Dealing With Death

In my previous post, I shared some of my thoughts about death when I was a third-year medical student. In this post, I address some of my current thoughts in answer to the questions that I posed nearly 40 years ago.

My knowledge and understanding about this topic were gained through my medical career that included directing a pediatric pulmonary and cystic fibrosis (CF) center for more than two decades, where I learned to deal with the death of children and young adults with severe lung diseases. Later, I founded a practice specializing in pediatric hypnosis and counseling. Also, for much of my adult life I have been involved actively with Judaism through synagogues and study of the Bible and Talmud.

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How Does Medicine Help Deal With Death?

As a medical student, I complained to my parents that medicine can postpone death, but does not help you deal with it.

Unfortunately, for the large part I think this remains true today. Over the past 40 years, palliative care teams and hospice care have been set up to help support patients and families through the end stages of life. However, when medical care providers transfer care of patients to a different care team, an unfortunate disruption occurs in the doctor/patient relationship that can cause further stress.

Further, palliative or hospice care is not of help for patients or families who may be grappling with the prospect of death for many years as they come to terms with the diagnosis of having a terminal illness.

Medical health care providers generally avoid in-depth discussion of death with their patients. When I have brought this up with colleagues, they have told me that they feel uncomfortable and unqualified to have such discussions. A few have told me that they cannot make time for such discussions.

Some have told me that it is up to clergy to address such issues, and yet religion has become irrelevant to many people in our society. Further, a spiritual advisor may not have sufficient knowledge to advise a medically complex individual on how to balance their medical and spiritual needs.

For example, I spoke recently to the director of a muscular dystrophy clinic, in which most of the affected patients will die in their 20s. I asked who spoke with these patients during their teen years as they consider how to balance their expectations of life and their short life expectancy. I wondered who counseled some of these patients if they developed existential questions about their lives.

The director told me that they do not have a social worker or psychologist on staff, and there was no one at the clinic who could talk knowledgeably and compassionately about these topics to the affected patients and their families.

I think there remains a significant gap in medicine between the spiritual and emotional needs of our patients and the care their physicians are prepared to offer. For my part, as the former director of a CF center at a time when the life expectancy of patients with that disease also was in the 20s, I counseled my patients a great deal about existential issues. I used to bring up these subjects, so that my patients and their families would understand that these can be discussed with me.

As a result, I felt my patients and their families were better prepared for the challenges of dealing with their difficult disease. Further, through dialogue with my patients, I became better informed regarding their thoughts, and how I could best help each patient throughout the course of their illness.

Patients’ psychological status has a large impact on the outcome of their illnesses as well as their life expectancies. For example, studies have shown that people who have an ongoing important purpose in their lives and optimists live longer (Hill & Torino, 2014; Jacobs et al., 2021). Other studies have shown that the severity of patients’ symptoms is related to their psychological states (Anbar, 2021).

Thus, in the interest of the best health care for our patients, I believe it’s incumbent upon healthcare professionals to become well-versed in counseling patients regarding how to live well, as defined by each patient, even within the shadow of death.

What Should a Physician Say to a Dying Person?

The question of what might be said to someone who is dying can be part of the discussion about how health care providers can better serve their patients.

First, I believe that we should recognize that our physical presence at the bedside of a dying individual can be helpful even if no words are exchanged. We should remember that appropriate touch, with patients’ permission, can provide great comfort, such as holding a hand, or placing a hand on the shoulder.

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Second, it is important to allow the patient to communicate with us. Let the patient express their feelings, such as anxiety about death, even if it makes us uncomfortable. If a patient is confused because of their condition, it is often helpful to go along with their ideas and reassure them, rather than attempt to bring them “back to reality.” For example, a patient suffering from dementia may feel very tranquil when they believe they are living in the past, and can become agitated if told their beliefs are not true.

When it is our turn to speak, there are many appropriate topics including how we enjoyed and became enriched through our work with the patient, what lessons they have taught us, and how we will remember them. I have thanked patients for the privilege of being able to work with them. In appropriate circumstances, the patient might be reassured that the dying process can be made as comfortable as possible and that their suffering will be alleviated at death.

Sometimes, it helps to offer patients assistance in completing important tasks they would like to accomplish before they die, such as contacting important people in their lives, getting out into nature for a final time, eating a special meal, or listening to moving music of their choice.

If a health care provider and patient are comfortable with spirituality, the patient can be given the opportunity to hear the provider’s thoughts about death and beyond. I often share lessons taught by my patients including the nearly universal belief of their subconscious that part of them will exist following the patients’ death.

Sometimes, I share stories of near-death experiences as reported to me by some patients, as a way of calming a dying patient’s anxiety. Many of the stories I have heard in this regard describe near-death experiences involving serenity, comfort, and a feeling of great love. Prayer can be helpful if the patient desires it.

If the dying process is prolonged, it can be helpful for the patient to be encouraged to make good use of whatever time remains in their lives. For example, I encourage patients and their families to work on memory books that can help the families after a patient’s death. In some circumstances, the patients may choose to write notes, or record audio or video tapes for their loved ones. The memory books can also include momentos from the patients’ lives, such as photographs or collectibles.

What Is a Human Who Can Be Living at This Moment and Dead at the Next?

This is the hardest question that I posed 40 years ago. When I asked the question, I was seeking a spiritual answer. Thus, I will answer in that vein.

I believe that a human is a being that is imbued with a soul that comes from God. As I explained in another post, the Hebrew word for breath comes from the same root as soul, as described in the Bible. Thus, when a baby takes his or her first breath, this might be the moment that the animating soul enters.

I believe that without a soul humans cannot be fully alive. Thus, we can be alive at one moment and dead at the next when our soul departs and returns to its source. Such a departure can occur during physical death after we take our last breath, but according to some of my patients this may also occur if we choose to commit an act of great evil.

A human might be thought of as an avatar of sorts for our soul. The statement, “I changed my mind” illustrates how we may become aware that our “self” is not our physical entity. Who is the “I” to whom the mind belongs? If we were our minds then we might have said, “I changed myself.”

What Is the Relationship Between God and Humans?

I believe that God works His wonders through acts of nature. As human beings are part of nature, I believe that God also can work through each one of us. This belief is echoed in the thought that we continue to participate in God’s act of creation of the world.

My medical student self might have asked for proof of the existence of God and the works of wonders that are attributed to Him. I now understand that we cannot receive such proof from another person. If someone else tells me that they have encountered God I might respond that this was a subjective experience and thus did not constitute proof. However, I would add that every person who experiences a possible divine encounter can choose to use it as a way to form or strengthen a belief in God. Fortunately, many people indeed report such events.

With or without a belief in God, a spiritual answer regarding the nature of human beings could be: Like other parts of nature, a human being lives and then dies. In this cycle, both life and death are important contributors to the nature of humans. As we have developed the ability to become aware of our own mortality, we can learn to treasure every day of our lives as a precious opportunity to be a blessing to others.

And if you find any of these spiritual answers to be helpful or persuasive, it seems appropriate to conclude this post with the Hebrew word that expresses a belief that an idea should or can be trusted: Amen.