Friday, 1 July 2011

Death: Don't Fear the Reaper?

We nearly lost Jenny – the little girl I wrote about recently here – last Saturday.

She had seemed a little out of sorts after her nap. She and I had worked on a jigsaw puzzle together and she had trouble concentrating. She was staggering a bit more than usual, but we suspect that she may have some balance problems as a result of the damage to her ears I mentioned in that previous post – it’s a difficult thing to be sure about with a three year old, particularly when they’re always dragging a heavy, corrugated double hose from their neck attached to a respirator as Jenny has to.

I had just mentioned my suspicion that something wasn’t quite right to my colleague when Jenny keeled over. She’d lost consciousness, had turned deadly pale and her lips were turning that shade of blue which tells you that she’s not getting any air. I picked her up, my colleague grabbing the respirator and we rushed to her room where there was a new tracheotomy tube, CPR bag (also known as an Ambu bag), and more equipment generally. I removed her tube as quickly as possible (noting in passing that it was blocked with a thick plug of mucus) and inserted a new one. My colleague started working the bag immediately, efficiently pumping air into the child’s lungs while I connected a tube from the tank in the corner to the bag to try to put some of the oxygen she’d been missing in the previous minutes back into her as quickly as possible. Reboot the system with a kick-start.

And nothing happened. We’ve had Jenny in this situation before but up to now, as soon as the tube was replaced and she started to get air again, she responded almost immediately. Not this time. My colleague was pumping away but Jenny still lay there, unmoving, white and blue, her eyes wide open, seeing nothing.

I started doing compression, briefly alternating both bag and compression while my colleague phoned for an ambulance …

… tell them as quick as they can, sirens and lights, no, we’ve already started resuscitation … shit, come on Jenny, come on girl, everything’s all right, come on now, darling, you can do it, come back to us now …

A minute went by, maybe two. I’m not sure – I certainly didn’t have time to look at my watch – and we continued compressing and bagging. A black feeling of despair started to knock at the edge of my consciousness as I sensed the possibility that Death had joined us in the room. Then she twitched.

Just once, then nothing. We carried on. She twitched again and then started to trash around weakly. The horrid inky blue colouring around her lips faded back to something approaching normal. Jenny was there again. I could almost hear the whispering whish of his black robe as Death slowly withdrew. Obviously he’d decided there was nothing for him here. Not this time.

When the ambulance crew arrived a few minutes later, Jenny was huddled in my arms, clinging tightly to me. A little girl, needing comfort.

Thanks, guys, no, it’ll be all right now, we’ll keep her here, we can do nearly everything they’d do in hospital anyhow, it’d just freak her out and they’d probably have to sedate her … sure, we’ll call you again if we have the feeling anything’s not quite right …

* * * * *

In over twenty years of nursing in one form or another, I’ve shared a room with Brother Death more frequently than most people – if not as often as those colleagues who work in Accident and Emergency Rooms around the world. But I’ve been there often enough when he arrived on the scene and, noting that the sand in his hourglass had run through, beckoned implacably with his bony finger.

While I would have fought him every inch of the way for Jenny – for there is something especially insulting, deeply wrong, which we are properly hardwired to feel about the potential death of any child – there have been many times when I will admit that I have seen his coming as welcome, inevitable, even overdue. But then, most of the over twenty years I have now spent in nursing have been, in one way or another, either in the area of geriatric care or the care of long-term very seriously ill people. I suppose this gives me a different perspective on death to that of most people – particularly in our society.

The instinct to see death as the ultimate enemy, to fight it with every fibre of our beings is programmed into that very fibre of our beings – at its most ultimate biological level. That which makes the double helix of deoxyribonucleic acid (DNA) unique is its “drive” to replicate itself, to continue and, ultimately, develop its existence by reproducing itself. It is dynamism, life, in its most elemental form; it can do no other than to strive to live, for this is what defines it and thus death is its antithesis.

