When I Die: Lessons from the Death Zone

Philip Gould's memoir When I Die is a frank and genuinely moving account of Gould's final days battling esophageal cancer. The book starts slow as the former Tony Blair advisor describes his original diagnosis in 2008 which led him to undergo a series of medical procedures and chemotherapy. After a couple years of remission, his cancer reappeared in a much more deadly form and at this point the book changes markedly from a somewhat perfunctory account of his various medical appointments to a much more spiritual one. There is something quite moving in the way that Gould faces his fate head on:

Before it started I thought: I simply cannot do this. I cannot do chemotherapy. It is too painful. It is too horrible.

But you do it.

Then the people treating you say: "By the way, mate, you are not going to have an oesophagus, you’re not going to have any of this or that or here or there, and you will never eat normally ever again."

And you get used to that.

Then you realise – whatever they throw at you, you can deal with it.

And that is because your body and your mind have an extraordinary capacity to deal with what is going to come later. It is just an amazing thing. You learn how to cope with these challenges, one after another. There is more in the human body than you will ever understand, more physically, more emotionally, more spiritually, more religiously, even. The body can cope. You can cope. You can do it. You can deal with the pain, you can deal with the discomfort, you can deal with the uncertainty, you can deal with it all. It is possible to deal with it all.

Realising that changes you as a person. Then there is the matter of courage.

You think: God, I’m scared, I’m a coward.

I thought I was a coward. I was the kind of guy who was frightened to go too fast on a bike in the evening. Too frightened to go on the big rides at Alton Towers, or do any of the scary swimming stuff, or even to duck my head under water. I just did not have the courage to do these things.

But when cancer came, bringing with it a great deal of fear and pain, I found I could deal with it. Time and time again I found the courage to deal with this acute and terrible pain.

The pain was and is bad. It is slow and mundane, day after day after day of pain, feeling sick, vomiting. Endless, endless, endless pain. But you get to be able to endure it. However horrible it is, cancer prepares you for what comes next. It prepared me. It braced me too for the fact that it might return; and when it did return, it prepared me to understand that it might come back in a much worse form.

It prepared me for all that, and then it tested me again. It said, actually, this is going to come back, and frankly it may come back in part because of human error. I am not, by the way, saying that necessarily happened. But nonetheless human error was a factor.

You have to live with that huge thing too. You live with the possibility that human error caused this.

So you are dealing all the time with a vast number of things. Fear. Uncertainty. Pain. And what I have found is that, as it goes on, you get stronger and stronger and stronger and freer and freer and freer. All the way through my cancer journey, my body and my mind have been able to cope with the next stage. Cancer prepares you to take the next step, even as you are completing the one before. In the end you lose your fear of the next step because you know you will be able to take it.

Gould had not been a religious man but he found a measure of spirituality late in life:

Saturday morning. Gail came to visit me in hospital and thus began three of the most extraordinary days of my life. I have never been a particularly emotional person but now I could see no alternative but to show her how I felt about everything that had happened and everything to come. I looked at Gail and wept.

I wept for the lost opportunities. I wept for the lost moments of happiness. And in the end, I wept for the lost companionship. I had never before been able to talk to her, or anyone else, with such intensity.

The power of cancer was proving much greater than the power of death. Until now I had always seen life as a succession of doors with names on them. Names like Birth, First Job, Marriage, Children, Retirement. And at almost every threshold I had crossed there was some genuine conceptual connection between what I expected to happen and what actually did. I felt this was dramatically not true of the door marked Death. When it comes to death there is a great gap between the name on the door and the reality.

I know that everyone has a different view of death, a different perspective on it, but I think they also share a consensus that death is wrong and belongs to another time and place.

Death is usually depicted as a time of decline, of growing irrelevance, as the ending of growth, the cessation of contribution. To some extent those things may be true. But for the dying themselves, like me, there is another dynamic at work: the sheer intensity of death leads us to assess our world in ways we have never done before, each contributing to a kind of pre-death moment of judgment.

For some it is God who judges us. That may be so, but I suspect that in fact it is we who judge ourselves. The unvarnished certainty that you are going to die within a certain period of time is an immensely powerful thing. It provides the opportunity for fulfilment and the experience of extraordinary depths of feeling and the chance of reconciliation that would never otherwise occur.

I spoke to David Sturgeon, a respected consultant psychiatrist, about these views. He said two things to me that affected me deeply.

The first was that the only way to have a good death is to accept it. The second was to understand that for many people, if not most, death is the most important time of life.

I remember very clearly seeing my daughters born and my father die. Both experiences had equal power. The babies arrived largely shorn of consciousness; my father, aged seventy-eight, departed with years of experience of life. What you are at the beginning of the journey is as important as what you are at the end.

Death is not frightening if you accept it. It is a time for immense change and transformation, a time to fulfil yourself and others, and a chance in a small way to change the world.

And these three days with Gail were life-changing for me. I was prepared to smash down my emotional barricades and be fully open and honest with her. I was ready to show her my acceptance of death and my vulnerability.

She responded in the same way, and by the afternoon our relationship had reached an intensity that we had never touched before.

This is a powerful and almost unbearably honest book about death and dying.