Death & Modern Man

Neither the sun nor death can be looked at steadily.

--La Rochefoucauld

Modern medicine has steadily prolonged lives, slashed death rates and, for many patients, changed drastically the very process of dying. Yet, except for a handful of psychiatrists, medical men have paid only cursory attention to the problem they have thus inadvertently intensified: How are the fatally ill to be helped to face the end?

Medical scientists cannot even agree on the time when death technically occurs. Is it when breathing stops? Or the heart? Or when brain waves cease? Psychologists and psychiatrists assert that fear of death is universal, but disagree about its true nature. Freud compared it with fears of castration. Others believe that patients fear dying itself less than their own helplessness and uselessness in the process. Some believe the fear of death is the instinctual root of all other fears.

Family Attitude. From his own observations in Colorado General and Colora do Psychopathic hospitals, one thing of which Psychiatrist Richard Vanden Bergh can be sure is that patients are sometimes left terribly alone when the end is near.

"All of us," he told a convention of nurses at the University of Colorado School of Medicine, "have seen the patient who is slowly dying of a chronic, debilitating illness and has been placed in the room farthest from the center of the ward. The doctors drop in briefly during rounds, glance at his chart, and leave almost immediately. The general attitude of the ward is: There's really nothing we can do for him--after all, he's dying anyway.' " This attitude is as appalling to many physicians as it is to just about all ministers of religion. But what is to be clone? The first question that arises is whether to tell a patient that he is dying. "Much depends," says the University of California's Dr. Alexander Simon, "on the attitude of the family and the patient's own attitude. There are some whom I would not tell about imminent death because they would panic." Another U. of C. psychiatrist, Dr. Robert D. Wald, believes that the opposite situation is more common: "The assumption is that people don't want to die. From my experience, I believe that--more often than is generally realized--people reach a point where they are willing to die." To Psychologist Herman Feifel of the University of Southern California, who has edited a book on The Meaning of Death, what the patient is told is less important than how he is told.

Who's Afraid? And what about the role of the family, now that so many more deaths occur in hospitals than at home? Psychiatrist Wald says tartly; "At death scenes, doctors and nurses are frightened of families. They feel accused by the relatives because they are revealed as not being all-powerful. Doctors tend to keep families away to protect their own selfesteem, though perhaps not consciously."

There are, to be sure, many cases in which it would do no good to have the family stage a death watch because the patient is in a coma. And such cases are becoming vastly more numerous now that medical science has learned to prolong the body's life, or at least some signs of life, long after the mind has become irreparably clouded. But Dr. Vanden Bergh says that he, and most doctors, have seen many patients who were not only conscious but alert right up to the end. Even with a patient who is technically comatose, there is no way for an outsider to be certain how much he senses of what is going on around him.

Probably the only patients who must necessarily be deprived of the comfort of kinfolk are the growing numbers who are sent after surgery to ultramodern recovery rooms from which visitors are barred because of the danger of infection. In most cases, the presence of the family is a good thing. Even if the patient does not know his relatives are there, it is good for them to have the opportunity to learn to accept the imminent loss of a loved one. But relatives may need to be coached in deathside manners. If they have not already faced their own emotional problems, they may become depressed or tearful or even hysterical. Then, instead of their helping the patient, it is the patient who finds himself having to console his visitors.

Too often, says Dr. Wald, there is a woeful lack of communication between patient and family when death is approaching. "This," he says, "is the very time when communication could be freer and more rewarding than ever before. It is a time when old emotional conflicts can be resolved. I've attended many patients who were dying, and knew it, but had had no chance to discuss their fears with anyone. Many were glad of the opportunity to talk."

What Is He Leaving? A major factor in all attitudes toward death is religious belief--or lack of it--in life hereafter. Some clergymen assert that such a belief is all that is needed to take the sting out of death. Others, like San Francisco's Rabbi Alvin I. Fine are more mod erate. "The Judaeo-Christian tradition," says he, "offers a way of looking at death. Religious belief and understanding are definitely helpful in facing death." Psychiatrists, who tend to be agnostics, complain that the clerical attitude generally puts too much emphasis on where a person is going and too little on what he is leaving. Like Rabbi Fine, they believe that a philosophy of death is an essential part of life.

Modern skepticism is intensifying the problem of facing death, says the Rev. Joseph T. Alves, head of Boston's Roman Catholic Family Counseling, Inc. A social psychologist, Father Alves is directing a project for training "social volunteers" to help the lonely aged adjust to modern society's pressures and to comfort those who are incurably ill. There is wide public misunderstanding, said Father Alves, of the full purpose of the Roman Catholic "sacrament of the sick." Long called "extreme unction," it is still too generally regarded as simply the last anointing before death. But in modern theology a broader and more ancient purpose has been re-emphasized. The sacrament is not only concerned with accommodation to death; it is a prayer to God to restore the patient to good health.

In the last analysis, each man must make his own accommodation to death. Almost universal is the sentiment of Dr. Charles W. Mayo, recently retired from active surgery at the Mayo Clinic: "I hope that when I die, it will be quick. But if there is some delay, then I hope I'll have somebody I love with me--somebody to hold my hand."

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