Apr/May 2019 Spotlight

Approaches to Dying 101

by Melissa Knox

Excerpted imagery from photography by Kris Saknussemm

Excerpted imagery from photography by Kris Saknussemm

"Life is pleasant. Death is peaceful. It's the transition that's troublesome." —Isaac Asimov

When my father learned he had an inoperable, fatal form of lung cancer and would die within a year, he took out three-year subscriptions to all his favorite magazines. For a full two-and-a-half years following his death, Art and Antiques, and similar publications, continued to thump regularly into my mailbox, clockwork reminders of Dad's delighted, zany belief that if he ordered as many years ahead as the magazines allowed, he couldn't possibly die before his subscription ran out.

When I needed a hospital, my husband and I chose, almost by accident, the one closest to our house in Northwestern Germany. I thought I'd fractured a bone. He was short on oxygen and needed to refill his tank. We took the hospital I walk past on my way to grocery-shopping, the one whose emergency room nurses had seen my daughter's finger stuck in the guinea pig cage, my oldest son's ankle fractured while rollerblading, my younger son's concussion that scared the living daylights out of us. I assumed I'd be in and out that afternoon.


In the middle of the night, my 82-year-old hospital roommate yelled—she thought I was her sister, the two of us little girls, back in wartime Germany in 1943—Wouldn't I take care of the sheep, she said, so she could go to the toilet? I turned my head and saw her flailing, trying to get out of her bed, but she'd had total hip replacement, wasn't supposed to move on her own. Vacuum wound-drainage bottles clattered around her.

"Would you like me to ring for the nurse?" I asked.

"Who are you? What are you doing in my room?" she replied.

"We're both in the hospital," I said, "I am your roommate."

"Yes, yes, yes," she grumbled. I rang for the nurse and sank back to sleep. A few hours later I woke again to the old woman's anguished thrashings and curses: "It's enough now! I have to go to the toilet!"

Now wide awake, and not eager to see her collapse on the floor, as she seemed likely to do, I said, "I can ring for the nurse again—you should stay in bed."

"Oh, you're still here?" She cried, clearly upset. In came the nurse, who brought the old woman a potty and soothed her to sleep. I fell into a fitful doze, wishing the old thing liked me, rueful I'd annoyed her.

In the morning she seemed far more chipper—remembering nothing of the night before. She was old, she told me—I knew just how old, since her name and birthdate were printed on the plastic container used for her dentures, which had been left on the glass shelf under our bathroom mirror. She'd been ten at the end of the Second World War. Like so many Germans who lived their young years in those terrible times, she was all worn out.

"My kidneys just don't want to work anymore," she confided, during one of the nurse's epic runs with the potty, "but one wants to live a little more, you know?" She fumbled with her pills; they rolled away into her bedding, and she scolded them as if they were naughty children.

She looked at me anxiously, and I said yes, indeed, I understood exactly what she meant. For I, her junior by more than two decades, had just been diagnosed with Stage four metastatic breast cancer. Stage five is death.

I didn't grow up starving in a war zone like her. My mother was well-fed and cared for by New York's best obstetricians during her pregnancy, unlike my roommate's undernourished mother, who probably scrabbled in the dirt for roots and carrots. I grew up eating good food and going to good schools. I endured no back-breaking farm labor, no labor at all in childhood or after. Until recently, I went to ballet and tap dance classes four days a week.

I lived right, ate right. There's no excuse for my cancer.

I didn't think of death until—a few moments before I was to be taken to the operating room to have a tumor on my femur removed—the young male nurse entered the room with a disposable razor and told me I had to shave "in the intimate area." I nearly burst into tears. Instead, I said I didn't see any need for that. I wanted to speak to the doctor. I didn't shave. The doctors said it was okay—they just wanted to avoid hair in the wound.

But for me, the moment I was asked to shave my private parts was the moment the world imploded. In my drab hospital johnny, wheeled out in the hall to await the trips to the operating room, gurney blocking bustling nurses and frantic doctors, I kept trying not to burst into tears. A naked pussy meant death. I am one who, until a few days before my diagnosis, enjoyed a regular and robust sex life. Naked in the genital area is anything but sexy. Naked is prickly itching as hair grows back in. Naked is death. I don't do naked.


