Fast or Slow: What’s the Best Way to Die?

Silhouette of death with scythe.Lighting info: one flash with cells behind model and rain from sprayer between the flash and the model

The grim reaper is fickle, inconsistent, and unpredictable.

To wit: This past weekend a 55-year-old childhood friend of my husband’s died suddenly and unexpectedly from a massive coronary, leaving everyone around him stunned.

Ironically, at the moment my husband looked up from Facebook to express his shock, I was in the middle of reading “My Father’s Body at Rest and in Motion,” Siddhartha Mukherjee’s scientific personal essay in the New Yorker about his octogenarian father’s excruciatingly slow demise, after suffering a few falls.

Mukherjee, a physician, considers the body’s proclivity toward homeostasis, which kept his elderly father’s failing body alive for months — much longer than seemed to make sense.

“Old age is a massacre,” Philip Roth wrote. For my father, though, it was more a maceration—a steady softening of fibrous resistance. He was not so much felled by death as downsized by it. The blood electrolytes that had seemed momentarily steady in the I.C.U. never really stabilized. In the geriatric ward of the new hospital, they tetherballed around their normal values, approaching and overshooting their limits cyclically. He was back to swirling his head vacantly most of the time. And soon all his physiological systems entered into cascading failure, coming undone in such rapid succession that you could imagine them pinging as they broke, like so many rubber bands. Ping: renal failure. Ping: severe arrhythmia. Ping: pneumonia and respiratory failure. Urinary-tract infection, sepsis, heart failure. Pingpingping.

Those feats of resilience surrendered to the fact of fragility. And, as the weeks bore on, an essential truth that I sought not to acknowledge became evident: the more I saw my father at the hospital, the worse I felt. Was he feeling any of this? Two months had elapsed since his admission to the geriatric ward.

I read Mukherjee’s piece on the heels of revisiting “A Life Worth Ending,” a similar 2012 New York Magazine piece by Michael Wolff (yes, that Michael Wolff) which I’d been reminded of on Twitter, about his mother’s “dwindling” in a miserable, expensive, endless-seeming purgatory in the year before her death.

(In my early 50s, about the same age both my grandmothers were when they died, I’m mildly fixated on death.)

Wolff — who includes the same Philip Roth quote in his piece — writes of his frustration witnessing his mother’s last years, when she seemed caught precariously and unenviably between life and death; not well enough to live on her own without tremendous intervention from her family and doctors, but not sick enough to quickly die. He makes a convincing case against the medical establishment’s endeavors to keep the dying alive long past such time as they are able to thrive on their own, leading to painful, slow deaths that deplete families and taxpayers.

Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

This is not anomalous; this is the norm.

The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

A few nights after their friend died, my husband and his brother attended the funeral. Afterward, the three of us got into a discussion about how strange it is that for the most part, none of us have any idea how or when we’ll exit this world, and no control over the matter. We debated whether those faster “traditional exits” Wolff identifies are better or worse than slower routes, which afford loved ones time to prepare and say goodbye.

We ended the evening as mystified as we’d been begun it.