In Memory of Teresa Death, an Ornament on the Tree of Life This morning I went to the funeral of one of my patients. Not because anyone had invited me, but because of the respect I sincerely felt for her. I cancelled my morning appointments and made my way to the farewell ceremony for Teresa, which was being held at ten-thirty. Although the central topic on the Farzanesh and Philosophy Conversations page (link to join the conversations: https://t.me/joinchat/Br1R4BRZa9lS8HYgpsyV6w) for the coming two weeks is “the meaning of death for life,” and I am also trying soon to publish my conversation on this subject with Ms Forouzmand, a psychologist living in the United States, even if none of this had been the case I would still have wanted to write a few lines out of respect for my patient Teresa. After years of enduring the suffering of scleroderma—a connective-tissue disease that can cause the skin and soft tissues to become hard and inflexible—she died a few days ago at the age of sixty-one. Through my work as a physician I have encountered the deaths of patients many times. With many of them, before their deaths, I have discussed the process of dying and what they wanted medically to be done for them. Many times I have stood before the lifeless bodies of people whose eyes had once been full of life, and I have had the privilege of being able to attend the farewell ceremonies of some of them. If you have never attended a farewell ceremony for someone outside Iran, I will try to draw for you a picture of this morning’s ceremony as one example of such ceremonies in Australia. The ceremony was held in a function hall. After parking my car, I walked toward the hall, which was surrounded by beautiful flower-filled gardens. In front of the entrance stood the black ceremonial hearse carrying the coffin, and two formally dressed people beside it welcomed me. A third person guided me into the hall and gave me a small booklet. Two photographs were beautifully placed on its cover: an image of Teresa in her youth looking toward another photograph taken in the final days of her life. Inside the booklet was a beautiful poem she herself had selected for those who would come to say goodbye, as well as the order of the ceremony and the programs that would take place. All the chairs faced a flat platform raised only slightly above the level of the seating. In its centre stood a white coffin covered in colourful flowers, in which Teresa’s body rested. Teresa had lost her hearing at the age of thirty-two. For this reason, half the people sitting on the left side of the hall were deaf, and beside the lectern stood an interpreter translating spoken language into sign language. After the opening introduction and a musical program, part of which Teresa herself had selected before her death, a part of the ceremony took place to which I have always wished our own culture could give greater attention and perhaps make room for within funeral rituals—which are, in truth, also meant to console those left behind. It is a practice that can transform a funeral into a celebration honouring the life of the person who has died. This part of the ceremony is called the eulogy. First, several people who knew the deceased very closely speak about that person’s life, characteristics, and achievements. Then those present are asked whether anyone else would like to speak, and several people from the gathering volunteer. I believe the eulogy is a very beautiful practice. It helps those present not only to form a clearer picture of the life of the person who has died but also to remember, for the last time, a beautiful and admirable image of them. A eulogy carries great emotional weight and is often accompanied by tears from both speaker and listeners, but it is not lamentation. At the same time, it often includes humour, sweet memories, and amusing moments from the deceased person’s life, bringing laughter to the speaker and those present. It makes possible a farewell that, like life itself, can be celebrated on both sides of sorrow and joy. Joseph Campbell, the great American mythologist, is quoted as describing death as an ornament on the tree of life, giving it a unique beauty beside which life itself can be celebrated. The eulogy places this final ornament on the tree of life so that the life may be remembered as a magnificent and meaningful celebration. There is respect in it for the person who has gone, consolation for those who remain, and many lessons for those present—lessons one may continue to think about for days and months. Continuation (2)... Perhaps you have noticed that, when someone dies, the image remembered by those who survive them usually begins to change within a few weeks or months. All of us have good and bad qualities, and sometimes the negative features of the person who has died were so prominent during life that they were at times difficult for those around them to tolerate. Yet within only a few months, survivors recalling that person begin to speak with humour about the deceased person’s miserliness, bad temper, stubbornness, or even dishonesty and lying—traits that had been astonishingly intolerable to them while the person was alive. Then, with the passage of time, all these features recede behind a more stable image that is, more or less, positive and worthy of respect. Death is the point at which the process of individuation comes to an end, leaving behind a still image accompanied by neither hope nor expectation. For the first time, what is is accepted as it is. It is as though everything—even the darker shadows of personality—suddenly finds its final meaning and is unveiled within the still, final image of the monument that was the