The Way We Die Now by Seamus O’Mahony


My dad died on February 15th and my world transformed. I am grief-stricken. It’s no surprise that I have turned to books seeking solace, or at least some kind of understanding. The first book I read was “When Breath Becomes Air” which in retrospect I found unsatisfactory and unhelpful. “The Way We Die Now” though has been a strangely compelling read despite its rather stark message. Right from the introduction O’Mahony warns us, “This is not a book of consolation; death is simply affliction and the end of our days. We are frail and vulnerable animals.”

He argues persuasively and passionately against the over medicalisation of death. As a Consultant Gastroenterologist at Cork University Hospital Dr O’Mahony has seen many people die and he uses a mixture of personal anecdotes, patient anecdotes, and high profile celebrity deaths, to highlight how our society places faith in medicine and expects to live despite disease. He explains how many patients receive what he believes to be useless treatments; procedures that take place for the sake of the hospital being seen to do something, often at the expense of a patient’s comfort. CPR that takes place after death is common apparently (and he is clear that CPR is rarely successful as it is in medical dramas. It’s a brutal technique that can leave people permanently damaged if they do survive.) Speaking about the overuse of PEG feeding he says “The procedure became for me a symbol of the medicalisation of death, and of the failure of modern medicine to care humanely for those most in need of its help.”

He is wonderfully dismissive of Kugler-Ross’s famous five stages; denial, anger, bargaining, depression and acceptance. “The power and terror of death refuses to be tamed by workshops, by trite formulae.” The myth of a “good death” is exploded. It is likely we will die whilst sedated and pain-free thanks to a syringe driver. We won’t make profound death bed statements, we won’t even speak. We will be removed from our own death, but that saves us from dying in terror and pain. There is rarely a peaceful, stoic acceptance. That word terror catches me and makes me realise I had some fairy story death narrative in my head where gradually people slip away. Here’s my comfort, such as it is, my dad died unexpectedly. His heart stopped. He did not know he was dying. We did not have the agonies of having to decide for him what interventions he should endure so that we could keep him with us. I fear I would have insisted on all of them, though I hope I would not have.

O’Mahony writes he was “…deeply impressed by how Catholic ritual – after the deaths of my great-uncle and father in-law – guided the bereaved during the days immediately following their deaths.” The issue in a secular society where “Evangelical atheism has accelerated the flight from religion” is how to find this kind of comfort, and he suggests we worry less about believing and be content with simply belonging. This really chimed with me. Dad had a full Catholic funeral; his body was received into church the night before and his priest led us gently through the rituals and beliefs. During the funeral he took the same care to explain. It felt unimportant I don’t share those beliefs. I was immensely grateful for this acknowledgement of loss and grief, this solemnity, this tribute to my dad.

The book explores “deluded optimism” where patients, doctors, and family and friends collude in a pretence there is hope where there is none. What bloody fools we are that we think we can tame death. There is so much that is interesting here; the fact that patients who have combined oncology/palliative care live on average 25% longer than those who forge on with treatment (seeing hospices as an admission of failure), and that doctors apparently often choose not to undergo extensive treatment themselves. The idea that doctors offer treatment because they don’t know what else to do and need to be seen as doing something is troubling, yet the instinct is to want them to do every possible thing to save the lives of those we love.

How afraid we are, of course, and we are right to be. There’s no magic here, but this is a cool, intelligent look at death, right in its ghastly, deathy face.

12 thoughts on “The Way We Die Now by Seamus O’Mahony”

  1. A beautifully honest review Sara…..I will most likely find myself a copy of ‘The way we die now’ as it seems from your review to reflect some of my own thoughts and views. Thank you for sharing this. It also highlights that who ever we are the death of someone dear is very individual and despite our own views we always want everything possible done for our loved ones….for who’s benefit though…ours or our loved one?? a sudden unexpected death is such a shock.. but…..with provoked thought isnt that the way we might all prefer to ‘go’. The wonderful memories of your father will live on in you and your lovely boys. Take care and thank you.

    1. Thank you Caroline. You have a far deeper knowledge and understanding than I about this and you are right when you ask who truly benefits from (over) interventions – we do it for us I suppose, and I hope we can all keep in mind what the patient would want and be strong enough to know when enough is enough.

      I’m sorry, I don’t have a physical copy of the book otherwise I’d gladly pass it in to you, but it was an advance e-book.

  2. I am sorry you had to go through this loss, Sara. The book sounds so sensible, cutting through all the crap that people try to share with you in such times – which is intended kindly, but doesn’t help. I reckon we get through it in our own time, in our own way. There are no acceptable words, other than to tell you that I miss my dad who died in May 2011, and I would have it no other way. “Missing” is, for me, an acknowledgement that there is a Dad-shaped gap in my life. A much loved wavery shape. xx

    1. Thank you Vanessa. Yes, there will always be a dad shaped absence and it’s testament to our lovely dads that that is simply the way things will be now – we were lucky to have them. “A much loved wavery shape” is ridiculously spot on. I was at mum’s today, dad’s birthday, and I could see the wavering shape of him in his chair, his absence was so strong it almost conjured him, and I wondered if that’s why some people believe in ghosts.

      The book *is* very sensible. A thought provoking read. xx

  3. Condolences Sara. I can relate to what you write here. Lost my mother in 2011 and it was very painful watching her fade into absence. Although raised Catholic, I lost touch with that faith a long time ago, but the priest’s presence was comforting, as was the simple dignity of the church ceremony, and as you say, the ‘acknowledgement of loss and grief’ it made me realise the importance of ritual

    1. Alice, thank you, I’m sorry I didn’t reply earlier. Yes, there really is some comfort to be had from the gravitas of the catholic rituals and the surrounding dignity it offers.

  4. Sorry that you lost your father unexpectantly. Even when we have warning and time to prepare, grief can be much more complex and difficult than anticipated. I would think that it is “deluded optimism” to say that it is a fact that certain patients live 25 % longer. It may be the result of one study , which may have backing from the palliative are industry.

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