Learning How to Die – Lessons from the Irish Wake

I did not want to believe it. I remember very clearly how he blindfolded my siblings and me and “kidnapped” us, surprising us with an all-day trip to our favorite theme park, Camp Snoopy.

And I probably would not have believed it if not for the unfamiliar sober look on my father's face when he told me it was my last chance to say goodbye. Finn's death still seemed imaginary. Finn was our family's best-loved uncle. He had an endearing wink that made you feel seen, a great dislike of authority that got him expelled from every Catholic high school in town, and a ruthless wit. He even ordered an ice-cream truck to greet the guests at his own funeral.

But Finn looked different that day. I watched, one after another, as my siblings, cousins, aunts and uncles approached the bedside. A shadow of candles framing his face cast a soft amber glow. Finally, it was my turn to step forward. I studied his face. He had sunken eyes, hollow cheeks and temples shining with the holy oils my aunts had applied. With my father, I made a cross over his cold lips and said goodbye. I was 12 when I learned how to die.

The Irish wake is our family's death ritual. The place where our loved ones die becomes, for a moment, a sacred memorial, and then quickly turns into a storyteller's stage. Tales are shared late into the evening. Some of these are true, the most embellished tales. Then come the songs. All are memorial songs sung from memory. All are known by heart because our parents sang them to us just as their parents had sung them. Eventually, our bellies ache from deep laughter and too much of grandmother's cheesy hot dishes, and love fills every corner of this sacred space.

Long before I went to medical school, the Irish wake was where I learned “what a good death looks like”. Together, we allowed every drop of complex emotion to rise to the surface—regret, pain, relief, laughter, gratitude—and then simmer like a pot of potatoes.

At 22, I stood over a lifeless body / cadaver again. I nervously entered the sterile laboratory and approached Table 8, where a cold, gray figure lay with a canvas cloth covering its head. Over the next 3 months, I moved my scalpel through every fold of the body's leathery skin, separating fascial planes from the muscles above, diving into yellow, coiled fat and slicing twisted purple veins. After months of mind-boggling memorization and stressful exams, I reached the course's notorious head-and-neck section. No study aid or lesson in Netter (Atlas of Human Anatomy) had prepared me for this task. As instructed, I carefully peeled back the cloth to reveal a square, cleft jaw, thin eyebrows and a curled upper lip. For the first time in 3 months, I saw a person.

My instructor said the cloth had been placed there out of respect. But nothing about masking this person's identity felt respectful. The canvas cloth was my introduction to an outdated principle of medical practice: accepting that a person's humanity could distract from the "real" work of being a doctor. I quickly covered the face again, as instructed.

At 28, I stood over a lifeless body again, but this time the stakes were higher. With a new stethoscope hanging around my neck, I was on a 30-hour shift in the medical intensive care unit (YBÜ). But it was not the fatigue of 30 hours that churned my stomach that morning; it was knowing that Ms. A. was going to die.

Ms. A. was almost my age, but her organs looked older. She had been born with a blood disease, and now most of her red blood cells were sickling and her major organs could no longer be perfused (there was no blood circulation). She was young, and her family was hopeful. But blood transfusions were no longer working. By the time we reached hospitalization, despite all the medical knowledge accumulated over the years and access to state-of-the-art drugs and equipment, we had reached a point at which there was only one path forward. Ms. A. was going to die.

It was 02:00 when I went to tell her family what might be the worst news of their lives. I stepped outside Ms. A.'s intensive care room. I methodically put on the mask and plastic gown intended to prevent infection, but which felt more like an attempt to hide the sadness and fear on my face. I looked into the room, where bundles of poles, tangled wires, tubes, needles and channels separated Ms. A. from me. Hospitals are very well equipped for medical interventions, but not equipped enough to handle the emotional and spiritual process of dying. I stood outside Ms. A.'s room a little longer and gathered the strength to face her family.

When I think of Ms. A.'s death, I see myself sitting at Finn's bedside. As a child, you give love effortlessly and without thinking. But through years of rigorous medical training, from cold cadaver laboratories to physically demanding, frightening codes, it becomes easier to let love go freely, to cover the face of a dying person, to put on your mask. Still, there are moments in medicine that crack our thick exterior.

When I shared the news with Ms. A.'s family, I was surprised, first by their silence and then by their gratitude. Somehow, trapped in that cluttered, sterile hospital room, amid an unimaginable loss, we shared a still, sacred moment.

Although my uncles might disagree, not everyone's dying scene has to look like an Irish wake or include my grandmother's hot dishes. But the Irish got one thing right: sharing the process of dying may help heal those left behind. Witnessing death is difficult, especially when your job description includes "offering healing". Still, perhaps the healthcare community can relearn this childlike skill of accompanying others. And in doing so, we may even find room to heal ourselves.

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