”We are living the dying of… someone else!”
Bruno Mazzocchi e Katriona Munthe
Abstract: in this work, we offer our contribution to those who are involved in helping professionals, who daily face the dying of those whom they assist, and how their impressions, their feelings of anxiety and sorrow come to paint within their imagination, their picture of death. For each of us, dying is a most intimate, unique event – something of which in advance and within our biological individuality we cannot have any living awareness. Since no one has ever returned from the unknown to explain their experience, the transformation of consciousness remains a fearful mystery. Therefore, can we try to smooth this anguish with words, images, and compassion? How can we try to form for ourselves and our patients, some illustration of the inner perception of dying? We have listened carefully to our patients and been present, accompanying their movements as far as possible, touching their emotions, slowly feeling their disengagement… We have been learning from different spiritualities, our philosophies, psychologies, and- further back- from the ancient Initiation practices. We propose an overview of the immense artistic and cultural creative source we have inherited, the aesthetic experiences of the mind that bring us closer to dying before dying. Our work resembles perhaps that of the ancient religions (from the Latin “Religare”, “to collect”) which weave together the stories, and the images, and through inspiration try to make sense of our fear, reconstructing recognizable patterns that allow the river of our flowing time, to yield gently, as it comes to a quiet standstill.
Keywords: dying, transformation, awareness of death
- PERCEPTIONS OF DEATH
B. M.
We who are alive – as long as we are alive – have no certain perception of death, we have only a perception of the process of dying; our experience as we watch others die. The dying of those around us gives us a measure of our lifetime. No one could feel the limits of their life span if they did not see others dying; and the impossibility of stopping the flow, of watching, impotent as a life ebbs away in time….
Sometimes, however, a man can “take possession” of his death. This is, of course, a deeply intimate matter for he has acquired this “ownership”, if he has achieved a sense of completion, in a very vital and conscious sense…. Often human beings can also foresee certain events, but they can only do this through experience ( through some form of memorized anticipation). However, when it comes to dying, we can have no experience, since no one has ever returned from the dead to describe the process which they have been through.
Only the experience of the dying of someone else is available to us, and so it is also lived as an anticipation ( a foretaste) of our death, we are living vicariously the experience, through the dying of another…. Will our death be different: we ask ourselves. Will it be peculiarly, individually, personal? Will it be wrapped in a mystery, a unique and unrepeatable experience?
We cannot assume that simply because we have “lived” through the deaths of others, we are ready and prepared for the death we desire…. With the death of another, we lose irremediably that person and the reciprocal sharing of our common “history”. Through our perception of others, Life and Death, stand together in a symmetrical relationship, and with the philosopher Epicure, we could remember perhaps that: Only the existence of the other can confirm my existence. And only the death of another can confirm my mortality.
K.M.
Dying implicitly has to do with relating – it involves all our relationships; with ourselves, with those whom we love, with God, or with Nature. How have we seen ourselves, our roles, or our identities in life? How has our existence been of some significance to the existence of others? And how – above all – have we felt we belonged in this world? Since the beginning, we have carried a deep longing to immerse ourselves in something that is much bigger and goes beyond our own lives and that, at the same time – somehow- can also enclose and embrace our sense of identity. We have called this love or belonging!
When watching and waiting on death, we perceive the precariousness, the insecurity, and the transience of each relationship. We see the strength of our connections, our affiliation to each other, and the environment slowly disintegrating. We are observing the process of separation. We are experiencing the breaking of a link…of a bond – and then – detachment. And we, who are still alive, find ourselves holding, uselessly, one loose end: suddenly, at the other end of the alliance, there is no one left.
John Everett Millais, Ophelia, c. 1851, oil on canvas, Tate Britain, London
- THOUGHTS OF DEATH
B. M.
Throughout history, thinking about dying, seems, mostly to be about “exorcising a terrifying fear,” said Pascal, who spoke of a “divertissement” (a diversion, a distraction, to avoid the menacing thought).
The thought of death when insinuated into our minds, throws a tragic shadow over our existence, that only some ritual form of exorcism can allow us to escape. The real answer to our fear of death, to this emotional upheaval, he says, is as long as possible to live intensely; to enjoy our pleasures, our dreams, the ideals, and the affections of others – yet this does not allow us to make the anguish disappears, but only to push it back, distracting and defending ourselves against the oncoming wave of darkness. According to other thinkers, however, there would be no significance to the story of an individual life if there were no open end, no promise, and no hope of immortality. A biographical story without immortality would only be – according to the philosopher Lombardi Vallauri:
“A sound lost in an inaudible universe.”
