On Being Blog

Contemplating Mortality: The Need to Remember That Death Is a Human and Personal Event, and Not Just a Medical One

by Krista Tippett, host

Photo by Long Lim/Flickr, cc by-nc-sa 2.0

It’s difficult to believe these days, when so many of us have had some experience of moving toward death with a loved one in hospice, or even a stranger on the CaringBridge website, how “badly” people died in this country until very recently. That’s the word Dr. Ira Byock uses. He began his life in emergency and family medicine and recalls that when people were deemed to be dying — when what was wrong with them was beyond “fixing” — they too often died in pain in the hospital or were simply sent home. Doctors practicing now still recall their training, implicit and explicit, that death was a failure of the body, and of medicine. We turned away from it, scientifically and culturally.

The palliative care and hospice movement arose first in England and then took hold in the U.S. in the 1970s and 80s to compassionately treat the pain of chronic illness and all the suffering — physical and otherwise — as the end of life approaches. Its spread has converged with the continued advance of medicine. In our lifetimes, many forms of cancer have transformed from fatal diagnoses to chronic illnesses.

As I was preparing for my interview with Dr. Byock, I re-read a gripping New Yorker article by the surgeon Atul Gawande. It chronicles the increasingly blurring boundaries between treating illness, prolonging life, and staving off death. When one woman asks him if her sister is dying, he realizes, “I wasn’t even sure what the word ‘dying’ meant anymore.”

Dr. Byock sees this as a human opportunity and challenge. Medicine is remarkable, he knows from the inside, and will continue to get more remarkable with the passage of time. But we must “grow the rest of the way up” and acknowledge that we have yet to make one person immortal. Even while we fight for life with all the tools at our disposal, we have to reckon with the reality of death. The good news, as he tells it, is that there are riches to be gained in that reckoning. That edge of life — which our miraculous medicine allows some to perch on longer than ever before — can be a time of unparalleled repair and celebration. Like it or not, as Dr. Byock says, death completes us. These days more than ever before, we can shape that moment of completion together with those we love.

With this kind of thinking, Dr. Byock is taking the impulse behind hospice to a new place. He goes so far as to suggest that dying can be a developmental stage of human learning and actualization — like adolescence or mid-life accomplishment. He names “the four things that matter most” — words that can be transformatively spoken and enacted — at the end of life: Please forgive me. I forgive you. Thank you. I love you. These are four sentences, a mere eleven words, with a power to call up a lifetime of struggle in so many of our families.

I think here of that phrase attributed to Oliver Wendell Holmes that has recurred so often in my interviews: the “simplicity that lies on the other side of complexity.” For in the time of life we call dying, as Dr. Byock describes, these elemental human capacities like thanks, love, and forgiveness can unfold in their most complex and immediately redemptive power.

I love this quote of the theologian Paul Tillich, which he put in the preface of his book The Four Things That Matter Most, and which points at the way being with dying has opened Dr. Byock’s imagination about the word “forgiveness”:

“Forgiving presupposes remembering. And it creates a forgetting not in the natural way we forget yesterday’s weather; but in the way of the great “in spite of” that says: I forget although I remember: Without this kind of forgetting no human relationship can endure healthily.”

One difficulty of this conversation is that there are no rules for when, in any life or any course of medical treatment, we can know we have crossed the boundary between fighting death and facing it. Dr. Byock suggests that this is not an either/or but a both/and. Still, there is something fierce and sacred in us that resists the end of our life and the death of those we love. That same impulse resists the kind of contemplation that happens in this conversation as well. One of Dr. Byock’s most basic insights may be his most helpful: we must remember that, even in the 21st century, death is never really a medical event but a human and personal event. Dying is a defining feature, strange and mysterious as it remains, of living.

What Unity and Fracture Looks Like, In a Poem

by Trent Gilliss, senior editor

“Who we are and how much we split ourselves apart,” says Jon Kabat-Zinn, often cannot be explained in a cognitive way. Rather than offer ”some definitive prose statement which is bound to be inadequate and incomplete,” the scientist and mindfulness guru offers (in the audio above and text below) the Nobel laureate Derek Walcott’s poem as a way of communicating his point about unity and fracture:

Love After Love

The time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror,
and each will smile at the other’s welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

“Love after Love” from COLLECTED POEMS 1948-1984 by Derek Walcott. Copyright © 1986 by Derek Walcott. Reprinted by permission of Farrar, Straus and Giroux, LLC.

