- © 2007 Canadian Medical Association
My 86-year-old father recently died after a lengthy and agonizing decline, and subsequently I found myself participating in the ancient, week-long Jewish mourning ceremony known as shiva. And I resolved after the traditional daily religious ceremony concluded to try to reflect to my fellow mourners in a brief speech something of what I had learned or felt over the course of the previous day about death and dying, and my father.
What struck me almost immediately was a line we daily read from the 49th Psalm. It was translated in my prayer book: “Like sheep, they are led to the grave, where death will be their shepherd.” What the words did almost immediately was trigger a realization of how much my father's dying had made me hate modern medicine. No, a feeling beyond hate, more despise, more detest, more loathe unto despair. Each day I would call my brother for updates and he would tell me about the newest spinal assay results, the latest yes/no/ can't tell interpretation of the latest CT scan, the most recent interacting medicine warfare.
Nothing stood still. Tuesday, it was a tube to drain water from his brain. Wednesday, if this drug caused him to lose his memory, that one helped him sleep better. Thursday, the physiotherapist moved his legs for him and he cried out in pain.
Ultimately it seemed the doctoring world had turned my father's failing health into a sporting contest headlined Medicine v. Death. What I got was each day's scores, which always suggested medicine was still winning — a partial result that we all knew was a fiction, because we all knew death would triumph in the end. But we couldn't say or admit to that because somehow that admission would imply that all the heroic treatment was a sham — that death was more powerful than medicine.
So I told the mourners the subtext of my father's dying was that it showed us we had come to deny death a central place at the grand table of dying because of our fears about what that would say to the healthy survivors about their next trip to the doctor. I said that while it seemed to me the biblical passage was confusing because sheep did not usually go to the grave but more typically to the slaughter (I later learned these sentences are among the most linguistically debated in the Bible), what we also derive from the image of shepherded death was the notion that death had a place in the torrent of living.
A high and honourable and ancient seat. It was a partner with life and not its adversary, not the thing that had to be endlessly loathed in order to make clear that almost everything my father went through was better than it. Death was life's shepherd. Death wasn't medicine's enemy.
And I told the mourners that if we didn't change our view on this, if we didn't become more ecumenical in our relationship with death, then we were, as I had, going to hate medicine more and more. Not the doctors, not the nurses, but medicine as a world view, as a technologically arrogant vision displaced from the biology of life. Medicine, which didn't let my father die soon enough, wouldn't let us die either. And I told them to talk to their doctors about this because this sporting contest, this medicalized endless decay was not just our onrushing fate but increasingly the sign of 21st-century humans' alienation from all the rest of biology.
And then I cried both for my dead father and for wholeness in the life/death universe that I felt had been ripped apart in the modern world. And I came back to Toronto and read 14 different translations of the psalm sentences and wrote the following poem.
The sounds of dying are purple, polka dot and piss.
Its colours shriek confusion, caries and abscess.
We are the generation of death walking.
We are the disease our medicine is stalking.
Give me not a never-ending end.
Give me death, life's better than best friend.
I call it “Death: one, Medicine: no score.”