On death

I still remember my first childhood realization of mortality as a concept. It disturbed me intensely. I cried long and hard – more for the realization that my loved ones could die, rather than my own fate. It is only after much placating that I calmed down. Of all my childhood memories, that one is truly vivid in my mind.

35 years later, as a physician, I stare death in the face every day. I see the fear of dying writ on my patient’s faces – even the “brave” ones. As much as I see this, I have been blessed that my patients seem to have the knack of cheating death – even when all else looks bleak. Yet, despite my best efforts in some, death came for them in ways unexpected. It helped me realize that life (and death) takes its own course. Physicians only help ease the pain. Let me illustrate.

Some years ago, a patient was transferred to my facility with a suspected heart attack. I confirmed the diagnosis and took him to the cath lab. 3 stents later, he was pain free and appeared grateful that we made the diagnosis and made him feel better. As a young man, he returned to a normal lifestyle, including bicycling. Six months hence, he returned for his followup and reported non specific symptoms but a very active lifestyle. A stress test was negative for any new blockages and I sent the man on his way. Another 3 months later, I came across a police report detailing his death while driving his bicycle with no helmet. It made me question the point of it all. Why struggle with fixing hearts, when life seems so cheap?

The answer came to me later, and in Gita-esque manner. The man was predestined to meet death on that road at that time. He was doing what he must. I fulfilled my duty of making my best attempt of treating the man’s pain and allaying his  anxiety. He met his death, in his favored activity and I helped keep him pain free getting there.

Why die?

Death is a renewal of the species. It is the essential evolutionary adjunct that keeps our species virile and robust. As a species we have outlived many long lived competitors to emerge the currently dominant species in our solar system (As far as we know!). At this time, the only threat to our dominance is from shorter lived entities like rats, cockroaches, mosquitoes, fungi, bacteria and viruses or combinations thereof. We look at them (often with irritation), much like (I like to believe) dinosaurs looking at puny prehensile mammals.

Why is dying “young” an advantage to the species? Doesn’t accepting that contradict everything that I do as a physician?

Let’s take an example of two wolf packs with 20 wolves each. In one (pack A), the wolves are of hardy stock, while in the other (Pack B), they are relatively delicate. Each pack has 10 males and 10 females. Pups (<1 year) don’t hunt and there are no old wolves – yet. Both packs are hunting well this summer. A disease affects both packs. In Pack A, their hardy constitution ensures that all the wolves survive. In Pack B, 2 pups and 2 older wolves die – a reflection of their delicate constitution and maybe poor environmental conditions. Months pass, a tough winter ensues. As expected Pack A survives but is tremendously weakened by starvation (more mouths to feed). Pack B has lost 1 more pup in the winter and 1 male. However with smaller numbers and more hunters, they did better with food. At this point, if there was to be a battle between packs, which do you think would do better, 20 starving and weakened wolves or 14 relatively intact but hungry ones?

 Fortunately, the standoff never happens. Fast forward to three years later. Pack A now has 35 wolves. Of these 8 are “geezers” (old wolves that don’t hunt) and 10 pups. Pack B has 35 wolves (thanks to better reproductive abilities in better fed females) but only 2 geezers and 10 pups. Less than half of Pack A hunts while 2/3 of Pack B catches more than they eat. A great famine and drought ensue. As expected, Pack B loses both geezers, 3 pups and 2 males. Pack A shows tremendous fortitude and loses just one geezer. However, this comes at extreme starvation and erosion of hunting ability.

A hungry pride of lions comes by and finds 2 wolf packs. After making easy pickings on Pack A, they are unable to catch up with Pack B and actually lose a young female in an ambush. Pack A’s lone surviving female is absorbed into Pack B. Pride of lions moves on.

As the instance above illustrates, the ability to die is an advantage, not a disadvantage. If you think beyond the paradigm of the individual but in terms of a family, a pack, a population, a nation or a species, the ability to dynamically keep the best features to fore, while minimizing liabilities is key to survival.

From a philosophical point of view, death is a renewal of the soul. After suffering the slings and arrows of the outrageous fortune that is our life, death is the opportunity to start afresh. It is returning weary at the end of a long day and falling asleep. It is as natural as eating, drinking, sex, evacuation and yes, birth. Yet, we view it with fear and loathing. If the soul is immortal, this body and this life are like clothes you have on today. Much like them, they are a bit rank at the end of the day and need to be laundered. Your soul moves on, the universe reutilizes your body.

What is the soul and do I have one? Is it better that the Joneses? 

No. Your soul is not some ethereal being arising from your belly button. It is not James Brown either.

It is the imprint you leave in space and time by your existence.

That is an indelible fact. Your existence is not only the proof but also a reflection of your soul. Just because you die next thursday, does not change the fact that you existed and lived Today. That is the immortal fact, your immortal soul. Whether you are moral or immoral, good or vile, dynamic or slothful, your soul is a reflection of that imprint on that part of space-time.

Do I know if my soul will be reborn? Why do I, or should I, need to know this?

I, frankly, don’t think I do. And I don’t think I care. What I do care about is making my soul the most beautiful thing I know. I live each moment, complete each action I do to the fullest. I live the dream.

If the soul is reborn, would you remember? When you wake up every morning, how much of the previous day do you really remember. Try looking and the details are pretty fuzzy when you start trying to make them out. When we are born, our souls take the information that they need from the prior existence to get things going. The brain and memory that they have to fit into is too small to carry the entire burden of memories of the last existence. And if you brought all your baggage with you, how would that be a renewal? We don’t even know why we exist, our minds lack the understanding. How could we cope with the burdens of a prior life. In an individual with infinite sagacity and peace, the ability to comprehend existence and the soul is such that they can carry the abbreviated memory of all their existences forward.

So where is the divinity of the soul?

The universal existence is divine. My soul is the space-time imprint of my part of that existence. By extension, logically, my soul IS a reflection of that divinity. In this, there is no good or evil. There is no past or present. It is just existence. Does that mean that I should be evil? Yes and No. You DON’T have to be evil. Evil is defined by perspective. In the story above, were the lions evil? They were just hungry. Was the disease evil for killing pups? You have to understand the purpose of your existence and live to fulfill it to the best of your ability. Today’s evil is often tomorrow’s hero, just as today’s hero is often tomorrow’s hated tyrant. Don’t worry about your labels, get on with your existence (and soul).