On Death and Dying

I grew up with operating room gore being the fodder for family dinner table discussions. My dad (a surgeon) never sought to shield us from the reality of life’s fragility. Every surgery, no matter how routine, or how skilled the surgeon, is a fraught undertaking. When people are under my dad’s knife he holds them in that liminal phase between life and death, and the outcome can never be certain.

I was late to get my period. Years later than all the rest of my peers. Late enough that my parents (who typically eschew going to the doctor in the spirit of the shoemaker’s children going unshod), decided I should see someone. A slew of tests and exams yielded nothing—nothing good and nothing bad. The doctor I was seeing recommended one final test to rule out his list of potential bad things that might be going on. He thought it was unlikely, but possible, that a tumor on my pituitary gland was the culprit of my missing period. Just months prior my grandmother had been diagnosed with an aggressive brain tumor and had died shortly thereafter. It was hard for me not to equate tumor with death sentence. At home that evening, sitting with my dad on the couch, I asked, “What happens if they find a tumor when they do the MRI?” He responded, “We’ll do everything we possibly can to take care of you.” “And what if it’s incurable?” I asked. “We’ll hold you and love you while you die,” he replied.

I’ve grown up in the southern culture where people candy coat bad news and criticism to the point that you are never quite sure if they love you or hate you. In a sea of sugar, my dad’s consistent line of honesty stands out in sharp relief.

My mom is of a similar mind—speaking of death in pragmatic (and sometimes irreverent) terms. The most organized woman I know, she’s been curating a file for years that is titled “Dead Parent File.” It has everything from how to handle the family farm to how to cancel my parent’s newspaper subscription, as well as a note that says, in essence, “We love you and trust your judgment.” Her one very clear request is that if we write her an obituary, we say explicitly that she died. Not that she passed, or went on to her great rewards, or that she lost her battle, but rather to just state plainly that she died.

My MRI turned out to be just fine, and my late period showed up on it’s own accord a few years later—an imaginary brush with death. Unlike my dad, I spend my days working with, and for, the most able of the able-bodied. I lead high school aged students on extended backpacking trips, and my colleagues are the sort that find pleasure in running ultra marathons and ascending sharp peaks. So despite growing up in a household that talked death, I’ve had little real experience with the only certain eventuality we all face.

Last summer, however, on the bus ride back to town from a month spent leading a backpacking trip in the Wind River Range in Wyoming, we came across a devastating wreck on the side of the highway. My co-instructors and I were all trained in wilderness first aid, and we stopped, leaving our twelve students on the bus, to see if we could be useful. There were multiple victims, from a single car crash. Most had been unbelted and were flung forcefully from the car, which was overturned, in the sagebrush. The man I helped was conscious but unable to say more than “My chest, my chest, help!” You take extensive first aid training when you work in the wilderness because help is often delayed. I had done scenarios with fake blood and fake patients many times before. Walking towards the scene from the bus it felt like I was walking into a scenario, but once I had the man’s head in my hands holding his spine stable, nothing about it bore any resemble to a scenario.

I knew the man needed advanced medical care and quickly. That care was on it’s way by virtue of the first responders--a family who witnessed the crash and provided initial and ongoing first aid. While we waited for the paramedics, my goal was to keep his spine stable and keep his airway open, and if he stopped breathing or his heart stopped beating, to start CPR. These tools and this knowledge felt woefully inadequate however. I think they felt woefully inadequate because they were. Because sometimes no amount of care, advanced or otherwise can save someone. I didn’t know that the man whose head I was holding was going to die in the Emergency Room later that day, but I did know that beyond protecting his spine and his airway, I could shade his face from the sun, I could talk to him and tell him what was happening with compassion and calm, and I could encourage him to breathe.

When he was airlifted away, and the other victims had left in their respective helicopters and ambulances, and my co-instructors and I returned to our bus full of sobered teens, I felt like the wind had been knocked out of me. From a joyous morning waking up in our tents, feeling the glow of accomplishment of completing a thirty day course in the wilderness to kneeling beside a man who was dying on the side of the road, was perhaps the widest arc of emotions in the shortest time span I’ve ever experienced.

When my supervisor wrote to ask me about how I was doing with regards to the wreck, I said to her in part: “My dad is a doctor, and I know even the most trained medical professionals are not magicians. But that reality doesn’t change how sad it is for a person to die young in a sudden accident. I’m glad we stopped. I’m sad for the family. I’m grateful our students saw what they saw from a distance and hope it will encourage them (and us) to not gloss over the risks we flirt with everyday in the front-country.” That sadness and hope remain a year out from the accident. The addendum I would add now is a question—How, when you dwell primarily in the world of the able-bodied, do you remain sensitized to the fragility of life, and allow that knowledge to cultivate gratitude for each moment you are not in catastrophe?