Chapter 3: How would you like to go?

While I'm often reminded of my mortality, I occasionally ponder what will ultimately be my end. I suspect it won't be my current ailments, despite their debilitating and tiresome nature. They may exhaust me, but I doubt they'll kill me. Even the prospect of prostate cancer, though concerning, likely won’t kill me either. So, what then will cause my inevitable demise?

If I had a choice, what I’m truly after is a sudden end, without any prior knowledge. In Orwell’s 1984, Winston is told by O’Brien the torturer that he will inevitably face a "silent and final end." But I’m not looking for a deterministic outcome like in 1984, where the Party (Authority) decides the time, place, and method without warning. No, I’m not kinky like that. But perhaps, deep down, I’m a coward. I think I could live with the idea that if the lights were turned off without any prior warning, I’d be okay with it. In other words, there would be no time for distress. The key is my aversion to inconvenience and pain.

Given that I’m going with the flow and taking it as it comes, what will it be for me in the end? For example, when I think back to my father’s death, it was pneumonia that ultimately killed him. He battled four primary tumours in the last decade or so of his life. His ongoing health issues landed him in the hospital, but they didn’t kill him. It was his presence in the hospital that led to his death. Had he not been there, he probably wouldn’t have contracted pneumonia. Of course, his days were numbered, but I bet he didn’t see it coming that way. I can’t say that he was disappointed. I’m sure that he took it in his stride.

From time to time, I find myself pondering the possibilities, imagining different scenarios. I assume that if I die in bed, it will likely be from some form of cancer. But which one? There are so many to choose from. I even entertain the thought: if I had a choice, which cancer would I pick? What am I really looking for in a cancer?

Clearly, a painful cancer that drags on wouldn't suit me. I’m looking for a quick, sharp illness that rushes in, painlessly does its damage, and then lights out. Something like, "Hi, honey, I'm home, and by the way, I've got pancreatic cancer. They reckon that I'll be dead in less than two weeks, tops." Then she’ll say, "What? That's not good. You have been looking a bit thin lately. Oh, and by the way, quickly write down the Netflix and Wi-Fi passwords." We did our wills last year, that was a relief.

What I would really like to avoid is a long, drawn-out painful illness. There are at least two scenarios that come to mind that I’d rather steer clear of. First, I’d hate to be barely alive, trudging from one specialist’s appointment to another. It would disrupt my life and the lives of those around me. I wouldn’t be able to drive myself, and all the specialist appointments would be hours away by car. They’d also be incredibly expensive.

The second scenario I’d want to avoid is needing a bed set up in the living room, where I’d lie for months, just waiting for the end. If it dragged on like that, I know I would feel like a pitiful burden. I imagine that every time someone walks through the front door, they’d be thinking, "Is he dead yet?" And if I’m asleep when they arrive, they might feel a sense of relief, hoping that I’ve finally passed. I hate how inconvenient death can be.

I've come to realize that life itself is full of inconveniences. It's nothing out of the ordinary. The weather can be either too hot or too cold. Your car decides to break down unexpectedly. People show up late or too early for appointments, making things inconvenient. Will everything ever be just-right? Probably not. So why complain about the inconvenience of death?

I remember that my birth was an inconvenience, though not to me, of course. Back then, I didn't understand. But I later learned that my birth interrupted my mother's career. She was about twenty-two and was the head dietitian at Geelong Hospital. That all changed because of me. On top of that, she developed gestational diabetes during the pregnancy, which made her sick. And to add to the drama, I had to be delivered with forceps because I weighed eleven pounds (five kilograms)! My mother would say, “There’s no virtue in necessity.” So don't talk to me about the inconvenience of birth and death.

I understand that complaining about the inconvenience of death contradicts my desire to make my death my final achievement. What kind of achievement would it be if I just complained? For instance, if I'm on my deathbed in the living room, maybe I should be grateful that I'm not stuck in the bedroom out the back.

For me, pain is imperfection, and I don't like it. So, what's wrong with me? Do I lack courage? Or am I just different, or too fussy? For example, I've always been averse to pain when playing sports. There are two sports in particular that come to mind, boxing and Australian Football.

I tried boxing when I was about fifteen. One night, at the gym, I was put in the ring to spar with Guy, a junior Golden Gloves champion. It wasn’t long before he had me in the corner and landed a sharp jab to my sternum. The surprising part was how instantly immobilized I became. I couldn't move my arms. Luckily, he didn’t follow through with a swift uppercut. Even the next day, I couldn’t use my arms. That’s where my boxing career ended.

I love watching football, particularly admiring the courage of players in a marking contest. In this game, the dominant principle is "eyes on the ball." When players compete for the ball, they put their bodies on the line, quite literally. They're not allowed to focus on the opposition players during the contest for the ball. Once a player has possession, it’s a different story. My advice? Dispose of the ball as quickly as possible, or you'll end up a dispossessed mangled mess on the ground. When I’m watching, I’m always thinking, “How do you do that?”

Clearly, those who box or play football have a different relationship with pain than I do. I’m averse to it, while they seem to be either drawn to it or, at the very least, it doesn't concern them as much as it does me.

