Facing Your Own Death

It is hard not to think about death in my business. Often I have pondered on my porch, Poe-like, how I would cope with the knowledge that my death was scheduled to occur in the near future. Would I abandon my patients immediately, and retire? Would I follow the Kubler-Ross steps in predictable fashion - or as an iconoclast, first accepting the inevitable, then becoming irreconcilably angry? How could I, or anyone, continue to interact with friends and family?

We are all so proud of our enlightenment and insight into human life, a product of modern collegiate and post-graduate education - but human death? Most of us cannot fathom the concept of our death. Our ordinarily brilliant minds clang with terror when considering the image of it. Such fear I believe is unhealthy because it robs us of the power of understanding - by that I mean a mature contemplation of death that can lead to proper planning for the future, or a deeper appreciation of the blessings surrounding us - in short, a richer life.

Fear of dying therefore seems to be hidden inside many of us - myself included. My career as a cancer specialist would seem to only increase my angst about death, since I see it every day, yet it was actually relieved when I met a patient who showed what it means to face the end with courage.

The last days of this patient, whom I shall call Mark, are worth sharing with anyone who is searching for a way to cope with a life-limiting illness. Mark was diagnosed in his thirties with a rare type of pancreatic cancer that took his life within six years. We initially thought his tumor could be resected, but at the time of surgery he was found to have tiny but widespread liver metastases. Mark's chance for cure was lost on the day he planned to be rid of his cancer. Although he lived for years after that, it was always while taking various chemotherapy regimens that often left him pale and bald. Eventually his liver metastases became resistant to all treatment, and it was time to move on to supportive care.

Mark was now faced with his upcoming mortality - the most profound experience in human life. What was his reaction to this inconsolable news? As his doctors, nurses, wife and family began to despair, he surged ahead with strength I had never before seen in a dying patient, and may never again. Mark faced his death with fortitude, grace, and a calm determination to carry on with his duties as a manager, husband and father.

St. Francis of Assisi, while hoeing his garden one sunny afternoon, was asked what he would do if he were suddenly to learn that he would die before sunset that very day. He replied, "I would finish hoeing my garden." This too was Mark's answer to the Spectre: "I shall keep living my life on my terms until I feel the grasp of your cold hand." He continued to drive himself to work. After arriving at the office he would rest for several minutes, gathering the strength to get out of his car and walk. Emaciated, with a faltering voice, he carried his load day after day, until he finally collapsed. Mark died two days after his last day at work.

Mark died three years ago, yet he still lives - inside of me. He has become my afflatus, my inspiration on living a life not measured by years, but by deeds. If there is one thing I learned from him it is this: life is only fulfilled when the mind and body are in motion. As long as I can stand and think, I will keep moving - see patients, laugh at jokes, wrestle with my sons, walk the dog, meet my wife for lunch, call old friends - get out and be a part of this great world, not wail in my chair how unfair it all is.

As St. Francis also said, "O Divine Master, grant that I may not so much seek to be consoled...as to console." This should be the prayer of every oncologist.