What's up, Hubski?
As I've disclosed in other comments I've made here, I'm in training to be a physician. Something that has been on my mind of late - both at a personal level as it applies to my own life but also within the context of medicine as an institution and what we actually do for patients - has been mortality.
I'm the kind of person that has been acutely aware of my own mortality since I was pretty young; I remember having the thought that I, too, would die at some point as I was going to sleep one night when I was 7 or 8. The thought terrified me - and, at times, it continues to do so. That my existence is finite and that death is permanent, eternal, and irreversible was and is disconcerting. I would like to think that I've matured since initially having this epitome, but if I had to answer the question, "are you afraid to die?," I think my answer would still be yes.
This sort of philosophical backdrop, in retrospect, makes me wonder why the hell I had any desire to become a physician - a job which inevitably involves intimate involvement with death. Though I'm a psychiatrist - a decision driven, in part, by my lack of desire to deal with people that are acutely ill in the "probably going to die pretty soon" sense - I will, of course, still deal with death. Mental illness is in many cases a terminal illness. Death by suicide is the ultimate complication, and in with the more severe illnesses (e.g., bipolar disorder and schizophrenia), suicide rates are disappointingly high despite treatment (anywhere from 10-25% depending upon the data you use). I have been fortunate enough to not have a patient under my care die yet, but I'm not foolish enough to believe that I can get through my career on a perfect streak. I couldn't imagine be a trauma surgeon, an intensivist (a physician, typically a sub-specialized anesthesiologist or internist, who works in the ICU setting), or any other physician that works with the acutely dying or near-dying on a daily basis. Naively, I still cling to the notion that my job is centered around not just keeping people alive, but enabling them to live a good, healthy, and fulfilling life.
This notion was challenged today, and it once again made me acutely aware of my own mortality. One of the long-honored traditions of medicine is the "morbidity and mortality" conference. These conferences typically involve the members of a department (e.g., cardiothoracic surgery) and involve discussion of patients in which there were unexpected complications (morbidity) or deaths (mortality). The impetus behind these conferences is to learn from them: in them, everything goes and candor is the rule. The point is not to place blame but, instead, to identify where shortfalls occurred if they did occur and how we can correct our systems and processes to prevent those shortfalls from happening again.
Today's case was a young man, an older teenager, who presented to the ER for sudden-onset blindness. An opthalmology consult was ordered, and examination of the retina revealed an occlusion of a branch of the retinal artery (the primary blood vessel responsible for providing blood flow to the retina, which itself is responsible for our ability to see). Initial workup involving a bunch of labs revealed a much more serious picture than expected - multiple findings suggesting systemic inflammation and widespread organ dysfunction though not outright failure - and he was quickly admitted for further care. He had no history of health problems and was otherwise healthy - an "upright citizen" (code for no drug use, risky behaviors, or other history of social problems that might otherwise impact health), as one physician at the conference described him. It was eventually discovered that he had bacterial endocarditis, or an infection of the valves of the heart. In particularly bad infections, this can lead to complete heart failure and death as these valves are critical to ensuring that the heart pumps effectively. A cardiac surgeon was consulted that evening - in these cases, valves are typically replaced and the patient treated with antibiotics - who ultimately decided to wait to operate in the morning given that he clinically looked well and he would have the advantage of a full set of staff available to help him in the case. A few hours later, it was noticed that he was looking acutely worse and had difficulty breathing, and shortly thereafter he went into cardiac arrest. A code was called, and he was successfully resuscitated multiple times but kept arresting. He ultimately arrested and was unable to be resuscitated and was dead less than 24 hours after arriving to the hospital. The case was especially heartbreaking because of his age and otherwise excellent health; in short, he simply wasn't the kind of guy who we expect to die suddenly in the hospital.
An autopsy revealed that he had an abscess (essentially a walled-off infection) involving his aortic valve and extending into his heart; it's believed that the infection expanded so far as to interrupt the heart's electrical conduction system, causing it to arrest. When he was still living, blood cultures to identify the presumed infection were obtained but had not grown out bacteria yet (it takes time for those buggers to reproduce enough for us to identify them). Those cultures as well as a culture of the abscess following his death revealed an infection due to a bacterium that commonly causes cavities. There's no way to know for sure what happened, but it's very likely those bacteria were dislodged during recent dental work, built up an infection in the heart, and - since he was young and otherwise healthy - grew without many symptoms until his body was unable to compensate any further.
