What doctors know about death that the rest of us don’t

Yet another story recently surfaced about how doctors don’t die like everyone else. Doctors die quietly at home, surrounded by family—not in the hospital like most Americans. This difference has been ascribed to knowledge about the limits of modern medicine and experience with the horror of lingering deaths on life support, and there is doubtless truth in those ascriptions. As a physician and writer, I believe that there is also another more subtle but equally important contributor, and that has to do with the stories we tell ourselves about death.

The language we use about death is illustrative of our attitudes. We speak of fighting and overcoming disease, of courage and bravery, of beating the odds. We also speak of giving up, letting go, losing the battle. It’s as though we believe that death isn’t inevitable, that we have some choice in the matter. We even say to one another, “If I die,” and “If you die,” not “When we die”—as though our probability of dying weren’t exactly 100%.

Our society has stories about deaths that are admirable and deaths that are not. The narratives aren’t just about people who jump in rivers to save drowning children or who are shot in an attempt at armed robbery. An airplane passenger who dies in a terrorist bombing is considered a hero, but if that same airplane passenger had died of a stroke before the terrorist boarded the plane, he would have just been considered unfortunate. Diseases even get different levels of cool points. Cancer is most often associated with the battle narrative; people who haven’t yet died from complications of their kidney failure don’t get to call themselves “survivors.” Heart attacks are easier to talk about than liver cirrhosis. AIDS was perhaps the most shameful way to die until activists changed the narrative, and now it is a noble disease. Breast cancer underwent the same gilding with pink gold thanks to activism.

When I was in high school, my English teacher had us read a short story about a man whose brother had been killed by a falling pig. I have often thought about that character, about how complicated grieving can be if your loved one dies in a way that is socially uncomfortable. Death by falling pig is disturbingly comical, but grieving is also complicated for those whose loved ones have died from causes our society considers shameful, such as mental illness or addiction. It should not be so. A child who lost her mother to complications of schizophrenia is just as deserving of our sympathy as a child who lost her mother in the World Trade Center on 9/11. The manner of their deaths should not alter our opinion of the value of those women’s lives or the significance of their daughters’ losses.

The narratives our society uses for death are not just a problem for surviving family members, they are perhaps an even greater problem for the dying. We want to believe that death is optional, so we don’t talk about it, and we don’t make plans for our deaths. When diagnosed with terminal illness, we focus on the fight, not on making our exit from the world as graceful as possible. When our family members are on their deathbeds, we show our love for them by lauding their courage, by not “giving up,” and by exhorting physicians to “do everything.”

The secret doctors know is that the stories aren’t true. There’s nothing more noble about dying from cancer than from alcoholism. There isn’t a battle against death to be fought, just treatments to endure when the disease is treatable and symptoms to endure when the treatments are futile. Death has always been inevitable, but once their deaths are imminent, doctors just want to be comfortable and to spend the last days with family. It turns out that this is what most of us want, and we can have it if we can just bring ourselves to let go of narratives that don’t make sense and get more comfortable with the truth.

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