How Not to Die
May 2 2013


How not to die
being kept alive
longer 
than anyone would want.
Machines beeping, whirring, wheezing
into inert cachectic flesh,
my anxious mind
locked-in,
speechless.

How not to die
in pain
or short of breath.
But also, how not to die
with meaning
left unaddressed.

Of self-consciousness,
a very private man
intruded upon
by strangers.
And how not to die
undignified

loathing his dependence,
wiped, suctioned, turned
on his bed of nails.

How not to die
is like the holy grail
of medical science,
a war on death
where the casualties
are the nearly dying.
So like friendly fire in the fog of war
keep out of range
of high calibre ordinance,
heroic intervention
however well-meant.
The complicit silence
of Oz-like men
and futile quests.

How not to die
anywhere, except
an ice flow, on a constant sea;
knowing it's time,
showing you care
for those left behind
by leaving them be.
Succumbing to the numbing cold
as if an airtight door
had whispered closed
behind you,
the quick compassionate end
for which all of us hope.

How not to die
before learning to trust
the primordial sea,
its water
salty as blood.
To dispense
with my useless body
as it always has,
inscrutably
as life began.

This poem came in response to an article by Jonathan Rauch, in The Atlantic of May 2013. Here's a link: http://theatln.tc/Z5MKL2.

I've read numerous pieces on the same theme, and have written tangentially about this before. I feel very strongly about end-of-life care. About the overkill of medical technology. About the push-pull of doctors and patients:  the pull of professional hubris; the push of families, who are poorly informed, as well as susceptible to guilt and unrealistic expectations. My philosophy of medicine tends toward therapeutic nihilism, anyway. But especially so when it comes to ICU deaths of the frail elderly and the unsalvageable: to heroic interventions that prolong death instead of prolonging life.

So I credit this piece with encouraging me not only to write this, but with the refrain, How Not to Die. I'm thrilled by the misdirection of this title:  as if the poem will be an instruction manual in immortality, when it really says the opposite -- a critique of our death-denying culture, of heroic high-tech medicine, of cruelly misplaced resources.