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A true acceptance of death gives freedom, courage, and power. Nobody can conquer death, but such an acceptance brings liberation – death loses its control over you and it transforms you completely as a person, says Philip Gould in his book, When I Die- Lessons from the Death Zone. The following book review is by Dr Ajey Hardeekar, followed by a book extract.

‘When I Die – Lessons from the Death Zone’
By Philip Gould (Edited by Keith Blackmore)
Paperback edition (2013), published by Abacus, an imprint of Little, Brown - London
Pages 240…Price: Rs.799/-

Most of us in India would never have heard of Philip Gould, nor would many of us know much about ‘gastro-oesophageal cancer’ (a cancer affecting the junction between the ‘food-pipe’ i.e. oesophagus, and the stomach) which happens to be one of the top ten cancers in the world. It is also a disease whose incidence is on the rise.

While we have fairly effective treatment options for say, breast cancer, gastro-oesophageal cancers continue to have a high mortality. This is mainly because the symptoms of early gastro-oesophageal cancer mimic those of the more common ailments like acidity, and dyspepsia and hence tend to get ignored. Besides, the operation for this cancer is quite ‘radical’. It involves removal of most of the ‘food-pipe’ as well as the stomach. That’s not all. Most patients also require undergoing chemotherapy and radiation too.

Philip Gould was polling and strategic adviser to former British Prime Minister Tony Blair. In January 2008 he was diagnosed with cancer of the gastro-oesophageal junction. After initial surgery and chemotherapy, the cancer seemed to have gone, but it recurred in 2010. Further treatment followed, but Philip ultimately succumbed to the disease in November 2011, at the rather young age of 61.

I suppose most cancer patients find themselves spending all their energy (and funds) in battling the disease, and putting up with the side-effects of treatment. It must be the rare individuals who go deep within themselves and try to find meaning in the midst of all this. Philip Gould was obviously one such individual; and an exceptional one at that.

This book became the focus of Philip’s life; so much so that he continued to read the proofs, and make suggestions and corrections almost till he breathed his last. He was keen to share his feelings, thoughts, and experiences with the world. The initial chapters, written by Philip deal with the course of his illness and the insights he gained during his journey from diagnosis, right up to his death. Philip’s account is followed by brief accounts written by his daughters Georgia and Grace, and a postscript by his wife Gail Rebuck, CEO of Random House (UK). Finally, there is an e-mail written to Philip by his close friend Alastair Campbell (Director of Communications and Strategy to Tony Blair, between 1997 and 2003), and an Obituary that had appeared in The Times.

Despite Philip Gould being steeped in the politics of New Labour and its leaders, this book has no political agenda. Politicians do appear in places, but they do so as close friends of Philip rather than as political leaders. Many of us tend to look upon politicians with distrust, and certainly do not have much regard for them. But we forget that they too are human. The constant focus on every minute of their life and every word they utter, means that they can rarely reveal their true, and innermost thoughts and feelings. This must be a pretty high price to pay for being in public office. Here we meet a deeply religious Tony Blair who was a genuine friend, and whose presence was a great comfort for Philip.

People generally abhor talking (or even thinking) about death. We know we are going to die one day, but prefer to act as if we weren’t. Even someone diagnosed with a serious cancer or any other fatal illness tends to be hopeful that somehow he/she would have a miraculous escape. Philip was no different at least initially.

But when his cancer recurred, and he was given a finite life of only a few weeks, things changed. He entered the last stage of his life – one that he calls the Death Zone, where conventional time ceases to have any meaning and death is a certainty. This is where the book gets thought-provoking. Philip asserts that his relationship with his wife and two daughters reached a higher plane, and he experienced a closeness and compassion that he had hitherto never felt. In fact he goes on to say that it was the certainty of death that brought about these changes; `

a person not in the Death Zone would find it nearly impossible to achieve such a sublime level in his relationships. He almost considers his cancer a blessing, adding that the bliss of this closeness was more than compensation for the travails of cancer. He goes on to say that if he were to be offered a miraculous cure, he may not like to go for it!

In the weeks before his passing, Philip Gould describes his intimate experience and relationship with the notion of the 'death zone'. In his final days he decides on a portrait. An image of himself, standing upon his grave site. Gould sends an impassioned message that reframes the perspective of life in the face of terminal illness. The portrait is on permanent exhibit at the National Portrait Gallery, London- Courtesy: Gimko Agency

He says that a true acceptance of death gives freedom, courage, and power. Nobody can conquer death, but such an acceptance brings liberation – death loses its control over you. Not only that, it transforms you completely as a person. Of course, some people continue to be in ‘denial’ mode when faced with death, and perhaps this is inevitable too. But for Philip denial was never an option.

Whether one believes in karma and after-life or not, the fact remains that we have to make peace with those around us and with ourselves if we are to die with some degree of ‘satisfaction’. My psychiatrist friend used to say that a dying person needs to have the feeling that he/she has ‘closed his/her file’, and nothing is left ‘pending’. It is this ‘closure’ that most people keep postponing till it is too late, as Philip discovered for himself. The finite life he had, forced him to take up this task urgently and ultimately led him to fulfillment.

Life can seem futile for a person who is struck by a fatal illness. Being in the shadow of death also raises questions of ‘purpose’. Philip found his, in the dissemination of his thoughts and feelings while in the Death Zone. Through this book, he hoped to dispel the fears associated with cancer in the minds of people, and show them that cancer can be fought with courage and dignity. He asserts that the human mind and body is capable of bearing great pain, and a person continually surpasses his/her own self, far beyond one’s imagination. In fact, death gives meaning to one’s life.

Philip was a strategist, and he approached his impending death with the same clear-headed thinking and planning that had defined his career. He even went to the extent of personally choosing (along with his wife Gail) the plot where he would be buried, and having himself photographed there! This photograph adorns the rear jacket of the book. Expectedly, the profits from the sale of the book are to go to cancer charities.

To a doctor, this book is also about two conflicting ways of health-care delivery, or perhaps ‘health-care management’ as it is increasingly being called. On the one hand we have the for-profit, market-driven private sector of the United States of America. This is a system being criticized for its inflated costs as well as for leaving a large chunk of America’s population with poor or no care because they are either not insured, or are under-insured. Philip underwent his first surgery at the Memorial Sloane-Kettering Cancer Center in New York, undoubtedly a centre of excellence for cancer treatment. His daughter Georgia was of opinion that he should take treatment in the National Health Service (NHS) of England. However, after recurrence of his cancer Philip underwent all further treatment in England as an NHS patient. The NHS is an exemplary public enterprise where most treatment is offered free of cost. The downside is that often there are long waiting-lists for routine procedures. Over the past few years the NHS has been at the centre of heated debates about reforming it and making it market driven, much to the chagrin of the public as well as the older generation of doctors. This debate (and its eventual outcome) is very significant for us in India, with its dismal health-care record. We have a very good private hospital infrastructure that has some of the best doctors in the world. It is increasingly being promoted as a destination for foreign patients who cannot afford treatment in their native country. This goes by the rather repugnant name of ‘medical tourism’. However the grim reality is that this sector is out of the reach of a majority of Indians. Some workable equivalent of the NHS is an urgent and dire need.

Keith Blackmore has done a very good job as editor, and the book reads easily. Cancer patients would certainly find it inspiring. But I would recommend it to anyone who has even the slightest philosophical bent of mind, or is interested in human relationships, irrespective of one’s political inclinations.

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