Life is often treated like a...

At 24, Arnold R. Beisser, having graduated from Stanford Medical School, completed his internship and planned for a surgical residency.

But it was 1950, the United States was fighting in Korea, and Beisser, a Naval reservist, was alerted that he was to be called to active duty. His residency had to be put on hold.

In the four months before his orders came, he devoted himself to his second love, tennis, winning a national championship and a high national ranking. He was young, strong, healthy and seemingly invincible.

Then, a few days after his 25th birthday, he was stricken with polio, paralyzed from the neck down. For two years, he would live in an iron lung, and any further recovery was minimal.

In the years since, he has built a life filled with love, laughter, friends and the rewards of a successful psychiatric career. His book, “Flying Without Wings,” was a moving, inspiring chronicle of this 40-year journey.

Now, in a new companion volume, “A Graceful Passage: Notes on the Freedom to Live or Die,” Beisser writes about death.

Here are his thoughts about death and dying:

Often, people ask me, “How do you bear not being able to move? How do you stand living like this?” And I then wonder, “How do I?”

Writing “Flying Without Wings” was an effort to try to answer that question for myself, how I felt about living with my disability. Now, as I grow older, and I’m in my mid-60s, age adds to declining health and I’m more aware that at some point I’m going to die. So I wanted to come to terms with that, for I don’t believe one can live well without acknowledging life is time-limited.

Death is one of the wonders of life, and like the other significant life events should be celebrated, not hidden away. Yet, even as our population is growing older, bringing the realities of death ever closer, people seem increasingly to deny that it is an essential part of life.

Unfortunately, we are influenced to expect that life is going to continue indefinitely. Life is often treated like a competitive sport, as though dying were the equivalent of losing. That is unfortunate because it dooms us all to be losers eventually.

Our fear of it has made death into a taboo subject, much like sex was for the Victorians. People don’t talk about it and it is given over to a group of specialists who take care of it so no one touches it or sees it.

Why should that be the case, since it is an essential feature of life? It hasn’t been characteristic of societies that have lived much longer than our own.

Many times during the last 40 years, I have thought I might die. When I get a cold, for example, I cannot cough or sneeze or blow my nose. Even minor ailments can be life-threatening. I still must use some kind of respirator about 16 hours a day to breathe and I must have my iron lung available for special emergencies.

In a reclining position in my electric wheelchair, I am able to breathe unassisted for a time. Those are my working hours, and I treasure them. I see patients, visit with friends and do some writing.

Until last year, my only means of writing was dictation, and, since it took me a long time to get it right, I had to dictate eight or 10 drafts. To my surprise, I recently discovered that I could use a word processor. I can lift one finger enough so when gravity causes it fall, I can type. Using my computer, it took only about six months to write “A Graceful Passage,” whereas “Flying Without Wings” took several years of dictation. And what pleasure it is to be in control of what I write in this way.

Although the title, “A Graceful Passage,” has been taken by some people to mean a book only about death, my intention was that it be about life, a celebration of life and all its wonders. It just happens that one of those wonders is death.

The important thing to me is living gracefully and well. And I do not mean only living gracefully when things go your way.

I would prefer to talk about life and living, but even the merest mention of death, in the context of the denial in which we live, will be highlighted.

My own attitudes toward death shift with my health and mood. Sometimes I fear it, sometimes I welcome it, even plan for it. Certainly, my life has been more precarious than most for the last 40 years and so I’m aware that it could be over at any time. Many times during these years I thought I might die. There are advantages to an ever-present awareness of death, if it makes you realize how precious life is and that each moment should be savored.

Now, however, it seems like I am not going to be able to hold out much longer, and when my life becomes too physically burdensome, I really don’t want to.

But years ago, I realized that being afraid of dying was really a cover for being afraid to live. Digging in to try to avoid dying, being preoccupied with that, keeps one from living life. If the focus is only on the outcome of something, one misses the process. The experience of living.

