It’s an age-old idea that mortality shapes our lives. Samuel Johnson wrote that the prospect of one’s own imminent death “wonderfully concentrates the mind.” Sam Keen, in the introduction to Ernest Becker’s Pulitzer Prize–winning seminal work, The Denial of Death, like Johnson, observes that the contemplation of our inevitable death is, “paradoxically, the tincture that adds sweetness to mortality.”
And yet, in contemporary Western society, most of us cling to denial. When I carefully broach the subject with patients that we are all going to die sooner or later, most look totally shocked. Doctors are hardly immune, either. I have been a family physician for almost three decades and death is my constant professional companion; if you’d asked me, I would have said I was comfortable with notion of mortality. But then, one morning, a few years ago, while I was staring into the bathroom mirror and noticing my first grey hair, my own fear bubbled up into stark consciousness. Like a clichéd lightning bolt coming out of the heavens, I suddenly realized I was terrified of dying. It got me thinking; if I’m not comfortable with thoughts of my own mortality, how many others in my profession feel similarly, and how does that affect the way we relate to our patients?
Nowadays, the majority of people die in hospital. The family doctor’s vigil by the bedside in the patient’s home has been replaced by the beeping gadgetry of modern medicine in a sterile and impersonal environment. Most of us are dying hidden away inside aged care facilities or in the ICU ward of hospitals, sequestered away from the eyes of the living as they go about their daily business – as if death is something that happens only to other people. As Elaine Kasket (yes, her real name!) points out in her seminal article “Death and the Doctor,” the coping mechanism of emotional detachment is “valued and rewarded in medical academia and practice.” Perhaps as a result, open and honest discussion around death over the past century has gradually become the last taboo in Western culture. What would it be like if, rather than pretending that death will never happen or is simply too far off to think about, we used the very notion of being mortal to influence how we live? Looking in the mirror the day I realized I was turning gray, I decided to turn around and stare into the Grim Reaper’s absent face. I needed to write a book inspired by my fear of death.
Death is an inescapable part of life. The Population Reference Bureau estimates that over 108 billion people have walked the earth over time—which works out to around 15 people dead for each person living now. On the same day as you celebrate your birthday, 150,000 people around the world are having their deathday. After five years on a road trip with Death alongside me in the passenger seat—during which I spoke to gravediggers, sword swallowers, base jumpers, taxidermists, terminally ill children, bereaved parents, and nonagenarian athletes—I’ve realised Death’s not always such a bad guy. I thought the research would be serious and morbid, but more often than not, it’s been a joyful and hilarious journey. I talked to a fascinating array of people, like Julie, a nonagenarian patient of mine vying to participate in the Senior Olympics 25m breaststroke race. Despite my reluctance, I agreed to sign her medical fitness form, and she went on to shock me by winning a gold medal. When I asked her how she did it, she replied, “It was easy, I just needed to finish the race.” She pulled the medal from her bag and smiled. “You see, Doc, I was the only entrant.” Then there was Aerial Manx, who holds the world record for the number of backflips performed while swallowing a sword. He risks his life for a living, and told me, “The time I feel most focused and at one with myself is when I have a sword down my gullet.” In 2012, Fearless Felix, who jumped 24 miles, from the stratosphere to Earth, said soon after landing: “Sometimes you have to go up really high to understand how small you really are.” If we keep death in our sights, it can help frame how we live. What is important to us? What do we hold dear, and how do we want to be in this world? In essence, death can be our teacher in the classroom of life.
Nowadays, we only need to look at TV series, movies and video games the likes of Game of Thrones, Plague Inc. and Call of Duty to see how deep the disconnect is from the reality of death. Oddly, the language of actual death is steeped in euphemism—we “pass away” or “take a dirt nap” or “check into the horizontal Hilton”—but “dying” is ubiquitous in our everyday lives: “I’m dying for a beer” or “I’d kill for a doughnut.” Sipping my tea in the kitchen, reading the day’s headlines of car crashes, terror attacks and suburban murderers we’ve grown strangely accustomed to, I overhear my son and his mates in the next room huddled around the screen: Kill him! Quick. Get those guys over there! Oh No!! I just died! All this serves to sanitize death—and in sanitizing death, we sanitize life.
