My sister, Jean, died as I was writing this book. Seven years older than I, Jean was a gentle soul and I loved her dearly. During our adult lives she lived on the East Coast, I on the West, but we always phoned one another weekly, and whenever I was in Washington I stayed with her and her husband, Morton, a cardiologist, who was always generous and welcoming.
Jean developed aggressive dementia and at my last visit to Washington, a few weeks before she died, she no longer recognized me. Because I felt I had already lost her, I was not shaken by the news of her death—not consciously. Instead, I welcomed it as a release for her and her family, and the following day Marilyn and I flew to Washington to attend her funeral.
I had intended to begin my eulogy by telling a story about our mother’s funeral in Washington fifteen years earlier. On that occasion, I tried to honor my mother by baking kichel, an old-world pastry, to be served at the family gathering after the funeral. My kichel looked good, and smelled wonderful, but, alas, were entirely tasteless: I had followed her recipe but forgotten to put in the sugar! Jean was always gracious and generous and my point in telling this story was to highlight my sister’s sweetness by saying that, if I were baking kichel for her, I could never have forgotten the sugar. But, though I had arrived at the funeral feeling composed and unaware of deep grief, I broke down completely during my remarks, and returned to my seat without finishing.
My seat was in the front row, close enough to touch my sister’s plain wooden casket. When gusts of strong wind arose and buffeted the cemetery, I saw, out of the corner of my eye, my sister’s casket begin to shake. Despite all my rationality, I could not get the bizarre thought out of my mind that my sister was trying to get out of her casket, and I had to fight the instinct to bolt from the gravesite. All the experience I’ve had with death, all the patients I’ve escorted to the very end, all my supreme detachment and rationality in prose about the topic of death—all of it evaporated in the presence of my own terror.
This incident shocked me. I had been trying for decades to understand and ameliorate my personal anxiety about death. I had played these fears out in my novels and stories and projected them onto fictional characters. In The Schopenhauer Cure, Julius, the group leader, announces that he has been diagnosed with a fatal illness, and the group members attempt to console him. One member of the group, Pam, tries to offer comfort by citing a passage from Vladimir Nabokov’s memoir, Speak, Memory, describing life as a spark between two identical pools of darkness—the one before birth and the one after death.
Immediately, Philip, the Schopenhauer clone and acolyte, responds in his usual condescending manner, saying, “Nabokov undoubtedly lifted the idea from Schopenhauer, who said that after death we will be as before our birth and then proceeded to prove the impossibility of there being more than one kind of nothingness.”
Pam, furious with Philip, says, “You think Schopenhauer once said something vaguely similar. Big fucking deal.”
Philip closes his eyes and begins reciting: “‘A man finds himself, to his great astonishment, suddenly existing after thousands and thousands of years of nonexistence; he lives for a little while: and then, again, comes an equally long period when he must exist no more.’ I quote from Schopenhauer’s essay, ‘Additional Remarks on the Doctrine of the Vanity of Existence.’ Is that vague enough for you, Pam?”
I cite this passage because of what it did not include: namely, that Schopenhauer’s and Nabokov’s statements both trace back to Epicurus, an ancient Greek philosopher who held that the primary source of human misery was our omnipresent fear of death. To ease that fear, Epicurus developed a series of potent secular arguments for the students in his school in Athens and stipulated that they learn them just as they might memorize a catechism. One of these arguments was the renowned “symmetry argument” positing that our state of nonbeing after death is identical to our state before our birth, and yet the thought of our “pre-being” state is never associated with anxiety. Philosophers throughout the ages have attacked this argument, and yet to my mind it is beautiful in its simplicity and still holds considerable power. It has offered comfort to many of my patients, and to me as well.
As I read more about Epicurus’s arguments to dispel death terror, a bombshell of an idea for my next book occurred to me and held me enthralled for a great many months. Here’s the idea. A horrific nightmare terrorizes a man: In a forest at nightfall he is pursued by some terrifying beast. He runs until he can run no farther; he stumbles, feels the creature pouncing upon him, and realizes this is his death. He awakens screaming, heart pounding, soaked in sweat. He jumps out of bed, quickly dresses, bolts from his bedroom and from his home, and sets off to find someone—an elder, a thinker, a healer, a priest, a doctor—anyone who can help with this death terror.
