AAs a medical examiner, the dead of all ages, shapes and sizes have been central to my career. Many times a day, over the past 40 years, I have looked intently and directly at death, knowing that for many – probably most – of the people I examine, the beginning of their last day had been quite normal. Death had come quickly and unexpectedly. So, as I get dressed each morning, I often wonder where I will be at the end of my day. At home? Or in a morgue, being slipped into a fridge on a shiny tray?
In medical circles, a global pandemic had been expected for several decades. The HIV/AIDS pandemic of the 1980s was a dark stage, resulting in approximately 36 million dead around the world, but I never anticipated that the first pandemic of the 21st century would develop from a virus in China. I expected it to come from a deadly DNA reorganization of the flu virus – as happened in 1918 when the “Spanish” flu killed at least 50 million people worldwide , and in the less lethal influenza pandemics that followed: 2 million died in the 1957 influenza pandemic and 1 million each in 1968 and 1977. The last notable influenza pandemic was swine flu, in 2009, which caused around 500,000 deaths. A severe influenza pandemic has been expected for about 50 years.
I know I’m unusual to have had such a long personal view of death and the inherently precarious nature of our lives. Many of us have never seen a corpse, even of a close relative. In our urban, westernized society, the tradition of paying homage to the body in an open casket in the living room is now rare. It was an opportunity to recognize the normality of death: to look it in the face; review your responses; to remember your own impermanence.
At the beginning of this century, it seemed to me that death had become a subject generally to be avoided, silenced, obscured and (if possible) simply ignored, at least until one was personally confronted with it. Now, the lack of that experience often means it feels overwhelming.
Before Covid, I noticed how our language was becoming more euphemistic. The noun is “death”, the verb is “to die”, but these words were rarely heard. Dying had become “passenger” – and the focus was usually on “softening that passage”, to cleanse and soften it and deal with death in a way that deflects distress. I felt I was seeing a significant disconnect developing between the deep, human process of grieving, with its inherent pain, stress, and sadness, and the emollient goals of the death industry. It was a disconnect that was welcomed by so many.
The pandemic has challenged this approach in almost every way. Suddenly, death and the consequences of death were at the center, day after day, of every news story. The facts were raw and painful, the words raw. The noun was “death”, the verb was “to die”. These people were not “past”. Covid, I hate your harvest, but thank you for rescuing such an endangered language.
As the pandemic continued, family interviews became the modern equivalent of the wake beside the casket in the living room. Where once there was little or no desire to see the body after death, now the denial of contact, at the end of life and after, was traumatic.
I hope one positive thing that will come out of our new reality is a change in society’s approach to death. It’s still too early to tell – and maybe I’ll never be able to tell, since I’m inside the taboo, looking out. But, from my point of view, I would say that a new willingness to engage with death would be a healthy change.
I was lucky. Few of my close family members have contracted Covid; none died or were even hospitalized. However, during the pandemic, three of my friends have died: two from natural illness – one suddenly, one slowly and painfully – and one from an accident. Covid killed many, but, even in the depths of a pandemic, I was reminded that people continue to die from other causes – and those causes also kill millions.
Let’s face the inescapable fact that humans are dying. Until then, life is for living.
Dr. Richard Shepherd is a pathologist and author. The Seven Ages of Death is out now (Michael Joseph, £20). To support the Guardian and the Observer, buy your copy at guardianbookshop.com. Delivery charges may apply