Death releases both Ivan Ilyich and his folk

On 9 September, Leo Tolstoy was wished a Happy 186th Birthday by Google Doodle. The Google homepage included a slideshow of Tolstoy’s works, including War and Peace, Anna Karenina and The Death of Ivan Ilyich.

The latter, written shortly after Tolstoy’s religious conversion, tells the story of the premature death of a Russian legal whizzkid. Living what seems to be a good life, aside from his rocky marriage, Ivan Ilyich injures his side while hanging plush curtains in his flashy new apartment. Within weeks, he has developed a pain that will not go away. Several expensive doctors are consulted, but they can neither explain nor treat his condition.

He’s dying and the novella records his terror as he battles with the idea of his own death. ‘I have been here. Now I am going there. Where?’ Oppressed by the length of the process, his family, friends and associates decide not to speak of it, but advise him to stay calm and follow doctors’ orders.

He spends his last days in agony and anguish but, just before his death, he sees with clarity that he has not, after all, lived well, but has lived only for himself. He suddenly feels pity for the people he’s leaving behind, and hopes his death will set them free. With that thought, his pain disappears. Just before his last breath, he whispers to himself, ‘Death has gone’.

Why go there?



“If we want the deaths our lives deserve, we need to start talking about it,” advises a Times leader today.

Yes, it’s Dying Matters Awareness week and all Funeralworld is a-flutter with wheezes to “start the conversation” and encourage people to make a will, jot down their end-of-life wishes and their funeral wishes, even sort out their digital legacy.

As ever, the narrative from Dying Matters is that “discussing dying and making end of life plans remain a taboo for many people.” A possible problem here is that the stats supporting this statement offer comfort to the ‘deniers’ by showing them they are with the majority. Most people, after all, want to be where everybody else is.

And, by gum, the deniers constitute a big majority: 83% of people say they are uncomfortable discussing dying and death. 51% say they are unaware of their partner’s end of life wishes. 63% haven’t written a will. 64% haven’t registered as an organ donor or got a donor card. 71% of people haven’t let someone know their funeral wishes. 94% haven’t written down their wishes or preferences about their future care, should they be unable to make decisions for themselves.

If you reckon it important for people to get their death admin sorted, the present state of affairs is dire. But Dying Matters reckons that 400,000 more people aged 5-75 are talking about this unappetising stuff now than 5 years ago. This, surely, ought to be the headline figure. No one wants to feel left behind.

The difficulty in chivvying people to ‘get their shit together’ is, of course, that it brings them face to face with the terrifying fact of their own extinction:

A week? or twenty years remain
And then–what kind of death?
A losing fight with frightful pain
Or a gasping fight for breath?

There’s this comfy consensus among people in the death business that if you can bring yourself to confront your fear of dying your fears will magically melt away and your life will be gloriously enriched. It ain’t necessarily so. On the contrary, thinking about death can magnify the terror – why wouldn’t it?

For the end is likely to be disagreeable. Sherwin Nuland, in his book How We Die, wrote: “I have not seen much dignity in the process by which we die. The quest to achieve true dignity fails when our bodies fail.”

Nuland wrote his book 20 years before his death in March this year. Did the contemplation of his own mortality induce equable acceptance? Here’s an extract from his obit in The Times:

It is not given to many of us to set the stage for our own demise. For the surgeon and medical ethicist Sherwin Nuland, author of the bestselling How We Die: Reflections on Life’s Final Chapter, the climax of his personal drama, with the audience watching intently and the curtain poised to fall, had been scripted years before and never needed revision. Yet when the time came, Nuland was reluctant to play the part, remaining in the wings, unsure of his lines, not ready to make his last entrance.

According to his daughter Amelia, he talked incessantly about what was happening to him. “I’m not scared of dying,” he told her, “but I’ve built such a beautiful life and I’m not ready to leave it.” Finally, as the end drew near, he seemed “scared and sad”, as if the morbidity of his lifelong preoccupation had, somewhat ironically, rendered him unable to confront the reality.

If only talking about it really did earn us “the deaths our lives deserve” and, in the words of Mayur Lakhani, chair of the Dying Matters Coalition,  “enable people to become more comfortable in discussing dying, death and bereavement.”

But if not talk, what else is there?


What we learn

“We quit this life without fanfare or flourish. We die as we live: simply, unadorned, and unknowing with little more true understanding of deeper meanings than that with which we entered this world.”


Go gentle

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country … Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment.

If this is how doctors choose to die, why do they go to such lengths to provide ‘futile care’ for their patients? 

Find out in this fascinating and important article in Zocalo.

Hat-tip to Rupee

An Experiential Enquiry into Death & Dying

Experiential retreat run by The Sammasati Project: An Experiential Enquiry into Death & Dying — 6-10 March 2013

An intense and tender process, this workshop provides an opportunity to gather the experience, knowledge, and skills needed to prepare for our own dying. Not only will this impact how we face our own death but how we live, post-workshop, too. It allows us to experience some of the many issues which confront a person when they realise that they will soon die such as fear, shock, guilt, grief, anger, regrets, pain, loss of control, completing relationships, changing perceptions, insights, relaxation, spiritual understandings and many more. 

