Jacob M. Appel practices medicine at Mount Sinai Hospital in New York City, and his writing has appeared in numerous literary journals. In the Kenyon Review, Appel’s “Sudden Death: A Eulogy” examines living in a world where we no longer suddenly drop dead as frequently as we used to:
The exact rate at which we are not dropping dead is difficult to calculate: while the government keeps meticulous records on the causes of our deaths, and the ages at which we perish, it makes no effort to estimate the speed of our grand finales. Nonetheless, as a physician, my anecdotal sense is that we’re not dying nearly as suddenly as we once did. “When I started as an intern,” an elderly colleague recently observed at a staff meeting, “most patients only stayed in the hospital for a day or two. Either you got better or you didn’t. Lingering wasn’t part of the protocol.” Today, in contrast, lingering is the norm. Insurance companies force you out of the hospital, not rigor mortis. Where a generation ago, the expectation was for men to retire at sixty-five and keel over at sixty-seven—the basis for the pension plans now bankrupting municipal governments—a massive myocardial infarction in one’s fifth or sixth decade is no longer inevitable. Stress tests and statins and improved resuscitation methods mean we are more likely to survive to our second heart attack, live beyond our third stroke. Life ends with a whimper, not a bang.
That is not to say that the Grim Reaper never arrives on a bolt of lightning: I’ve lost a medical school mentor to a plane crash, a neighbor to suicide, a childhood friend to a brain aneurysm. Thousands of Americans, smoking less but eating more, still do succumb to heart attacks in their fifties and sixties. But we greet these swift departures not only with grief, as we have always done, but also with a sense of indignation simmering toward outrage. In an age of prenatal genetic testing and full-body PET scans and rampant agnosticism, all varieties of death strike many of us as anathema. Death without fair warning becomes truly obscene.