On Wasting the Pandemic

With nearly 3.3 million deaths from COVID-19 worldwide, the pandemic has provided an opportunity to talk about death. And we are squandering it.

Rather than acknowledge human finitude and ask how we might prepare for the inevitable, we ran with warp speed toward the fix.

As a medical doctor, I unequivocally affirm that masks and vaccines are essential. But so too is the recognition of—and indeed the preparation for—our mortality. Pandemic or not, the human death rate continues at a steady 100 percent. Why, then, do we neglect the work of preparing for death?

Part of the answer has to do with the dominant social narrative about disease. We view sickness and death as enemies to be conquered. This military metaphor for physical ailments goes back at least to the 1880s, Susan Sontag tells us, when bacteria were identified as “agents of disease.” The language was later appropriated for cancer, drug addiction, and obesity.

The military has also adopted the metaphor. In February, when the army deployed soldiers to help with the COVID-19 vaccine administration, Army Chief of Staff Gen. James McConville said, “The Army is committed to making this happen… We've got to defeat this enemy.” But it’s difficult to prepare for death when our goal is to annihilate it.

Another reason we don’t anticipate death is that we don’t see it. Hospitals and nursing homes have for decades shielded death from public view. Although most people say they want to die at home, about 60 percent die in institutions. And the battle plan against COVID-19—widespread visitor restrictions—made it even less likely that the public would see death.

Beginning in March 2020, and for much of the last year, hospitals and nursing homes locked their doors to visitors, volunteers, and non-essential workers. These restrictions were necessary to mitigate spread. But they also meant that few witnessed the dying struggle of coronavirus victims. And limits on social gatherings meant that few could corporally mourn their dead.

A third reason we are wasting the opportunity to prepare for death is that, frankly, we’re distracted. For some, the pandemic has meant job loss, hunger, and financial stress. For others, it has meant creative escapes. For many, the struggle of work-from-home with children in online school has been a daily hell. When survival becomes the goal, it is difficult to plan for anything, let alone for non-survival.

My patients sometimes worry that preparing for death will jinx them. I remind them that we should think of it as we do retirement planning. Just because we save for retirement doesn’t mean we’re more or less likely to lose our jobs. We save because it is wise.

Earlier generations found great wisdom in anticipating and preparing for death. After the Bubonic Plague struck Western Europe in the mid-1300s and consumed up to two-thirds of the population, there developed a genre of handbooks on the preparation for death. Known collectively as the “art of dying,” the booklets offered basic instruction on living with a view to the end. They called for a regular acknowledgment of human finitude within the context of community to help people make sense of values, goals, and beliefs. I revive this concept in my recent book, The Lost Art of Dying.

Sometimes I give my patients this thought experiment. Imagine, God forbid, you receive a terrible diagnosis. What would you do differently? What might you change now in order to realize what’s most important to you?

Then I ask my patients to picture who would be gathered around their deathbed. What is the state of those relationships today? Which do you need to mend or nurture now to ensure solidarity in the end? These conversations might be uncomfortable at first, but they move us forward.

Experts generally agree that COVID-19 is here to stay—at least for a while. With vaccine hesitancy, we’re unlikely to achieve herd immunity, and the virus is constantly mutating. But if it’s not coronavirus, it’ll be something else.

Death may catch us by surprise, but it ought not to catch us unprepared.