This story was a stark reminder of the incredible toughness - illustrated by his ability to live with this infection for what was likely weeks or months - and its fragility. It reminded me of the incredible suddenness with which life may end. Do you think this kid had any understanding or expectation that he would be dead the week before he arrived to us? And it reignited by hypochondriasis and neurosis when it comes to how I interpret my own maladies. A random episode of numbness becomes, to me, a sign of multiple sclerosis or Lou Gherig's disease; headaches make me fearful of a brain tumor; some recent episodes of anxiety presenting largely with cardiac symptoms raised the possibility that I might have some undiagnosed heart abnormality that would result in my untimely death (comfortingly, "sudden cardiac death" is an actual diagnosis).
Most importantly, I was reminded of medicine's potency at pushing back death but also of its inability to prevent it. I struggle with the dichotomy of being concerned about my health - of being aggressive when it comes to seeing a physician and living as healthy a lifestyle as possible - with the reality that I will still die regardless of what I do and attempting to forgo the anxiety associated with self-diagnosis and constantly wondering, "is this the symptom that does me in?" In medical school, I spent a year learning about the elegance and beauty of the human machine, the next year learning every possible way it could (and does) go wrong and result in our ultimate demise, and the next two seeing those stories play out in real people. Even after those experiences, I'm still left with an uncertainty about it all: whether this profession is as noble as I once thought it was; whether we really do all that much good; and whether worrying about my own death is a relevant concern I should dedicate bandwidth to or not (and my incredible failure to control my visceral reactions to the realization that I must and will die).
I use that story as an introduction to ask: how do you frame your own mortality, Hubski? If you've managed to become comfortable with your own mortality, what insight or experience made that possible for you? If not, what emotions does the thought of your mortality bring to you, and how do you deal with them in productive (or unproductive) ways?
I was terrified of it when I was very young, but it was a specter then. When I was 14 years old, my father broke his neck in front of me. He lived more than 20 years beyond that, but died prematurely due to being a quadriplegic. From the moment of my father's injury onward, death was real to me. I think about it on a daily basis. I wish that weren't the case. I am not ready for it, and I don't expect that I will be. Death has visited my family, and premature death threatens family members and friends of mine. Of course, it might threaten me too, but I am unaware at this time. In a good moment, I can appreciate a kind of poetry about the condition of being an immortal-seeming consciousness in a mortal body, but mostly the cold reality that death is brutal and arbitrary washes that away. I saw a hit and run victim covered with a bloody white sheet last week. I'm infinitely happy that I have life, and it's well worth the caveat that it's going to end. However, I have no idea what a healthy outlook on death would be. I'm pretty sure what a healthy outlook on life looks like, and I do my best to concentrate on that.
Damn, frikking great commentary here. I'm in remission after having lymphoma for 2.5 years. I've thought about dying pretty much every day, and in a real practical sense not just a "what-if". I've set up google inactive account manager to alert friends and family to my "secret caches" to unlock my digital life and leave directions to make things easier for those cleaning up after me. That went a long way towards peace of mind. This has changed me in an unexpected way. How can one be optimistic about the future when you know you're going to die? How does anything you do matter? It's enough to make me wish I could swallow the stories put out by one or another religion. One thing that keeps me going is my children: my children are my immortality, not just for my genetics but for my attitudes and knowledge. I need to stay alive for them. Even though I know the entire world will be gone someday, that enough for me, it's enough "scope". And so I try to make something of myself. Put as much into the world as I can before I go. And hope that I can leave behind enough good stuff to help my kids, and maybe other kids too. Life. It sucks. But it's the only game in town. If you don't play, you get nothing. And I want something. I want it bad.
Kudos, Mike. My kids keep me going - wanting to better myself and give something to the world - and they are the ones that will be dying on me; or so says the world of medicine. I refuse to give up hope, however, and appreciate your honesty. When you know how badly life can suck, you cherish those peaceful, joyful moments all the more. Your kids have a great dad!
