A matter of life and death

This is a post about Linny the cat, Atul Gawande, and David Bowie.

“Death is not the opposite of life. Life has no opposite. The opposite of death is birth.” – Eckhart Tolle.

“To the well-organised mind, death is but the next great adventure.” – Albus Dumbledore, Harry Potter and the Philosopher’s Stone, JK Rowling.

David Bowie, one of my musical heroes, died in January at the age of 69, after what media reports called “a brave 18-month battle with cancer”. It seems clear to me that Bowie saw his end coming, and chose to spend the last months of his life making his final record. This made me wonder what I might do in a similar situation. And then I realised – I am 15 years younger than David Bowie. I can choose to start living as though I have 15 years left. (Any time after that will be a bonus.)

David Bowie Heroes









Not a rant, a conversation

Dear readers, it is not my intention to rant at you. I want to start a conversation about life and death, hopefully many conversations. I’m keen to get the discussion happening now, before you and I get to a stage of life where it’s an emergency, a matter of life or death.

Here are some of the questions I want to raise: How much time do I have left? What will I do with it? And, what am I prepared to do, in order to continue living?

I don’t know the answer to any of this, but I want to talk about it.

Being Mortal

I’ve been reading Being Mortal, Atul Gawande’s courageous and thought-provoking look at a truly scary subject. Gawande clearly demonstrates that as individuals and as a wider culture, we are woefully unprepared for death. Our medical system is so focused on saving life, that it can’t help people die. Often it can’t even let people die. Doctors won’t admit to terminally ill people that they are dying. Gawande writes that even when patients ask him outright if they are going to die, he finds it very difficult to give them a straight answer.

Gawande looks at mortality from many standpoints: his own, as an American surgeon, facing the limitations of what he can do; as his father’s son, standing by as his father faces illness and death. He also talks about the experiences of some of his patients and about initiatives which are seeking to do things differently.

Living well, without regrets

Two of my closest family members died of cancer at 60. My father, Ralph, left much of his life’s work unfinished, and had many regrets. He didn’t see my five-year-old half-brother Richard grow up. Ralph’s sister, my beloved aunt Rosemary, was only 50 when she discovered she had terminal inoperable stomach cancer. She took the diagnosis as a challenge and lived well for several years, before the cancer finally caught up with her. Neither Ralph nor Rosie got to meet any of their grandchildren.

I took from Rosie’s example that I shouldn’t wait for a life sentence before I started living well.

Rosie and Alice

Rosie and I at Aberystwyth, the last time I saw her.

Linny’s last stroll

Last week I had to call the Grim Reaper for a cat. Linny was a beautiful sleek tabby, 18 years old, a gracious old gentleman. For most of his life he was the much-loved pet of family friends, before he came to live with us last year. He had a good, long life, way beyond his nine lives, but he had a number of age-related ailments, which were eroding his quality of life.

A kind vet and her assistant came to our house. Sara and Elliot, who had cared for the cat since they were toddlers, were present. The vet explained to us what she was planning to do. She gently put a lure into a vein in the cat’s leg. It didn’t seem to cause him pain. Then Elliot held Linny in his lap. The vet injected a dose of painkiller. Linny closed his eyes, and he was gone.

It was a peaceful and dignified death. We should all be so lucky.

I could make the choice to end Linny’s life, even though it was emotionally hard. But, I can’t make this choice for myself. Unless there’s a law change, ending my own life would be regarded as a shocking suicide, no matter how old I was or how sick I was. And I would have to be very careful not to do it in any way that would leave my family open to legal action.

Linny the cat

Linny was a charming cat, who lived well.

Facing death

Gawande writes about hospice, which provides support and palliative care for people who have accepted that they are dying. People often assume that opting for hospice care means giving up on life, but in fact it may be the opposite.

He finds that people receiving hospice care may have much better quality of life (and even live longer) than people who spend their last months fighting for a cure for their condition, often in intensive care.

Unsurprisingly, Gawande has some interesting observations about assisted suicide. He thinks there’s a place for it, but if people could access and accept hospice care, there might not be so much need for it. He points out that some countries where assisted suicide has been legal for many years have been very slow to develop palliative care services (e.g. the Netherlands, where in 2012 one in 35 people sought assisted suicide at their death). “Assisted living is far harder than assisted death, but its possibilities are far greater, as well.”

As he witnesses the gradual progress of his father’s illness, Gawande finds his ideas changing: “Only now did I begin to recognize how understanding the finitude of one’s time could be a gift.”

Atul Gawande (2014) Being Mortal: Illness, Medicine, and What Matters in the End. Profile Books, London.