“From the moment we are born, we are on a crash course with dying.”

Dr. Pamela Prince Pyle

Tick. Tock. Tick. Tock. Tick…Tock

You perch on the edge of the chair with rigid arms and fidgety feet. Your eyes are drawn to the clock face and its stiff second-hand jerking between invisible numbers. Tick. Tock. Tick. Tock. 

Time has become so meaningful to you that you are deeply aware of each instrument in which it is measured. Ticking clocks, trilling alarms, and calendar pages that you rip from their spiral prison become your focus. You count the sunrises and mourn the sunsets for night has become a place of fear. 

Time stopped for you when you were first diagnosed. The immutable truth of your mortality was forced upon you by words you did not expect to hear. Then time raced as your battle began. Now, it stops and starts and stutters along with this pilgrimage across barren lands. 

Many are there with you, even in this moment, waiting to share your heavy burden. You struggle to share what you don’t even understand. Death is certain. Yet, in its certainty, it is also incomprehensible to imagine you actually arriving at its door. Therefore, time becomes your imminent companion to warn you of its approach. 

You are given time and times and plan accordingly. Yet, the waiting pain surpasses the dying pain. You have bound yourself so tightly to death that you have forgotten to live. You are a dead man watching time. 

What to do When You’re Dying

If these words resonate with you, you are not alone. As a physician for over three decades, I have been with thousands in their living and dying journey. The majority of these have been encountered through the foreign land of a hospital. 

Patients have a brush with their own mortality when they enter a hospital. They forego all sense of dignity as belongings are passed to the busy ones and clothing is replaced with conformity in ubiquitous sterile gowns. A band is placed on one’s wrist to identify who they once were. 

Most will escape with their life. Some know it may not be true for them. Others find themselves in a revolving door at the hospital more often spit back into the bowels of the hospital than exiting into the comparative sweet aroma of fresh air and freedom. 

I have had countless encounters with this latter group and most feel helpless in their circumstance. They are told to keep fighting their disease as if surrendering to the ravaging effects of its warfare is failure upon their part. They are told to keep fighting for the loved ones who surround them with tear-stained faces, hoping for miracles. They are told to keep fighting for their time which has become an unknowable force of good or evil depending on the day. 

It is impossible to characterize the weariness which accompanies all of this fighting. However, its effect is evident as each time that same patient crosses my path. Sallow skin, slumped shoulders, feet drag along the ground from step to step and thinning bodies take up less space on the stretcher or bed where I go to speak to them. 

The time I have with them is brief but intensely personal. A day in the hospital with clinicians who listen, who care, when a patient is most vulnerable can become an opportunity for the patient to express his or her wishes regarding the fight. I find it deeply comforting for the patient to have some sense of control when facing death. This truth reigns if time is long or short. 

With the context of hours upon hours of these conversations, in the next five posts let me share the pilgrimage of others about how to prepare for death.