For curiously we human beings turn to our personal history to find that immortality which – in fact- would curtail that same history! We ask you to find in our lifetime, authentic personal and universal significance, worthiness, and even fame (enough to live on….in the memory of others). We ask to exchange the perishable with the perennial, the ephemeral with the eternal. History is generated by a desire, which if realized, would arrest at birth the moving story of life. The idea of death unfortunately escapes any rational form of understanding; and as an abstract concept, it cannot exist. Only the death of another – or rather the dying of another- which is tangibly concrete, and can be physically and psychologically perceived, as a visible evolution over a greater or a lesser lapse of time. The religions of the world, mostly reflect on that which could exist after life. They propose to alleviate our suffering in the here and now, with a blissful vision of eternal well-being. Even so, we find that Christian spirituality has many doubts about a particular dead person’s beatitude, and many theological discussions debate our happiness after death.
K. M.
Yet the idea of death is within us from the very beginning; it is tied like gravity to our daily living and generates suffering that we know every time we have been through loss. We find it in the pain we encounter when disappointed when we have been negligent when we have lost something that we loved or longed for something unobtainable and resigned ourselves when we have had to let the story go….
The idea of death as an interruption in the transient flow of life is also at the same time, an experience of instant actuality; an experience of “Here and Now”. Suddenly everything stops in the PRESENT- it is inconceivable – but it is happening!
The idea of death cannot be contained in conventional concepts of time, it’s true, but we have experience of a-temporal dimensions where our thinking has to be different…. where already we have an idea of the inner shadow behind all the visible forms of our reality: it is their capacity to disintegrate… back into non-existence, it is their impermanence that we try so hard to deny!
As we recount our personal histories, we try to bring forward the importance of our lives, our growth and development…. the adventure of overcoming our fears and anguish, and our achievements and we give ourselves the role of a hero…. to emerge for a little while (in our own eyes, at least) from that background void of non-existence. We fear the void where we are no more: It is the fear of our underlying disappearance into insignificance. But there are other philosophical and scientific traditions from the past, that have taught us instead to open up, and allow this flowing pain of life, this mourning impermanence, to mingle and mix into our awareness, seeing in the power and generosity of what is happening to us now, a fleeting gift! We know of many rituals that teach us to welcome and accept this flow of pain and joy, moment after moment .… seeing beauty in the ephemeral, in the very precarious preciousness of that which will not last.… We learn to let go of our “persona”, to become aware of falling back into belonging (not to the void), but to a living, breathing, vibrating universe. We learn to be in the present, (to no longer resist the painful intensity and the depth) of what is happening all around us NOW – And suddenly we can bear it, and we awake – to find that every instant is held together in perfect balance. There is integrity and value, even beauty to the many precarious parts. Yes, here, there is some kind of an underlying unchanging, loving, atmosphere in which time has stopped still and everything JUST IS!
St. Augustine ( in his Confessions XI, II) explains this experience:
“They long to know eternity,
but their minds flutter futile
In the flow of the past and the future.
Who can hold back and fix the mind
So that stabilised for an instant,
It may awake for an instant
to the splendour of eternity,
always stable and contrast it to time,
which is never stable
To then realise that there is no comparison.”
And Einstein stated that there is only one really important question that each of us needs to answer for ourselves:
Is this Universe benevolent?
George Frederick Watts, Found Drowned, c. 1850, oil on canvas, Watts Gallery, Compton
- UNDERSTANDING DEATH
B. M.
Death is a double phenomenon, in so much as it is both an individual event and a social and universal happening. It should never be hidden or obscured from view.
I believe that it should be recounted, narrated like an old story, and told over and over again with honesty, for we can turn back to our cultural heritage, to the ancient traditions of our ancestors, to find the wisdom, the encouragement even new insight, to face our fears. Re-telling the story of the different deaths that we have known, even if we never come to truly understand them, is as close as we can come to approaching an experience that is so personal, so unique, that it seems truly, that we are not able to share in life, the essence of this extraordinary event!
I think we should try to find a key; a perspective from which to observe and read our stories. They tell us of the many ways to be… to stand…. to understand, our mortality. Through literature (though our choice must inevitably also be subjective and very personal) we discover that we can intimately enter these deep, essential dimensions of Being. Also, of course, we learn through the words and feelings of our patients; we have, in our professions, experienced this gradual approach to the unknown and the unknowable. Our work, during all this time, has been an attempt to listen, to grow, to slowly surrender our little ego, to something vast and empty, that is beyond us…. It has taken love and courage to open sincerely and to find and stay with, or to “stand” the surprise, the ignorance, the horror…..the wonder of dying! Waiting for death is not the kind of waiting that fills us with expectations. No, it is a waiting that is a giving of ourselves with curiosity, openly and unconditionally, with HOPE, to the profoundly transformative experience of Mystery.
