Sometimes you get revelations in the most unlikely places. For me, it happened in a New York theater, with a line of dialogue that gripped me like a pair of hands shaking me by the shoulders:
“I don’t understand why we prepare so … wonderfully and elaborately for birth, and yet so appallingly and haphazardly for death.”
Absorbed as I was in Jake Gyllenhaal’s solo performance of A Life, his character Abe’s alternate ruminations over his pregnant wife and dying father have had me pondering my own choices. I think about all of the effort my wife and I put into preparing for the birth of our son — choosing names, childbirth classes, room décor, stockpiling diapers, researching strollers and breast pumps, planning child care. Then I compare that with what little we’ve invested in planning for our or our parents’ eventual deaths. Birth is wonderful and exciting, and death is mournful and sad. Yet in A Life, the playwright reminds us that both can happen around the same time, and denying the certainty of death may leave us so emotionally shattered, we are ill-equipped to love and nurture a new life, never mind caring for others who depend on us.
At the health-care system where I am a primary-care physician, we have an advanced care planning initiative called “Our Care Wishes.” Patients can go online to store and share a custom-created document that explains their end-of-life preferences. Along with specifying desired treatments and denoting a surrogate decision-maker, users can write a letter to loved ones, describe how they want to spend their final days, and how they wish their life to be remembered and celebrated. It is a compassionate program that addresses a serious gap in our care of patients, especially those with serious or terminal illness.
The “Our Care Wishes” platform has been available for some time, yet it wasn’t until I saw this performance of A Life that the urgency of it really struck me. Seeing birth and death so vividly contrasted on stage is what it took to jolt me out of my complacency about addressing this issue with my patients, and with my own family. A great work of art transported me into the narratives of characters the likes of whom I may never meet in life, yet who seem familiar in important ways. It augmented my perspective on relationships by presenting angles of vision that I may never have access to but can well imagine.
The writer David Foster Wallace said in a 1993 interview: “We all suffer alone in the real world. True empathy’s impossible. But if a piece of fiction can allow us imaginatively to identify with a character’s pain, we might then also more easily conceive of others identifying with their own. This is nourishing, redemptive; we become less alone inside. It might just be that simple.”
Preparing for the end of life is no less important than planning for childbirth. Although I have known this in theory for some time, it took immersing myself in a great stage work to raise this to its needed level of urgency. I just ordered a box of “Our Care Wishes” brochures to give to my patients — and my family.
Jeffrey Millstein is a primary-care physician and medical director for patient experience-regional practices of Penn Medicine.