The Myth Of “Saving” Lives

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The Raising of Lazarus by Rembrandt

This post has been sitting in my drafts folder (i.e. the tomb) for months because I worked on it too long the first day, evening caught me unawares, and the basic idea suddenly turned stupid.  (My posts are like vampire victims.  Sunset frees my inner critic to suck the blood out of ’em.)

But then a few days ago I came across the following article, Faulty Rhetoric: ‘Save a Life’, written by a real doctor and voila!  My idea sat up in its coffin.  The blood is back, my friends.

Let’s see if I can finish before nightfall this time.  EDITOR

The myth that modern medicine can “save” lives is a primal myth, an archetypal one.

If there was ever a contest to pick the One Medical Myth To Rule Them All, I’d put my money on this puppy because its seductive, prolific, tenacious little tentacles reach into almost every corner of medicine.  The belief that we can save lives is arguably the basis of our entire modern health care system and therefore the majority share of our economy, too.

And yet it’s not true.  (Hence, the myth part.)  It’s based on…well, denial of course.  But also a verbal trick so simple that you’ll laugh when you hear it…or cry, or dismiss it as stupid and irrelevant…but here’s the gig:

To create this myth all you have to do is substitute the phrase “we can save lives” for the phrase “we can extend lives” and poof!  Instant, just-add-water myth. One tiny word change and we humans now wield power over death itself instead of just (some, a little, not very much) power over time.  We don our godhood.

Pretty nifty, no?

The truth is, of course, that nobody can save any life from death.  No one survives permanently.  All we can ever do is…maybe, hopefully…buy ourselves some extra time.

(And I am NOT knocking time here.  If you have something meaningful to do with it every second is sweet, not to mention that occasionally the amount of time purchased is substantial, like years or decades or even, in the case of children, an entire life’s worth.  No.  All I’m saying is that, in the end, a “saved” life dies just like an unsaved one does.  Death is never defeated, just delayed.)

Well…so fucking what? you may be asking and thank you if you are.  That’s a very important question.

The problem doesn’t lie on the individual level.  It’s not inherently bad for a person to hope for delivery from death.  In fact, in the short-term it can help.  Denial is a powerful and effective coping mechanism applied wisely.  It really, truly is.

The harm comes in when our collective, societal focus (and the lion’s share of our national resources) shift en masse from managing time wisely to trying to “save lives” and defeat death completely.  Chaos and tragedy are bound to ensue.  It’s like a bunch of people flying in a plane who yell screw the landing strip, Henry! and cheer the pilot on as he tries to stay aloft indefinitely.

Get where I’m going?  Anyone else having visions of an airliner full of screaming people plunging out of the sky to explode in a gigantic ball of fire when it hits?  Anyone else worried about what it might fall on?  (Anyone see parallels with our current healthcare system?)

In life, as in flight, it’s absolutely critical to always keep one’s final destination in mind because ultimately, most people don’t want to live just for the sake of being alive anymore than they want to fly just for the sake of being up in the air.  They want to use both to experience something more…companionship, family, travel, learning, laughing, growing, adventuring, building, loving one another…something.

So what is most likely to provide the highest quality time (rather than escape from death)?

Would it be to walk into a doctor’s office and beg, Save me Doc!  Save me!  I don’t want to die!

Or would it be to sit down and calmly, realistically say, Okay Doc. Before we talk treatments, you need to know a couple things.  1) How I’d like to live whatever time I have left and, 2) how I’d ultimately like to die…peaceful, complete, surrounded, and loved.  Not strapped to a gurney, blue, and bankrupt with my loved ones traumatized for life.  Now.  Is there a treatment ticket I can purchase that will buy me some meaningful time but still eventually wind up on THAT landing strip?

Of course for conversation that to happen, we each have to first figure out how we’d most like to live and die, because that’s something no doctor…however good, however wise…can tell us.  But figuring that out is also how we finally start to grow up in this new medical paradigm we’ve all created together.   And it’s the only way any of us will ever learn to navigate its labyrinth successfully, harnessing the miraculous benefits it offers while avoiding the substantial harms it can inflict.

