Death Is No Ending, So Let’s Try To Live & Die Well
Our experts are predicting that 100,000–240,000 Americans may die in this pandemic, an estimate some belief is overly optimistic. They say if we don’t shelter in place, 2 million Americans might die. Many more will die all over the rest of the world.
It’s not just the loss of human lives that are shocking our systems right now. We are facing so many little deaths—the death of jobs, the death of financial security, the death of community, the death of our way of life, the death of so many dreams. So many things we thought we are entitled to are now being shown to luxuries we no longer have. In addition to staring death in the face, we can no longer turn away from our entitlement and privilege. To say this is not easy would be the understatement of the century. In times like this, we need so much compassion—not just for each other, but for the parts of us that might be very triggered right now. Death is hard. But we can do hard things with great love.
Nobody wants to talk about death right now, but this pandemic is thought we are so solid and right in front of us. I know someone now, someone close to me, who is grieving from a coronavirus death. My oldest BFF is flattened with Covid-19 but expected to recover. Many of my physician friends and clients are also sick. I know someone else who is young—with asthma—and sick with it. Watching her air hunger over Zoom left me in a puddle of unwept tears and brought up some PTSD flashbacks of watching my mother gasp for breath before her death two years ago. All this sickness, suffering, and death is very triggering—for all of us.
I know doctors on the front lines of epicenters in San Francisco, Seattle, New York, Italy, and the Netherlands, and it’s hard to watch from the sidelines as my peers are expected to work insane hours with insufficient protection gear. Some of them were doctors on the front lines of the AIDS epidemic in San Francisco, and this is activating PTSD flashbacks of that time, but at least back then they had enough masks, gowns, and gloves, back when they didn’t know how it was spread. Wars and epidemics put us up close and personal with the dying and the dead. And even though doctors are trained to be professional with dying and dead people, they’re also human, and it takes a toll on you—emotionally and physically—to be the one looking into the eyes of a gasping man when you don’t have enough respirators, and you have to hold his hand and cradle him in your arms and tell him goodbye, at great peril to your own personal safety as he coughs on you while you have no mask.
The War On Death
Part of why this is so hard is because of the relationship we have with death. We live in a culture where we consider every life precious and worth fighting for. We use extreme measures to save lives, like respirators and C-sections, heart surgery, and defibrillators, luxuries many of the indigenous people I met on my Sacred Medicine journey do not have. We keep extreme preemie babies alive with modern technology. We bring people back after they die and hook them up to life support. In the world of conventional medicine, death is a failure, something to be avoided at all costs.
But this is the modern technological view of death, not the only view of death. Because many people in the world don’t have access to such life-saving measures, they wind up with a different relationship with death. One of my physician clients comes from a country where infant mortality is high, so babies don’t even get named until they’ve survived until at least six months old, perhaps as a way of limiting how much parents attach until the grave risk of losing a baby is at least partially past. In cultures like this, death is less of an enemy to fight and more of a presence to engage with respectfully. In some cultures like Tibet, death is not something to fear or resist; instead, it is considered of great value to know how to die well, as described in the classic The Tibetan Book of the Dead and the more modern Tibetan Book of Living and Dying by Sogyal Rinpoche.
Tibetan Buddhist practices invite us to practice dying every day so that when our time comes, we have rehearsed for that last breath, something that can help us die well. The Tibetan Buddhists are aware that death may come quickly and unexpectedly. Our time of death is always a mystery. So we practice dying well, in case our time comes with little to no warning. Only when we are prepared to die well can we live well, they say. But do we Westerners ever think about whether we’re prepared to die well?
This daily brush with death also offers us practices for gratitude, something Jeff Foster invites us to touch upon in this poem.
You, Will, Lose Everything
You will lose everything. Your money, your power, your fame, your success, perhaps even your memories. Your looks will go. Loved ones will die. Your body will fall apart. Everything that seems permanent is impermanent and will be smashed. The experience will gradually, or not so gradually, strip away everything that it can strip away. Waking up means facing this reality with open eyes and no longer turning away.
But right now, we stand on sacred and holy ground, for that which will be lost has not yet been lost, and realizing this is the key to unspeakable joy. Whoever or whatever is in your life right now has not yet been taken away from you. This may sound trivial, obvious, like nothing, but really it is the key to everything, the why and how and wherefore of existence. Impermanence has already rendered everything and everyone around you so deeply holy and significant and worthy of your heartbreaking gratitude. Loss has already transfigured your life into an altar.
