Death has been on my mind lately. My family would say that it is always on my mind. Maybe it is because I'm a physician who by law can pronounce a person dead.

Parents of friends, members of the Greatest Generation, are coming to the end of their incredible lives. Some are going to their graves without telling their heroic tales of survival from both the depths of the Depression to the depths of war.

Reading the obituaries fuels the interest. This habit is both to check to see if there are any patients of mine listed and to search out any acquaintances. There is also the dark humor of seeing if my own picture is there.

There is a voyeurism of sorts as one reads and sees the life stories. There is a feeling of both relief and a touch of arrogance that the photos on the page don't include mine. There is an interest of who were these people who have gone fishing or die doing what they liked or who met their maker surrounded by their loving family or who are no longer suffering.

It is one of the reasons why I don't do funerals. Looking around and seeing everyone in the service, I know it will be my turn some day. It is like a moving conveyor belt. The honored guest will be laid to rest, and then someone from the congregation will take that person's place and the ritual of death will be replayed over and over again. The music may change and there will be new flowers, but the play will be re-enacted with different actors in the same roles.

Death has always been part of living. Our ancestral parents buried their children, and they in turn were buried by their children. Massive pyramids of stone crowned their preserved corpses; others were just covered with rocks and dirt or exposed to the elements. Some societies dressed up their deceased like going to a party, others in the clothes that had covered their nakedness. Some were honored and entombed in giant mausoleums dedicated to their greatness, others' bones commingled with their fellow slaves, fallen soldiers or the many nameless sick.

Looking at the pictures of some of the deceased with their gray hairs and time-worn wrinkled skin gives me hope I will live beyond this moment. The problem is that we learn in our childhood how to grow old. There is a lesson daily if we are reared with grandparents or parents who are sick or chronically ill. For me it was my job as a teenager to "check on Dad." For a man with heart disease, being late for dinner could have been his silent signal of goodbye. For a boy of 14, when it was my turn to get up from the prepared table and go look for him, I could and still can imagine the image of this body slightly curled lying on his right side. I would approach the closed bathroom door and call out if he were OK. A response told me he was alive for another day and dinner.

In medicine, death is always there even if not part of the daily duties such as with the oncologists or the tumor surgeons; it is still part of every differential diagnosis. As a pediatrician, when I hear about a child with a fever I fear they could be infected with some fatal pathogen. Even with the most common of ailments, like asthma, there are those who die on the way to the hospital, or the supposedly simplest of surgical cases has a fatal complication.

I envy the truly living who don't have to think about their patients and the potential role of adding to the gallery of the obituaries in Section B. The message is also that we have to be careful of our teaching of aging and dying to our children. Being alive for our sake and theirs is a good way of living.


Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected]