Review: The Way We Die Now

The Way We Die Now is not the best book I’ve read this year but it may be the most important. In Seamus O’Mahony’s opinion, modern society has forgotten how to deal with death. There are many reasons for this, the collapse of religious belief, the demolition of the extended family, the triumph of the scientific and rational worldview, even our delusions of curing death “real soon now” contribute to our collective denial. Yet death persists. Death remains absolute, sovereign, implacable, terrifying, “majestic and cruel.” Even if we realize our singularity fantasies and greatly extend life death will never be banished. Even the gods die! We must face death, but must we turn it into a carnival of “medical excess?”

I have seen medical excess. My mother was diagnosed with Stage IV Glioblastoma: a form of brain cancer that is so deadly it’s been nicknamed the terminator. Actually, the terminator is flattered by the comparison. Some survived their encounter with fictional terminators. Nobody survives stage IV Glioblastoma: “there is no stage V.” When I heard mom’s diagnosis I looked for actuarial survival statistics. Credible statistics for common fatal diseases are harder to track down than you might expect. I eventually found a paper that cast survival times in a useful form. Median survival was less than three months for younger and healthier patients than my mother. She died about two months after her diagnosis – right on statistical schedule. The universe does not make personal exemptions.

Her death was inevitable, but the expensive, futile, painful and isolating medical gauntlet she endured was not. She just wanted to go home, perhaps to “turn her head to the wall,” perhaps to binge on The Big Bang Theory – she still enjoyed a few silly shows. It doesn’t matter what the dying choose to do with their remaining hours, but it sure as hell matters that we honor their choices and the Way We Die Now makes a compelling case that we are failing “to be brave.” I know I acquiesced to the medial default for my mother; I still feel I should have fought harder for what she wanted.

According to O’Mahony, the medical default is full intervention even when it’s pointless and wasteful. He also notes that doctors are in a no-win situation. If they suggest doing nothing they’re accused of euthanizing patients. If they go full interventionist Rambo they’re inflicting needless suffering and profiting from the dying. Both extremes often end up in court, as if we could fix death with more litigation. Obviously, something in the middle is the best course and O’Mahony argues that doctors should not set the middle course.

Our infantile society needs to grow up and face death like adults. Nothing makes our magical thinking about death clearer than Somerset Maugham’s¹ observations about a “dog’s death.” Maugham hoped he was lucky enough to die a dog’s death! A dog’s death is meant to be a horrible thing but is it really worse than human medical excess? When it comes to sick animals we are clear-headed and compassionate. We don’t subject them to futile treatments, we make them comfortable and take away their pain. I once had a cat that came down with pancreatitis. She wasted away on the top of our fridge until one day we took her to the vet. Her death was calm and without terror. My cat had a better death than my mother. I suspect many pets die with greater dignity than their owners. This is fundamentally wrong and we all know it.

There are no easy answers; it sucks to be mortal. We can’t say until we face it ourselves how we should die so how can we dictate to others? I only hope that when my time comes I have it within me to follow the one bit of advice O’Mahony offers that may apply to all us – “be brave.’

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