The Emergency Department

The patient died.

Just hours earlier, I had been shadowing him in the Emergency Department after he had recovered from a heart attack. He was looking forward to getting home for Christmas, spending time with family, and the trips he and his wife had planned since retirement. He was frightened of dying throughout his stay, and was relieved to hear things were going to be okay.

The fear of death is a pervasive one.

That moment forced me to confront a question that is easy to avoid but worth answering: 𝐚𝐦 𝐈 𝐚𝐟𝐫𝐚𝐢𝐝 𝐨𝐟 𝐝𝐲𝐢𝐧𝐠?

When you think about it carefully, dying is fundamentally a break from consciousness, not so different from falling asleep, being under general anaesthesia, or being knocked unconscious. From your perspective, there is no experience of death itself, nor of loss. So I don’t think it is really death that scares us.

I think what scares us is something else: the feeling that we have not really lived.

When people are afraid of dying, what are they actually asking for? More time. Time to do the things they kept putting off. Time to become the person they meant to be. At that point, many would trade everything they have for just one more day.

The fear of death is often not fear of death at all. It is fear of regret. Fear of having sacrificed your days for an unguaranteed tomorrow.

As such, we can formulate a solution to what is often considered life’s greatest fear. As with many seemingly complex problems, the solution is blazingly simple, though not easy: 𝐬𝐭𝐚𝐫𝐭 𝐥𝐢𝐯𝐢𝐧𝐠 𝐭𝐡𝐞 𝐥𝐢𝐟𝐞 𝐲𝐨𝐮 𝐰𝐚𝐧𝐭 𝐧𝐨𝐰. 𝐃𝐨 𝐧𝐨𝐭 𝐤𝐞𝐞𝐩 𝐩𝐮𝐭𝐭𝐢𝐧𝐠 𝐢𝐭 𝐨𝐟𝐟. 𝐀𝐢𝐦 𝐭𝐨 𝐦𝐚𝐤𝐞 𝐞𝐚𝐜𝐡 𝐝𝐚𝐲 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐞 𝐢𝐧 𝐢𝐭𝐬𝐞𝐥𝐟 𝐫𝐚𝐭𝐡𝐞𝐫 𝐭𝐡𝐚𝐧 𝐬𝐚𝐜𝐫𝐢𝐟𝐢𝐜𝐢𝐧𝐠 𝐭𝐨𝐝𝐚𝐲 𝐟𝐨𝐫 𝐚𝐧 𝐮𝐧𝐠𝐮𝐚𝐫𝐚𝐧𝐭𝐞𝐞𝐝 𝐭𝐨𝐦𝐨𝐫𝐫𝐨𝐰.

When you begin living this way, the fear of death seems to diminish naturally as 1) you are too busy living to dwell on it, and 2) you stop accumulating regrets.

If your life plan depends on delaying everything meaningful until some future version of success, it is worth asking whether it is a plan at all, or simply a mirage. If achieving your goals requires sacrificing the best years of your life in the hope of eventually reaching some utopian destination, recognise the trade-off clearly, then do yourself a favour and reject the mirage.

As a useful reality check, it’s worth occasionally reflecting on the five most common regrets at the end of life:

1. “I wish I’d had the courage to live a life true to myself, not the life others expected of me.”
2. “I wish I hadn’t worked so hard.”
3. “I wish I’d had the courage to express my feelings.”
4. “I wish I had stayed in touch with my friends.”
5. “I wish that I had let myself be happier.”

A few questions I regularly return to for clarity and introspection are:

• What would you do if you had 10 years left to live?
• What goals are yours, and not from status or prestige?
• What is the highest-leverage thing you can do right now?

The fear of death may be the most fundamental of all fears, underpinning many of the others (failure, rejection, embarrassment, uncertainty). Yet contemplating mortality offers a surprisingly powerful decision-making heuristic: if time is finite, what choice will matter most in the long run?