When death is ever-present, every Covid-19-free breath, every moment we still have left, has the opportunity to evoke unspeakable joy. Those we have not yet lost are still with us. Are we present with this gratitude, aware as we are with this brush with impermanence?
Death in the Q’eros
In the village I visited in Peru, the chief’s wife was pregnant, and the night I arrived, just before settling into the hut I was sheltered in along with ten villagers, his wife went into labor. I asked if she needed my help, telling him I was an OB/GYN. He said no, that the women of the Q’eros just went to their huts and delivered on their own. Not wanting to impose my Western ways on their peaceful way of life, I trusted all was well.
The next morning, I asked the chief how his wife was. How was the baby? Boy or girl? He said, “Baby died.” I started to cry, but he waved off my tears. “Pachamama gives. Pachamama takes back.” Pachamama is Mother Earth, their feminine nature deity, who they worship with many ceremonies.
Where was his wife, I asked, wanting to offer my comfort.
“In the alpaca fields,” he said, “tending to the alpacas.”
“Isn’t she sad?” I asked.
He nodded. Yes, of course, he told me, but then he explained that she will be sad with everyone else during their quarterly grief ritual when everyone grieves together over anything they’ve lost over the past few months.
I was shocked by this cultural relationship to death, so vastly different from the way my people experience and view death. Curious what else was different, I asked what happened when someone got very ill and might die. I was told they call the paqo, the shaman, or spiritual leader of the tribe. The paqo attends the sick person in order to help them die well, to help the sick person go home. “Then we are happy our loved one got to go home.” They are also sad, he said, but only sad for themselves. “Pachamama gives. Pachamama takes back.”
This was inconceivable to me. In my experience in US hospitals, if a woman lost a baby, she was wrecked for life. She would grieve for years, maybe start a blog about it, maybe write a book about it, maybe join a support group for other moms who have lost babies. She might also sue her doctor because surely, every life can be saved by modern medicine, and if a baby died, some doctor must have f*cked up.
The loss of her baby would become a defining event in the life of an American woman who feels she is entitled to a “healthy mom, healthy baby” outcome to childbirth, something most women worldwide are not entitled to. When an American woman loses her baby, our hearts go out to her and we cradle her in her despair, rallying around her, maybe having a fundraiser to help support her because she might not be able to go back to work due to her understandable distress. People would bring casseroles, as they would to awake. She would definitely not be back in the alpaca fields the next day, nor would she have a communal grief ritual to help her process her pain. She’d be more likely to hold her grief inside and never have it witnessed.
I’m not intending to diminish the distress an American woman might have if she lost a child. If I lost my daughter, I’m sure I’d be one of those women who is wrecked by grief in a way that would define the rest of my life. It’s part of my inculturation, to cherish the preciousness of every life, especially a child’s life, and to feel entitled to out-live my child. Such is our cultural expectation, and I’m not intending to judge anyone who responds this way. I’m only pointing out that this is a particularly privileged, modern interpretation of death and not the only one currently active in the world.
I’m not intending to suggest that American women who lose a child shouldn’t respond with such intense suffering. I also don’t mean to suggest that we should bully someone who loses a loved one into “bucking up.” Nor do I intend to suggest that Q’eros women don’t also deserve grieving time and caretaking. I certainly needed a lot of coddling when my mother died two years ago, and if my daughter were to die—of this virus or anything else—I would be wrecked and might never fully recover. I’m just pointing out the differences in how cultures respond to death, inviting us to have compassion for every human, not just the privileged and underprivileged who will of this virus—or who will suffer and/or die as unintended consequences of this virus—from economic instability, hunger, domestic violence, child abuse, suicide, overdose, or some other unexpected cause of death we may not anticipate. All death deserves our sensitivity and compassion.
