Thinking about death can be far less anxiety producing than thinking about dying. But, surprisingly, contemplating end of life scenarios really tells us more about how we want to live.
The End of Suffering
The last time I spoke to my dad on the phone, he was eighty-eight years old. He was in a hospice facility because he couldn’t make it to the bathroom on his own. His wife couldn’t carry him. He was weak and winded. His lungs were shot.
I asked him two questions.
“What’s your quality of life?”
He said, “Zero.”
“Are you afraid to die?”
He said, “No.”
Then he told me he had to get off the phone because his physical therapist had arrived. The purpose of the therapist’s visit was superfluous, but the visit was not. It gave my dad another moment of human connection before he let go of life a few days later.
My father’s wife never faced the fact that he was dying, so he didn’t either, which left him with no choice but to suffer. He knew that dying was release from suffering, but had to accept it to know release.
When is Illness Dying?
I can understand Dad’s confusion about dying. His mother died when he was two. His father died at sixty. Most of the people in our extended family smoked or drank, so they died in their fifties, sixties and seventies.
Most of them died at home. Most of them died in their sleep. They seemed to accept that they were dying.
Given the ability of modern medical science to keep a body going even after our organs shut down, more of us are going to have to define for ourselves what living and dying really mean.
Sobering Scenarios
Some of the circumstances that the Oregon Health Decisions pamphlet ask us to imagine include:
If I have an incurable illness which will most probably cause my death, and I can no longer speak for myself…
It’s relatively easy for me to say I do not want to spend my last months having medical treatments that have no hope of curing my illness.
I also say no thank you to a tube placed in my nose, mouth, or stomach, or a needle or catheter placed in my body to give me water and other fluids.
And I’ll pass on the breathing machine, too.
It’s completely counterintuitive, but contemplating death with a clear mind transformed my relationship to it. Contemplating my responses to dying actually focuses me on how I want to live.
Appointing a Health Care Representative
Who should we choose to make decisions for us when we can’t make them for ourselves? Someone we love and trust? Someone who knows us very well? Someone who is not emotionally attached to us? Someone who lives nearby?
The most anxiety relieving qualification for me is someone who has discussed my wishes with me. We all have our own thoughts about what constitutes a good death. I wouldn’t want to die someone else’s death.
Clarity or Comfort
If I have a brain disease that cannot be reversed and I cannot recognize my family and friends, speak meaningfully to them, or live independently…
I don’t want to receive treatment for the brain disease that would prolong my life or be treated for any other illness that would cause my death.
I do want to control pain and suffering even though I could become physically dependent on the drugs.
Thinking about my relationship to pain treatment when I am aware of my surroundings and lucid is more complicated. I haven’t yet used mindfulness practices to manage chronic pain, but would be willing to give them a try based on their track record.
Resolving Conflicts
I currently don’t have any bad blood relationships to contend with. A useful tool for keeping relationships from deteriorating is to remember that we all screw up, we’re all going to die, and that dying with bitterness isn’t ideal.
Palliative care doctor Ira Byock recommends in his book The Four Things That Matter Most keeping these phrases in mind just in case.
Please forgive me.
I forgive you.
Thank you.
I love you.
I don’t have any nagging religious questions to resolve about the afterlife, but recognize that many people do. That’s why I asked my dad if he was afraid of dying. If he had been, I would have tried to find him someone equipped to address his fears.
When it comes to resolving the conflict of what to do with the body, I was torn between organ and tissue donation, and medical research. I decided on the latter because it could potentially benefit more people and would cover decisions surrounding cremation. This aligns with my values of not burdening my family and friends.
It’s a Wonderful Life
My partner bought plane tickets to visit her ninety-five-year-old father at the end of June. Proving the old adage that death can come at any time, he passed away in early June.
Yesterday, on her first Father’s Day without a father, my partner read me some of the kind comments that her dad’s former music students left in response to his online obituary. (The marching band pictured at the top of this post is the one her father formed.) It was her “It’s a Wonderful Life” moment.
In his article, Seven Keys to a Good Death, Charles Garfield recommends reviewing our lives to recognize all the people we’ve loved, everyone who has loved us, and things we have done to contribute to the greater good.
My strategy for this comes from one of my favorite mindfulness teachers. He recommends taking a few minutes at the end of each day to write down things that made us happy, kindnesses that we performed for others, and things others did for us. I like the three good things format for doing this. For quality over quantity (once per week), a gratitude journal is also a good choice.
Hopefully, calling to mind all that I’m grateful for when the time comes will reassure me it’s okay to let go.
Ten Minute Exercise
You can begin relieving some of your own anxiety about dying by searching Advance Directive and your state. It should take less than ten minutes to find it.
For more encouragement, watch Timothy Ihrig’s TedTalk How to Die Well.
It runs 13:32, but you can watch it in less than 10 minutes at 1.5x speed.
This Fresh Air episode: “Inside The Fight For The Right To Die: Logistical And Ethical Challenges” with journalist Katie Engelhart serves as additional motivation to complete an Advance Directive.
And here’s a great post by Ciana P. Stewart on “How to Make Your Death Kinder to Those You Love.“