And (looks at the watch quick) I’m…done!  With five hours of light still left.  Well done, me.

copyright Dia Osborn 2013

 

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Earthporn (My new favorite word)

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I just heard this term today from my daughter-in-all-but-law and had to laugh.  It’s so true!  The best of “nature” photography really is like porn.  I can lose myself for hours on the National Geographic website or Hubble or Nature’s Best Photography, hungrily staring at these beautiful objects of desire that I then can’t stop thinking about afterwards.

sZSdtcFThese three photos are from a photography website called Imgur that has an entire section devoted to Earthporn.  (I could lose weeks of my life on this site.  Weeks.)  For anyone else who’s helplessly in love with this planet (or who’s just watched the news, or overheard an argument about politics, or hung up on yet one more telemarketer) I highly recommend it.  It makes you forget everything and feel good again…

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…just like porn.

Writing Into The Dark, Muddy Holes

Ach.  I’m wrestling with a painful, scary part of my book right now and it’s hard slogging.  It involves writing the story of some early violence in my life and feels a lot like Brer Rabbit wrestling with the Tar Baby.  Sticky stuff.

So far every time I reach for the memories I feel like one of those old-time Mississippi fisherman going after catfish in the river bank.  Back in the day they used to swim down through the murky water to the holes in the mud where the catfish hide, then they’d stick a fist in.  If there was a catfish in there, and if it wanted to eat (but catfish allus wanna eat) it’d swallow that fist whole and not let go again till the fisherman pulled it out of its hole and all the way back up to the surface, just a-dangling off the end of his arm like a long, slimy hand.

Dinner served.

But sometimes…sometimes…a man would hook one of the old giants and then there’d be hell to pay.  Too big to pull out of its hole with a mouth too strong to break free of, the tables would be turned.  Oh, that unfortunate fisherman would struggle for a while to be sure, but in the end his thrashing would slow and stop and his body’d just float there in the current, bumping up against the bank from time to time all white and wide-eyed, like it was so surprised it was now the property of Ole’ Man River his self.

These memories of violence are like one of those old catfish giants and I have to be real careful swimming that deep.  I know which holes are theirs, down at the very bottom and darker than all the rest, but I also know that if I do this right, if I’m brave and smart and catch ’em to where they have to give me a gift to make me let ’em go, then they’ll make me not be afraid anymore.  That’s all I want.

So how do I perform this mythical feat?  How do I catch ’em?  That’s where the vast power of language comes into play.  The events themselves, those sudden and brief eruptions of rage and violation that happened so very many years ago now, are long dead.  But they set their stories loose in my life, dark tales feeding and growing down in their holes.

I need to reshape and retell these stories.  Need to put them into harness and make them work for me instead of against me.

Namazu and Kashima from Japanese mythology

It was the dying who tried to teach me how to do that and if I can just get through this first part of the book and finally reach their stories…their luminous, beautiful stories…I know it’ll get easier.

copyright Dia Osborn 2011

PARAPROSDOKIANS

I’m a language geek, which is why these kinds of word plays appeal to me so.  My brother forwarded the following to me in an email (my siblings are all language geeks, too) and I loved it so much I thought I’d post it here.

From the email: 

What in the world is a paraprosdokian? you ask.  Well.  It’s “a figure of speech in which the latter part of a sentence or phrase is surprising or unexpected; frequently used in a humorous situation.” 

For instance, “Where there’s a will, I want to be in it,” is a paraprosdokian.

OK, so now enjoy these:

1. Do not argue with an idiot. He will drag you down to his level and beat you with experience.

2. Light travels faster than sound, which is why some people appear bright until you hear them speak.

3. War does not determine who is right – only who is left.

4. Knowledge is knowing a tomato is a fruit. Wisdom is not putting it in a fruit salad.

5. You do not need a parachute to skydive. You only need a parachute to skydive twice.

6. There’s a fine line between cuddling and holding someone down so they can’t get away.

7. Hospitality is making your guests feel at home even when you wish they were.

8. When tempted to fight fire with fire, remember most people use water.

And then, because eight is simply not enough, I found some additional paraprosdokians in a Wikipedia article.  Here are some of those:

  • “If I am reading this graph correctly — I’d be very surprised.” —Stephen Colbert
  • “If all the girls who attended the Yale prom were laid end to end, I wouldn’t be a bit surprised.” —Dorothy Parker
  • “I’ve had a perfectly wonderful evening, but this wasn’t it.” —Groucho Marx
  • “I like going to the park and watching the children run around because they don’t know I’m using blanks.” —Emo Philips
  • “If I could just say a few words…I’d be a better public speaker.” —Homer Simpson
  • “I haven’t slept for ten days, because that would be too long.” —Mitch Hedberg

And here are two more I just found here:

  • “I don’t mean to sound bitter, cold, or cruel, but I am, so that’s how it comes out.” — Bill Hicks
  • “It’s too bad that whole families have to be torn apart by something as simple as wild dogs.” — Jack Handey

Enough!!  I dare you to Google paraprosdokians yourself…I just dare you.

copyright Dia Osborn 2011

Bone Monsters And The Evolution of Vocabulary

In the spirit of Halloween, here’s a spooky story.  And because I am who I am and can’t help myself, there are a few thoughts on dying that follow. (It’s like a tic.)

