(This article was written as a part of The Op-Ed Project.)
While we may fear meeting death alone, most of us are actually more afraid of dying surrounded by the wrong kind of people — that is, by health care workers.
Yet that is all too likely to be our fate. Statistics are squirrely, but many point in this direction. Seven out of 10 Americans express the wish to die at home. More than 80 percent of patients say they want to avoid hospitalization and intensive care at the end of life. And yet, the current reality is that about three-quarters of us actually die in some kind of institutional setting.
What is the source of this disconnect? As someone who has spent most of the last 15 years grappling with loved ones’ life-threatening illnesses and deaths (and co-authored a book on the topic), I’ve come to the conclusion that it starts with our attitudes — with our failure to recognize that our births guarantee our deaths.
It Starts With Acceptance
Paradoxically, it is only by accepting death as a basic truth that we can make the most life-enhancing decisions, ones that pave the way for the kind of peaceful death most of us say we want.
If this is my last chance at life as I’ve known it, I don’t want to be feeling this lousy or angry or annoyed.
Prominent among these is creating an advance care directive and — this is key — making sure that the people likely to be making treatment decisions at our end of life, including doctors and our family members, know what we’ve decided. This last critical step is taken all too rarely. Indeed, one study reports that only 25 percent of doctors were aware of their patients’ advance directives.
Beyond such practical considerations, I have experienced how a deep awareness of mortality enhances the time we have to live. When I lost two of my closest friends to murder in 2001, I was forced to confront the reality that one moment we are here and the next we might simply not be, even in a tranquil, rural place like the Upper Valley of the Connecticut River, where I make my home.
Is this my last moment on earth? While relatively few of us will die violent or sudden deaths, asking this question has trained me to snap myself out of bad moods: If this is my last chance at life as I’ve known it, I don’t want to be feeling this lousy or angry or annoyed, my inner voice would reason. How can I reframe my current circumstances? Could I possibly make something constructive happen right now?
This perspective proved invaluable when my father, who hadn’t lived a particularly healthy adult lifestyle, developed some of the most common health problems of our society: diabetes, neuropathy, arthritis, heart and kidney disease and dementia. When someone has as many problems as my father did, the health care system proposes a lot of solutions.
My family learned to ask: How will this treatment affect him while he is undergoing it and in its aftermath? If it is not too painful or disruptive, will it improve the quality of his life? Is there any “good” that we can make happen in this stage of his suffering?
By following our answers to such questions, we decided not to authorize a pacemaker for him, for instance, even though the rehabilitation home he was in threatened to discharge him if we did not. We responded in turn by organizing more help for our mother and bringing him home. That’s where my father died peacefully three years later, on hospice and surrounded by members of his family.
A Scary Diagnosis
This approach helped me directly, too, when I was diagnosed last year with early stage invasive breast cancer. Bouncing between shock, anxiety, and — amazingly enough — laughter, my husband and I tried to wade through the barrage of information we received by asking what kind of life I could be living during and after various treatments.
We presented the surgeon with a piece of paper that summarized our lifestyle goals and included a question about what was likely to happen if we did nothing. When we opted for my having surgery and radiation treatment, we knew we were opting for frequent trips to the hospital. I would get dressed up to the nines and smile at as many people as would look at me. The one thing I was sure was under my control was not adding to the level of worry and sadness of the people in that space.
Like most ordinary mortals, I do not know what’s next for me. But I know I am going to keep living my life to the hilt by making conscious choices. By being conscious about choices. If I’m lucky enough not to develop dementia, I plan to be doing, or getting ready to do, something I love.