Some Thoughts

SPOILER ALERT: This essay will deal with the subject of death. If that offends you, depresses you, or is of no interest, now is the time to bail out. No one will know except you.

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You're probably aware by now that I've had surgery for cancer (of the pancreas) but since no evidence of spread was found during the procedure, and all the lymph nodes removed were free of tumor, my doctor is optimistic. So am I. The surgery was six months ago today (irrespective of when you're reading this, “today” is September 15^th, 2016 and I was operated on on March 15^th) and a CT examination I had earlier this week (because of a continued elevation of a particular blood marker) only demonstrated the presence of a fluid collection at the operative site – a not uncommon event – but no evidence of recurrence. In all likelihood that fluid collection, a seroma, was the cause of the blood abnormality. What could be bad? I'm receiving chemotherapy as a “precautionary” measure but there's no particular finding to follow apart from how I feel, which is fine apart from occasional abdominal pains which aren't new. Actually I'm hungry most of the time.

What follows is something I wrote earlier this week. It will serve as a beginning of a description of my thought processes during the past few months.

Feeling pretty good today. The anxiety has worn off and I'm back to my usual (lack of) serenity. Yesterday's I was dying (literally, I thought) but not today. Not “dying” in the sense that a stand-up comedian might suggest – “I was dying out there” – but in a very physical sense. With the rising Ca 19-9 and the increasing abdominal symptoms [probably psychosomatic] I was convinced that there was a recurrence. The reassurance from the CT has eased my mind. There are still some explanations required, but they're relatively insignificant.

I wrote it earlier this week, the day following the CT – the day my doctor read the report to me. Since a couple of weeks prior to my surgery, starting about the time the diagnosis was originally made, I've been keeping a “diary” of my thoughts about the whole affair. (I've also had separate ideas that I haven't recorded and I'll include them as I relate a summary of the maunderings that appear in the diary.) I may even have expounded on some of them before in this series of essays. Who remembers? Indulge me. I'd do the same for you.

Not surprisingly, a lot of the diary is devoted to thoughts about death. It hasn't really mattered whether I was feeling well at the time or whether my symptoms were obvious – death has always been coloring my thoughts (and, from now on, I guess it always will). It's been difficult to consider anything without giving thought to how my death would affect it. That means that I've wondered about the wisdom of buying new things that I can do without if I'm going to die soon; it means that I keep wondering how everything will work out. I'm convinced that my death will mean a complete separation from all my experiences in this world; that if, in some form of “life” after death, I have any cognition, it will be totally unrelated to my life's contents: I won't have any knowledge of the people I knew or the world in which I lived. It will be a totally unrelated phenomenon, one lacking in awareness of this world. It's not all bad, though. I don't recall large parts of my childhood yet I don't suffer from the lack. And if my understanding of the teachings of my heritage is correct, it will be far more glorious than anything I've ever experienced.

But I've spent more time pondering what concerns me more, which is the possibility of eternal nothingness. If that's the case, however, I'll never know it. And that's what probably bothers me more than any other consideration. I'll never know what people said about me at my funeral – for better or for worse. Some, but not all, will be true. Of course it will all be complimentary – you don't speak ill of the dead. At least not in front of a grieving family and other witnesses. But, as I said, I'll never know.

And, I fear, I'll never know what happened with my children, grandchildren, and the generations that followed, nor what happened to my country and the world situation. And I'll be completely ignorant of the fate of my people. But, of course, I won't be aware of that ignorance or of my lack of knowledge of other matters – of anything at all.

And that's the “rub.” I've always wanted to know how things turn out. What happened next. Sleep has never been a threat because I was always confident I'd wake up afterwards. I'm not especially concerned about nightmares since, for the most part, they haven't been a problem. And dreams provided interesting interludes – diverting nocturnes. I didn't always remember their contents, but, when I awoke, I knew that I had had them and enjoyed myself along the way.

“When I awoke.” That was the key. I was sure that I'd wake up. There was a future. So if I missed something while I was sleeping I could always catch up on it when I awoke. But if the scenario of eternal nothingness is correct there will be no catching up. I'll never know, and I'll never know that I don't know. And I won't care. In fact I won't anything.

I'm not afraid of death. I'm aware that I haven't gone through all of Kubler Ross's stages. Denial of course. I'm perpetually in denial. But no anger, bargaining, or depression. Straight through to acceptance. Of course at my age death is always on the horizon so I've come to accept the idea that, sooner or later, it will come. It's normal. Death is a normal part of life. I'm no different from everyone who preceded me. And, after a while, I'll be forgotten by those who knew me. Those who didn't will have nothing to forget.

And I'll never know what happened next.

DABDA

                                                                                                                              

Like everyone else, especially the very young and the old, I've been thinking about death.

