How To Live Like You're Dying

“Live Like You’re Dying.” 

Replied one of my friends a few weeks ago after I jokingly brought up the idea of dropping everything and moving to Portugal amidst our conversation about work stress. We both laughed the moment off, but I went home and that one line just kept ringing inside my head. What does it really mean to live like you’re dying?

For most people, including myself, when we hear statements like these, cool experiences flood our minds. Things like: running a marathon, learning a new language, flying in a hot air balloon, and being a part of a flash mob. And while all of these things seem exciting, I can’t help but wonder: If I were on my deathbed, would the fact that I had gone skydiving or could speak French really bring me any peace? It seems that underneath our modern and somewhat glamorized understanding of what it means to live like we’re dying lie much more sober and pragmatic questions that we rarely ever take the time to ask ourselves until circumstances leave us no choice. 

Imagine you wake up tomorrow with a minor headache, one of many you have been having recently. They've been manageable, so nothing alarming. “It’s probably nothing,” you say to yourself as you pop an Advil and get ready for your day. But by bedtime, the pain is so unbearable that you have to go see a doctor.  As you lie on the hospital bed facing the bright white lights flooding the entire room, your doctor walks in with a file in his hand and a grim look on his face. He says to you that they found a brain tumor. “That can’t be!” you say to yourself. Just yesterday you were planning on taking a trip with your friends for the summer. To make matters worse, the doctor tells you that there’s nothing they can do about the tumor but manage it. It’s terminal. You’ve got less than 18 months. Walking out of the hospital with the realization of your own mortality staring you right in the face, in what ways would your perception about life and what matters change? 

This might not be the case for many of us, but the lessons in it are universal. How would you change the way you live your life from day to day if you found out you only had 10 more years to live? How about five? One year? Six months? If you only had just one week left here on Earth, what would you cherish the most?

These questions are intense. It makes sense why people who are fortunate enough to be able to avoid them, for the most part, choose to do so. But what if the answer to our questions about what makes life meaningful lies not in the quality of our experiences, as we’re so commonly told, but rather in the process of letting all of those experiences go?

There may be no profession that grants a person a closer look into the experience of death than palliative care nursing. This caregiving approach aims to ease the suffering of patients with terminal illnesses. One palliative care nurse, Bronnie Ware, who assisted patients through the last 12 weeks of life, wrote in her book The Top Five Regrets of the Dying of the experiences she gathered from her patients in the face of mortality. The top five regrets were, “I wish I had let myself be happier”, “I wish I stayed in touch with my friends”, “I wish I’d had the courage to express my feelings”, “I wish I hadn’t worked so hard” and most commonly, “I wish I’d had the courage to live a life true to myself, not the life others expected of me.” As I read through the list, what struck me the most was the second most common regret, “I wish I hadn’t worked so hard.” I found this regret so ironic because of how incompatible it is with the way that we, as not-yet-dying people, so commonly seek to derive meaning from our lives. The truth is that most of us do not have the privilege of working fulfilling jobs. Many of us are stuck in the rat race, doing boring jobs with no altruistic value, just to fend for ourselves. There are only a handful of people who get to find fulfillment and meaning in their work. 

People like Paul Kalanithi, a neurosurgeon who was diagnosed with stage four lung cancer at the age of 36, during his last year of residency. Paul spent the final year of his life continuing to work as a surgeon, even when he was forced to stare his own mortality in the face. In his novel, When Breath Becomes Air, Paul wrote “I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life – and not merely life but another’s identitywas obvious in its sacredness.” He spent his last few months on Earth powering through excruciating pain to complete shifts that, at times, spanned multiple days and nights and required his non-stop focus. It’s amazing that Paul was able to find meaning and fulfillment in his work as a neurosurgeon. But for many of us, we spend 40 hours every week working a job we wouldn’t consider worth it  in the final moments of life. 

The types of jobs that, on our deathbeds, we’ll end up “wish(ing) we hadn’t worked so hard” atThe reality is that finding a career that provides both economic security and a personal sense of meaning is quite a difficult balance to strike and maybe one that not everyone is able to achieve. So then, is all hope lost for us who cannot have our meanings tied to our jobs and are forced to continue in our unfulfilling endeavors? 

Matthieu Ricard, a renowned writer, philosopher and Buddhist monk once wrote “We try to create outer conditions that we believe will make us happy. But it is the mind itself that translates outer conditions into happiness or suffering. This is why we can be deeply unhappy even though we “have it all” ...and, conversely, we can remain strong and serene in the face of hardship.” What if it wasn’t the profession itself that gave Paul meaning in life? What if it was the way his mind translated his profession that gave him strength and serenity even in the final days of life? 

A recent survey in the United States found that around 1 in 5 physicians plan on leaving the practice within two years, while about 1 in 3 health professionals plan on at least reducing their workload within the next 12 months. So even in a profession that’s altruistic in nature, there are still loads of people with the desire to quit. Whether for stress-related reasons, or simply because it doesn’t fulfill them in the way they perhaps thought it would. 

