“Life is like lickin’ honey off a thorn.” -Louis Adamic
“Count no man happy until he be dead.” -Solon
Solon’s comment circa 595 BCE was meant to cheer on his Athenians during an early Battle of Salamis. His point was that a man cannot die happy having had an unhappy end; so, one should endeavor vigorously to make that end happy. Other versions are that Solon countered the boasts of Croesus about his great wealth which produced in him monumental happiness by making the above quote. As it turns out, Croesus met his end in a defeat by Cyrus, the Persian and was sentenced to burn on a pyre. Worry, fear, guilt, regret, and uncertainty, do not contribute to that kind of finish to an otherwise happy life. But the approach need not be so dramatic as trying to be of good cheer while facing death in a history changing great battle. One of the major missions of hospice care is to erase all the negative elements of a person’s life and allow him/her to slip quietly into the state of permanent rest having dreams, memories, and activities that bring pleasure and self-acceptance.
In modern terms, Poet Robert Frost foretold the demise of his and others’ stardom when they outlive their heydays:
“No memory of having starred,
Atones for later disregard
Or keeps the end from being hard.”
When facing a hard end, it is most useful to relive happy memories with friends and family with a special underlining of family. As a person who has lived a life with pain since the beginning of his 70th decade, I can agree with the writer:
“I saw that pain itself was only food for memory; for pleasure ends in itself.” -Lawrence Durrell
For me, the late period of life associated with unrelentingly present pain became a time of contemplation and reflection and an opportunity to do something I had always dreamed of doing—to write and publish novels. At 83, I can hold 43 of them. I am determined to write more and not to let my end with pain dominate my happiness of doing what I love to do in the presence of my loving wife and family.
Doctors and nurses must forget that they are superspecialists and be the most important calling in life after mother and fatherhood to give succor and comfort to their patients. The goal of hospice care is not to cure diseases or to prolong life, but to make life a comfort and a joy for the dying. That is as important as giving a man a new knee, removing a woman’s breast cancer, correcting a baby’s deformity, or prolonging useful life for people with chronic diseases like diabetes.
Tragic ends occur—and in some instances—are unavoidable and uncorrectable no matter what effort or caring a physician, a mother, or a husband, may wish for a different outcome. Physicians who care for accident victims and patients with rapid onset incurable diseases, or even dreaded fatal iatrogenic problems must learn an inner toughness and ability to keep going despite their altogether human impotence or failing. When dealing with patients and families of such dreadful happenings, we must remember the value of the truth, of humility—even with ascending careers as emergency room physicians, brain surgeons, or transplant doctors. We cannot control everything, cure everything, or change everything. We can be part of the great heritage of the ancient Greek Hippocratic Oath:
“I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness,
that I will observe and keep this underwritten oath, to the utmost of my power and judgment. I will reverence my master who taught me the art…
With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.
Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.
Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.
Further, I will comport myself and use my knowledge in a godly manner. I will not cut for the stone, but will commit that affair entirely to the surgeons.
Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood,
and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.
Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.
If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!”
I swore that oath at the age of twenty-seven and have held it sacred through my student and training years, as a naval general surgeon, and as a practicing neurosurgeon in the navy, in academia, and two areas of private practice. I have made mistakes, but never one of not caring for my patients or of defrauding any patient by excessive billing or unnecessary surgery. Many of my patients suffered grievous and irreparable wounds, even death. More than one of the deaths could be considered my fault–despite my best efforts–owing to the decisions I made. But… I determined from the beginning that I would hold the Hippocratic promises as binding, even if unspoken, guarantees with my patients. I did that to the best of my ability for all my human frailties, and I will die with the knowledge and comfort that I was a good doctor.
My conclusion for all of that, is to remind doctors and all care providers of the magnitude of the promise they make to ease suffering and above all else, “to do no harm.” And, I remind my colleagues of the need to be hyperaware that their good intentions may actually bring harm. If that happens, resort to the truth, and give as much solace as can be brought to bear.
Physicians, you have been blessed with a fine and comprehensive education. That includes a definite acquaintanceship with the literature of the ages which can stand you in good stead when you meet with and provide care for a dying person.
“Tho’ much is taken, much abides; and tho’ we are not now that strength which in old days moved earth and heaven, that which we are, we are.
One equal temper of heroic hearts, made weak by time and fate, but strong in will to strive, to seek, to find, and not to yield.” -Ulysses
That final line is inscribed at Observation Hill, Antarctica, to commemorate explorer Robert Falcon Scott and his party who died on their return trip from the South Pole reached by them January 17, 1912. It is a good motto for all of us, especially as we approach our own ends.