I remember an episode of Scrubs where Dr. Cox was worried about his daughter getting sick. He does the whole overprotective parent thing and takes it way overboard. In the end JD gives him a speech about how he is going to worry more than other parents. He says that he will worry more because he's seen the worst. He knows of every potential horror story. I wish I could find a video of it but Google seems to be failing me. I think my problem has been the opposite of yours. I remember being about the same age (8-9) when my mortality first struck me. The difference was that I was very ready to die. I was in church and we were talking about heaven. I found myself really wanting to die. That feeling never left me, I always felt like I was ready to die. When I stopped believing in heaven so much (that's a whole different story) My feeling of wanting to die didn't go away. I've fought with suicidal thoughts throughout much of my life. Every time I got sick or something I would secretly hope that this would be the illness that would do me in. Fighting that battle has made me pretty numb to death in general. I don't still want to die like I used to but I am ready for it. It's not something that scares me. I know that I am going to stop existing one day. It doesn't really bring up any emotions, at least not any I'm aware of. It's almost like blind acceptance.
The episode that always does me in is in the real last season, where JD and Turk are going to go to steak night, but stay inside with a patient instead that they know is going to die. And they talked to him all night. I couldn't possibly imagine that.
The way I deal with death is by realizing that when I'm dead I won't know that I am dead. The only thing I can consciously experience is life so why not make it the best it can possibly be? You did not exist for literally an eternity before you were born and you felt no pain, no suffering, no worrying. That exact same nothingness will continue on after you are dead. Nothing to worry about except for living a happy, meaningful life while you have the opportunity to do so.
This is basically how I feel, but with one caveat - I still fear death, if only a little. The thing that's really behind that fear for me is the thought of an early death, i.e. a death that ends my life before I've gotten the chance to do something meaningful with it. But all I can do for now is tell myself that at least if I die "too soon," I probably won't have any idea that it's happened. Some of my friends describe my quest for meaning and fear of a useless life as somehow noble, but the way I see it it's more selfish than anything else. I don't want to leave this life before I've really made an impact on the world, and sometimes I'm not even sure if I would mind that impact being distinctly negative. That's one of the reasons I really identified with Augustus in The Fault in Our Stars. (Great book, btw. Check it out if you haven't - YA lit doesn't have to be just for YAs.)
Ok, quick (Or not so quick, after I type it all out) backstory about OftenBen then into opinion/meat of the post. I was diagnosed with Hypertrophic Cardiomyopathy when I was three months old. At the time they called it Ideopathic Hypertrophic Subaortic Stenosis (I'll remember that my whole life. Sends the hospital staff for a loop when a 5 year old know his diagnosis and treatment better than they do) but basically what it means is that my heart is enlarged. Specifically my thickening is worst in my septum and lower chambers of my heart which means that I can't have as much blood in my heart at any given time as you normal folk, as well as some other issues. I tire out quickly, get short of breath doing any kind of 'normal' physical activity and could spontaneously go into cardiac arrest. I had my first (and so far only!!!) open heart surgery at 11, to remove part of the septum that was causing an obstruction to my outflow tract, had my first pacemaker placed at 14, and got my newest one at 19, which is supposed to last me well into my 30's. When you grow up with THAT kind of Damoclesian doom over your head you come to terms with your mortality pretty quickly. When I was younger I was very Christian, and knew that, even though I would die someday, and probably sooner than most people, I would be unconscious when it actually happened and then I would be in heaven, no sweat. Then I went to college, smoked pot, tried to be really Christian for a while even though I was starting to have doubts, and then lost my faith entirely when I realized that people couldn't have the kinds of questions I did and keep their faith. That period of time, combined with some really fucked up shit with my family, got me a depression diagnosis and a SSRI perscription, during which I didn't think too much about my mortality, or anything really. I contemplated suicide for a while at my lowest point, and the thing that really stopped me from more than idly daydreaming about it was thinking about all the time, effort and money that had been put into keeping me alive thus far. Since stopping the SSRI's and being more honest with myself about what I actually DO believe, rather than what I WANT to believe, I've decided that for right now, I'd rather live. I could theoretically start a spiral into full blown cardiac failure at any time, but for now my prognosis looks pretty good for the next few years, medically anyway. At some point, I will no longer BE, so while I still AM, I want to have fun, and maybe accomplish some good before I go. A while ago we had this thread about how we want to be remembered and I didn't have an answer then. I still don't have one, but I want to think that someday I will. Until the day comes when I am no more, I'll keep and treasure my pessimism, my anger, my sadness, and fear along with my hope, my love, my joy and my bravery to face each day, because they are so fully mine. I use my coming death as a reason to get something done now, while I'm still able to do so. Sometimes it feels like building a sandcastle below the high tide mark, but when the tide comes in, I'll be gone with the castle.
