The European 14th century featured, among other devastations, a “great famine,” a “little ice age,” most of the Hundred Years’ War, and the Black Death, the worst plague known to history, which itself killed nearly one-in-three Europeans over a mere five or so years. The carnage had many consequences, and one was that the Church lost priests, and another was that Christians began to think of the final judgement as a close, personal concern, rather than a collective eschatological worry. And so the Council of Constance (1414–18) ordered up the Ars Moriendi, or Art of Dying, a catechetical manual suitable for use by priests and lay people that brought efficiency to the work of preparing the dying for salvation.

The initial edition of the Ars contained six chapters. Four dispensed practical instruction to the dying—including the rather important if belated news that a good life was the best preparation for a good death—while a fifth chapter prescribed behavior for family and friends attending the deathbed, and a sixth listed prayers. It was a model that must have proved very useful, because scores of copycat works (e.g., Craft and Knowledge for to Die Well and The Rules and Exercises of Holy Dying) were published across Europe over the next 200 years. In Rome, the Jesuit and cardinal Robert Bellarmine published the most popular Catholic ars of its time, titled De arte bene moriendi (1620), which some entrepreneurial British publishers stripped of its Catholic flavorings and republished in English. This edition, too, sold well.

Times change, but an interest in how to die endures. Today’s typical ars moriendi, however, is less likely to focus on gaining eternal life than on finding an artful way out of this one, a path between the Scylla of inadequate healthcare and the Charybdis of over-medicalization. Atul Gawande’s Being Mortal: Medicine and What Matters in the End (2014) is, by my lights, the most moving and wisest example of the genre, because it treats matters of the spirit in addition to untangling—as best can be done—the tripwires hidden within DNRs and the dangers of seeking counsel from the best people at Mayo and Mass General and then MD Anderson and Sloan Kettering.

Can these books—or earlier books or other books—prepare us at the end? Can they make us wise in our reckoning with mortality? Perhaps. Deathbed conversions, however—whether as a matter of religion or character—are rare. As the old ars moriendi intimated, most of us die pretty much as we’ve lived. If we’re Socrates, we die cogently and content under Plato’s care; if we’re Ivan Ilyich, we die, as Tolstoy savagely noted, like a man whose “life had been most simple and most ordinary—and therefore most terrible.”

So with my ever-harried mother, whose heartbreaking final words, whispered to a granddaughter who’d accompanied her on the long, last ambulance ride, were “I’m afraid.” So my unbridled father, whose last act on this earth was to momentarily rise in his hospital bed and throw a (blessedly feeble) punch at a nearby doctor. So my boisterous friend Burt, sailing off while regaling nurses (and only female nurses) with stories of his youthful exploits as a college varsity swimmer. And my friend Brian, a man of exuberant devotions and affections, writing not long ago to tell me he had been diagnosed with “a whopping brain tumor” (no other kind would have suited Brian), and then, “But I had the best luckiest blessedest life ever. Mary married me and the kids arrived.”

Perhaps the most artful and instructive dying that I’ve witnessed was lived by my friend David some years back. Receiving his surprise terminal cancer diagnosis, he went home and set up on a sofa in his living room beneath a bank of windows that looked out on a grand sugar maple and the woods behind. He took books from his shelves in various rooms and set them on a coffee table near the sofa, serious stuff: Kierkegaard, Kant, Homer, Plato, Shakespeare, Freud, the Bhagavad Gita, the Bible. And he read and received visitors (and ate chocolate and sipped Jim Beam) most every day for as long as he could. And each day he walked in his drive, testing his strength, calculating the tether’s shortening. And after a time, men came and put the sofa away, replacing it with a hospital bed. And a nurse came each day to treat his pain. (She did well by him.) He died one afternoon at the height of summer. The windows were open. He seemed to be dozing. His wife was beside him, reading. His teenage son was asleep on a nearby cot. His last words were to no one and everyone, and I’m certain he’d been considering them at least since the day the doctor told him there was no hope, and maybe for years before that. He was that kind of man, who studied his responsibilities as son, husband, father, friend, invalid, and mortal and made every effort to honor them. He opened his eyes and whispered, “Life is a miracle.” Then he died.

Our story on how student nurses come to learn their solemn duties begins here.

—Ben Birnbaum

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