Loving life while accepting death.

HIS MOTHER FOUND HIM LYING motionless on the floor. There was a pistol in his right hand and a note explaining his plan to commit suicide. There wasn't much blood except for some that had trickled from the bullet hole at his temple. His eyes were open but empty, as if staring into nothingness. She called his name and shook him to see if he moved. He didn't. She wasn't sure if he was already dead or still had some life in him. She desperately hoped for any chance to save him. He was only twenty years old.

His mother didn't know how long ago he'd shot himself. She just walked into the house after buying some groceries and found him on the living room floor, next to the chair from which he'd slid. She called 911. When the paramedics arrived at the house, there were no signs that he was breathing. They immediately put a tube down his throat into his lungs to help him breathe and transported him to the emergency room. The ER doctor examined him and didn't find any evidence of obvious brain activity, but the doctor wanted either a neurologist or a neurosurgeon to determine if the patient was brain dead. A CAT scan of the brain showed how the bullet had shattered the skull at the entry site, went through the entire brain from right to left, and got stuck in the skull on the left side. There was a lot of hemorrhaging throughout the bullet track and the entire brain was swollen.

That was the story I heard when I was told about the young man. From the details of the ER doctor's neurological examination of him, I had a sense that he was already dead and there was nothing I, as a neurosurgeon, could do to make any difference. Yet usually the family clings to hope that something can be done by someone like me. Often with suicidal gun shots to the brain, when the neurosurgeon evaluates the patient's condition, either the patient is brain dead or the damage caused by the bullet traversing a critical part of the brain is so severe that it makes it impossible to consider any surgery. In this young man's case, the latter was exactly the situation.

After examining the young man and determining he was brain dead, I went to meet the family--mother, father, and two sisters. Needless to say, there were a lot of tears being shed. We exchanged introductions and the father also introduced their parish priest. I told them the sad truth that the boy was dead. There were more tears and the girls hugged their mother while sobbing uncontrollably. The father, who wept silently, put his hand on his wife's shoulder. The priest in turn put his hand on the father's shoulder. There was stunned, disbelieving silence for a few moments and then the mother asked the priest to pray for her boy. Everybody held one another's hands in a small circle and I was asked to join, too. As a doctor, and knowing what I do about life and death, I'm not a man of prayer. But I never refuse, if a mourning family asks me, to hold hands with them while they pray. The priest said the prayer, mentioning something to the effect that the young man's soul is going to be in heaven, in the presence of God. Afterward, I told the family that I was sorry I couldn't help and then took my leave.

As I was driving home I kept thinking about the priest's words regarding the soul and heaven. I don't believe in the existence of a soul, at least not the way many people have defined it, as variably as human imagination permits, throughout the past centuries. In the past I had always looked for the soul as a tangible, observable part of a person. I have done an extensive dissection of an entire human cadaver during the anatomy course at my medical school and I have studied the physiology of the heart and brain, but I haven't found a soul anywhere. And the word soul was never mentioned once in all the medical textbooks I've studied. As far as heaven is concerned, I've been checking out the pictures of the universe beamed down by the Hubble telescope and have yet to come across a picture of paradise among the stars. Yet millions of people do believe. And now I think I have an idea why.

Situations like that of the young man who killed himself remind me of the emotional predicaments people face and give me some insight into why we believe the way we do. I don't think I could ever imagine how devastating, horrible, and unimaginably unbearable it must be to face the sudden death of a loved one, especially someone young. How does one cope with such shocking loss? The emotions must be overwhelming and uncontrollable. I can imagine how a tragedy like that can make even a mentally strong person break down from the weight of emotional burden and turmoil. I don't know how I would cope with such a tragedy if I ever had to face it personally. I hope it never happens to me, and I wish it wouldn't happen to anybody else.

But the reality is that there are millions of people facing such unexpected, overwhelming personal tragedies of different kinds. It's a daunting task to console the sorrowful heart with reason and rationality alone, at least right away. We all need immediate comforting thoughts and a shoulder to lean on to give us some peace of mind and buy enough time for the emotional wounds to heal. If I understand correctly, the ideas of heaven and eternal life offer solace in situations of intolerable and devastating loss, similar to the one I had just witnessed. Somehow faith, even if imagined, is capable of consoling the grieving heart and calming the troubled mind. I think that belief in eternal life in heaven is like afterlife insurance. For millions of people, spirituality and faith in the soul, heaven, and life after death provide the emotional strength to cope with such tragedies.

Considering myself a man of science, I have a hard time accepting such belief, but for many people that belief is essential. If one is a nonbeliever, one's rationality has to be deep rooted and unshakable so as to prevent one from falling into the abyss of depression or sending the restless and inquisitive mind into a land of madness.

I suppose a weeping heart settles down and heals faster with a spiritual concept than with a scientific explanation. And mortality can be scary and the finality of death too hopeless for some to handle. But it is also possible to face the finitude of life with calmness and achieve a happiness that can create for us a kind of earthly paradise.

Let me step back a little and explain.

I remember a beautiful evening. The sun was just setting on the horizon over bluish gray waters of the tropical ocean. It was a spectacular, large, and perfectly round reddish orange ball, which has never stopped mesmerizing me no matter how many times I've watched it.

