What is death? Or more importantly, what does it really mean to die? Doctors and nurses confront mortality every day at work, but so does everyone else who lives—or rather, exists—in the present. Death is often considered a taboo subject, and to those who have never experienced it up close, death may seem like an intangible yet inevasible reality. A few brave souls walking their final journey have documented the transition from being “alive” to “lifeless”—literally when breath becomes air—including the sociology professor Morrie Schwartz, author Amy Rosenthal, and neurosurgeon Dr. Paul Kalanithi. In their words, they address the questions: what happens when you realize that your time is finite? How would you live tomorrow differently?

“To live is the rarest thing in the world; most people exist, that is all.”        -Oscar Wilde

Dr. Morrie Schwartz, who preferred to be called “Morrie”, was a sociology professor at Brandeis University until 1994, when he was diagnosed with ALS and given a prognosis of 12-18 months. Mitch Albom, a former student of Morrie’s, rediscovered his old professor during an interview with Ted Koppel on Nightline. In a series of visits collectively published in Albom’s bestseller Tuesdays with Morrie, the pair explored a variety of topics including forgiveness, aging, and regret. Despite losing the freedom to enjoy simple, everyday pleasures, Morrie bravely approached his disease with defiance and acceptance—defiance of ALS’s threat to rob him of his dignity, and acceptance of death’s inevitability. An interesting analogy he presented was that of a little bird on his shoulder, symbolic of his self-consciousness, which he asked every day “Will you sing your last note today?” Morrie’s sobering acknowledgement of the fine line between life and death motivated him to live the remainder of his life fully, and he summed this up in a quote: “When you learn how to die, you learn how to live.”

Another exemplar of a brave soul is Amy Rosenthal, a prolific writer of children’s books and a poignant memoirist who recently passed away from terminal ovarian cancer. A mere 10 days before she took her last breath, Amy wrote a bittersweet paean titled “You May Want to Marry my Husband” on the New York Times’ “Modern Love” column. Humorous yet endearing, she lauds her spouse of 26 years while facing her imminent demise. What strikes me as most heartwarming is her cheerfulness amidst the pain—her ability to remain spirited despite having her energy “drained by morphine and a lack of cheeseburgers”. Reading her letter, one experiences the pressing time limit that Amy faces, a person who loves life as much as anyone else, who “wants more time with her husband, more time with her children, more time sipping martinis at the Green Mill Jazz Club on Thursdays nights—but that is not going to happen”. Her optimism and sincere anticipation for her loved ones’ new lives are admirable qualities, rarely seen even in the disease-free public; must it take death to highlight such simple yet integral values?

Personally, the narrative I found most compelling was Dr. Paul Kalanithi’s, a neurosurgery resident who diagnosed himself with stage IV lung cancer at 37. Paul was at the prime of his life: he had acquired a B.A. in literature, an M.A. in Philosophy, and an M.D. at Stanford, Cambridge, and Yale respectively; he was happily married and looked forward to starting a family; he was the archetype of a medical humanities enthusiast. In his memoir When Breath Becomes Air, Kalanithi eloquently tells the story of how, like many students, he had “postponed learning how to live while pursuing a career”. As his perspective shifted from a physician’s to a patient’s, he notes with chagrin how communication breaks down between the two—he was often treated as a “problem” by inexperienced interns, even dehumanized. In his new role as a patient, he eventually stopped flipping through CT scans and instead began asking “who will I be, and for how long? What does the future even mean anymore?” His story was abruptly cut short 2 years ago in March, but in his final great contribution to the humanities, Kalanithi immortalizes the beauty of medicine and life, urging us to continue pursuing what makes life truly meaningful.

Death and dying are topics that should be openly recognized, discussed, and accepted between doctors, patients, and their families. Reflections on the implications of diagnoses, the “human” part of any disease, is often of far greater value to patients compared to the facts and figures (stats and scans) that are thrown at them in a disorienting manner. In the end, as Dr. Kalanithi expresses beautifully: “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”

Posted by Fiona Pat

Fiona is a freshman studying Neuroscience, Psychology, and Bioethics. A member of HMR’s Medical Humanities team, she explores topics involving the more nuanced, “human” aspects of medicine, such as philosophy and the arts. The quintessential Hopkins pre-med, Fiona aspires to advance medicine by disseminating research findings through HMR, and by conducting research at the med campus’s Snyder lab. She also hopes to bridge the gap between healthcare and the local community by volunteering at the JHH’s Adult Emergency Department, the American Red Cross, and SHARE. You can catch her in Brody tweeting the latest medical news, drawing Orgo mechanisms, or hunting for crab cakes around Baltimore.

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