Concluding My Journey

My journey to self-discovery began almost fifty years ago when, as an eight-year-old child, I went to watch a movie with my parents. The movie was called Anand in Hindi. It was a very tragic movie in which the main character, RajaBabu, dies of cancer.

I was inconsolable at the tragic death. For several days, I cried. Finally, my dad suggested that when I grow up, I should become a cancer doctor and help people like RajaBabu.

As a young adult, I bought a red motor cycle and started riding rural India in search of beauty of nature and tranquility and serenity. With camera slung across my front and torn satchel across my back, I zoomed through villages and across jungles teeming with wildlife. As lions roared and birds sang and villagers fed their cows, I was searching that “One” that would give me lasting bliss and peace. I struggled to find myself and my call in this life.

These journeys of reflection and self-discovery brought me across seven seas. I never realized that the answer to who I was, where I came from, and where I will spend eternity was always within me. That what I was looking for was, is, and will always be there, an inseparable part of me.

I have always been a part of the Universe. Even before I was born, I was floating in the Universe like a brown autumn leaf, freely, as part of cosmic consciousness. Then I decided to experience a human life for a limited span, as my genome-encoded DNA mixed a blueprint of this body with elements borrowed from planet earth. Now people call this part of cosmic consciousness “Kashyap.”

But through all of my searching, I never forgot my dad’s encouragement to become a cancer doctor. Now, as an oncologist living with life and death every day, I have come to a realization that I am nothing but an awareness covered in a temporary shelter of physical body that mother nature granted from the basic elements of life.

In these few episodes of learnings from other inquirers like me, I have shared their journey through the physical body and then back into the higher awareness or wherever they chose to move on to. Harry has granted linguistic tone to my understanding of life and death. I have shared my own quest from ignorance to bliss, from darkness to light and one day, I will start my own transcendence from death of this physical body to immortal soul.

I invite you to join my journey as we explore this eternal cycle of love and bliss around us. We can find that illumination even in the darkest hour of death. If you find yourself watching this play of life and death all around us, yet notice eternal bliss and light amidst it all, and live life to the fullest as if there is no tomorrow, I feel my efforts will be paid.

What Does It Mean to Die Well?

“Oh teach me to see Death and not to fear, But rather to take truce. How often have I seen you at the bier, And their look fresh and spruce! You fragrant flowers! And then teach me that my breath Like yours may perfume and sweeten my Death.”

Steve Jobs once said, “No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet, death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It is life's change agent. It clears out the old to make way for the new.”

Everyone understands the inevitability of death for all of us here on earth. We all know that our time is limited, and we see it around us as we go about our daily lives. We see our grandparents, and eventually our parents, pass away of old age as we are left to mourn. We suffer the loss of friends to things no one could have predicted—a car accident or a sudden heart attack. We are acutely aware that our time on earth is limited to a finite number of ticks of the clock; indeed, we don’t have any clue as to what that allotment is. We see it in the news when a hurricane strikes and leaves hundreds dead in its wake, or when an earthquake levels a city along with many of the souls who once resided in it.

And yet, despite its omnipresence around us, no one ever wants to think about death, or talk about it, or prepare for it. There is an unspoken fear and taboo surrounding the topic, almost as if people believe that if they avoid talking about it they may be able to stave its strike. In particular, certain manifestations of death are especially singled out as harbingers of this fear.

I see this every day in my professional life as a practicing oncologist. The moment that the words cancer and death are mentioned in a conversation, the listener invariably recoils in horror.

And yet, millions of people each year are forced into this recoil when diagnosed with cancer, abruptly forced to face the sudden fear of impending death just behind the curtain of the fatal words “I’m afraid you have cancer.” Their plans come to a screeching halt and, like deer in headlights, they are forced into a life of little more than waiting for that final breath before they pass away.

It is at that moment that the eternal awareness, that we all know deep down, rises to the surface; that like everyone else they know, they too will be leaving this world.

Until that moment, the desire to cling to life in an almost mythological quest for eternity, combined with often-profoundly mischaracterized illusions around new discoveries in science, created a happy apathy and mirage of longevity. Until confronted with a stark eventuality, we all think we’re going to live forever.

This apathy causes us to suffer more when it is lifted by the shroud of an impending demise. I see it every day; patients in their last few days enduring horrifically painful therapies when we have already informed them that the end result of that dreadful suffering will be maybe two or three more weeks of life spent in agonizing pain. The pain and the therapy do not allow them to spend time with their loved ones or enjoy the comforts of life. Those few weeks are spent chained to a hospital bed. We are too willing, it seems, to bargain away quality time with those we love and freedom from debilitating pain in exchange for fourteen to twenty-one more days on earth. And in that last leg of the marathon, instead of preparing and planning for a graceful and pain-free departure surrounded by those we hold dearest, we prefer to ruin those last, most precious moments in pursuit of a farfetched cure, ensuring that the final days we spend on earth are the most miserable of our entire lives.