The sea breeze was beginning to cool and felt pleasant on my face. A sailboat was moving lazily across the waters, in step with the unhurried island life. My wife was watching the sunset as well, and my two boys, six and two years old, were playing in the sand on the beach, letting fistfuls of sand slip through their fingers. Bare feet, sand, shells, and water--a perfect combination for my boys, and for their father! It was like paradise; one of those moments that captured the essence of everything I feel about life itself.

Life is a marvelous thing. To me it is joyful and exhilarating at times, wonderful most of the time. Of course it can also be sorrowful. It can be calm, serene, and sedate, like that evening, but it can also be noisy and confusing. My deep appreciation for life didn't happen overnight. The path to this philosophical understanding or destination has been tortuous, with detours of uncertainty, despair, fear, and even depression, fortunately only transient. But the journey has been well worth it.

Ironically, that journey (I wonder if I should call it my spiritual journey) began with a sudden preoccupation with death during my teenage years.

Death was a terrifying thought to me. I realize now that it wasn't death itself that bothered me but rather the fear of death--for once you're dead, you're dead and that's it. You won't be feeling or thinking a thing after death. It's only while you're alive that the thought of death is excruciating. Worry about death alone won't kill you but can torture you, slowly and intermittently, but sometimes incessantly. I say that out of personal experience.

I'll never forget the moment the dreadful thought of my own mortality sprang into my consciousness. I remember the exact feelings I experienced: a chilling sensation, a sense of loneliness, hopelessness, and inexplicable fear followed by depression. It made me dread being alone. I needed to see somebody--anybody--to get some comfort by knowing I wasn't alone. I had to do everything in my power to keep my mind occupied and distracted, otherwise the thought of death would creep into my consciousness. The worst part was that the thought wasn't fleeting. It haunted me--not for a day or two, or even a month or two, but for a whole year. (I wonder if that boy who shot himself had felt the same way?)

I was sixteen years old, growing up in India, when I first began thinking about my mortality. I wanted to run away from the thought of it--if there were a way to do so. But I don't think anybody can do that. One's mind is like one's shadow on a sunny day: you cannot just get away from it. As the writer Khalil Gibran said, "Your mind is a dutiful servant if you control it, but an excruciating master if you let it control you." Needless to say, my uncontrollable preoccupation with death made me restless and unhappy, not the way a sixteen-year-old should be. My friends were busy thinking about girls while I was trying to submerge the thought of death.

I wished for eternal life. I questioned why we have to die. I felt it was unfair. Life is good. No, life is damn good--and then you die. I remember how, prior to being consumed with thoughts of death, I'd been carefree. I'd been looking forward to the future, had dreamt about it, and, in a way, had predominantly lived for the future--until that day when my mind was seized with my own mortality. There was no context. Nobody in my family was ill or had died. The thought just happened. I know I have an inquisitive mind, but I didn't intentionally go searching for answers about the end of my existence.

Eventually, a year later, my mental salvation resulted from an idea I discovered in "The Law of Life," a short story by Jack London, which I came across in a book in my father's library.

It is about the death of an old, blind Eskimo, left behind by his son as his tribe moved on in search of food. It was his people's custom to leave behind any unnecessary and burdensome objects so as to make their nomadic way of life easy and practical. An old, blind man wasn't of much use to the group and a big burden on the limited and precious supply of food. The son was nice enough to leave a sizable ration of food for his father.

As the old man remembers doing the same thing to his father and appreciates his son's generosity, he feels something wet on his hand and realizes that it is a wolf licking him. He drives it away, only to be surrounded by a pack of wolves within a short time. Soon he realizes the futility of fighting and gives up against the pack of wolves. He accepts death as "the law of life" and that his time has come. That short but dramatic story made me accept death as an inescapable reality. There was no point in fighting the inevitable.

I still don't like death, of course, but by accepting its inevitability I now have peace of mind. The Dalai Lama explains that death is actually a part of our lives, something that is bound to happen. Since it is inevitable, it makes more sense to try to understand death instead of avoiding thinking about it. The Dali Lama believes that we all have the same body and so we will all die, but from the beginning our attitude should be one of acceptance: "You have to think about and accept death in order not to be terrified by it."

Boy, do I know exactly what he means! Some may have difficulty accepting that finality. We may have to be careful not to be too consumed by the idea of death. There is a danger that we may be overcome with despair if our thoughts dwell on the exquisite and final truth of death, especially if one's life is miserable. No wonder some, like that young man, may even give up because they feel there is no point. It is hard to go on with daily life thinking about the reality that, in the end, all of this won't matter. But it does matter, right now.

Twenty-eight years have passed since I came to terms with my mortality, and I still don't have any idea what brought on that preoccupation that consumed me for a whole year. But now I don't think much about death. Instead, I think about life--the beauty, pleasure, wonder, and magnificence of it.

As a surgeon, however, I occasionally have to face that final darkness, especially with encounters and experiences like those of grieving families. But I'm not terrified anymore of my own eventual mortality. The awareness of inescapable finality has been transformed into a healthy inspiration and a sense of urgency to celebrate my life before I die.

I think it's what that young man might have realized if given another chance.

Dr. Vivekanand Palavali is a neurosurgeon and native of India who now practices neurosurgery in Michigan. This article is excerpted and adapted from his just published book of essays entitled A Mindful Life: A Brain Surgeon's Personal Experiences and Philosophical Reflections on Living Life Fully.