I recently re-subscribed to The Sun magazine after several years of doing without it. I like the philosophy of The Sun. It invites its readers to submit short pieces on the assigned topic each month and it does not include any advertising.
Once I re-subscribed, I looked forward to the first issue arriving. When it did, initially I was disappointed. The topic of the that April 2014 issue was death. After all, like most people, I’d rather not think about death. I spend most of my time and effort working to avoid death by eating healthy, watching all the signs that indicate my health may be slipping, although never getting quite as much exercise as I know I should. And since I am long past the years when I was convinced I was invincible, it is all too clear to me that death is out there and will come for me, probably sooner than I’d like. But as I read each article, I found the message optimistic and uplifting.
Both the interview and the first essay were pieces about and by Katy Butler, a journalist who brought together the lessons she learned after her 79-year-old father’s stroke and subsequent health challenges as well as her research into how modern medicine has changed the way we approach the end of life into her first book, Knocking on Heaven’s Door: The Path to a Better Way of Death.
Her father’s case was not a good death. After the stroke, he developed a hernia, but the surgeon wouldn’t agree to correct it unless a pacemaker was installed to keep his heart pumping. Butler described the amount of information her mother received about the pacemaker as less than she received when she purchased a new Camry. With the pacemaker in place, her father had the hernia surgery but neither of the surgeries did anything to slow his decline into dementia. Her father did not enjoy his final years of life. Because he couldn’t do even the simplest tasks for himself, her mother was exhausted through the process, what Butler calls overtreatment and perverse economic incentives in the medical industry. Butler argues that medical decisions should be made based on the whole patient – and for Butler the whole patient includes the family that will survive the individual.
From my own experience, I have seen how too many doctors no longer seem to consider the even more limited single individual patient as a whole patient. The cardiologists see the patient’s heart. The oncologists see the patient’s cancer. The infectious disease specialists see the pneumonia or MRSA. The orthopedists see the patient’s bones. The result: one doctor sees progress while another sees doom. The patient and family are left dizzy and confused, in need of advocates to explain what everything means.
Butler didn’t just discuss health and medical treatment in the interview. She discussed the full range of issues involved at end of life. From drawing up an advanced medical directive to ensure those closest know what your wishes are to preparing a living trust to help those who survive take the necessary steps after death. In my own family, we learned how much of a gift it was that our parents had pre-planned their funerals so that when my mother died unexpectedly, neither my father nor the rest of us had to make decisions, something most of us were not in the right frame of mind to do. My mother had already picked out the hymns she wanted sung at her funeral. She had picked out the casket and the liner she wanted. Instead of getting bogged down in these decisions, we could focus on what we needed to do – mourn her passing and celebrate what she gave to each of us.
Before that first issue of The Sun arrived, my husband and I had already met with a lawyer to draw up our living trust, new wills and advanced directives. It was something we knew we needed to do because we had moved from one coast to the other and we now have a grandchild to include. But I still found myself reluctant to think about the details. I knew it was the right thing to do, but I hadn’t yet reached the point that it felt right. After reading Butler’s interview and article, I felt much better.
Butler refers to death as a sacred occasion. “Death used to be a spiritual ordeal; now it’s a technological failing. We’ve taken a domestic and religious event, in which the most important factor was the dying person’s state of mind, and moved it into the hospital and mechanized it, putting patients, families, doctors, and nurses at the mercy of technology. Nonetheless we still want death to be a sacred occasion.”
A peaceful state of mind, the knowledge that I am taking all the steps I can before it is too late to make sure that no one around me has to guess what my wishes are or to have to wonder what I would like done with the things I will inevitably leave behind – that is a good death, the end of a good life.