When I first became paralyzed, lost my profession, my ability to move and even breathe, I did ask myself the questions others always ask me: How I could stand to live as I do, and even whether I wanted to?

But I am glad the health care system was there to keep me alive. My life has been rich. I have no regrets. Whatever my disability, I think of it as no different than a loss that someone else might have. It is just more obvious, more dramatic. Of course, I am something of a curiosity to people and they want to talk about those things they find curious; they want to see my iron lung and know how I manage. My desire, however, is to spend as little time on those things as possible and maximize the time I have to enjoy the things that are meaningful in my life--my work, my friends, those I love.

When one has organized his life around something and then it’s lost, it is devastating, whatever it may be--a loved one, an ideal or something you could do. You must grieve. You wonder, “What am I going to do now? How can I bear to live?” I certainly felt that way about no longer being able to participate in athletics. I felt that way about the career I had anticipated.

But what seems unbearable at one point in time seems quite understandable and quite acceptable at another. For example, if someone had told me 40 years ago that I’d have to live in a wheelchair for the rest of my life, I’d have said, “I don’t want to live. I can’t stand it. That’s not who I am. I’m not a patient. I’m a doctor. I’m not a cripple. I’m an athlete. That’s who I am, and I’m not going to be one of those other things.” But somehow, now, those other things do seem like ordinary parts of my life.

Now I don’t think about being in a wheelchair. I don’t think about using a respirator. Except, that is, when the burdens grow and are no longer manageable. Then, it becomes all-consuming and there is no time for what I value. At those times, I do wonder again, “Is it worth it?”

I have always been afraid of being a burden to others; now I am witnessing my own physical decline, as eventually everyone does. Recently I had to sign some papers, and I realized I could no longer write my name.

I think anyone who suffers loss can have thoughts about ending it all. Of course, in my case I didn’t have much of an opportunity. I couldn’t even move. (The humorous irony in that may escape most people, but it would be recognized by most disabled people.) But I remember on some of the hospital wards where I was a patient, a major topic of discussion was how it might be possible to get done in, to pull the plug.

The “Why me?” question and the anger are all parts of the bereavement process. But if you get through that process, then it’s not necessarily a big part of life. People ask me, “Do you ever think about how your life might have been if you hadn’t become disabled?” The only time I do is when they ask me. I don’t feel like I’ve been robbed.

I am not preoccupied with death, nor do I want to add to the public debate over right-to-die. But I hope I can help people to start thinking about death with more equanimity, as something we can talk about that--like birth--is one of the things to celebrate in life.

We need to open some healing dialogues about death. I don’t have a clear prescription for society, but I do know that other cultures have found ways of integrating the end of life with the whole of life. For example, we need to learn to celebrate the rhythms of nature as other cultures have. Cultures like the American Indians saw death as an integral part of life. With us, it’s like we have no past or future. But we need to know from where we came and where we want to go.

I think many people are afraid of dying because of the way in which the death industry functions. I’ve had occasion in recent years to talk with a number of terminally ill people. So often, I’ve heard them say the same thing: “What I would really like to do would be to die and be buried and nourish the soil and have the flowers be born from me. That would make me feel so much better about dying.” I’ve thought about that, a pine box that’s bio-degradeable, no cement crypt to put the coffin in. There may be very good reasons for laws against those things, but they keep us from our connection with the seasons of time. I once read that societies that don’t tend the graves of their ancestors are in decline and will end soon.

Because it is so precarious, I think more and more of the meaning of life. Until now, my own life has been rich, full and rewarding, but I know the time will come when that will no longer be so. As it will for everyone. We may need to think of life in terms of its meaning, rather than its elemental biology.

Jesus and Socrates were two great figures in Western civilization, Socrates epitomizing the secular society, Jesus the religious society. Each very likely could have saved his biological life by simply renouncing what gave it meaning, his beliefs. Had they done that, they would have lived longer on Earth. But their lives would have been meaningless and they would not have become the spiritual triumphs for which they are known today.

