9—
"Am I in Heaven Now?"
Case History
An intern usually works on a team with two other interns, and the team as a whole is responsible for a certain service or ward. Every third day and night, one intern is on call. During those twenty-four hours he works up any new patient who comes in. An intern knows his own patients best, of course, but he also gets to know some of his fellow interns' patients quite well because on rounds each day the entire team sees everyone's patients and at night, when on call, he takes care of all patients on the service.
Sometimes one patient becomes the team's favorite, and the interns and that patient develop a very warm relationship. On morning rounds, all the doctors look forward to going into that patient's room. It is almost like visiting a friend. That is what happened when I was an intern on the C.C.U. Our favorite patient there was Mr. L, an eighty-four-year-old retired carpenter. He had been admitted for a myocardial infarction by my fellow intern, Dr. Miller.
Why did we all like Mr. L so much? I think it was because he was always very friendly and always had a kind word for everyone. In addition, he had a delightful sense of humor, and we enjoyed exchanging quips and gibes with him.
As the days of Mr. L's hospitalization went by, we learned that he had lived a full, rich life. We also saw that he did not seem to regret or to be at all bitter that he was now coming to the end of it. He did not even seem to be bothered by the fear that possesses most patients in the C.C.U.—the fear they might die at any moment. In sum, Mr. L was one of those rare elderly people who seem to recognize how fortunate they have been. He had not been sick before and was not in pain now. He seemed to be enjoying every minute of life, even now.
Later, I realized that a patient like Mr. L—someone who does not appear to fear his own death—probably puts the medical staff more at ease because his relaxed state of mind takes some of the burden off the doctors and removes some of the tenseness and fear from the relationship. After all, it is never easy when a patient thinks of you—the physician—as the sole barrier standing between himself and the Angel of Death.
Of course, there were good reasons—selfish ones—that we enjoyed going to see Mr. L. Not the least of these was that on rounds in the C.C.U. interns take care of a lot of very sick people who are obviously extremely miserable. Just seeing Mr. L, therefore, with his cheerful nature, relaxed outlook, and spry sense of humor was a relief, even a delight.
By his fourth day in the C.C.U., Mr. L was doing pretty well, and we were thinking about transferring him to the regular medical floor. We had discussed that possibility at morning rounds. Around noon that day, I looked for Dr. Miller because I wanted to eat lunch with him. After searching everywhere, I finally found him in Mr. L's room.
A very strange scene greeted me. In the middle of the room was Mr. L, half-reclining, half-rising on his pillow. Next to him, near the head of the bed, stood Dr. Miller surrounded by several nurses who were hovering about like seraphim. As I entered the room, Mr. L was smiling and thanking everybody for being so kind and for taking such good care of him. After finishing, he turned to each person and said good-bye individually. When he noticed me, he also thanked me and said good-bye.
"Where do you think you are going, Mr. L?" I asked.
"I'll be dying shortly," he answered.
Dr. Miller whispered to me that he had just checked Mr. L over and had found nothing wrong. His vital signs were completely stable, and he was not complaining of any pain or of anything at all. In fact, he had no complaints. Yet for some reason, he (bought he was going to die.
Naturally, we all reassured him that nothing was wrong.
"The only place you'll be going, Mr. L," Dr. Miller said, "is to the regular medical floor, and that's because you've been doing so well."
Mr. L just smiled and continued to thank us and say good-bye.
After several minutes of convincing ourselves that nothing was amiss, Miller and I left for the cafeteria. About ten minutes later, there was an emergency call from the C.C.U. to the cafeteria. Since Miller and I were on the same team and were eating together, we answered the Stat call together
"Mr. L has become hypotensive and is unconscious," the voice on the telephone said. Hypotension itself is always a significant warning sign that a patient in the C.C.U. may be in terrible difficulty.
We rushed back to the unit. There, we went through the usual procedures to maintain a patient's blood pressure, and after a while, Mr. L. began to stabilize. Eventually, he also regained consciousness. When he woke up, he looked right up at Dr. Miller and asked, with a look of wonder on his face, "Oh, am I in heaven now?"
"If you can see Dr. Miller, you can't possibly be in heaven," I answered.
