Living and dying: Which do you prefer?
Recently, I watched Inception. What a great film. It made me think about death and life.
This was poignant as in the past month I have lost 2 friends and my cat, whom I was very close to. Death of others makes me question my own life.
As a nurse it was part of a standard nursing assessment form to address living and dying with our patients. With little information on how to go about it, we were just supposed to address this aspect of a person’s health.
The truth is that I never used to discuss it.
I assumed that because someone was breathing that they must be living. How wrong could I have been?
Part of my role as a nurse was to assess my patient’s potential for independence upon leaving hospital. What I didn’t realise for many years was that I was also supposed to assess what living meant to my patients.
What does living mean to you?
Do you find the joy in life or does it treat you not so well? Is your glass half empty or full?
I did not ever think to ask such questions to my patients until the day I met Dorothy.
Whilst working for a nurse agency in Sydney I was sent to a rehabilitation unit in a private hospital. I was given several consecutive night shifts on the same ward. This was rare for me.
Sometimes I just don’t know.
During that time I started reading a book called The Tibetan Book of Living and Dying. I remember reading in the beginning of the book that, a big difference between eastern and western cultures is our beliefs about death. In the east people prepare for death from birth. In the west we tend to wait until it’s staring us in the face.
It made me think.
Having witnessed hundreds of people, of all different ages, die, I had asked myself more than just a few questions; on more than just a few occasions. Was death the end? Is that it? What was the purpose of life? What is life? I also witnessed the reactions of those left behind. People have very different responses when a loved one dies. When our emotions are high our intelligence can lower. Since our emotions can override our logic, we must be receiving information from at least two sources; head and heart.
Then, one night, things changed for me.
Every night I had been around to each patient on the ward, had a brief chat, assessed their state, recorded their observations and handed them their drugs. This is a standard start to an evening working on a ward. I had met Dorothy before. Each night I had visited Dorothy she had always been smiling and appeared happy. She had fallen over and broken her hip three months ago. She had no other medical history and had been independent all of her life prior to her fall.
We had engaged in a brief chat every night and then came the news that she would be discharged home the next morning. I left Dorothy until last that evening, as I wanted a longer chat and to congratulate her. I walked in her room. “Good evening Dorothy, I hear that celebrations are in order,” I said, beaming a smile at her.
Dorothy had been smiling but after a few seconds of my words sinking in, her face dropped and she looked very sad indeed; “What have I got to celebrate? A long pause followed as my smile slowly dropped. Then, Dorothy continued, “It has taken me three months to be able to walk from my bed to the toilet with a Zimmer frame. I am completely dependent on people to look after me. I can’t go shopping and my daughter has just had a baby. I cannot impose on her. What have I got to look forward to? I’m just a burden on everyone.” She was very frightened and her body radiated it.
I was shocked. How could I have got it so wrong?
I had taken her constant smiles and friendliness as her being happy for being alive. Dorothy had just been returning my smile when I walked in to see her each night. Really, she was already dying a little more each day. Three months of struggle in hospital had resulted in her being told that she would be going home and somebody would be in twice a day to help her and get her some shopping and help her wash and dress.
Dorothy was about to become a prisoner in her own home. Her life force was being drained. And I felt it.
In that moment I brushed aside everything that I had ever believed about living and dying and entered into a discussion, unlike any other in my life before then. “Do you believe in life after death?” I asked. A pause ensued as Dorothy looked bemused. I could see that she had never really given it much thought.
Eventually, she looked up at me and said, “I’d like to think so; but I just don’t know.”
Then I thought of The Tibetan Book of Living and Dying that I was reading.
“Did you know that some cultures believe in reincarnation? As a result they do not fear death as many people in the western world. The Dalai Lama is actually the 14th reincarnation of the Dalai Lama. You will not convince his followers of anything to the contrary. There are also Native American Indians who know when they are going to die and give away all of their worldly belongings, in order to release the ties of this life.” I said, stunned as I did. All of this information was inside me yet I’d never really thought about the possibility of life after death.
Meanwhile, Dorothy’s expression changed.
We went on to talk about the possibility of there being something beyond life as we knew it. I did not necessarily believe it but I did know that the idea was cheering Dorothy up, so I continued. It’s amazing how receptive some people are to new beliefs and rapid change when they have truly stopped living and lost all hope of ever really living again.
I had listened to many people talk about their fear of death as they approached their final curtain and I had not done anything to dissuade them.
It was time for a new approach to living and dying.
For almost two hours we investigated ideas and Dorothy’s energy increased as we spoke. Just before I left the room, Dorothy grabbed my hand tight, with both of hers. “Thank you Adam. This has probably been the most useful conversation of my life.” I smiled and squeezed her hands before leaving her to sleep.
I looked in the next morning to say goodbye but she was asleep, so I smiled and left.
I returned to the ward the next night. As I arrived on the ward the resuscitation team were running down the ward to Dorothy’s door. She was lying on the floor to a stunned audience. Not one of the medical or nursing staff could explain it.Dorothy had been deemed medically fit to go home that day and she had clearly decided not to. She had been dying since losing her independence. Without her health her life was over, in her mind.
People were in tears and staff were consoling each other at the unexpected nature of Dorothy’s passing away. As I stood in that room and contemplated what was going on I realized that Dorothy had made her decision and that she was ready to die, in order that she could truly live.
Ultimately, we will all be dead one day.
However, there are two ways to look at death; absence of breath, or absence of life. Absence of breath is how a doctor decides if you’re dead rather than alive. Unfortunately, this distinction comes at too late a stage to do anything about it. Absence of life can also encompass all in the former category, however, its remit is extended to those who would rather complain, blame and be bitter. In these states you are not truly living. They are symptoms of living death.
Living occurs when we enjoy life and take full responsibility for everything that happens to us, including how we feel.
Life is living in the here and now. You never know when death will arrive. Nobody knows when. Everybody knows that one day it will arrive.
Do you fear that day or embrace your life?
When I witnessed Dorothy lying on the floor, dead, in front of me it caused a reaction within me. That day I started to wonder just what death was and whether there was something else.
Then I considered my options.
I had only two; believe that death is the end and live in fear of it, or, believe that there was some sort of life beyond this existence and live in happiness and contentment. It did not take me long to decide which option worked best. Dorothy gave me a gift; a gift of hope. Whilst I do not know anything for sure, I do know that my current beliefs and mindset allow me to feel better.
True or not, I strongly recommend this option.
It also allows me to use death as a reason to celebrate life.
To Brendan, Steph and Dogcat I celebrate your lives and promise to live my own to the full.