Death 101: The Art of Dying (as taught by Atul Gawande…and my mother)
I’ve come a long way, baby. From being the scarediest of cats about so many things. High bridges, for instance. And death.
For the longest time, my parents sheltered my brothers and me from post-mortem matters. It wasn’t until the eighth grade that I attended a funeral, my paternal grandfather’s. In the back of the church sanctuary I stayed that afternoon, afraid that death…I don’t know…might somehow be contagious.
The second funeral I attended was the service of a high school homeroom buddy. He died drag racing. Which burst my back-then-belief that death couldn’t touch a teenager.
Years later I married into an Italian family. Where weddings and funerals are basically, family reunions.
This not only made mandatory my presence at viewings and memorial services, but also my walking within feet if not inches of the dearly departed. Something which to date, I’d somehow managed to avoid.
Always I held my breath, fearing the fragrance of formaldehyde. Equally terrifying was the prospect of offering condolences to the deceased’s loved ones. What words are adequate, comforting? Inoffensive?
A decade ago, a “Job season” wrested me from my dread-of-death grip.
In a little over a year, my husband Tony and I lost five close family members, including both of our fathers.
Those experiences toughened me considerably with regard to death. Though I still cannot bring myself to kiss a corpse’s cheek, I am now able to pat their hand and tell them how good they look.
Last year, Tony lost his mother.
Her departure was different from the others in that her passing was blessedly brief. Not a lingering fade due to dementia or cancer. She suffered a fall, sustained a head trauma, and a week later she was gone.
Before her passing, though, hospice employees helped us formulate a multi-faceted care plan:
- Arrange for a hospital bed in her home
- Transport her home
- Position the bed in front of her ginormous-screen television
- Let her spend her final days in the presence of all movies John Wayne on the Western Channel
Alas, Mom T passed away before our hospice care plan transpired. Even so, the plan seemed a good one, and cheered us.
But not everyone is a fan of hospice.
Some folks believe HOSPICE a 7-letter curse word, a synonym for “giving up.”
In my opinion, this thinking is flawed. I say this because I’ve read Atul Gawande’s important book, Being Mortal,* twice now. The second read was to prepare for my own mother’s end-times which were imminent.
My oldest brother and I, as well as Mom’s doctors, agreed hospice was the best plan of action going forward.
Despite the overwhelming evidence that no drug or procedure existed that could truly fix my mom — “fix” meaning to restore my mother to her former level of function — a few loved ones balked at the mention of hospice.
“In less than a month, with a few bad reports, you’re already considering hospice?”
Yes. Allow me to explain. Or rather, I’ll paste the words I sent out in response to various inquiries.
The goal of ordinary medicine is to extend life. By contrast, hospice aims to, “give each client the fullest possible life now, today.”
Hospice, a type of palliative care, can yield some or all of the following benefits:
- Better symptom management (which can mean less suffering)
- Better quality of life
- Increased feeling of control
- Avoidance of risks associated with treatment and hospitalization
- Decreased costs with improved utilization of health care resources
- Longer maintenance of mental awareness
- The ability to interact — for a longer period of time, often in their own home — with family, friends, and beloved pets.
Please note: Patients with a terminal illness do not usually have to pay for hospice care. Currently, most hospice patients have their costs covered by Medicare, through the Medicare Hospice Benefit.
Also worth considering is the study that showed individuals who pondered key questions (see the list below) and acted accordingly–typically opting for hospice services–lived 25% longer than people who did not.
To my mind,
Hospice is not giving up on your loved one. Choosing hospice actually gives them the possibility of a longer life with better quality.
On this subject, Gawande advises pondering the afore-mentioned key questions in advance of a health crisis: “…people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”
As I sat with my mother one year ago, it was a comfort to know I was honoring her final wish: “I want to go home.”
There in her cozy apartment with her beloved cat Rosie, Mom appeared peaceful. I also felt peace. And thankfully, no fear.
I never intended to, but it seems I earned another masters degree last summer. In an idea Guwande mentions in his book — Ars Moriendi: the art of dying. With my mentoring professors being Atul Gawande and my mother.
Key Questions:
- What are your biggest fears and concerns regarding your death?
- At the end of your life, what goals are most important to you?
- What trade-offs are you willing to make, and not?
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For more lessons from a life half lived, visit dianetarantini.com.