The Way We Die Now (7 page)

Ó Súilleabháin here writes about ‘the existence of the human soul’ as if its discovery was a scientific fact, akin to a sub-atomic particle. He viewed these wake practices as ‘pagan’ in origin, and ‘certain aspects of traditional wakes’ were eventually stamped out by the clergy, using pulpit denunciation and various synodal decrees. ‘Certain aspects of traditional wakes’ or ‘wake abuses’ almost certainly involved sex and alcohol, but Ó Súilleabháin could not go into any great detail about this when he wrote his book. Nor could he have foreseen how Ireland would shortly and dramatically shed its Christianity.

Wakes are now rare, even in Ireland, and tame events compared to the Dionysian extravaganzas described in
Irish Wake Amusements.
The last wake I attended was that of an old neighbour, the wife of the man from our street who had dropped dead at forty. She had more than forty years of widowhood, and had died a great-grandmother. It was held in the little house where she had raised her six children and she was laid out in the front parlour – the ‘good room’; neighbours arrived in a regular stream and remarked how beautiful she looked. I sat next to the open coffin, and had tea and cake with her family. It was a happy, creaturely gathering and there was something about it that was intimate and serene – the fine old woman, the modest room. That which caused revulsion in Dumfries, in Cork was companionable and easy.

*

My aunt, a nun in the Bon Secours order, died in 2010 after many years of severe dementia. During these years, she had been cared for in the convent infirmary with a love and attentiveness that was the most persuasive argument for Christianity that I have encountered. When she died, her fellow sisters gathered in the small sitting- room of the nuns’ infirmary, where she was laid out. After the recitation of the rosary, they sang hymns; the sound of these old women’s voices had a strange grandeur and pathos.

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Death has become fashionable as a topic of public discussion, but, despite all the celebrity memoirs and earnest newspaper articles, it is still largely hidden. In Europe, the process of secularization has advanced so far that we will never see a return to Philippe Ariès’s ‘tame death’. Could we fashion a secular version of tame death? I doubt it: death is tamed by ritual, and ritual is primarily a religious phenomenon. We will never go back to a pre-Enlightenment Christianity in Europe, and secular rituals will not emerge.

Perhaps it is impossible for us, afflicted by a lethal combination of secularism and individualism, to see inside the minds of our ancestors. In our atomized world, death is far more shocking for us because we cannot imagine anything beyond this self, this life.

When Philippe Ariès described how ‘tame death’ gradually became ‘hidden death’, he called it ‘the beginning of the lie’, and used Tolstoy’s novella
The Death of Ivan Ilyich
(1886) as a key text to illustrate this dramatic shift in human behaviour. Ilyich is a successful judge in his forties. His life is devoted to advancing his career and maintaining the proprieties of his bourgeois life. He has grown distant from his vain, superficial wife, and concerns himself with house furnishings and card-games. He is taken ill with a vague pain in his abdomen, which is diagnosed by various doctors as ‘appendicitis’ and a ‘loose kidney’. His pain gradually gets worse, and it eventually becomes clear that he is dying. His family and the doctors try to hide the awful truth from him:

Ivan Ilyich’s great misery was due to the deception that for some reason or other everyone kept up with him – that he was simply ill, and not dying, and that he need only keep quiet and follow the doctor’s orders, and then some great change for the better would be the result. He knew that whatever they might do, there would be no result except more agonizing sufferings and death. And he was made miserable by this lie, made miserable at their refusing to acknowledge what they all knew and he knew, by their persisting in lying over him about his awful position, and in forcing him too to take part in this lie. Lying, lying, this lying carried on over him on the eve of his death, and destined to bring that terrible solemn act of his death down to the level of all their visits, curtains, sturgeons for dinner... was a horrible agony for Ivan Ilyich. And, strange to say, many times when they had been going through the regular performance over him, he had been within a hair’s breadth of screaming at them: ‘Cease your lying! You know, and I know, that I’m dying; so do, at least, give over lying!’ But he never had the spirit to do this. The terrible, awful act of his dying was, he saw, by all those about him, brought down to the level of a casual, unpleasant, and to some extent indecorous, incident (somewhat as they would behave with a person who should enter a drawing-room smelling unpleasant). It was brought down to this level by that very decorum to which he had been enslaved all his life.

