Death and Dying

If I say "carbon-based life forms" you might picture a lump of coal or, to my surprise, a musical group.  Not only that, though. If you are a scientist, you know that all life forms on this earth are based on the carbon atom. That category, "All life," includes us.  And all life has certain characteristics; the one of interest to me right now is mortality.

Consumable products have a "shelf life," more obvious when it comes to a bag of lettuce, but true also of hard cheese.  Even things "die."  Engineered structures are calculated to have an MTTB, or "mean time to breakdown," or an MTBF, "mean time before failures."  We humans have one too - we call it life expectancy.

If you've been around this blog a while you know that one of my key labels is death.  In this, I am not weird, just speaking as a Buddhist.  It surprised me when I got interested in Buddhism, how much it talks about death, and some people find it gloomy and depressing. But Buddhism is just trying to hold us up to the fact of life.  This is about learning to encounter your own death and those of your loved ones with some equanimity, about deeply understanding reality.  Living things are born, grow, age, in a pattern that inevitably leads to death. Somewhere I have read that when he first saw a dead person, Prince Siddhartha said, "If this be death, then cursed be birth." He was not enlightened yet.

It's a funny thing to think about, how frantic we get (see yesterday's blog) when we get (ominous music here) A Diagnosis.  I am still reactive when I hear a friend has cancer, that powerful stealth invader, and at age 68½ I hear that often.  I see dying people who won't take care of this future by making out their wills or installing accessible showers, who keep falling because they won't use a cane.  I see people who are pissed off all the time that this is happening to them.  Multiple causes feed into this denial, and I believe one of them is the deep American belief that personal will and personal actions can conquer anything.  Not so. Not death.



[image: Spirea blossoms]

Every day's a novel

[image: a promotion for a movie titled Fear2. You might still be able to get one of these coats for your cat here.]

Yesterday was a day like a Russian novel for me, full of events and dread, with recovery at the end. Here is the sketchy outline, the events, and some nods to the places I went in my mind.

Kidney doctor in the morning, Tom couldn't go with me. I was pretty sure my recent shortness of breath was caused by further kidney failure. Hoped it was that and not recurrence of my breast cancer. The night before I did some hectic research on accesses for dialysis. The doctor is satisfied with me not going back on it yet, just watching my slo-o-ow trend downward. But he could hear "some whistling" in my lungs, and I had gained four pounds in two months. That could be from fluid in the lungs, what, congestive heart failure? He wanted to order a chest x-ray. We agreed I would call my PCP about it instead.

11:00 Went out and sat in parking lot, called my primary care doctor's clinic and got in with one of the other doctors at 1:15. People take not breathing very seriously. That and no heartbeat. If you want attention in the ER, not breathing is excellent.

Called Tom. Got him just leaving his own pulmonary function tests. (More fear on that later.) We agreed to meet at home and make lunch. He offered to drive me up to PCP. I felt gratitude, and thought about the pleasures of marriage in old age. I had no idea when I was young.
Breathing raspy now. Pneumonia. Maybe bronchitis. Hoped it wasn't the antibiotic resistant kind that kills people.

1:15. Dr. very smart and attentive to detail. Ruled out heart, discussed COPD and emphysema, etc., which can start EVEN THO YOU QUIT SMOKING 20 YEARS AGO! How unfair. He walked me around the hall briskly, thot I did good. Ordered a breathing test and chest x-ray. Went home trying to adjust to the idea of chronic lung disease.

3:30 His nurse calls to say he has revued my breathing test and it is okay. It will be two days to have the radiologist look at the chest x-ray. That's my fault, I'm breathing.

5:00 Couldn't nap. Starving. Worried about my blood sugar. How could I be so hungry? I must be getting diabetic. Eat some leftovers. Something wrong with my friend G's phone. I try her cellphone, leave a message.

7:00 I am definitely either manic or depressed, hit by a crazed desire to cook a creamy pasta dish with Tom's help, substituting bacon for pancetta and so on, using some frozen peas that were used as an ice pack on my ankle back when. We play Iron Chef in the kitchen. It's really active and the food turns out good.
~~~~~~~
I am not a reader of Russian novels myself. I just know they have a reputation for being very long. I assume most of that is not actual action, but people thinking and feeling. The subjective, as in the deep exploration of the fears highlighted above. It did seem like a long day. And all those fears were real, if temporary. Even then, it was kind of funny, like, What now? Watching myself as one of those farces where people dressed in ridiculous clothes keep bobbing their heads out of doors and hiding in closets.

Oh yes, in with all of this, it was a beautiful sunny day today, one more in an improbable string of them. I hope yours was better. And now it's time for the weekly taking out of the trash. Garbage. I mean plain ordinary actual tangible garbage, which would really smell bad by next week. Kind of thing you have to do if you're alive.

Courageously battling X

Scanning the obituaries in the local paper today, I soon came across the person who had died "after a long, courageous battle with leukemia." I wondered just what that meant. I decided it meant she didn't make other people uncomfortably aware of her pain and fear. She didn't cry much in front of other people, she didn't whine, she smiled, she put on a pink turban and went to parties and tried every kind of chemo, proven or not. Effort. I mean, what the hell does it mean to "courageously" "battle" the inevitable? Can you battle in a cowardly way? Or can you just battle, without any adjectives? Or can you not battle at all, and can that be a dignified choice?

Going down to the basic assumption, that battling is good, I wonder whether this is a distinctly American thing, part of the dream of conquering all frontiers through sheer force of will (i.e., doing violence to the Other)? I could, in my mind, imagine someone in a far distant culture and time - okay, maybe in that simple mountainside hut - who knows she has a terminal illness and doesn't fight it. Perhaps she watches her progress, or regress, with some interest. If she is a Buddhist nun, say, she has often meditated on the inevitability of death.

But an American will say, "There's always a chance! There's always the possibility of a miracle," which Western doctors call "remission," meaning, the cancer has become less aggressive, and we don't know why. So this courage seems to consist in part of hanging onto a dream, no matter how shredded and remote. Hanging on to hope. Continuing to work when everyone knows working doesn't work anymore.

Let me say I do not now have cancer, as far as I know. August 12 I will celebrate twelve years since my surgery for breast cancer. I do have kidney failure, and now the as-yet undiagnosed heart thing. And there's Tom, shaken and further handicapped by breaking his arm when he fell just walking across the carpet in our own house. A moment of inattention, lost balance, that's all it takes.

I feel very burdened by this idea that admirable people are those who fight, and who do so "courageously." It's hard enough to do what seems to be the right thing, go to the doctors, watch the diet, undergo the tests and the misery of hospitalizations, do the exercises, wear the event monitor and the orthotics and the tennis shoes. Do I have to do it with a cheerful attitude?

Yesterday I told my Chinese doctor that I have been put on Hold on the transplant list because I can't take steroids. He seemed genuinely shocked. We all thought he was helping me hold on until I got the call. I was working my way up the list. I had a future. It promised new problems, but also renewed energy. It is a bitter irony to me to see the sudden flurry of interest in kidney donation - the Boomers, who are five or six years behind me, are turning old, and they always change things. If they want kidneys, there will soon be a universal donor law in place. No longer will we have the spectacle of thousands of people dying every year, waiting. (As an aside, I wonder what portion of the extraordinary expense the universal health coverage will pay?)

The famous definition of courage is Hemingway's, "grace under pressure." What did he mean by that, I wonder? He had faced wild animals, bulls, guns. He defined the heroic masculine life. But after a continuous string of physical and mental illnesses, even he was finally no longer able to fight.