I imagined a book consisting of eight or nine chapters, each beginning with the same first paragraph: the nightmare, the awakening, and the setting out to seek help for his death terror. Yet each chapter would be set in a different century! The first would take place in the third century BC in Athens, and the dreamer would rush to the Agora, the section of Athens where many of the important schools of philosophy were located. He would walk past the Academy, founded by Plato and now led by his nephew, Speusippus; past the Lyceum, the school of Aristotle; past the schools of the Stoics and the Cynics; and finally would reach his destination, the Garden of Epicurus, where, at sunrise, he would be permitted to enter.
Another chapter might be set in the time of St. Augustine, another during the Reformation, another in the late eighteenth century at the time of Schopenhauer, another in the days of Freud, perhaps another at the time of Sartre or Camus, and perhaps others in a Muslim and a Buddhist country.
But one thing at a time. I decided to write the entire episode in Epicurus’s Greece in 300 BC, and then turn to each of the later time periods. For months I researched the details of daily life in Greece in that era, the clothing, the type of breakfast, the customs of daily life. I studied ancient and current historical and philosophical texts, read novels set in ancient Greece (by Mary Renault and others), and eventually arrived at the sad realization that the research required to write this and the chapters in the other time periods would consume the rest of my life. With great regrets I abandoned the project. It’s the only book I’ve ever started and did not finish.
Instead, I decided to discuss the work of Epicurus in a nonfiction book on death anxiety, and that book gradually morphed into Staring at the Sun, published in 2008. Staring at the Sun traces my thoughts about death that emerged from my clinical practice with healthy as well as terminally ill patients. The book’s title comes from a seventeenth-century maxim by François de La Rochefoucauld: “One cannot stare straight into the face of the sun or death.” Though I use the maxim for my title, I challenge its truth in the text by emphasizing that much good may come from staring directly at death.
I illustrate that idea not only with clinical but also with literary vignettes. For example, Ebenezer Scrooge in Dickens’s Christmas Carol begins the story as a miserly, isolated creature, but by the end he is a kind, generous, and beloved man. Whence the transformation? Dickens gave Scrooge a strong dose of existential shock therapy when the Ghost of Christmas Yet to Come allows Scrooge to view his own gravesite and read his name on the headstone.
Throughout Staring at the Sun, the confrontation with death serves as an awakening experience, one that teaches us how to live more fully. Therapists sensitized to this process see it often. As I mentioned earlier, in my clinical practice I often suggest that patients draw a line on a sheet of paper and imagine that one end of the line represents their birth and the other end their death. I ask them to indicate where they are now situated on the line, and meditate on that for a few moments. The film Yalom’s Cure begins with my voice suggesting this exercise.
During my training as a psychiatrist, I never once heard death discussed in therapy seminars or in case discussions. It was as though the field still followed the advice of Adolf Meyer, the longtime dean of American psychiatrists: “Don’t scratch where it doesn’t itch”—in other words, don’t raise troublesome topics unless the patient does, especially in areas that might be beyond our capacity to assuage. I’ve taken the contrary position: since death itches all the time, there is much to be gained by helping patients explore their posture toward it.
I agree entirely with the Czech existential novelist Milan Kundera, who wrote that the act of forgetting offers us a foretaste of death. In other words, what terrifies us about death is not only loss of the future but also loss of the past. As I reread my own books, I often fail to remember the faces and names of the patients I have written about: I’ve disguised them so well I cannot recognize who they were. I ache sometimes to think of all the intimate and wrenching hours I spent with individuals who are now lost to memory.
