My patient, stoic and pensive, told me that he’d made it through his last year of work by dreaming of the European cruise he and his wife planned to take the week after he retired. “I thought I’d paid my dues,” he whispered. “I was just waiting for the best part of life to finally start.”
He rarely took time off and had pushed through nausea and occasional abdominal pain that had worsened during his final months of work. Freedom, he’d thought, lay just beyond the newly visible finish line. But a diagnosis of stomach cancer, which had spread to his liver and lungs, had left him too breathless to walk, too nauseous to endure a boat ride, too weak to dress himself. Instead of living out his dreams, he was living out his death.
I thought of him recently after watching “Dying for Sex,” a television series in which a woman named Molly is diagnosed with incurable breast cancer. Realizing that she is dying, Molly decides to leave her husband and seeks sexual fulfillment before her death in hospice care. Loosely based on a true story, the show illustrates how mortality forces clarity about how we truly wish to live. But it also illuminates another fact: Many of us do not ask ourselves what it means to live fully and authentically until death is both certain and soon.
We live alongside death. It speeds down highways recklessly and blooms clandestinely within our bodies. We have no idea when we will meet death, or how. Living with an awareness of this specific uncertainty can be terrifying, yet I’ve found that death also shimmers with a singular magnificence: the possibility of living freely.
Popular culture would have us believe in cliché bucket lists, which call to mind outlandish activities that defy the physical limitations imposed by illness or the emotional limitations of common sense. Morgan Freeman and Jack Nicholson skydive in “The Bucket List,” despite terminal lung cancer. Queen Latifah withdraws her life savings and jets to Europe after learning she has weeks to live in “Last Holiday.”
Greeting death with the fantasia of daredevil activities or adopting a newly carefree persona is a tempting salve for our fear of that last great unknown. But in my experience, considered reflection on mortality nudges people toward a more complicated version of the ordinary, not novel permutations of extremes. I often hear variations on similar wishes: A daughter wants a small wedding ceremony in the hospital so her dying parent can attend. A brother calls an estranged sister, asking her to visit so that he can say goodbye. I have heard uncommon goals too: wanting to take a long-postponed trip to the Alamo, to write a romance novel, to breed one last litter of puppies and inhale, one final time, the milky sweet of their young fur. These wishes are at their core the same desire, reconciling the differences between the life we have and the one we longed for.
While contemplating our deaths can guide us to a place of deep honesty with ourselves, sometimes helping us to live more fully, it also can teach us to inhabit and understand our bodies more fully, too. Death will unravel our bodies in ways we cannot predict. Will we die in a sudden car crash, avoiding the indignities of a physical decline? Or will dementia claim our bodies and minds in an uncertain sequence?
Molly experiences her body as many of us do, alternately as a tomb and as a portal to transcendence. Her sick body is pinned in place during radiation, a green light shining directly into her fearful eyes. But even so, her eyelids flicker and her cheeks bloom when she climaxes with another person for the first time. The physical limitations of illness do not entirely constrain her; the majority of my patients are not so lucky.
Molly’s body still burns with desire and she has a support system that helps her achieve what she wants. That wasn’t the case for my patient who dieted her whole life, figuring that she’d eat with abandon in her later years; esophageal cancer stole her appetite and left her unable to swallow, dependent on a feeding tube. It wasn’t the case for a woman who wanted to fly to her home country once last time; she died before she could get there, immobilized by A.L.S. For them, relegating pleasure and fulfillment to an indeterminate time in the future meant forfeiting crucial parts of the lives they had envisioned for themselves before death arrived.
Our bodies absorb our lives; terror and joy alike live in our skin. Molly begins to face the abuse she suffered as a child. My patient began to cry regularly about the traumas of his youth and losing his loving relationship with his wife. Dying offers the opportunity to face what we have simply accepted as part of our lives — formative events and experiences that we don’t challenge or question, but simply accept and accommodate like a messy roommate.
But we don’t have to wait until we are dying to consider what it means to live freely. For all of us, reconceptualizing death as a guide can help us to begin an ongoing conversation with ourselves about who we are and what we’d like our lives to mean. Think about how you spent the last six months. What and who brought you fulfillment and joy? What would you do differently if you could? If those were the last six months of your life, what would your regrets be?
These questions, deceptively simple, are as commonplace and ordinary as death itself. Our answers to these questions evolve as our lives unfold. What and who seems to matter the most to you right now may change. If we begin this inquiry before death arrives, we may die as fully as we have lived.
Rearranging our waning lives around previously buried desires isn’t always practical or possible, emotionally or financially. But even if we cannot upend our existence in the name of slumbering passions, we can find freedom in the life the body offers, paying attention to the burn of grief and the pulse of joy, the intensity of an embrace or the taste of butter on toast. Even as we die, our bodies are capable of more than devolution from illness.
Several months after I first met my patient who dreamed of European travel, his wife rushed him to the emergency room, her voice trembling as she described the way his skin glowed yellow seemingly overnight, the ferocity in his voice when he refused to go to the hospital, their daughter’s decision to leave school to help care for him. He smiled when I pulled up a chair next to his bed.
“It would have been so nice to see Belgium,” he murmured. “I could have brought you some really good chocolate.”
Sunita Puri is the author of “That Good Night: Life and Medicine in the Eleventh Hour.” She is an associate professor of medicine at the University of California, Irvine, where she directs the palliative care consultation service.
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: [email protected].
Follow the New York Times Opinion section on Facebook, Instagram, TikTok, Bluesky, WhatsApp and Threads.
The post Living to Die Well appeared first on New York Times.
