It’s either a very short consult, or a very long one. Because it’s often the first real question they’ve asked in their life, and the opener goes something like this.

“It’s a bit of a weird one. I’m afraid, like terrified, of death.”

“Yes.”

There is no upward inflection in my yes, no encouraging question at the end of it. It’s like they’ve told me that the Middle East is a tragedy, or we landed on the moon, or salted caramel is getting old this decade. They laugh self consciously. Sometimes I can’t resist  making the obvious joke and say, ”I can’t help you.” Then we both laugh, in the desperate camaraderie of two dying men in a battlefield trench, and have a cigarette.

Working as a doctor in an inner city clinic, I see an odd mix. The poor, sick and addicted. The rich, smart and successful. Students living on a bag of rice and the joy of being young. Bankers living on cocaine and expectation. Single mothers living to see their children do better, and refugees who astound me with their ability to keep living.

Those who come to talk about their crippling fear of mortality aren’t usually the ones who have seen the curtain lift on their death. They haven’t had a cancer diagnoses or a family history of a horrible neurodegenerative disorder. They usually have perfect bodies and perfect lives. They drink kale shakes, and they actually like them. They have functional relationships and the right amount of wealth. They work in sustainable finance start ups, they volunteer and spend time in the garden. They are well adjusted, metabolically sound and environmentally conscious. They have had their genome mapped and know the diseases to which they are prone, and they are working hard, desperately hard, to avoid them. They stomp on every hint of ageing. As their thirties progress, living in fear becomes intolerable.

Sometimes they’ve lost a loved one and need to talk. Others want the fear obliterated, preferably with medication. Some are truly choosing me to receive their existential cry, and if that’s the case, I’m honoured. We end up talking literature, philosophy and quantum physics, and depending on the number of people in the waiting room, science fiction and fantasy. They are consulting me about the meaning of life, and while I have no idea, I’m in.

Some of them assume they have a mental health disorder, and certainly we talk about that. But most often they don’t. This is a completely reasonable and appropriate fear, perhaps the only reasonable fear. It’s not disordered thinking, it’s probably the clearest thought they’ve ever had.

Humans have always feared death, but this group seem to have no framework with which to approach that fear. They seem almost annoyed that they have to die, perhaps because they have mastered the unpleasant side effects of life. Studies have shown that materialistic goal setting and values are associated with poorer well-being. These people are rich in things other than money – health, community, beauty, experience and safety. Could it be that these “non-material” elements are also a form of materialism, another thing we must learn to lose before we can accept death? J.R.R. Tolkien’s Númenóreans were gifted long life, wisdom and beauty, and “in the zenith of their bliss,” started grumbling about their mortality. Their pursuit of immortality led to conflict, fear, dissatisfaction with life and ultimately their downfall. The gospel of Matthew records Jesus’ observation, “it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.” French philosopher and political activist Simone Weil wrote that “the recognition of human wretchedness is difficult for whoever is rich and powerful because he is almost invincibly led to believe that he is something.” I believe our fear of death is an opportunity, a prodding, to look deeper into our nature. This is perhaps confronting when life is so satisfactory.

I don’t know what the meaning of life is, and I am afraid of death. But I’ll be crash tackled into my grave, shredded. I want to use up every enzyme in my liver, my forehead creased with love and thought and anger. Skin leathered by the wind and sun is a small price to pay for years of adventure in this world. I’m not ashamed of the evidence my thighs carry of a thousand good meals with friends. If you could wear neurones out with thought, I would want mine flayed.

My imperfect body works well and I like it, most days. But it’s a means to an end, not an end in itself. There’s something sad about building, rigging and polishing a perfect boat and then sailing it around a safe harbour to keep it that way. In The Prophet, Kahlil Gibran writes, “If you would indeed behold the spirit of death, open your heart wide unto the body of life.”

I have a patient whose body is barely holding together its remaining limbs. He struggles into the consult room each week, broken and gasping, knowing I can do nothing for him, and worse, he can do nothing for himself.

He grins.

”Hey Doc, I’m still fu*#!d, how are you?” And we laugh and have a cigarette.

That Lady Doctor

This piece originally featured in Womankind magazine, issue 14