K. M.
Mystery– through initiation, ritual, and theatre, through myth, and all the symbolic journeys to the underworld- ( the Eleusinian Mysteries, Orphic theatre, the sacred Dionysian representations….the Tibetan and the Egyptian “Books of the Dead”… perhaps above all, by Dante’s “Divine Comedy ”) – all introduce us to the experience of dying before dying! And sometimes, also through extraordinary insight, we can find in trauma, extreme pain, or after an accident – a pattern of the same story: We see this journey of separation, of loss and mourning, and finally, the experience of reintegration where again the fragments of our self-understanding come together in one coherent design. Sometimes there is a perception of the Absolute within the rhythm and assimilation of the relative; within the changing seasons, in the developing passion between the masculine and the feminine, in the positive and the negative magnetic opposites, in the wisdom of some fundamental pulse that allows Nature to open and release us into greater consciousness, or to close and connect us, in an embrace of intimate secrecy. We have to conclude that the process of dying cannot be understood from an objective point of view! We must allow and give back to ourselves the value of a profoundly subjective and imaginative experience.
Gustav Klimt, Death and Life, 1915, oil on canvas, Leopold Museum, Vienna
- BEING WITH DEATH
B.M, K.M.
Referring again to Saint Augustine (Confessions IX) I remember he recounts the story of his mother’s last illness; She asks her sons to help her make the journey of return to her birthplace ( perhaps in today’s Algeria, to Tagaste). Her condition worsens during travel, and St. Augustine suddenly realizes that he and his brother Navigius, who are both constantly present at her side, are coming as close as they possibly can to being with her experience of dying. An experience that is of course, absolutely individual and personal. But they are actually “sharing” this luminous intimacy! She asks her sons finally, to stop- to give up the agonizing journey- she asks them to disembark with her in Ostia ( in Italy), and having transmitted to them, her serenity, she dies, leaving St Augustine to delve into the pain of losing his mother to death, while also trying to explain it. Another today, who with great humility tries to describe the indescribable is the American writer, Raymond Carver in his book “The Cathedral”. This autobiographic novel speaks of his clumsy attempts to welcome a blind visitor to his home. It was a friend of his wife, who deeply embarrassed him, who made him face up to his incredible uncertainty about how to behave … So he turned on the television; they were transmitting a documentary about cathedrals. The blind man asks Carver to describe the cathedral they are speaking about the writer finds himself quite incapable of finding the words to explain…to someone who has never seen anything at all! Finally, it is the blind man himself, who takes Carver’s hand and guides him in designing the construction. Together they are drawing a cathedral, that is becoming more and more beautiful, more and more real, and….. to both of them, ever more significant. Frank Ostaseski (Being a Compassionate Companion, 2005) says much the same thing, in preparing his doctors and nurses for Hospice Care: “You, who help to care for someone who is terminally ill, will find yourselves constantly asking yourselves about your capacity and your motivations. You will question your attachments and your aversions, and you will doubt your strongest convictions. Impotence and insecurity will become your constant companions. Above all, you will face the fragility of your own life. Anguish will tear open your heart. But perhaps it is just here – in the open heart- that we discover what is really of use to others.” In our professional lives, we become ever more aware of the uselessness of our own words in these moments. And so we come to fall back, for comfort, on the great writers of the past: Virginia Woolf herself, so desperately drowning in depression (before finally committing suicide), and wanting to write about death to research the great journey ahead- finds instead that, on the contrary, they are still the visions of Life that are pursuing her over and again. And Teresa of Avila sustained that:
“Words must lead to actions…. for these prepare the soul, bringing hope and readiness, bringing tenderness and compassion”.
-Yet –
“ The most important things are the most difficult to articulate. Words seem to render miserable the events of which we then become ashamed, because they have impoverished the infinite importance that these once held in our minds. Once spoken out loud, those same things are reduced to but a natural size, a daily dimension of reality.”
And we have observed in our daily hospital rounds, more than our words, we can inspire trust in our patients, listen to them, and constantly be prepared to adapt to their changing needs that require our real commitment.
Anton Chekhov, the great Russian writer (in Ward No.6) recounts the story of Mojsejka, a little Jewish boy in a psychiatric hospital. He is not a principal character, he is by no means a hero, but he is surely a victim!
With no words at all, he witnesses life and death in the lunatic asylum:
“He loves to be of service, he brings water to his companions, he pulls the covers over them when they sleep, bringing them, if he can find one, a copeck, a little hat, or sometimes feeding the man who is paralyzed in the bed to his left…”
This place is where death, at last, comes as a relief!
This is also very much what Ostaseski used to teach us about service in the Zen Hospice of San Francisco: We were to wait outside our patient’s room trying to concentrate all our attention on the present moment. We had as yet, no idea of what would be needed and asked for behind that door. We prepared – with flexibility, availability, and openness – but above all with no expectation….to cross the threshold into our patient’s room. He would say:
“Too often, we who assist others, are looking to confirm our own living identity (the helper’s syndrome.) We find strategies to distance ourselves from the pain and the suffering of the other. We may do this through pity, fear, professional warmth, or even with a charitable gesture… But so doing, we arm ourselves as “the helper” in front of “the defenseless”!
