The Process of Dyiing: A Reflective Essay and Poem

by Michelle Silver, MD Candidate 2019

Honorable Mention  2017 Gerald F. Berlin Creative Writing Award

Last spring, I took the Caring for the Seriously Ill elective: an introduction to terminal illness from the perspective of the health care provider. Everyone knows that to pursue a profession that saves lives, you will face death. But we don’t like to think about the death part. Death is unempirical, making it difficult to rationalize: a scientist’s worst nightmare. This is why I signed up for the elective: to learn how the rational embrace what’s illogical.
As people come to share their stories, I am brought back to my first experience with death. I am 12 again, sitting in a chair across from my grandfather’s hospital bed. He is pale, emaciated, mute, and hooked up to every kind of wire and tube you can imagine. But he can see me. I read from the letter I spent weeks writing and re-writing, holding back tears as I remind him of our last Patriots game together. He managed to get the family tickets for the 10th row, right on the fifty-yard line. We were cheering and laughing, barely noticing the snow and subzero temperature. Naturally, with perfect seats and a close game, I came down with a fever at halftime. My grandfather insisted everyone stay, while he and I went to his car in the stadium parking lot and listen to the game on the radio. At this moment in the story I look up at the face behind the tubes and wires, and his eyes widen, fixated on me. He is listening. Now, I start crying. I finish my letter and 24 hours later he is gone.
Back in the classroom at UMass, I remember my role as a provider. To learn how to assist with other people’s experiences with terminal illness. I am introduced to a man who lost his wife; a family who lost a child; sisters who lost their mother. Yet with each story I can’t help but relate it to my own. The sheer frustration in knowing someone you love is going to die and that there is absolutely nothing you can do about it. I listen to their versions of their last Patriots games, the nurses and doctors that helped them, the difficult decisions they made. I listen to physicians, family members, support systems all talk about coping with loss. And something becomes abundantly clear – regardless of your role, it elicits the same raw response: a vulnerability that we all identify with.
Sure, I am now 12 years older and with the medical knowledge that can explain to me the etiology and prognosis of my grandfather’s mesothelioma. But would any of this knowledge really have changed how I wanted to spend my final moments with him?
One of the most important things I’ve learned at UMass in this regard came from a mentor. She told me the three questions she asks every terminal patient, to find a way to turn this news into something meaningful. I wrote a poem about these questions, questions I hope to learn from, no matter what role I play in a human’s death.

The Process of Dying (a spoken word poem)

What is a good death?
Is there anything worse than death?
What do you want to do before you die?

If I tell you you have cancer you become a different entity
This aggressive assertation’s an assault on your identity
No matter what comes next I have now become the enemy
And all you can express to me is passionate enmity

It’s common to fear death because it goes against what’s lyrical
In life we share experiences but with death there’s no empirical
No way to know what happens next it almost seems satirical
To suddenly deprive us of this one and only miracle

Slow down…

As you cycle through denial, anger, bargain and depress
Let us find some options, ways to mitigate the pain and stress
You were dealt a hand that can’t be changed reasoned or re-assessed
But with this hand, a final play, a power that you still possess

For this process to begin we will explore it in its depth
Don’t let those witches prophesize your ending as did in Macbeth
Let’s find a way to go in peace / give meaning to each final breath
Contemplate this crucial question, ask yourself what’s a good death?
Rationalize…

While hard to entertain the end its worse to think of the converse
To know the state you may be in of suffering as the pains disperse
What limits must be set for you while still here on this universe
So ask yourself now at this time—death may be bad but what is worse?

Plan…

And now we craft a plan unique to all and everything that’s you
Consider all your loved ones, passions, hobbies, fears –what you value
Some time for self-reflection / to make goals that you can follow through
To address my final question—before you die, what is there left to do?

Conclude…

It’s hard to know what’s right with these complex questions that we face
But remember death is stigmatized—lets change that view to fit your pace
A mentor she once told me that if I approach each coming case
With these three questions there will be acceptance to a better place:

What is a good death?
Is there anything worse than death?
What do you want to do before you die?