Death, Endings and interruptions, and being mindfully judgmental

Vladimir: I don’t understand.

Estragon: Use your intelligence, can’t you?

Vladimir uses his intelligence.

Vladimir: (finally) I remain in the dark.

(Samuel Beckett: Waiting for Godot)

‘Side by side with the exigencies of life, love is the greatest educator; and it is by the love of those nearest to him that the incomplete human being is induced to respect the decrees of necessity… (Freud: Some Character Types met with in Psychoanalytic work)

We have a prime minister who is in common political parlance, a ‘dead woman walking’. In politics death is a metaphor for loss of power and position. Boris Johnson was ‘stabbed in the back’ by his friend Michael Gove after Cameron’s decision to ‘fall on his sword’ in 2016 after the referendum. The metaphor refers back to the time when political failure did indeed tend to have fatal consequences – as a lot of things did once – giving birth, horse riding, cold weather… death accompanied people all through their lives.

But not now. Death before the age of about 70 is regarded as an affront. It shouldn’t be happening. Death should meaningfully round off your life, when you no longer have any further use for your life. We are never really prepared for an ending that is almost always an interruption rather than a conclusion.

So finishing life with a heart attack is in many ways ideal. One moment you’re trying to get the mower going, or shouting at the television, the next – well, there isn’t a next. Or rather, what comes next is not your responsibility any more. Apart from that possibility, in almost everyone’s life, there comes a time when a realization sidles into consciousness that it’s curtains. For a few of us it may be a sudden perception of an imminent conclusion to one’s time here, on the occasion of a nasty accident, say, in the crush of an upside down car, or in a sense of complete numbness at the bottom of a mountain fall. In the films, it’s the moment when the guy looks down at where the bullet’s gone in, or when he looks up at where his fingers are losing their grip on the ledge. It’s all over. This is how it ends. But most of us have a bit more time to get the hang of the business. What it means or doesn’t. How we feel about it, what we need to do about it. How to relate to others, those closest to us. What we can do for them.

For me it started when Claudia found a little lump by my collarbone. This was mid-June. The ultrasound guy took a biopsy sample and said just by looking at it he could tell that it was cancerous. But of course if that’s all there is it can be removed, no worries. Then my cough was investigated, and a chest x-ray showed infection – so pneumonia, but what else? A blood test seems to have been definitive, but we weren’t told anything. The thoracic specialist was deliberately vague – and ordered a bronchoscopy. Then I had a Petscan, and the same day we went for a routine meeting with my oncologist. We wanted the meeting just so that we could get some more painkillers…

However, there was someone else in charge of the meeting; it’s funny how seniority is communicated, but you could somehow tell that she was a high-up. Very smoothly, and almost reassuringly, she told us that the game was up. The cancer had spread to liver, lung, and bones. It was incurable. I think she was not altogether impressed by the thoracic guy’s ducking out of giving us the bad news.

As we left, I said to Claudia, ‘I’m sorry, Clau’, and the senior nurse specialist, Sarah, hugged her. Like all men apparently, I was not overly fussed by the news. It wasn’t consciously expected, but it had been coming. I have just read a little piece in a magazine by a woman who was cured of breast cancer and yet felt very depressed since her recovery: ‘I am grieving for the person I was before I had cancer.’ In all areas of her life she ‘has been shaken to the core’ by the experience. Of course, she is a good bit younger than I am. She has young children, whereas my son is finishing his second degree. But it is interesting how differently we react to our very different situations. I’m disappointed to be missing the final agreeably uneventful (one hopes) act of my life, where one lets go of things. Apparently, one’s seventies are often the happiest decade of one’s life - I guess it is partly because you stop worrying about the future (because there isn’t one). And I haven’t even started to get my state pension, that agreeably free bit of money every week. But I don’t feel obviously upset – as yet anyway – by the prospect of a relatively imminent termination to this, my own personal experience of life.

So now we have a new oncologist, a young bloke. And after a couple of meetings he decided to go for hormone therapy rather than chemo. He thought that I had been through enough appalling side effects. The side effects with hormone therapy are to do with loss of testosterone – so my chest may get a bit breasty, I may become a bit more emotionally labile (Claudia says I’m moody enough as it is) – oh, and I’ll be impotent. Which sounds ok to me - well, you can’t have everything…

I say I wasn’t too fussed by the news, but obviously there is a fundamental change of outlook. All through the months of very painful recovery from the radiotherapy I was looking forward to a pain-free life ahead of me well into my seventies. I could make plans. Now, I am looking forward to the considerable pain of bone cancer and chemo at some point, and generally managing my end-game. Other people, especially friends and family, see my death as the really significant component of my situation. In particular, Claudia will be on her own; she will go from being very much a couple to the experience of an intimate absence at her side, in her home, in her life. But for me, at the moment anyway, it’s the short bit of life I have left that is my personal concern, more than its future absence (which by its nature is hard to envisage).

