Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
America, We Have to Talk About Death
America is generally a pretty optimistic country. It makes sense. We are a people that came from distant shores to join the people born here to create a wonderful mishmash that holds certain Truths to be Self-Evident. People who did not believe in these common truths would not have survived here or stayed here. This would not be the land they chose to raise children. They would flee for easier paths. I know, America, it’s been a rough 200 years or so. We’ve been through a lot together.
We have done so much to foster life in this country. We have developed spectacular, truly spectacular, medical advancements that have propelled us into the higher life expectancies. We discovered hand washing (at least in the sense that it was totally necessary in medical care). In 1879, we created the vaccine for cholera. In 1902, an American (Karl Landsteiner) developed ABO blood typing. Paul Zoll invented the first cardiac pacemaker in 1952. These are such wonderful innovations! We have sustained life in so many complex cases that used to be fatal. There were no treatments for the disease, just the symptoms. People used to suffer needlessly because we did not have the technology to help them.
But America, people now suffer needlessly because of the technology we have.
I know, we are generally a forward-looking people. We are a people of hope and often, of faith (in something, anyway). We see miracles every day. We pray for miracles every day. We face down fear and death and we keep on going.
Sometimes, though, it is time to sit down with Death and come to terms.
America, Death is also a part of life. Death is the natural conclusion of certain processes. We can push it further away and perhaps even delay it for a while, but death is inevitable. Death happens for all of us. Young, old, sick, and otherwise healthy. Death does not discriminate.
We need to face Death, America. We need to understand it and we need to stop fearing it to the point that we never let it enter our thoughts or our conversations. We need to talk about Death. We need to talk about dying. We need to talk about the process of natural death; the slowing down and winding down of the processes of the body. We also need to talk about preparing for death. I know, I know. This isn’t a fun conversation. But it is necessary. See, America, we have done everything to prevent death. But death will still happen. Death is not a matter of if, but when. So when it comes, and it will, we need to be prepared. We need to know what you want. We need to know how you want to live, but more importantly perhaps, we need to know how you want to die.
Do you want your death to be according to age or according to function? If you are 96 years old and are still completely intact, independently living but get hit by a car, do you want to be resuscitated because your heart has stopped? Do you want to accept your natural death? What if you are 22 years old and have multiple chronic health issues when that car hits you? What about then? What means more to you, time or quality? Do you want to be put on life support for your family, so that they can come to terms with your impending death?
We say life support. We say resuscitation. These are clean words. These are nice words.
Make no mistake: it is not clean. It is not nice. It is not gentle.
The reality, America, is much harder to face. Do you want a team of six people compressing your ribs two inches in depth (probably breaking them in the process) in order to make your heart pump blood? Do you want someone putting a tube into your windpipe so that you can get some oxygen into your lungs? Some people say no, they want a DNR. They want a limited DNR.
They do not want those violent compressions. They do not want that intrusive intubation.
But please, please, give epinephrine! Give drugs! Save lives!
America, when the heart is not beating there is no circulation. When there is no circulation, the drugs do not move anywhere. If the drugs do not move anywhere, they are not pushed around the body. Are you starting to understand, America? You can say no compressions, but what you mean is that there will be no pumping. If there is no pumping, then why medications?
We need to think about this now, America, before it is our own time to go (by whatever cause). We need to think about the ways that we want to live (if I can’t breathe, do I want a tracheostomy?) and the ways we want to die (at home or in the hospital?). Maybe even more importantly, we need to talk about this. We need to talk about this with each other. We need to talk about this with our families. We need to talk about it early and we need to get it in writing.
America, this is not about giving up. This is about keeping control.
Americans like their independence. We like to choose how we are going to live our lives.
If we want to keep our independence and our dignity, we need to think further down the line. Choose how you are going to live. Tell others how you choose to die.
I’m glad we had this talk, America. Same time again next year? I suspect we might need a reminder by then.
Published in Healthcare
Two frequent virtues for Joseph’s comments:
They are sharp, intelligent, well observed, hard to refute;
and second, they don’t metaphorically send you out of the theater with a happy bounce in your step, whistling the theme song.
There is no such thing. If you are mostly intact, I believe they will try. I understand not wanting your care to change based on code status (that’s a different lecture!) but it is good to have an Advanced Directive which delineates your wishes and who may make decisions.
It does help to have your thoughts and feelings in some sort of writing, even if it is just, “No permanent tubes, my wife can make all the decisions”.
It saves a lot of family strife.