I do tolerate a lot of pain. For example, my histamine sensitivity has caused headaches and gut inflammation for decades. Arthritis in my hands, knuckles, and wrists is always painful, and my tennis elbow acts up frequently. I tolerate it, but I don't like it.

I’ve discovered that tolerating pain isn't the same as managing it. Managing pain means accepting it. There's no choice but to tolerate pain. The alternative is unconsciousness. And here I am, talking about my final achievement, which requires mindful awareness, which is consciousness. In consciousness, there is pain.

We have no choice but to tolerate pain, but we do have a choice to manage it. To manage pain means to accept it. We do have a choice in accepting the pain. Tolerating the pain is rejecting it. It's like those annoying neighbours; you tolerate them, hoping they'll eventually leave.

I've learned some valuable lessons about managing pain. Over the years, I've gone through long periods where I've felt so irritable I could scream, yell, rant, and rave. This is my histamine sensitivity at its worst. The pain is a constant, unrelenting headache, along with an inflamed gut and something else that makes me feel incredibly irritable, grumpy, short-tempered, and angry. It's as if something spiky and burning is coursing through my veins.

I remember the moment when an insight flashed through my mind. The realization was simple, my pain is not a reason to be rude, grumpy, or intolerant of other people. I was standing at the kitchen sink, washing teacups for afternoon tea, when I noticed how thick the air felt around me. It was me. The people in my life were tiptoeing around me. I was finding fault with everything that was happening. Then it dawned on me, no matter how bad I feel, it has nothing to do with them. It's not their fault. I have to bite the bullet or else I’ll drive them away.

I now refer to this as bullet-biting therapy. Remember those old spaghetti westerns where someone gets shot, and the bullet needs to be dug out of his chest? The story was always the same. The doctor was called, always arriving drunk and needing a steady stream of coffee to stay awake and alert. The patient was given a bullet to bite down on while the drunken doctor dug around in his chest. This is pain management. What else can you say about pain management other than looking for ways to manage the pain? The pain is managed because it exists. In other words, the management of the pain requires its acceptance.

The bullet-biting is when you hold your tongue to protect the people around you. The key is to understand that your projection of your pain is the issue. Passing-on the pain is not sustainable if you need people to care about you.

I can see that death is going to challenge me. Death, particularly dying in bed from cancer, is likely to be inconvenient and painful. I hate inconvenience, and I’m averse to pain. How then will death be my final achievement if I don’t address these issues?

Even if I broaden my scope beyond cancer and, say, hope for kidney failure as my cause of death, I still need to contend with the inconvenience. You see, I’ve heard that dying from kidney failure is quite pleasant. I heard it described as drifting off into a haze of euphoria. Sounds like my kind of death. But I’ve also heard that it can drag on a bit in the lead-up.

I realise that I can’t depend on luck for getting a good disease to die from. The perfect death would be quick and painless and even euphoric. That sounds like trying to win Lotto. I’ve never won a major prize in Lotto. The odds are stacked against a win.

I'm going out on a limb here, but I believe morphine has a valid role in pain management. There are at least two legitimate reasons to use morphine in this way. Firstly, if you experience an injury, morphine can be a blessing in managing the pain, say from six broken ribs. With broken ribs, the pain can be so severe that it may cause your breathing to slow down and become so shallow that you’ll develop pneumonia and possibly die. The second, more obvious reason for morphine use is in the terminal stage of life.

I’ve experienced morphine. I had a car accident one day on my way to speak to a client about his car accident. As it turned out, I had six broken ribs on my right side. The police were the first on hand, and the officer tried to get me to do a breath test. I couldn’t do it. Then the ambulance arrived, and I was asked to get out of the car. I couldn’t do that either. The paramedic hit me with an injection of morphine. Then he asked me to get out of the car again, and I couldn’t. So, he hit me with a second shot, then dragged me out and got me into the back of the ambulance.

Now, here’s the thing about morphine. It doesn’t take away the pain. I can distinctly remember feeling the pain of my six broken ribs. I can remember how painful it was. In other words, it was painful, but, most interestingly, it didn’t matter. I was in pain, but it didn’t matter. The irony did not escape me.

Let’s say that because of pneumonia you needed to drown for twenty hours before you finally get to die. I can imagine that the pain of drowning would be utterly brutal over that time. The morphine takes away the importance of the brutality, thus allowing you to relax into the process and just let it happen, as it will.

To get on track with my final achievement, inconvenience is one of those effects that I can reframe. So, instead of complaining about the inconvenience, I need to be grateful that people care enough about me to tolerate the inconvenience. I need to feel lucky and privileged to be in the position of embarrassment. My embarrassment needs to reflect my gratitude. I can definitely work on that.

Likewise, I need pain management strategies. So, the way I see it, I’ll need bullet-biting therapy up to a point, and then I will need morphine for the last bit. For my final achievement, it is comforting to know that once the pain becomes intolerable and unmanageable, then the morphine will be there. If there was a cupboard of comforts, morphine would be there in the back corner.