A Thousand Little Deaths

By Dugdale, Lydia S. | The Hastings Center Report, July-August 2011 | Go to article overview

A Thousand Little Deaths


Dugdale, Lydia S., The Hastings Center Report


Doctor, just one more thing." I marvel every time I hear this, nearly always as I reach for the door. It is as though all patients receive copies of the same instructions, perhaps posted somewhere in the waiting room:

1. Wait until your appointment has run over time.

2. Watch until your doctor stands to leave.

3. Ask a question of grave importance that cannot possibly be answered quickly.

I released the doorknob. "Yes, sir?"

"I was wondering if you had any advice for me on preparing to die. You see, I got a copy of the pathology report and even though my oncologist didn't tell me the prognosis was bad, I did a little of my own research. I learned that 'high grade' and 'poorly differentiated' don't bode well for me. My wife is much younger than I am, and I guess I'm just kind of thinking ahead, you know, for her sake."

Advice on preparing to die, in one minute or less.

I took a deep breath, and as I did so, a myriad of questions bubbled to the surface. What did he mean, "preparing to die?" Was he talking about managing his estate? Or did he want the name of a good funeral director, someone who could help him plan his ceremony and order his casket? Was he religious? Did he want advice on spiritual preparation for death, a prescription for redemption? Or was he worried about physical suffering and the burden he would be to his wife? Was he interested in hospice or doctor-assisted suicide? Was this some sort of anticipatory grief? Did he understand what he was asking?

In his classic work The Hour of Our Death, French historian Philippe Aries traces the history of Western attitudes toward death over the past millennium, recounting the evolution in rites, rituals, and cultural values that transformed what he calls a "tame death" into an untame, "invisible death." He writes that whether tame or not, death "always remains a misfortune, a mal-heur!" He continues:

It is remarkable that in the old Romance languages physical pain, psychological suffering, grief, crime, punishment, and the reverses of fortune were all expressed by the same word, derived from malum, either alone or in combination with other words: in French, malheur, maladie, malchance, le malin (misfortune, illness, mishap, the devil). It was not until later that an attempt was made to distinguish the various meanings. In the beginning there was only one evil that had various aspects: suffering, sin, and death. …

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