It is never easy to contemplate the end-of-life, whether its own our experience or that of a loved one.
This has made a recent swath of beautiful essays a surprise. In different publications over the past few weeks, I've stumbled upon writers who were contemplating final days. These are, no doubt, hard stories to read. I had to take breaks as I read about Paul Kalanithi's experience facing metastatic lung cancer while parenting a toddler, and was devastated as I followed Liz Lopatto's contemplations on how to give her ailing cat the best death possible. But I also learned so much from reading these essays, too, about what it means to have a good death versus a difficult endfrom those forced to grapple with the issue. These are four stories that have stood out to me recently, alongside one essay from a few years ago that sticks with me today.
My Own Life | Oliver Sacks
As recently as last month, popular author and neurologist Oliver Sacks was in great health, even swimming a mile every day. Then, everything changed: the 81-year-old was diagnosed with terminal liver cancer. In a beautiful op-ed, published in late February in the New York Times, he describes his state of mind and how he'll face his final moments. What I liked about this essay is how Sacks describes how his world view shifts as he sees his time on earth getting shorter, and how he thinks about the value of his time.
Before I go | Paul Kalanithi
Kalanthi began noticing symptoms — "weight loss, fevers, night sweats, unremitting back pain, cough" — during his sixth year of residency as a neurologist at Stanford. A CT scan revealed metastatic lung cancer. Kalanthi writes about his daughter, Cady and how he "probably won't live long enough for her to have a memory of me." Much of his essay focuses on an interesting discussion of time, how it's become a double-edged sword. Each day, he sees his daughter grow older, a joy. But every day is also one that brings him closer to his likely death from cancer.
As I lay dying | Laurie Becklund
Becklund's essay was published posthumonously after her death on February 8 of this year. One of the unique issues she grapples with is how to discuss her terminal diagnosis with others and the challenge of not becoming defined by a disease. "Who would ever sign another book contract with a dying woman?" she writes. "Or remember Laurie Becklund, valedictorian, Fulbright scholar, former Times staff writer who exposed the Salvadoran death squads and helped The Times win a Pulitzer Prize for coverage of the 1992 L.A. riots? More important, and more honest, who would ever again look at me just as Laurie?"
Everything I know about a good death I learned from my cat | Liz Lopatto
Dorothy Parker was Lopatto's cat, a stray adopted from a local vet. And Dorothy Parker, known mostly as Dottie, died peacefullywhen she passed away earlier this month. Lopatto's essay is, in part, about what she learned about end-of-life care for humans from her cat. But perhaps more than that, it's also about the limitations of how much her experience caring for a pet can transfer to caring for another person.
Yes, Lopatto's essay is about a cat rather than a human being. No, it does not make it any easier to read. She describes in searing detail about the experience of caring for another being at the end of life. "Dottie used to weigh almost 20 pounds; she now weighs six," Lopatto writes. "My vet is right about Dottie being close to death, that it’s probably a matter of weeks rather than months."
Letting Go | Atul Gawande
"Letting Go" is a beautiful, difficult true story of death. You know from the very first sentence — "Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die" — that it is going to be tragic. This story has long been one of my favorite pieces of health care journalism because it grapples so starkly with the difficult realities of end-of-life care.
In the story, Monopoli is diagnosed with stage four lung cancer, a surprise for a non-smoking young woman. It's a devastating death sentence: doctors know that lung cancer that advanced is terminal. Gawande knew this too — Monpoli was his patient. But actually discussing this fact with a young patient with a newborn baby seemed impossible.
"Having any sort of discussion where you begin to say, 'look you probably only have a few months to live. How do we make the best of that time without giving up on the options that you have?' That was a conversation I wasn't ready to have," Gawande recounts of the case in a new Frontline documentary.
What's tragic about Monopoli's case was, of course, her death at an early age, in her 30s. But the tragedy that Gawande hones in on — the type of tragedy we talk about much less — is how terribly Monopoli's last days played out.