He believed that helping, requires us to create a bridge over the chasm of fear so that we can reach the other person. We honestly must bring to the bedside, our strength, our impotence, our wounds, and our happiness – yes all of it – to become a truly benevolent presence we need to share in the experience of extreme passion and pain. There is a beautiful book by the director of the European Institute of Oncology in Milan, Marco Venturino: “What the goldfish dreams”. The story tells of the CEO of a big enterprise, who has advanced cancer.
Clinical good sense suggests it would not be a good idea to operate, but after a famous surgeon has been urgently requested and adequately paid by the VIP, the operation goes ahead. Inexorably however the man, now a patient, is transferred to intensive care because the operation had not been a success. Suspended by wires and machines, rather like some macabre marionette, he meets his anesthetist. This is a doctor, who impaired in his sentimental life and embittered by his work, has taken to drinking to compensate for it all, but still manages to be sensitive and substantially efficient. A tormented and profoundly human relationship grows between the two men; one who receives a filtered reality through his “goldfish bowl”, is silently conscious that he is dying – and the other, the anesthetist who must care for him, opens up to allow a deeply intuitive and empathic flowing communication to encircle them both.
Human affectionate contact is rarely taught in our hospitals where “body objects” all too often are simply manipulated: we medicate a foot, reconstruct a breast, or replace a liver…. But we do not often try to heal the person who suffers an injury to that part of their body, we do not often care for the Human Being who is showing their individual and subjective pain.
It may be a question of daring to touch differently and so entering into a closer connection with the dying. We need to become more conscious of all that comes into play when we stimulate a degree of attention and become more aware of the quality of presence that we bring into our Palliative Care and how it can change the way even the most aggressive medical intervention is to be accepted and lived.
Italo Calvino, in the early eighties, became for us an enlightened guide, his cultural and deeply compassionate attitude towards humanity, most certainly influenced our early interest in Palliative Care, for he taught us to dive into the Medical Humanities and re-integrate our understanding of that which happens in the mind with those techniques which work on the body. More or less unconsciously we carry the inheritance of our species, we reconnect to those who have preceded us along the way, imagining their lives and through memory believing that we can reunite in their energy, as individuals once again welcomed back into the human stream that flows on through time.
An expression of Calvino’s in Six memos for the next millennium comes to mind:
“The imagination is a place where the rain gets in”
The aphorism seems to reveal how we can always return to our common culture, the source of all imagination, and our cultural heritage, each time we find ourselves in difficulty trying to communicate with another, each time we are in fear, for our professional and ethical commitments as we try to care for others and ourselves.
Calvino of course, was preparing the book for a series of American Lessons which he had intended to deliver at Harvard University, (had he not prematurely died in 1985). He was fully aware of the eponymous – Charles Eliot Norton Poetry Lectureship- that he was called to deliver, and very aware that his predecessor was a Dante scholar!
His expression therefore directly refers to Dante’s words:
“Poi piovve dentro a l’alta fantasia”
(Purgatory XVII)
Next rain, started to fall into my high phantasy.
So he introduces his lecture on Visibility – the value of representation; Words create an imaginative process of association, memory, perception, and meaning…. Visualization is raining onto the reader’s mind. This understanding of Dante’s struggle to communicate, to express “that which is beyond expression” in terms of all our senses, can only be resolved by directly appealing to the imagination.
In our case to the imagination of those who together are trying to share the journey of transformation through death.
There is no Frigate like a Book
(Emily Dickinson)
To take us Lands away
Nor any Coursers like a Page
Of prancing Poetry
This travel may the poorest take
Without oppress of Toll
How frugal is the Chariot
That bears the Human soul.
We end our efforts to “Enlighten Death” with this last metaphor that reminds us all, of the vast open spaces, which like the vistas of our imaginations invite us to travel into the beauty and the exaltation of the Mind. We can touch the experience of Being and journey through the underworlds of death and darkness, but then we can emerge to find ourselves lovingly embraced in the freedom of our imagination, and begin to participate in a timeless dimension of conscious awareness.
Bibliography:
Frank Ostaseski: “ the Five Invitations”
( Flatiron books 2017)
“Being a compassionate companion”
(Mondadori 2006)
Marie Hennezel: “La mort Intime”
(Robert Laffront 1995)
Katriona Munthe: “Le cifre dell’Infinito”
( Melusina 1993)
Irvin Yalomn: “Staring a the sun”
(Jossey-Bass 2009)
Stanislav Grof: “The ultimate Journey”
(Maps 2006)