Death is always with us, in the marrow of every passing moment

Every business should have a reading list, a pile of books to remind you why it is that you do what you do, to draw you back to a sense of meaning and narrative and to place your work in a larger context. For Swansong, the reading list centres on the notion of dying well.

Being Mortal: Medicine and What Matters Most by Atul Gawande is the book that most strongly influenced my own thinking. I read it soon after working with other researchers at UCT to estimate the cost of care in the South African medical scheme environment in the last year of life. The results were astounding. And when I connected this to my personal experiences of prolonged private sector deaths it felt like something was terribly amiss. As Gawande says “people with serious illness have priorities besides simply prolonging their lives. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity and extraordinary suffering.”

The book is magnificent because it moves between the personal and the systemic, weaving together narrative and science. Gawande doesn’t just articulate the problems with dying in a modern healthcare system, he also points to a wide array of potential solutions. Atul Gawande shares numerous stories of patients figuring out what matters to them most, a process that then guides their end-of-life decision making. My favourite story was of a patient who most valued being able to eat ice-cream and watch sport. I recently engaged in a Swansong session to articulate my own end-of-life wishes – a process that I found illuminating and empowering.

I love the way Paul Kalanithi’s wife Lucy describes completing an advanced directive as an act of love: “like a wedding vow, a pact to take care of someone, codifying the promise that till death do us part: I will be there. If needed, I will speak for you. I will honour your last wishes.” Lucy was married to doctor-turned-patient Paul Kalanithi. His memoir When Breath Becomes Air was written in the last months of his life as he courageously faced his stage 4 lung cancer diagnosis. It is heart-breakingly moving – and inspiring.

Our work as actuaries is abstracted from the human reality underpinning mortality tables and life insurance policies. The roots of actuarial science lie in death and dying. But we spend almost no time in our training as actuaries engaging with the humanity of what that means. If not in the work space, then perhaps in our personal lives, what occurs when we turn our gaze towards to own demise?

Kathryn Mannix, an experienced palliative doctor, argues that our societal fear of death is directly linked to tucking death away inside hospitals. She tells the stories of her patients as a way of normalising death. As Frank Ostaseski, founder of Zen Hospice and author of The Five Invitations says “Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight. She helps us to discover what matters most.”