Introduction

I learned abouta lot ofthings in medical school, but

mortalitywasn’t one ofthem.Although I wasgivena
dry,leatherycorpsetodissectinmyfirstterm,thatwas
solely a way to learn about human anatomy. Our
textbookshadalmostnothingonagingorfrailtyordying.
Howtheprocessunfolds,howpeopleexperiencetheend
of their lives, and how it affects those around them
seemedbesidethepoint.Thewaywesawit,andtheway
ourprofessorssawit,thepurposeofmedicalschooling
wastoteachhowtosavelives,nothowtotendtotheir
demise.

TheonetimeIrememberdiscussingmortalitywasduring
anhourwespentonTheDeathofIvanIlyich,Tolstoy’s
classic novella. It was in a weekly seminar called
Patient-Doctor—part of theschool’s effort to makeus
moreroundedandhumanephysicians.Someweekswe
wouldpracticeourphysicalexaminationetiquette;other
weeks we’d learn aboutthe effects ofsocioeconomics
andraceonhealth.Andoneafternoonwecontemplated
thesufferingofIvanIlyichashe layillandworsening
from some unnamed, untreatable disease.

Inthestory,IvanIlyichisforty-fiveyearsold,amidlevel
SaintPetersburg magistrate whoseliferevolvesmostly
aroundpettyconcernsofsocialstatus.Oneday,hefalls
offastepladderanddevelopsapaininhisside.Insteadof
abating,thepaingetsworse,andhebecomesunableto
work. Formerly an “intelligent, polished, lively and
agreeable man,” he grows depressed and enfeebled.
Friends and colleaguesavoid him.His wife calls in a