I believe that death anxiety lies behind the presenting complaints of many patients. Consider, for example, the discomfort that accompanies big birthdays (age thirty or forty or fifty), which remind us of the inexorable passage of time. I saw a patient recently who described several nights of terrifying nightmares. In one, an intruder had threatened her life; in another, she had felt herself falling through space. She mentioned that her fiftieth birthday was approaching, and she dreaded the party her family was giving. I urged her to explore all the connotations of being fifty. She said that she felt fifty was truly old and recalled how old her mother had looked at fifty. Both her parents had died in their late sixties, and thus she knew she was now two-thirds through her life. Before we met, she had never spoken openly about how she might die, about her funeral, or about her religious beliefs, and though our sessions were painful, I believe that demystifying the process ultimately offered her relief. Death anxiety lurks in many of our milestones—in the empty nest syndrome, retirement, the midlife crisis, and high school and college reunions—as well as in our grief at the deaths of others. I believe that most nightmares are driven by death anxiety that has escaped its corral.
Now, as I write these lines, ten years after writing Staring at the Sun—ten years closer to my own death—I don’t believe I could write as dispassionately about the subject as I did then. In the past year, I have not only lost my sister, but also lost three of my oldest and closest friends—Herb Kotz, Larry Zaroff, and Bob Berger.
Larry and Herb were my classmates in college and medical school. We were anatomy partners in dissecting a cadaver and roomed together during our internships. The three of us with our wives vacationed together in many places: the Poconos, the Eastern Shore of Maryland, the Hudson Valley, Cape May, and Napa Valley. We loved the days and nights we spent together talking, biking, playing games, and sharing meals.
Larry had a long career as a cardiac surgeon in Rochester, New York, but then, after thirty years of practice, switched fields, obtaining a PhD in the history of medicine at Stanford. In his final years he taught literature to undergraduates and medical students before dying suddenly of a ruptured aortic aneurism. In my brief eulogy at his funeral, I tried to add a lighter note by describing a vacation trip the six of us had taken in the Poconos at a time when Larry was in his bad-clothes phase and had worn a beaten-up, wrinkled T-shirt to a fancy restaurant. We all harangued him about his appearance until he stood up and left the table. He returned ten minutes later looking quite dapper: he had just bought the shirt off our waiter’s back! (The waiter, fortunately, had a spare one in his locker.) Though I wanted to lighten the atmosphere with this tale at the funeral, I choked up and struggled to get the words out.
Herb, who had trained as a gynecologist and then as an oncologist, gradually developed dementia. He lived his last years in a state of such confusion and physical pain that I felt, as with my sister, that I had lost him long before he died. I was too ill with the flu to travel to Washington, DC, for his funeral, but sent my remarks with a friend to be read at the graveside.
I felt relief for him and for his family, and yet, at the precise time of his funeral, I grew agitated, took a brief walk in San Francisco, and unexpectedly broke into tears, recalling a scene I hadn’t thought of in many years. When Herb and I were in college and medical school, we had often played pinochle on Sundays with his Uncle Louie, a bachelor who lived with Herb’s family. Louie, an endearing man with a tendency toward hypochondriasis, always started the evening by announcing that he wasn’t sure he could play well that night because there was “something wrong upstairs,” pointing to his head. That was the cue for each of us to whip out our brand new stethoscopes and blood pressure cuffs and, for a five-dollar fee, take his blood pressure, listen to his heart, and pronounce him healthy. Louie was such a good player that we didn’t hang on to our five dollars very long: almost always, by the end of the evening, he had recouped his money and then some.
I loved those evenings. But Uncle Louie is long dead, and now, with Herb gone as well, I experienced a staggering loneliness as I realized I no longer had a witness to that scene of so long ago. It now existed only in my mind, somewhere in the mysteries of my crackling neural circuits, and when I died it would vanish entirely. Of course, I’ve known these things in the abstract for decades, and emphasized them in books and lectures and many therapeutic hours, but I am feeling them now, feeling that when we perish, every one of our precious, joyful, unique memories vanishes with us.
I’m also grieving Bob Berger, my dear friend of over sixty years, who died a few weeks after Herb. After a cardiac arrest, Bob was unconscious for several hours before being resuscitated, and during a brief interval of lucidity he called me on the phone. Jocular as ever, he rasped, “I bring you a message from the other side.” That was all he said: his condition quickly worsened. He slumped back into a coma and died two weeks later.