When I was four years old I learned about death. I was told it was like going to sleep. I soon had the realization that my mother would die someday and as a result of my worry spent several sleepless nights. Then, as I lay in bed, it struck me that I would die some day. I have never completely recovered from this realization.
As a child I had existential depression- normally something the gifted have a tendency towards, although I am not considered gifted. I had huge frustrations about “The Great Mystery”, something which caused me anger. What the heck. Why are we we here? What’s going on? Why is nature so ruthless? Why is there suffering? Is this some kind of cruel joke? This went on in a fairly intense way until I became a mother at the age of thirty. Motherhood helped, it gave me a purpose in a way which I could feel deeply.
I still have these feelings of fear and frustration. Age has helped me to calm down a bit.
There is another thing which has helped me. I became a student of Northwest Coast Indian medicine. It happened sort of by accident. I was looking for help with what I later (in my forties) figured out was a lifelong series of derealization panic attacks. I have had these attacks at least since the age of seven, and I believe they may have originated with learning about death when I was four. Once I figured out what they were I pretty much stopped having them. The attacks had been diagnosed as petit mal epilepsy by doctors (neurologists etc) throughout my childhood.
I am not a new age airy-fairy sort of person. I did get involved with the traditional teachings of the area in which I live. I studied seriously within the Indian community for many years.
I still have no idea about “The Great Mystery”.
What did happen is that I had numerous experiences which I can not explain with logic. I learned that there is something beyond what we normally experience of this world. I don’t understand it. However, the fact that there is something beyond what we understand, something spiritual in the very basic sense of the word- this is a great encouragement to me.
My personal experiences lead me to believe that time and space are complicated and that somehow every possibility exists at one time (outside of time). Something like what greatscott said.
I will share one thing that happened to me, because it directly relates to the subject.
During one of my college summers I was in another state taking care of my grandmother. My grandfather had recently passed away. One morning I woke up with a woman’s voice in my head, saying “Al says to check your mailbox at school when you return.” I thought, “Who is Al?” It wasn’t until that afternoon when I saw mail addressed to my grandfather that I realized his name, Albert, could be shortened to Al. He had always gone by Bert. So, of course, at the end of the summer when I returned home I checked my school mailbox. This was a cubby in a hallway. It should have been empty. I never received school mail in the summers. By chance, however, a teacher had left a graded paper in my cubby and had set it there too late for me to find as school let out. It was a paper about death and dying. The only thing I had ever written on the subject. It was a comforting essay, with references to the work of Elisabeth Kübler-Ross. My grandparents had an intense fear of death and I do believe that my grandfather, somehow, sent this message to me to let me know that “everything is OK”.
Of course this could have been coincidence, my subconscious, or whatever. But even so, it is a comforting memory. Because of this orientation that I have, I find that I am guided by feelings of what is important in life. To me, what is important is self expression, doing for others, following my heart. I feel that if I make this sort of use of my life then I am doing the best I can in this baffling world. Somehow I don’t fear death as much if I don’t feel I’ve wasted my life.
I don't think I'm comfortable with my own mortality, nor do I think of myself as a fatalist, but my mortality is something I have only limited control over. That said, I'm with others in this thread in that I think that making good use of my time is very important (which is why this period of intermittent employment really gets to me sometimes). I called the instructor of a conflict in healthcare course that I just recently completed, to pick her brain about how I can approach my next steps toward creating a meaningful career for myself. In our discussion it became increasingly clear that my interests didn't really fit into the mold offered by graduate programs. I'm really interested in conflict engagement, diplomacy and behavioral psychology and unfortunately my instructor pointed out that graduate programs in these fields tend to move people in very different directions and that it may be that my interests will conspire to lead me to create a niche for myself. Or attempt to. Now, a big part of our conversation had to do with figuring out what questions to ask various academics such that I would be able to more easily figure out how to beat a path. I feel like that's how I view mortality. I've been around death more times than some and yet it's not something that I really understand. I understand the biological meaning of death and how people deal with grief and how it has affected me or has not affected me, but I don't understand how that all applies to me or doesn't. I recently had a birthday and when I think about time passing I realize that I have so much more than I used to and that I willingly made that choice. Oh for the days of money in my pocket, booze in my gut, girls in my bed and the sunshine of utter apathy. At this point I'm sure if I live long enough, I'll be able to look back at all the peaks and valleys of whatever life I've lived and know that I'd have lived as much as I cared to but what I find gets to me these days is the weight of possibility. It's like that scene in Indiana Jones and the Last Crusade when they find that room with the grail. Maybe I'm Indiana. Or maybe I'm Belloch. Either way, there's no "carpenter's cup" and having to make that choice feels like a death. I'm not sure what that means either, but I guess that to me death is ultimately the end of possibility and for some reason that unsettles me more than the thought of dying.
