What the Dying Teach Us About Living

Oncologist turns the 'be here now' mindfulness movement on its head

Sometimes we resolve to make every minute count for something.

This sounds like a wonderful goal, but in my work as an oncologist and palliative care physician, I come into daily contact with people who are facing the final days, weeks, or months of their lives.

These are individuals who literally may be able to count the remainder of their minutes. Spoiler alert for those of you who are not facing a serious illness: Dying people often feel the pressure to make every minute count, and they can find that intensity exhausting rather than inspirational.

To get a sense of it, imagine a moment from your life where a minute — just 60 seconds — truly mattered. You’re late for a meeting and cursing the extra two minutes you spent composing an email. You’re cramming for an exam and lamenting all those evenings you spent doing something else instead of studying. You’re on a first date with someone you really like and can feel the pressure to make every word, gesture and look count.

Now pause, and contemplate trying to give every minute of your life the same level of attention. Does that feel overwhelming?

Let me tell you about Keith, a man with a progressive and debilitating neurological disease that steadily rendered him unable to move, swallow, and breathe while leaving his mind intact (his was like amyotrophic lateral sclerosis or ALS or Lou Gehrig’s Disease). Recently, I wrote about Keith in a piece for The  Journal of the American Medical Association called “When Minutes Matter.” Keith told me, using three breaths, “Minutes (breath) matter, (breath) it’s exhausting.”

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Armed with the knowledge that his final minute was rapidly approaching, he was worn out by the need to make every minute count. Keith longed for a few minutes that didn’t matter so he might have a chance to relax without feeling guilt or regret.

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My work teaches me that paying attention to every breath is neither a reasonable nor even aspirational life goal. Paying attention and being present at times is as important as the moments in our lives in which we lose track of time or get lost in a moment. We should be as content paying attention to a moment, like listening to the birds tweet in the morning, or an important conversation with our child, as losing ourselves in a book or a movie, a long shower, or a leisurely breakfast.

We need space for our mind to process and to rest in order for us to function at an optimum. Being present in a moment is wonderful and fulfilling but requires intense effort. My work has taught me that both focus and rest are vital to happiness.

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Perhaps our life, our spiritual and intellectual force, is like a fire in the fireplace: At times it burns hot and other times it smolders, but it always needs to be tended and nurtured. Judy Sorum Brown’s poem “Fire” reminds us that the space around the logs is as important to a burning fire as the logs themselves are. I suggest we give attention to both our presence and absences in life, being mindful that we need the space of a moment that doesn’t matter.

Toby Campbell, MD, is an associate professor of oncology and a palliative care physician at the University of Wisconsin Carbone Cancer Center.

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