With the End in Mind: Dying, Death, and Wisdom in an Age of Denial

by Kathryn Mannix

The death rate remains 100 per cent, and the pattern of the final days, and the way we actually die, are unchanged. What is different is that we have lost the familiarity we once had with that process, and we have lost the vocabulary and etiquette that served us so well in past times, when death was acknowledged to be inevitable. Instead of dying in a dear and familiar room with people we love around us, we now die in ambulances and emergency rooms and intensive care units, our loved ones separated from us by the machinery of life preservation.

There are only two days with fewer than twenty-four hours in each lifetime, sitting like bookends astride our lives: one is celebrated every year, yet it is the other that makes us see living as precious.

I escape to ponder whether bravery is about being fearless or about tolerating fear.

Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, often need to tell their story repeatedly, and that is an important part of transferring the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it.

This last vigil is a place of accountability, a dawning realisation of the true value of the life that is about to end; a place of watching and listening; a time to contemplate what connects us, and how the approaching separation will change our own lives forever. How intently we serve, who only sit and wait.

By choosing not to believe the bad or dreaded thing is happening, a person can avoid distress completely. Difficulties may arise as it becomes harder and harder for them to ignore evidence that something is seriously wrong: if they have not accepted any bad news at all, then nor have they made any emotional adjustment for it. If their denial breaks down suddenly, they may become completely overwhelmed by the realisation of how bad things really are.

Using denial to cope with an unbearable sorrow can help someone to avoid facing their distress, but if they can no longer maintain their defence, the cataclysmic truth can rush in like an unstoppable tide, drowning them in their own dread.

Our human spirit may stumble as the path ahead appears too daunting, yet with support and encouragement, our resilience can be re-enabled and used to find creative solutions. We are all individuals, and one person’s plan may not be a good fit for another who, outwardly at least, appears to be in a similar situation. Enabling people to be architects of their own solution is key to respecting their dignity. They are only in a new phase of life; they have not abdicated personhood.

Whether CBT first aid or the full CBT intervention, the core principle is that we are made unhappy by the way we interpret events. Distressing emotions are triggered by disturbing underlying thoughts, and helping a patient to notice these thoughts and to consider whether or not they are accurate and helpful is key to enabling them to change.

Before the age of around five, children do not understand the irreversibility of death, nor that death renders the body totally non-functional.

Some time around the age of seven, children become aware that death happens to everybody, and a little later, that it will even happen to them. This may lead to a period of anxiety and frequent requests for reassurance that immediate family members will not die.

by being able to sit with the deepest anguish and not shut it down, it is possible to enable people to explore their most distressing thoughts, process them, and even find more helpful ways to deal with them.

Stepping back to find perspective is a challenge. It requires the insight to acknowledge that there may be another way to look at a situation, and the humility to be prepared to examine our own view, and to change our mind if necessary. It may be easier to step back if we approach life with an attitude of curiosity rather than certainty, intrigued by what we may discover for and about ourselves.

Sometimes, it seems, a pain in the body is actually a pain in the soul, a pain in the deepest part of our being, often without a name or any recognition. By diving into his dream with him, that nurse enabled Pete to heal his deepest hurt, and that healing allowed him to die in peace.

The second part of life is about transcendence to wisdom, and for many people this only develops over a long lifetime. For others, though, there can be an early transition, and this is very often through a personal experience of deep loss and enormous pain – exactly like the experience of knowing they have an incurable illness that our patients encounter; the knowledge that death is approaching, and that it will mean the end of everything they hold familiar and dear. Each of the wisdom traditions describes this transformation process in its own way, yet the key ‘Golden Rule’ of all of them is the development of a sense of compassion for others. The focus moves from ‘me’ to ‘everyone and everything’. This includes a kindness to oneself, and the ability to recognise and forgive one’s own faults in the same loving way that those transformed, second-part-of-life people forgive the faults of others.

the first of the recurring last messages of dying people: ‘I am sorry. Please forgive me.’ It also supports their desire to avoid causing any further hurt, and this translates into a deeper patience with others’ shortcomings.

the second of the last messages is often ‘Don’t worry about it. I forgive you. It is no longer a hurt between us.’ Sometimes

The need to express gratitude to others is another of the last messages. ‘Thank you’ is now a heartfelt statement of appreciation, not a mere courtesy.

The last and most frequent of the last messages is ‘I love you.’

But they are examples of what we can all become: beacons of compassion, living in the moment, looking backwards with gratitude and forgiveness, and focused on the simple things that really matter.

What are the values that guide your decisions in life? How well have you met your own expectations? Do you judge yourself with as much kindness as you judge other people? Is there any change you would like to make so that your way of life fits better with your values and beliefs? What first step could you take?

Thinking about the last messages, who would you like to thank? And what for? Is there a way to let them know of your gratitude? Can you write a letter? Send an email? Shout to the wind? Tell the story of your gratitude to someone who will join you in a moment of appreciation?

What about forgiveness? Whose forgiveness would you like to seek? And what for? Do you need to apologise to someone, or is it time to forgive yourself? How can you express your sense of regret? Perhaps it’s time to make contact wit...

Perhaps you are the offended party. Is there anyone you would like to forgive? Does anyone need your reassurance that a past quarrel or misunderstanding is no longer a grievance between you?

And then there is all that love to be communicated. Sure, you can leave letters and cards and material goods in your will. But it’s so much more meaningful to say it in person, or to write now, and give them a chance to know that you love them while you are still here.

This makes hard times slightly easier to bear, and good times immediately precious. Both happiness and disappointment will pass in time. Awareness of the temporary essence of all lived experience is humbling.

Death itself is perceived by ancient wisdom as a necessary and even welcome component of the human condition: a finality that ends uncertainty or despair; a mandated temporal boundary that makes time and relationships priceless; a promise of the laying down of the burdens of living, and the end of the repeated daily struggle.