The theater of illness Aug 13 2010
He was in the hands of medicine. He was hopeful but realistic. He will come to feel increasingly like a member of the audience in the theater of his own illness. I've been there. There were times when I seemed to have nothing to do with it. One night, unable to speak, I caught the eye of a nurse through my open door and pointed to the blood leaking from my hospital gown. She pushed a panic button and my bed was surrounded by an emergency team, the duty physician pushing his fingers with great force against my carotid artery to halt the bleeding. I was hoisted on my sheet over to a gurney, and raced to the OR. "Move it, people," he shouted. "We're going to lose this man."
Anderson Cooper asked Hitchens whether he'd been moved by the prayer groups supporting him to pray himself:
"No, that's all meaningless to me. I don't think souls or bodies can be changed by incantation." There was a catch in his voice, and the slightest hint of tears. That was the moment -- not the cancer or the dying -- that got to me. Prayer groups also prayed for me, and I was grateful and moved. It isn't the sad people in movies who make me cry, it's the good ones.
Hitchens added that if there should be reports of his deathbed conversion, they would be reports of a man "irrational and babbling with pain." As long as he retains his thinking ability, he said, there will be no conversion to belief in God. This is what I expected him to say. Deathbed conversions have always seemed to me like a Hail Mary Pass, proving nothing about religion and much about desperation.
I wrote this at Snarkmarket at the beginning of the week:
Recent efforts by Tony Judt, Christopher Hitchens, Atul Gawande, following on slightly older ones by Joan Didion and Phillip Roth, make me wonder whether we've achieved a new breakthrough in our ability to write about death -- perhaps especially protracted death, death within the context of medical treatment, in a secular context, which as Gawande reminds us, is comparatively new and certainly much more common.
Here's the section of Gawande's recent New Yorker essay I was thinking of:
For all but our most recent history, dying was typically a brief process. Whether the cause was childhood infection, difficult childbirth, heart attack, or pneumonia, the interval between recognizing that you had a life-threatening ailment and death was often just a matter of days or weeks... [A]s the end-of-life researcher Joanne Lynn has observed, people usually experienced life-threatening illness the way they experienced bad weather--as something that struck with little warning--and you either got through it or you didn't.
An unexpected cost of the secularization/medicalization of death is that we lose the language we need to talk our way through it:
Dying used to be accompanied by a prescribed set of customs. Guides to ars moriendi, the art of dying, were extraordinarily popular; a 1415 medieval Latin text was reprinted in more than a hundred editions across Europe. Reaffirming one's faith, repenting one's sins, and letting go of one's worldly possessions and desires were crucial, and the guides provided families with prayers and questions for the dying in order to put them in the right frame of mind during their final hours. Last words came to hold a particular place of reverence.
These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition--advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn't. So everyone struggles with this uncertainty--with how, and when, to accept that the battle is lost.
That's one of the stunning things about Gawande's essay -- how much of what it describes is a failure of language. No one can speak, at least directly; we can only watch.