With the end in mind

I’ve only seen one person die. One afternoon when we were in graduate school, a knock came on the door and the wife of the couple across the hall asked me to see about her husband, that something was wrong with him. I found Steve on their bed, convulsing. I slid him away from the headboard, against which he was banging his head and held him until he stilled. At that point, he stopped breathing and I couldn’t find a pulse, so I moved him onto the floor and commenced mouth-to-mouth, as I was trained to do in Red Cross lifesaving class until the ambulance arrived. Later, I heard that Steve was DOA and that he had some kind of undiagnosed congenital heart problem.

Both of my parents died a few years ago, in upstate NY. I was hundreds of miles away. My dad had been in a nursing home with dementia and his death wasn’t unexpected. My mom’s death followed surgery for a femur fracture after she fell while dancing with my dad.

I realize that I don’t have many years left, and so when I stumbled across the book “With the end in mind: Dying, death, and wisdom in an age of denial” by Katheryn Mannix, I thought it would be a good idea to do what I’ve done for all my adult life—read what the experts say. Mannix is a British physician, trained specifically in palliative care. Her book is a series of episodes with various patients she’s seen in her decades of practice. Each story is “true,” although names and identifying details are changed, and each story illustrates the variety and complexity of the dying process on individuals and their loved ones.

Mannix reminds us that 100 years ago and more, observing death was a common part of life experience, but that more recently, more and more people die in hospital or hospice, not at home. As a result, the experience of a dying person is unfamiliar, at least in industrialized societies. She shows us that the dying process is similar to the birthing process, in that there is a fairly stereotypical sequence as the process approaches its conclusion. For most, the dying person eventually drops into a sleep that becomes unconsciousness and then coma. There is a typical pattern of breathing that diminishes in frequency and intensity until it stops. In most cases, there are no signs of suffering.

As a physician, Mannix is focused on the needs of each patient in terms of pain mitigation and other discomfort, to provide the dying with the smoothest path and to allow the survivors to see their loved one take this final journey peacefully. Mannix takes us inside her head as she navigates the complexities of each patient, their culture, their support system. Some are children, some in mid-life, and many are elderly. I found myself crying a little at the end of each story. Every so often, the stories are interrupted by a page or two of reflection on what Mannix meant for us to see, as well as offering some questions about how we might apply these vicarious experiences to our own lives and expectations.

We are all going to die. If we live long enough, we will see many of our loved ones predecease us. If you are interested in expanding your toolkit of intellectual and emotional coping mechanisms to anticipate these inevitable realities, I highly recommend this book. https://bookoutlet.com/products/9780316504485B/with-the-end-in-mind-dying-death-and-wisdom-in-an-age-of-denial?source=ppc&ppc_campaign=&keyword=&gclid=Cj0KCQjwn4qWBhCvARIsAFNAMigepwcasu91M7AKGQ3RbzyV6TuK5WoO-7zvpDx0Er5cxy7MiOzG3bIaAirWEALw_wcB&fbclid=IwAR1y5iw22ZXUPsf3KD4_g-FQ2fejN-oBiGB_ho_MEyTo7faHnjEMpwzMDfg