In a way, that to me is the issue: At what point does life lose its meaning? When one is no longer able to either contribute or to take from life, what then?

We certainly have the means to make choices possible. I wouldn’t, however, want anyone to have the impression that I, in any way, am saying that if somebody feels life is difficult, then it’s OK to bail out. Life experiences are always transitory and that includes the worst ones as well as the good ones. Things look pretty black at night, then in the morning they look brighter.

Depression is the great deceiver. This is of particular concern because the people who are dying at the most alarming rates in our society are the young. Teen-age suicides are at an alarming rate, so are teen-age murders, and there are, tragically, so many children who never have a chance, children born with AIDS or deprived in other ways. We who are blessed with a plethora of resources, and I am one, have the opportunity to consider these matters responsibly.

One of the most popular courses at UCLA is Ed Shneidman’s thanatology. They can’t find a classroom big enough. The young may well be beginning to recognize that we have to take death into account in order to live well.

One of the problems, as I see it, is that right-to-die and right-to-live have become abstractions of legal, social policy and public debate--quite outside the realm of the personal issues that people are facing, that their families must experience. We must look past the polemics of polarized ideologies. It’s too easy to say things that will add to this debate and obscure the individual and family agony. I do not want to do that and I speak only for myself.

I have a living will, which stipulates no heroic lifesaving measures. And, like nearly everyone I know, I’d like to die at home. I’ve had years of personal experience with hospitalization, both as a patient and a doctor. It’s clearly preferable in the doctor role. And, as well-meaning as hospitals may be, they aren’t very pleasant places. Committed as they are to saving lives, hospitals, doctors and nurses are caught between the twin legal pressures from malpractice insurance on the one hand and right-to-life legislation on the other. The system keeps people alive, whatever their wishes.

To me, the ultimate horror would be to be in a hospital where the health care system has taken over my life and is moving inexorably toward decisions about me in which I have little or no say. I know that I am not alone in this dread of helplessness and loss of control.

I often wonder at what appears a blind pursuit of everlasting health and the extravagant predictions of the potential for life extension. Are we pursuing immortality? If so, it would not be life any more as we know it and it would be wise to consider the consequences. Of course, I favor good health and fitness. The question is whether the time spent jogging or in the gym is meaningful in itself. Would a person wish to spend his last day that way . . . or is it in quest of a future that may be bleak? At the present, it is doubtful that all the effort may make much change in the outcome, maybe only a day, a week.

I don’t know what happens after death; no one has come back to tell us for sure, so everyone is free to choose his beliefs. I do, however, believe how I live this moment is important. I’d better live it as though it were forever because, in a sense, it is. It may determine whether I move the world one millimicron in the direction that I want it to go. My values are nothing unique, traditional things like honesty, loyalty--they are in the Boy Scout oath. I’m always a little embarrassed by saying love, but I do think that, in one sense, it is the most important value and includes all the others.

There has been considerble debate of late about the morality of keeping the elderly alive at great economic cost, past their ability to live lives of meaning. It’s clear that we have to establish some priorities. With limited resources, we establish priorities whether deliberately or not, and that includes who shall live and who shall die.

A while ago, my wife and I visited a number of nursing homes, knowing that the time might come when my mother, who is in her 90s, would not be able to live alone or with the limitations of our help. Talking with the residents, I came away feeling that we are in danger of being able to sustain biological life while we forget why.

Now, please understand, I’d like to see everyone who wants to live have every support possible to do so with dignity. But it does cause me to step back when I see people living in a state of humiliation, or of degradation, people who would just as soon not be alive, using up resources, and, in effect, depriving others of opportunities.

We live in a society in which only those who can afford it have the best medical care. If we had a more comfortable feeling about death, our decisions could be both more rational and spiritual. Death is no great tragedy; it is simply a part of living. I’m not afraid of death, or of being dead. However, the process of arriving there does sometimes bother me. And I think that’s true for many people. When they go, they hope it’s without too much agony and pain and without depriving their families of their resources.