Without further ado I give you:

My Son And The Bone Monster

One night long ago, on a full moon in July, Father was away on a business trip leaving me, his pregnant wife, and our just-turned-three-year old son alone in the house to sleep.  It was a warm and peaceful summer night, not the kind where spectral things usually wake and wander, yet my sleep was restless and I woke up several times during the night to glimpse something shadowy passing down the hallway outside my bedroom door.  Each time I shook it off and went back to sleep, thinking it was just my imagination playing tricks on me.

In the morning I was jolted from slumber by the high-pitched screaming of my son, and I threw back the covers, leaped out of bed, and ran down the hall before I was even half-awake.

I entered the room to find him wide awake and sitting bolt upright, his back pressed hard against the headboard of his bed.  The bright morning sun streamed through the windows illuminating the entire room, yet he was looking into the empty corner near the foot of his bed as though he could see something.

As I approached the bedside he dragged his eyes away from the corner, looked at me and screamed, “It’s a bone monster!  A BONE MONSTER!!”  And I, of course, responded by doing what every good mother does; I tried to reassure him that nothing was there.  That the suspicious corner was actually empty, that bone monsters don’t really exist, that he’d just had a nightmare.

But he only shook his head in frustration, looked me straight in the eye, and said in a low, urgent, rational kind of voice, “No, Mommy.  Not that kind. This is a REAL bone monster!!!”  His voice rose back up to a scream by the last word and he raised his arm and pointed into the empty corner, as though the proof was right there before both our eyes.

That did it for me. The hair rose on the back of my neck and I climbed onto the bed, scooped him into my arms, and pressed my own back against the headboard.  I flashed back to the strange impressions I’d had during the night, of shadowy things passing down the hallway toward his room, and the coincidence gave me just enough pause to quit telling him he wasn’t experiencing something.  His terror was certainly real.  He’d done a remarkable job for a three-year old of communicating that he understood what a nightmare was and that what he was currently experiencing was something else.  I respected the effort and decided to bail on a rational approach and go with maternal instinct instead.  Here’s what She had to say:

Honey, he’s facing a monster here.  Imaginary or not, are you gonna let this thing fuck with your child?

Well, not when you put it like that.  No.

So I planted myself firmly on the bed, gripped my trembling son against my chest, and crooned ferocious words of protection into his ears.  It’s not gonna get you, sweetheart.  I won’t let it.  I will rip that freaking monster bone from bone…tear its head off, smash it down in the street, and run over it with the car a million times…before I’ll ever, EVER, let it get anywhere near you.  And trust me, I meant every word.

I continued along these lines until Bone Monster seemed to throw in the towel and leave.  I realized we’d won when my son suddenly relaxed, looked up, and told me he was hungry. Hallelujah.  We got up, got dressed, and traipsed out to the kitchen to make pancakes.

As far as I know, the Bone Monster has never returned.

Now, I don’t know why my son and I saw the things we did that night but, since it never happened again, not knowing doesn’t matter.

What’s more interesting to me is that my son called what he was seeing a Bone Monster.  Frankly, the term confused me at first.  (And apparently, only me.  Everyone else who hears the story immediately recognizes that he’s describing a skeleton.)  But when I realized what he’d done…that in lieu of the word skeleton which he hadn’t learned yet, he’d put two words together that he did know, bone and monster…the linguistic elegance of the feat just about knocked my socks off.

Think about it for a second.  The two words he chose had a lot of depth.  Both are multiple use, ancient words that have existed in pretty much every language since the dawn of time.  Bone is steeped in anthropological and folklore traditions as well as modern medical and scientific understanding while monster, still used to describe everything from childhood scary things to giant construction equipment to the heads of despotic political regimes, is quite simply one of the greatest words of all time.  (In fact, with the emotional relief its capable of delivering, I think monster ranks right up there with obscenities.  It can be that powerful.)