I seems like I'm a bit out of the ordinary, but I don't think about death or my death much unless forcibly confronted with it (someone close to me dies, reading a horrifying story online, etc.) I've got too much living to do to die, and I certainly do not want to think about my death while living. I don't think about not thinking about it - I just don't think about it. It's just not a part of my daily life. One of my all-time favorite movies is Harold and Maude. If you haven't seen it, go out and watch it right now. It touches on a lot of subjects - coming of age, love, wealth, death, etc. The soundtrack is amazing and the psychiatrist has some fantastic quotes that will probably make you chuckle.
Maude: Vice, virtue. It's best not to be too moral. You cheat yourself out of too much life. Aim above morality. If you apply that to life, then you're bound to live it fully.”"Harold: I sure am picking up on vices.
I can relate to how you feel. For me it seems like I am still too much in the spur of life to care about it - just too far away, it seems. It's the easier answer, I know. I don’t want to live like I’ve already lived / but I do want to get busy living Edit: You know what, I do have something to say about it. I had to translate some Latin, the letters about Pompeii. One sentence always stuck with me. The people in the city were aware that they were probably going to die (as hell broke open over them), but didn't know when it would happen. After a while, some of the people were screaming for Death to come, just so their fears would come to an end. I don't think about death too much: it'll only hurt me if I do occupy my mind with it.
I have accepted the fact that I will die some day, but, I don't know if this is a "false" acceptance. What I mean by that is that when push comes to shove - maybe I will be afraid of dying... However, I live my life exactly the way I want to. I have little or almost no regrets, I try to be a good person and take pride in that, but at the same time getting out of the comfort zone. I live now, for I will be dead one day. So I am comfortable with my own mortality.
I had a philosophy teacher in high school who said that if you want to be truly happy you need to accept your death. He was a cool teacher and all but it wasn't like he was some kind of awe inspiring font of wisdom but for some reason that bit really stuck with me. I believe that I am unafraid of my own death. I still fear pain and the pain which my death would bring my family. It saddens me to think that if I die I would not get to see my daughter grow up or have whatever aid and wisdom I might give her and how my wife would cope (just thinking about not getting to know my daughter as an adult makes me tear up), but I never fret about the fact that some day that which is me will be entirely gone. maybe the fear I feel for my family is my fear of death but I certainly feel no resentment at the fact I will end. As far as the nobility of medicine. If it weren't for antibiotics I'd be dead today. I got bit on the hand by a cat a few years back and if it weren't for antibiotics I'd be lucky if my nickname was "stumpy". I've seen lots of terrible psychiatrist, my family is plagued by mental illness, but I can't say that things would have been worse for many of my family members without it, a few were even better off. When my father in law was dying of cancer he was overcome by fear and worry about his death. After he had a few sessions with a psychiatrist and end of life councilor he was able to face his death with sad resignation (which sounds pretty grim but it was actually a great comfort to him and his daughters). With out the intercession of mental health professionals I think that his final weeks would have been incredibly more painful on him and my whole family, I am truly grateful for their intercession.
Subjectively: Have you ever fainted or gone under anesthesia, to have time jump in the blink of an eye? What happened in between? It doesn't matter. Time means absolutely nothing if you're not conscious. So at the very least, I don't think the concept of being dead itself should be worrisome.
Philosophically: Other than that - and this is maybe unfounded - but I like to hope/assume that all instances in time actually exist together in a higher dimensional space. It just so happens that - (1) nearby instants in time are very similar to one another, and (2) the notion of the "arrow" of time is somewhat of an illusion derived from how our brains are built to have memory. But really all of these moments exist together despite our private subjective experience in the moment giving an illusion that time is moving forward. So in that sense, we're like books. It has a first page, middle pages, and a last page. There is an ordering. But the book is always still there. Every word is still on the page. And in that regard, we are immortals who cannot subjectively experience our own immortality. To give credit to the book analogy: the TED talk show on NPR recently had a good ep on "fear" and death was one of the topics : http://www.npr.org/2014/05/23/312544032/should-we-be-afraid-of-death
Last... do you really want to waste the precious moments that life has given you worrying about something you can't even have a subjective experience of? In a sense, it's JUST as silly as worrying about what a random person down the street is cooking for dinner every night. You can't/don't actually experience it. It's totally useless stress! Getting meta: there's so much we don't know about the universe. It could even be the case that time loops at some point. What if it is the case that your moments exist together for all "eternity" (for lack of a better term). Then you'd feel REALLY silly about wasting your time fretting, because you'd be re-living that worry over, and over, and over, and over.
