Abstract
Die Wise is a book that presents a radical vista of possibilities about death and dying to both seasoned health professionals in palliative practice and the reading public. “We are not tutored in the ways of dying, nor in what it asks of us, nor in what it could mean,” according to Jenkinson, who asserts that dying wise is a life's work, an act of love, and immensely hard labor. The author does his utmost to articulate what he thinks dying asks of us, describe what it could mean, and to explore the nature of dying within a death-phobic culture.
The book is structured within 11 chapters and boasts a comprehensive index. It is augmented with extensive vivid scenarios from his years in practice. The core strength of Die Wise resides within the tough, provocative questions that Jenkinson liberally sprinkles throughout the 11 chapters; questions that beg to be written down, wrestled with, and pondered over. He shapes the writing around three fundamental questions. His responses to those questions elicit more questions that every palliative care practitioner needs to wrestle with from time to time. Questions are such as “What do dying people need from the rest of us? … How do you get ready to do something you desperately do not want to do? … What are we asking of a dying person when we ask them to be ready before we begin speaking and behaving with them as if they are dying? What if we let death be the catastrophe that it is?”
A warning: this is an unsettling read for a seasoned practitioner of any discipline in the field of palliative care. With a background in theology and social work and 20 years of experience in what he calls the death trade, Jenkinson provokes and prods established thinking and traditional norms. Prepare to be rankled, outraged, challenged, touched, heartened, and, at times, deeply moved.
The writer challenges some of the tenets of palliative practice such as hope, truth, honesty, symptom management, and the philosophy of palliative care. For example, the chapter on hope portrays hope as a tyrant and a thief because “hope almost always makes sure that it is too late to learn how to die for dying people in a death- phobic culture.” He argues that to be hope-free is radical and liberating, a state that allows a dying person to live in the Now and fully experience Today, in contrast to longing for a grail of More Time and time that is Not Yet in a place that is Not Here. To be hope-free, he would assert, leaves us to be fully present to those we love, and gives us a chance to wrestle with our dying with meaning.
Each death approached with openness and honesty adds to the body of knowledge that teaches our loved ones how to die because “every death that precedes our own could be a school, our initiation hut, every dying person and every witness, our fierce teacher.” In the chapter on hope, the author challenges, even mocks palliative care models at times, but neglects to provide a fulsome understanding of the principles of palliative care. I sense he is taking aim, without quite realizing it, at a truncated, anemic version of hospice palliative practice, not the full spectrum of palliative principles. He is not describing the robust hospice palliative models conceptualized by the originator of the modern hospice movement, Dr. Cecily Saunders of the UK in the late 60s or Dr Florence Wald of the United States in the early 70s. What he really skewers is managed care, where he depicts a singular focus on symptom management that neglects the personhood of the dying person.
The benefits of Die Wise are not limited to health professionals. Although somewhat lengthy and dense for the reading public, the content opens new vistas of thought and perspectives. For example, Jenkinson suggests that instead of viewing death as an executioner in our lives, to try to see death as an angel. Not some pink-cheeked cherub to be sure, but that of a laborer or messenger, staying true to the original meaning of the word angel. “What if your dying was an angel? What if your dying job, should you choose to accept it, is to wrestle this angel of your dying instead of fighting it? What if you wrestle with the angel of your dying life instead of fighting the executioner of your disease? … Let the difference between the two unfold a little.” Nine short words that can transform the experience of dying.
Again, the questions shape the text: “What happens when we don't let dying change everything? What does dying ask of us? How can we possibly feel able when dying comes to call? … How can we ever have a real knowledge of dying that can serve us and those we love when we have so little experience of it? So little chance to learn it? … When do we let people off the meat-hook of ‘trying’?” These are necessary, poignant, and potent questions that Jenkinson insists we, the readers, wrestle with from cover to cover. It is a heroic journey really, to stay with the writer through the 11 chapters that focus on the “plain certainty of death.”
This book is for those who labor in the field of palliative care and want to see it anew. This book is for those seeking to know more about life's last certain, mysterious human experience in which we, as a society, are poorly schooled. And lastly, this book is for every friend or family member of someone who wants to die wise and needs the support of his/her loved ones to do so. The lasting impression of Die Wise is one of a deep sense of yearning. The author yearns to bring death into society's conversation with life with honesty, gravity, and a deep respect for its rightful place in our lives. That is his manifesto-one he delivers with generous measures of shock and awe and wisdom.