Yet if life is the governing postulate of the DNA which defines our biological reality, the second law of thermodynamics – the tendency to entropy, the decay of order in any system to a formless random soup – is its counter-postulate at the level of the physical reality in which biological existence finds itself; death. And it is within this field of tension created by our biological drive to live and the inevitable ultimate failure of that drive (at least on the individual level) in death that we experience and attempt to make sense of and infuse meaning into our individual livings.

Given this basic existential tension, it is no wonder, then, that our initial deepest reaction to death is one of instinctive negation; our very genes cry out, “No, this cannot be, this must not be!” Yet another part of us knows that it is inevitable, that it comes for every living thing, for the experience of birth, growth, growth, maturation, decay and death is something ever present. One of the images we use for death is that of “the Grim Reaper;” when the grain is ripe it will be harvested and the scythe will cut through the stems, mowing all that comes into its path.

This challenge for us to find meaning in the fundamental existential experience of contradiction between life and its inevitable ending defines us in all sorts of ways. It is, I believe, a basic impulse for our deep instinct towards religion – for most religions have, as one of their central themes, the question of death and our inability to accept it as a final ending. The unthinking urge to live, the defining aspect of our genetic coding at a level much deeper than our reason, finds an expression in our rational, “spiritual” attempts to affirm life as an absolute principle beyond the caesura of death. Death, the ending of the existence which defines our experience is unthinkable, unimaginable, therefore it cannot be the end – instead it is explained as a phase change, or as something which entered the world as a kind of flaw which is to be overcome.

It is not my intent here to use this argument to refute any religion, or religion as such; rather to try to see it within a wider existential context without making any claims of validity, one way or another.

Still, the contradiction between our drive to live and our realisation that this living must end has exercised humanity through all its history. While our very living is a continual negation of death – more, we also possess the ability to make new life through our children – at the same time we know how fragile that life is, how it can be wiped out in an instant. Memento mori [remember your mortality] is also a continual theme, from the slave whispering reminders of human finitude into the ear of the Roman general celebrating a triumph to the Catholic tradition of signing the foreheads of believers with ash on Ash Wednesday, accompanied by the saying, “Remember, man, that you are dust and into dust you shall return.”

And, of course, like most such antitheses, the art is in finding a balance – a balance between our driving lust for life and our realisation of our inevitable mortality. This challenge faces us daily as individuals, it also faces us as societies. For societies have tended in one direction or another – from the ancient Egyptian obsession with death to the sybaritic classical Roman Nunc est bibendum [let us eat, drink and be merry], from the post-plague medieval danse macabre to a tendency today to try to banish dying and death completely from the public consciousness into hospitals and funeral homes.

The immense advances made in hygiene, nutrition and medicine have made death a much less commonplace occurrence in the developed world in the past century and a half. Whereas for most of history death was an ever-present companion of life and could happen to you at any time, today, in much of the world, we confidently expect to live well beyond seventy or eighty. With tragic exceptions, death has become a province of the old and is done quietly, away from a society which often seems obsessed with the icons of youth, vitality and rude health.

Yet Brother Death is not defied, he still waits in the wings, the inevitable final encounter we will all make. It is right that we fight him with all the means available to us, for such is the very drive of life itself, but it is also the defining fact of our existence that this is a fight which we will all eventually lose. It is not space, as Gene Rodenberry poetically put it at the beginning of Star Trek, which is the final frontier, the final frontier is death and it is the boundary we all ultimately reach at the end of our journey through life.

Living fully, richly, is accepting that our lives are bounded by their ending, tapping into the power caused by the dynamic tension between our burgeoning vitality and the inevitable victory of entropy. Keeping the opposites in balance without denying or abandoning either. It is the very transitory nature of life which makes it so marvellously sweet. At the moments which are the most wonderful, the most ecstatic, we find ourselves wishing that this could go on forever. But the very impetus of that wish has its roots in the germ of knowledge that this too, like all other things, will pass.

Do not go gentle into that good night,
Old age should burn and rage at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
Dylan Thomas, 1951


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