Tuesday, July 21, 2015

The Givenness of Death

Death comes.

Hospices across the universe manage death and dying, often without the slightest idea of death as it is in itself. As a specialist in hospice and palliative medicine, I am often part of a team dedicated to death, or more accurately, to the looks of death when it is happening. When death is happening, a human being is dying, which is the process through which a living being exits life,  a life lived in a world of living and non-living things. The living and the dead. The dead are things formerly living, having gone through the process of an exit from life. The hospice team specializes in the death of a human subject; there is no palliation for fishes and trees. Every living thing dies (despite the odd and remarkable life cycle of turritopsis dohrnii); but we only manage the death of humans---it is the human thing to do.

We pronounce death. We declare that a human has died and has exited life. We even speak of the 'remains,' a thing left behind,  such as after a departure. A presence is exchanged for an absence. The official declaration is a matter of ownership and the public health. We protect the living from the dead. We protect the dead from accidental life by embalming or cremation, lest life creep back in, a very rare occurrence. Such is the final act in the management of the dead. The dead really must stay dead. It is the human thing to do.

Dying is the human thing to do. We all do it. Death is manner of the human condition. It is also the least examined thing we do. Thanatology does not begin to touch death; not even in its most morbid observations (turritopsis, not thanatopsis). When does death make an appearance: how does the phenomenality of death enter experience as it is in itself? Neither Addie Bundren nor Agamemnon get to report back to base camp, and the tales they do tell are for the lips of the living, the logoi of the dead; which is not to say they do not speak---they are given their lines.

As our patients lay dying, we minister to lives woven into the death-in-coming. Death presents itself to the life it entangles, and to those eyes that dare to manage it. Just what or who is managing what or whom? This death at a distance is the very hermeneutics of death, if we dare to experience its givenness. This hermeneutics of death is the space between the living and the dead, the call of death in its givenness to the one who would read its hieroglyphics. Even when we paint over dying with morphine and other opacities, death shines through in its phenomenality and givenness. We can know of the givenness of death by the response to its call. As the ones who want to know, we know death in its insistence to be heard, its command to interrogate it, through the hermeneutic that cuts a gap between we who would know and a death who would speak.

The symptom is death in its lowest degree of givenness. To understand it as a metaphor is to already read it, and misread it at that. The symptom is not a mode of similarity. Death's symptoms are extensions of itself; their reach is metonymy, and they foreclose on death's wholeness. We tend to know death by its parts. The 'death rattle,' the coalescence of secretions in a throat betraying the personhood of the dying, chills its hearer. For some, the sound is the very voice of death, gripping a loved one by the throat. By the time this symptom makes its appearance, the dying are oblivious, so it is a gift only for the hearer. It is a symptom more often treated to 'treat' a family member, than to alleviate suffering in the dying. The secret is to dry the secretions and quiet the sound of death, denying it embodiment. Another symptom, 'air hunger' or dyspnea, is horrific for the dying and their witnesses. Morphine blankets air hunger, subdues it, gives it rest; the body relaxes as this finger of death loosens it grip on everyone in the room.  We add to the massive presence of death in every intervention; we give death a shape and a rhythm, and make its invisibility visible, if only in outline.

Our own presence to death invests it with meaning, the meaning it calls to us as it beckons us to display its self. This the moment of two selves: reading and being read, interpreting and being interpreted. We so want to abbreviate death, we would close it off with a signature on a death certificate. But if we want to know death, we must allow it to appear, to makes its presence known to our own presence. What is in the room when the last breath, the last beat of a broken heart, has had its say? I am in the presence of death, now without a symptom, without a metonym to make it all a bit more palatable. I am present to death as death. What is becoming visible? Death is an idol created by my gaze upon the invisible. Death is in life's place, a complete transubstantiation symbolized in the lifeless body before me: the accidents of the flesh, which give death its metaphor.

Death does not mean the absence of life. Death, in its pure givenness, means the change in substance. That is the difference to which I bring my own presence. Death wants to present itself in its whole givenness, which we are wont to foreshorten through its metonymy, our very desire to keep it at arms length. But we do not let death appear through the perspective of foreshortening, which distorts it to fit it into a frame, our picture of death. To be with death is to stand in death, the space in the room that wants to mean as it wraps its cellophane self around my presence and the lifelessness before me. Death embraces the living and the dead with its difference that builds its cathedral to house a sacred space.

Death sacralizes all things and erases every profanation in the event that is death. Death is the difference that cuts a gap in the space of my hermeneutic attitude  that give it a voice in which to whisper its call. This eventive gap cuts into the lack that reshapes my reader's self, now something also different, and new.  This death is the event of my own death as a movement from the profane to the sacred. It is the same death that I will die. The wholeness of death is in the difference it makes for everyone. It is the same difference. I know death because I am as human as the dying and dead before me. Death appears before me as I appear before death. I do not sign so fast: I sign for myself when I sign for the dead. I tarry, for I do not certify death; I ratify it with the signature that I use to sign off on what we all do.

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