It is never easy to contemplate the end-of-life, whether its own our experience or that of a loved one.
This has made a recent swath of beautiful essays a surprise. In different publications over the past few weeks, I've stumbled upon writers who were contemplating final days. These are, no doubt, hard stories to read. I had to take breaks as I read about Paul Kalanithi's experience facing metastatic lung cancer while parenting a toddler, and was devastated as I followed Liz Lopatto's contemplations on how to give her ailing cat the best death possible. But I also learned so much from reading these essays, too, about what it means to have a good death versus a difficult endfrom those forced to grapple with the issue. These are four stories that have stood out to me recently, alongside one essay from a few years ago that sticks with me today.
My Own Life | Oliver Sacks
As recently as last month, popular author and neurologist Oliver Sacks was in great health, even swimming a mile every day. Then, everything changed: the 81-year-old was diagnosed with terminal liver cancer. In a beautiful op-ed, published in late February in the New York Times, he describes his state of mind and how he'll face his final moments. What I liked about this essay is how Sacks describes how his world view shifts as he sees his time on earth getting shorter, and how he thinks about the value of his time.
Before I go | Paul Kalanithi
Kalanthi began noticing symptoms — "weight loss, fevers, night sweats, unremitting back pain, cough" — during his sixth year of residency as a neurologist at Stanford. A CT scan revealed metastatic lung cancer. Kalanthi writes about his daughter, Cady and how he "probably won't live long enough for her to have a memory of me." Much of his essay focuses on an interesting discussion of time, how it's become a double-edged sword. Each day, he sees his daughter grow older, a joy. But every day is also one that brings him closer to his likely death from cancer.
As I lay dying | Laurie Becklund
Becklund's essay was published posthumonously after her death on February 8 of this year. One of the unique issues she grapples with is how to discuss her terminal diagnosis with others and the challenge of not becoming defined by a disease. "Who would ever sign another book contract with a dying woman?" she writes. "Or remember Laurie Becklund, valedictorian, Fulbright scholar, former Times staff writer who exposed the Salvadoran death squads and helped The Times win a Pulitzer Prize for coverage of the 1992 L.A. riots? More important, and more honest, who would ever again look at me just as Laurie?"
Everything I know about a good death I learned from my cat | Liz Lopatto
Dorothy Parker was Lopatto's cat, a stray adopted from a local vet. And Dorothy Parker, known mostly as Dottie, died peacefullywhen she passed away earlier this month. Lopatto's essay is, in part, about what she learned about end-of-life care for humans from her cat. But perhaps more than that, it's also about the limitations of how much her experience caring for a pet can transfer to caring for another person.
Yes, Lopatto's essay is about a cat rather than a human being. No, it does not make it any easier to read. She describes in searing detail about the experience of caring for another being at the end of life. "Dottie used to weigh almost 20 pounds; she now weighs six," Lopatto writes. "My vet is right about Dottie being close to death, that it’s probably a matter of weeks rather than months."
Letting Go | Atul Gawande
"Letting Go" is a beautiful, difficult true story of death. You know from the very first sentence — "Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die" — that it is going to be tragic. This story has long been one of my favorite pieces of health care journalism because it grapples so starkly with the difficult realities of end-of-life care.
In the story, Monopoli is diagnosed with stage four lung cancer, a surprise for a non-smoking young woman. It's a devastating death sentence: doctors know that lung cancer that advanced is terminal. Gawande knew this too — Monpoli was his patient. But actually discussing this fact with a young patient with a newborn baby seemed impossible.
"Having any sort of discussion where you begin to say, 'look you probably only have a few months to live. How do we make the best of that time without giving up on the options that you have?' That was a conversation I wasn't ready to have," Gawande recounts of the case in a new Frontline documentary.
What's tragic about Monopoli's case was, of course, her death at an early age, in her 30s. But the tragedy that Gawande hones in on — the type of tragedy we talk about much less — is how terribly Monopoli's last days played out.
"These essays...show us the human and inhuman realities of capital punishment through the eyes of the condemned and those who work with them. By focusing on those awaiting death, they present the awful truth behind the statistics in concrete, personal terms." --William J. Bowers, author of Legal Homicide Between 1930 and 1967, there were 3,859 executions carried out under state and civil authority in the United States. Since the ten-year moratorium on capital punishment ended in 1977, more than one hundred prisoners have been executed. There are more than two thousand men and women now living on death row awaiting their executions. Facing the Death Penalty offers an in-depth examination of what life under a sentence of death is like for condemned inmates and their families, how and why various professionals assist them in their struggle for life, and what these personal experiences with capital punishment tell us about the wisdom of this penal policy. The contributors include historians, attorneys, sociologists, anthropologists, criminologists, a minister, a philosopher, and three prisoners. One of the prisoner-contributors is Willie Jasper Darden, Jr., whose case and recent execution after fourteen years on death row drew international attention. The inter-disciplinary perspectives offered in this book will not solve the death penalty debate, but they offer important and unique insights on the full effects of American capital punishment provisions. While the book does not set out to generate sympathy for those convicted of horrible crimes, taken together, the essays build a case for abolition of the death penalty. "This work stands with the best of what's been written. It represents the best of those who have seen the worst." --Colman McCarthy, The Washington Post Book World