Senior Psychcare

Does the fashion of our dying count in the final reckoning of how we have lived our lives? Nearly my first job at the University of Chicago was to go through the Platonic dialogues on the trial and death of Socrates. "Then, holding the cup to his lips, quite readily and cheerfully he drank off the poison. " It is the supreme moment in the Western philosophical tradition, when wisdom and courage, resignation and defiance, combine to overcome injustice and, in a sense, death itself.

Would that we could all die as Socrates did. Typically we don't. "The good death has increasingly become a misconception," wrote the Yale physician and bioethicist Sherwin Nuland in his 1993 prize-winning publication "How We Die." Dying, in Dr. Nuland's eloquent telling, amounts to "a sequence of harmful occurrences that involve by their very nature the disintegration of the dying individual's humanity." Who can—who would dare—judge a man's value when his mind and body are being picked bare by disease?

I've been thinking about all this for over a year now as I watched a brain tumor, along with the related medical interventions, pick away at my father bit by bit. First, an operation to eliminate the cancerous growth, which wiped out his right field of vision and took away his ability to read and drive. Next came debilitating rounds of chemo and radiation, along with an agonizing case of shingles. Then avascular necrosis set in, making him unable to walk. Subsequently, as the tumor returned, his memory began to slip. Near the end he was almost totally blind, couldn't utter a sentence, couldn't take a pill, couldn't hold his meals down. Cancer is a heist culminating in murder.

I assume Dr. Nuland's book should have prepared me for this. I suppose, too, that I should have recognised what was approaching after visiting my aunt as she was dying of brain cancer. My father had been with me on that journey to wish his sister a last happy birthday. His own tumor was recognized 3 weeks afterwards.

But I wasn't ready. My father, generally in excellent shape, had a way of projecting an air of indestructibility. When he called to tell me about the prognosis, it was in a tone suggesting it was only slightly more serious than a fender-bender. The 5-year survival rate for his kind of cancer is 4%. I looked that up on the Web, then persuaded myself that he was surely in the 4%.

"The body has 1, 000 lines of innovative defense," I recall my father telling me as a youngster, in what must have been one of our very first talks about dying. And I had believed him, because to me he was the living proof.

To grow up is to realize that the self-belief a parent radiates around his children is hardly ever the assurance the parent senses. I knew my father well enough to know his various anxieties and various insecurities. I knew he had seen his own father die of brain cancer and was intimately familiar with the course of the sickness. I knew that, born optimist though he was, he had no faith in an afterlife. My father treasured the life he had, lived it fully and well, had no desire to abandon it.

All this meant that the verdict should have been devastating to him. Still he never betrayed the slightest sign of concern. Apart from when his shingles were at their most excruciating, he continued to be his content, involved, stimulating self. For a while I put this down to his belief that he would in some way beat the cancer, a belief I was keen to share.

Yet my father retained his usual sangfroid even when it grew to be obvious that there would be no getting well. There were no 5 phases of grief, no rounds of denial, anger, bargaining and melancholy. About six weeks before the end, when we had brought him to a hospice, I asked if he wouldn't rather be at home. "Given where I am," he responded with a cocked eyebrow, "I am where I am." I was stunned he could even speak. We brought him home regardless.

How did my father retain his composure in the face of his progressive deterioration? We never spoke about it. I sometimes chalked it up to being born in the 1930s, before the baby boom and the cult of self. He was not a complainer. To bemoan his illness after a lifetime in which the good breaks outnumbered the negative ones would have appeared to him ungrateful. The worst he ever mentioned to me about his cancer was that it was "a bummer."

Yet there was something different at work. The sicker my father got, the more dependent he started to be on his family, the less he had to give back. What could he offer, other than not to sink us into the horror he surely must have felt? So he retained his usual energetic and joyful interest in our lives and the lives of his close friends and in politics and the films we watched with each other. Sticking to the routine and the lighthearted was his way of being protective with the folks he adored. For as long as he could muster his wits, death was not permitted to enter the room.

Throughout his existence my father taught me many lessons: about language, history and beliefs; about integrity, loyalty and love. In the end, he taught me that death cannot destroy the dignity of a dignified man.