His essay "That to Philosophize is to Learn to Die" recently struck a chord. Death, being ineluctably the ultimate end of all men, is strangely absent fom the modern dialogue. It is something to flee from, a unpleasant flaw to lock up in a chest in a cobwebbed, dusty attic. Especially here in 21st century America where we almost beatify accomplishment and material achievement, Death has become an embarassing scandal, an unmentionable. The cycle of life has been overrun by the concept of unending progress and self-improvement. There is always another day. Anyone can become or achieve whatever she wants, if she puts her mind to it and works hard enough. This is the orthodoxy of an America that has found a way to fuse Christian elitism (we are the exceptional, chosen nation) with a crass free market materialism that rewards the strong and purposeful. Willful neglect of the final leveling force, the geat socialist, Death, is the only way to maintain the illusion of interminable vigor and prosperity. Early death is now always a "tragedy". The death of the old and decrepit is shunted off stage, to poorly lit vigils in stale smelling nursing homes or worse.
The goal of our career is death. It is the necessary object of our aim. If it frightens us, how is it possible to go a step foward without feverishness? The remedy of the common herd is not to think about it.The Surgeon has seen far too many gruesome scenes in noisy, halogen-lit ICU's where mystified sons and daughters, glassy eyed with fatigue, wander from bedside to vending machine, uncertain of what to do, adrift without instructions. There is a pain etched on their faces that transcends mere grief at the impending loss of a loved parent, rather it is almost a wrenching plea to make it all stop, a cry of "why are you making me watch this?" or "get me out of here". One becomes numb to it all after a while. The medical professionals are used to it. The listless wretches pass them like ghosts.
Meanwhile, a ninety year old gets hooked up to a dialysis machine. A 78 year old with severe COPD gets slammed with four different antibiotics, facial expression a sadistic half smile ossified by propofol and the endotracheal tube tugging at the side of his mouth. An 82 year old demented soul returns from emergency surgery for a perforated cecum status post colonoscopy for "GI bleeding". Maybe one in ten will leave the ICU, injected back into the slow flow of delta detritus out to sea, deposited in yellow curtained nursing homes or LTACH's, shadows of the previous people they used to be.
Why do we ignore Death, the Surgeon wonders. Why is it the foe? Why is it not integrated into a healthy worldview? Why do we fail to attend to our last days, when we have the capacity to do so? Why isn't the scandal to be without a last will, a legally binding document that eliminates the bewildered stares of loved ones left behind?
It is no wonder they are so often caught in the trap. These people take fright at the mere mention of death, and most of them cross themselves at that name, as at the name of the Devil. And because death is mentioned in wills, don't expect them to set about writing a will until the doctor has given them their final sentence; and then, between the pain and the fright, Lord knows with what fine judgement they will concoct it.