“Death is not the greatest loss in life…”

“Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.” – Norman Cousins

We all know that some day we will die. But what if that day were today? Many movies have explored life and death, often humorously, as in the 2007 movie “The Bucket List.” This movie, like many others, reminds us that as life approaches its meeting with death, we feel more deeply that which gives our lives meaning. Somehow, death reminds us of the importance of savoring life, of eking out every ounce of life. 

This begs the question: what does it mean to live? Ironically, in this era of healthcare reform, there is very little discussion about health and what it means to be healthy. Most of the conversation revolves around insurance, cost of care and quality measures. While these are important to address, in sum they don’t capture what it means to be healthy, to live, to thrive.

The story of our health, our relationships, our dreams is a story that needs to be heard. If your life were a story, how would you write the last chapter? After all of the accomplishments and accolades, what would give meaning to your meeting with death? Coming to terms with death is challenging because it’s really about coming to terms with life. How am I living my life? If these were my last moments, where would I be, and with whom? If we avoid these questions, we are handing our pen to someone else.

In emergency care, we see the meeting of life and death daily. Sometimes, life and death merely exchange glances. Other times, they converse and agree to meet at a later time. But sometimes, they decide to embrace in the hospital, jointly penning the last chapter of a life story. In a hospital setting, the last moments of life can last anywhere from seconds to days to months, depending on how one defines life. The meaning of those last few moments for both patient and family seems to be determined by family, friends, and the palliation of suffering, not by medical testing. Even the most heroic measures many times fall short. In those profound moments when life is embracing death, we must know where we stand and where our loved ones stand. And we must consider that dying to live is not living.