What’s the best way to die? As I finished reading Paul Kalanithi’s book, When Breath Becomes Air, my brain went into a spin. Is it best to die like Paul Kalanithi with stage four untreatable lung cancer or Morrie Schwartz with amyotrophic lateral sclerosis in Mitch Albom’s Tuesdays with Morrie or a close friend’s sister who died of stage four ovarian cancer responsive to treatment but complicated by something fatal, surrounded by close family and friends, with some days, weeks or months to say goodbyes to loved ones, or like my husband Anil who lived well right up to the moment and died suddenly, unexpectedly and peacefully without anyone knowing or suspecting that a ruptured plaque was going to take his life away. Is there such a thing as the best way to die? Not just for me, but for everyone in this world in general? Death is something we don’t have control over in our lives. Except in case of a suicide. “All suicides are untreated depression”, one psychiatry professor vehemently said. This was in response to a comment I heard from someone that I repeated, “What if someone thinks his or her life purpose is over and decides to end it”? In the few situations we do have control, as in terminal illness, should we control it? If yes, by how much? What about ‘rational suicide’ that’s legal in Switzerland or Oregon?

Death was an abstract concept in my mind until it was up close and personal few months ago. I have seen several patients die in my professional life, reviewed their charts for preventability and ‘opportunities for improvement’ to be applied in the care of future patients, pronounced death, and communicated loss to loved ones. I have seen grandparents die, but their death was expected for some time before they actually died. Most of the other deaths were suicides or motor vehicle accidents. While motor vehicle accident were due to ‘human error’ and everyone needs to drive safely to protect their own lives and those of others on the road, suicides were something else. Most people with suicide in their immediate family never fully recover from it. I have seen that society treats them very unkindly. They don’t receive as much compassion as family members who lose their loved ones to other forms of death. It’s like they want to show them compassion only after they receive ‘proof’ that there was no negligence on the family’s part. Medical textbooks a hundred years used to characterize those committing suicide as being ‘extremely selfish, and disrespectful of family and societal values’. There were suicides in medical school that we remember with sadness at reunions. “She couldn’t take it.” “The pressure was too much.” Homicides are completely something else. Even if the perpetrator is mentally ill, the thought of dying because of someone else’s action is plain awful. The immigrant engineer who died in Kansas recently because of a crazy ignorant person with easy access to a gun – it’s just God awful! I feel terrible for his wife – she probably feels far worse than how I feel about my husband’s death. And dying because of suicide bombers and terrorists, and the death of a suicide bomber himself or herself?

All these thoughts made me look up a form of meditation I had seen in the passing many months earlier. Death Meditation. I remember laughing at the term when I saw it. What?! They take these things (things like meditation) far too far, I thought to myself. After my brain calmed down from all the spinning, I googled the term. What exactly does it mean? Death Meditation! It was still very amusing to me as I looked it up. Then I got more serious as I started reading through what came before me. It turns out there are many variations of this activity. There is a lot about this in Tibetan Buddhism. The one that caught my attention is here. I don’t know anything about the center that hosts this guided meditation document, but as I read through it and practice it, the basic idea is in these three sentences. 1. Death is inevitable (Scientifically speaking, the mortality rate in our society is 100%). 2. The time of death is uncertain for each of us. (Paul Kalanithi repeatedly asks his oncologist, “where am I on the survival/ Kaplan-Meier plot?” His oncologist very smartly sidesteps the question without making him feel like she is not addressing his questions.) So, there is no good answer to the question, “which dot will I be on the survival plot?” (For those not trained in science, a survival or Kaplan-Meier plot/ curve is a representation of what percent of people are alive at each time point, usually years. Each dot on the curve is a person who has left this world. These plots are used in evaluating mortality from various causes. 3. Only spiritual practice or a knowledge and peace that you lived a life of good values can help you at the time of death. If you remember conversations around those who have died, everyone feels good about someone who left the world in peace, leaving behind loving family and friends. So, what’s the best way to become the best dot on a survival plot? I suppose the word ‘best’ invokes a sense of comparison and competition. The happiest dot? The most peaceful dot? Happy and peaceful dot? We have a lot of work to do as a society in order to make sure each of us is a happy, peaceful dot on those survival plots!