This experiential understanding in turn will help us to be of greater support to others in their dying process whether they are family, friends or in a professional environment if we are in the health or caring sector. It is the first module of the Sammasati Support–Person Training, which can be continued in April at the same venue.

This workshop is in the form of a retreat and will include an exploration of the mystic Osho’s vision of dying consciously and joyfully. We will experiment with a range of meditative methods, and gain an experiential understanding of the transition called dying and the practice of the bardo.

The process can provide a greater appreciation of life, of the profundity of death, and of the pivotal role of meditation throughout.

Doctor and author Michael Murphy suggests, ‘If there is no training, and [support people] have not taken conscious heed of their own loneliness and disconnection, no wonder that there is bluster and fear [about dying]. Since dying involves body, soul, and spirit… lectures or instruction manuals are inadequate since feelings are very much involved. In order to be a truly competent guide, [the support person’s] training needs to be very personal, helping him to imagine his own dying and the dying of those he loves. Only then will he be in a more comfortable position to help others, since he himself will be able to become more a witness and guide…(The Wisdom of Dying: Practices for Living).

Read some testimonials from previous participants of this workshop on and watch the video testimonials at

£595 – includes accommodation and food
£545 – early bird price if paid in full before 17 January 2013

Venue: Monkton Wyld Court, Bridport, Dorset DT6 6DQ

Date: 6 March at 18:00 until 10 March at 18:00

The course will be facilitated by Maneesha James and Sudheer Niet who both have extensive experience in facilitating and teaching meditation; relating or ‘being with’ skills; supporting others in the dying process and a background in nursing.

Note that, as for those wishing to participate in the entire Training, an interview with Maneesha is a pre-requisite.

Please see our Training page at for more information and contact details.

Links to the retreat are also:


Approaching death

“You get nearer to the shore and you can actually, for the first time, not just make out this dim, insubstantial cliff, but you can see the little houses and cars moving.”

Jonathan Miller

From consumption to diabetes – changing causes of death in New England

Posted by Vale

Back in 1812 in Boston it was consumption that was most likely to kill you, although out of 942 recorded deaths, teething killed 15 and childbed 14, the same number that were killed by the quinsy.

In 1900 tuberculosis was near the top of the list, but pneumonia or influenza had overtaken it. A bad year for the flu?

By 2010 TB has disappeared, pneumonia languishes like a fading football team towards the bottom of the league buy cialis online aus table, while cancer has leapt to prominence.

From the three tables shown, it isn’t until 2010 that diabetes makes an appearance or suicide.

I’ve taken all the data from a fascinating article in the New England Journal of Medicine describing how, over 200 years, different diseases have come to the fore. More interesting are its reflections on the way that the different diseases that kill us are expressions of the society we live in.

Its worth a look.

Time’s up, take yourself out

A theme that we like to explore on this blog is the way in which longevity has reconfigured the landscape of dying. The blessing of long life has its downside: protracted decline. We are likely to linger longer, much longer, than our forebears. There’s a physical cost in chronic illness and possibly, also, mental enfeeblement. There’s the emotional cost to the elderly and their families. And then there’s the financial cost, which the government has wrestled with and now kicked deftly into the long grass.

In the Sunday Times Minette Marrin wrestled with it, too. I’ll have to quote a lot of it because the ST website is paywalled. She suggests some interesting solutions:

Last Thursday the Office for Budget Responsibility (OBR) announced in a chilling report that the escalating costs of an ageing population will mean yet more national austerity. Pointing out that the proportion of people over 65, who now make up 17% of the population, will rise to 26% by 2061, it estimates many increased costs, in care of the elderly, health and pensions, amounting to an added £80 billion a year in today’s money.

In the next 20 years, the number of people over 70 is set to rise by 50%, reaching nearly 10m, according to the Office for National Statistics.

The OBR states that Britain’s public spending will be “clearly unsustainable” over the next 50 years, despite the spending cuts. So, far from care for the elderly rising above today’s inadequate standards, it is almost certain to fall further below them. There’s no money now and in future there’s going to be even less. 

Universal bus passes (which cost £1 billion a year), winter fuel allowances (£2 billion) and free television licences must go. 

Everyone must accept that their savings, including their homes, may have to be spent on paying for care in old age. There’s no universal right to leave one’s property to one’s children.

Taxes of all kinds must rise hugely, or else there will have to be a large hypothecated tax upon people reaching old age. Services to old people must be reduced … Health service care must be rationed for the very old. Palliative care of every kind should be available, but not ambitious treatments.

There should be fewer old people. I’ve often felt the best thing one can do for one’s children is to die before real infirmity sets in. The taboo against deliberately shuffling off this mortal coil, as people did in other cultures in the interests of younger people, is wrong. Most people say they never want to be a burden to others in old age; it would be good if more of us felt able to prove we mean it, by taking a timely and pleasant walk up the snowy mountain. Especially since there’s no money left. [Our bold]