I have been a family physician in Pakistan for almost twenty years. In that time, I have seen more death than most people care to imagine. And yet, even now, what surprises me most is not death itself, but how surprised we remain by it.
Pakistan is a country of around 250 million people. Our crude death rate is a little over six deaths per thousand population per year. This means that death is not an occasional visitor. It is a daily and routine presence in our streets, hospitals, homes and families. And still, every death is treated as an unexpected tragedy, as if some cosmic error has occurred.
This is even more puzzling because we live in a triple disease burden country. Infectious diseases continue to kill, non-communicable diseases like heart disease, diabetes and cancer are rising rapidly, and accidents and injuries claim lives every single day. Death here is not subtle. It is frequent and visible. Yet we continue to act astonished when it arrives.
As a society, our response to death is oddly confused. There is grief, of course, but it is often buried under layers of ritual, performance and hypocrisy. There is excessive food when no one has an appetite. There are crowds when silence might heal more. There are repeated phrases of consolation that sound impressive but offer little comfort.
We proudly describe ourselves as a deeply religious society. We speak often of the will of God. And yet, when death arrives, we behave as though God has done something highly unreasonable. We quote faith, but emotionally we protest. If we truly believed what we say, perhaps death would still hurt, but it would not shock us so completely.
In clinics and wards, I see families unprepared, not because they do not love their loved ones, but because we never teach people how to think about death. We do not talk about dying, about limits of treatment, about dignity at the end of life. We avoid these conversations until the very last moment, then wonder why everything feels chaotic and painful.
Death is not a failure of medicine or faith. It is a certainty of life. A society that refuses to acknowledge this condemns itself to confusion, fear and performative mourning. Perhaps it is time we stopped pretending death is rare, unfair or unnatural. It is common. It is promised. And understanding it better might make us live, and grieve, with a little more honesty.
—The writer is Associate Professor, Health Services Academy, Islamabad.
