On Dying an Honorable Death

William J. Welch, MD

am not aware that Gurdjieff made many serious promises to those who worked in his orbit, but two of them I heard him repeat many times. One was that those who undertook the work he proposed would never again “sleep” as peacefully as before in the so-called waking state of their ordinary life; and the other was that those who followed his mode of self-study and inner discipline would at least have the possibility of dying an honorable death, and not simply perish—as he put it—“like a dirty dog.”

What he meant by an honorable death was not, I think, as simple as it sounds. Nor did he necessarily refer only to physical death, but to that death in life, the demise of the lord fool in each of us, whose vanity and self-illusion must die in order that a new life may begin, the rebirth of which religions speak.

But to most of us it is physical death, the end of the body’s life, the often miserable and humiliating stop to our existence that throws the details of our life into perspective and makes the measurement of a man’s life possible. Until a man dies, what is trivial seems important and much that is important has been deferred, put aside, or ignored. Somewhere here, the idea of an honorable death takes on meaning, or so it seems to me after the long exposure to death that is the lot of every doctor.

There has long been a conspiracy of evasion and silence surrounding the subject. Recently, it is true, doctors have returned to a study of their attitudes toward death, particularly since life-sustaining technology has proliferated and the distinction between existence and life has come painfully to the forefront.

It is awkward and uncomfortable for doctors to talk about death, perhaps because we are so conditioned to denying it not only professionally, but socially as well. Even recently, when a professional society was formed for the study of death and required a name, the habit of evasion won out and it was given the title of the Thanatopsis Society, rather than the Society for the Contemplation of Death.

And the studies I have seen, solemnly counting down the presumed psychological phases of the dying patient, such as denial, anger, bargaining, depression, and so on, are informed by such shallowness, couched in such pseudo scientific lingo as to be hardly more than an embarrassment.

We are contemptuous of the medicine man who counts on ecstatic dance and a threatening headdress to cure his patient of pneumonia, not inquiring whether we are any less bemused by our own superstitions when we undertake to measure and quantify an experience as inscrutable as life itself with a logical technique hardly more appropriate to its subject than a devil’s mask to the well-being of a hardy population of pneumococci.

When death is sudden and without warning, any notion of preparation is of course out of the question, unless the person has been making a long and intensive inner preparation on his own. It seems difficult to understand the ancient prayer for deliverance from sudden death, when from a practical point of view, it disposes of all concern and anticipation in one swift and final blow. Many a doctor who has sweated out the agonal, evasive actions that so often are the prelude to the inevitable in a beeping, whistling, whitely lighted, intensive care unit, finds himself wishing quite the other kind of end for himself.

As knowledge of “intensive care” becomes more widely disseminated, the same feeling is gaining ground among those who see themselves as potential victims of such well-intentioned, often futile, torture. I have not counted recently the number of testaments in my files from patients who have made special trips to my office to “arrange in advance” that they will not be subjected to the heroics of modern medicine when their lives are drawing to an end. Greater than the fear of death itself, in the minds of many, is the fear of mechanically sustained existence and the prolongation of helpless life.

Of course, the decision is not as simple as it seems. Thousands of people are alive today who at another moment in time would have gone to their graves, had it not been for the aggressive treatment of what we now realize are reversible catastrophes. And when no one can be sure whether heroics will prevail or not, the question is begged, and heroics are set in motion in the hope and belief that even the longest chance and the toughest odds are worth risking if the outcome is favorable.

When it is not favorable, there are few more difficult decisions to take than the one to “pull the plug,” to turn off the life-supporting hardware and accept defeat. And it is especially agonizing because, when heroics fail, the ravaged meat that is left lifeless in a tangle of wires, tubes, and bloody, sodden sheets rebukes his would-be saviors and seems to cry out to have been better left alone, to have been allowed to die in peace.

In any event, it is not the terror of the actual moment of death, which there is good reason to believe is no more than the delicious giving up that we all know well when we fall gratefully to sleep in a state of fatigue; it is rather the gnawing uncertainty of outer darkness, nothingness and nonexistence that is the hardest to bear in the contemplation of death. And the fuller one’s life, the more one has pondered its meaning, the larger one’s inner life, the more there may well be to face, if such a man’s fate is to know in advance that death is not only inevitable, which he has always vaguely accepted, but is imminent.