Bob and I first met in Boston in my second year of medical school. Though we subsequently lived on different coasts, we remained lifelong friends, and kept in touch frequently by phone and visits. Fifty years after our first meeting, he asked me to help him write about his life as an adolescent when the Germans overran his native Hungary. He told me about passing as a Christian and participating in the Resistance during the Nazi occupation of Budapest. He related hair-raising stories, one after the other. For example, at the age of sixteen, he and a fellow Resistance fighter, on motorcycle, had followed lines of Jews who had been tied together and were being forced to walk through the woods to the Danube, where they were to be thrown into the river and drowned. There was no hope of saving any of the captives, but Bob and his friend drove by and threw grenades to kill the Nazi guards. Later, when Bob was away for a few days, trying, unsuccessfully, to find his mother, their landlord had turned his roommate, another close friend, over to the Nazis, who had dragged him into the street and pulled down his pants. When they saw he was circumcised, they shot him in the abdomen and left him to die, warning onlookers to offer no help, not even a drink of water. I heard such horrific tales, one after another—all for the first time—and at the end of the evening I said to him, “Bob, we’ve been so close. We’ve known each other for fifty years. Why have you never told me any of this before?” His answer stunned me: “Irv, you weren’t ready to hear it.”
I didn’t protest. I knew he was right: I hadn’t been ready to hear it, and I must have conveyed that to him in a multitude of ways. I had long avoided any type of exposure to the Holocaust. I was horrified, as a teenager, when, shortly after the Allies liberated the concentration camps, the newsreels showed the few survivors, looking like human skeletons, and the mountains of corpses everywhere, being moved by bulldozers. Decades later, when Marilyn and I went to see Schindler’s List, she drove separately, knowing that I would most likely bolt before the end of the film. And I did. For me it was a predictable formula. If I saw or read anything graphic about the horrors of the Holocaust, I would be swept by a storm of feelings: terrible sorrow, unbearable rage, crippling agony, to think of what the victims must have experienced, and to think of myself in their place. (It was sheer luck that I had been safe in America rather than in Europe, where my father’s sister and her entire family, and my uncle Abe’s wife and four children, were murdered.) I never expressed my feelings explicitly to Bob, but he had picked them up in many ways: he told me that, though I had listened to some of his other wartime stories, I had never once asked him a question.
A half-century later, Bob had a horrendous experience in a Nicaraguan airport when someone attempted to kidnap him. He was heavily traumatized and it was shortly afterward that he contacted me and asked me to write about his life experience during his adolescence in Nazi-occupied Budapest. We spent a great many hours together discussing the kidnapping and all the memories it revived of the wartime years.
I braided his adolescent life experiences together with an account of our friendship into a novella, I’m Calling the Police, published in the United States as an ebook. In Europe eight countries published it in paperback. The title is taken from a particularly hair-raising incident in the novella. Though it had been over sixty years since the end of the war when the book was published, Bob so feared the Nazis that he balked at having his real name on the book jacket. I reminded him that any living Nazis would be in their nineties and harmless, but he insisted on using a pseudonym—Robert Brent—for the English and Hungarian versions. Only after a sustained campaign did he relent and agree to have his real name on seven of the translations, including the German one.
I have often marveled at Bob’s courage and tenacity. As an orphan, he came from a displaced persons (DP) camp to the United States after World War II speaking not a word of English. After attending less than two years at Boston Latin High School, he was accepted to Harvard, where he not only performed well enough to get into medical school, but also played varsity soccer—and all of this when he was completely alone in the world. Later he married Pat Downs, a physician, the daughter of two physicians, and the granddaughter of Harry Emerson Fosdick, the eminent pastor of the interdenominational Riverside Church in Manhattan. Bob asked her to convert to Judaism before their marriage and Pat agreed. In the conversion process, Pat told me, things were proceeding well until the rabbi announced that Jewish dietary laws banned the eating of shellfish, including lobster. Having spent much of her early life in Maine, Pat was stunned. She had eaten lobster all her life and felt this was too much, a potential deal-breaker. The rabbi, perhaps because of Pat’s eminent grandfather, was so eager to bring her into the fold that, after consulting with a consortium of rabbis, he made a rare exception: she, alone of all Jews, would be permitted to eat lobster.