Perhaps that humor was inappropriate, but we had always joked with Mr. L, and the words just came out. Anyway, all the medical staff in the room (including Miller, three or four nurses, and Dr. Smith, the resident on our service) smiled.
Mr. L did not react at all. He merely said good-bye to everyone again, closed his eyes, and died.
We tried to resuscitate him but were unsuccessful.
Later, when Miller and I left the room, we were completely thunderstruck. How had Mr. L. known, when we hadn't known anything at all? How had he had that presentiment?
Presentiment—is that long shadow—on the Lawn—
Indicative that Suns go down—
The Notice to the startled Grass
That Darkness—is about to pass—[1]
I have often thought about that case. Now, years later, I see in Mr, L's dying a symbol of how he had lived: even in dying, he had shown his delight in, and consideration for, life. In fact, his dying was the nicest, most easeful death I have ever seen, at once earthbound and elevating. What was the secret of his serenity in dying?
Literary Parallels
It might appear to be easy to find cases in literature where dying appears both earthbound and elevating, but it is not. For we wish to shun what is melodramatic or didactic, moralizing or sermonizing, too consciously artistic or intellectualistic. What we wanted to find was something as unadorned and uplifting as Mr. L's last days: a dying that is a simple, yet richly human reflection of living.
We found examples in works by two very different writers: Ivan Turgenev (1818–1883), the Russian novelist and storywriter who lived for long stretches of time in Paris and Baden-Baden, and Emily Dickenson (1830–1886), the American poet who sequestered herself for much of her adult life in her father's house in Amherst, Massachusetts.
Ivan Turgenev
In "Death," one of the stories in Turgenev's A Sportsman's Sketches , the sportsman-narrator relates several cases in which people faced death calmly or showed, at the approach of death, a tremendous concern for life and the living.
The first case focuses on apparently worldly, yet finely human, details. The narrator is visiting his friend, the surgeon Kapiton. A peasant, Vassily Dmitritch, arrives. After Kapiton has examined me peasant, he tells him that his condition is serious and he ought to stay in the hospital. But the wary surgeon also warns Vassily Dmitritch that he "can't answer for anything."
"So bad as that?" muttered the astounded peasant. . . . [Vassily Dmitritch] pondered and pondered, his eyes fixed on the floor, then he . . . picked up his cap. "Where you are off to, Vassily Dmitritch?" "Where? why home to be sure, if it's so bad. I must put things to right, if it's like that." "But you'll do yourself harm, Vassily Dmitritch; you will, really. . . ." "No, . . . Kapiton . . . , if I must die, I'll die at home." . . . The peasant . . . gave Kapiton half-a-rouble, went out of the room, and took his seat in the cart. "Well, good-bye, Kapiton . . . , don't remember evil against me, and remember my orphans, if anything. . . ." Three days later he was dead.[2]
What is striking here is the way in which Vassily Dmitritch confronts the news of his impending death. Exhibiting neither fear nor anger, he displays a self-possession and an attention to material concerns that are at once practical and spiritual. He wants to return home to set his affairs "to right," and instead of grieving for himself, he thinks about his children, who will be orphans. His concern for the material is not selfish, therefore, but selfless. In addition, Vassily Dmitritch seems to accept death as a natural part of life, as something that is inevitable and therefore not really unexpected, whenever it comes. Perhaps this helps explain why he is able to face the news of his approaching death with calmness, self-control, and an overriding concern for others.
The narrator relates another quietly moving acceptance of death. In this case, religion and practical concerns for life mingle simply and sublimely.
I was present at an old lady's death-bed; the priest had begun reading the prayers for the dying over her, but, suddenly no-
ticing that the patient seemed to be actually dying, he made haste to give her the cross to kiss. The lady turned away with an air of displeasure. "You're in too great a hurry, father." she said, in a voice almost inarticulate; "in too great a hurry." . . . She kissed the cross, put her hand under her pillow and expired. Under the pillow was a silver rouble; she had meant to pay the priest for the service at her own death.[3]
The lady's calmness in dying forms a wonderful contrast to the priest's evident anxiety, his rushing to give her the cross. Further, her kissing the cross and reaching immediately after for the silver rouble to pay the priest reveal a self-possessed calmness at once worldly and spiritual.
