Last Rites

I finished Atul Gawande’s Better on the plane to L.A. There is something so soothing about these collections of essays by doctors and this one, though a bit uneven in the opening chapters, wound up being really rewarding and pleasurable. Gawande is a New Yorker writer and thanks Malcolm Gladwell as a friend. He shares a style of thinking, a kind of brilliant pragmatism, with Gladwell and the Freakonomics guys. The question of Better is about performance. How can doctors be better doctors without waiting for technological and scientific breakthroughs?

One of the chapters concerns the moral dilemmas of capital punishment and, specifically, the problems for doctors who work at executions. In all of this fascinating and troubling piece, something stood out for me, as it clearly did for Gawande. One of the doctors who, by a chance chain of events, finds himself putting a central line into an inmate about to be killed, tells Gawande that he had simply cleaned the site with antiseptic and inserted the line. Why the antiseptic? Gawande asks. “Habit, I guess.”

These habits are amazing and a really important clue, I think, to our attachment to life. Here, a doctor humanizes the condemned man by treating him as a patient until the very end. But sometimes it’s the condemned who humanizes himself. In “A Hanging,” George Orwell notices how the condemned man sidesteps a puddle on his way to the gallows. And, in Mrs. Dalloway, Septimus frantically scans the room for a quick escape: “he considered Mrs Filmer’s nice clean bread knife with ‘Bread’ carved on the handle. Ah, but one mustn’t spoil that.”

The humanity of these moments--the last moments of life--their mundanity, their strange thoughtfulness is one of the great mysteries of life and death. Septimus thinks about Mrs. Filmer, his landlady. She likes that bread knife. It would be wrong to spoil it. There’s a clarity to that thought that puts the troubling facts of his suicide, his illness, into sharper relief.

When people die of old age or from long illness, there is often a gradual fading out. Travel ceases to interest. Then, the news. Books. Finally, even family loosens its hold. But these people, condemned to die by the state or driven to death by their own demons, are fully and completely alive until the very last moment.