The September 12th issue of NEWSWEEK ran a thought provoking article entitled The Case for Killing Granny. It touched on the many different aspects of health care that are in the news daily: health care reform, skyrocketing costs, medicare-gone-wild and more. This article is not about the plethora of problems we’re each facing or about to be facing. It’s simply about where we would like to die.
As for me, coming from a family that hasn’t had a single member before me that didn’t have strokes, heart attacks, diabetes, high blood pressure or high cholesterol, I may not have to make a decision. I may just go by way of “the big bang” as I have often joked about. Like my good friend Charlie that died at the age of 50, perhaps my heart will just explode into a million pieces one day, and there will be no discussion about whether they should try to bring me back, artificially extend my life or set up a machine to do the breathing for me.
However, I hardly ever eat red meat or fried foods, I don’t smoke, I gave up alcohol over four years ago, and I try to do at least a little exercise on a regular basis. Hey, at least I mow the lawn in the summer. On the other hand, one of those hot days may be my last. But this brings us to another scenario. Suppose I’m now 80, in relatively decent shape, and know that somewhere in the next five to fifteen years that things will certainly turn for the worse, health-wise, as life runs its course.
Where do we want to die? If it’s left up to us, it seems like we have three choices, maybe four. Surveys show that 70 percent of us would prefer to die at home. However, half of us are still dying in hospitals.1 In a hospital could be a second choice, letting the medical community do all that they can to keep us alive, but what a futile battle. All of us are going to have our final day. A third choice would to be to die at home, but with hospice care coming to see us, rather than us having to make steady trips to the hospital. A fourth option, though not available in every state, and just now getting started in Oklahoma, would be to pass our final months, weeks and/or days in a hospice facility. Other than dying in a car wreck, being struck by lightening or drowning, that about wraps up the possibilities.
Let’s consider each of these. My mother, who had high blood pressure, diabetes, hardening of the arteries and dementia, passed away peacefully in her sleep the day after her 82nd Halloween celebration. My wife and I were lucky enough to be with her the night of Halloween. We carved pumpkins for her and let her be the contest judge, and we gave out candy to the local trick-or-treaters. We even put on costumes, mom included, as the only human-sized sunflower in Oklahoma. We all had fun and took pictures together after having a nice evening. The next day mom’s caregiver called me to tell me that mom had passed away. That was that. End of story. Mom had lived a good life and was fortunate to be one of the lucky ones that was able to pass away in the comfort of not just her own home, but her own bed. Given a choice, we’d all write a script like that for our last days.
My dad wasn’t so lucky. At 81 my dad had a stroke which started his downfall. The local emergency room told us that he barely had a pulse and that they were surprised he was even still alive. They sent him home. After taking him to the hospital across the river in Texas the next day, he was transferred to a rehab hospital in Plano, Texas. That was the last trip dad would make. Weeks of treatment and endless tests did nothing to extend his life any longer than he was meant to live. With all sorts of tubes hooked up to him and every monitor imaginable, he passed away in that hospital with my mom sitting outside in the waiting room. That’s not where he had wanted to spend his last days, and I’m sorry that things worked out that way.
Another possibility is to just stay at home. If we know our time is coming, we can fill out a living will with implicit directions as to what kind of life-saving efforts we do want exercised on our behalf and those that we don’t. I’m only 53, but I filled mine out years ago. My mom had her living will filled out and notarized before she lost her mental capacities. If she had wound up being whisked off to the hospital, they were not going to be able to do much more than keep her comfortable with pains meds, because she had signed a document stating her final wishes. Not just that, but both hospitals in our area, here in Oklahoma and across the river in Texas had this document on file. In case something were to happen while we were driving, we had a notarized copy in the car as well. Mom didn’t want to go through the living torture that dad had gone through. Thankfully, if we do stay at home and not allow ourselves to be whisked off to the hospital, we don’t necessarily have to be in pain. Hospice care is provided by companies certified to send skilled medical personnel to your home to administer pain meds, and do whatever else is necessary to help you be comfortable in your final months, weeks or days. I like the sound of this.
Some states have facilities where you can check into a hospice, when it is believed you are in you last six months of life, and the personnel will do all they can to make your final days as comfortable as possible. This is really nice, if it exists in your state, and your insurance or medicare will cover it. (Rules vary state-to-state.) I know first hand that this is a nice way to go, as my wife and I watched as both of her parents, eighty and ninety-one years old, passed away in a hospice facility in Pittsburgh, Pennsylvania. Having driven two days straight, we were even able to be there and hold dad’s hand as he peacefully drifted to sleep for the last time.
