Richard Smith: Has my mother been given “the gift of forgetting?”

richard_smith_2014This morning I read the line “The gift of forgetting” in a poem by Wisława Szymborska. Immediately I asked myself if it is a gift to forget, and quickly—and somewhat counterintuitively—decided it was.

Something else that I’d read this morning in a book by a neurosurgeon supported the conclusion. Henry Marsh in his uncomfortably honest book First Do No Harm writes about his many failures, the failures that are an unavoidable part of neurosurgery as well as his many mistakes, and is grateful that he has forgotten most of them. He speculates that the greatest neurosurgeons may be the ones who are least disturbed by their failures and most able to forget them quickly.

And inevitably I think of my mother, who has spent 10 years without any short term memory and with her long term memory fading progressively. Is her forgetting a gift?

Then I think of a workshop I was doing in Bangalore last week. As so often, I was diverted into my near party piece of asking people how they wanted to die. There are four broad options: sudden death, organ failure, cancer, and the long slow death of dementia or frailty. As usual, everybody except one participant opted for sudden death. But the one exception was the person most familiar with death and dying: a palliative care physician who is also an anthropologist. He opted for dementia/frailty.

I must have asked this question to around 500 people by now. Nobody has ever opted for organ failure, and only one other person has opted for dementia/frailty. A few have opted for cancer, and I created a global storm by arguing that cancer, with its relative quickness and opportunity to say goodbye, was the best.

But I have begun to change. I visit my mother almost every week, and the hour and a bit we spend together is enjoyable. I’ve always been glad when I cycle away, but perhaps because I’m getting so used to the nursing home and its gallimaufry of inhabitants I’m beginning to come round to the idea that perhaps the long, slow death of dementia is not so bad. You slowly fade away, casting aside the worries of the world, abdicating gracefully all responsibilities, and forgetting who you are and even that you are going to die. When death finally comes calling his touch may be very light—no raging against the dying of the light.

All this thinking has had a practical effect. Like many doctors I have boasted that I will kill myself if I know I’m becoming demented, always doubting that I’d actually have the courage to do so. Now I’m resigned to dementia if that is to be my fate. That’s progress.

Richard Smith was the editor of The BMJ until 2004.

Competing interests: None declared.

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  • willshome

    The quality of care is absolutely key. Short term memory loss can free you from distress – or it can trap you in it. There can be a constant need for reassurance, which is a (frustrating) joy to provide. Like many mental conditions, it all comes down to money in the end. Having enough yourself, or the community taking proper responsibility.

  • justarando

    I’ve always wanted to die in surgery, but don’t understand why others I’ve discussed this with always pooh-pooh the idea. Before surgery, there is relative closure with loved ones, they understand that there is a chance you won’t make it out alive, it’s a painless death, and there is clean body disposal. What’s not to like?