With so many well known and lesser known individuals dying, I thought it appropriate to share the subject of ‘death’ with you living folk. ‘Living’ is a relative concept incorporating the full spectrum of life – vital, optimistic, value-contributing, inspiring; idling in obligatory existence; pre-terminal existence.

I guess I was just one of those people destined to engage professionally with much human death. And so I’ve become somewhat of an expert in matters of death. I am in fact a ‘mortologist’! My earliest recollection of death was awakening as a kid of six years old or so, in a full anxiety state mortified by the fear of dying. I needed serious consoling which came in the form of my mom assuring me that I wasn’t going to die and that I should go back to sleep. And indeed life continued. My next encounter with death was the sudden passing of ‘uncle’ Joe. He was our electrical repairman who suffered a sudden and fatal heart attack in his mid-forties. I was devastated. How could a person so much alive be suddenly so dead and no more? There was a feeling of loss, desolation, hopelessness and a touch of foreboding. But this too, passed. Until the death of my mom’s brother, uncle Mike. I was now fifteen years old, living within the dogma of religious orthodoxy. Uncle Mike had been tragically killed by a speeding vehicle while walking home from the synagogue. The entire family was traumatized. The wheels came off from daily life for a while. I remember exiting the synagogue the night after Mike’s death and looking up at the clear, starry sky with the moon perched on the horizon and thinking ‘where is uncle Mike?’ and ‘where the hell is heaven?’.

Uncle Mike’s funeral marked my first visit to a cemetery and my first funeral. The coffin containing uncle Mike’s final mortal remains was wheeled in and at that moment the background weeping morphed into a crescendo of sobbing and wailing appropriate for the tragedy. Numbed, I was swept along in the wake of the loss, the finality and the end of a life. Standing at the graveside I listened to the Rabbi as he affirmed with authority that ‘the Lord giveth and the Lord taketh’ and that uncle Mike was such a good and righteous person that the Almighty chose to recall him to His side. And I thought, no way. This is bullshit. And so began my permanent separation from religious dogma and formal religion in all its forms.

I arrived for my interview for a post as a junior resident in neurosurgery towards the end of my time as a military conscript. In the interview with the chief of the unit, I remember vividly one particular question put to me by the Prof. ‘Do you have a strong right shoulder?’, he inquired. I thought it to be a trick question at the time. ‘Pretty average, Prof.’ I responded. ‘Well…’ continued the chief ‘you need a strong right shoulder to do neurosurgery because wherever you go and whatever you do, you will always carry the Angel of Death on your right shoulder!’ A great inspiration on the threshold of commencing a difficult and stressful profession!

And death there was aplenty. Not only in the practice of neurosurgery, with the head injuries, brain hemorhages malignant tumors and the like, but also in the fact that protocol required that all brain dead patients had to be assessed and removed from life-support in any of the hospital departments, by a neurosurgical resident. This applied especially to the brain dead whose organs were to be harvested for transplantation. We were awash in blood, tragedy and death. So much so that when a new funeral home opened its doors, the only clinicians invited to the grand opening were the neurosurgeons!!

There occurred a pivotal moment in the course of my residency. An encounter with tragic death of the worst kind which finally drove me to begin formulating some kind of sustaining, personal philosophy to ease my passage through this extreme profession. I was called one day to the ER, as the resident on emergency call. I arrived in the ER only to find it deserted of all humanity, bar one nursing sister who was seated at the nurse’s station, weeping. Without saying a word to me she pointed to the main entrance. I had no idea what was going on. I walked to the main entrance and there was parked the ‘disaster bus’, an ambulance bus used for large numbers of casualties. Again, no sign of people or activity. I climbed on the bus … and seized up in shock at what confronted me. A bus full of dead children lying on side shelves three high, from the front to the back of the bus. All unscathed and still in their school uniforms. And all were drenched. I walked slowly down the length of the bus trying to absorb this macabre and tragic scene. I then found out that a double-decker school bus had driven off a bridge into the lake below. These were the drowned fatalities. Protocol required that the bodies be brought to the nearest ER for certification before transfer to the State Mortuary.

And so began my life-long study of death. Not the physiology of death but death in a greater context. We’re all going to die one day. That’s an absolute fact, as real as having to pay taxes (for most of us!) But the ‘why’, the ‘when’ and the ‘how’ were the factors that intrigued me. And so I broadened the scope of my clinical enquiry. I questioned patients and their relatives about life preceding the diagnosis and/or death. This enquiry included personal and professional life, beliefs, emotions and in many cases, nurture history. In addition I began formulating a sub-sample of such patients who had survived near fatal physical trauma only to develop a malignant medical condition within two years, and vice-versa, patients who had survived malignancies only to succumb to trauma soon thereafter. Yes, the statisticians would have a field day ripping me apart with the small sample. There’s a lot of people suffering fatal injuries and there’s also a lot of malignant tumors around, so there’s bound to be overlap. But I knew these people personally and therefore while this may have been closer to anecdotal, I was familiar with their life profiles and prevailing causes and effects.

My conclusions in summary: The high risk life situations that predispose to death from illness and/physical trauma include –

  • Nurture
    deprivation and associated compromise of emotional health, predisposing to
    periods of great fear as well as recurring, profound periods of
    hopeless-helplessness in the teenager or adult
  • A
    prolonged and pervasive existential crisis characterized by a subjective
    feeling of terminal hopeless-helplessness (the male of the species often
    suppresses these feelings)
  • Inappropriate
    and extreme fear which becomes an obsessional focal point of existence,
    eclipsing any potential positivity, optimism and hope
  • In
    the case of children under the age of six years that died (brain tumors,
    terminal meningitis) there was a high incidence of discord at home
    (chiefly, parental separation and/or divorce). It was as if the children
    absorbed the pain.

Based on over twenty years of coaching those with potentially terminal illnesses, I have come to realize that we are often not aware of subtle and often suppressed feelings in others, including those close to us. In fact the afflicted have often not engaged in any meaningful way with themselves and are unaware of potentially damaging, deep seated emotions. As regards the potential influences in the environment, we know only too well that loss of a close friend or relative can precipitate a pre-morbid cascade of emotions which may result in the death of the responding individual. The classical and documented example is the death of a spouse relatively soon after the death of the partner following a long term relationship. This for me clearly illustrates the precipitation of a potentially terminal hopeless-helpless mind state which may culminate in death unless ‘revived’ by some new meaning or purpose.

Let me play out with one of my favorite poems …. yes, you guessed it – Death be not proud by John Donne.

Death, be not proud, though some have called thee

Mighty and dreadful, for thou are not so;

For those whom thou think’st thou dost overthrow

Die not, poor Death, nor yet canst thou kill me.

From rest and sleep, which but thy pictures be,

Much pleasure; then from thee much more must flow,

And soonest our best men with thee do go,

Rest of their bones, and soul’s delivery.

Thou’art slave to fate, chance, kings, and desperate men,

And dost with poison, war, and sickness dwell,

And poppy’or charms can make us sleep as well

And better than thy stroke; why swell’st thou then?

One short sleep past, we wake eternally,

And death shall be no more; Death, thou shalt die.

Copyright reserved – Ian Weinberg 2017