An iconic physician advocate, made famous by Hollywood, reflects upon ‘Fun Death’

(The author is the real-life inspiration behind the hit movie of his name. Known around the world for more than four decades, he has been promoting his philosophy that the best healthcare needs laughter, joy and creativity, and he is founder of The Gesundheit Institute. This is an excerpt from his best-selling book Gesundheit. – Jay Niver, editor)

Death has had a lot of bad press. Many living hours are spent in dread of this great mystery. Dying is one of the few things everybody must do, but often we cannot bear to think of it. Our society is so uncomfortable with death that despite the incredible concern about it, few people are willing to discuss it openly as a stimulating topic of conversation.

If death is mentioned at all, it is usually in whispers – even secretive tones. Is this “deathism?” Does something about our upbringing, reinforced by our education, the arts, and even the medical profession, perpetuate the myth that death is not part of nature’s great design but some horrible trick or punishment? Must we buy into the Grim Reaper routine? Are we not free to choose how we look at death?

During my medical training, no one ever gave us a lecture on death. This is a terrible oversight. People die. Lives are shattered by the fear of it, and families are devastated when it occurs. Yet medical education ignores it. The implication seems to be that death represents a therapeutic failure. This is an insidious trap for a physician, who should approach medicine with far more humility. Physicians are not here to prevent death! We are here to help patients live the highest quality of life and, when that is no longer possible, to facilitate the highest quality of death.

If we physicians cannot be fully comfortable with death, we are cheating ourselves and our patients out of a glorious swan song. When I began to practice ward medicine during my third year of medical school, it became obvious that death was the most discomforting fact of life.  So often, patients who were obviously dying were neglected: left to die.

“There is nothing we can do,” the staff said. The only time physicians seemed comfortable with a dying person was during a Code Blue, when state-of-the-art medicine was aggressively applied. If the attempt was unsuccessful, everybody felt they had done their best – which, of course, they had. But it appeared to me that for many professionals, the resuscitation attempt was an exhilarating final heroic effort to save the patient.

I believe that dealing with dying is where the art of medicine begins. It is a fault of modern medicine that physicians cannot see the potential to make the last rite of passage wondrous experience.

There is no greater validation of faith than the fact of death. There is no greater reason to develop a belief system and surrender to it. Whether one’s belief system suggests nothingness or immortality, either can ease the act of dying.

It is important for a physician to explore a person’s faith and perspective on death as a routine part of the medical history. If these views are not clearly defined, part of the treatment should be to define them. I find most patients grateful for the time spent on these matters, and it bonds our relationship. Whenever I spend time with a dying person, I have, in fact, found a living person. The young who are dying have been most vocal about this. I remember an 11-year-old girl who had a huge bony tumor of the face with one eye floating out in the mass. Most people found it difficult to be with her because of her appearance. He pain was not in her dying, but in the loneliness of being a person others could not bear to see. She and I played, joked, and enjoyed her life away. This is when I made a commitment to enjoy the profoundly ill and act normal around them.

Another friend in his early 20s with cancer said emphatically that he was a living person and hated the discomfort people showed about his dying. That discomfort, he said, interfered with his life. He went to a big dance shortly before he died, and, with only part of one lung left, danced longer and harder than most of the people present. Dying is that process a few minutes before death when the brain is deprived of oxygen; everything else is living.

When I began medical practice, I had to decide how I was going to address the issue of death. I took my cue from 19^th-century literature. Novel after novel described home death experiences that were wonderful for both patient and family. It made great sense. What could possibly be better than to die in the company of family and friends, surrounded by home and treasures one had lived with?

In the hospital, dying people I interviewed felt lonely and estranged from their environment. What perked them up were visitors and a few mementos of their lives that were kept nearby. When I spoke to healthcare professionals, few , if any, felt this was how they wanted to die. Many said that when their time came, they would end their lives with medication.

So I encouraged patients to die at home and agreed to attend to them there.  Each time I have done so, a great deal of fear has been removed from the death experience. Each time, patients and family have been deeply grateful, often experiencing the same joy and exhilaration as at a home birth. These families are among the most thankful I have known.

I realize how few people have ever fully experienced the death of a loved one. When I was 16, my own father died in a hospital with no family around and no chance to say goodbye. I feel anger and cheated that I was not with him.