Views & Reviews Review of the Week

Mortal thoughts

BMJ 2008; 336 doi: (Published 01 May 2008) Cite this as: BMJ 2008;336:1021
  1. John Quin, consultant physician, Royal Sussex County Hospital, Brighton
  1. Jdquin{at}

A new meditation on death by Julian Barnes is perfect for doctors in a similarly anxious state about the grim reaper, finds John Quin

Thanatophobe—well, who isn’t one? An old boss, then in his 60s when I was in my 20s, once expressed amazement that I should think daily of death. The top man blithely never thought of the Big One. Julian Barnes does—“at least once each waking day.” He’s an expert “pit-gazer” and suffers “intermittent nocturnal attacks” of bolt upright panic. He regards his fear of death, though, as “low-level, reasonable, practical.” He wonders whether worrying about it can be another form of male boasting: “Night sweats, screaming—Ha!—that’s primary school stuff . . . MY FEAR OF DEATH IS BIGGER THAN YOURS AND I CAN GET IT UP MORE OFTEN.” This is the funniest book about death since Evelyn Waugh’s The Loved One.

Barnes tells us that “of all the professions, medicine is the one most likely to attract people with high personal anxieties about dying.” And that “this is good news in one major sense—Doctors are Against Death; less good in that they may unwittingly transfer their own fears onto their patients, over-insist on curability, and shun death as failure.” His own GP is writing about death too, a paper full of literary references. “Hey, that’s my territory,” he realises and then wonders if he is at the start of “a long preliminary conversation” between himself and what may turn out to be his own “death-doctor.” He admires her piece, notes her distaste for the overmedicalisation of death, but has reservations about her view of life as a narrative and death as the end of the story. Barnes thinks life is just “one damn thing after another—a gutter replaced, a washing machine fixed,” that it is of little if any meaning and all ending with a punchline to a joke we don’t get.

Barnes has a “vicious awareness that this is a rented world.” He thinks “death is the one appalling fact that defines life; unless you are constantly aware of it, you cannot begin to understand what life is about; unless you know and feel that the days of wine and roses are limited, that the wine will madeirize and the roses turn brown . . . there is no context to such pleasures and interests as come your way on the road to the grave.” All very well, but he knows he can’t face death down, not with words. He admits to limited experience of seeing dead people. Death has ceased to be with us in the house. He fears “the catheter and the stairlift, the oozing body and the wasting brain.”

The book is deliberately and enjoyably discursive, with nods to the usual haunted greats like Larkin, Flaubert, and Montaigne—“since we cannot defeat death, the best form of counter-attack is to have it constantly in mind.” And as chummy as an undertaker he quotes Maugham growling that we die as dogs die, extending the simile: “We die as well-groomed, well-tranquilised dogs with good health insurance policies might die. But still caninely.” Thanks a lot, pal.

Barnes is thumpingly realistic about his own future: “I expect my departure to have been preceded by severe pain, fear, and exasperation at the imprecise or euphemistic use of language around me”; “Unknown person dies, not many mourn.” That is our likely obituary in the eyes of the world. My brother-in-law once told me about an uncle of his who died but of whom no one could remember anything except that he could eat a digestive biscuit whole. We were silent for a bit then laughed hard. That this is what it should come to, your entire existence reduced to the ability to scoff a biscuit. Barnes would love to think that we are not a number, that we are free men, but he knows that when you get down to it we are all just waiting to be crunched.

Like an expert oenophile all the options concerning thinking about death are examined here, sniffed, tasted, rolled around the palate—and then spat out. Barnes seems to be getting close when he suggests that “God might have set up His own experiment, with us playing rat.” Certainly this is how this book reads, with the writer in a trap, like a doctor who looks at all the differential diagnoses and investigates them, opening and closing all the doors, only to find that death is the ultimate pyrexia of unknown origin, a problem unresolved by observation. Death’s virtues, Barnes suggests, are “at best artisanal: diligence, stubborn application and a sense of contradictoriness which at times rises to a level of irony; but it doesn’t have enough subtlety, or ambiguity, and is more repetitive than a Bruckner symphony.”

Maybe, however, he’d be cheered in his graveyard visits by Marcel Duchamp’s epitaph, “D’ailleurs, c’est toujours les autres qui meurent” (“Besides, it’s always other people who die.”) Barnes on death then: as bracingly real as a tsunami of variceal blood over your flashy new scrubs.

“Of all the professions, medicine is the one most likely to attract people with high personal anxieties about dying”


  • Nothing to be Frightened of

  • Julian Barnes

  • Jonathan Cape, £16.99, pp 250

  • ISBN 978 0 224 08523 6

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