My father takes me down to the arroyo when I am so small that I do not yet reach his waist. My feet fumble across flaking desert skin and he pulls me along gently by my hand and tells me to be careful of small cacti and the bones of dead jack rabbits. He does not let me straddle the rift where the earth divides into repelling mounds of sand. Instead, he slips his hands beneath my arms and swings me around in a half circle, his red face wrinkling into a smile.
That morning, my father had crept into my room with the sun and shaken me into consciousness. “Get your sneakers,” he had whispered. “We’re going on a treasure hunt.”
It is minutes later now and we are trudging down an overgrown trail, tactfully descending the deep slopes of New Mexican land. Everything smells strongly of mud and salt and soaked manure from the horse barn down the road. I almost trip over a weed, but my father steadies me and says, “Almost there, baby.”
The arroyo is different than I have ever seen it. It is scattered with long, silver puddles. In the pink glow of the rising sun, the sand looks shiny and slippery. Around us, green tufts of vegetation burst from the earth in unpredictable patterns and yellow wildflowers with thin stems knock softly against each other in the wind.
My father tells me to wait and he steps down into the wet sand. I watch as his sandals sink deep into the ground and leave long footsteps. He crouches suddenly, and digs into the earth with a discarded stick. Then he stands, approaches me, and places in my hand something slimy and smooth.
“A pottery shard,” he says, in explanation. “From the Native Americans, who lived right here a thousand years ago. The rain washes them up. If we’re lucky, we’ll find all the pieces of an entire pot.”
I look down at the strange triangular stone and wipe the sand from its surface. He lifts me up in his arms, carries me back toward the house.
My father gives me a book about Georgia O’Keeffe for my fifth birthday. We read it together and he bounces me on his knee and licks his fingertips before turning the pages. He points at a landscape that looks like a rumpled tablecloth and tells me, “This is why we’re here.” I steal a flashlight and flip through the book under my covers at night. I touch the same glossy picture and whisper, “This is why we’re here.”
When I am 6 years old, the Sunday school teacher asks me what my father does for a living. I tell her he is an artist like Georgia O’Keeffe. I do not know that I am lying. I do not know that he hasn’t sold a piece in months. I do not know that my mother sits at the kitchen table after I go to sleep and cries because the mortgage is past due and she can’t figure out a way to tell me that this year, Santa Claus just might not make it.
For Christmas, my father gives me a sparkling blue stone he found in the arroyo. I say thank you and pretend I mean it. Later, I stand on the edge of our brick patio and wind up my arm and throw the rock as far as it will go. It disappears inside the bristles of a pine tree.
I do not say goodbye to the arroyo before shutting the car door and stretching the seatbelt across my chest. I do not say goodbye because I think that I won’t miss it. We are leaving New Mexico. We are going to New York where my father will get a real job and we will become a real family. We drive alongside a cliff, the rock rough and jagged and sprinkled with a thousand tiny diamonds. I press my finger against the glass. This is why we’re here.
When I am 16 years old, my father takes me back to New Mexico and we go once more to the arroyo. The neglected trail is long gone now and we stumble in our tennis shoes over dried up cacti and colorless desert flowers. I am too old now to hold my father’s hand. He walks a few steps ahead of me and I do not see his face.
The arroyo is bone-dry, littered with dented soda cans, beaten strips of tire and mud-stained garbage bags. Many monsoon seasons have left the sides of the arroyo tall and smooth, except for the dried roots of long-dead plants, still lodged in the dirt, which reach out toward us like skeleton hands.
My father crouches over and his shirt draws taut across his back. He delicately parts the earth with his fingers and searches for something that he will never find again.
“No more pottery,” he says. He looks at me and squints his eyes against the sun. “It must have washed far away by now.”
Suddenly comes to me the vague image of my father in ripped jeans, pressing a pottery shard into my palm.
I wonder if he, too, has washed far away.