Wednesday, December 03, 2008

Death, The Universe, and ... Nothing.

A few years back, right after my grandfather died after a months-long struggle in the hospital, I was sitting at a family reunion in attendance of two of my aunts as they spoke about death. They were talking about how they wanted to go, very much in the same manner as someone picking out the kind of car they would like to own.

One Aunt was talking about how she'd like to have a quick heart attack and get it over with. The other one said she'd rather pass in the night in her sleep.

The conversation was going back and forth as I remember it for about 10 minutes as I sat mortified that they would talk about death so casually. I finally said "I want to be dropped from a plane."

That pretty much ended the conversation.

As funny as this sounds, I'm realizing that I missed an opportunity to have a good solid discussion about the subject with two people that cared. Death, it seems, makes us all uncomfortable. Often bandied about by political parties as agenda items, death is not an easy subject, even today, to converse about. I'm a good 10 years older now, and after witnessing two more deaths in the family (my Mother in-law and my Father in-law) I realize that the people with the most experience with it are closer to it. As children we're not typically roped into any real discussions on the subject both out of respect and fear -- no one wants their kids to be mortified and it's understandable.

You would think that adults would be more prepared for it than they are. As usual, the people with the most valuable input now for me and the recent experiences I've had are the ones in retirement. They've seen the most death, they're closer to it and they've obviously given it more thought.

All of this is clear in my mind as my wife's mom passed yesterday at noon. It was a long struggle -- she was diagnosed with congestive heart failure last year in the spring and they gave her (at that time) no more than a month or so. Hospice came, made her comfortable and we all said our long goodbyes. Months passed. The hospice people aren't really setup for engagements that last for that length of time -- so they eventually had to pack up and go.

Speaking of hospice: I honestly can't imagine going through death without these people. The hospice in our case was Hospice of the Valley in Youngstown -- and they're angels in my humble opinion. The nurse on point for both deaths is an amazing person who was there for both deaths -- a caring soul who has a heart of gold. People can have an impact on your life that words cannot describe.

Back to this last situation -- as my wife's Mom came near to death the hospice people were called back. They arrived, did what they could to make her comfortable, and finally, yesterday, she passed on. Death was a release and I honestly cannot imagine how painful it would have been without the aid and comfort brought by hospice.

We spend a lot of time thinking about Life -- we spend very little time as a society thinking about or preparing for Death. It's a difficult subject and it's made complicated by right-to-life agenda, the medical and legal establishments. I understand more now why Kevorkian is so passionate about this subject. Face it: Quality of Life (er, Quality of death? -- not in our vocabulary.) doesn't quite have the ease of conversational value (in the context of our media) that it should. Things like Britney Spears underwear, for example, get a lot more attention.

Don't believe me? Google search on the word "Kevorkian", and you get about 890 thousand hits. Google search "Britney Spears Underwear" and you're at about 3.5 million hits.

Don't get me wrong: I understand the aversion to death and all things death related. I'm merely pointing out human nature. A lot of people are probably saying "Thank you Captain Obvious", in other words, to this observation.

Back to the recent situation and why I'm writing this entry. The person in question had multiple (about 3) opportunities to die. At each of these moments, there was too much ambiguity and not enough preparation. This isn't a criticism of the people on point (my wife and related family) -- it's an observation of the circumstance. It's hard to have a conversation with someone near death about what to do when they're close to dying and unconscious.

I know what some people are thinking: "Living Will" -- and my wife's Mom has a living will that clearly says not to resuscitate. No, it's a bit more complicated than that due to the situation. If, for example, she was having a heart attack, it was next to impossible to sit down and say "We're just going to sit by and watch you die". Possibly if they (the family) could have had a conversation about what to do in that circumstance, things might have been different, in other words. The situation is complicated by an obvious problem: Someone wishing to be left to die of a heart attack, comfortably, can't really get a hospice-like service engaged that quickly. So, when that occurred, the ambulance was called, she was rushed to the hospital and of course, the doctors in those situations will do what they're trained to do -- keep people alive.

All of this is hard to comprehend unless you've been there. It's hard to watch a slow painful death when it takes hours -- it's even harder to watch when it takes years. I don't see an easy fix for this. Death is heard to gauge, hard to talk about and even harder to legislate. You're out of control of the situation and normal problem-solving skills, while handy for dealing with the side-effects, don't help much in this context as we're geared (wired, so it seems) to keep people alive by default.

The living will is a good device to make sure people don't keep bringing you back into a bad situation -- it's unfortunately, in my humble opinion, not enough to ensure comfort and quality of life. Complicating matters is the simple fact that no one wants to converse about death. Worse, the conversation, if possible, would need to be documented and take place while you're able to think clearly. Finally, even if there were controls that could document your full wishes when you're near death, our society isn't geared to help people die quickly if they want that as an option.

All of these points trouble me. I return to the punch line from the beginning of this post -- the more I think about it, the more it sounds like the best option for me. Quick and full of acceleration -- not a bad way to go, actually.

No comments: