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.