In sickness and in health till death do us part

Document Type



Emergency Medicine


As a young physician I would challenge the potential fatality of illness, and my medical overconfidence scorned the concept of being at death's door. Now that I'm older and hopefully wiser, my exposure to recent illness, dying, and death in my own patients, family, and friends makes me ponder my own mortality. From a nonmedical perspective, overcoming fear of death is part of life. If we consider dying and death to be a journey, then that realization can be quite emancipating and exhilarating. We are then more likely to embrace both life (and death?) more passionately.

End-of-life decision-making has been a huge part of my professional medical training in America. I have had many discussions with my wife, Ayesha, about how no heroic measures should be taken if I were to be in a serious motor vehicle collision, or if I developed a neurologic illness or cancer that left me devastated and on a ventilator. An advanced directive is helpful, but despite that, the decision to discontinue care can be a hard one for a spouse.

To get some insight, I approached my teacher, Rakhshee Niazi, who recently lost her husband to amyotrophic lateral sclerosis (ALS). I asked her: “How did you reconcile with your decision to have your husband, Anver, fully resuscitated the time when he ended up on the ventilator and for the subsequent 15 years? Did you and Anver at any point consider do-not-resuscitate (DNR) status? I've never had this discussion with someone who actually had to go through with making such a decision. I've assumed from my cut-and-dried medical perspective that logic would be to let the person go.”

The response that I got from her shook me to my soul. It presented a very different perspective and is a stark reminder that there are few absolutes in life.


This work was published before the author joined Aga Khan University.