The primary one that taught me one thing about dying and defiance was the mom of a household good friend, an older girl who had moved from Punjab to the US to be nearer to her son. I keep in mind her as delicate and draped at all times in pastel salwar kameezes. After she was recognized with breast most cancers, which moved rapidly to say her bones and her mind, her want to return to Punjab intensified. When my mother and father instructed me in regards to the finish of her life, it was with a combination of disbelief and conviction: She survived the days-long journey to the village the place she’d been born—laboring to breathe for almost the whole flight, grimacing by prayers when she ran out of ache treatment—and died two days after she arrived.
I considered her story this week as I examine former President Jimmy Carter’s intention to reside lengthy sufficient to vote for Kamala Harris. Carter, who has been on hospice for nicely over a yr, turned 100 on Tuesday and has survived far longer than many anticipated he would. The notion that he has rallied in an effort to contribute in a single last strategy to American democracy raises a well-recognized query that arises in my very own work with sufferers and households: Do now we have some management, aware or not, over after we die? Can an individual stretch the times of their life to incorporate a final significant act or second?
As a palliative-care doctor, I’ve encountered the phenomenon of individuals dying solely after particular circumstances materialize. There was the gentleman whose household held vigil within the intensive-care unit whereas he continued on, improbably, even with out the help of the ventilator, dying solely after his estranged son had arrived. There was the girl whose fragility precluded any additional chemotherapy, however who survived lengthy sufficient with out it to witness the start of her first grandchild. There was the girl who was deeply protecting of her daughter, and died from cirrhosis solely after she’d left for the night time, presumably to spare her the agony of witnessing her dying. The surprising occurs ceaselessly sufficient that I inform sufferers and households that two timelines form the second of dying: the timeline of the physique, ruled by the extra predictable legal guidelines of physiology, and that of the soul, which can decide the second of dying in a manner that defies medical understanding and human expectations. When individuals surprise in regards to the circumstance of the final heartbeat, of the ultimate breath, I can see how they by no means cease looking for their family members’ personhood or intention, a final gesture that reveals or solidifies who that individual is.
Regardless of the prevalence of tales suggesting that individuals could have the flexibility to time their dying, no scientific proof helps this commentary. Many years in the past, a number of research documented a dip in deaths simply earlier than Jewish holidays, with a corresponding rise instantly afterward, suggesting that maybe individuals might select to die after one last vacation celebration. A bigger research later discovered that sure holidays (Christmas and Thanksgiving, on this case) and personally significant days (birthdays) had no important impact on patterns of dying. However this phenomenon doesn’t lend itself simply to statistical evaluation, both: The significance of holidays, for example, can’t fairly stand in for the very particular person motivations that outline the anecdotes shared in hospital break rooms or round a dinner desk. And the human reality that many acknowledge in these tales raises the query of whether or not we imagine them any much less totally within the absence of proof.
Palliative care usually includes serving to individuals confront and develop a relationship to uncertainty, which governs a lot of the expertise of sickness. And when my sufferers inform me about themselves and about who they’re now that they’re sick, willpower usually makes an look. Many say that in the event that they concentrate on the optimistic, or visualize the disappearance of their most cancers, or struggle laborious sufficient, they may win the battle for extra time. I hear of their phrases echoes of what Nietzsche wrote, what the psychiatrist Viktor Frankl used to make sense of his years in German focus camps: “He who has a why to reside for can bear nearly any how.”
And we wish to imagine that love or want or dedication or heroism continues to be doable proper up till the very finish. As my sufferers develop sicker, and as dying approaches, I discuss with them and their households about what they will hope for even when a remedy isn’t doable. That, the truth is, dying can nonetheless comprise one thing generative. A time which will have appeared past additional that means turns into as a substitute a possibility, or an extension of the dying individual’s commitments to their nation, their household, their desires. Quickly, President Carter will have the ability to forged that vote: Subsequent week, Georgia registrars will begin mailing out absentee ballots; early voting begins the week after that. His promise to himself is a reminder that dying can’t totally dampen objective, whilst an individual’s life narrows.
The concept that willpower will be an ally in opposition to dying is interesting too, as a result of it presents the potential for transcendence, of defying the bounds that the physique, or sickness, could impose. However, having additionally seen the numerous ways in which the physique doesn’t bend to the thoughts, I do discover myself relating to willpower with warning: What in case you as a individual are a fighter, however your physique merely can’t struggle the most cancers any longer? I ponder, with my sufferers, if they will attempt for extra time with out shouldering private duty for the bounds of biology. Equally, two individuals on ventilators could love their households equally. One could die solely after the ultimate beloved member of the family arrives, whereas the opposite could die earlier than the individual speeding throughout the ocean makes it dwelling. We don’t at all times know why. If Carter casts his vote and dies shortly thereafter, that may affirm the notion that others, too, can write the ultimate sentence of their story. However what wouldn’t it imply if Carter died earlier than casting his vote? If he lived one other yr, or if he lived to see Donald Trump take workplace once more, or watch the election be violently contested? Dwelling with loss requires remembering that we are able to find the individual now we have beloved or admired in any given set of occasions that comprised their life, not simply the final one.
I attempt to think about my household good friend’s lengthy flight from Los Angeles to Delhi, and her trip within the taxi again to Punjab. I take into consideration how she discovered a strategy to endure what she was instructed she couldn’t, all to really feel beneath her ft the soil she knew greatest, to die within the one place that she felt belonged to her. What if her docs had been proper and she or he had died on the airplane? My household may need mourned her single-mindedness, or we would have admired her defiance nonetheless. What makes these tales so compelling is that they remind us that dying, nevertheless ravenous, can’t devour hope or risk, even when what transpires will not be the ending we imagined.
