Death Becomes Me

I've been spending the past month or so digging into literature about death, dying and grief. From a cultural perspective to a medical one to a fundamentally personal one, my readings have taken me into a topic that has lingered in my mind for many, many years now.

My first regular journalism job, outside of student journalism, was as an obituary writer for the Fort Worth Star-Telegram. Sunday was a very popular day for the obit page, and on my busy, busy Saturdays, talking to one relative or another of a recently deceased person, I learned all sorts of curious things about people's attitudes toward death.

Later, in my first full-time reporting job, having run away from Texas and taken a job at a little paper in California, was mainly education reporting, along with the occasional visit to the site of a car wreck. Some of the situations were appalling and gruesome. Others looked more benign ... but weren't.

One early morning, I got a call as I was heading into work. Illness and vacations on the photography staff left us without a photog to head out to a collision that had just occurred. I always had my camera on hand in those days, and I was asked to stop by the wreck before getting into the newsroom. At the scene -- a T-bone caused when an old woman pulled out into oncoming traffic, probably because of early morning sunlight -- I shot some film while the paramedics worked on the woman. Her husband, in the passenger's seat that took the brunt of the impact, was DOA. She appeared less injured, but was actually in pretty bad shape herself. As I snapped pictures, she raised her hand as if to swipe away the breathing mask the paramedics were using on her. Then her hand fell. She was later "officially" pronounced dead, but this moment, which I caught with my camera, was her last.

Not too long ago, I happened upon that photo. It was taken in harsh early morning light, and I made the mistake of developing it in acufine, as the photographers had been using a mislabeled bottle. The result is a photo of high contrast. Too much light. Even though the important details are visible, the high contrast made it unacceptable for print and it never ran in the paper.

Even if it had been good, I would have objected to running it anyway. I knew the moment captured there, and it seemed crass to run such an image in the paper. I have held onto the print for more than 15 years now.

I remember crying. I remember it being the first and only time of my journalism career that I cried because of a death. I was in the car, leaving the scene, driving to the paper, alone. My body shook and heaved at the thought in my head: Someone will get a call today. She was probably someone's grandmother. They will learn that both of these people are dead. Just like that. Dead.

Then, I wondered why my journalism school didn't prepare me -- or any of my other colleagues -- for the death and tragedy we would inevitably see as news reporters. I cried a little more. And then, I thought: Well, this is my job. This happens on my job. It's my job to deal with it. As if flicking a switch, my tears evaporated, my mind stilled, and distance from death descended upon me.

That was just the beginning of my career. In the years that followed, I went places I shouldn't have gone. Talked to people I shouldn't have talked to. And did things that, in retrospect, make me wonder how I came out unscathed. All in denial of my own death.

(By the way, my internship faculty, Lightfoot, seems to think it unlikely that I did come out "unscathed." He told me in a meeting the other week that he has "an understanding of what working in journalism does to people, and what is asked of people who survive in that line of work." I imagine there's more to that statement than even Lightfoot realizes.)

In any case, the thing which made me leave journalism in the end was another tragedy.

Ten years ago, my youngest brother was in a car wreck and suffered injuries from which he never recovered. He died four years later in a nursing home. I had issues with the manner in which I was pressured to stay at the job -- being short-staffed and having too many people already on vacation took precedence, in the eyes of my editors, over me leaving for Texas. My compliance ended up costing me dearly.

But it also changed my life. What I witnessed in the ICU when I finally arrived on the scene three weeks and one severe brain injury later -- and what I saw over the next four years as my brother withered up in a nursing home and died -- overhauled the way I understood medicine, as practiced in the United States. It also forced me to begin facing my own death, realizing it may come at *any* moment. Sooner or later, but ... it will happen.

It has been a long process of awareness and growing acceptance. The result is that I seem to be a lot more at ease in talking about death than many people I know.

I can't say as I blame them. In my research I've been reading a little bit about Terror Management Theory, which seems to be a psychological theory that humans keep their thoughts and awareness of death at bay as a way to live without the "terror" of annihilation. (I say it seems to be this because I don't really know. As noted, I've only read a little bit.) In any case, if what I've read about that has merit, it makes sense why people have difficulty discussing the subject.

But I think we need to get over that shit.

Seeing what happened to my brother and thinking about the last month of my aunt's life -- she died of cancer earlier this year -- has impressed upon me the urgency of having serious discussions with others about the care we want to receive at the end of life. About this time last year, I asked S2 to be my durable power of attorney for health care. Normally, that responsibility falls to a spouse, but as I'm not married (and can't legally get married), I need to give the legal power to someone in a formal way. Either that, or be subected to the truely "outrageous fortune" of having warring family members, who hold end-of-life care perspectives that clash with my own, end up making the decisions by default.

Dying is not something any of us want to do by default, let me assure you. As was made very evident to me in my brother's case, biological science has advance to the point that it's doing things to prolong human life just because it can, whether or not it should.

Left unchecked, I can easily envision a future in which millions of Americans -- thanks to the aging of the Baby Boom generation -- end up as "living corpses" rotting away on ventilators and feeding tubes for years on end. They'll malinger in health-care institutions of one sort or another with terminal cancers or organ failures for which machines can compensate (but only to the end of keeping the person ensconsed in the hospital, feeling sick, weary and alone). Every time someone in this frail, ailing population begins to die, a "code" team will rush in and resuscitate them.

Far beyond being an unbearable financial burden on our already expensive health system, such a future would be morally bereft. I came to the conclusion 10 years ago that medicine had achieved an element of inhumanity in its practice. Keeping someone alive -- at all costs, no matter how dear -- is fundamentally cruel when it denies them the right to a peaceful and humane death.

We are the only ones who can stop this from happening to ourselves. We cannot count on medicine to do it for us. Doctors are trained to keep people alive, not to help them die well. They need to be able to discuss with patients more honestly the prospect of treatment designed mainly for comfort rather than "cure."

I suppose what's more frightening is that insurance companies may eventually step into the breech where doctors fear to tread. Profit-seeking corporate bureaucrats -- or rather, the people who run the insurance industry (for which I also once worked) -- should not be making decisions about how people die, either.

So the responsibility becomes ours. How do we get to have the death we deserve? I'm talking about the one where, when presented with a life-threatening situation, we are afforded all reasonable measures (and, if we choose to have them, the unreasonable ones, as well). But, ultimately, I'm thinking of how we deserve to die in the most comfort possible, in the company of those we love, at peace with the unavoidable stage of life that is happening to us.

Because it *will* happen to us.

From my counseling perspective, there's a lot of work that can be done with people to help them reach peace at the end of their lives. Part of the work is in helping people define what kind of care they want when dying -- and then to enlist the support of others to make sure their wishes are upheld. Another huge part has to do with helping them address issues of meaning about the life they have lived, regardless of its shortcomings and mistakes. And yet another aspect is helping the loved ones of a dying person honor the process of dying itself rather than denying (and thus invalidating) the profound experience of the one who is dying.

So that is the beginning of my independent study. Something nice and light. To complement my internship....