Facing the Abyss
I think many of us can imagine this common scene in any Indiana Jones movie: Harrison Ford is running through a jungle, arrows flying past him. He looks behind him, stumbles over a stump, rolls down a hill, and then starts running again. Soon, he realizes that there is a clearing ahead, and he looks hopeful -- that is, until he runs a few more feet, and suddenly realizes he’s facing a 10,000-foot abyss.
I often use this scene as a metaphor for the experience of many people who are approaching death. As their health gradually fails, and they negotiate the health care system, we as physicians will encourage them to utilize Advance Directives (ADs). These documents can assist with clarifying their personal goals of care (GOC) and making their wishes known about the role of medical interventions as they become increasingly ill. Commonly known as a Living Will and Durable Power of Attorney for Health Care (there are other terms as well), these documents allow a person to have some control over the difficult decisions that may need to be made about measures that support and prolong life, even if they are unable to speak for themselves.
Clearly, ADs are also helpful in providing peace of mind as people--often reluctantly--anticipate their declining health and worry about what lies ahead. Often, there is a general sense of relief as these documents are completed; patients and their loved ones can then confidently and affirmatively reply when one of a myriad of sources asks “do you have a Living Will?” They have checked all of the boxes and no longer need to worry about anything related to their future health needs. That is, until they suddenly realize that it is time to die, and it is they who are facing the 10,000-foot abyss.
When we’re in the clearing, most of us think we’re all set, confident with our completed ADs, but we are unprepared for what comes next. We live in the most death-denying culture in history (The Denial of Death by Ernest Becker), we tend to keep thoughts about our own death at arms-length while we are living. We are not encouraged by society to imagine or consider our own deaths -- not by health care providers, financial planners, or even many of our faith traditions. Sadly, we are lulled into believing that completing the AD is all we need to worry about. And, when we find ourselves on our deathbeds, we often symbolically cry out “no one told me about this part!!!”
Our systemic denial of death is partly fueled by the medicalization of death that has occurred during the past 100 years or so. Sadly, we have forgotten the wisdom of the ages that reminds us that life and death are two sides of the same coin.
During the Middle Ages, for example, the societal concept of Memento Mori (remember death) allowed people to remind themselves, and each other, that they are mortal beings and that death will come. These ever-present reminders were not morbid; they were life enhancing. The realization that death may come tomorrow allowed people the opportunity to make today the best it could be, to truly live life to its fullest.
In 2025, we are too distracted by too many things to make the time to imagine how we would want our dying to be. This type of imagining does not happen with doom scrolling, texting, tweeting, or Google-searching.
So, at this moment, I encourage you to make the time and create or find the space to begin to imagine…
Imagine what your own version of Memento Mori could be. How can you find life enriching ways to be grateful for your life? How can you find ways to encourage others to appreciate each moment TODAY?
Imagine your own death. If you had a magic wand, how would you want your death to be? What would be important to you? What role would your spiritual belief system play? What role would your family play? What role would the medical system play? What regrets would you want to avoid? How would you want to be remembered?
I suggest that even beginning to consider these things will make that 10,000-foot abyss less surprising, less scary, and perhaps not an abyss at all.
In the next post, I will share some thoughts about prepping for death. Until then…
Bas sona