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  • Writer's pictureAnna Kaminski

On Mortality

Updated: May 3, 2020

Every day, at five random intervals, my phone pings. Each message begins the same way: "Don't forget: you're going to die." No, I'm not on the receiving end of death threats. Some time ago, I uploaded the free WeCroak app, whose sole purpose is to send you timely reminders of your mortality. It's the brainchild of entrepreneur Hansa Bergwall and it was inspired by a Bhutanese belief: to be a happy person, one must contemplate death five times daily.

The idea is that you receive five quotes per day from people as diverse as Plato and Emily Dickinson, all vaguely on the subject of death and the relentless passage of time, and it should jolt you into considering whether or not you are living your best life, and if not - if you're stuck in a job you hate, or a dead-end relationship - then it should prompt you to make that leap and change your life for the better, because no one really knows when they are going to die, and it could be a lot sooner than you think.

Some of the more memorable quotes have stuck with me:

"The material of the doomed stars and the material of my doomed body are actually the same material. Literally the same atoms…"

Alan Lightman

"Life is a hard battle anyway. If we laugh and sing a little as we fight the good fight of freedom, it makes it all go easier. I will not allow my life's light to be determined by the darkness around me."

Sojourner Truth

"Death is not an event in life: we do not live to experience death."

Ludwig Wittgenstein

"Story is our only boat for sailing on the river of time, but in the great rapids and the winding shallows no boat is safe."

Ursula Le Guin

"Whatever you're meant to do, do it now. The conditions are always impossible."

Doris Lessing

Lately, though, these messages have acquired an ominous feel to them, as the pandemic comes ever closer, so I would like to talk about my fear that I will die in this pandemic. I appreciate that that's not the approach that most people I know are taking; most people tell each themselves and each other that they'll be fine, that statistically there's little chance that they, or their loved ones will be among the 4%, and that may well be true, but I'm unable do that. When I was a teenager, my mentor expressed the thought that humans expend a great deal of energy on trying to block out the fact that death is an inescapable certainly, and that it will come for each and every one of us. I think he was right, and I, personally, find it easier to acknowledge and engage with my fears, because the suppression effort is more draining than facing the anxiety fuelled by fear of death.

Here goes. Today, I woke up from a nightmare in which I was faced with the prospect of fighting off an enormous horned demon with a plastic spork (spoon/fork). You don't have to be Freud to get that this is the mind's projection of feelings of impotence in the face of threatening circumstances. This is not unusual; when I am particularly troubled by something, I find that my dreams take on dark hues and I find myself either running from something dark and evil, or fighting something dark and evil, often with a completely inadequate weapon.(Apart from that one time, when I managed to conjure up a light sabre).

This morning I learned that the mother-in-law of one of my oldest friends has displayed symptoms of Covid-19, and that my friend is now self-isolating, possibly infected. At a friend's school in Madrid, Covid-19 has taken the brother and grandfather of one of her students. A 37-year old British official at the British embassy in Hungary has just succumbed. He was a year younger than me. A 21-year-old with no preexisting health conditions just died in the UK, the youngest British victim to date.

One in six Covid-19 patients fighting for their life on ventilators in ICU units are between the ages of 18-49, many with no preexisting health conditions, so don't tell me it only claims the old and infirm. When a friend of mine from London made some flippant remark about how it's "only the flu, but everyone's freaking out as if we're all going to die", I got angry, because it's manifestly not the flu, and because anger is my default emotion whenever I have no control over a bad and frightening situation, and god knows I have no control over a deadly virus.

I have a chronic respiratory condition that makes me particularly vulnerable. My lungs are my weak spot and this bastard virus causes viral pneumonia in 15% of the heavily affected cases, and outright respiratory failure in 5%. I've had pneumonia twice in two years, and the first time it almost killed me (though that was partly my own fault). There is little doubt in my mind that I'd be among the 15%; there is a possibility that I'd end up in the exclusive club of the 5%, or the even more exclusive club of the 'black tags'.

My respiratory condition made itself properly known in 2017, when I developed a persistent cough while on a work trip to Kenya. I ignored it, since I've been getting hard-to-shake coughs for many years (since that time I stayed in a converted prison in Sweden in 2011 and then hacked up my lungs for weeks afterwards), but then it got to the stage where my breathing became constricted at times. Did I go to the doctor? No, I went on a safari instead. It was the very end of my trip, you see, and I was really looking forward to staying with the Maasai and walking on the savannah. The safari was amazing; the animal sightings - mind-blowing (and I'm pretty sure I did actually see all the elephants, lions, wildebeest, zebra, hippos, hyenas, and that they weren't just the product of my fevered brain); the hot air balloon over the Maasai Mara at dawn - one of the most transcendent experiences of my life. By that point, I was finding it difficult to swallow because of a really painful throat and was hallucinating part of the time (I spent a chunk of one night awake and paranoid that there was a leopard on my roof, trying to get at me). It took considerable effort for me to walk the 40m from the main lodge building to my room in the evenings, escorted by my Maasai guard with a spear. When the Maasai took me walking in the savannah, I could barely keep up with them, and not just because my short legs couldn't match their long-legged stride.