life of the person who has died. From this perspective, a eulogy is an extraordinary ceremony because nothing in it is entirely hidden. Although the person’s beauty and virtues are emphasised, shortcomings and failures are also contemplated, and one attempts for the final time to understand and forgive them within the shadow of all that was beautiful. Now that we have reached this point, let me tell you about Teresa: what I knew of her and what I learned from her eulogy. It was about ten months ago that she first came to see me accompanied by an interpreter who knew sign language for people who are deaf. She had already arranged for her complete medical file to be transferred to my clinic, and through her careful planning all the necessary information was available to me. What I remember from our first meeting is the feeling of heartfelt joy I experienced afterwards. Her sick, suffering, frail body in a wheelchair stood in a strange contrast to the smile that never disappeared from her lips and the vivid intelligence and life in her eyes. Her presence conveyed a deep sense of joy, confidence, intelligence, quickness, and clarity of mind. Although Teresa was deaf, she could speak clearly and needed assistance only to understand parts of what others said. She understood much of the conversation by lip-reading, although for certainty and respect she usually waited for her accompanying sign-language interpreter to complete the translation and interpretation of the conversation. Looking through her medical file, I learned that she had been diagnosed with scleroderma at the age of twenty-nine. Given the severity of her illness, she had been told that her life expectancy, even in the best circumstances, was somewhere between ten and fifteen years. Through her exceptional spirit and strength of personality, she had lived almost twenty years beyond the most optimistic predictions, although living had exacted a painful price. She had undergone thirty-six major operations on different parts of her body, and relentless, untameable pain accompanied her day and night. I remember that the first time I examined her suffering body, I began with her toes because severe impairment of blood flow in scleroderma affects the extremities more than other parts of the body. When she removed her socks, what appeared before me were feet on which only two of ten toes remained. The others had been amputated over the years because of impaired circulation and infection in order to save her life. Her whole body had been wounded either by the illness or by surgeons’ blades, and it was difficult to believe that her extraordinary spirit had kept alive a body that should, by all predictions, have died years earlier. In the months that followed, whenever I saw her, what continually struck me was the strength and solidity of Teresa’s character. She always managed to place her pain and illness like wallpaper behind the magnificent image of her personality: the illness was visible, yet it was difficult to focus on it instead of on Teresa herself. Unlike many patients with chronic illness whom I see every day, she never made pain the central subject of our consultation. She tried to focus only on how to manage her illness and its many complications, which had severely affected everything from her kidneys to her gastrointestinal system. At the beginning of the new year, she brought me a greeting card she had made herself. The precision, delicacy, and beauty of that handmade card reminded me of fingers that could not even bend properly, and I found myself asking how she could be so “much” that such a terrible disease became so small beside her. She was unmistakably larger and higher than her suffering. Continued (3) .... Over the years I have come to feel that there are only two groups of people in the world: heroes and victims. Every day I see many patients who regard themselves as victims: victims of their childhood and their parents, victims of poverty and addiction, victims of their illnesses—simple or complex, acute or chronic, curable or incurable—victims of their suffering and pain, victims of others, victims of government, and even victims of themselves and of negative characteristics from which they believe there is no escape. Looking at their way of thinking and at the direction their lives take, I have learned one thing: it does not matter why we believe ourselves to be victims. Even if we have the best reasons, the consequence remains the same. We are victims, and to be a victim means that we are “less” while many other people and things are “more” than us; we are “below” while our suffering and pain stand above us; we are “small” while everything else is greater and larger than we are. Against this way of seeing, I have sometimes had the privilege of meeting courageous people such as Teresa, who are heroes in my world. People who are always more, always higher. They remind me of the image of Christ carrying a cross upon his shoulders, a crown of thorns upon his head and a scourged body, yet carrying his cross proudly to the summit of the hill of life in order to create, upon that cross, a magnificent image of himself. Heroes who wake each day and cry out: Where is the cross of my suffering? Give it to me so that I may take it upon my shoulders and climb the hill of life’s difficulties. Give me my share of suffering in this world and I will accept it openly and proudly; and if I can, I will carry the weight of your suffering as well. For me, Teresa was a living embodiment of the heroes I had always admired, and this was why I did not want to miss saying goodbye to her. With all my heart, and with pride, I went to say my final farewell. Yet there was something