My next hospital roommate was 17 at the end of the Second World War. She stared at me as they wheeled her into the room. When I introduced myself and she continued to look through me, a frown furrowing her brow, I thought her unfriendly, surly. I realized how wrong I was after I returned from a trip down the hall with my husband. There sat the old lady on the edge of her bed—almost sliding to the floor—with my manuscript gripped in her hands. Somehow, she'd gotten it out of my wheelchair, where I'd set it down. My husband stepped forward and seized the pages. She tightened her grip and gave him that look I took for surly, insisting that these were her medical forms. She pulled back hard when he tried to pry my pages from her ancient fingers.

"But, you see, they have my wife's handwriting on them," said my husband, finally managing to loosen them from her surprisingly strong grip. She had, I saw, a tenacious hold on life although she could remember nothing, not what the nurse had said five minutes before. A neurologist came in to ask her to count backwards. He inquired whether she was dissatisfied with her life.

I felt, before she answered, grateful I had not had a life like hers—hiding from bombs until her late teenage years, starving, slaving away in a department store as a low-level clerk, married to a gardener who seems to have been a difficult man. She looked the neurologist dead in the eye and said with an air of surprise, "No, I am satisfied with my life."

Death could approach; she'd had everything she ever wanted.


I haven't. Here is my 13-year-old daughter, with long, blondish-brownish hair, like mine at that age. Aunts on both sides of my family insisted my hair was "just like Mama's!" My daughter worries her hair is too curly. She has no idea how pretty she is. She can't believe me when I tell her, although she is pleased. How stunned I felt at 13 with the notion I was pretty. When my smiling aunt said I'd break hearts, I wanted to dive under the table. My daughter radiates growth, dimples, the loveliness of self-discovery, the shy awkwardness of the early teens—how self-conscious she is of the braces and pimples that only offset her beauty.

I love to say good morning to her and her brother, I am glad I got her through her first period, and I can't stand the thought of her not being able to ask me questions she'll have as she moves from thirteen to twenty. I want to see her through to the time when she knows that no matter which pair of blue jeans she wears, she is still the same pretty, smart girl. Yes, I want to see her walk down the aisle with a beloved. I want to be there when she gives birth.


Here is my younger son: he is very tall, the kind of slim tall resulting from rapid growth. He is 15, filled with a desire to do things exactly right. He plays smooth jazz piano. He sits at the same place every day to do his homework. He wants to be "the best" but feels relieved by advice to forget that and just be himself. He asks me and my husband questions. I am so glad he asks. We answer, as much as we can, how much protein he should eat, how many calories are on his plate since he's body-building, how come a kid in his class said this or did that, what percentage of the US population believes X or Y.

All of these questions strike me as the expression of a single one: Have I really figured out this situation? Is my judgment correct? And yes, my son, your judgment is very good, and the best thing about your questions is your desire for answers. He and I read The Adventures of Huckleberry Finn together. How will he do, how will he feel, if he says, "I have a question," and instead of being able to look into his eyes and answer him, I am not there. I'm erased, or part of the ether, or rotting dead flesh? He will think these things, turn over such thoughts in his mind, and I will not be there to help him.


My oldest: he's the one who got to be with us through his 18th birthday, before we started fraying at the seams. We went to his orchestra concerts; we enjoyed watching him graduate high school, walking across the stage to the tune of—his choice—"Hail to the Chief." We tell ourselves he's launched—he's a hard-working law student. We had a weekend there, eating sushi around his tiny kitchen table, the five of us. We had that! We gloat over WhatsApp photos he sends of his home-cooked gourmet meals. Of the first, important girlfriend, the one I hope will hold his hand in bad times, too.

One approach to death is considering the possibility that I won't get to see him graduate from law school, and I won't get to see the 15-year-old grow even taller, the 13-year-old blossom.

If death is nothingness, I am not exactly afraid of it—it sounds painless—but I dread leaving my husband and children, and I dread the thought of not enjoying the sip of wine, the bite of meat, the kiss, that I now routinely love. I am much more afraid of leaving everyone and all my senses behind than of being mindless, soulless, vanished.