As a friend of mine with a fatal disease said as we tried together to face his death: “How does a man prepare himself for nothing?”

This was a man, to be sure not bemused by dreams of paradise, but by no means a blunted agnostic. Indeed, his adult life had been almost wholly taken up with an intense, almost buoyant concern for probing and experiencing the mystery of his own life to the fullest extent he could.

For six months, when it had become apparent that the operation he had undergone the previous year was not the success we had hoped for, he tried to come to terms with the imminent obliteration of the life he knew and valued, with having to leave behind his wife, and the two small children who were watching him strangely withering before their uncomprehending eyes.

The moment even came when we talked of other things quite easily, to return without strain or awkwardness to our underlying concern, as if we needed to return but only with deliberation when something had to be said. With two levels of reality alive simultaneously, both took on a larger intensity, and the perspective of the one was enhanced by the vividness and immediacy of the other.

Throughout the whole ordeal, which continued from early spring into August (he remarked casually early in May that it would be over in the middle of August, and so it was) my friend was at home in his own room, surrounded by his family; later his elderly mother, his sister, and his brother came from abroad to be with him.

Only in the last week or so was a professional nurse in attendance, and she was also a friend who had stood by, waiting to be called when she would be needed. Until very near the end, he required only occasional painkillers, for he resisted the blunting of his other senses as the price of relief.

As the days passed and the poignancy of his situation bore in on all those around him, he seemed increasingly to gain inner strength and became in fact their emotional support. He was impatient with sentimentality, and when he sensed the others yielding to tears of anticipation, he drew them to the present moment and reminded them in his indirect way that the time he had left must be lived, not wasted in floods of incontinent misery.

He succeeded, I think, in accepting the fact of his own fate in the light of our common lot, and instead of dissolving in anguish lived out his remaining days in a state of awareness, heightened by the knowledge of the imminent disappearance of the sights, sounds, and nuances of human exchange.

One day he snapped my picture as I stood at the head of his bed, with one of those cameras that produce an instant print. After peeling it off, he handed the camera to me to take his picture. He was gaunt and wasted by then, and I shrank from confronting him with his image, but there was no getting out of it. He looked at the uncompromising picture of his sunken cheeks, staring eyes, and wattled neck in silence. Then, with a wry smile, he said: “There’s not much left of me, is there?”

“Not much left of your damned liver,” I responded, “but plenty of you.” And we managed to laugh.

As the end neared, he slipped gradually into a merciful coma, rousing a little from time to time as those around him cared for his body, or simply sat with him, as they did throughout the final hours.

It was an honorable death, and a far cry from an impersonal hospital room, with the family carefully excluded by starched officials and the tangle of tubes in arm and leg, bladder, and gullet, with wheezing suction machines. and whistling tanks of oxygen, which reassure the healers even as they unwittingly destroy whatever meaning the experience may have for the object of their ministrations.

Talking about death in the abstract, or its study for medical students as a process which they will learn to “manage,” seems to me to be more fatuous than even we as doctors need to be. Difficult though it is to accept in the fullness of life, the answer to life is in fact death. And the substance of a man’s life, if it is required of him to anticipate and prepare himself for it, will be the stuff from which he will fashion his own participation in its end. If he has made the effort to be alive to his life, if he has somehow found a way not to squander his life, if he has been lucky enough to be awakened to his own ultimate mystery while he lives, the chances are that he will bring something of substance to his last experience.

When that is the case, events often contrive to protect him from a dog’s death, provided, of course, that he is not blown up in one of our periodical psychoses of mutual destruction, or mindlessly butchered in our streets by an addict or drunken motorist—which puts all questions of death in the context of the contemporary jungle we live in, and may put a close to more of our dilemmas than we anticipate.

Dr. William J. Welch, president of the Gurdjieff Foundation of New York in the years 1984–1997, was a man of great heart and knowledge. His generation of direct Gurdjieff pupils established the Foundation in 1953. He was, with little exaggeration, everyone’s doctor owing to his expertise, warmth, and humanity. His book of 1972, “What Happened in Between: A Doctor’s Story,”[1] has a chapter about Mr. Gurdjieff that belongs to the “canon” of irreplaceable memoirs. We publish here, with his family’s permission, another unique chapter from that book.