Imagine again yourself with a terminal illness. Except this time you’re lying in a hospital bed experiencing the last few days of your life, 18 months after the tumor was first discovered. In the past six months, the illness had progressed rapidly, causing more deterioration to your mobility, cognition and overall identity than you would have ever imagined on the day of your initial diagnosis. The illness has left you with no choice but to gradually say goodbye to all of the activities that once brought you joy. Even simple, everyday things like brewing yourself a pot of coffee in the morning or going on a spontaneous walk around the lake with a friend are long gone now. As you lay there in that bed, listening to the beeping of the machines that are struggling to keep you alive, will you be able to still feel any happiness? Will you be able to feel as though your life still has meaning? Or will all semblance of meaning and happiness be lost?

Thinking about these questions is unpleasant and it makes a lot of sense why so many of us avoid them. In fact, some people are so terrified of death that it becomes a taboo subject, something they avoid talking about at all costs. But emerging evidence suggests that this fear of death might just be the root cause of some of the real dangers in our world today. Terror management theory proposes that there is a connection between the awareness of our own mortality and the ways in which we will go on to impose and force our world views onto others. If this theory were to be proven true, it could go on to expose that things like nationalism, terrorism, international conflicts and racism are caused by our individual and collective awareness of mortality. 

There have been several hundred studies done on TMT yet thus far, the results are still a bit scattered, but one conclusion that can be pretty safely made is that when someone is reminded of their mortality, a common coping mechanism for the terror they feel is to enter an unconscious, fear driven state of mind. Within this fear space, people are more likely to double down on whatever attachments they have to the social, political, racial or other cultural groups they identify with as a means of seeking comfort and community. Although these findings are extraordinarily telling about the ways in which our fears of death influence the ways we act in our lives, what they don't account for are the people who are not afraid of death. 

The people who have found ways to soothe their unconscious terror surrounding the topic of mortality and found a way to accept it, allowing it to instead be a motivating factor for the ways they choose to live. Take Claire Wineland for example, a girl who was born with cystic fibrosis and given about 10 years to live. Despite the tremendous pain her disease caused and having to grow up with the ever-present awareness of death looming over her shoulder, Claire spent most of her younger years playing games with nurses and elaborately decorating her hospital rooms, exploring every opportunity to feel happiness and a sense of meaning. Sadly, things became much more sinister when Claire’s lungs collapsed at the age of 13 and she fell into a medically induced coma with a 1% chance of survival.  Claire miraculously emerged from the coma after 16 days, but as she came back to reality she soon realized that the near-death experience had radically transformed her understanding of what mattered most in life. 

A year later, at the age of fourteen, Claire started a foundation called The Clarity Project to raise money for other terminally ill children with Cystic Fibrosis. She then spent the rest of her teenage years giving inspirational speeches filled with insights such as “The quality of your life isn’t determined by whether you're healthy or sick or rich or poor. It’s determined by what you make out of your experience as a human being.” and “The moment you realize it’s not about avoiding suffering, it’s about making something from your suffering, you’re incredibly free.” When you listen to Claire deliver these insights, it’s hard to believe that she was just a teenager at the time she said them. Her wisdom allotted her the nickname “little Buddha” amongst her followers. Although Claire only lived until the age of 21, so many would say that her awareness of her mortality combined with the near-death experience accelerated her understanding of who she was and what she wanted to do in the world.

While many of us spend our entire lives from 0 to 80 without any sense of meaning, faced with her own mortality, Claire was able to live meaningfully with the knowledge that she might not have as much time as everyone else.  And Claire’s story does not exist in a vacuum. Reports of people discovering newfound clarity about what makes their lives meaningful within terminal illness diagnosis and near-death experiences are rather common. 

On her experience of being diagnosed with breast cancer, Audre Lorde, an infamous American writer, poet and activist wrote “In becoming forcibly and essentially aware of my mortality, and of what I wished and wanted for my life, however short it might be, priorities and omissions became strongly etched in a merciless light, and what I most regretted were my silences… I was going to die, if not sooner than later, whether or not I had ever spoken to myself. My silences had not protected me. Your silence will not protect you.” That message, about the importance of speaking your truth, rings loud and clear throughout the entirety of Lorde’s book, The Cancer Journals

It also ties in perfectly with the most common regret reported by Bronnie Ware patients. “I wish I'd had the courage to live a life true to myself, not the life others expected of me.”  We live in an exciting, rapidly growing and ever-evolving world, during a time period where the invention of things like the internet, virtual reality and electric cars have created more possibilities than ever before. 

Every day we face an immense amount of pressure to be more successful, make more money, connect with more people, achieve larger than life accolades, break world records and transverse the unknown. And yet, despite all of this, our core values and what matters most in the end have remained the same for millenia. We all want to have lived a life with a sense of purpose, meaning and fulfillment. But, despite how seemingly obvious these core values seem, the day-to-day chaos of being alive can make them quite difficult to live by. The trick to do so lies in learning how to hold these deep truths close, despite their commonality, and to continuously remember to prioritize what matters most, even in situations where doing so isn’t the easiest or even the most beneficial choice.

Imagine yourself lying in that hospital bed again, one last time, except now you are in your final minutes on this plane of existence. You reflect back on the pivotal moments of your life with newfound clarity, watching little snippets of memories swirl around your head like a 3D movie. While not everyone will suffer a terminal illness, all of us, in one way or another, will have to come face-to-face with death. Would you be happy if that moment came today? Tomorrow? Seven days from now, or even 6 months from now? 

If you won’t, then you need to start living like you’re dying.