Oct 31, 2011

Death Be Not Proud

I submitted this essay for publication in JAMA's A Piece of My Mind but was rejected. So I figure I'll publish it myself!

My Asian parentage in a conservative country meant that talking about death is much of a taboo as of drugs or sex. From childhood, we learned to ask no more questions when Mum or Dad says “I’m attending a funeral today.” Even when my paternal uncle passed, we drove back bantering all the way, embalmed and sealed his coffin, and buried him along with all our words.
When I enter medical school, I know death is an issue we all have to encounter in our careers. After all, medicine is to life and death as tailors are to fabrics. However, we are youthful flaming torches, the pillars of society; leaders of the future. Death seems the distant if not unimaginable end, yet. To us, life is limitless and we are omnipotent.
It wasn’t until my third year of medical school that I come face to face with death. “Silent mentors” we call it – cadavers willingly donated to our university to better medical education and lecture us (silently) on death. For the first time death was discussed openly, along with endless stories behind each selfless sacrifice and breaking social constraints. The traditional Chinese believes it is of utmost importance that you return dust to dust in physical completeness, lest you return handicapped should karma dictates another cycle of mortal suffering on Earth. These silent mentors are pioneers in their league – consenting medical students they never knew or talked to stripping them bare to the bone; occasionally having to confront protesting family members amidst their own terminal disease. Their goals simple – “I’d rather you make countless mistakes on my lifeless body than one single mistake on a living, pulsating patient.” Apart from anatomical knowledge, I promised myself a grandiose goal of learning about death, of overcoming the fear of it. I read Pauline Chen's “Final Exam: A Surgeon's Reflection on Mortality” and was touched by the closeness of death, anatomy and afterlife. I was prepared for the next step.
That semester, we literally lived in Anatomy Hall. Burdened by self expectations and the daily minute of silence before dissection, death studieseventually got tossed   under the drawer. Our hot-blooded omnipotence in fall eventually waned into survival instincts by mid-winter and a great sense of relief by end of term. I ended up second in anatomy but still on the starting point about death - still feared, unspeakable and unapproachable. 
During Chinese New Year the following year, I picked up a copy of the local newspaper on boarding my flight home. “All Bodies Found” it said. Shockingly, five students and a young teacher drowned in a boating incident in my hometown. They are my high school juniors, some of them I know distantly. The idea of such an abrupt end to six youthful spirits is deeply traumatic. The nation mourns as my Alma mater flew her flag at half mast, agonized parents find solace in pale chrysanthemum and roses lining school desks, and I wept every day reading the papers. Mum was surprised why his son suddenly became so emotional. Partly I was crying for the bereaved, the other part was for my unsettled understanding of death.
Prof. Huang auscultated me in numerous positions with both his stethoscopes. Surrounded by a dozen classmates in our heart sound class, I became my own patient because I couldn’t find another. I have congenital perimembranous ventricular septal defect. Prof. Huang looked at me sternly and declared, “you will have to get surgery someday, possibly before 40. Or else you will die from heart failure.” I took it lightheartedly. I twittered “time to unearth grandpa’s golden ingots this weekend!” But my end is already in sight.
Way too late, I started pondering the meaning of life in order to understand death. Why live if every one, everything, is destined to die one day? Why leave an impact if we’re bound to be forgotten? Why the aimless pursuits of material comforts, fame, glory, and recognition, if we will be gone and these worldly possessions recycled? Death still strikes the most fragile spot - I littered a tableful of Kleenex during September 11th anniversary; I sat tearing in front of a hospital computer on Steve Jobs’ passing.
Two weeks after the world mourned for Mr. Jobs, Apple posted a memorial page for tributes dedicated to the great man. Watching heartfelt words flash through a minimalistic clean interface, I think I found solace in my fears and answers to my questions. We fear and resist death because we are still so ready to live. As Buddhists believe, still tangled by mortal triviality disqualifying us for eternal tranquility. In other words, do your best, follow your heart and intuition, and leave the rest to faith. Leaving no regrets at the end of the day, literally, as we never know when is our last. Then we are truly, sincerely, fearless of death.
In fact, death makes living more precious. Knowing that all of us will eventually become part of history, we strive to leave legacies. Some bring up wonderful children, a partial imprint of their future; some design life-changing devices; some live forever in the hearts of others.
With hindsight, I recounted the story of my silent mentor. Extremely sensitive to pain, she left us with the notion that she would feel more worthwhile suffering the scalpel than that of rotting or cremation. At least it serves to educate five aspiring medical doctors. She had seen beyond her mortal self, willing to leave behind a declining but still useful carbon shell for us medical students. She lives forever in our hearts.
We never really leave the world without traces. Every humanly interaction, every patient we talked to and educated, every family we comforted, every tweet or Facebook update, had in a tiny way shaped the world for the better. Learning that my days are numbered (without surgery) helps me appreciate more the simple joys of everyday life - running on a crisp winter morning, eating pancakes with raisins and overflowing syrup, getting the full text of an article I really wanted on PubMed (you never know with our hospital). I may not live to have children, write textbooks, or be surgeon general, but I lived in my parents’, classmates’ and the few patients’ hearts I cared for. For some littlest amount of time they depended on me and I didn’t fail them. That is sacrifice I am capable of.
So I read through Mr. Job’s memorial tribute with elation and relief. Pondering whether to write an email thanking him for enlightenment, living today as if it is the last. No regrets.