{"id":42218,"date":"2018-05-30T10:11:30","date_gmt":"2018-05-30T09:11:30","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42218"},"modified":"2018-06-22T12:12:48","modified_gmt":"2018-06-22T11:12:48","slug":"peter-brindley-youre-going-to-die-why-not-live","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/05\/30\/peter-brindley-youre-going-to-die-why-not-live\/","title":{"rendered":"Peter Brindley: You\u2019re going to die, why not live?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Several months ago, <a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/04\/peter-brindley-and-matt-morgan-all-i-want-for-christmasis-to-slow-down\/\">I committed to \u201cjust slow down,\u201d<\/a>\u00a0to reduce computer worship, and to be more present and thoughtful. Well, the report card is in: moderate effort; minimal progress; see teacher after class. For a pathological overachiever this failing grade is unsettling. I had set out to conquer electronic addiction and black mirror distraction. Instead I am still pacing the bottom rung of our 12 step programme. All this despite knowing the only truth that really matters: you know that we\u2019re all going to die, right? <\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite my advantages<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">or perhaps because of those advantages<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">I have found confronting the big truths to be darn hard work. It is always easier to buy something shiny, and there are no shortages of self-aggrandizing distractions. Presumably it is no different for our patients, and I will endeavor to cut them some slack. Forget transcendence, after only a few days of internet sobriety I fell off the wagon with an embarrassing thud. It was even too hard to replace the hard liquor of screen time with the near beer of a good book. Who\u2019d have \u201cthunk it\u201d: change is as tough as platitudes are easy. Apocryphal Granddad was right: if I really wanted to change I would have done so already. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Focusing on what really matters takes old fashioned grit and new fangled insight. We clinicians ought to have both. Our job at the business end of life and death should mean that we accept what most people ignore: life is a terminal event, and no cash, nor fame will change that. To quote Stratford\u2019s favorite son, \u201c<a href=\"https:\/\/www.enotes.com\/homework-help\/what-significance-this-passage-339238\">all that lives must die<\/a>.\u201d To quote my equally sage spouse, nobody will care in 50 years. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Maybe I can blame my genes and ancestors. After all, presumably my forebears were selected for action, not for deep thought. They would have gone hungry had they contemplated the impermanence of life, let alone the sound of one hand clapping. However, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epigenetics\">epigenetics<\/a>\u00a0is increasingly making the case that our choices and environment can turn on and off methyl groups and histones throughout our life. Moreover, these changes in genetic expression may endure for generations. Think of it like a series of light switches, and we have both the on-off variety and those fancy dimmer switches. If true, then we can influence our genetic lottery, and that of our offspring. If I needed a scientific rationale to do the right thing I now have one. <\/span><\/p>\n<p><span style=\"font-weight: 400\">In contrast, there is a growing trend towards nihilism and tribalism. Regardless of one\u2019s politics there is something concerning about a world with Trump on one side of the pond, Brexit on the other, and a flotsam tide of dissatisfaction all around. It is hardly surprising that to most people Nirvana is a 90s grunge band, and that yoga is more about buying designer stretchy pants. It seems like chutzpah to implore people to find meaning and give gratitude, but this may be our best medicine. Similarly, it seems laughably anachronistic to remind healthcare workers that we are lucky, not cursed, to serve others. Wish me luck as I try chanting that mantra during the next thankless shift.<\/span><\/p>\n<p><span style=\"font-weight: 400\">If we at least accept that every journey starts with a single step then I\u2019ll offer this binary proposition: it is great to be alive, and it will be fine to be dead. Unfortunately, modern medicine is increasingly creating a state that is neither fully alive nor fully dead. While the movie\u00a0<em>Princess Bride<\/em> has been, ironically, quoted to death, Billy Crystal\u2019s character makes a prescient observation: \u201cmostly dead is slightly alive.\u201d Modern medicine excels at keeping people alive long after they can recover or thrive. There can be lawsuits for those that refuse to acquiesce. There is also money aplenty to be made from administering a literal death of a thousand cuts. Technology has become simultaneously too easy to start and too difficult to stop. The next medical revolution should be to regain humanity and relegate machines. We need to relearn how to die because it is going to happen<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">spoiler alert<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">to every darn one of us. No matter how starched your white coat is, doctor, one day you\u2019ll be taking a dirt nap. <\/span><\/p>\n<p><span style=\"font-weight: 400\">It is likely part of the human condition that we would rather dismiss death with a joke than face it head-on. Woody Allen is credited with saying: \u201cI am not scared of dying, I just don\u2019t want to be there when it happens\u201d and Spike Milligan\u2019s tombstone reads: \u201cI told you I was ill.\u201d However, the statistics are clear and cold: you are increasingly likely to \u201cbe there when it happens.\u201d You are also far more likely to have endured increasingly frailty as opposed to sudden death. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Approximately 75% of Westerners now die in hospital, 25% of those in intensive care, and more and more following lengthy battles. Most relevant is that many of us will also die with regrets. <a href=\"https:\/\/www.theguardian.com\/lifeandstyle\/2012\/feb\/01\/top-five-regrets-of-the-dying\">Surveys suggest that we are likely to wish<\/a> we had lived a life truer to ourselves, to have not worked so hard, to have expressed our feelings clearly, to have kept in touch with friends, and to have allowed ourselves to be happier. Fortunately, there is still time. Unfortunately, it is also later than we wish to believe.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Peter Brindley<\/strong>, p<\/span><\/em><span style=\"font-weight: 400\"><em>rofessor in the Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada.\u00a0<\/em>Twitter:\u00a0<a href=\"https:\/\/twitter.com\/docpgb\">@docpgb<\/a><\/span><\/p>\n<p><strong>Competing interests<\/strong>: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Several months ago, I committed to \u201cjust slow down,\u201d\u00a0to reduce computer worship, and to be more present and thoughtful. Well, the report card is in: moderate effort; minimal progress; see [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/05\/30\/peter-brindley-youre-going-to-die-why-not-live\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42232,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18895],"tags":[],"class_list":["post-42218","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-peter-brindley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Peter Brindley: You\u2019re going to die, why not live? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/05\/30\/peter-brindley-youre-going-to-die-why-not-live\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Peter Brindley: You\u2019re going to die, why not live? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Several months ago, I committed to \u201cjust slow down,\u201d\u00a0to reduce computer worship, and to be more present and thoughtful. 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