Memento Mori: What Makes Life Worth Living

I sent my living will off into the abyss a few days ago. Signed it. Filed it. Done.

And I sat there after and thought — that's not about how I want to end things. That's about how I want to live. Every day between now and whenever. That document is my will while living. And that's what this is about.

There's a Latin phrase. Memento mori. It means remember that you will die.

Most people hear that and want to change the subject. I get it. But stay with me.

Because the Stoics didn't use it to be morbid. Marcus Aurelius wrote it to himself in private — you could leave life right now, let that determine what you do and say and think. It wasn't a threat. It was a clarifying lens. When you remember that you're going to die, you stop wasting time on things that don't matter. You get honest about what does. (Meditations, trans. Gregory Hays, Modern Library, 2002.)

I've had a lot of that clarity lately.

Viktor Frankl

There's a man named Viktor Frankl. Austrian psychiatrist. Holocaust survivor. He wrote a book called Man's Search for Meaning and I'm just going to tell you — read it. I'm not going to summarize it well enough to do it justice, but here's the part I keep coming back to.

Frankl survived Auschwitz. While he was there, stripped to nothing, watching people die around him every day, he started noticing something. It wasn't always the strongest who survived. It was usually the ones who had something to live for. A reason. A person. A purpose. A faith.

I read that for the first time and thought — I've seen that. Not in Auschwitz. In the CVICU.

The patients who stopped fighting didn't just feel worse. They deteriorated. Fast. I watched it. I had patients who were encouraged, who had their family there, who had a reason to get up and walk — and they did well. And I had patients who were done before the surgery was done. Men who had built empires. Men who had pushed through everything life threw at them. And they just stopped.

It's not always the strongest that make it. It's usually the ones with a reason to.

Hebrews 12

Here's where Frankl and I part ways a little. Because when I read him, he takes me straight to Hebrews 12.

Jesus couldn't change the cross. He couldn't get down from it. But he could fix his eyes on what was on the other side of it. He chose what he anchored to. And that choice is what got him through.

Same thing with Frankl. He couldn't change the walls of Auschwitz. But he could choose what lived inside him.

My surgery is not the cross. It is not Auschwitz. I'm not making that comparison. But the template works at any scale. The freedom to choose your attitude — that one nobody can take from you. Not a surgeon. Not a diagnosis. Not a bad outcome.

Three Ways to Find Meaning

Frankl said there are three ways to find meaning. Through creation. Through experience. Through attitude.

Creation — you build something that didn't exist before. For me that's this website. I built it while preparing for brain surgery. That's not a coincidence. That's the point.

Experience — you go through something and you use it. As much as this hospital stay is going to be hard, I know I'm going to walk out the other side with something I didn't have before. The perspective of a patient. And honestly? That's something I wish I'd had last spring, when I was the one at the bedside.

And then attitude. The hardest one. Because attitude isn't a feeling. This is the part people miss. Frankl didn't feel his way through Auschwitz. He chose. My patients in the CVICU didn't feel like walking. They chose to walk. They chose to be optimistic. Those are different things. You don't wait until you feel ready. You decide, and then you move.

So how do I turn pain into purpose? I identify my values. I know what they are — I've got a whole book for that. I find my why. My why is pretty clear. I exist to glorify and honor the Lord. That doesn't change based on what's happening to my skull. And then I practice gratitude, I embrace this challenge, and I connect with people.

This past week I've had more people pray for me than I've ever had pray for me. More people reach out. More conversations. More connections. I've spoken to more people in seven days than I've spoken to in months.

But I want to be careful here — and Frankl was careful too. Suffering doesn't automatically make you wiser. Pain is not redemptive by default. He's not saying go find suffering. He's saying when it's unavoidable — when the surgery is already scheduled, when the cross is already there — what generates meaning is not the suffering itself. It's what you anchor to. What you decide to do with it.

That's what he called tragic optimism. Holding both things at once. Yes this is hard. And I choose to praise through it.

The last two church services I've been to, I've broken down in tears. Full tears. And I've been praising at the same time. I don't know how to explain that to someone who hasn't experienced it. You don't manufacture that. That's a gift. And I don't think you can access it without faith.

