It started out as a routine Tuesday, a clinic day for me, I would be spending most of my time seeing cancer patients, collaborating with the physician assistants assigned to me, trying to inspire and teach the students, residents and fellows on the oncology service. The press of the cancer clinic at the University of Iowa, the major referral center for most of the state, drove me to focus on the next patient, the next difficult conversation, the next chemotherapy order, prescription, lab test, system hiccup, the tedium that filled the day. But, during clinic that morning, rumors and mumblings started, instigated initially from the waiting room or maybe phone calls from outside, that something major was happening in New York; a jetliner had just crashed into the World Trade Center. Nobody knew yet just what this meant, but we, like the rest of the nation, tried to stay focused on our mission, the needs right in front of us, while also keeping abreast of the events of September 11, 2001 and what those events meant to us and those we loved.
At one point, during a brief lull in the activity of the team station, a conversation started about sudden, unexpected death, and whether that might be preferable to the dying that was likely for many of our cancer patients: gradual weakening with worsening pain, increasing dependency, and loss of ability to be active or even function independently, followed by eventual death from disease. I remember someone asking for a show of hands from those in the room, how many would prefer to know they were dying and have opportunity to make arrangements and say good-bye, and how many would prefer to not see it coming, just to be alive one second and dead the next. In the room that day the results of this question were pretty typical, about a third voted for sudden death, a third for the more protracted process, and a third did not commit, either because they were too busy with something else or maybe the whole idea was too difficult to think about, especially on that emotionally-charged day.
So, what makes for a “good dying?” Americans consistently list characteristics like being at home, being free from pain, having friends and family present, and maintaining dignity as descriptions of what a good dying might look like. If that is the case, then maybe the dying over time might be preferable, though I have known many whose protracted course seemed to be only interminable suffering. But what did those who died on 9/11 teach us? The stories that we heard from passengers on the jetliners, people in the falling twin towers, ordinary folks across the nation, were those of desperate attempts to reach those they loved, of seeking reassurance, of communicating final wishes, good-byes, long-distance embraces.
These who died suddenly showed us that good dying best happens in community, in the presence of a loved other, whether it is a spouse, child, dog, God, or maybe the friend you just made sharing your last moments in a doomed airplane.
Photo by Sara K Schwittek, REUTERS