Bunan (1603–1676)
Acknowledgments
First off, I want to express my gratitude to the doctors and nurses who saved my life and took care of me as I recovered at the Gulf Coast Medical Center in Fort Myers, Florida. I am singularly grateful to my cardiologist, Nemalan Selveraj, and to my primary care physician, Shaila Hegde, both of whom embody a rare dedication to the healing arts and an extraordinary capacity for empathy. I also want to pay tribute to the amazing group of nurses at the Institute for Hermeneutic Phenomenology at the University of Buffalo’s College of Nursing. Among this group, I am especially thankful to Annie Vandermause and Suzanne Dickerson, whose friendship and support have been invaluable to me. And there are a number of philosophers, medical humanists, and scholars whose work inspired me and helped guide this project along, including Havi Carel, Arthur Frank, Joseph Davis, Gordon Marino, Drew Leder, Nicole Piemonte, Richard Polt, Fredrik Svenaeus, and the late Charles Guignon.
The initial ideas for this book came about in the weeks and months that followed my heart attack in December 2017. In an effort to make sense of my collapsing world, I worked on a couple of essays. The first was a short narrative of the experience, “Notes from a Heart Attack: A Phenomenology of an Altered Body,” later published in the collection Phenomenology of the Broken Body, edited by Espen Dahl, Cassandra Falke, and Thor Eirik Eriksen (London: Routledge, 2019). At around the same time, the sociologist Joseph Davis reached out and invited me to a conference on the ethics of aging held at the Institute for Advanced Studies in Culture at the University of Virginia. I was too anxious and weak to travel at the time but managed to write a paper for the event: “The Contraction of Time and Existential Awakening: A Phenomenology of Authentic Aging.” The conference papers were published in the collection The Evening of Life: The Challenges of Aging and Dying Well (Notre Dame, IN: University of Notre Dame Press, 2020). I am grateful to the editors of these two collections and to Routledge and the University of Notre Dame Press for permission to reprint portions of these chapters.
The excellent editorial team at Polity has once again exceeded all my expectations. I am deeply grateful to my commissioning editor, Pascal Porcheron, who was an early champion of the project and encouraged me to make the book more personal, in an effort to disclose more of my own emotional and philosophical struggles. He went through the entire manuscript line by line, offering valuable feedback and commentary throughout. And Manuela Tecusan’s masterful copyediting greatly improved the writing and corrected countless syntactical blunders. I am also grateful to two anonymous reviewers for their critical feedback and recommendations.
I also want to thank my loving partner, Jane Kayser, who was with me for the entire journey and offered unwavering support and encouragement as she listened to me read aloud from early chapters of the book. But, more than anyone, I am thankful to my parents, Jim and Margaret Aho. In the autumn of their own lives, they have taught me what it means to face up to mortality and to live with a sense of awe, gratitude, and joy. This book is dedicated to them.
Introduction To Learn How to Die
It was a beautiful, sun-dappled December morning in south Florida. The sky was blue, the humidity low, and there was not a breath of wind as I began my bike ride through leafy neighborhoods in Naples, Bonita Springs, and Fort Myers. Three-and-a-half hours and sixty miles later, I was pedaling over the Estero Bridge toward my house and was suddenly overcome with nausea and lightheadedness. I squeezed the brakes, threw my bike to the ground, and vomited all over the street. Confused and thinking I had food poisoning or simply overdid it on the ride, I slowly rode back home. Then the chest pain came as a dull, persistent ache. I called my girlfriend, telling her that I was having some trouble. She said it sounded like I was having a heart attack. I dismissed it. “No, I’m just hungry and dehydrated and need to take a shower.” She raced to my house and convinced me to go to the hospital as the dizziness deepened. After a quick ECG in the emergency room, I was ushered into a suite of scurrying doctors and nurses who were already preparing the surgery. All I heard above the din was, “Massive heart attack … Widowmaker … LAD blocked … LAD blocked!”
A week after my heart attack was Christmas Day, and I was deeply shaken as I began to take the first tentative steps back into my life. I wanted to begin the day with a slow stroll around the block, but only got to the end of the driveway. My right calf felt tight and achy and my toes were numb. I came back to the house with a grim face: “Something’s wrong.” My girlfriend rushed me back to the hospital, where I received an ultrasound on my leg and, sure enough, a dangerous blood clot was found in my femoral artery. There were multiple days of treatment with a vascular surgeon, angiograms to examine the clot, and various tubes inserted through my left groin down to my right calf. (The right groin couldn’t be used, as this was the side that they had gone up in order to place the stent in my heart.) The surgeon was unable to remove the clot, so he opted for an aggressive intravenous clot buster treatment combined with high doses of blood thinners. I was unable to eat or stand for three days. Every hour, nurses would measure the size of my calf to see if blood was flowing, and each hour I was gripped by terror that the clot was getting larger or the pulse in my right foot was getting weaker. Each night was a din of buzzers, beeps, blood tests, and vital sign checks. I slept in fits and starts.
I was finally released from intensive care after the clot buster medication had done its work, and I was able to move to my own hospital room for observation. The diagnosis was that a clot in my heart had been discharged during the heart attack, and that I would need to be on a battery of blood thinners to prevent future clots from forming. On the second night of observation, an alarm and flashing red light erupted from the heart monitor that hung on the wall; it signalled a thirty-second burst of ventricular tachycardia. The next morning my cardiologist warned me that I had experienced a potentially deadly arrhythmia, which made me vulnerable to what he called “sudden cardiac death.” The solution was to wear a portable heart defibrillator (or “life vest”) for the next few months, as the clot dissolved, and then decide whether or not to implant an electronic defibrillator in my chest.
The combined effect of these events left me shattered. I was only forty-eight years old but suddenly felt old and frail. Ordinary tasks such as walking up the stairs or getting out of the car left me exhausted and out of breath. My future, once open and expansive with possibilities, had collapsed. And the interpretation I had of myself as a healthy and energetic college professor fell to pieces. I felt trapped in a meaningless present, left to the moment-to-moment rituals of taking medication, checking my blood pressure and pulse, and arranging the next doctor visit. I was suddenly forced to confront the existential questions I had spent so many years teaching and writing about, “Who am I?” and “What is the meaning of my life?” Indeed, the ideas of existentialism, that distinctive brand of European philosophy that exploded on the scene in mid-twentieth-century France, became an obsession for me as I convalesced at home, frightened and vulnerable. Its focus on the flesh-and-blood experiences of the individual, its emphasis on being authentic and honest about our condition, and its engagement with the ultimate questions of human existence, of the meaning of life and death, were more pressing and vital to me than ever. And I began to see the ideas of existentialism being played out in real life in my biweekly sessions of cardiac rehab.
Here nurses would put a group of heart attack survivors on treadmills and rowing machines and gently encourage us to exercise for thirty minutes while carefully monitoring our heart rate and blood pressure. I was at least twenty years younger than anyone else in the room, and over the course of these sessions I began to talk with and learn from my elders. What struck me initially was how differently they seemed to interpret the experience of their failing bodies. Whereas I was gripped by dread and was hypervigilant about every skipped heartbeat and flashing pain in my chest, they appeared far less shaken. They spoke of the importance of not worrying about things you can’t control, about letting go and taking pleasure in little things. There was an elderly woman, Beverly, who appeared to sense my distress. She sat next to me at the end of one of my final
