Life, death and the beauty of unknowing

'We're born with millions of little lights shining in our hearts 

And they die along the way' - All the little lights, Passenger, All the Little Lights, 2012

'For small creatures such as we the vastness is bearable only through love' - Carl Sagan

'The greatest steps we take are those alongside others' - Anon

Today, behind a curtain, in a corner, behind an old chest, a heart stopped. A young doctor, his warm hands trembling slightly, his eyes focused on a wise but tired face, cradled the weathered hands of almost a century's experience. Slowly but surely, a steady pulse faded and then gave way forever. Outside feet bustled and machines beeped rhythmically. Voices sang the soft chorus of the curious symphony of normal life. The world kept spinning, the universe kept growing and moved on with one less soul, its impact etched forever in the eternal voyage of time.

As doctors we may see death as the failure of our treatment. However, it is worth remembering that it is natural. We, as physicians, are the newcomers to millions of years of life, death and adaption. For life to have flourished in such beautiful and incalculable diversity on this tiny earth, the rules of evolution have been harsh and unforgiving, much like a painter working on a masterpiece. Death is the brush that may turn a canvas from bare to breathtaking and affords us the time and intellect to contemplate its own existence and meaning to our time here.

Religion, philosophy and science have all tried extensively to make sense of such natural phenomena, to give it reason. Human thinking is to assert logic, the gift of foresight being one given by the development of our brains to predict the future, to see danger and plan for winter, to make crops and sing songs, to plan for our survival and that of our kin. Death is both a warning of the end, but also a reminder that we are to live. The idea of an afterlife is one of hopeful beauty, one that may guide morality but in itself does not promote a worthy life, only places limits on its significance. The recognition of death removes these limits.

As I stood at this elderly lady's bedside, the eyes of her loving family fixed on her, I felt only the last moments of life. I imagined the first bright light, tentative steps and unabashed giggles, first words and blushes, love and loss, a thousand sunrises and sunsets, smiles and tempered glances. I forgot my textbooks, just looked and listened. I did not attempt to characterise the change in her pulse, just let it slow. I heard a last breath, watched a last rise and fall of her chest, and whatever mystery happens at the end of life filter into the air between us.

I would like to think that her brave decision to accept her own end, can teach us all about the value of a short life worth living. We are born into different circumstances, a lucky collection of genes formed of molecules built at the centre of a ball of gravity and fire. We are finely melded through eons to form beings of love and want, and given a short time to do so. Endings remind us of beginning, and the imperative to find value in the in-between. This lady had lived her story, and then passed it to us.

When we reach the end of life there is often a peaceful neutrality, and if we are lucky, a cathartic end to a long and winding narrative. This old soul, happy in her last hours, would leave behind a wealth of experience and a million tiny impacts on a million other lives. She was the protagonist in her story, but only one character in the ever changing tale of life. My role as a doctor was to be just another character, one who could learn and take her message away. Here is just one page.

On the way home I smiled and stuck my tongue out at a toddler. She smiled back, her big blue eyes lighting up and a grin spreading from ear to tiny ear. I thought of the old lady, her kind smile and wise eyes, and I thought that the story of life is beautiful. Death is inevitable, yes, but it can be a gentle goodbye that reminds us that we live. Let us learn from these experiences that a life worth living is worth living now, so one day our faces may be kind, tired, but loving and wise. I'd like to think that smiling toddler has all of that to learn. I certainly have.

Ben is a young NHS doctor in the Southwest. His interests including neurology, health communication and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the southwest around medical humanities.

Read more articles by Dr Ben Janaway


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