How We Die_ Reflections On Life's Final Chapter Part 9

The rest of us must make do with what we will be given. Through an understanding of the mechanisms by which the commonest mortal diseases kill, through the wisdom that comes of realistic expectations, through a new understanding with our physicians that we do not ask of them what they cannot give, the end can be managed with the greatest degree of control allowed by the pathological process that kills us.

Though the hour of death itself is commonly tranquil and often preceded by blissful unawareness, the serenity is usually bought at a fearful price-and the price is the process by which we reach that point. There are some who manage to achieve moments of n.o.bility in which they somehow transcend the indignities being visited on them, and these moments are to be cherished. But such intervals do not lessen the distress over which they briefly triumph. Life is dappled with periods of pain, and for some of us is suffused with it. In the course of ordinary living, the pain is mitigated by periods of peace and times of joy. In dying, however, there is only the affliction. Its brief respites and ebbs are known always to be fleeting and soon succeeded by a recurrence of the travail. The peace, and sometimes the joy, that may come occurs with the release. In this sense, there is often a serenity-sometimes even a dignity-in the act of death, but rarely in the process of dying.

And so, if the cla.s.sic image of dying with dignity must be modified or even discarded, what is to be salvaged of our hope for the final memories we leave to those who love us? The dignity that we seek in dying must be found in the dignity with which we have lived our lives. Ars moriendi Ars moriendi is is ars vivendi ars vivendi: The art of dying is the art of living. The honesty and grace of the years of life that are ending is the real measure of how we die. It is not in the last weeks or days that we compose the message that will be remembered, but in all the decades that preceded them. Who has lived in dignity, dies in dignity. William Cullen Bryant was only twenty-seven years old when he added a final section to his contemplation on death, "Thanatopsis," but he already understood, as poets often do: So live, that when thy summons comes to join The innumerable caravan, which moves To that mysterious realm, where each shall take His chamber in the silent halls of death, Thou go not, like the quarry-slave at night, Scourged to his dungeon, but, sustained and soothed By an unfaltering trust, approach thy grave, Like one who wraps the drapery of his couch About him, and lies down to pleasant dreams.

VIII: A Story of AIDS

*1His name was officially Ismail, which is the Spanish form. But since he and others used the English form Ishmael more or less interchangeably with the Spanish, I will also refer to him as Ishmael.

Also by Sherwin B. Nuland

The Origins of Anesthesia

Doctors: The Biography of Medicine

Medicines: The Art of Healing

The Face of Mercy