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The Lost Art of Dying: Reviving Forgotten Wisdom

Yale Medicine Magazine, 2021 Issue 167

The first time internist Lydia Dugdale met Mr. Turner, he was dead. She’d heard a code on the loudspeaker at Yale New Haven Hospital, run to the man’s bedside, and helped restart his heart. Some of his ribs were fractured in the attempt to revive him. Dugdale, MD, FW ’09, MAR ’18, sought out Mr. Turner’s family and suggested that they allow the 88-year-old man to die. The family said no, hoping Jesus might spare him. A few hours later, Dugdale helped revive Mr. Turner again. The third time, his heart stopped for good.

“It was excruciating to resuscitate this skeletal, aged, cancer-riddled man three times in one night,” said Dugdale, who was a School of Medicine faculty member for a decade before moving to New York in 2019. An associate professor of medicine, she now directs the Center for Clinical Medical Ethics (CCME) at Columbia University and continues to see patients.

Even as a medical student, Dugdale wondered how to prevent the “horrible deaths” she sometimes witnessed. That became her central question when she studied for a master’s degree in ethics at Yale Divinity School. The key, she decided, is that both doctors and patients must acknowledge on a visceral level that death is real. But how can we weave that awareness into everyday life?

In The Lost Art of Dying: Reviving Forgotten Wisdom, Dugdale provides a curriculum. She calls her book “a revitalized ars moriendi,” modeled on the handbooks for dying published in 15th-century Europe following the Black Death. Dugdale explains how to proceed to 21st-century mortals: to routinely acknowledge our finitude; to lean on a community for solidarity; to explore whether spirituality and rituals might provide comfort; and to consider avoiding hospitals once the body becomes frail.

Dugdale suspects that ironically, doctors may be among the least capable guides when approaching death. The knowledge they acquire during training can give doctors the illusion that they don’t fear death. Suggesting another last-ditch treatment serves as a distraction. “If no one presses ‘pause,’” Dugdale warns, “the medical machine keeps moving.” As the body slows, so should medicine.

Dugdale recommends that doctors practice talking about death with patients. They can also direct patients to such websites as Five Wishes that address issues surrounding death and provide end-of-life planning documents.

Preparing for death doesn’t mean embracing it, Dugdale says, but rather learning “how to live well with a view to the endgame.” Last spring, reminders of that endgame pervaded life in New York City. “During COVID, there were sirens, sirens, sirens — everywhere, all the time,” said Dugdale. “One day I saw a neighbor from across the street being taken out [through] the window. I guess the person was dead, and they [the ambulance crew] couldn’t get in through the door.”

Dugdale thought, “That could have been one of us,” and she told the story to her husband and their two school-age daughters. All four felt cranky and claustrophobic in their small apartment, but she told them, “We need to treasure these days together, because we don’t know how long we will be together as a family. There is no guarantee that we will get through this pandemic with all four of us alive.”

More ordinary events also remind Dugdale of her mortality. When her knee hurts during a run or she needs glasses to read small print, she thinks, “Wow, I’m only in my forties, but things fall apart. These are the kinds of things that all add up to my death.”

When one of her daughters was just 3, the two of them stumbled upon a dead mouse while walking across a field in Vermont. Her daughter was shaken. “We sat there for a while and talked about death,” Dugdale recalls. “You can walk past it and cover it up with some leaves and pretend it’s not there. Or you can just sit with it.”

More information about the author and the book is at lydiadugdale.com.