So think about it. How do you want to go? Don’t be like the majority of Americans and avoid talking about it. Make some decisions while you still can. At the very least talk about it with your loved ones so they can know your wishes. Fill out a living will. This gives you control over your final days and will help your family hold fast to the tough decisions that you have already spelled out in your living will. If your heart stops and you are in a coma, you have the power to declare now that you are not to be resuscitated if such an event occurs. Stash that document in your house and in your vehicle and make sure your closest family knows about it. Without it, the doctors will put forth quite a bit of effort to help you that you may not want. You may wind up breathing, but barely alive. We can have a say in how we spend our final days. Do this for yourself as well as for your loved ones. A full discussion of living wills, also known as advanced directives, is offered free by the Oklahoma Bar Association, which also provides a free copy of an Oklahoma living will form at http://www.okbar.org/news/press_06/AdvDirective.htm or by writing them at Oklahoma Bar Association, P.O. Box 53036, 1901 N. Lincoln Blvd., Oklahoma City, OK 73152-3036
Les O'Riley
There is an excellent article and video on the AARP Magazine site, from the June / July 2009 issue called “A Good Life; A Good Death” that talks about hospice care. Check it out and come back and share your thoughts. ~ Les
http://www.aarpmagazine.org/family/gift_of_hospice.html?CMP=KNC-360I-YAHOO-ATM&HBX_PK=hospice
Here’s the link to a NYTimes blog post on the cost of dying: http://egan.blogs.nytimes.com/2009/09/23/the-way-we-die-now/
That’s a good article, Chris, thanks for the link. The following comment really hit it on the head: “But for reasons both cynical and clinical, the American political debate on health care treats end-of-life care like a contagion — an unspeakable one at that.” In discussing the state of Oregon, I didn’t even KNOW that they legalized medical-assisted suicide. Interesting. The politicians sure don’t want to go near that with a ten foot pole. Too bad a certain politician tried to scare America with talk of “Death Panels.” Thanks again for the link. Good one.
~ Les
Well written. I have no preference on my location. I will say I’d prefer not to die in pain or violently like a crash or fire. I occasionally visit NDERF.org (Near Death Experience Research Foundation) It’s a site which posts Near Death experience accounts. Whether or not the accounts have been fabricated, or influenced by drug interactions, I don’t know. Statistically speaking, they’re probably false. I will say they do bring a sense of comfort when read.
Thomas, I remember we have talked about NDERF.org before. I’ll have to revisit it. As I recall, it had some pretty interesting accounts. ~ Les
I don’t plan to die at all so I won’t have to worry about it.
Within twenty years we wont have to, all the technical advances in genetic manipulation and personalized medicine will keep us functioning indefinitely. The problem will always be- where the heck did I put the car keys? Do I still drive? Where was I going to go anyway? What’s your name again–oh, you say you’re my wife??
You bring up a good point. I sure hope they keep the mind improvements up to pace with their life extending efforts. At my rate of mental deterioration, I wouldn’t even be able to add this comment coherently if I was 110 years old now. I probably wouldn’t even remember my log-on password.
Sorry it’s taken me so long to explore your site, Les. This is a fascinating article. I was just thinking about the topic yesterday.
There is assisted suicide here in Oregon. It is carefully monitored and a decision that is treated with great dignity and concern.
Another ritual exists here, and probably in Oklahoma, too. I read a statement by a sheriff in our sparsely populated eastern counties. About once or twice a year, he gets a call to go out looking for an elderly rancher who has decided to treat his cancer/health problems. These stalwart ol’ boys have decided to heck with expensive hospitals and tubes. They take their guns and go to the backwoods to solve their problem.
It seems a sad, lonely way to exit this world to me.
You are right. We need to talk about dying.
The Oklahoma Palliative Care Resource Center is a state-wide site for information on palliative care, hospice and ethical issues regarding end-of-life experiences.
It also has the Oklahoma Advance Directive for download in English, Spanish and Vietnamese.
Try it. Palliative Care feels good, like a medical treatment should.
Thanks for the submission. Before her mind had been claimed by Alzheimer’s, my mom had prepared both an advance care directive and a durable power of attorney. While she thankfully did not need the benefits of an advanced care directive, the durable power of attorney came in handy, allowing me to take care of all the things my mom would have continued to do if she had been able to keep a better grip on her mental capacities. I encourage everyone to check out the articles and links at The Oklahoma Palliative Care Resource Center. My wife and I had our advance care directives filled out before I turned 50. It’s nice to be ahead of the game. This site offers lots of insight even to those that do not live in Oklahoma. Thanks, Annette, for letting us know about them.