It is possible, of course, that these deaths are romanticized, to some degree, by the sportsman-narrator; however, both dying people display an undeniable earthiness and materiality. Each exhibits a practical attention to physical and human concerns, including possessions, feelings, and other people. Perhaps it is their devotion to life and to other people that enable Vassily Dmitritch and the old Russian lady to face death in ways that are so calm and practical—and also sublime.
But what if a person who is devoted to life and the human existence is afraid of dying? Can that person arrive at a sense of calmness in the face of death? Emily Dickinson gives us some answers to these questions, for in some of her poems she tries out, as it were, the experience of dying. In addition, she probes the problem of death itself.
Emily Dickinson
Despite her secretive life, Emily Dickinson establishes in her poetry an extraordinary intimacy with her reader. She does this, partly, by her constant probings of human joys, emotions, and problems. These probings were related to her own life.
Reared in the Puritan tradition that taught man to see "life as a preparation,"[4] Emily Dickinson often wrote about
God, immortality, and eternity; she sought to apprehend life—and death—in terms of the infinite. But she also rejected aspects of Puritanism. For example, for the most part, she renounced religious formalism; ceased going to church altogether by the time she was thirty; and instead of disparaging life on earth, sang its praises lyrically and joyfully. One of the most striking things about her poetry is her intense, even passionate, love of life and life's sensations. We see and feel that love, for instance, in the following poem, in which the narrator revels sensuously and ecstatically in her indulgence in nature and in life:
I taste a liquor never brewed—
From Tankards scooped in Pearl—
Not all the Vats upon the Rhine
Yield such an Alcohol!
Inebriate of Air—am I—
And Debauchee of Dew—
Reeling—thro endless summer days—
From inns of Molten Blue— . . .[5]
Although one senses throughout Dickinson's poetry her impassioned love of life, one senses just as strongly her constant concern with death. She portrayed death essentially in two ways: as an existential phenomenon, the experience of dying itself, and as the central religious mystery, the emblem of the resurrection.
In several poems (including "I felt a Funeral, in my Brain . . . ," "I heard a Fly buzz—when I died—," and "The Sun kept setting—setting—still . . ."), the poet portrays herself undergoing the physical, emotional, and cognitive sensations of dying. It is almost as though she were trying to feel, and in that way come to terms with, the act of dying before the fact itself.
The most fear-filled of these poems is "I felt a Funeral, in my Brain . . .":
I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading—treading—till it seemed
That Sense was breaking through—
And when they all were seated,
A Service, like a Drum—
Kept beating—beating—till I thought
My Mind was going numb—
And then I heard them lift a Box
And creak across my Soul
With those same Boots of Lead, again,
Then Space—began to toll,
As all the Heavens were a Bell,
And Being, but an Ear,
And I, and Silence, some strange Race
Wrecked, solitary, here—
And then a Plank in Reason, broke,
And I dropped down, and down—
And hit a World, at every plunge,
And Finished knowing—then—[6]
The first four stanzas convey through sounds, images, and repetitions the poet's terror. With hallucinatory intensity, she feels a funeral "treading—treading" in her skull, invading her mind and her senses. Like the pounding of her heart, a mournful service keeps "beating—beating" until she thinks she is losing her mind. Her terror mounts in stanzas three and four as the coffin is lifted and sounds and silence clash in her solitary soul. Suddenly, however, there is a kind of relief, in the form of a release. As the narrator's reason collapses in the last stanza, and she feels herself plunging "down, and down," she loses consciousness. Because of that loss, she is freed from her fear: she "finished knowing—then—." What this poem dramatizes is that even if the experience of dying may be initially terrifying, it is ultimately easeful. For the dying person loses consciousness and, therefore, fear.
In "The Sun kept setting—setting—still . . . ," Dickinson depicts, through repetitions and descriptions of nature and
herself, her slipping away from life and from her bodily sensations. We sense around her and in her a feeling of falling, failing, and loss. But in this poem, Dickinson does not seem to fear dying. In fact, in the last two lines, she realizes that she is dying, "but," she says, she is "not afraid to know."