It is this fate that, as a physician who has been at the deathbed of countless numbers of my patients, I want to help people avoid.

Cancer treatment has advanced to the point where we can successfully treat and cure some forms of cancer. Even when the disease is incurable, we can add years to one’s life. And when there is no hope left, we also have the ability to provide patients with estimates of how much time they have before the disease takes them, and give them the opportunity to plan for their exit before facing it. At that point, when therapy has failed, when a timer has been placed on our moments walking the earth, the single most important thing we can do is be prepared.

When the topic comes up, the gut reaction is simply “I don’t want to die” and the mind automatically moves on to something else. This is a perfectly natural and life-affirming thought, and it is true that if we constantly thought about death, we would lose the ability to actually live our lives. But there are exceptions. When faced with the certain knowledge that, despite our not wanting to die, death is foreseeably coming on a relatively predictable timetable, such denial needs to change. At that point, my patients who have had the most peaceful, meaningful, and dignified exits from mortal life started to ask something else. Those who were able to enjoy their final moments and pass away in peace instead asked, “Since I cannot avoid dying, how I can I die well?”

As a society, the most exciting time in any family’s life is preparing for the birth of their children. For expecting parents, and their grandparents and aunts and uncles and friends, nothing matters more than planning and getting ready for the arrival of a new member of the family. Our lives change with baby showers, preparations, and an entirely different lifestyle to accommodate the needs of the new arrival. Yet we don’t show nearly the same degree of preparation for our departure from this world. The fact that we will someday depart is established the instant we’re born. Still, an unspoken taboo seems to forbid us from planning for a smooth, graceful and celebratory death and departure.

What is the meaning, value and concept of a good death? When should we start thinking and talking about the process of death and dying?

The moment a terminal illness like cancer is diagnosed, death lurks beneath every discussion, sometimes addressed directly but usually left alone. As physicians, it is our responsibility to be the lighthouse that guides patients through the rough waters that they are now forced to sail. How then do we prepare our patients for a good death? Is it possible for us to rise above our own hopes, fears, and vulnerabilities and be candid in preparing patients for death? How do we communicate the truth about death? Can we define it in absolute terms or is it best communicated in innuendo and purposeful silence?

Is death really as bad as what our fears make us dread? Maybe. Maybe not. Science has not been able to solve that mystery, and it is highly doubtful it will ever be solved. The only people who can answer that question are well past communicating with the living. What we can do, though, is face our own reluctance and hesitation to understand and accept our finitude and embrace our mortality. We keep chasing that mirage of longevity instead of preparing with grace and dignity for our own inevitable exit from this world, something that no one will ever escape.

We human beings die and know we are going to die. The choices we make are shaped in countless ways by how we think about death, what we believe happens after death, and by what death—and life—ultimately means. So thinking about death is an essential element of the reflective human life, and it brings us face-to-face with questions of meaning in the face of finitude and loss. In what ways might death threaten the meaning of our lives? And in what ways might death make a meaningful life possible?

What does it mean to die well? Some people aspire to die as consciously as possible, knowing that they are going to die and wanting to fully experience each moment of it. This allows them to say the things that need to be said, to get their affairs in order and, perhaps, gain further insight into the nature of life and death.

The experience of dying is highly individualized. According to Ira Byock (Au:Dying Well: Peace and Possibilities at the End of Life. New York: Riverhead Books, 1997), “Patients who died most peacefully and families who felt enriched by the passing of a loved one tended to be particularly active in terms of their relationships and discussions of personal and spiritual matters.”

Byock also found that “good deaths” were not random events or matters of luck. They could be fostered by the choices of the dying person—choices that could achieve important goals, even on death’s doorstep. “Even as they are dying,” Byock wrote, “most people can accomplish meaningful tasks and grow in ways that are important to them and their families.”

There is great value in asking the question: “Am I prepared to die?” Let’s consider what that preparation involves.

Most of us would admit that, at least in some way, we fear death. But what if we’re making a mistake—an error of reason? What if our fear of death is based on a misconception about death that, if corrected, would eliminate our fear? And what if that misconception were the belief that death is bad? Wouldn’t we have lived an entire life fleeing a specter that, in actuality, was terrible only through our own interpretation of it?

I have spent thousands of hours near death with my patients. I have seen and experienced death in every shape and form. I have seen young and old, male and female, rich and poor, all die in different ways. Despite all the miracles of modern medicine, I’ve seen many people die, sometimes even in the prime of their lives.

In this book I share several of my own experiences with everyday people like you and me who were forced by cancer to face their own mortality. I have worked with such patients and helped them prepare for the journey beyond life, helped their families cope with loss, and helped them all find closure in the time that God left to them. All of these patients had common anxieties and concerns:

It is my sincerest hope and prayer that, without having to face the knowledge of a terminal illness as these patients did before searching for their answers, you will find a comforting, and perhaps even peaceful, answer to your own questions as you read about how others faced them.