Towards the end, Ilyich realizes that he had ‘not lived as one ought’, that his death, like his life, was full of lies. ‘From that moment’, writes Tolstoy, ‘there began the scream that never ceased for three days, and was so awful that through two closed doors one could not hear it without horror.’ Only at the very end does Ilyich experience any peace, when his young son takes his hand, and the dying man feels tenderness and forgiveness for his family.

Ivan Ilyich’s agony is an example of what Cicely Saunders, the founder of the hospice movement in Britain, called ‘total pain’. By this she meant a kind of suffering beyond physical pain, marked by hopelessness, loneliness and existential despair. In my view,
The Death of Ivan Ilyich
is the most powerful, the most true, depiction of dying in fiction. The novella has had a strange afterlife:
ivans xtc.
(2002), a film loosely based on the story, is an account of the final days of an amoral Hollywood agent who is dying of cancer. Nowadays, ‘the scream that never ceased for three days’ would have been drowned out by the syringe-driver, but The Lie is alive and well.

In 1923, Dr Felix Deutsch examined his patient, the sixty-seven-year-old Sigmund Freud, and found that he had an oral cancer. Deutsch confided in six of Freud’s closest associates, and it was decided that the great man must not be told. Later, when Ernest Jones – psychoanalyst and author of the first major biography of Freud – admitted to Freud that the truth had been kept from him, the great man demanded, ‘
Mit welchem Recht
?’ (‘With what right?’). Deutsch resigned as Freud’s personal physician and was replaced by a young doctor called Max Schur. At their first meeting, Freud told Schur what he considered the two most important elements of the doctor–patient relationship: first, that they always tell each other the truth, and second, ‘that when the time comes, you won’t let me suffer unnecessarily’.

John McGahern wrote about his mother’s death in
Memoir.
(McGahern himself was sickening when he wrote this book, and mortally ill by the time of publication.) She had been diagnosed with breast cancer during pregnancy, and went to the Mater Hospital in Dublin for treatment: ‘When we asked about her we were warned not to ask but to pray to God. To veil everything in secrecy and darkness was natural to my father, and it turned out that my mother was far from happy with this secrecy.’

Meanwhile her husband, McGahern’s monstrous police sergeant father, was secretly corresponding with his wife’s surgeon: ‘Dear Sir,... Would you, therefore be good enough to advise me on the following: 1. Should my wife give up teaching? 2. What is your opinion of her chances of recovery? 3. What roughly are the percentages of recovery from her disease taken at this stage she was operated on?’

The surgeon duly replied: ‘She probably has a 30% chance of complete recovery.’ Clearly, patient confidentiality was not greatly observed in 1940s Ireland. McGahern observed: ‘He communicated neither this nor the previous report to my mother or to anybody else...’ McGahern’s mother died, attended only by her sister and a nurse. Her husband was stationed in the police barracks of another town. The children were taken away before the end to the barracks and their father, and his world of secrecy and evasion. His mother’s death was ‘hidden’:

Those who are dying are marked not only by themselves but by the world they are losing. They have become the other people who die and threaten the illusion of endless continuity. Life goes on, but not for the dying, and this must be hidden or obscured or denied... My mother’s faith must have been a strength, but even this was used against her when my father accused her of losing her faith in God. No matter how strong that faith was, it could hardly alleviate the human pain of losing everyone who depended on her whom she loved and held dear. She had no one to communicate this to after her forty-two years in a world where many loved her.