You don't, perhaps, get to choose an approach to death so much as death picks its approach to you. I find I can't "get religion," or take consolation in any rituals. I've always had a certain romantic attachment to the Greek and Roman gods. When we took a Mediterranean cruise and stopped on the isle of Delos to sees the ruins of Apollo's gigantic temple, admiring the descendent of the very tree under which he and Leto came into the world, I tried praying to him. I pictured something out of D'Aulaire's Book of Greek Myths, a childhood favorite: that Apollo is blue-eyed, curly-haired, with a peaceful expression.

In fact, he's remarkably similar in looks to my husband, who prays to his own Catholic God. From time to time I've sent up a prayer when the evening star is just starting to shine, usually while turning the corner from Achenbachhang, the street with overly-neat German window boxes and tidy little white houses. I can see the lights of our house through the large, unkempt hedge surrounding the side of it as I head toward our front door. On these walks, I briefly prayed for long life and health for me and everyone in my family. I'd think the prayer in the direction of any god that might be out there. It seemed to me that Apollo and some Christian God could probably work together for my family, the more gods the merrier. And then the cancer came, and I started wondering if I'd angered the gods by praying to too many of them. Except I'm not a believer.

I asked my husband if he thinks he'll get to see his parents again after he dies; he believes in some kind of soul and assumes he will. Then I started dreading all the relatives and others I would never want to see again—I'm not sure I'd want to see my father, probably not for more than a few minutes, and I wouldn't want to go anywhere near my former psychoanalyst, whom I feared for decades. I wouldn't want to see my grandfather. My mother, either. Maybe my grandmother, who had such a wonderful deep-green perfume in a crystal bottle on a small vanity table in a bathroom under the stairs. What was that gorgeous perfume?

"I want to just see you and the kids!" I told my husband. This is my approach: I tell him what I want. I tell him I love him. We talk about how the kids could live in the house after we both die, and we try to arrange for guardians, a couple whom we trust, to take over as parents.

Approaches to death: Knowing the questions the family will want to ask you and answering them while you can. Approaches to death: feeling distracted so you don't know it's coming? Morphined? Would I want to be that out of things? Approaches to death: ignoring it, once business is taken care of, and enjoying the daily things I like.

Side effect of approaching death: I want to watch, again, a video I happened upon years ago about a Glasgow boy who claimed, from the time he could speak at age two, that he'd lived on the island of Barra with his mother, father, brothers, and sisters. He remembered a previous life. I watched the video again—the child seems utterly convincing, his mother, too, the psychiatrist as well. None seems a faker. The little boy says that when you die, you just fall into another mummy's tummy. That's what happened to him, he said. He seems to have been calmed by the visit to the empty Barra house, where he realized his former family no longer lived. Saddened, but free of the compulsion to tell them he was there, he was all right. They, like he, had moved on to other lives.


I don't know if my father would have liked the Glasgow boy's story, but he would have liked its Scottishness. He never tired of telling me his Scottish ancestors had ended up in a part of the world that eventually became Pennsylvania as payment for being mercenary soldiers to William of Orange. These hardy Scotsman, Dad said, had trudged to the Carolinas, where, sometime in the 17th Century, our family was well on its way to becoming Southern Gothic.

I liked the Scottish part of the story, too: I loved the little boy's accent, and the glimpses of the island of Barra that I saw appealed to me as if I had been there. Yes, dejá vu, but a rationalist would say I was just reminded of Nantucket and New England, and a rationalist might be right. As an approach to death, however, rationalism offers no comfort. Religion is absurd. I'm down to rumination, practicalities, red wine, and chocolate. My "approach" is not methodical, but why would it be? I've never had a methodical moment. I've always drifted along from one hunch to another. I lived that way, and I suppose I will die that way as well.

When my husband and son came to pick me up from the hospital, the old lady—who chased her naughty pills, and whose nocturnal moaning and mutterings I'd managed to soothe by playing her Scottish ballads on YouTube—cried. "I won't get such a nice roommate as you again!" she wept. She was going into an altenheim, an assisted living place for old people, she said. Like me, she couldn't go back home.

I climbed into our car, got up our house steps. To sleep in my own bed, to watch the yellow tram rumble across the old stone bridge, the one resembling a Roman viaduct. To gaze at my favorite ceramic jewelry box, in vibrant colors, storing necklaces and earrings I want to wear often. To know I can't count on that. Leaving the hospital, coming back to my house, I can't return home again. Home is the place that existed before I knew death was approaching.


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