What matters in the End?

“Death is inevitable; Each moment is precious; Nothing matters in the End”

Recently, in a light conversation, I said, “We all are going to die” in the context of this dreaded pandemic. I could see the expression of people disliking that comment because no one wants to talk about death in our society. Death is seen as inauspicious. We all want to live in a fantasy and don’t want to think that we all have limited time. This thinking has repercussions not only on our health but also on our future. As the author says, “how we seek to spend our time may depend on how much time we perceive you will live forever.”

This book is actually about the experience of death and how the medical system has failed to understand what it means to deal with a finite life and make the final years a joyful experience. Do we forget the inevitability of death and the fleeting nature of life? When we become old, we don’t want to talk about death, we talk about living.

The beauty of this book is that it has been written by a surgeon who is also a professor at Harvard Medical School. This book has his personal accounts of dealing with terminal patients and also the death of his own father. The author has shown how the medical system has failed to educate medical professionals about aging, frailty, or dying. Gawande speaks about the failure of the medical system in informing or educating a patient about his condition? There is a need to understand the unfolding of the whole process and its impacts on people around them.

Death had no meaning to me until someone close died in my family. Society teaches people “not so important things” such as making a lot of money, buying a big house, memorizing every formula to pass every exam, and studying for the GRE. However, no one teaches us how to live our lives. What does death mean? Especially as we grow older, we have no idea what we are fighting for. What are our priorities? What are the trade-offs? We don’t talk about our worries or hopes for the future. How much are we willing to sacrifice? What are we willing to give up?

How care of the elderly has changed from ‘multi-generational systems support’ provided by the family to institutionalized nursing homes. Nursing homes today act as prisons. The elderly don’t feel comfortable in them. They feel chained and restricted. The elderly living here always yearned for privacy at home.

We are so engrossed in living this life that we forget to ask the question: what’s the purpose of our lives? Did we ever ask this question to ourselves? What makes life worth living when we will become old and unable to care for ourselves? To answer this question, the author discusses psychologist Abraham Maslow‘s influential paper, “A Theory of Human Motivation” which is depicted in the form of a pyramid and talks about the hierarchy of needs of people. According to Maslow, ‘safety’ and ‘survival’ remain the primary and fundamental goals of our life even in our old age.

Maslow’s hierarchy of needs

People in old age focus on being rather than doing and they live in ‘the present than the future. Old age generally functions at the peak of this pyramid and focuses on ‘self-actualization.’ “Living is a kind of skill. The calm and wisdom of old are achieved over time,” says the author. As per various experiments (discussed in this book by the author) conducted during some crises like the 9/11 attacks, the SARS epidemic 2003, etc., old and young both valued the bliss of life and focused on being rather than doing. This might be true for the current pandemic also. People these days from all generations are slowly realizing the meaning of life.

This book also shows the results of experiments of assisted living done on various old people where they were given small freedoms in terms of taking care of plants, spending time with a cat, a dog or a bird, etc., helped them to live a longer life. The most important finding of the experiment was “having a reason to live” which reduced the death rate. Harvard Philosopher Josiah Royce in his book, “The Philosophy of Loyalty,” informs us that people seek a cause beyond themselves. That cause could be anything: it can be small or very big. ‘We all require devotion to something more than ourselves for our lives to be endurable.’

The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don’t, mortality is only a horror. But if you do, it is not.

Josiah Royce(The Philosophy of Loyalty)

The biggest problem in the medical sector is that they never focus on the well-being of the people, rather they focus on physical health. They are hell bent on repairing the body parts and not the nurturing of the human soul. Not only the medical field but society as a whole needs to understand this, as people grow old and become aware of their fleeting life, they are more interested in writing the story of their lives and believe in living in the moment.

Amid this pandemic, there is a need to remember our old traditions of the ‘art of dying and accept death and decline as normal and eternal truth. We must accept our lives of old age that will come along with sickness, frailty, and isolation. Ultimately, we will need the support and care of others. We would rather spend the last days of our lives with our family members than in ICU. In a nutshell, Gawande has made several important points about life and death, especially how medical science can correct the wrongs committed till today in failing to accept the inevitable. Acceptance will lead to find solutions that can make old people’s lives better and joyful in their last days.

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7 thoughts on “What matters in the End?

  1. I have not read the book but your review does make me interested in it.
    As the CEO of Apple Steve Jobs said in his famous speech that it is when we are faced with death that we get a clear perspective of things.
    I guess death is an oxymoron – the most fleeting yet the most absolute.

    Liked by 1 person

  2. Comment received from Minaxi via Whatsapp:

    Death’ is absolute, but how one reaches there is what life is all about. Sum total of all our mistakes, happiness, fulfillment, belonging, and accumulation of almost everything, matters once we reach self-actualization, (which is rare) although. Priorities change’ with time and each phase demand a different version of oneself. Having a reason to live, to look, and to dream is what everyone aspires but somehow people forget this in the process reaching the top of the hierarchy. Society as a whole can only do one thing that is let others live as they want and accept them as they are, as death accept everyone as they are. People need to understand between a comfortable life and peaceful life, dying people, and when in sickness everyone thinks about the later, without a doubt and the person wants to be surrounded by their loved ones.
    ‘Medicine can cure the body but love and hugs will heal the soul.’
    Caregiving and kindness are the tools one needs to practice at each stage of life. Acceptance is the key to peace’ and like old age, the wisdom at different stages is different to different people, one must learn to respect that.
    Everything comes to an end but the question is how it should be in the end depends on how we lived and perceived things. Decorate that road with memories of a lifetime and honestly nothing matters in the end except how much you loved living.
    ‘We should live today as it is our last, many times we have been told this by elders because they have experienced and learned with time that only hope remains immortal, not people.’


  3. Comment received from Minaxi via Whatsapp:

    You have correctly summed up everything, as I haven’t read this book, but with your review this is surely going to be in my bucket list of 2020.
    As always your thoughts make me think differently and gives a new dimension.


  4. Fantastic topic and very relevant in these times. This review has really made me want to reach out for the book and give it a read. Thank you.

    Liked by 1 person

  5. Interesting piece. When we are kids we want to grow up soon as adulthood seems freedom. But old age brings along the problem of emotional loneliness and physical fragility. Learning to accept this and preparing for the end to mortal life by cherishing each day’s mundane flow and finding purpose amidst the slowdown in life is the key.
    Well reviewed and analysed.

    Liked by 1 person

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