To the extent anyone is comfortable with discussing mortality, we assume the elderly should be. (Though as I’ve learned from working with my patients, not even the very old have always made their peace.) Yet, death is present from womb to tomb, and developmental studies show that children generally pass through various stages of awareness of death. At a young age, it may be through exposure to the idea of mortality through small events, such as the daily drive past a cemetery on the way to kindergarten, an upturned beetle in the garden, or an ailing cat that is taken to the vet and never comes home. Toddlers and pre-schoolers will usually take this sort of loss in their stride, having difficulty comprehending the permanence and universality of death. This can also be a time when fear of death sets in, especially if there has been the loss of someone as significant as a much loved grandparent. Although I often found it harrowing interviewing dying children or their parents for my book, I also felt uplifted by their wisdom and honesty and the emphasis on making the most out of whatever time they had left together. A researcher at the University of Queensland, Virginia Slaughter—yes, her real name!—found that when death and dying are discussed with children aged 4-8 in biological, rather than abstract, terms, there was a direct correlation with a decreased fear of death. She comments: “The best way is to put it in the context of the whole life cycle—birth, growth, getting older, dying. … It’s the reality of all living things and not something to be terrified about. When parents avoid that topic, misunderstandings proliferate.” The joke newspaper The Onion suggests a simple way of opening up a discussion of death with kids: “Buy a goldfish; wait.”
I suspect part of my own discomfort around thoughts of mortality stems from my personal experiences. I was the child of refugees from a war-torn Europe. My mother survived the brutality of Bergen-Belsen only to find herself alone in the world after liberation, aged twenty-one, her entire family tree burnt to a stump. The dead were a palpable presence in my house as I was growing up, haunting my parents’ conversations or draped heavily over the silence. This not only helped form a weighty imagination for a writer, but probably also led me to become a physician. It also made me realise from a very young age how precious a day can be.
My mother wouldn’t even allow me to have a pet, to spare me the grief she was all too familiar with. Perhaps in reaction to this, I resolved to raise my own children with a veritable menagerie—a crazy tortoiseshell called Shnoopsie; the evil Kitty, who acted out his Superhero frustration about the ordinariness of his name; furry mutts named Toomuch and Couchon; generations of bunnies begat from the original sin of Schnitzel and Chips, which occurred in our backyard Garden of Eden; and a host of guppies—Herring, ET, Flower and Gefilte Fish. I was determined to expose my young offspring to the inevitability of animals’ deaths, always helpful primers on the natural cycle of life and death. I’m not sure it was enough to counteract the overiding pull of cultural attitudes to death.
The young adult stage of our lives is supposed to represent the onset of maturity, yet it is also a time when we push death away, bathing in the seemingly untouchable fountain of youth. The enculturation of death denial is at its height at this stage of life, but so too are suicide rates and risk-taking behaviours. In 1974, tightrope artist Philippe Petit walked along a cable suspended between the two buildings of the World Trade Center, teetering 400m above ground. He never saw himself as taking risks (don’t try this at home!): “Death frames the highwire. … I do all of the preparations a non-death seeker would do. It was terrifying. Still, I grabbed the balancing pole not with the feeling of a man who is about to die.”
In The Denial of Death, Ernest Becker writes:
As soon as a man lifts his nose from the ground and starts sniffing at eternal problems like life and death … then he is in trouble. Most men spare themselves this trouble by keeping their minds on the small problems of their lives. … They ‘tranquilize themselves with the trivial’—and so they can lead normal lives.
I set out to write a book in order to stare down my own irrational fear of death. At the outset, as I collected piles of books and articles, the process felt daunting, but it ended up being so enjoyable. I have seen some of my remarkable patients, when forced by circumstance to confront their own mortality, rise above and conquer this terror. They have shown me that contemplating death does not have to be something dreadful.
It is my hope that engaging with the notion of death, a subject crucial to the very essence of our being, will prompt widespread, deep public discussion. Its time has come. And there are signs that death is the new black: Since I first set out to write my book and research the last taboo, death cafes, death salons and natural death centres—places where people come together to talk openly and honestly about mortality in a friendly environment—have started springing up around the Western world. Books like Atul Gawande’s Being Mortal and Caitlin Doughty’s Smoke Gets in Your Eyes & Other Lessons from the Crematory have hit bestseller lists. Even Hollywood has been tackling deeper end-of-life themes with a modicum of sensibility in films such as The Fault in Our Stars and Me Before You. If the current death movement is anything to go by, there are indications the cultural mentality about death is shifting, shaking off a hundred years of collective censorship. People are increasingly curious to talk about mortality. This openness to exposing our private vulnerability and anxiety might embolden others to speak their own truths, and this common bond could forge a greater connectedness between us. We are witnessing a generational shift from aging baby boomers who brought in the sexual revolution and are not going to die lying down, to Gen Y who wants to talk about it openly, while partying along to death themes. Traditionally, we have draped the Grim Reaper in the darkest of colors, but I hope death will have its moment in the sun again after a century of being buried out of sight.
Acknowledging that we are going to die leads us to ask that most vital of questions: How do we want to live? I have tried to offer an approach to death that is both reverent and celebratory, and which helps us devour everything life has to offer. Public discourse about death is crucial, and this discussion can and must lead us to grab life by the horns, with fervent joy.