Mark Ackerman, PA-C

By Mark Ackerman, PA

Several years ago after I graduated from college my Great Uncle Ray had a heart attack during my grandfather’s funeral. This was not his first heart attack but was to be his last. He was taken to the hospital and admitted to the ICU where doctors worked diligently to save his life. In the end however, there was not much they could do after the multiple surgeries he had already had. His immediate family which included 8 children rallied to be there for him, hoping of course that he would still be alive when they got there. When the last member did get there, the whole family circled his bed, held hands and started to pray. Uncle Ray took his last breath during that prayer and passed away at the moment the prayer had finished.
One of his children, a cardiac nurse at the time, later made the comment about her dad that he had “died well.” Now for all of us who were not used to experiencing death in general, and especially not the death of a family member, the comment was difficult to interpret. What does it mean to die well?
Dying well is not a new concept of course but is less and less a popular descriptor these days. We are more accustom to hear more about dying without suffering, dying without pain, and dying quickly. I think that partially this has to do with a philosophical change in the collective minds of our culture to not think of death on a personal level. In many instances, we have become numb to death. We hear about it constantly on the news, we see it constantly in movies and TV shows and experience a digital version of it through video games. For the young, death simply becomes a numbers game; how many people died in the war today, how many people died in the hurricane today, how many people died of covid today; and then life goes on without much of an impact from death.
In the 15th century there was a widely distributed book that was written around the time of the bubonic plague entitled “Ars Moriende” which in English is, “The Art of Dying”. It was essentially a treatise on how to die well. The conclusion of the book, sorry to give it away, is that the art of dying well, is really about the art of living well.
So what is artistic about dying anyway? One way to think about this is that art, by definition is about “a creative activity or work that is both beautiful and excellent.” So while I think it may be difficult to be creative at the end of our lives, I think we can, as above, have a beautiful and excellent death, if we first have a beautiful and excellent life.
One thing that does allow for creativity in death is that death usually comes in several stages. There is of course the “moment” we physically die, which can be difficult to determine at times; but often this moment is preceded by a “process” of dying which typically happens in a hospital or in a hospice type setting or even just at home. There can also be a recurrent process of dying, in that people can (like my uncle Ray) have multiple surgeries that intervene to save our lives and restore us to a higher, previous level of health. Even still, there can be a preceding “activity” of dying in which we are physically active. (I think for example of my Uncle Doug who died of inoperable pancreatic cancer. It was a 3 year process for him to die, and for the first year, he continued to go to work.) Finally, there is a sense that all of us, while living, are simultaneously in the process, albeit a very slow one, of dying. It is in these stages that we can craft a beautiful and excellent death.
I think that the art of dying also comes in the decisions we make in terms of how we anticipate death. While death is thought of in a primarily physical aspect, we often forget that there are spiritual, philosophical, emotional and social aspects of dying. Physical death also means dying to our possessions, our financial resources and our social contacts. Forgetting these aspects of death often leads us to a lack of artful dying. I see this a lot in our culture where it is more common to pursue a quick, easy and painless death. This has unfortunately become our default attitude as a culture instead of dying creatively and beautifully. Look at the number of people who are dying through suicide and the number of people advocating for physician assisted suicide. Look at the growing sentiment that people in old age are just a “burden” to their families and society. Look at other countries where governments are promoting a “duty to die” mentality.
In anticipating our death, I think we have to back away from the mindset that defines death as just a physical process that we need to go through as fast as we can. We often forget that death can be a growing experience- especially in people who have a lifesaving intervention by a surgical procedure, medication change or another person. In ignorance of these things we have unfortunately come to a check box attitude in regards to our anticipating our death. We not only have bucket lists but we have forms to check in regards to how we will die; with our without CPR, a ventilator, nutrition or fluids. All of these are physical interventions of course and completely lack the creative introspection of the spiritual, philosophical, and social and cultural effects of death. It is in these other aspects where the experience of death can help us to grow and spark our creativity.
Dying well, I think, is done when we live a life for others. It is in that framework that dying takes on more meaning than just simply passing away quickly without any suffering.
Finally, and here is the practical medical advice of this article: you can plan to die well by talking with your physician about how to die well as much as you talk about how to live well. At your next wellness exam, make sure you spend some time asking questions about death and bring a family member with you. While you should always have paper work with checkboxes to make your wishes known (in the event that no family member can be with you) this cannot address all the possibilities of how somebody dies. Instead, it is that family member who understands how you want to die well that can be your advocate. A medical power of attorney is invaluable in today’s world. Life should be about quality, a beautiful, creative and excellent quality. The more we strive for that, the more we can live well and thus die well.