Carrying Forward Sitting Bull’s Songs and Memories that Keep History Alive in the Hardest of Times

by Krista Tippett, host

I can’t say that I knew much about Sitting Bull when we began this research several years ago. His was the final name in our first series of shows on the spiritual legacy of historical figures. We here at On Being have delved into the universally recognized names of Albert Einstein, Charles Darwin, and Rumi. And we’ve explored significant theological figures of the 20th century, including Reinhold Niebuhr, Aimee Semple McPherson, and Rabbi Abraham Joshua Heschel too. This fall, we’ll be launching a second series, beginning with the scientist and theologian Pierre Teilhard de Chardin.

Producing these shows has been extraordinarily rich at times and at others extraordinarily hard. None of them has felt more complex or more daunting in the end than Tatanka Iyotake.

The word “elusive” also describes the process of approaching the facts of this man’s life and the meaning of his legacy. That is in part because of the complexity of this legacy and of the terrible history of the United States government’s treatment of native peoples, of which the story of the Lakota on the northern Great Plains is just a part. It is also a function of the relative privacy and largely oral nature of the historical record of Lakota culture.

Sitting Bull was a thorn in the side of the U.S. government that first gave the Black Hills to the Lakota, then wanted them back after gold (Sitting Bull called it “shining dust”) was discovered there. He refused to negotiate or sign treaties with federal authorities; he didn’t, decreeing from observation and experience that their promises were not good — and certainly not to be trusted over lands that he understood as a sacred inheritance. General Custer’s army attacked, and Sitting Bull’s troops improbably prevailed. Thereafter and until the end of his life, he was pursued as Public Enemy No. 1 by American journalists and politicians. I’ve read some of those reports; Sitting Bull was portrayed like the Osama bin Laden of his day.

After weeks and months of being steeped in what feels like this hidden realm of American history, I feel confident about the truth of that paragraph I’ve just written. I know, at the same time, that it is nearly as simplified as those newspaper reports of Sitting Bull’s day — one side of narrative made up of competing and utterly irreconcilable points of view. In the end there was, to be sure, violence all around.

Sitting Bull’s own relatives and people were divided over his leadership and his resistance to any partnership with the federal government. Members of his own extended family were implicated in his death. This is a wound they carry even today, layered among the many wounds they have carried forward out of the settlement of the American frontier and into the present.

In the end, Sitting Bull’s mistrust of treaties was vindicated by the history that followed. He is not remembered in Lakota oral history principally for that, or for the victory at Little Big Horn. He is remembered for qualities of character that were invisible to press and politicians of his time yet that inspire and strengthen his people even now: humility towards the land, compassion towards living beings, and the ultimate sacrifice of his life on behalf of his people.

Of all I have learned that makes me ashamed of this history and my implication in it as an American citizen, I am appalled that it was not until 1978 — 1978! — that the American Indian Religious Freedom Act guaranteed the right of the Lakota and other tribes to perform their sacred rituals and ceremonies. And these were at the essence of Sitting Bull’s life and legacy. Ceremony is the very element of Lakota spirituality and lifeways. 

Sitting Bull helped shape the vision quest and the Sun Dance. Yet even while his closest lineal descendant, Ernie LaPointe, was growing up, which is not that far away in our lifetime, his family lived in fear of speaking openly or performing these ceremonies.

It is very moving to hear from Cedric Good House, who lives on the Standing Rock Reservation where Sitting Bull died, how the vision quest and Sun Dance are now experienced as sources of healing, very much in the best spirit of Sitting Bull’s memory. Cedric Good House brought his son to our interview and is carrying forward songs that keep different memories and meanings of history alive in the hardest of times. I interviewed them in late November 2009. As we finished and said our goodbyes, Cedric Good House wished me a “Happy Thanksgiving” — a blessing that warmed me and stayed with me for days, containing, as it does, such a long view of history in which true generosity can be obtained.

He also offered the image of the pilgrimage some of the Lakota make on horseback each December, in memory of Sitting Bull’s death and life — from Standing Rock Reservation straddling the Dakotas to Wounded Knee on the Pine Ridge Reservation in southwestern South Dakota. This is painful history to know as my own. But I am grateful for it, and more complete. I’m delighted to know Sitting Bull by his real name, Tatanka Iyotake, and to witness his enduring teachings of humility, compassion, passion, and healing alive in our midst.

I  also recommend reading Sitting Bull by Bill Yenne and Sitting Bull: His Life and Legacy by Ernie LaPointe.

I consider these two books as complementary reading. Bill Yenne’s biography is meticulously researched and gives you a detailed understanding of Sitting Bull’s life within a larger historical and geographical context.

On the other hand, Ernie LaPointe brings the gift of simple storytelling to the page through the oral tradition of his family and culture. Reading one account gives a richer sense of the other, and through this we gain a better understanding of “parallel histories” in contemporary American culture.