I was in a bad state when I landed in the UK. I was supposed to go on a work trip to Vietnam a week later, but my doctor examined me, listened to my chest, told me that my lungs "sound like crunchy snow" - definitely a bad thing!; informed me that I was basically at death's door, told me off for not seeking medical help sooner and put me on bed rest, which lasted a month and a half because I just wasn't getting better. During the worst two weeks, my wonderful, no-nonsense GP called me every evening to make sure I hadn't popped my clogs. (She only told me the reason later, when I seemed to be over the worst of it. She's not a woman given to hyperbole, and only then did it finally get through to me how I close I came to shuffling off this mortal coil). It took me 18 months to claw my way back to around 90% of my former health and I was warned that, in all likelihood, I'll never again attain 100%.

Apart from bacterial pneumonia, my lungs became infected with pseudomonas, a common and very tenacious bacteria that lives in soil and only takes up residence in damaged lungs, and is really hard to evict once it starts using your ventricles as a condo. It took three rounds of a particularly unpleasant, nausea-inducing antibiotic to give it the heave-ho. There were relapses, too, with periods when I found it hard to breathe, and was choked both by my faulty lungs and by anger over the fact that my body - my formerly healthy, robust little body - was betraying me. In the early weeks of my treatment, when none of the antibiotics seemed to be working, and terms such as "pulmonary fibrosis" and "possible lung transplant" were tossed about, I wallowed in despair, thinking that I didn't want to live a vastly diminished life. Then I felt hugely guilty, remembering a patient that I worked with back in my days as a healthcare assistant. He had motor neurone disease, and an irrepressible joie de vivre regardless; something as trivial as wheezy lungs wouldn't have held him back.

Over six months after my coming back from Kenya, I was finally sent for a lung biopsy, whereby my throat was numbed so that the doctor could stick a camera tube into my lung and have a look. The sedation kicked in, but not before my heart was hammering at 240 beats per hour, because the numbing of the throat felt close to not being able to breathe. I have no memory of 20 minutes of my life and only came to in the recovery room, smiling woozily at the nurse because I was doped up to the eyeballs.

The results were cautiously encouraging. Inflammation, but no visible scarring. Still, I lost my nerve for a while, and for a few months after being bedridden, I couldn't see myself travelling again. That passed, and I cautiously agreed to a very gentle gig in the Channel Islands, some seven months after my initial illness, safe in the knowledge that I could easily receive medical help there. No more "machete gigs" for me, I thought. No more Haiti, or India, or Papua New Guinea.

Then came a further setback during what was supposed to be a writer's retreat in one of my favourite corners of the world - the village of Nida on Lithuania's Curonian Spit, a tranquil, pine-scented place by the Curonian Lagoon, part of the Baltic Sea.

I got a fever shortly after getting to Nida and thought that maybe it was the flu, which I've only had once in my life. It took me six days of functioning fairly normally in the mornings and then being floored by a fever of over 40 degrees every afternoon, bedridden, shaking, and surprisingly indifferent as to whether I lived or died, before I finally twigged that maybe it wasn't the flu, and dragged myself to the village poliklinika. It was a remarkable setup: a duty doctor, a couple of nurses, an x-ray room and a blood cultures lab all under one roof. I was seen quickly, the doctor listened to my chest, sent me to give blood and have a chest x-ray and rapidly returned a verdict: I had pneumonia and was a complete idiot for not seeking medical help sooner. (You see a pattern emerging here, don't you?) She then sent me to the local pharmacy for some IV drugs; one of the nurses parked me on a gurney behind a divider curtain in the treatment room, put a cannula in my vein, told me off for fidgeting and put me on an anti-inflammatory drip for an hour.

The fever disappeared straight away, I immediately felt better, and soon ate my first bowl of spicy bean soup in a week, having subsisted largely on sauerkraut and grapes up till then.

The same autumn, I finally got seen by one of the UK's top respiratory specialists who taught me how best to manage my condition and who told me that provided I monitored my breathing daily, took preemptive measures and nipped any burgeoning infection in the bud, I should be able to lead a more or less normal life. At around 85-90% of what I used to take for granted. So in theory, I could lead a long life yet. But with Covid-19, all bets are off.

