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Meaning-Making and the Process of Dying

“As I think back about my taste of death, it is clear that my preparatory thinking enhanced the possibility of a peaceful letting go. Can we ever be sure when our lease is up? Waiting until coda-time may be too late.”

  1. David Martin, Facing Death page 68

My last post ended with a consideration of death’s long-term trajectory that we observe as we age. Although it has been regarded as a decidedly morose thought, the idea that we’re all slowly dying has some real merit. Perhaps it deserves a chance to re-enter conversations about death without the “I’m-13-and-this-is-deep” associations. One mistake we make in our conception of death is to project binaries onto it. Although we can usually delineate experientially between what is alive and what is dead, pinpointing the exact moment of death has become increasingly problematic as medicine understands physiology with increasing nuance. Degrees of brain death, the mere existence of the Harvard Ad Hoc Committee on Brain Death, and the ensuing legal and philosophical debates demonstrate that death is no black and white matter. Thomas W. Laqueur elaborates in the afterword of Interdisciplinary Perspectives on Mortality and its Timings about how the physiological state of death is negotiated in the modern hospital for comatose patients:

This is what happens: First, doctors use clinical criteria to rule out other reasons for someone being in a deep and persistent coma rather than whole brain death: abnormally low body temperature; evidence of barbiturate poisoning, for example. Then, they administer a battery of neurological tests, dating back to the nineteenth and early twentieth century, that cumulatively show whether the lower brain, the part that controls breathing, is functional. There are many more. All bear testimony to the glorious history of nineteenth-century neurology and, cumulatively, to the destruction of the place in the brain that controls breathing as well as so much else. Only when all of these examinations indicate that the brain stem, and hence the whole brain, is indeed dead is a person eligible for the determinative test for death. The candidate is given a big hit of pure oxygen so that her blood is fully saturated: (10 minutes pre-oxygenation). Then the ventilator is shut off. If she does not breathe within three minutes—in some jurisdictions, five or even eight minutes—she will never never never never breathe again. We know this because the part of the brain that controls breathing is, as the earlier tests had suggested, truly gone. The time of death, to repeat, is recorded not when the patient, already suspected for some time of being brain dead, on the basis of various neurological tests, but when she failed the apnea test and was dead in the old-fashioned way.” (148-149)

Does this medical evidence feel conclusive? Maybe not. According to Laqueur, patients are sometimes hooked back into the ventilator to protect the viability of their organs for transplant after the death is recorded. Our stomachs may still churn at the thought of removing ventilator support in the first place, but somehow replacing it feels like another transgression. The issue is fraught medically, but also from a more pedestrian perspective: we don’t like to have to take control of the threshold between a breathing moment and a subsequent non-breathing moment, and something visceral tells us so when we read the above description. Additionally, a profound reframing of this death moment and the life at stake occurs: comatose patients become “candidates” for death, which becomes “real” only once a series of tests have been passed.

Robert Morison charges us to avoid the “fallacy of misplaced concreteness” when it comes to death.[i] He identifies the danger of squishy, process words like “living” and “dying” being replaced by apparently bounded, static words like “life” and “death.” Similarly, in Cuttin’ the Body Loose, William Gavin argued that “the word death does not have meaning invariance; it has meant different things to different cultures at different times. More strongly put, there is no such thing as death ‘in itself,’ or, if there is, we don’t know anything about it.”[ii] All of these subtleties around our constructions of death lead us away from the so-called objective, biological “facts” and towards the subjective expressions of life, particularly through story. Eric J. Cassell argues that “there are two distinct things happening in the terminally ill, the death of the body and the passing of the person.”[iii] Quantitative measures, however suspect, can measure the death of the body, but the passing of the person relies on narrative for meaning-making. Importantly, meaning-making in death narratives relies on the audience as much as the storyteller. Gavin posits, “the absurd thing is, that one has to do this [address their own mortality], and, that one can never accomplish the task of making death and dying meaningful.”[iv] Importantly, in the work of making meaning for our deaths, the meaning is made for the ones we leave behind. Although this is true for any audience-storyteller relationship, it seems more piquant when the storyteller is gone. What the dying do in crafting an end of life narrative is more for the people who will tell their story than it is for themselves. To shift the perspective (and perhaps state the obvious), in the way we live and die, we take part in the dictation of our legacy and afterlives.

In this week’s sole clip, Carl Henley, a retired professor emeritus from the School of Social Work, describes an unusual experience from the final weeks of his wife’s dementia-related death. Whatever the cause of this final conversation they got to share, it created space for a significant moment of meaning-making. This moment is a story worth repeating and probably a precious thing for Carl to reflect on in the absence of his wife. We can’t count on experiences like this to happen to us or our loved ones, so perhaps embracing dying as an ongoing process rather than a moment in time would provoke more conversations like this in our own lives. Perhaps we would have a greater sense of urgency when it comes to embracing those sweet moments of human warmth and vulnerability when they happen across our path.

[i] See Morison’s piece “Death: Process or Event?” in Death Inside Out: The Hastings Center Report edited by Peter Steinfels and Robert M. Veatch (1975). Quote from page 64.

[ii] Page 32

[iii] See Cassell’s piece “Dying in a Technological Society” in Death Inside Out. Quote from page 45.

[iv] Page 191