Facing these concerns head-on seems like the best approach. How We Die is an instructive corrective to unrealistic hopes of a "death with dignity." Dr. Nuland writes well, as do you, making medical issues understandable without dumbing them down. I may as well mention that he died in March. I find Dr. Yalom quite insightful on these questions. Sometimes humor is the best medicine.
A lot of young people have an invincible complex - that is to say they do death defying things because they think they won't die. When I was young I did some ridiculously dangerous things, but I think it was because I didn't worry about death. I don't know why, but I don't think I have ever feared it. I worry about death a little more now - but even now, it's really more about what it would do to my wife and children that gives me any reservations. I've spent the last three days visiting the bedside of a friend who is in her final days. She is washing in and out of consciousness. Her breathing is getting more difficult. Last night they started the morphine. I don't think she'll be alive when I go this evening. She is surrounded by family. Other friends like me have been visiting. When she comes around… she just smiles. She cracks a joke. Yesterday after a long period of unresponsive haze, only showing a slight signal of "no" to a nurse asking if she was hungry, she blinked a little, then looked at me with laser like focus and said "I WOULD like some tapioca." I don't think she fears death right now. She seems very peaceful (even before the morphine). I think her peace comes from living a very full life. A happy marriage. A few successful small businesses. Several kids. Serving in her community and church. Countless friends. ok… rambling thoughts over.
Thinking about this a while ago gave me a pretty significant panic attack last year, just two days before my 22nd birthday which fucked me up for a good few weeks. After this (for that and other reasons related to semi-frequent bouts of depression and anxiety) I started seeing a counsellor about my issues. The counselling didn't do much to ease my problems nor solve them and I still have issues today. It was through doing searches online out of curiosity that I came across the research of Dr Ian Stevenson and Dr Jim B. Tucker, both child psychology researchers at the University of Virginia who studied children across the world claiming to remember living previous lives for decades and had accumulated thousands of case reports. It was that which gave me hope but now I'm not so sure because as much as I'd hate to believe it, the skeptics have a point. We have no evidence beyond this which suggests the existence of reincarnation and it is based on memories which have either been skewed through confirmation bias, fabricated, imagined or correlated through pure coincidence to suggest consciousness reincarnates in a different body.
digi - this is the post we were talking about yesterday at The Middle East
I try to focus on life and not on death. That said, I try to keep myself in good shape to avoid complications that will lead to dying. The time I spend dead will be the same as the time I spent prior to being live, and eventually "I" will come again as something else. I don't believe that I will immediately return as another person, animal, or other being/object. But I do believe that at some point, somewhere, there is a return from the nothingness and emptiness.
I've never believed in god. I went to church as a young child, then not for a long time, then again as a high schooler before stopping altogether some time in 12th grade (all of this being in an anglican church, which is really like church "lite" with tea and cookies afterward). When you don't have a faith, you end up having to confront mortality without the guise of an afterlife pretty quickly, so i didn't necessarily have a singular experience that helped me come to grips with death. The way I see it, the days you have on this planet are of an unknown number that is continually ticking down to zero. You might die tomorrow, you might die when you're 111, but no one can know. Since you have that Unknown, the only thing you can do with your life is make sure that the things you spend your time doing are worthwhile to you. I don't mean that in a selfish, "fuck everyone I'm going to do what I want" sort of way, I mean that in a " I think this cause is worthwhile so I donate my time to this charity" or " I like to drive and my friend needs to do errands. I'll drive my friend around to do his errands", or "Music is my passion, so I'm going to make it the focus of my life". In essence, live your life in a way that if you died tomorrow, you would think "There's more I wanted to do, but I think I did alright", or "I'm okay with this". Make sure the people you care for know it, tell your parents you love them (because you do have to love them, even if you don't necessarily like them), and, as they say in those inspirational coming-out speeches, "live your truth" Dying is uninteresting, everyone does it, and everyone is alone and afraid when it happens. It's how you use the time between your birth and your death that makes any lick of difference to anyone.