Bob chose to train as a heart surgeon—he told me that the only time he felt entirely alive was when he held a beating heart in his hand. He had an extraordinary career as a cardiac surgeon, became professor of surgery at Boston University, wrote over five hundred research and clinical papers in professional journals, and was on the brink of doing the world’s first heart transplant before another surgeon, Christiaan Barnard, beat him to the punch.
At the end of 2015, after suffering the loss of my sister and of my three close friends, I had several weeks of the flu, with loss of appetite and weight loss, and then an acute bout of gastroenteritis, most likely food poisoning, with vomiting and diarrhea that left me dehydrated. My blood pressure was so dangerously low that my son Reid drove me from San Francisco to the Stanford emergency room, where I remained for a day and a half. I received seven liters of intravenous fluid, and my blood pressure slowly returned to normal. As I awaited the results of an abdominal CT scan, I had, for the first time, a strong sense that I might be dying. My physician daughter, Eve, and my wife stayed with me, offering comfort, and I tried to soothe myself by drawing upon a thought I had often invoked in my work with patients: the greater the sense of unlived life, the greater the terror of death. This equation calmed me as I considered how few regrets I have about the life I’ve lived.
After discharge from the hospital I weighed only 139 pounds—about 20 pounds under my average weight. Sometimes the hazy memory of my medical education creates problems. In this instance, I was haunted by a medical maxim: If the patient has significant weight loss of unknown cause, think of an occult cancer. I imagined my abdomen laced with metastatic lesions. During this time I comforted myself with a thought experiment suggested by Richard Dawkins: Imagine a laser-thin spotlight moving inexorably along the immense ruler of time. Everything that the beam has passed is lost in the darkness of the past; everything ahead of the spotlight is hidden in the darkness of that yet to be. Only that which is illuminated by the laser-thin spot of light is alive and aware. That thought always brings me solace: it makes me feel lucky to be alive at this moment.
I sometimes think the very act of writing is my effort to dispel the passage of time and inevitable death. Faulkner put it best: “The aim of every artist is to arrest motion and hold it fixed so that at some point a stranger reads it and it comes back to life again.” I believe that thought explains the intensity of my passion to write—and to never stop writing.
I take very seriously the idea that, if one lives well and has no deep regrets, then one faces death with more serenity. I have heard this message not only from many dying patients but also from great-souled writers such as Tolstoy, whose Ivan Ilych realized he was dying so badly because he had lived so badly. All my reading and life experiences have taught me the importance of living in such a manner that I would die with few regrets. In my later years, I have made a conscious effort to be generous and gentle with everyone I encounter, and I proceed into my later eighties with a reasonable degree of contentment.
Another reminder of my mortality is my email. For more than twenty years I’v
e been receiving a good amount of fan mail each day. I attempt to respond to each letter—I think of it as my form of daily Buddhist lovingkindness meditation. It gives me joy to think that my work offers something to those who write me. But I am also aware, as the years go by, of the ever-increasing numbers of email—a rush that is fueled by the knowledge that I shan’t live too much longer. Increasingly, this message is entirely explicit, as in this email that came a few days ago:
…I wanted to write to you a long time ago, but thought that you would get overwhelmed with emails and would not have the time to read them all; however I thought I would email you anyway. As you say yourself, your age is advanced and you may not be around for much longer and then it would be too late.
Or in another that arrived the following day:
…To put it bluntly, and I think you will appreciate this, I realize you will no longer be here at some point. I don’t want to take your existence for granted and regret not contacting you when it’s too late.… It would mean a lot to me to have an exchange with you because most people I know are not interested in discussing death, nor have they made their own personal connection with the fact that they will die.
Sometimes, in recent years, I have started lectures by acknowledging the size of the audience and saying, “I’m aware that, as I age, audiences grow larger and larger. And of course that is wonderfully affirming. But if I put on my existential spectacles I see a darker side and I wonder, why such a rush to see me?”