The practice of mindfulness is generally introduced as the practice of paying attention to non-cognitive experience, which for most people is a real challenge. Most people keep reverting to imagining that mindfulness involves changing how you think about things. Most people cannot imagine paying attention without thinking about what you are paying attention to. It is with regular meditation that this attitude starts to shift. And it is with meditation over some years that a truer sense of the nature of things, of the nature of the mind, develops. Mindfulness is being able to take in experience without that instinctive liking or disliking taking over, and the conceptualizing mind tightening up around that reaction.

And the interesting thing here is that as you do so, you start to become aware that your sensations and feeling are in fact much more interesting than your thoughts and emotions. That experience of your presence in the world becomes more real and rich than your piffling thoughts and feelings about it. Your

experiencing of the world does not, curiously, centre on you and your feelings.

As you get more experienced, you learn to live in a world that consists almost entirely of non-cognitive experience, mostly sensation and feeling, with emotions and also, of course, cognitions or thoughts being registered as coming and going like the froth on the surface of the sea. On this basis you can learn to be mindful of your thoughts and emotions as thoughts and emotions. In particular you learn to judge those thoughts and emotions.

Mindfulness is popularly characterized, following the great Jon Kabat-Zinn, as attention that is ‘non-judgmental’. But this non-judgmental attention is what enables the beginner to apply themselves to sensations as sensations, and feelings as feelings, without getting lost in our judgments about that experience. Eventually, though, you do want to be able to judge, not your experience, but how you go about reacting to your experience. Are your emotional responses helpful or unhelpful, are they what you would call ‘negative’ or are they ‘positive’?

Now most people imagine that being aware is not enough, that once you are aware of something you then need to act on that awareness. And generally this is the case – when you are aware that the cat has been sick on the floor, being aware isn’t enough; you need to get on with cleaning up the mess. However, in the case of internal experience, it’s different. Awareness of your own mental state is transformative in itself. If you recognize a negative mental state for what it is, something unhelpful, its hold on the mind is weakened; conversely, you recognize a positive mood or attitude as helpful, and that is enough to encourage it. You don’t need to berate yourself. So this is judgment as simply an aspect of awareness, an acknowledgment of the reality of our situation in terms of what we are bringing to this situation.

So in this respect, as a practitioner, I always have work to do, however difficult my life may become. In particular, I am aware that I need to be mindful of the states of mind I get into in response to what will be painful experience without the reassurance of some kind of recovery. I have noticed for example couples talking together at the Macmillan Cancer centre, and one of them (the one with cancer) will sometimes be speaking almost savagely to their partner. It is as if you feel that your partner is not carrying their fair share of this unbearable burden of slow and painful (and actually humiliating) death by cancer. There is an assumption that dying of cancer gives you a free pass in terms of being ratty and unpleasant. In fact, of course, your partner has their own unbearable burden to manage, the burden of love, of not being able to take away your pain, and of facing life without you.

My hearing has become very poor. And then there’s my right eye. I had an operation recently to help the eyelid to close, but it is still uncomfortable, and also I seem to have double vision. It’s as if I can’t focus. I still have some ulceration in the mouth, which makes eating and drinking intermittently painful. The salt in sea water also stings. I still have no saliva. So eating anything tends to feel too dry, and without having the saliva to prepare the food to swallow, it can be hard work getting things down. My taste buds still don’t operate quite as they used to, though there has been some improvement recently. It is as if the world of pleasure, of appetite, is closing its doors to me. That cry from the guts, ‘I want!’ is just not there.

I mention sea-water because we’re on holiday in Croatia. By the sea. You might think Croatia is a Mediterranean country. The coastline is very long and very beautiful. But cuisine-wise, the capital is Zagreb, and Croatia was part of the Austro-Hungarian empire. And after that it was part of the Soviet empire. Even the language has a bread-queue, cabbage soup, boot polish-adulterated coffee sound to it. Italy is only around the corner, a short boat trip away, so you might think Croatians would now be visiting Italy and getting a taste for precisely intense pasta dishes involving basil and pine nuts and all the rest of it. But no, the food here is heavy, meaty and tasteless. You can have ‘pasta with beef’; or ‘vegetarian pasta’ and er, that’s it.

However, in a place like this, because of the warmth – over 30 degrees - the pores are more open, the mind looser, more relaxed. Here you are, sitting on the beach, and everyone around you is also being stunned and seduced into silence and innocence by the same sensory combination. You have the whole busy world behind you, the endless ocean, with its unseen cool dark depths before you, the pebbles gently shifting beneath your weight through your towel, fragrant pines, bright green against the drenched blue of the sky, their branches scattering and softening the light, the sun’s warmth playing with the sweet breeze over the skin so that the skin feels like a single organ, the little waves endlessly reinventing themselves around the shoreline rocks, with that hypnotic rhythm taking the edge off the silence. And you feel the breath of the body as something intimate with this world. And then you step down into the turquoise water, you make that ancient elemental transition from air to water, to the body’s surprise and delight, in finding a new way of experiencing itself. And then when I come out of the water and stand with the sun warming my back, and Claudia there reading her book, I think, ‘Must I go so soon?’ But I am also grateful to the world that I can be so sorrowful to be leaving it.

I mean, being very ill does reconcile you to dying. Death is much less of a problem to you when your life is difficult and painful. But you can’t complain if you occasionally feel well enough to want to continue living.