They Are Going Home
In a culture that has been isolated above the tree line at 15,000 feet in the Andes, far from the luxuries of modern medicine, such a prevailing attitude about death makes sense. For most of us, however, this is beyond our ability to even relate. Every life is precious, right? We must fight death like we are fighting a war. We celebrate every “win” when doctors save lives, and if they fail to save someone, we often chastise or sue them for their loss. If we don’t blame the doctor for losing the war, the doctor is likely to blame herself. Only when death is peaceful, and we have advance notice, or when someone is very old, only when we have had time to accept that death is coming, as with those in Hospice, can we maybe see death as a joyous homecoming.
But why is that?
Right now, a lot of people are dying. The reality is that a lot of people are always dying. Children are dying of starvation. People are dying in genocides. People die from the flu every year. Yet we don’t normally track all those deaths on a daily basis, the way we’re counting coronavirus deaths. Why is that? Is it just because it’s happening on American soil, to American people, to people who are more privileged than the starving children in third world countries, people who are used to being able to stave off death more easily than we can right now?
More deaths will likely follow. These people with acute respiratory distress from Covid-19 don’t die slowly like cancer patients, or heart failure patients do. They don’t have time to go home and die well with Hospice, surrounded by loved ones, singing, and praying. They are dying while desperate doctors intubate them and pray for a respirator to hook them up to, and sometimes they die even then, waving goodbye on a phone app, isolated alone inside glass ICU rooms.
When these Covid-19 patients die, we praise these doctors for at least trying—putting them on pedestals as heroes—and they are. We know they are doing the best they can. Yet my doctor friends are expressing to me that they feel like failures when they are looking into the eyes of people gasping for breath, people they just can’t help because supplies are too limited and there aren’t enough ventilators or ICU beds. It doesn’t occur to many doctors that our job might not be to control life and death. It might not be our job to save anyone. Maybe our job is to do our best with the tools we’ve got—but without this rabid hunger to heal someone that results in feeling like failures if we can’t.
Some people are professional death doulas, but doctors aren’t usually trained in the kinds of skills death doulas learn to practice. Those in palliative care become experts at midwifing deaths, but the doctors midwifing death right now are often emergency room physicians and ICU doctors, people who are certainly up close and personal with death, but who usually have more tools at their disposal to save lives than they currently have.
In the Whole Health Medicine Institute program I founded as a training program for doctors, I have been preparing the doctors for years for what is happening now, helping them understand that, given the trajectory of our collective human choices, our jobs as doctors might not be so much about saving lives, but to midwife death. We’ve been feeling it coming, whether from a pandemic or climate change or something else—this mass exodus of human lives from this incarnated realm where we have been making choices that breed the soil to grow death, through the choices of our own making, individually and collectively. When I ask the doctors whether they would be up for the challenge of midwifing a
dying species through its own possible extinction, they feel initially triggered, and then their nervous systems relax. Yes, they’ve told me. We can do that. We know how to be with people who are sick, suffering, and dying. We can help people die well.
Well, here we are. And it’s harder than many of us thought, even those of us who have been preparing for times like this.
To help people die well when it’s our time is not something they teach us in medical school. To help people go home with presence, love, peace, and open hearts is not something we’re experienced with when people go suddenly and with little warning, especially when those people are young, privileged, or otherwise healthy.
Maybe this is one of those paradoxes of healing—to do what we can in order to facilitate living AND to recognize that we’re not in control of life and death and help people go home when it’s time. Maybe in those moments when we face a suffering human who is going home, we can give them what we can—love, touch, singing, comfort, and reassurance that they’re finally going home, and death is no end. Death is a new beginning.
Let’s Do What We Can
S0 . . . I’m grateful for modern medicine and their attempts to save lives right now with emergency measures like respirators. But let’s face reality here. Modern medicine doesn’t currently offer much that will help with this virus. We don’t have a well tested pharmaceutical cure, we have a shortage of supplies, and there is no vaccine yet. I’m all for using modern medicine when it works, but right now, we are limited in what works. This means that using all the other tools in the world’s cutting edge and ancient medicine bag—as prevention and treatment intended to optimize outcomes—is necessary now more than ever. Some know how to use these tools, yet the CDC is not publicizing them and recommending we all use them. It is my opinion that we should be using these other healing tools in the hospitals right now, and doctors should be using them in order to stay healthy through all this. These tools from the world’s medicine bag could save lives right now.
Until then, stay well. Let’s all do what we can to stay in our hearts and practice being kinder than is necessary when so many of us are so triggered. We are indeed all in this together.