There is an app on my phone that reminds me I will die 5 times per day. Did you know? There is an app for that.
A tattooed chaplain I had dated introduced me to the app, and I had paid 99 cents for it. Apparently, those that contemplate their mortality live longer and happier lives than those that do not. This is a practice in Bhutan.
This is not a practice in America, land of the free mammogram and home of the medically adept. In America, we marginalize death, so as not to spook the living.
Once there was a patient who received a palliative care letter. I did not know her at the time. Accidentally on-purpose, the letter was sent. She was not ready for the letter, I heard, yet the letter was ready for her.
Whispers were that it was patented as a ‘patient relation’ issue, and the Sender was never found. (Perhaps it was a modern medicine issue, where palliation means death, and death is failure.) How hopeful it is to deem an appropriately-timed letter offensive.
Someday, I want to be buried by humans with this hope. I imagine them curious, folding me back into the earth, unsure of what may become of my carcass. I imagine specks of ground freckling my former face like sunshine. The shovelers would powder-dust me with dirt like a bundt cake. Maybe they’d expect a poppyseed of me to germinate. Perhaps I’d reincarnate as a worm or dirt.
The next day in clinic, we met.
She sat, posture perfect in a lime green gingham button up, legs crossed neatly and acid-wash jeans pressed precisely. Little silver rings circled her fingers and a delicate chain looped her neck, dipping into her sallowed clavicle. I thought she looked thin, fit. Our attending said she was wasting. I wonder if I will be that willowy during my decomposure, or if I will bloat up, thick with steroids.
She ate brassicaceous vegetables. Minded her manners. Exercised, probably. Portioned meals, I presume. And still had pancreatic cancer with a 2 year projection at best. You can do everything right, and you will still die.
This is when I downloaded the chaplain’s app. I see myself in her, and I want to be ready when I receive my palliative care letter. I want to be ready right now. Not everyone is gifted an expiration date.
Humans are farmer’s market veggies: fresh, plucked, vibrant, and earthy to the core. Some sit, ready for acute devouring under the hot summer sunflower sun. Some wait, chronically nestled into artificial cooling devices for later sizzling with cooking devices and saucy spices. Unlike an egg carton, there is no neat, electronic print of a ‘best by’ date for fresh produce. Like humans, you know when vegetables are past their prime by appearance, varying by make and model and care.
One week later, an electronic notice bolded a tomato-red emergency department visit in the chart of my green-gingham patient: symptomatic gallstones.
So begins the deterioration, I think. I regret thinking this way. I like her.
So begins my jading of which people speak. Empathy declines, they say. Somewhere between idealistic medical school beginnings and humbling clinical rotations, students begin comparing patients to farmer’s market produce, an ‘ob-vegetification’ process. Snap-judgments rank patients on a sliding scale of ripeness. Disease progression ranges from small perky spinach, to thick-leaved spinach, to ‘probably-ok-to-eat’ spinach, to dark wilted-spinach, and finalizes with spinach that coalesces into a green-kelp goop at the bottom of a plastic bag. chilling.
I want her to be thick-leaved spinach. I want the silver rings on her spindled digits to fit properly, like rings on thick asparagus fingers. Her fingers are slender haricot verts. The tasteful rings slide wildly, clanging together with movement.
With a knife they went into her bloated belly, after the red and furious gall. On the monitor I did not see the cancer. I wonder where it lived in her. I could have looked it up, but I did not, out of misdirected reverence. They stapled, cut, and caught the swollen gallbladder in a plastic fishnet baggie. Then, they pulled it out of her, spattering red beet juice on the blue, billowy drapes. Then, they desufflated her abdomen.
I guess they left the cancer inside.
After surgery, the rice crispies under her skin crinkled like tissue paper when I touched her. That is when I felt the fragility of separated sinews. Delicate, like frosted lace.
I am of this gossamer material as well. At this moment, she has her place in medicine, as I have mine. We both have plots in the planted ground and a finite quantity of ripened seconds above it.
She will die. The chaplain will die, as will I, outlived by a 0.99 cent app that predicts our shared certainty.
- DeWall, C., & Baumeister, R. (2007). From Terror to Joy: Automatic Tuning to Positive Affective Information Following Mortality Salience. Association for Psychological Science, 18(11) ↵
- Institute of Medicine (US) Committee on Care at the End of Life; Field MJ, Cassel CK, editors. Approaching Death: Improving Care at the End of Life. Washington (DC): National Academies Press (US); 1997. 2, A Profile of Death and Dying in America ↵
- Chen, D. C. R., Kirshenbaum, D. S., Yan, J., Kirshenbaum, E., & Aseltine, R. H. (2012). Characterizing Changes in Student Empathy Throughout Medical School. Medical Teacher, 34(4), 305–311 ↵