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Education  |   March 2012
Close Quarters: An Introspective*
Author Affiliations & Notes
  • Richard L. Saupé, M.D.
  • Richmond, Massachusetts.
Article Information
Education / Central and Peripheral Nervous Systems / Ophthalmologic Anesthesia / Pediatric Anesthesia
Education   |   March 2012
Close Quarters: An Introspective*
Anesthesiology 3 2012, Vol.116, 729-731. doi:10.1097/ALN.0b013e318245bfe9
Anesthesiology 3 2012, Vol.116, 729-731. doi:10.1097/ALN.0b013e318245bfe9
I HAD never thought much about death. Certainly not my own, anyway. As a child, death was a concept as elusive to me as the size of the universe, or politics. It was “grown-up” stuff – something you only dealt with or thought about when it stared you in the face.
My earliest memory of death involved a motor vehicle accident, which claimed the lives of two parents – close friends of my own parents – and their oldest daughter. Their younger daughter, who couldn't have been more than three at the time, survived the accident. As tragic as the story sounds, I distinctly remember hearing about it and feeling nothing. In fact, one of the few memories I have about the incident was sitting in a quiet church, attending the funeral services, and having my sister lean over and whisper in my ear, “you're supposed to cry at funerals, you know.” I was five at the time. Reflecting back on this story, and my presumably underdeveloped lack of social consciousness, I was later able to understand why my daughter didn't cry at her grandmother's funeral, but bawled her eyes out when our family fish was floating at the top of its bowl one day. It's because she was five.
As a young man, the concept of death slowly began to crystallize into something worthy of feeling. When I was about ten years old, our family dog, a giant St. Bernard, went to sleep one evening after dinner and never woke up. She had eaten almost nothing that night, which was very unusual for a St. Bernard, so I guess I should have suspected something was going on. The next day my dad sat me down in my room and told me that she had died during the night. It was the worst day of my young life.
In my twenty-somethings, I was hit much harder with the reality of death. My cousin was a young man, not yet forty, with a beautiful wife and two adorable young children. In a bizarre series of events, he was involved in a minor motor vehicle accident, which left him with a concussion and short-term memory loss, during which time he became profoundly introspective, and claimed to have found God. A week later, while working on a car in his garage, an untimely spark collided with a poorly-ventilated container of gasoline. You can guess what happened next: the entire garage was engulfed in smoke and flames in a matter of minutes. My cousin never made it out alive.
Needless to say, attending that funeral was one of the worst experiences of my life. Because he had been trapped in the burning building, cremation was the only option for his disposition. I'll never forget watching his wife, shell-shocked and emotionally vacant, carrying his ashes down the aisle of the church with a blank stare in her eyes. It felt as though you could look right through her soul. Her two children followed behind.
My fortieth birthday was when it hit me. While family and friends were singing happy birthday, rather than making a wish I found myself realizing that my life was, statistically more likely than not, half over.
My dad used to have an expression when talking about the phases of a person's life. He would reach into his pocket and pull out three quarters, which he then placed on the table in a linear arrangement. “The quarter on the left,” he explained, “represents the beginning of your life. The one on the right is the end of your life.” Then he would place the third quarter in a position which he felt was representative of the person he was talking to, and explain, “This is where you are right now.” Usually the quarter in the middle was closer to the one on the right than the one on the left, at which point he would declare, “You're quarters are only getting closer together.”
I should clarify that my father's demonstration usually was used to try to convince one of his friends that he or she should retire early, rather than later, before their quarters were too close together to have any meaningful time left in their life. My father was lucky enough to be able to retire in his mid-fifties, and I can honestly say he made the most of every day of his retirement, knowing full well that someday it would come to an end.
I was forty-five years old when I received the diagnosis. Weight loss, fatigue, abdominal pain … then the jaundice. I had seen enough pancreatic cancer in my life to know what that meant. I knew what the options were, and none of them were good. If Steve Jobs couldn't beat it, what hope did I have?
Of course I went through the normal stages of grief described by Dr. Kübler-Ross: Denial (“This can't be happening”); Anger (“Why me?!?”); Bargaining (“If only I had eaten better…”); Grief (“Well, I guess this is it…”).
Then something strange happened. I guess I would have to refer to it as “Acceptance,” but I was overcome by a profound sense of peace, and oddly enough, relief. Even though I knew that my quarters were nearly touching, I was strangely okay with the idea of my own mortality. I wasn't even sure what was waiting for me on the other side of the spiritual fence – I had been a practicing agnostic for most of my life – but for some reason that didn't bother me. And even though my life was cut cruelly short, I wasn't afraid of dying.
It's a funny thing, death. It's out there, waiting for all of us. No one knows when or how it's going to happen (unless you plan your own suicide, I suppose) but I think it's safe to say that most people are afraid of dying, or at the very least, don't want to think about it.
Cancer is funny like that. It forces you to think about it. It forces you to think about the “what ifs” and the “if onlys,” but when it comes down to it, having a terminal illness makes you really think about what's truly important in your life. Maybe going to Egypt to see the pyramids was on your list of things to do before you die, but when the day finally comes that you realize your life is measured in days or weeks, rather than years, all the rest of those “to-do” items seem to fall away, and what's left is all that is truly important. Maybe it's spending time with family. Maybe it's driving up the west coast with the wind in your hair. Maybe it is  taking that trip to Egypt. Whatever it is, you find the strength to make it worthwhile.
I was never much for organized religion, but the events of the last few months have given me hope. Hope for something more. Hope for something better. Hope for something waiting on the other side. I often find myself reciting the 23rd Psalm in my head: “Yea, though I walk through the valley of the shadow of death, I shall fear no evil, for Thou art with me.” Catchy phrase, I think.