STELLA

“Recently, I was sitting with a dying patient who was in pain and short of breath. I said, “I can see you are suffering.” He replied, “I’m not a person anymore. I can’t walk outside; I can’t play the piano. I’m just not a person. My time is up.” This exchange recorded in the essay “Narrative Possibilities: Using Mindfulness in Clinical Practice” by Julie Connelly, MD, author of the most recent post to this site, raises an urgent yet fundamentally unanswerable question: does the death of personhood precede death of the person? In his fragile physical state, moving toward death while immobilized on his deathbed, the man believed he had witnessed the interment of his personhood even as his body lived. Reading this exchange for the first time left me dismayed. That he no longer identified as a person because of his physical limitations was admission that level of ability relative to one’s past corresponds to one’s very existence as a person, and consequently, that disability means diminished personhood. While I will leave ontological argumentation to the philosophers in this case, personal experience gives me reason and license, presumably, to comment on the matter. Working each day with older adults who, because of illness or frailty, are no longer able to engage in activities that once defined them, I see that, while certain abilities have been lost, their personhood remains intact. I see their creativity emerge as they find new ways to interact in a world that ill health has made alien to them. An artist paints with her left hand when her right is crippled; a professor of literature invents a kind of sign language when words begin to escape her; a dancer taps her toes to the sound of music when weak limbs have left her all but in a wheelchair. Even days from death, an opera enthusiast enjoys one last show with a friend, watching scenes unfold on screen across from her hospital bed. These encounters reveal personhood bright and clear, where diminished faculties of mind and body have inspired adaptation, not evacuation, of identity. Personhood is more than ability, and the dying person continues to have access to personhood as long as it has modes of expression beyond those that it once had in the past—and these are infinite.

While I do not mean to extrapolate the dying man’s words as a general statement on the nature of personhood at the end of life, I do believe the implications that his words evoke must be challenged if we are to exit the dangerous territory in which dis/ability solely defines identity. Yet a second reading of his confession raises a different interpretation. “My time is up,” he concluded, casting his resignation of personhood in a new light. While his words may reveal the nature and degree of his suffering—his perceived distance from a former identity—his final statement suggests acceptance of his mortality. Perhaps, in some ways, resigning one’s personhood becomes a way to relinquish ties to identity as a living person and enter into the identity of one who is dying. For some, this subtle change in perception may be the key to a peaceful death. Perhaps the death of personhood must precede death of the person in some cases to ease or even enact the transition from life to death.

Much more can be understood from the man’s words, especially in the full context of his final days as described in Connelly’s essay, but for now those musings will remain unwritten. Nevertheless, this brief exchange between a patient and his doctor aroused in me both conflict and new insight. While it represents a seemingly fatalistic outlook on personhood at the end of life that need not, and indeed should not, apply to all dying persons, it does describe a mode of experiencing the dying process that may in fact help release ties that fundamentally resist the transition. For those of us whose time is not yet up, Connelly’s account calls on us to meet the dying person where he is—to abandon preconceptions of what is “best” for him (oh, how I would have liked to show him how much of his personhood remained to him without the ability to walk outdoors or play piano!) and to support his personhood or to accept his denial of it, as relationship and circumstance see fit. Personhood may indeed die before the person, but it is not inevitable—and it may yet never die at all. But that is for another post.

 — LC, 2013