By Martha Calihan, MD | 12/02/2021

Are You Ready to Die?

Are You Ready to Die?

Because the truth is, death is the only certainty in each of our lives; the one absolute fact for each of us from the moment we are born.

So why then, is death such an unwelcome topic of conversation?

In our culture, the last 100 years have seen both the medicalization and the sanitization of death to the degree that many of us have not ever experienced death first hand, haven’t seen a dead body, haven’t been with someone as they transitioned from this life.

And in our ignorance our fear is born.

Our deaths often do not occur at home, and thus are no longer experienced as a natural part of life. A recent report from Stanford School of Medicine states that, despite the fact that over 80% of us say we would prefer to die at home, the majority of Americans die in hospitals and other care facilities, where the day to day care of the one dying is in the hands of the staff, not a family member.

Can we change that? Can we make choices about our death and dying process?

The answer is categorically yes. Most of us will not have a sudden death; we will instead have a slower unwinding of our life; often dealing with a chronic illness or condition for which there is no cure. And in this situation, we have choices. We have decisions we can make to direct those caring for us. We can choose more or less intervention, where we want to be when the time comes, what care and comfort measures are important to us. We can make decisions about whether and when we might want to move into palliative care or hospice care.

Let me tell you how i know this to be true….

As I describe in my book, A Death Lived, when my husband, Charles died, it was after a prolonged illness and multiple hospitalizations. There were further options and treatments being offered, but the end result was not likely to change. There was no cure available.

We had the opportunity to have many, many conversations about his situation and about the fact that we were heading towards his death. And we took that opportunity to talk…over and over, and in our talking, he arrived at his decision about his end of life care. I, and we, as a family, understood his values and his choices. And we were able to support and honor his decisions when the time came without the added burden of wondering what he would have wanted when he could no longer speak for himself.

His clarity and honesty were his final gift to us.

We learned that as we made decisions about end of life care, we needed to communicate our decisions to those who needed to know. We can’t assume that our family, friends or named health care proxy will make the choices and decisions we would want if we haven’t talked with them; if we haven’t had the sometimes hard and painful discussions. In our case, we were lucky to have the conversations, over and over again, until it was clear that as a family, we were all on the same page.

I know, it’s not easy to have these conversations. Charles and I had to be willing to admit that he was going to die, and we had to be willing to understand options and what different interventions might be available. Our conversations allowed us to know and understand what we valued, what we each feared and desired.

We can’t have a lot of judgment about someone’s choices and decisions: there is no absolute right or wrong. What matters is that each of us be able to determine what we would want done when we are dying. Yes, we can always change our mind, butwhat is important is having the conversation(s) and having someone who understands and can honor our choices if the time comes that we can no longer speak for ourself.

Charles had, and took, the opportunity to have his death reflect the essence of who he was as a man, to be in alignment with his values and ideals. To take advantage of this opportunity we needed to have made decisions about what was important to us; to have communicated these decisions to our family and friends. And to do this, he and we, had to have had the difficult conversations.

So please, do it now, before it’s too late. Trust me, you will be glad you did.


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