“And yet most of us live our day-to-day lives without focusing too much on our own mortality. For better and for worse, we do not live each day as if it could be our last; we do not make the fact of death a dominant reality in our everyday lives. When a loved one dies or some tragedy strikes, we are perhaps reminded of our mortal condition; we might imagine our children throwing dirt into our graves. But the immediacy of life quickly returns, and we live again, for a while, as if the horizon of the future were very long, if not indefinite.”ⁱ

Cohen and George are right. It's an intellectual exercise, not “a dominant reality in [my] everyday [life].” However unreal though, every now and then it comes to mind. For example, I was thinking about death while listening to a eulogy at a funeral I attended recently. I wondered about what would be said at my funeral. (Don't we all?) There are so many characteristics a person has, so many ideas he has about himself. How are these distilled by the speaker? How is a choice made about what to emphasize? What will be included in my obituary and what will be omitted? I know the aspects of my personality and my life that I'd want to be mentioned, but the decisions will be made by the speaker.ⁱⁱ And, if the funeral is typical, my virtues will be overblown. How can I fault that?

Of course I won't know what is said. I've constructed the same scenarios as everyone else for what death is like, and only the least plausible includes consciousness of the life I would have just left.ⁱⁱⁱ Nothing is more likely. Or, better said, “nothingness” is more likely.^iv Among the other possibilities is a kind of consciousness of the soul, and knowledge and participation in some form of “afterlife.” It's hard to imagine what this might be, but I treasure it as a possibility in order keep open the hope that the end of life is not the end. I can imagine dying. There may be pain, or there may not. I may be competent or unable to understand the world around me. Indeed, I may be insensate. But I cannot imagine death. I'll be alive when dying. There will always be a future for me, no matter how bleak. Unfortunately, as far as we know that is not the case with death. And that is what leads to fear.

Elisabeth Kübler-Ross characterized the reactions to the expectation of death and to that fear: denial, anger, bargaining, depression, and acceptance – DABDA.^v It's reassuring to think that ultimately I'll probably come to accept death, and knowing that, I've already worked out a form of rationalization of it. It doesn't tell me what death is like, only that I shouldn't be afraid of it.

I like to think of death as similar to what I experienced as a child. (And it's comforting to do so.) My parents forced me to take a nap or to go to sleep, and I fought it.^vi And that was especially true when something exciting, like a party for me, was planned for the other end of the sleep. But when I awoke, rested, it was clear they were right and the new “life” I was experiencing was better than anything that preceded it. Sadly, I didn't remember that the next time sleep was forced on me, so I feared it and fought it the next time.^vii

Even so, it is our understanding – right or wrong – that there are things worse than death. From Patrick Henry's perspective, and that of many of his fellow Founding Fathers, the most valid stance was “Give me Liberty or give me Death.”^viii And, in the words of Nathan Hale on the scaffold, “I only regret that I have but one life to give for my country.”

More recently the motto was “Better dead than red.” Catchy, if somewhat jingoistic. Some may have taken it seriously, but in all likelihood most considered it more a slogan than a policy. Most examples of self-sacrifice are probably impulsive.^ix That doesn't make them less heroic, for those whose instinct is to save others at the expense of their own lives demonstrate lifelong training in patriotism and in concern for others. Perhaps it's genetic,^x and is an evolutionary strategy for species continuity, but whatever the reason for giving one's life for others, it demonstrates that for those people death was preferable to the alternative.

Not so heroically, we all rush toward death. We don't think of it in those terms, but that's the reality. We live, as Cohen and George remind us, “as if the horizon of the future were very long, if not indefinite.” We're eager to reach the next milestone in our journey – a birthday, anniversary, new job, daughter's wedding, or retirement – for what we consider to be reasons of enjoyment. Or we're determined that some unpleasant task will be completed and we can move on. But all of these things will take place in a future which we seek earnestly. And all bring us closer to death, although that is never on our minds. Nor should it be. After all, there's no point in thinking about things like death. Even if others do. We won't have to worry about it for a long time.

That's denial. It's the first step.

Next episode: “I Cannot Tell A Lie” – My memory isn't good enough.

I        Eric Cohen and Robert P. George, “The Problems and Possibilities of Modern Genetics,” in Constitution 3.0, Jeffrey Rosen and Benjamin Wittes, editors. Page 186.

ii        Of course I won't hear it, but that doesn't keep me from wondering. Perhaps I'll prepare a résumé for the speakers in order that nothing I consider important will be unavailable. That, however, is no guarantee that it will be used.

iii       But since I cannot know what G-d has in store for us, the speculation is childish.

iv       See note iii.

v       On Death and Dying, 1969, Routledge.

vi      I didn't know what sleep was, and whether I would awaken. And even if I did, I'd miss so much.

vii     It may be fantasy, but it's reassuring. Moreso than believing, as many do, that nothing follows life but the rotting of the corpse. (If they're right they'll never know it.) And from my point of view,such a fantasy is no loss. In fact I will have been happier than I might have been. If they're wrong, they've spent a lifetime anticipating a nothingness of their own creation.

viii    That, of course, didn't prevent them from allowing slavery in the Constitution. Politics and all that. Henry, himself, condemning a strong central government along with condemning life in general under British rule, opposed the Constitution, but still owned the slaves he inherited. “I am drawn along by the general inconvenience of living without them.” Inconvenience, apparently, was also worse than death.

ix      Suicide may also be impulsive, but that's not the subject here.

x       See http://plato.stanford.edu/entries/altruism-biological/