Everyone wants to go to heaven, but no one wants to die to reach there.
Many individuals state, that if ever given a choice, they would prefer abrupt death over an anticipated one. This is to avoid prolonged pain and presumed misery of the latter. Most feel that it would be lucky to die suddenly and death during sleep may be the ultimate expression of one’s good fortune. Many religious scriptures have also discussed various modes of death. A few of them praise sudden death for a quick liberation of a human soul without prolonged suffering, terming it as God’s way of blessing a human being.
Interactions with family members of both abrupt as well as anticipated death makes me wonder whether a desire for abrupt death is really what one should wish for.
Case 1: Forty-two years old Mr Prakash (name changed), an employee at an online retail company, was brought to the emergency with uneasiness and severe breathlessness. He was accompanied by his wife and daughters aged 13 and 8 years. He was diagnosed with a massive heart attack. Before any definitive treatment could be commenced, he had a cardiac arrest in the emergency and could not be revived. For Mrs Prakash who is a home maker, all hell, literally broke lose at this time. She was completely clueless about their family’s financial matters and wasn’t even sure if her husband had legally nominated her in his bank accounts. Her constant apprehension, even in this moment of extreme personal loss, was about how their own life would move ahead.
Case 2: Mr Nayyar (name changed), a 52 years old vice president of a prominent MNC, met me in my OPD for a pre-chemotherapy cardiac evaluation. He had been diagnosed with disseminated cancer a week prior, a condition for which no definitive treatment was possible. Putting on a brave front, Mr Nayyar told me that he wasn’t afraid of meeting his maker anymore, as within the week since his diagnosis, he had executed his will and got his financial and social affairs in order. Even his children – who were both abroad, had flown back to be with their father in his hour of grief and need. Sadly, he died a fortnight later.
Sudden death (also called sudden unexpected natural death) is defined as death occurring within 24 hours of the onset of symptoms, in a previously healthy individual. The definition excludes deaths due to accidents and natural calamities, which even though sudden, are not natural.
TIME TO SAY GOODBYE: DIFFERING PERSPECTIVES
Each death results in emotional sadness and grief for family and friends. However, relative merits and demerits of sudden death depend on many factors. From an individual’s perspective sudden death does avoid pain, hospitalization, invasive interventions (with their attendant costs) and overall perceived misery. Viewed through the looking glass of the family however, sudden death leaves many unresolved material and financial issues. This causes a more prolonged disruption in worldly affairs. Emotionally too, sudden death deprives immediate family members and friends of an opportunity to meet the person or to say goodbye.
This scenario is more common in contemporary life when children might have moved away for jobs or education. A second related issue is the structure and inner dynamics of the affected family. Some families follow an inclusive philosophy where the spouse and adult children are a part of financial decision making. Such families are better prepared for any eventuality as they have organized their financial nominations and enacted their wills. Perhaps more common is the other scenario where the bread earner is the only person aware of the “administrative” affairs of the family. It is obvious that such families will find it more difficult to deal with sudden death of the nodal person.
Another factor is the dying individual’s age. A family copes better with sudden death of an elderly person with settled personal affairs than a younger person with unfinished social obligations.
Finally, a family’s size and support structure also play an important role. Joint families with a larger support system are more likely to absorb the grief of sudden loss better than a smaller nuclear family. Paradoxically however, smaller families may also find it more difficult to cope with prolonged illness or hospitalisation prior that accompanies an anticipated death.
ANTICPATED DEATH MAY NOT BE SO BAD AFTER ALL
Anticipated death, as discussed above, surely offers a few advantages. Even though most humans are scared of pain and suffering, medical progress does ensure that physical pain is minimal or eliminated in medical conditions where pain is a worry. Better palliative and home care also makes it possible for people to spend time with their loved ones and manage their social and financial affairs in a more organised way. Finally, speaking of a personal choice, anticipated death might offer an individual to fulfil some options from his bucket list – whether its a pilgrimage, planned holiday or a material possession. Some people may even go as far as planning their own funeral, very much like celebration or wedding. Abrupt death disallows that.
In conclusion, I must emphasise that a discussion about the specific mode of death- abrupt versus anticipated – is largely theoretical and rhetorical. While one cannot control his mode or time of death, social and financial fallouts of unanticipated and abrupt death can certainly be mitigated. On reaching a particular age and stage in life, it is important that all adults frankly discuss illness and death with their family members. It is also better to bring them to speed about family finances and organize nominations and wills. Finally, one must ponder about and clearly state their individual choices about end-of-life care (including mechanical support or not) or a willingness to donate organs. Only then would we have prepared adequately for what is often called the final journey. It would do us all good to remember that life can be fickle.
Prof Hemant Madan is an Interventional Cardiologist and Programme Head, Cardiac Sciences for Narayana Health. He can be contacted at dr.h.madan@gmail.com