On the Prospect of Certain Death: A Perspective on the Inevitable in Today’s Era of Modern Medicine
Miraculously, we’ve come as a species to accept our own mortality. A fundamental part of our development into emotionally mature adults is the realization and understanding that all of us will one day cease to exist; our loved ones, our friends, our pets, anything and everything that lives, will die. The rationalization of this prospect and the way we individually come to realize this differs greatly from person to person — a family member will die, a pet will “run away,” or some variation on the theme, and maybe we believe we’ll see them again in paradise, or maybe they’re just gone forever, irreversibly lost. Maybe you’re okay with it, and you don’t think about it too much, or maybe it terrifies you and steals sleep from you. Regardless, you understand that your death is inevitable.
Is it though? With modern medicine progressing at a rate never before seen, is the secret to anti-aging, immortality, or something of the likes within our grasp in the near future?
Nope, probably not. The idea that we can subvert the grasp of that hooded guy with the scythe forever is a little puerile, or maybe just a little too hopeful. We’re biological ticking time-bombs — when you learn about the intricate machinery that keeps your heart beating and your cells dividing on a second-by-second basis, you’ll start to wonder how you’re even alive in the first place. Abstracting further away from the biology itself, we’re machines that manufacture our own untimely deaths. We do stupid things that kill us. We kill each other, sometimes on accident, though regrettably often on purpose. Sometimes we tragically kill ourselves.
The escape from mortality is not a matter of biology at this point in the development of our species — there is plenty we can already do to expand our average lifespan that doesn’t involve fancy million dollar labs at research institutes. The challenge of immortality is surprisingly interdisciplinary in this regard, in that if a cure for aging came out tomorrow (a purely biological solution), we’d still, with certainty, find a way to mess it up. There would be death regardless of the availability, cost, or mechanism of the cure, simply because we, as a species who knows and has known only of mortality for the past hundred-thousand years, are not ready for that kind of paradigm shift.
This really begs the question: should we really be focused on achieving biological immortality when present barriers outside of our cunning pharmacological control stand taller? What’s the point in a cure for death at a point in time when we’re still killing each other? Though, in fairness, an argument can be made in support of biological immortality as well; maybe the experience of two lifetimes is what it would take for us to gain the wisdom necessary to transcend these barriers. Or maybe ten lifetimes — or maybe it’s not possible, and maybe our brains are wired in such a way that we’re fundamentally unable to handle the prospect of eternity (or functional eternity, for that matter). You can call me a cynic, but I don’t see the latter argument as a realistic byproduct of immortality (take a look at the Greek gods, and tell me if they’ve transcended pettiness with their immortality). The argument can be made that we, as a species, should be focused on alleviating the greatest present causes of death — war, famine, violence, poverty, etc., before we concern ourselves with playing god on our biology.
Don’t get me wrong, we absolutely must continue to strive to elucidate our fascinating biology and the mysteries of life through basic science and research, and we should strive similarly to develop novel therapeutics to treat diseases that shorten our lifespan. There is plenty of suffering to go around, and there’s plenty of suffering to alleviate as well. The doctors and scientists of tomorrow have just as much work ahead of them as the social workers and activists of today.
I remember the first time I saw a patient die. I was shadowing a team of physicians in my sophomore year of college, and we had been rounding on a patient with congestive heart failure and endocarditis, a potentially deadly infection of the heart. Several large clumps of bacteria and blood that grew on his heart valve had detached and traveled to his brain, causing multiple strokes. After about a week, he tragically passed away. I remember walking to the autopsy room in silence and carefully putting on my gloves, mask, and gown, before we headed in.
There he lay, dead on the table, his chest cavity splayed open like a cabinet. His organs had already been removed by the time we arrived, and a large pool of blood stagnated in his chest cavity. The physicians were unfazed. I can’t imagine how many autopsies they’d seen before. I, on the other had, was a different story.
I’d always imagined that I could remain calm and undaunted in the face of the macabre, but my reaction was much more visceral. The blood drained from my face and my heart pounded, particularly as I looked at his face. He didn’t look asleep, as the dead are commonly described. The stillness and lack of life was eerie and unsettling, and reinforced the permanence of it all. There was no coming back — he’s irreversibly gone.
To my surprise, I didn’t feel the “peace” that is always described to coexist with death. I didn’t feel that he was now “at peace.” Nothing of the sort. Instead I heard the roar of the void, a cacophony of confusion and terror from a once animated body, now lying vacant on a cold table. Where was the peace he was promised?
“I don’t believe in a future life,” said Raskolnikov.
Svidrigaïlov sat lost in thought.
“And what if there are only spiders there, or something of that sort,” he said suddenly.
“He is a madman,” thought Raskolnikov.
“We always imagine eternity as something beyond our conception, something vast, vast! But why must it be vast? Instead of all that, what if it’s one little room, like a bath house in the country, black and grimy and spiders in every corner, and that’s all eternity is? I sometimes fancy it like that.”
“Can it be you can imagine nothing juster and more comforting than that?” Raskolnikov cried, with a feeling of anguish.
“Juster? And how can we tell, perhaps that is just, and do you know it’s what I would certainly have made it,” answered Svidrigaïlov, with a vague smile.
— Dostoevsky, Crime and Punishment
Death, reinforced by this strikingly vivid memory, has always struck me with a great and unrelenting anxiety. The uncertainty on what comes next, whether there is paradise, hell, the void, or something entirely different all contribute to a terrifying uncertainty. The afterlife, if it exists, doesn’t need to make sense to us. There isn’t necessarily some cosmic rule dictating that an afterlife must be just, fair, or even comprehensible to us. The most devout and pure may all suffer brutally in the end, while the worst of sinners are sent to paradise, or vice versa, or some mix, or neither — it doesn’t change anything in the grand scheme of things. Atoms of hydrogen don’t change their mass and electrons don’t change their charge if all of humanity burns.
Thus, I’d be lying to you if I didn’t say that I often desperately (and selfishly) hope for a cure to aging, some magic elixir or gene therapy to enable functional immortality, simply so I don’t have to face what comes after. I’m happy here, on Earth, as a human, and I don’t want that to change. It’s a strange thing to write an article like this, nobly proclaiming that we have bigger problems than death to solve at the moment, while simultaneously crossing my fingers that we’ll find a solution anyway.
Yet, as I plan on one day becoming a physician, a profession so closely intertwined with death, I’ve had to come to a sort of compromise, or at least understanding, with death. I’ve had to learn to accept that we perish and expire, and that it’s going to happen more often than not, at least statically speaking. I take great comfort and hope in the idea that I will one day take part in alleviating, at least partially, the suffering and plight that disease and disorder cause on people and their loved ones. I realize and accept that my future career will not be to subvert death itself, but rather to delay its untimely grasp, or, in many cases, simply alleviate the pain and suffering that accompany it. My role as a physician will be to comfort and help families when they face the same terror that I faced a year ago in that autopsy room.