So separately they pack a punch, but putting these two words together created a description that was unbelievably sophisticated.  It conveyed not only a physical description of what he was seeing (a collection of bones-sans-flesh that were still arranged in the original shape of some kind of creature) but the intense emotional impact as well (monster–communicating supernatural animation, malice, and immediate threat.)

And it was all because he didn’t know the word skeleton yet.

But children do this all the time, you might argue.  So what?  And of course you’d be right.  Small children are wizards of language right out of the gate, which is probably why we usually take the sophisticated achievement that it is for granted.  I honestly don’t know why I woke up for a minute and saw it this time, but I did.  I goggled.  Positively gaped.

But here’s where it gets even more interesting.  The thing is; It’s not just kids who do this, falling back on old words to describe new thingsIt’s what we all do, whenever we try to communicate about rare experiences. Common names don’t exist yet for uncommon things so if we’re going to try and talk about them anyway, we always have to cobble together existing language in a new way.

And, finally, here it comes…

This is what I feel like I’m up against when trying to talk about my work with the dying.  I mean, I have to use the word dying.  I have to.  Physiologically, that’s just what’s happening.  But it’s also a misleading word, because when I say dying most people hear horror + terror + suffering + death, and then they shut down and that’s the end of the conversation.

For a lot of people dying is the Bone Monster.

But it means something different to me.  After working around it a while, caring for and learning from the people who were doing it, the word dying gained more grace and lost some darkness.  When I say it now there’s still horror in it, of course, but there’s also something strange and luminous involved that takes my breath away.  Its terror is countered by first hand observation of our inherent reservoir of courage, and its suffering is buoyed by my discovery of unsuspected strength.

And death?  It’s still there, too.  But now its death + the dawning awareness that our lives are so irrevocably entwined…our dreams, emotions, cells, and breath are so deeply woven into the physical fabric of the world itself…that on some weird, tangible level that I can see and touch and smell and hear and yet still can’t name, we’re indestructible.

I guess for me, dying is the whole package now, instead of just its worst parts.  I think of it as both Bone Monster and everything that protects us from bone monsters at the same time.  It reminds me of my son’s bedroom that morning; where there was a terrifying source of darkness in the corner, but there was also a fierce, radiant bond of love on the bed. That radiant bond exists in the rooms of the dying, too, and I saw it over and over again, a benign force that seems to emanate from everyone involved but also from the environment.  Almost as though it’s structural, like something we’re made out of.

Sorry, that’s the best I can do.  I don’t have adequate language to describe it except in the most primitive terms, which is incredibly frustrating and part of the reason why I started this blog.  I realize I keep harping on this over and over again.  I think it’s just my way of trying to work out some viable language.

Currently, we have hundreds of common ways to describe the horrible aspects of dying but almost none that describe the beauty involved.  It’s no wonder so many people are still dying bad deaths.  Maybe if we start developing some language for the good parts, too, it’ll get easier to start building good deaths for everyone?

copyright Dia Osborn 2011

The Danger of Blowholes

This photo was taken moments before the man behind the water spray was sucked down a blowhole on Maui last week:

Photo from the article in the Daily Mail.

Sadly, he only came back up to the surface once before being dragged under again and disappearing for good.  At the time the article was written, his body had still not been found.

It’s an odd way to go, death by blowhole, but that’s not what grabbed me.  My eldest brother was also sucked down a blowhole, decades ago now, also in Hawaii only on Oahu, not Maui.  It was during a high surf alert generated by an earthquake on the Asian side of the Pacific rim and, as soon as they heard about it, Bro (an occasionally professional surfer), his girlfriend, and another surfer friend drove up to Waimea Bay to check out the waves.

They weren’t going there to surf.  The waves were coming in around thirty feet and big wave surfing wasn’t yet as popular as it is today.  No. They were just heading up to watch, because waves that big are a rare phenomenon and, like solar eclipses, tornadoes, and eagles mating, sightings are a privilege and opportunities shouldn’t be wasted.

The three were standing up on the cliffs overlooking the bay, admiring the monster surf, when they first noticed it.  Huge spray coming out of a blowhole none of them had ever seen before.  It clearly had a long tunnel, starting down in the bay and running all the way up through the rock to its exit farther out on the point, and no one had noticed it before because it was inactive in smaller water.  It took seismically generated waves to finally send water all the way up and out the top, and Bro and company were understandably excited by the discovery.  They wandered out to take a closer look.

