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The Final Act: How We Can Learn To Face Our Deaths With Clarity And Compassion

Issue 255.5

Those of us who have lived seven decades or more can set an example by approaching death openly, with curiosity, even with hope.

Karen Malpede Apr 22

I am not a medical professional, far from it. I have not consulted a doctor in over 20 years. I have no primary care physician and, as an artist, I have lived most of my life without health insurance. Staying healthy was a necessity. I have been in hospital once for one day to have a child, needing Pitocin but refusing an epidural. I left the next morning, against medical advice, healthy infant in my arms. But, of course, I’ve cared for people who were ill and, at present, am working hard to keep my 87-year-old, vital husband, who has treatable multiple myeloma, safe from COVID-19.

I, like everyone, have been reading harrowing and moving reports from the front lines by nurses and doctors, describing their heroic acts and the unforeseen difficulties of treating and recovering from this wily virus, which can attack not just lungs, but kidneys and brain.

I would like to think that what old people might offer now is wisdom. Instead, we are voiceless.

My nightmare from the start of the pandemic has been to watch my husband wheeled from our apartment by emergency medical workers in plastic gowns and face masks (assuming that they do have the right PPE) never to see him or talk to him again. Knowing he would likely be intubated and die alone in pain. The nightmare could work the other way, of course, and I, a heretofore-healthy 74-year-old, could be the one wheeled away. What would become of him in that case, and of our two 15-year-old cocker spaniels for whom I also have primary care.

We have talks about both scenarios. We joke about dying together in our bed and letting the dogs eat us. We talk about not going to the hospital. About not wanting to overtax an already overtaxed medical system. About not wishing to die alone. However, death happens (and death does happen), let’s make a good show of it, we agreed last night.

We spend our evenings reading out loud, first The Plague, by Albert Camus, now Left Hand of Darkness by Ursula Le Guin. My husband had never read either book and because he also suffers from macular degeneration (though he is still a working actor), I do the reading. For him, this is a special pleasure, listening to literature again. When the pandemic began, we immediately bought a case of wine. I have been cooking, as usual, organic vegetables, pastas, beans and fresh-caught fish. Our meals are Mediterranean gourmet. We have candles on the table. I dress each day in one of three pandemic suits I bought; stylish, comfortable one-piece yoga clothing made sustainably from trees.

It is time for nonmedical personnel, especially those of us deemed elderly, whether we feel that way or not, to initiate a public conversation about death. We need to ask if it is our right to demand doctors and nurses decades younger than we risk contagion performing herculean tasks just to keep us alive and in what state. Especially when the recovery from severe COVID-19 is likely to be lengthy and difficult, years-long for the young and for the elderly mainly impossible.

Our culture teaches that medical intervention can save lives and that life is worthwhile at any cost. Yet we see now the grave inequities not only in our medical system but also in our society that put the poor, the unhoused, undocumented, incarcerated and essential workers at so much greater risk.

We are coming to understand who is “essential” and who is not. Those who care for others, underpaid and previously undervalued, are those who keep the society functional insofar as it is in this pandemic.  

I would like to think that what old people might offer, now, is wisdom. Instead, we are voiceless. We are the “at-risk” who, therefore, should be quiet and submit to whatever grave interventions medical science has to offer — at whatever cost to doctors, nurses, ourselves and society, itself.  I know there are elderly in the hospital who have requested “do not resuscitate” and “do not intubate” orders. To some degree, some people are taking some sort of control. But should they be in hospital at all, separate from family who love them, cared for by overstressed strangers in plastic gear? To what end?

As elders, we should insist upon a dignified death of our choosing and the mandate to initiate public conversations about what such deaths might be (different, of course, for every person).

It does not demean the unique value of each life to suggest that death is the inevitable last act. Nor does it demean my life to say I have no wish that others, unprotected nurses or doctors, for instance, die keeping me alive. Especially when my full recovery is likely to be impossible.

This is not to say that seniors should sacrifice themselves in order to “open up” the country and get the “great economy” back on track. Far from it. How one dies is the last great challenge of how one lives. Like all major personal life events, how to die should be the prerogative of the one doing the dying.

George Bartenieff performing in Other Than We. Photo: (c) Beatriz Schiller.

Those of us Americans who have lived seven decades or more have enjoyed perhaps the last best times ever known to humankind. No matter our politics, and mine have always been pacifist and left-leaning, we believed in progress, possibility. We thought about and fought for a better future for our children, for the planet and for humankind. We are privileged and have been extremely lucky, many of us, to have crafted the lives and careers we sought, raised the children we chose, loved whomever we wished. Done, mainly, as we pleased. Eaten our fill.

Our final act is death. We have a duty to approach death openly, with curiosity, even with hope,  because if we can set an example now of how to die and, at the same time, relieve the medical establishment of the futile burden of trying so hard to keep us going just a little longer, we will have provided a true service. If we can find gratitude for what we have enjoyed alongside love for the vastness of the wide world we are about to re-enter — as vapors, fragments, memories, food for worms, as nothingness — we might use the single great achievement of homo sapiens, our conscious awareness of ourselves, to approach death as, yes, personal annihilation, but, perhaps, by sparing younger lives and needed medical equipment, also as an offering to a future that seems so desperately imperiled but which our open-hearted dance toward death might help to heal. 

We will need courage. The courage of numbers, of one another. Without prescribing, blaming or agreeing, we need the courage to speak of and to find a good death.

Karen Malpede is playwright, director, author: Plays in Time (Intellect, U. Chicago, 2017), Other Than We (Laertes, 2019). She is the co-founder, with George Bartenieff, of Theater Three Collaborative. Her email is kmalpede@gmail.com.

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