EDITORIAL: Death, Dying, the Grim Reaper . . . and Woody Allen

Howard Daniel

Filmmaker Woody Allen once remarked, “I don’t want to achieve immortality through my work. I want to achieve it through not dying.”

If that thought elicits even a flicker of a smile on the face of anyone reading this editorial, then this issue of Marin Medicine—whose featured topic, Death and Dying, is inescapably depressing—will have unexpectedly opened on a less gloomy note.

While the next seven articles offer virtually nothing mirthful (except for a few grins in Dr. Sal Iaquinta’s review of Working Stiff), their authors do give readers any number of heartening thoughts. Such as, for example, in their discussions of the End of Life Option Act, the wondrous benefits of hospice care, end-of-life planning, and progress in learning to ease, for patients and their families, the last hours of life.

None of this affects the inevitability of death, of course, but it might be argued that the efforts described in the following articles to soften—in various ways—the end-of-life transition represent significant progress as compared with the way death was handled not too many years ago.

Of course, the contemporary “American way of death” is often negatively compared with the good, old-fashioned—and perhaps somewhat idealized—way in which some people used to pass away (and many of those in hospice care now do): in the comfort of their own home and bed, surrounded by loving family members. What such critiques, stingingly accurate in many respects, sometimes overlook are the enormous advances that modern medicine brings to the alleviation of the dreadful suffering that too often precedes the arrival of the Grim Reaper.

Also frequently overlooked in critiques of the way we die is the breathtaking rise in lifespan wrought by advances in public health and modern medicine. While dying patients often pray for the Grim Reaper’s speedy arrival, we all welcome the decades-long delay with which he makes his appearance in modern times and in economically advanced countries, as compared to the early age at which he used to appear. In Hippocrates’ day, life expectancy at birth is estimated to have been about 30 years. In ancient Rome, those who didn’t die in childhood could expect to live to their late 40s. In the United States, average lifespan—now in the upper 70s, depending on socio-economic circumstance—rose by more than three decades over the course of the 20th century.

A friend mordantly observes that life is a mortal condition. Today, it might ironically be added: perhaps only in our lifetime! And Woody Allen’s. Who knows what the future will bring!\

Shifting gears briefly, following is a short preview of the rest of this issue. Dr. Kristen Brooks begins with a survey of the pros and cons—and protections for physicians as well as patients—of the End of Life Option Act, which enters into force on June 9, almost simultaneously with the publication of this issue. Dr. Raymund Damian discusses end-of-life planning and care. Hospice care is sensitively and touchingly treated in an article by Dr. Molly Bourne. Dr. Scott Schmidt tells us about the RESPECT Project for patients going through end-of-life transition, which he helped develop for Kaiser San Rafael Medical Center. “Everything you ever wanted to know about death certificates, but were afraid to ask” would be a good alternative title for an article by Dr. A. Jay Chapman. Following these articles is a two-page spread on CMA end-of-life resources.

The issue’s Out of the Office article, by Dr. John Maa, provides a somber look at a different aspect of death and dying. It is a retelling of a suicide and its aftermath that he chanced to witness at the Golden Gate Bridge. Dr. Sal Iaquinta then gives us engaging reviews of a pair of books: Working Stiff and When Breath Becomes Air. The theme concludes with “From Death to Medical Satire,” a report on the 2016 Health Care Leadership Academy.

Four upbeat articles complete the issue: Dr. Matt Willis brings us good news about the upward trend in the Marin County vaccination rate. Dr. Gregg Tolliver provides an update on the transformation of Marin General Hospital. Dr. Peter Bretan gives us a report on last November’s AMA House of Delegates meeting. And MMS Executive Director Cynthia Melody closes with a tour through Marin Medicine’s metamorphoses over six decades. Worthwhile reading, all of it.

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Mr. Daniel edits Marin Medicine.
Email: howard@pen4rent.com