My father has always been a strong man. He could walk far, carry heavy loads, and move everything from furniture to heavy barrels. He’s also strong in his faith, carrying heavy burdens for others when they can’t do it alone. He has had his share of illnesses and surgeries, but none have incapacitated him until now. Now he tires easily, walking a few steps to the table then back to his chair.
As he falls asleep and I sit, watching the rising and falling of his chest. I know one thing with certainty. This will be his final illness.
How do you measure a life?
A few years ago, the British Museum set out to tell the story of the challenges faced from birth to death and the way different cultures respond to those challenges. The center of the exhibit was a “Cradle to Grave” visual display of the estimated average of drugs prescribed to every person in Britain in their lifetime.
Down a long table in the middle of a massive hall were thousands of drugs sewn into a mesh fabric. A sign introduced the gallery, “This gallery explores how people everywhere deal with the tough realities of life and death. These challenges are shared by all, but strategies to deal with them vary from place to place, people to people.” In all, there were 14,000 pills.
Each pill had a story behind it: a story of symptoms, emergency or doctor visits, further testing and diagnoses, and finally treatment or comfort until death. Some of the pills indicated a disease cycle—asthma or diabetes, arthritis or breast cancer. Others told a story of increasing pain, beginning with Tylenol and ending with morphine.
Pharmaceuticals dominate the narrative that shows how much a Western society relies on pills for ordinary life. We have medicalized birth, death, and everything between. Want to stop smoking? Take a pill. Need freedom from the hot flashes of menopause? Take a pill. Want to feel happier? Take a pill. Need to lose weight? Take a pill. And on it goes. Just looking through the display is exhausting.
But around the room, display cases of how different cultures dealt with life from the cradle to the grave relayed a different story. These glass cases showed a more complex and broader view of health and illness. And each of these cases represent symbols of health as well as ways to ward off illness, the cases depict how our health as humans is deeply dependent on our relationships with each other, with animals, and with the spiritual and physical world.
An Insufficient Measure
As a public health nurse, culturally based views of health and illness are something I deal with in my office—not just in books. I work with communities whose ideas of health and illness vary greatly from Western biomedicine.
Western biomedicine, with its heavy emphasis on intervention and its massive pharmaceutical options, can be a gift. But it is also dangerous. The “take-a-pill” mentality can push a fractured understanding of who we are as human beings and ultimately of what it means to be human. Pills and aggressive treatments may prolong life, but at what cost?
Perhaps the truest words about our relationship with 14,000 pills come from the creators themselves—a group of artists called Pharmacopoeia.
In the end we are asked to consider the deeply complex relationship we have with prescription drugs. They are both wonderful and dangerous. They allow us to live longer, they allow us to suffer less, but they may also offer false promises of happiness and health and immortality that they cannot possibly deliver. In this they are more like the spirits and gods of other cultures than we care to believe.
I think of their words as I survey the pills on my father’s menu. The pills are many, and they are not enough.
But my father is more than his pills, more than his diseases. He has lived a remarkable life across the globe. From the golden-hued New England autumns to the Bougainvillea branched deserts of Pakistan, he has logged hundreds of thousands of airplane miles and an equal number of adventures. He speaks three languages, translated the Bible from English to Greek to Sindhi, and has been known to get in a canoe and go fishing with a full canister of oxygen by his side. Just two years ago, he and my mom went to Istanbul to visit my brother where he wandered through the colors and pungent smells of the Spice Bazaar, talking to shop owners and bystanders, smiling and laughing, making friends with all he passed.
Now he’s near the end. He can’t get relief from a hacking cough. His body deteriorates daily. There will come a day when no matter how many pills he takes and no matter how much oxygen he inhales, it will not be enough.
We will throw away the pills and the nebulizer, the syringes and the needles. What will remain of his life? What will remain are the relationships—with his wife, his children, his grandchildren, and his God?
In the End
In the book Being Mortal: Medicine and What Happens in the End, the author and physician Atul Gawande addresses his chosen profession’s limitations in the final and inevitable journey of aging and death. Modern medicine is not just about health and survival, but also about well-being. He follows with this.
If to be human is to be limited, then the role of caring professions and institutions—from surgeons to nursing homes—ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the large aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.
My father is now awake. He turns to look at me, a slow smile spreading over his face. “You’re still here?” he asks. I look at him and I love him. “I’m still here, Dad.”
Epilogue: A few weeks after writing this essay, my dad died. He was at home on his way to the breakfast table. “Just seven more steps,” my brother said to him, his arm supporting my dad’s back. My dad looked at my brother. “I don’t think I can go on,” he said. And with that, he died.
Cover image by Sam Wheeler.