Thinking back to the worst days of 2017, a 'dress rehearsal', if you will, for the final chapter of my life - whenever that may come to pass - I've come to realise that it's not oblivion that frightens me. I'm pretty sanguine about the prospect of blinking out of existence. In fact, during the most troubled days of Brexit, when I was grieving for the loss of my home, of my idea of home, of my sense of belonging, and found myself outright blubbering - not just a single stoic, movie star tear, but full-on, blotchy-faced, snot-spraying, full-throated sobbing, I remember thinking that it would actually be quite pleasant to just cease to be. Not to kill myself - nothing as difficult and messy and extreme as all that, but to just stop existing. Because then I wouldn't have to deal with any of it.

What frightens me is not the prospect of no longer existing - because by that point, presumably I will no longer care. It's the pre-demise suffering - the visceral fear and the helplessness - that I find highly objectionable. It was a real shock to the system, back in 2017, to discover that there were certain things I couldn't overcome through sheer force of will, that I couldn't get better just because I wanted to. For the first time since I was a child, I found myself utterly dependant on others. The visceral fear was triggered by the episodes during which my lungs spasmed - I'd try to breathe in, and it felt as if the air was hitting some sort of barrier and wasn't going into my lungs; I'd try again, with the same results; my body would flood with adrenaline, thinking it was being suffocated, and while outwardly I may have looked relatively normal, it felt like I were drowning inside. It would only last around 30 seconds at a time or so, but those seconds seemed interminable.

I consider myself a rational person, and have always had a pretty fatalistic approach to life. I've always made an effort to keep up my friendships and to see my friends and family whenever I could, in between work trips, because tomorrow is promised to no one. I manage my respiratory issues as best I can, measuring my lung output every morning and evening with a peak flow meter, using my inhalers as and when needed, taking anti-inflammatory steroids when my lung output drops below the prescribed amount. I'm a cautious traveller now, and accept that my days of travels to much of India, China and other 'lung-unfriendly' places are most likely over. (Ironically, I accepted a gig in Arctic Canada last year, figuring that endless forest and plenty of fresh air would be a boon, and then had to get out of the Northwest Territories like a bat out of hell because the Arctic was on fire). But none of this prepares me for the possibility of loss close to home.

My entire family falls into the highly vulnerable group. My parents - by virtue of their advanced age; my sister - because of her own respiratory issues. There is nothing I can do for them, besides telling them not to take any risks, and they're all wilful and stubborn. I can't place them in a hermetically-sealed container for the duration of the pandemic. I can't stop prevent them from inadvertently getting exposed. I cannot protect the people I care about, and it's this helplessness in the face of encroaching darkness that makes me well up at the drop of a hat these days. I've never been a crier. "Likkle but tallawah", the Jamaicans used to call me. "Little but tough". Well, not anymore.

One of the worst things about Covid-19 is that it robs people of the process of grieving, of being able to mourn properly from the moment your loved one falls gravely ill. I've been following what's been happening in Italy, and there, they can't even attend the funerals of family members. If someone gets ill, they must face it alone in hospital; no one is allowed to visit them because of potential contagion. When I was a healthcare worker, I was privy to a lot of mortality. I worked in a hospital, a hospice, nursing homes, private homes. When I sat with terminally ill patients while they slipped from this world to wherever it is we go afterwards, I discovered that even if a person wasn't particularly touchy-feely during their life, during their last moments, most wanted to hold my hand, as if that physical closeness would somehow keep them from slipping into the abyss, even though I wasn't their kin. It seems that no one wants to die alone. That most people want to be comforted before slipping away.

I've taken what practical steps I can. There is a packed bag sitting by my front door, with my meds and other things I might need for a hospital stay, just in case. I stay away from people because they might be incubi and succubi of viral plague. I've asked one of my friends to be the first point of contact for my family in case I get sick. I've checked flights to see if I can get myself to the UK if need be (nothing directly from Malaga, but there are expensive flights via Barcelona). Not that it matters. If a member of my family gets sick, then I wouldn't be able to visit them in hospital, help to take care of them or comfort them in their last moments, and the fact that the British government hasn't bothered to secure thousands of additional ventilators in time means that doctors will have to triage, like they do in Lombardy, and most likely decide that no one over 60 gets intubated. In the starkest terms, that means that if either of my parents get sick, if they don't recover on their own, they will be left to die. That if A&E doctors have to choose between my sister with her underlying health issues, and someone her age but without, and only have one ventilator...

What I'm trying to come to terms with here is my own impotence. My inability to influence events outside my immediate control - a terrifying prospect for a control freak. I'm frightened of getting cripplingly ill again, of being unable to fend for myself, and of maybe surviving, and being left with lungs the texture of cracked glass (pulmonary fibrosis), never to climb a mountain again, or even go up a short flight of stairs without wheezing. Or of outright dying. I'm not okay with the idea of dying. Specifically, of dying due to respiratory complications brought on by Covid-19. Of dying now, when there are still plans and goals left unfulfilled. I'm frightened of losing my loved ones to the virus. I'm just not ready for any of it.

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