Psalm 39:4 "LORD, let me know my end, and what is the measure of my days; let me know how fleeting my life is! (RSV)
In a perfect world we live out the "measure of our days" in good health then gently fall asleep, never to wake again.
That's death via Norman Rockwell.
In the Norman Rockwell world 70% of Americans want to die at home. In the real world, only 30% do.
Last year Atul Gawande brilliantly described the emotional and factual cost of end-of-life care in his award-winning article, "Letting Go," published in the August 2, 2010 issue of The New Yorker. He dared to ask at what point medical treatments intended to extend life actually result in more intrusive treatments, more suffering and a greater financial burden on the patient's family.
The story - or what he called the 'dire reality' - was told through the life of a mother who had inoperable non-small cell lung cancer. She was young. She was hopeful. The unraveling tale of chemotherapy followed by increasingly intrusive interventions to counteract the side affects accumulated and spiraled down, one episode after another. How could her story have been changed? Could it have been? Can we direct the trajectory of our final months?
I believe we can.
You may find me off center, talking about death on the heels of a gracious holiday and in the advent of another. I do so because I fear death much less than unnecessary and unwanted care. Intubation. Chest tubes. Forced feeding. IV antibiotics to stave off this infection or that. CPR.
Hang around health care long enough and you'll find it won't take long before you find what you DON'T want. And if you live life on your terms, and pride yourself in doing so, you'll want to die on your own terms as well as much as is humanly possible. To do so you need to write it down.
"You only die once," Gawande wrote.
I also write this today because I've just returned from dealing with an 88-year old man who has not thought through his end-of-life issues. This has to do with how you want to live and be treated, not who will handle the funeral. He has an opposite problem from the young women Gawande wrote about; who so wanted to live she couldn't understand death was near.
My father-in- law still thinks he'll always drive his car and take care of himself. He never considered there might be a point where he couldn't. And the rest of us, his children by biology and marriage, are left deciding the issues for him. Things he used to care about, like filling the bird feeders before the winter winds hit, or making sure the water softener has been cleaned out, are immaterial now. He moves from his bed, to the kitchen table to his lounge chair, where he quickly falls asleep. He doesn't think he's dying either, but his mind diminishes by the day. It's too late for him.
We all need to make our wishes known. Or someone else will. Write your own last chapter. Outline it. Think it through and write it down. It's your life and it will - hopefully much later rather than sooner - be your death. November, if you didn't already know, is National Hospice and Palliative Care Month. In this incredible video, Engage With Grace posted by Renee Berry, speaker Alexandra Drane encourages all of us to answer these five questions:
Five simple questions:
1) Where do you fall on the medical spectrum: from supportive and comfort care only to take all measures possible?
2) If there were a choice, would you prefer to die at home, or in a hospital?
3) Could a loved one correctly describe how you'd want to be treated in the case of a terminal illness?
4) Is there someone you trust whom you've appointed to advocate on your behalf when the time is near?
5) Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advance directive?
Cancer and its treatment teach you about mortality. It can leave you feeling powerless. Turn the table and empower yourself. By determining what you don't want you very well might define how strongly, how vividly, how incredibly, you are living your life today.
All good things to you,
Jody
That's death via Norman Rockwell.
In the Norman Rockwell world 70% of Americans want to die at home. In the real world, only 30% do.
Last year Atul Gawande brilliantly described the emotional and factual cost of end-of-life care in his award-winning article, "Letting Go," published in the August 2, 2010 issue of The New Yorker. He dared to ask at what point medical treatments intended to extend life actually result in more intrusive treatments, more suffering and a greater financial burden on the patient's family.
The story - or what he called the 'dire reality' - was told through the life of a mother who had inoperable non-small cell lung cancer. She was young. She was hopeful. The unraveling tale of chemotherapy followed by increasingly intrusive interventions to counteract the side affects accumulated and spiraled down, one episode after another. How could her story have been changed? Could it have been? Can we direct the trajectory of our final months?
I believe we can.
You may find me off center, talking about death on the heels of a gracious holiday and in the advent of another. I do so because I fear death much less than unnecessary and unwanted care. Intubation. Chest tubes. Forced feeding. IV antibiotics to stave off this infection or that. CPR.
Hang around health care long enough and you'll find it won't take long before you find what you DON'T want. And if you live life on your terms, and pride yourself in doing so, you'll want to die on your own terms as well as much as is humanly possible. To do so you need to write it down.
"You only die once," Gawande wrote.
I also write this today because I've just returned from dealing with an 88-year old man who has not thought through his end-of-life issues. This has to do with how you want to live and be treated, not who will handle the funeral. He has an opposite problem from the young women Gawande wrote about; who so wanted to live she couldn't understand death was near.
My father-in- law still thinks he'll always drive his car and take care of himself. He never considered there might be a point where he couldn't. And the rest of us, his children by biology and marriage, are left deciding the issues for him. Things he used to care about, like filling the bird feeders before the winter winds hit, or making sure the water softener has been cleaned out, are immaterial now. He moves from his bed, to the kitchen table to his lounge chair, where he quickly falls asleep. He doesn't think he's dying either, but his mind diminishes by the day. It's too late for him.
We all need to make our wishes known. Or someone else will. Write your own last chapter. Outline it. Think it through and write it down. It's your life and it will - hopefully much later rather than sooner - be your death. November, if you didn't already know, is National Hospice and Palliative Care Month. In this incredible video, Engage With Grace posted by Renee Berry, speaker Alexandra Drane encourages all of us to answer these five questions:
Five simple questions:
1) Where do you fall on the medical spectrum: from supportive and comfort care only to take all measures possible?
2) If there were a choice, would you prefer to die at home, or in a hospital?
3) Could a loved one correctly describe how you'd want to be treated in the case of a terminal illness?
4) Is there someone you trust whom you've appointed to advocate on your behalf when the time is near?
5) Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advance directive?
Cancer and its treatment teach you about mortality. It can leave you feeling powerless. Turn the table and empower yourself. By determining what you don't want you very well might define how strongly, how vividly, how incredibly, you are living your life today.
All good things to you,
Jody
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