Warning: philosophical ruminations follow

I've been teaching Piper about ruminants, and the concept of cows and goats eating something tough like grass, which needs lots of chewing and time sitting in other stomachs and then to be brought back up for more chewing before the nutritional value in the food can be absorbed. And so for years I've called my "food for thought" that needs to be brought back up and chewed on repeatedly, my "cud". The following is some early chews; I still don't know what I think yet.

There have been a number of "end of life" issues which have been swimming round my head trying to inform my thoughts on what to do next. The first is my fiscally frugal sense that if we all were to do all of the medical innovations that are available that not only will Medicare go bust but that our creative energies wouldn't be focused on the front end of life where there is a more fruitful impact than at the very end of life. I believe that we need public policy made into law which provides a firm boundary to what the public arena, our tax supported government programs will pay in any given situation. Good luck to any politician trying to get that made into law, but I believe it's important to do so, even if that would have precluded some of what has been spent in the last month keeping Gil alive.

I also feel the need for education and forums for family members about both the inevitability of death but also the many different benefit versus cost ratios. There's, of course, the quality of life one, is the intervention going to cost more quality of life (pain, disorientation, dis ability etc) than it delivers of enjoyable life. There is the money and time ratio, a million dollars for one week as an example. Is the money spent worth the time. And others I can't even remember right now. But the education family forum discussions would hopefully help families be willing to let go especially when their loved one dying has already made it clear that they have let go. Having public policy which limits end of life expenditures would help this.

But my most recent thoughts come from realizing that all the thinking in the world is abstraction when compared to the perspective that only the one staring death in the eye has. I'm getting whiffs of this from my dreams and proximity to Gil's struggle, but I have no illusion that I can grasp this from where I am now. I think the person who is sensing death may be able to realize that death is what makes living a joy, that the finite resource of life is what makes for savoring and passion and drive and ... That if we had no death then life would be one more thing to squander and not be careful with. I suspect that the closeness of death makes it possible, if not easier, to see death as an important gift that alters our value system, our senses, our experience of time. A gift that if we could stop fearing it earlier in life (though I suspect never as dearly as one close to death can) might make our living so much more precious and appreciated.

Of course, early deaths and wasted deaths and cruel deaths and (I know, I know, I don't know) are much harder to make peace with than lives which have been full and well lived. But I am humbled by the complexity of end of life decisions. If Gil needed transfusion for the rest of his life would we decide to do it? as compared to, needing transfusions til we see if his own bone marrow will rally and carry him for another golf playing mamboing year or so, which is where we are at the moment? When is enough, enough? Is it a certain age? or level of illness or disability? Heaven forbid it's an income class decision. I don't know, but it is not as simple as it looked before this crisis, when my thoughts were stuck in the frugality of Medicare mode.

So the latest chewing of this "cud" has left me with the idea of looking at our biological fear of death and how it evolves over a lifetime. It's appropriate for young folks to fear death enough to be careful with their young bodies and all their potential. And of course that drunken sense of immortality of youth often costs them, but hopefully wisens them if they live to tell the tale.

But after a certain age, particularly as time speeds up and we're so caught up in our busyness that we sometime don't even notice that we are alive, perhaps exploring our fear of death, and learning different perspectives on death might make it easier when we are at that end of life stage to make better decisions about when to let go into our own deaths as well as those of our loved ones. And you may have noticed, I haven't once mentioned an after life, both because I don't know if there is one, but because I feel that it's irrelevant on this side of death. We've been given this precious gift of life by way of our parents lovemaking and we are free to make beauty and kindness with it or to scribble and crumple it up. Though I suspect that scribblers have a harder time at the end stage.

So I'm left with looking at my fear of death, and the mess our societal policies and decisions are in because of our fear of death. But, more relevantly, hoping to explore with Gil his fear of death which is one I can visit only in my dreams. He, as he has always been, is my teacher.