Well we’re also more radically individualistic and solitary than any other nation. In traditional cultures the individual may die but the family, the nation, the tribe lives on.
Let’s talk about death, baby
Let’s talk about you and me
Let’s talk about all the good things
And the bad things that may be
That probably has a lot to do with it. Also, as a developing country, people died in transit. People died on the ships over, traveling to other states, and moving West. I think there might be a bit of collective PTSD from having to bury people on the way, rather than with family. As a society, it is harder to respect the dead and keep it kindly in mind when it seems to be nipping at your heels!
We’re a new nation, I think that is part of it. But I also think it is because we are so wealthy and we do not have single-payer, national health systems. In those, the State has the final call. We are still (currently) independent enough that we can choose whether it is morally right or wrong to sustain a family member’s failing life.
Great post. You might want to read The Postmortal, Drew Magary’s excellent novel. It makes the point that natural death is essential not only for a good society but for a meaningful life.
Wear a medic alert bracelet or necklace with your allergy.
In the ER I have had episodes where a family member was demanding I “do everything” and another family member demanding I “let them go”. Cultural factors can make it even more complex.
I was trained to deliver the bad news when a patient died in such a way that I would be able to beat a hasty retreat ie know where the door is and make sure it’s open and no one is between me and the door. I’ve had people try and assault me, or whole families completely losing it and trashing the room , throwing chairs, smashing lamps, punching the walls. One of my residents was beaten up when he told a family their relative had died. He had allowed himself to get trapped in the room and couldn’t escape.
My usual method of telling the family was to have them placed in the family room, identify the closest relative and go up to them.
I would try to sit in front of them, or kneel if I had to to get to eye level if they were sitting, and if I felt they were receptive put my hand on their shoulder and say, “I’m sorry, but (relative) has died.” Not “passed”. Not “gone”, or any other euphemism. They had to hear the word. Otherwise they could completely block out the reality. I would immediately tell them the person had not suffered, and that the EMS team and the ER had done everything they could for the relative. I then asked if the person had recently been sick, or feeling ill, which got them talking to me. After awhile I would ask if they had any other questions for me, and again stress, no suffering, everything done, and my sorrow for their loss.
I just want to restate the part about “talk to your family”. Don’t let the first time they hear about your wishes be when you are in the hospital. Also, don’t wait until the day of surgery to decide to fill out your advanced directive. These are things to be discussed at length with the parties involved in a non-pressured situation. Just talk about this stuff, people. Death is part of life. Get over whatever hangups you have about it. You are not going to live forever. Oh, and quit watching so much stupid TV.
On a similar note, please make sure you have a will if you have more than 2 cents to your name when you die. That causes just as much (if not more) family issues before your body is even cold.
I had a blast at my dads visitation. I met people I’d never met and heard stories I’d never heard before.
A co-worker of mine died a few years later. At his funeral his teenaged kids spent all their time talking to their own friends instead of mingling. I thought about (and regret that I didn’t) going up to them and tell them that this was most likely the only opportunity they’d ever have to talk to some of their dads friends and hear about their dad and what he meant to people.
The problem with a slow death is that it’s slow.
The problem with a fast death is you don’t get a chance to say goodbye or wrap up your affairs.
My grandmother did it right. Heart attack, a day or two in the hospital for people to visit, then she died in her sleep that night.
Great post!
Like I said in a comment on a different post, I’m mourning the loss of jobs, the loss of our great economy, and the loss of normalcy more than I am those who died from COVID or COVID related deaths . . .
While putting together photo collages for the visitation, I found this picture in an old album. Had no context for it.
The other guy (my dad’s in the dark jacket) was at the visitation, was able to tell me the year (1960), where they were working (Western Publishing), and what kind of computer it was. I had a nice five or ten minute conversation with him.
Poor TRN, if she wore a necklace with all her allergies scrawled on it she’d look like Flava Flav
I do, whenever I’m not with my hubby.
Man, that’s rough on the kids. Of course they only talked to friends! They probably were beside themselves with grief and put in an awkward position.
Because we don’t talk about death, we also forget our history. We never hear stories, we never open up. There’s always later, later. Then there’s not and it’s lost or forgotten.
Yeah, Dennis was a good guy. Died of a brain tumor in his 40s. I still remember one of his last days at work. He was suffering from a bit of vertigo (which turned out to be the tumor. It was diagnosed a week or so later when he got lost on the drive into the office). Anyway, I spent some time in his office standing in front of his desk swaying back and forth as I talked to him.
