Abstract
Dying Well, a one hour-long episode of the TED Radio Hour podcast, asks us to consider our mortality and the discomfort we feel when doing so. In Dying Well, we meet five panelists—John Rosenthal a lawyer, Michelle Knox a banker and travel blogger, Emily Levine a humorist, Caitlin Doughty a mortician, and Lux Narayan an entrepreneur—who suggest that avoiding this discomfort through suppression of death thoughts actually works against us. The essence of dying well, they claim, is not found in rejecting death's darkness, but staring it in the face and knowing it; put simply—to stop sitting with what we want and start sitting with what is.
The podcast begins with John Rosenthal. His wife published a beautiful essay about him, advertising his strengths and virtues as a soon-to-be single man. It was published 10 days before she died of ovarian cancer. John shares his grieving process with us, complicated by not clearly knowing what dying looks like. He recalled the herculean effort required to walk up steps, his wife's skin-and-bone arms, the experience of carrying her lifeless body to the crematorium—knowing she would never fall asleep next to him again. John's reflection reminds us, medical providers, that educating and normalizing the expected process of dying and death could improve the experience for all those involved.
John's sentiment is echoed by Michelle Knox. Michelle suggests that explicit death talk can help us exert control over the uncontrollable: if we spoke about it when we were young, she asserts, then we could control some important aspects of the dying process (assuming we are not hit by a bus). For instance, she urges us to consider: where will I die? Do I want a religious ceremony? Will the ceremony be somber or celebratory? If there are competing priorities during the dying process, what is most important to me? In addition, discussing death with your family provides them with a how-to-guide to best honor you. Knox suggests that death talk not only helps you die as you wish, but also it serves to buoy your grieving loved ones who will one day struggle to stay afloat.
Emily Levine gives the most compelling reason to “make friends with reality”: because it hurts less. Through humor, humility, and jabs at the Democratic party, she shared her personal experience of facing, rather than running from, the reality of stage IV lung cancer. This decision helped her reconcile trauma around her own mother's death and lead her to an immensely exciting rabbit hole of ideas, dug by centuries of philosophers and biologists concerned with mortality. This world of stimulation enriched her final years with meaning, purpose, and ultimate peace. Emily insists that she will be a delicious meal for the microbes underground. She seems sincerely aware of and humbled by her part in the circle of life. Emily died on February 9, 2019, leaving behind the legacy of her ideas. Denying death is a form of death; accepting reality is liberation.
Next we are introduced to Caitlin Doughty, who focuses on death denial through the lens of burial. She explores the painstaking efforts we take to protect ourselves from death thoughts while exposing the multibillion-dollar dying industry that capitalizes on our death fears; fears that follow us to the grave (or really, into our $3,000 dark cherry wood coffins with almond velvet interior fabric). After we die, she reminds us, we are manicured and injected with chemical dyes (perhaps to make us look as though we are resting). We are not returned to the earth, but are lowered by a crane into a large vault inside a smaller rubber-sealed fortress. Caitlin argues that these principles—protection, sanitation, and beautification—serve a death-denying function. This process “ignores the fact that death can be an emotionally messy and complex affair, and that there's beauty in decay; beauty in the natural return to the earth from whence we came.” Our death fears, designed to protect us from decay and eternal isolation, paradoxically isolate us eternally—although we are beautified for the fungi and bacteria. Caitlin also suggests that death denial, as manifested by the burial business, is environmentally irresponsible. Think your carbon foot print is small with cremation? Think again: according to Doughty, a single cremation uses the natural gas equivalent of a 500-mile car trip. She emphasizes the real and multifaceted consequences of denying death.
Lastly, we are introduced to Lux Narayan. Lux starts his days reading the obituary section of The New York Times, and he wondered about unifying threads. He recounts how he ran 2000 obituaries from the Times, from 2015 to 2016, through a mathematical black box and unearthed “lessons on how you might get your obituary featured, even if you weren't around to enjoy it.” These obituaries shared one word in common: “help.” The deceased, memorialized in this prestigious newspaper, were all helpers who changed the world for the better. They helped create Spiderman, developed acting and writing workshops for veterans, and paved the way for African American women to sit in congress. Lux concludes, “If more people lived their lives trying to be famous in death, the world would be a much better place.”
As a hospitalist with a palliative soul, the day-to-day grind of the hospital can wear on the central tenet of my calling to medicine: the alleviation of suffering. There is such profound suffering in the face of death denial, as it isolates us from ourselves, each other, and our world. The avoidance of death reverberates the siren of existential fear and loneliness and, although it is done with protective intent, death denial is destructive—complicating the process of grief, mourning, and loss. Listen to the TED Radio hour episode, Dying Well today, and refresh the potency of this concept before stepping foot in your hospital or clinic tomorrow.