The Sun kept setting—setting—still
No Hue of Afternoon—
Upon the Village I perceived—
From House to House 'twas Noon—
The Dusk kept dropping—dropping—still
No Dew upon the Grass—
But only on my Forehead stopped—
And wandered in my Face—
My Feet kept drowsing—drowsing—still
My fingers were awake—
Yet why so little sound—Myself
Unto my Seeming—make?
How well I knew the Light before—
I could see it now—
Tis Dying—I am doing—but
I'm not afraid to know—[7]
In these poems Dickinson faced and, in a sense, overcame her fear of dying in existential terms. In some other poems she pondered the problem in religious terms, and, what is even more fascinating, she explored death, dying, and afterlife in terms of life itself.
To the believer, of course, the ultimate consolations for physical death are immortality and eternity. Although we can see these beliefs in many of Dickinson's poems, we wish to focus on how the poet viewed the relationship between earth and her vision of heaven. This is evident in "I never saw a Moor—," a poem in which Dickinson says she felt certain she would find heaven, as if the trail had been clearly marked for her.
I never saw a Moor—
I never saw the Sea—
Yet know I how the Heather looks
And what a Billow be.
I never spoke with God
Nor visited in Heaven—
Yet certain am I of the spot
As if the Checks were given—[8]
What is fascinating here is the parallel Dickinson draws between nature and heaven, that is, she knows about heaven in the same way she knows about life on earth.
This parallel points out something very important about Emily Dickinson: her ideas about God and heaven are intimately related to her ideas about life and living. Indeed, she maintained, heaven was to be sought—and found—in life "below" on earth.
Who has not found the Heaven—below—
Will fail of it above—
For Angels rent the House next ours,
Wherever we remove—[9]
It is not surprising, then, that Dickinson often overcame her anxieties about death and dying by drawing strength from her love of life, living, and other people. We see this, for example, in "Of Death I try to think like this—," a poem in which the poet conquers her fear of death by thinking about it in terms of what she understands and loves: life. In the first stanza, she compares death to a brook that invites just because it inspires fear, but that very fear, she adds, is spiced with sweetness. She concludes this stanza by saying that the brook that lures us to danger is there only to welcome and entice us to a better place: the heavenly realm where the "Flower Hesperian" grows. In the second stanza, the narrator draws strength by recalling how when she was a timid child her bolder playmates would brave all, including possible drowning, to leap across a brook that seemed like a sea to her and grasp an alluring flower. Thus, she implies, reaching out toward death would be no more
frightening than what her playmates used to do: clutch that "flower beyond."
Of Death I try to think like this—
The Well in which they lay us
Is but the Likeness of the Brook
That menaced not to slay us,
But to invite by that Dismay
Which is the Zest of sweetness
To the same Flower Hesperian,
Decoying but to greet us—
I do remember when a Child
With bolder Playmates straying
To where a Brook that seemed a Sea
Withheld us by its roaring
From just a Purple Flower beyond
Until constrained to clutch it
If Doom itself were the result,
The boldest leaped, and clutched it—[10]
Several things helped Dickinson to overcome her anxieties about death and dying. In existential terms, she found solace in realizing that because dying brings the loss of both feeling and consciousness, it also brings the loss of fear. In religious terms, she found strength not only in her beliefs in God, heaven, and eternity but also, and above all, perhaps, in her love of life and of other people. For her, the heaven "above" was inseparable from the "Heaven—below." Death, therefore, was a natural part of life and, by extension, heaven, a natural part of earth.
Of Death and Life
We think back to Mr. L and then to Turgenev's characters and Dickinson's poems. It is possible that they all were calm or could become calm when facing or thinking about death just because they all had cared so much about life, living,
and other people. Maybe that is the reason their deaths or thoughts about death could be at once earthbound and elevating. Perhaps nothing illustrates this idea better than Dickinson's poem that celebrates such an experience. Although the lyric below is ultimately concerned with death and getting to heaven, it is devoted, tunelessly, to life.
Some keep the Sabbath going to Church—
I keep it, staying at Home—
With a Bobolink for a Chorister—
And an Orchard, for a Dome—
Some keep the Sabbath in Surplice—
I just wear my Wings—
And instead of tolling the Bell. for Church,
Our little Sexton—sings.
God preaches, a noted Clergyman—
And the sermon is never long,
So instead of getting to Heaven at last—
I'm going, all along.[11]