Ghost Ship

Sept 9 2015

How remarkable

that the brain perseveres

as the body fails.

The most complicated object in the universe

is still furiously at work,

valiantly extracting

the last scrap of glucose,

hogging oxygen, atom-by-atom

from precious blood.

While the heart gasps and sucks

liver cells exhaust themselves

kidneys drink their poison.

Contemplating undone tasks.

Scribbling

its final revelations.

Embracing love

and fearing death

and wondering what comes next.

Like an alchemist, conjuring gold from lead,

somehow transmuting

whatever trickle of blood that's left

into thought

                 ...mind

                               ... self.

How sad

that the brain goes on

but the body not.

Or worse, when the mind has gone

and the machinery labours on

tenaciously clinging to life.

Like an ocean liner

whose bridge is sightless, lights have dimmed

while engines shudder, pistons pound

in the sweaty depths of its hull.

A ghost ship, rudder stuck,

endlessly circling round and round

until finally running aground.

An empty vessel

blissfully unaware?

Or a vital mind, betrayed;

still sentient, passionate, resisting death

to life's ignominious end?

Oliver Sacks -- a man whom I greatly admire; and with whom, in the most modest way possible, I somewhat identify -- has just died. He died doing what he did best, right to the end: writing long-hand letters to friends and acquaintances; chronicling his demise in the New York Times; consigning a final article -- published post-mortem -- to the New Yorker (the latest issue; which I just downloaded yesterday, and am greatly looking forward to reading). He clearly did not embrace death with fatalism or philosophy. I think he felt his body had betrayed him, and he was certainly not tired of life. But in the end, he did come to accommodate the inevitable, and may have found some solace in continuing his work, in accepting love, and in gratitude for a well-lived life.

His struggle with death and dying led to this poem. One wonders how the brain, in all its marvellous and ineffable complexity, manages to soldier on, even as the body fails. And imagines how furious he felt as his still incisive, curious, and vital mind was inexorably dragged down by his dying body.

Of course, we more often read of the opposite: the living dead, in whom a demented brain inhabits a strong body, stubbornly clinging to existence.

Yes, blissful ignorance has much to be said for it. But even with the pain of knowledge and the burden of fear, isn't it better to be sharp right up to the final breath than to have already died? To at least have a chance to complete your life, to make peace with death, to have a chance of finding meaning? To be intact and be useful to the very end? That's the dilemma of the poem. Oliver Sacks suffered from his premature death. But he also enriched the rest of us almost to his final day. (Which is, of course, why scribbling gets such prominence in that stanza: someone like Sacks (and me, apparently!) can't help writing and scribbling and journaling no more than we can help breathing.)

Death is probably harder for confirmed atheists like Sacks and me. I know that faith is not easy, and believers struggle with it. But when you now that death is final, there can be no possibility of consolation. Maybe that's why he kept writing so assiduously: his work was his posterity, his only after-life.

I've been asked why I don't write more about physiology, the practice of medicine, my own experiences. Perhaps if I had started writing earlier, this would have been the case. As it happened, the overlap between my working life and writing life was relatively short. And my memory is notoriously poor. But here is one of the few instances when I do. And, as always when I do, I wonder if I'm not just causing eyes to glaze over and pages to abruptly turn. Does anyone care to read about oxygen and glucose and assorted viscera?!! (At least I stuck with glucose, instead of contending with fatty acids and ketones. And spared myself trying to rhyme haemoglobin!)

I love the most complicated object in the universe. Of course, this isn't original (although I may have paraphrased). And I'd happily give credit, if only I could remember who said it first.

The final line was a choice between "ignominious" and "mysterious". "Mysterious", of course, always works: death, after all, is the ultimate mystery. But I preferred ignominious because it conveys this sense of betrayal, resentment, and unfairness that I think coloured Sacks' slow death by cancer: how he resisted death; how he "burn(ed) at the dying of the light." And because, despite our romanticism and hope, I don't think there are really many good deaths. Not when death is so often accompanied by pain, shortness of breath, indignity, and loss of control.