To Sleep, Perchance to Dream (If You’re Unlucky?)

Fall foliage

There’s no better time of year to read a book about death—and America’s stubborn unpreparedness to care for its aging population— than fall. As John Oliver said in his comedic diatribe on seasonal pumpkin-spiced lattes, which don’t actually have any pumpkin in them:

Just about anything that reminds us of autumn is a better flavor than pumpkin spice… [I’d personally rather drink] ‘a keen awareness of my own mortality’-spiced latte, because that’s what foliage is!

Indeed. As I discussed in From Glaciers to Icebergs, my children mourn the loss of the leaves. Each year, they react to the changing colors with a little less sadness, but the wistfulness this season inspires may never go away completely­—at least it never did for me.

GawandeWith this mindset, while sipping tea (not a pumpkin-spice latte!), I picked up Atul Gawande’s Being Mortal: Medicine and What Matters in the End. I read the first 30% of it at Chanticleer, which is currently displaying a poignant assortment of chlorophyll-depleted leaves.

Next week, I’ll write a more thorough post on this sobering piece of nonfiction. For now, I want to focus on Gawande’s description of how well his medical education prepared him to address the inevitable end of his patients’ lives:

I learned about a lot of things in medical school, but mortality wasn’t one of them… The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy’s classic novella…The late-nineteenth-century Russia of Tolstoy’s story seemed harsh and almost primitive to us… [W]e put Ivan Ilyich out of our heads.

It’s interesting that medical schools would use fiction to train future doctors about real-life, a fact that only reminds me of how important it is for writers of this literature to experience and observe the real world themselves before committing those “truths” to paper.

However, as powerful and insightful as literature can be, an hour spent on Tolstoy’s novella is hardly enough to train medical professionals to handle the challenges their aging patients will face (to the extent anyone can be “trained” to handle it well).

This is how Gawande describes the way he and his colleagues confronted death:

The first times, some cry. Some shut down. Some hardly notice. When I saw my first deaths, I was too guarded to cry. But I dreamt about them. I had recurring nightmares in which I’d find my patients’ corpses in my house—in my own bed.

Sometimes I consider myself lucky because I don’t remember my dreams­—particularly when Gawande’s book is among my bedtime reading.

Not all books about death are depressing, though, or so Mr. A.M.B. tells me. The book he was reading at Chanticleer, Irvin Yalom’s Staring at the Sun, a psychiatry book about “overcoming the terror of death,” was far more uplifting. I’ll write more about that next week, too.

Chanticleer October 2014

*In case you’re interested, here’s an article on research into why some people remember dreams better than others do.

*The pictures are from Chanticleer (October 2014).


  1. The leaves have not started changing color where I live yet, but fall is always slow to come to my area. My daughter says her favorite season is spring and talks endlessly about it. Except when she tells me Christmas can only come when it snows. I tried to explain to her we don’t live in a part of the country where it snows in the winter, but she doesn’t believe me. Yet.

    As for the real topic of this post, death. Well, it’s something I think a lot of this time of year. I like what Dr. Gawande says. I never really thought about how doctors and other medical professionals deal with the death of patients. In the telling of families a loved one has died, yes, but not specifically on their own reactions.

    I look forward to your further thoughts on the subject.

    Oh, and thanks for the links about people remembering their dreams.

    1. After last winter (with all those “polar vortices”), I wish I lived in a part of the country without snow! Fall is just beautiful here, though. The leaves have become particularly colorful over the last week.

      Gawande’s book is a very interesting read. I’ll have another post on it shortly!

  2. Gawande sounds like a very thoughtful doctor. We need more of those. But death is not something we should be afraid of, especially when it follows a long illness and is an expected and timely outcome of that illness. Death is an inevitable transition that all of us will experience, to fear death is to fear life. Med-school training should begin with that thought, and then emphasize that no physician should feel any blame for a patient’s death if they have done everything medically possible to save that patient’s life.

    1. Thanks for your thoughtful comment. Gawande discusses how death is a natural part of life, one that the medical establishment and society shouldn’t ignore. One of the questions he raises is when treatment should stop, such as when the harm of potentially life-prolonging measures is severe. It’s a very interesting read.

  3. I think it’s time for this country to legalize euthanasia. While there are many who would never consider taking this step, I and my friends have discussed it at length. We want to die with dignity, not spend years in bed, possibly in great pain, waiting to croak. And I don’t want to have to fly to Oregon to have this choice available to me.

    1. I was hoping that Gawande’s book would address death with dignity in greater detail than it did. I haven’t given it much thought (yet), but it seems like there are times when it’s the best option for terminally ill patients.

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