What I Saw From the Other Side of the Bed

I worked in the CVICU. I've been on the provider side of this thing long enough to know there's a problem nobody talks about.

ICU culture is built to optimize organ function. That's it. Not to treat people like people. Research in critical care sociology has documented it plainly — in the ICU, the patient becomes a body whose organs must be maintained, and that body disappears behind the machines.

I've been on both sides of that sentence now.

When I worked that unit, my approach was simple. I treated every patient like my grandma or grandpa. Like my mom or my dad. I let professionalism slip a little. I tried to make people laugh. I was just there to love the person, not manage the case. And I still felt the gap. I still felt the pull of the system toward the clinical and away from the human.

The numbers back it up. Delirium rates under old protocols were hitting 70–80% in mechanically ventilated patients.^[1] Patients losing 10 to 25% of their muscle mass in four or five days.^[2] People walking out with PTSD, hallucinations, lasting brain damage.^[3] One patient in Dr. Wes Ely's research — he's at Vanderbilt, where I'm having my surgery — believed every night that he was in a game show where he had to shoot someone with a bag on their head. That was his ICU experience.

How do you create a Viktor Frankl in that environment? How do you encourage someone to choose to walk, to choose to fight? You can't. The climate has to change before the outcome can.

I didn't know that quote when I was working the unit. But I was trying to live it.

My Two Doctors

I found two doctors when I started this process. The difference between them was exactly this. Personified.

The first doctor saw a case. The second doctor saw me. He knew I had clinical experience. He treated me as an ally. He talked to me like someone who understood what was happening, because I did. And that changed everything. Not just emotionally — it changed the actual quality of care I was going to receive.

One of the residents from the first team even said, off the record, that they wouldn't send a family member there.

When it's your name on the consent forms, that distinction is everything. I'm so glad I found the second doctor.

Patient Choice vs. Patient Voice

Here's what caught me off guard when I filled out my own advanced directive.

The whole document is about what you want. Interventions. Devices. Measures. DNR or full code. And I filled it out. But the research is clear — what actually guides good end-of-life decision making isn't what you want. It's what you value.

Those are different questions.

What do you want is a medical question. What do you value is a meaning question.

Would I want aggressive intervention if I couldn't recognize my family? What quality of life makes the fight worth having? What matters enough to endure for?

Those aren't questions for a form. Those are questions for your whole life. And if you can answer them clearly — if you know what you're living for — then you can answer the form. But most people fill it out in crisis, terrified, without ever having thought about the underlying question.

The document should follow from the life. Not the other way around.

My values all root back to my faith. That's what makes things meaningful enough to fight for. Physicians are responsible for the science. Patients are responsible for naming what matters. And if we don't advocate for our own voice in that room, the system will default to treating the disease.

The Image Behind the Machines

I'll be honest about something I don't talk about much.

Working afterlife care. Working with patients who were heavily sedated, who were unresponsive, who were essentially gone while still connected to machines — I used a mental trick to protect myself. I stopped thinking of them as people and started thinking of them as a car I was maintaining. Mechanic, not caregiver. It was easier on my mental state. It let me function.

There was still respect. But there was something I had to turn off to get through the shift.

What I didn't have language for then is this: every person is made in the image of God. That means every person has unconditional worth. Not conditional on their cognition. Not on their organ function. Not on what they can contribute or what it costs to keep them here. Unconditional.

When a patient disappears behind the machines, what gets lost is personhood. And no machine can grant or revoke that. It is inherent. It was there before the tubes. It doesn't leave.

That's why this matters. That's the gap. That's what needs to close — in every unit, at every bedside.

What I'm Standing On

My living will sits on four things.

Death is not defeat. Worst case, it's a win. I can live boldly because of that.

Life is sacred. Every person I care for, and every person who cares for me, carries the image of their Creator.

God is sovereign. Nothing about this is outside His control. I'm at the best institution. I have the best team. I'm in the best possible hands. That's not luck.

Prayer matters. Be still. Trust the Lord. I need that. The people around me need that.

Memento mori. Remember that you will die. Not to scare yourself into something. To clarify what matters. To stop wasting the time between now and then.