Mortality was arguably the main theme of Samuel Beckett’s work, but even he found himself powerless to resist the Lie. In May 1954, his only brother Frank was diagnosed with terminal lung cancer, aged fifty-two. Beckett travelled from Paris to Dublin, where he spent several months caring for his brother. Frank’s wife and Beckett agreed that Frank should not be told the truth, a decision that caused Beckett great anguish, as described by James Knowlson in
Damned to Fame
, his biography of Beckett: ‘He found that one of the worst things about the situation was “the atmosphere of duplicity and subterfuge”, as he listened with an aching heart to his brother making plans for better days.’

Philippe Ariès described how a key component of the ‘hidden death’ was concealment of the truth from the dying:

A new relationship had been established that brought the dying man and his entourage closer on an emotional level; but the initiative, if not the power, still belonged to the dying. Here [in the ‘Hidden Death’] the relationship persists, but it has been reversed, and the dying man has become dependent on his entourage... When this happens – and this is the situation today – it will be assumed that it is the duty of the entourage to keep the dying man in ignorance of his condition. How many times have we heard it said of a husband, child or relative, ‘At least I have the satisfaction of knowing that he never felt a thing.’ ‘Never feeling a thing’ has replaced ‘feeling his death to be imminent’.

Ariès described how ‘the final dialogue’ of the tame death – ‘the last farewells, the last words of counsel’ − had been ‘abolished by the obligation to keep the dying man in ignorance’. He argued that ‘The Lie’ robbed the dying: ‘The last communion with God and/or others was the great privilege of the dying. For centuries there was no question of depriving them of this privilege. But when the lie was maintained to the end, it eliminated this communion and its joys.’

Sherwin Nuland, the late American surgeon and writer, author of
How We Die
(1993), reflected on his experience of concealing from his dying brother the full extent of his disease. Nuland observed that the dying themselves sometimes collude in the Lie. This is usually at a subconscious level: they may not wish to face the awful truth. They may actively deny the truth. They may be afraid of ‘upsetting’ their relatives, or even their doctors:

At no time did I ever consider sharing with him what I knew to be the virtually certain prognosis that he would not survive till summer... Harvey Nuland had a first-class mind and two perfectly good ears, not to mention the keen degree of insight common in those accustomed to adversity, and yet – again and again – I was taken aback by the magnitude of his denial, until near his last days. There was something in him that refused the evidence of his senses. The clamor of his wish to live drowned out the pleadings of his wish to know...

Sometimes the very sick display what appears to me a remarkable indifference, a lack of curiosity. In
Nothing to be Frightened Of
(2008), his meditation on death (and his terror of it), Julian Barnes wrote about his father, who was diagnosed with cancer, which he survived: ‘My father was diagnosed with Hodgkin’s disease in his early fifties. He didn’t ask the doctors what was wrong with him, and therefore wasn’t told. He went through the treatments, and the hospital recalls, and the gradually less frequent check-ups for twenty years without ever asking.’

This is not an unusual reaction to serious illness: I have seen it many times. I suspect it is some form of primitive reflex that protects our personality from disintegrating in times of crisis. This denial, this lack of curiosity, is a recurring theme in my experience of dying. Few of us behave as we imagine we might, or hope that we would, when faced with the news that our demise is near.

Kieran Sweeney, a doctor and writer, was diagnosed with pulmonary mesothelioma in 2009. The condition, a type of lung cancer usually caused by exposure to asbestos, is almost invariably fatal. He wrote about his diagnosis in the
British Medical Journal
:

The next 48 hours are spent talking to our four beautiful kids, aged mid-teens to early 20s, whose joyous careers are currently sprinkled through school, part-time jobs and university. I can’t really convey in words the catastrophic hurt my news has inflicted on them, and it is an insult, which at their age they should never have to endure. I will die of this tumour, I say, and we must address that, neither accepting nor comprehending it. This tumour will kill my body, I say, but I will yield my spirit and personhood reluctantly. We embrace. They weep. I weep for them, for fear for myself, and for the unthinkable horror that they will continue to inhabit the world in which I will play no part.