I felt kind of bad about it after I found ut about the tumor, but he probably would have done the same to me. This was the guy who tested the computer generated voice pager system [DECtalk] by sending me pages calling me a putz.
There’s been a huge cultural shift on that as well. Catholics used to pray for protection from a “sudden and unprovided death,” it was seen as a blessing to not only have sufficient time to say goodbye and wrap up one’s worldly affairs but more importantly to receive the final sacraments and spiritually prepare to meet your Maker.
I’d rather people make my chest look like Mike Tyson’s punching bag, get electrocuted, and otherwise made worse for wear if it keeps someone from jumping the gun and declaring me dead for non-medical reasons.
My dad passed a week ago today. We had never dealt with death up close in my family before this. He had been ill for a couple of years, but around Christmas time he took what the doctors referred to as a “global decline”. My mom wanted to put him in a home, as he had lost the ability to stand, continence, everything. He was still with it enough to tell me he didn’t want to go to an institution, so we kids volunteered to help my mom in whatever way needed and she agreed to have him come home. It was very difficult at first, but the worst of it is just figuring out all the care, hospice, etc. We went to my parents’ house sometimes multiple times a day to change the bedding, lift him and clean him, etc. For two months we had hospice and private care people in. We all supported my mom and helped her out and my dad sort of gradually faded away, in relative peace, until he died. I absolutely have a decreased fear of death after doing this. I feel like this is a gift he has given all of us who helped him. We didn’t know how any of it would go and we had never cared for anyone at end of life, and now we all know what it is, how it goes, what to do, and also how to give comfort. Death that is unexpected for younger people, or especially for a child is something to be feared. But the knowledge that everything was done, and done well, for an older person is very comforting. We are all grieving and sad, but we are also relieved and in a way happy that we were able to do right by my dad and give him peace and dignity in his last couple of months.
Huh. Over 500,000 dead and counting. But you apparently can’t be bothered to mourn that.
I’d probably be inclined to give my wife a budget. If it looks like you can save my life for under $X, go ahead. If it looks like it will be more than that, pull the plug. If only hospitals were more like veterinary clinics, where they tell you up front what something is going to cost.
And if the bounty on your head gets good enough; go for it.
Oi. My dude. This is not the place for that. If you want to talk about how those people got extra infections and were on life support with family members who didn’t want to withdraw it, then fine, maybe this is the place.
But we’re especially not talking about that stuff here.
Is there an alert bracelet for that?
Later: never mind. :-)
Okay, enough suspense. What kind of computer was it?
(Not to hijack the important death conversation, but since you ask…)
I had to run upstairs and graph the picture off my other desk. He wrote the details on the back (this was March 1995, 26 years ago either yesterday or today.)
It was 1958 (with a question mark), it was Western Publishing, the computer was “either a Univac III or Model I File Computer”.
When I google Univac III, Wikipedia tells me it was introduced in 1962. But there is this for Model 1 file computer, which explicitly references 1958.
I do have some univac programming manuals of my dads on a shelf somewhere, probably from around that same vintage. My folks lived in New York City for a few months in the mid-to-late 50s (my sister b: 1955 was in a stroller in the few pictures I have from then), I *think* while my dad was taking training.
Those manuals may be of surprising value. It seems that Wikipedia no longer accepts sources from things just that people remember, it had to be “published” somewhere. (The main reason why I didn’t contribute this year as I have in the past. I think it’s nonsense. An over-reaction to people who want to fill Wikipedia with advocacy/agenda stuff.) Which means that if nobody has Univac manuals any more, apparently Wikipedia will have to delete all references to Univac.
duplicate
I will move this to a standalone post this weekend if I have time, but…
Just grabbed the two manuals I have off the shelf. One is loose-bound titled “programming UNIVAC”. It doesn’t have a title page or copyright statement, but in an introductory section it goes through a number of companies and agencies and their use of the Univac. It mentions “Franklin Life Insurance received its UNIVAC system in Springfield, Illinois on January 5, 1955”, and says Consolidated Edison Co of NY installation “will be made during 1956.”
The other one is a Hardcover title “Programming UNIVAC Systems Instruction Manual I” Copyright January 1953 by Remington Rand. Priced at $18.50, which I’m guessing is pretty [redacted] pricey for 1953.
It also has a handwritten note on the inside front cover: “$100 reward. Stolen from Dave Burrows!!!”. My dad’s name is not Dave, or Burrows.