The character quality of resilience needs to be instilled into every human from birth to death, by parents, pediatricians, theologists, governments, militaries, and gerontologists, and hospice care givers. Physicians have a particular duty to work to help their patients to achieve that quality before it is too late.
William Wordsworth, Ode: Intimations of Immortality from Recollections of Early Childhood
There was a time when meadow, grove, and stream,
The earth, and every common sight,
To me did seem
Apparelled in celestial light,
The glory and the freshness of a dream.
It is not now as it hath been of yore;—
Turn wheresoe’er I may,
By night or day.
The things which I have seen I now can see no more.
The Rainbow comes and goes,
And lovely is the Rose,
The Moon doth with delight
Look round her when the heavens are bare,
Waters on a starry night
Are beautiful and fair;
The sunshine is a glorious birth;
But yet I know, where’er I go,
That there hath past away a glory from the earth.
Ye blessèd creatures, I have heard the call
Ye to each other make; I see
The heavens laugh with you in your jubilee;
My heart is at your festival,
My head hath its coronal,
The fulness of your bliss, I feel—I feel it all.
Oh evil day! if I were sullen
While Earth herself is adorning,
This sweet May-morning,
And the Children are culling
On every side…
The pansy at my feet
Doth the same tale repeat:
Whither is fled the visionary gleam?
Where is it now, the glory and the dream?
Our birth is but a sleep and a forgetting:
The Soul that rises with us, our life’s Star,
Hath had elsewhere its setting,
And cometh from afar:
Not in entire forgetfulness,
And not in utter nakedness,
But trailing clouds of glory do we come
From God, who is our home:
Heaven lies about us in our infancy!…
A wedding or a festival,
A mourning or a funeral;
And this hath now his heart,
And unto this he frames his song:
Then will he fit his tongue
To dialogues of business, love, or strife;
But it will not be long
Ere this be thrown aside,
And with new joy and pride
The little Actor cons another part;
Filling from time to time his “humorous stage”
With all the Persons, down to palsied Age,
That Life brings with her in her equipage;
As if his whole vocation
Were endless imitation…
Mighty Prophet! Seer blest!
On whom those truths do rest,
Which we are toiling all our lives to find,
In darkness lost, the darkness of the grave;
Thou, over whom thy Immortality
Broods like the Day, a Master o’er a Slave…
Why with such earnest pains dost thou provoke
The years to bring the inevitable yoke,
Thus blindly with thy blessedness at strife?
Full soon thy Soul shall have her earthly freight,
And custom lie upon thee with a weight,
Heavy as frost, and deep almost as life!…
The thought of our past years in me doth breed
Perpetual benediction: not indeed
For that which is most worthy to be blest;
Delight and liberty, the simple creed
Of Childhood, whether busy or at rest,
With new-fledged hope still fluttering in his breast:…
Those shadowy recollections,
Which, be they what they may
Are yet the fountain-light of all our day,
Are yet a master-light of all our seeing;
Uphold us, cherish, and have power to make
Our noisy years seem moments in the being
Of the eternal Silence: truths that wake,
To perish never;
Which neither listlessness, nor mad endeavour,
Nor Man nor Boy,
Nor all that is at enmity with joy,
Can utterly abolish or destroy!
Hence in a season of calm weather
Though inland far we be,
Our Souls have sight of that immortal sea
Which brought us hither,
Can in a moment travel thither,
And see the Children sport upon the shore,
And hear the mighty waters rolling evermore.
Then sing, ye Birds, sing, sing a joyous song!
And let the young Lambs bound
As to the tabor’s sound!
We in thought will join your throng,
Ye that pipe and ye that play,
Ye that through your hearts to-day
Feel the gladness of the May!…
Though nothing can bring back the hour
Of splendour in the grass, of glory in the flower;
We will grieve not, rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering;
In the faith that looks through death…
Yet in my heart of hearts I feel your might;
I only have relinquished one delight…
The innocent brightness of a new-born Day
Is lovely yet…
Another race hath been, and other palms are won.
Thanks to the human heart by which we live,
Thanks to its tenderness, its joys, and fears,
To me the meanest flower that blows can give
Thoughts that do often lie too deep for tears.
-Heavily abridged by Carl Douglass
“Love make us poets, and the approach of death should make us philosophers.
