Birthday Ruminations: Life, Death and in Between

Today is my 43rd birthday, and I am working from home, spending some quiet time with Tina the Dog and a hammock. Calls and emails come in from time to time. Lawnmowers and other daytime neighborhood comings and goings fill the air.

Even as life continues on its usual trajectory, death lurks in the shadows. We really do spend a great deal of our time ignoring death, avoiding death, trying to beat Death at his own game. Movies portray death in many guises: as the demise of a self-destructive addict, the heroic death of a firefighter, the needless accidental death of a child, the tragic death of hundreds due to natural disasters, wars, famine, and genocide. The media bring us news of death daily as famous celebrities die, dozens of people are slaughtered by car bombs in Baghdad, or bridges and mines collapse in our cities and towns. Eventually, news of death becomes so routine, so ubiquitous, we are almost immune to its import, its very impact diminished through repetition, our eyes glazed over in disbelief.

As a medical provider, my desire, of course, is to assist my patients in postponing death, improving their health and quality of life, as well as trying to ensure that chronic diseases are treated, prevented, or stabilized. Colonoscopies, mammograms, testicular exams, blood tests---these are all means to the end of thwarting illness and death. But even these scientific machinations cannot save us all, and cancer grows in parts not scoped, or disease manifests when some aberrant gene decides to turn itself on. We are all works in progress, and as the saying goes, nothing is more certain in life than death and taxes.

When terminal illness strikes a family member, the other members of that family are forced into an intimate conversation with mortality. Through the processes of denial and ignorance, we can potentially shield ourselves from some aspect of this reality, but when push comes to shove, Death will force himself through the door one way or another.

In Ingmar Bergman's film The Seventh Seal, the protagonist---a knight journeying through a a Europe gripped by the Black Plague---challenges Death to a game of chess, buying time while still knowing what the eventual endgame will be. This is a lesson for us all---we can buy time, we can stall, we can challenge Death at every turn, but even on a day which celebrates our birth, death must also be a part of the inner conversation.

I often want to ask a dying person what it feels like to know that one's life is so very close to its end. Is there a breathless panic that not enough has been done? Are there regrets of relationships still unhealed? Is there a kind of relief that one feels? Is there lamenting of places not visited, photos not taken, pictures not painted, songs not written? And what of acceptance and peace? How does one face one's imminent death knowing full well that there was so much more to be done, so much more living to enjoy? How does one reconcile that in one's mind and heart?

Obviously to me, one of the most effective ways to beat Death at his own game is to embrace life in all of its challenges and curve-balls, throwing oneself into each day with abandon and determination. Unfortunately, we all occasionally lose sight of our mortality, putting off until tomorrow what we could do today, knowing full well somewhere in the back of our minds that tomorrow may never come. As for cleaning the bathroom or mowing the lawn, I see no problem with putting that off 'til the 'morrow. But telling someone how much you love them, looking into the eyes of a child, smelling a rose in full bloom, or writing that long-dreamed of novel---these are the things that simply cannot wait. A dirty bathroom is one thing. An unhealed relationship is quite another.

So, as a birthday present to myself, I take this moment to reflect on life and death, and make a pact to continue to remind myself of the importance of each day and my ability to embrace it for all it's worth. Doing any less is only inviting Death to eventually rob me of something I treasure through the mechanisms of regret and remorse. We should all strive to deny Death that opportunity, and allow Life its share of victory and everyday bliss.