still more remarkable: something that had happened three weeks before her death. She had sent me a form to sign. In this document, an Advance Care Directive, she had requested not only that she not be resuscitated in the event of cardiac arrest, but also that ventilation, antibiotics, and any other medical intervention intended to prolong her life be withheld. I was astonished and postponed signing it until I could meet Teresa, because I wanted to understand her reasons and make sure she understood precisely what her decisions meant. Apart from one fall from her wheelchair two months earlier that had fractured her cheekbone, there had been no new serious acute problem suggesting the imminent death of someone who, for more than thirty years, had defeated death again and again through the force of her love of life. I saw Teresa for the last time in my consulting room two weeks before her death. As always, she had a joyful smile on her face and showed no sign of anxiety or sadness. She joked with me that if I did not sign the form, she would request that after her death I be the doctor who signed her death certificate. I think she had understood how much I hated the idea of being the final doctor to sign the document recording death’s victory over her thirty-year struggle. With complete calm she told me she felt the time to leave had come. She was in no hurry for it, but she knew she did not have much time left. I explained that medically there was no reason to think her death was imminent, although that possibility had of course existed at every moment of the previous thirty years. She was completely determined, but in the end she agreed that if she developed an infection it could be treated with antibiotics. Perhaps she accepted that concession simply to restore some peace to me. I signed and stamped the documents. On Monday morning, when I sat down at my desk, there was a note waiting for me saying that Teresa’s interpreter had called to let us know that Teresa had died peacefully the previous day. Continued (4) ... Today, at Teresa’s eulogy, I learned much more about her life. In a large room opening onto the hall, Teresa’s artwork had been displayed: paintings, knitted pieces, and embroidered works. All of them were filled with bright and beautiful colours. From the speech of a friend who had known her for thirty years, I learned that in her youth Teresa had been a Miss Australia candidate and that, despite being diagnosed with scleroderma and losing her hearing, she had completed university studies in education and continued teaching children until the final day when teaching became physically impossible for her. Her friend had been Teresa’s first teacher of sign language for the deaf. She said that after all these years she had still never met anyone who learned the language as quickly as Teresa. Again and again she spoke of Teresa’s innate intelligence and capacity to learn, and of how she never stopped reading or educating herself. She spoke of her determination, of how two years earlier—despite the objections of all her doctors—Teresa had travelled to Japan, a country she had always wanted to see, for her final overseas journey, and of how ten years earlier she had launched a campaign that raised tens of thousands of dollars in Australia and New Zealand for people with scleroderma. When the audience was asked whether anyone wished to speak about Teresa, I too was ready to say something about her and what I had learned from her. But when I raised my hand, I was astonished to see almost the entire room raise theirs. I wondered whether there can be anything more beautiful at the end of a life than for dozens of people, after we are gone, to be ready to speak with love about the effect our life had upon theirs. This is what remains from a life lived wholeheartedly, deliberately and reflectively. Several of Teresa’s deaf friends stood in front of her coffin and, facing both her and the gathering, spoke in sign language about the effect her life had had upon them and upon the way they understood their own physical limitations. They spoke of the lessons in joy and resistance they had learned from her. The final words of each person who spoke, directed toward Teresa’s still and long-suffering body, were that they loved her and would remember her with love until the end of their lives. I looked at this scene and thought of Joseph Campbell’s phrase, and of how death upon the magnificent tree of Teresa’s life had become only a beautiful ornament inviting us to remember and celebrate the beauty of her life—a height from which even the immense tragedy of her illness and pain appeared smaller than the beauty of the life she had lived. Death is a black curtain that makes the beautiful colours of life shine a hundred times more brightly. Even if death is a final and sorrowful event, there is something more frightening than death: the thought that we might be condemned to immortality forever, unable ever to leave this life on this planet. Immortality may at first seem a seductive temptation, but perhaps we should ask how compelling that temptation would remain after one hundred years, two hundred years, five hundred years, one thousand years, ten thousand years. Perhaps only then would we feel how good it is that we are not condemned to eternal life with all its suffering and repetition. The limited time of life allows us to give meaning to our living, to live intensely, to love, to experience, and to create from our fleeting life on this planet an image worthy of remembrance—an image whose influence may travel from us to others and through them into a future in which we are no longer present, but whose beauty we have helped to create.