without internalizing the experiences of the civilians we slaughtered. Lack of recognition justifies lack of action and, in the case of covid-19, it constitutes the vacancy of mass mobilization against a viral time bomb.
Solnit’s writing goes on to summarize psychiatrist Robert Jay Lifton’s conclusions on the emotional fallout of collective trauma:
When Robert Jay Lifton went to investigate the psychology of survivors of the atomic bombings of Hiroshima and Nagasaki, he coined the term “psychic numbing” to describe the survival strategy of dissociation and apathy — “a diminished capacity or inclination to feel.” In such extreme circumstances it was necessary or at least understandable, but even there Lifton called it “dehumanization” and cautioned that it “comes to resemble what has been called ‘miscarried repair.’ ” He compared it with immune disorders that begin by eradicating outside elements and then turn on the body itself.
Our longstanding inability to absorb the grotesque and undesirable parts of life is swiveling around to settle its crosshairs on our own heads. We stand to lose far more than biological life.
So, I want to talk about death.
I want to talk about how ugly it is, ventilators and all. I want to talk about the pit in my stomach that is growing every day, especially when I think about our vulnerable and how Coronavirus is gearing up to rip through these communities like a hungry tornado. I want to give myself space to marinate in the sorrow that washes over me when I think about the likelihood that at least one person I know well is going to die excruciatingly in complete isolation. We need to process the disintegration of the dying person’s humanity so that we do not squander the living’s dignity. We need not be paralyzed nor fraught with fear, but, more importantly, we need not be numbed.
