The Dangerous Myth of a Good Death

Keep some room in your heart for the unimaginable. ~ Mary Oliver

As a pediatric oncology nurse, I saw more than my fair share of death. My dying patients were children — some infants, some toddlers, some teens — all leaving this world far before what logic would dictate was “their time.” All of them were, in terms of experience, “innocents.” They were far too young to have made any enemies or done anyone any harm — far too young to have become embittered or to accumulate regrets. With very few exceptions, their hearts were pure, open, and unscarred.

Yet many of these children died what could only be described as horrific deaths. Despite the miracles of modern medicine, the support of loving families, and the best nurses in the world, they suffered terribly in the end.

I recall one little boy who was dying of leukemia. His gut had been destroyed by the high dose chemotherapy that doctors gave him in a last ditch effort to buy him and his family some more time. He spent the last weeks of his life sitting on the toilet, doubled over in pain. We could not give him enough morphine, no matter how high we turned up the drip, to make the pain stop. His parents sat by his side throughout the ordeal, doing what they could to comfort him. Their suffering was as palpable as their child’s.

I saw children who had bone marrow transplants to treat their cancers, their entire bodies ravaged by radiation and chemotherapy. Their mouths too sore to swallow their own saliva; their skin on fire from radiation burns, nauseated and vomiting, they suffered terribly for weeks. Fortunately, many of them made it to the other side of the suffering, and quite a few went on to lead normal, healthy lives. But many of them did not. For them, death was a painful struggle to the end.

For these children, there was no chance at all of a good death. Death was a release from suffering and, if one believes in an afterlife, a chance to go to a better place. But it was not the glorious, transformative experience that many of the thought leaders in today’s death positive movement seem to promise those who approach death in a certain way. It was painful, messy and ugly. Perhaps the moment of death was peaceful– since no one has ever come back to tell us about it, there’s no way to know. But the process — even for the youngest of them– was not.

The Truth About Death

Today, as we learn to talk more openly about death and dying and embrace death as a part of life (which is absolutely a good thing), there seems to be more and more discussion in certain circles about an almost mystical experience called a Good Death. And every day there seems to be a new crop of experts who promise to teach us how to achieve this end. Yet most of their advice is actually not about how to die well, because no one who is living can really tell another how to die. It is about being present with death’s inevitability, and using that certainty as a catalyst to creating a better life.

This, too, is a good thing. Accepting the fact that we are all going to die is a remarkably effective way to move towards living an authentic and spiritually centered life. Talking about death and realizing it is a journey we all take can help decrease the anxiety we feel about the greatest of all unknowns. But it’s a mistake to believe that doing these things will guarantee us a choice about when and how death will come, or that we (or the people we love) will have the resources to meet it in the way we would like when it does. We can and should prepare for death and make whatever plans we can. But whether our plans are realized or evaporate into thin air is, in the end, not something we control.

In his remarkable book, “The Five Invitations,” Frank Ostaseski writes very eloquently about the increasingly popular characterization of this mythical Good Death. “We treasure the romantic hope that when people pass way, everything will be tied up neatly. All problems will have been resolved, and they will be utterly at peace.” he writes.

But this is rarely the reality, he says. “Very few people walk toward the immense challenge of dying and find peace and beauty there. But who are we to say how another should die?” I would add: Who are we to assume that even we will make the journey in the way we imagine we will?

Holding Space

Placing expectations on the dying is an easy mistake to make. But when we do so, we limit our ability to open our hearts to what is happening and be truly present with the person who is making the journey in the here and now. When we assign labels such as “good” and “bad” or “right” and “wrong” to an experience so intimate and so personal, we add an element of judgement that can add to the person’s suffering, and make the process of dying far more difficult than it might have been. When we impose our beliefs about what death “should” look like on someone who is dying, we deny them unconditional love and  acceptance they need and deserve. 

Instead, I would like to suggest that we practice the art of holding space.

Holding space for another means accepting them and their experience with an open heart. It means letting go of judgement and of our need to mold reality to fit our preconceived notion of what it ought to be. It means admitting that we have no control, and being present with that in an authentic way.

For most of us, this is a very difficult thing to do. But we can do it, albeit imperfectly, if we surrender to the fact that death, like life, is messy, unpredictable, scary and challenging — and if we come to terms with the fact that each of us will make the journey in the best way we know how.   

About Kathleen

Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years experience as a registered nurse caring for families and children facing life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.