Death of a Billionaire

avatar By Jason Tibbels, MD
Executive Medical Director
Mar
27
2012

Death is no respecter of persons.  It is simply an inevitable moment that we are all marching toward, whether we acknowledge it along the way or not.  I think about that moment often.  I’m not sure if that’s a function of getting a little older, or solely due to my career path; it’s probably both.  Over the last five years, I have seen the dying process in hundreds of its myriad manifestations, some more admirable than others.  Each and every one has etched its story into my own.

I’m asked frequently whether my job is depressing, or if I have difficulty not bringing my work home.  With few exceptions, I can honestly answer an unequivocal, “No”.  In fact, I don’t find caring for dying patients depressing at all.  There have been more sad moments than I can count, but that number is dwarfed by the moments that I count as joy.  I have learned a lot from dying patients and their families, and hopefully I have honored some of those pearls by applying them to my own life.

I suppose it’s easy for me to consider my own mortality, I’m faced with it every day.  I know that time is coming, I just haven’t been told when.  Only ten percent of the population dies suddenly, which leaves most of us to face it as a “process”.  Just like other things in our life that we know are coming, I think it’s worth thinking about how we will handle dying.  Some of this planning is philosophical, but much of it is practical as well.  Does your family know how you feel about life sustaining measures in the face of prolonging a life with no quality?  Will your children be left to wonder whether you would want artificial nutrition or ventilation with no hope of meaningful recovery?  I can’t tell you how many times I have sat with families who are facing difficult decisions about whether to continue certain interventions when a prior discussion would have made it simple.  My wife and children will not be left wondering if I would have approved of their decision.

In terms of the less practical matters, I’d like to share an excerpt from Steve Jobs’ eulogy given by his sister and published October 30, 2011 in the New York Times:

When I arrived, he and his Laurene were joking together like partners who’d lived and worked together every day of their lives. He looked into his children’s eyes as if he couldn’t unlock his gaze.

Until about 2 in the afternoon, his wife could rouse him, to talk to his friends from Apple.

Then, after awhile, it was clear that he would no longer wake to us.

His breathing changed. It became severe, deliberate, purposeful. I could feel him counting his steps again, pushing farther than before.

This is what I learned: he was working at this, too. Death didn’t happen to Steve, he achieved it.

He told me, when he was saying goodbye and telling me he was sorry, so sorry we wouldn’t be able to be old together as we’d always planned, that he was going to a better place.

Steve’s final words, hours earlier, were monosyllables, repeated three times.

Before embarking, he’d looked at his sister Patty, then for a long time at his children, then at his life’s partner, Laurene, and then over their shoulders past them.

Steve’s final words were:

OH WOW. OH WOW. OH WOW.

I’ve seen this moment in some variation many times, and as I read this description of such an intimate moment, I was reminded that death is the great equalizer.  Here was a man with every resource imaginable, but in the end, even Steve Jobs saw that death could be done well.  I hope that someday, death doesn’t “happen” to me, but I “achieve” it.



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