fb-pixel Skip to main content
James Carroll

Facing our mortality

Atul Gawande, who wrote “Being Mortal.”

‘I AM AN old man and have known a great many troubles,” Mark Twain is said to have remarked, “but most of them never happened.” The capacity to imagine the future is a boon to human life, but it is a burden, too. Anxiousness about what is coming is part of how we prepare for any outcome, whether the looming threat comes true or not. Fear of what approaches can be its worst aspect. So daily living can include a steady parade of anticipated difficulties, yet the regularity with which they replace themselves with new fancied objects of dread points to this anguish itself as essential to the human condition.

For many people, dread of the imagined worst is proper, since, in this cruel world, the worst happens to some again and again. The fortunate ones, like Mark Twain, are those for whom forward-looking readiness to confront misery often turns out to have been a savvy mode of preparing for the relatively mundane difficulties that define most days, even bad ones. Still, the troubles that Twain and his lucky kind anticipate, yet may or may not actually suffer — matters of money, say, or relationships, career, illness, varieties of normal loss — nevertheless add up to an implicit reckoning with the universal worry that is mostly deflected for as long as possible. Being mortal is the problem without a name, and without a solution. Even “being mortal” is a deflecting euphemism, since the subject is death.


Such, in fact, is the meditation prompted in one man’s mind by Atul Gawande’s “Being Mortal,” an eloquent and moving book whose current popularity suggests how this exquisitely difficult problem is common to all. Every living creature dies. Humans know it in advance, but spend a lot of energy attempting to not know what we know very well. We fend off the idea of death, or, in Gawande’s terms, “medicalize” it by imagining a future whose open-endedness depends only on the next clinical procedure or the right health care setting. We treat death as if it were an interruption of the human lifespan, instead of the natural endpoint of it. In the process, no matter how much good will caregivers and loved ones supply, the actual needs of the dying take second place to professionally defined purposes and personal sensibilities of others. For all involved, but especially for the one being cared for, who is rarely invited to offer heartfelt expression on this, the greatest subject, the denial of death destroys the meaning of life.

Perhaps that’s where our mundane worries come in. Free-floating minor anguish of the kind Twain regretted pushes back at the illusion that there is nothing major to worry about. Even the most commonplace of worries can be a little whisper from the soul, saying, “Pay attention to ‘what matters in the end,’” in Gawande’s phrase. He is a surgeon at Brigham and Women’s Hospital in Boston, and offers ample wisdom on the inevitabilities attached to aging and terminal illness, but his book is most useful for its reflection on the finite interplay between the human body and time. When it comes to facing the limits of life, “There are many worries and real terrors,” he writes, citing an expert caregiver. Yet no one worry, nor any single terror, lays bare the full truth of the dying person’s situation. “Arriving at an acceptance of one’s mortality is a process, not an epiphany.” It happens over a lifetime, not all at once.


Essential to that process, across that lifetime, are all the “troubles,” in Twain’s word, that unsettle every person’s present with an imagined future. With an Atul Gawande at hand, even “the real terrors” can dissipate simply because, as he shows, they can be thought about, faced directly, and — if not overcome — changed in what they mean. Time itself, far from being a curse, is an agent of such changed meaning, which is why, no doubt, Twain identified his recognition as attached to old age.


The worries of life are real in the moment, whether they ultimately come to pass or not. But they can amount in the end to a cumulative kind of practice for, well, the end. In addition to being burdensome woes, that is, transient concerns can enable a positive reckoning with the absolute worry that is death. In that way, our “great many troubles” can be our great friends.


Dr. Angelo Volandes: Prescribing the end-of-life conversation

Joanna Weiss: Can we talk about death?

Alex Beam: The peculiar urgency of mortality

James Carroll writes regularly for the Globe.