Sunday, March 18, 2007


A famous anecdote of Alexander the Great tells of the great hero once finding a scholar meticulously studying two sets of bones. Out of sheer curiosity he asked the latter what he was looking for. To which the scholar replied, “That which I cannot see: the difference between your father’s bones and those of his slaves.”

Take note that this took place during a time when kings were literally worshipped, where palaces kept trains of servants and slavery was still the norm. And I am reminded of the oft-spoken ode to death, the all-powerful equalizer: “Ashes to ashes, dust to dust.” We begin from nothing, and to nothing we shall end. Whatever we have here on earth, we leave to our loved ones and to those whom we will.

We had a pretty much similar experience last week during class. It was supposed to be just another ordinary lecture on death and the dying process, but what took place thereafter was beyond a medical student’s usual expectations for we did not only tackle biological matters but had heart-to-heart group discussions on how it would’ve felt to die, on how one expected to die.

Suffice to say the activity elicited a variety of reactions – surprise, discomfort, nonchalance, fear – a few even regarded it as fun. One of my classmates joked, “Why, of course I’m afraid of death! I don’t even get to have grandchildren!” The truth is we were all caught unawares. It’s not as if we go around thinking about the day we die every minute of our lives, otherwise it completely erases the essence of living. Death is a subject long regarded as culturally taboo, but which is now being laid out so openly for us to dissect and relate with.

Surely everyone wants to die a good, and if possible, painless death. What, therefore, constitutes a “good” death? Then rose another interesting debate on how death is to be considered “timely”. How do you characterize a “good” and “timely” death?

Semantics can sometimes exert a formidable influence, as there lies a great deal of difference between “good” and “timely”. Take for instance martyrs who fought for a country’s freedom – what kind of death did they die? Good, because it was a death transcending a far higher purpose; at the same time, untimely because most, if not all, died at the prime of their lives.

In a way, I am led to think that somehow, having a concept of death enables us to have a concept of life. Eternal existence without meaning is pointless; it is only when we realize that our days are numbered (more so with not knowing where this numbering will end) that we truly wake up to our feet and attempt to accomplish a myriad things while the day is not yet done. Thus we have a cliché I personally keep and repeat over and over to myself: “Carpe diem”, seizing the day, the way to live life to the fullest.

Yet however hard you try to stretch each day to the very last second, time will not always be enough. And this goes without saying that no one is ever really prepared for death. Like lightning, it may strike at a time when we least expect it, or during a moment when we thought leaving this world is the last thing on our mind.

Medically speaking, managing a dying person essentially devolves into two aspects of the healing process which must go hand in hand: curative and palliative. The first has something to do with treatment of disease and preventing its complications; the second focuses on improving or at least maintaining the quality of life. What seems to be the point here? For one, we have always been so preoccupied with the curative aspect. And this is easily demonstrated in situations where families and doctors try to utilize every method and resource possible just to prolong life, oftentimes not minding the fact that the patient himself is actually ready to die. But enter the palliative aspect where empowerment of the dying and preservation of their dignity is the main concern – and you have the touching picture of patients dying with a smile on their lips.

As it was explained during the one-hour talk, it is not so much the fear of death per se, but more with the process leading to death: an overwhelming feeling of weakness, noisy and rattled breathing, breathlessness, difficulty swallowing. One of the lecturers shared her ordeal with Non-Hodgkin’s lymphoma – a malignancy of the lymph nodes – and she remarked that going through and eventually triumphing over the ordeal made her understand and empathize with dying patients more.

We were also told of a certain tribe in Indonesia that actually celebrates death! As with birth, marriage or any other celebrated occasion, death is seen as a milestone where one is shipped off into another new dimension. How plausible this may sound can only be deduced if we try to look at death as some sort of transition: In the same way that the fetus transits from the relatively quiescent environment of the mother’s womb to the outside world, so do individuals make the same journey to the great beyond.

And perhaps history does celebrate this journey just as much as life itself. What with the age-old mysteries of mummification, of Egyptian artwork portraying Pharaoh’s death as a grandiose journey on a magnificent ship, of Hades and his boatman Charon ferrying across the sinister rivers of the netherworld. Myth has its basis. After all, as the Egyptians once believed, death is only the beginning.