If you ask people what frightens them most, those are at the top of the list. And I’ve heard so many people express their fear that someday they’ll be old and have no money, they’ll be homeless, out on the street. That they would die alone, unloved and in humiliation.

The elderly who wish to live should be able to live with our support and with dignity. Dignity is, of course, a highly personal, highly idiosyncratic concept. The thing that seems most important is being with people you care about and who care about you, and in a place where you feel as though you make some meaningful contribution, and in circumstances that aren’t too alien. Consistency is security when you get to be older.

We, however, are creating a society in which the young have neither the desire, nor the practical means, of caring for the elderly. Whatever we can do to support the integrity of communities will be an important step toward supporting the family. If the family is supported, then there will very likely be places for people of all ages, and, if that occurs, the continuity of time and generations can be restored. We will be able to see more clearly the ways in which life continues after we are gone.

The medical profession increasingly has the ability to extend life through technology. I owe a lot to technology, yet it has been a love-hate relationship. Maybe the technology associated with medical care has advanced beyond the code of behavior. On the horizon is support for the idea of a patient becoming a partner in the treatment so that, hopefully, at each stage there might be mutual discussion about options and costs, benefits and liabilities. When it comes to the right to die, nobody should ever make that decision alone, or be forced to make that decision alone, as isolation may be the very cause of their wanting to die.

But it seems inhumane to me to keep someone alive for years when that person is, for all intents and purposes, dead, unconscious, deriving no joy from the fact of being biologically alive, contributing nothing, in essence a financial and emotional burden for self and family.

I respect that life is sacred and that we should do nothing to interfere with it. But I would add that we are already doing things to interfere with it with technology. We are already interfering with the natural processes. We seem, as a society, to have less reluctance about maintaining suffering without hope than we do about helping people have a graceful death.

This is a very tricky business and I understand the hazards. We must be vigilant about finding an all-encompassing answer, for we know where final solutions can lead. Obviously, any right thinking person believes in free choice and right-to-life. But when it gets down to trying to put this into some sort of code, what happens is that it ignores the immediate human experience of the people involved.

Where does mercy stop and murder begin? I wish I knew. If I were the father of someone being kept alive artificially, without hope of a life with meaning, and the law told me I could not help my child to die, I don’t know what I’d do.

But I want to re-emphasize that my interest is not so much in death, but in living well. If somebody were to read this and say, “This guy came up with a position that people should end their lives when they get ready to,” I’d say, “God, that’s appalling.”

Just think of all the things that could go wrong under those circumstances.

My health is failing, yet I know that I do not want to live only because I am afraid to die, or because others are afraid to let me die. And I want to allow others the same standards if they wish.

But I do believe that being technically kept alive in serious discomfort without meaning or purpose is nothing less than a violation of the sanctity of life. Sometimes, as a physician, seeing the hopelessly ill or infirm being kept alive at all costs, I feel we are like the sorcerer’s apprentice, dabbling with a magic we do not fully understand. If death and suffering are inevitable, one should be able to choose, and to celebrate that choice with loved ones.

I would like my passage to be a celebration, surrounded by those I love. We will sit together, with perhaps a toast or two. I hope we will reminisce, laugh a lot, and cry. If the party goes very well, we will not be able to tell the laughter from the tears. When the last guest is gone, I will close my eyes, and quietly slip away.

READER’S GUIDE

Dr. Arnold R. Beisser, 64, lives with his wife, Rita, in Brentwood. His 1989 book, “Flying Without Wings,” was published in hardcover by Doubleday, in paperback by Bantam. “A Graceful Passage: Notes on the Freedom to Live or Die” was published last month by Doubleday. His next book, “The Only Gift: Thoughts on the Meaning of Friendship,” is scheduled for publication next year.