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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
Hey, maybe you could still collect the reward!
“Univac” was once as universally synonymous with “computer” as Kleenex is to facial tissue or Xerox is to photocopying. It used to be said that people thought that all computers were Univacs, and all Univacs were made by IBM.
Putz.
Back in the 60s-70s, the story was that DEC (Digital Equipment Corporation) named theirs “Programmed Data Processors” (the PDP moniker) because it would have been otherwise impossible to sell them to government institutions, agencies, etc since IBM had gotten the definitions made up to the point where only stuff from IBM qualified as “computers” as far as they were concerned.
I think a lot of it is, with technology and the logistics revolution, America has migrated from mostly rural to mostly urban/suburban. This made death alien and intrusive.
If you grow up on the farm, or the ranch, you understand life and death, and that death comes for everyone. Kids that grow up on the farm don’t need to meditate on dying, they already know that everything dies. Just as (an aside, but illustrative) they don’t need sex education. They mature wading through fecundity.
My internal calculus for engaging people on matters of life and death is: does this person know he is going to die, someday (and know viscerally, not intellectually)? Does this person believe he will be judged when he does die?
Excellent.
Nothing makes you think more seriously about this topic than hearing this sentence: “The cancer has Metastasized.”
Such a timely post. My husband and I are in the midst of facing, processing, and helping both of our fathers navigate through cancer diagnoses. Each has a different kind, with different treatment protocols, none of them pleasant. Both are contemplating and weighing their options.
Should I take chemo or not?
How much am I willing to endure?
I’m almost 75 [and 80] and I’ve had a good life. Maybe it’s just my time…
While I’m extremely sad they are suffering and don’t like thinking of them not being here with us anymore, I am thankful that they are both willing to ask those questions and have difficult conversations.
My Dad and I talk nearly every day. If a day passes without a call, my phone usually rings early the next day with Darth Vader’s voice saying, “I am your father.” That’s the ring tone assigned to his number not because I see him as evil Darth Vader but because the original Star Wars trilogy holds special memories in our family and somewhere along the line I jokingly said, “Father, this is your Daughter,” in a very poor attempt at mimicking Darth Vader’s voice. Not missing a beat, Dad replied, “Good, I am your Father.” (His Darth impression was much better than mine!)
I don’t know what I will do when my Dad dies. He’s believed in me since before the day he and Mom brought me home from Catholic Charities. He’s my biggest cheerleader; the one who, when I was 12, stood next to me while I debated with the Archbishop about how and why girls should be allowed to be altar servers (I won.) He’s the one who knew I’d get that music scholarship. He’s also never sugar coated anything — he’s held me accountable, always expected me to do my best, and he’s the first one to tell me when I need to get out of my own way. Besides my husband, he’s the first person I call with any important news.
When we talked last night, Dad said, “Just when I think I’ve made peace with things and feel okay with accepting whatever the outcome is of all these shenanigans, my throat catches and I think, but wait! I don’t want to miss any of this wonder or miss anything my amazing daughter and sons and grandkids are going to do.” My reply, through (hopefully) well controlled tears: “Well, Dad, you’re not going to miss it, you’re just going to have a much better seat for all of it.”
My Mom lost her battle with cancer more than a decade ago and we didn’t talk about anything except how she was going to fight it. I hope we don’t make that mistake again. I’m processing. It’s not easy, but yes, we have to talk about this.
I made it easy for my boy…..His name is Luke.
And yes when he calls, my phone plays the Darth Vader march.
It really isn’t easy. I’m so glad that you’re talking about it. And there’s nothing wrong with changing your mind! This isn’t permanent! It’s a talk. People need to talk about what they want to do and how they want to live their lives.
I don’t know your fathers’ diagnoses or what the prognosis is, but I will be praying for all of you. Whatever my prayers are worth, I’ll be sending them up to the powers that be along with my gratitude that someone is having this mind-numbingly difficult conversation. Ultimately, I hope they maintain an excellent quality of life for whatever life they have left to live. That’s the best any of us can do, really!
Many thanks for the prayers — that means a lot, and I truly believe they work. More importantly, our Dads believe in their power. :)