Now understand, these were experienced island people.  They knew about blowholes.  They understood how strong and deadly water that only reaches up to your ankles can be.  But somehow, in spite of keeping what they thought was a safe distance, the wash coming out of the hole suddenly snaked across the cliff, wrapped around Bro’s feet, whipped them out from under him, and sucked him struggling and clawing back to the mouth of the hole, over the edge, and down inside it.  Just like that.  Blink of an eye.

The Hawaiian Akua are known to be mischievous.

He had just enough time before going under to grab a lungful of air and, because he was a surfer and accustomed to spending long periods of time held under by powerful waves, his lungs could hold a lot.  He began the descent and traveled deeper and deeper down the wormhole, with no idea where it would come out or even if it would remain large enough to allow his passage all the way through.  What he did know was a long, narrow, hurtling slide down through water, rock, and darkness, with a steadily growing pressure in his chest as his air started to run out.

Finally, as he was beginning to think he might not make it, he felt himself whoosh out the bottom of the tunnel into open water. He immediately struck for the surface and when he broke into open air, found he was so far out in the bay he was actually past the surf line.

Needless to say, Bro’s girlfriend and friend were freaking out back on the cliff, and they failed to spot him where he came up because they were looking closer to shore.  But eventually someone sighted him and called the Coast Guard who quickly launched a rescue.  I’m delighted to tell you that my brother survived to tell the tale.  Because he was a strong swimmer, and because he didn’t lose his head, and because our Aumakua were protecting him, and because…well…it just wasn’t his day to die.

Working with hospice is about working with those who die slowly, navigating the process as it gradually unfolds, step by step, over a period of time.  Sudden death is different.  When a person dies abruptly the laws that govern the dying process are moving so fast that it becomes impossible to see the underlying physiological sequence in action.  It’s still taking place mind you.  Every physical body has to go through a shutting down process on it’s way to death.  But while a wasting disease takes us through those stages one at a time, sudden death strikes every point along the sequence simultaneously.

Why is this important?  Because even though these stages of the dying process are the only part we have any control over, we leverage this control into an illusion that we actually have some power over death itself. (We can save lives!  We can!!)  But when a sudden death comes along and collapses the various stages into a singular, catastrophic event which is beyond our ability to influence, then our illusion of control over death is instantly vaporized.

Poof.

The shock of this is absolutely terrifying.  As a people we are very, very, committed to both our denial of death and our illusion of power over it. Pretending like we can somehow conquer it by throwing billions and trillions of dollars into ever-escalating research, treatment, surgeries, medical insurance, regulations, legislation, screenings, hospitals, and drugs has become one of…if not the…central tenet of our modern society.  The pursuit of this illusion has actually now taken over the bulk of our economy.  It’s consuming more and more of the healthy parts of our individual lives.  It’s really, truly massive.

Which is, of course, what makes those moments when the illusion shatters so horrifying.

While medical/technological advances are granting us a greater level of confidence and control than we’ve ever known before, that control is not…and never has been…over death.  It’s over time.  Yet we constantly forget this.

What I’m trying to say here is that dying is negotiable, but death is destiny.  When it’s time to die, it’s just time, whether it’s at the end of a long illness or on the lip of a blowhole.  I realize that saying something like this sounds superstitious in a society that prizes rational thinking, analysis, and control as much as ours does, but only as long as we’re speaking in today’s relatively young scientific language.  In other, older languages this understanding of death as destiny is common.

Try talking to soldiers who’ve seen active duty on the battlefield, or emergency room personnel working long shifts in busy, urban hospitals, or 8,000 meter mountain climbers who’ve seen a lot of companions die climbing, or morticians, or clergy who work with the bereaved, or anyone else who’s been around it a lot and gained an intimate knowledge of the mechanics of sudden death.  They’ll say pretty much the same thing I am; while devastating to watch, the experience also grants one an expanded perspective of reality, an aching grasp of the limits of life, and a deeper understanding of mystery, than all the long, hallowed hallways of science strung together will ever be able to deliver.

To close, here’s an outrageous video from Neptune Surfing.  It was evidently taken at Waimea Bay in 2009 during a storm surge that was creating more monster waves.  Yeah, baby.

copyright Dia Osborn 2011