Talking about living well is a generally enjoyable topic: what are the things that make life pleasant and bring me joy? That’s something I can definitely get my head around discussing. But talking about dying well? Not so much for me, or I suspect for most of us. And yet, death is a reality and it’s surely better to plan that process, as best you can, instead of dying and leaving your family and friends to wonder just what you might have had in mind for your “departure.” That’s why I decided to attend Sacred Threads Center’s one-day workshop, “Can We Talk About Something Else? Difficult Conversations About Living Well and Dying Well;” I wanted to see what I could learn about the “Dying Well” part and hopefully find ways to live well today and be less fearful when thinking about the end of my life. Surprisingly, I learned that thinking about and planning the “dying well” part of life is a key factor in continuing to live well!
Rosemary and Marie, the Sacred Threads founders, have a way of presenting topics that cut right to the heart of the key issues we all face in our journeys. This day was exquisitely planned with four presenters who discussed different aspects of why, how, and when to have these conversations.
Guy Spinelli MD, began by discussing what he has learned from his patients about facing death. As he says, “life turns on a dime, so we ought to be thinking about our end of life wishes and have that conversation with our loved ones NOW because if we don’t have that conversation our wishes may not be honored.” But when is the right time to talk about your wishes? Most of us think/pretend that death is too far away to worry about, and yet as Dr. Spinelli says “we never know what will happen when we walk out the door,” so he suggests that “the right time is now before a crisis occurs.” He discussed one of the most important steps we need to take immediately if we haven’t done it so far, which is to complete a Health Care Proxy and assign someone you trust to carry out your wishes and speak on your behalf. (This is a legal document but does not require a lawyer for you to complete it. It is different than a living will, also called a directive to physicians or advance directive, which is a document that lets you state your specific detailed wishes for end-of-life medical care in case you become unable to communicate your decisions.) In addition there is a MOLST (POLST) form that you complete with your physician which details Medical Orders for Life Sustaining Treatment (usually printed on fluorescent paper and suggested for you to keep on your refrigerator or some easy to see place in your home). Phew! That’s three different forms that I’m betting most people haven’t prepared. Dr. Spinelli’s closing words were advising us to speak with our physicians so they can be advocates for our wishes.
The next speaker, Deb Turiano, MD Associate Director of VNA Hospice and a palliative physician, echoed Spinelli’s advice and encouraged us to start having these conversations early and have them often. She suggests that we even have our children complete a Health Care Proxy when they turn 18. As she says, “We are a society of over-planners but we don’t plan for dying because we don’t want to have that talk.” She stresses that by making our end of life wishes known long before death is imminent, we can be sure that “what is most important about our humanness be recognized at the end of life.” Perhaps her most powerful suggestion is how to approach the conversation with our loved ones who often do not want to have the conversation with us. She suggests we start by saying, “I’m asking you for a gift—a gift of your time and your intention. This is really important to me and hope you will honor me with your gift of time so we can have this vital conversation.” Dr. Turiano’s gentle nature exudes a sense of peace about herself and her work. Perhaps that is a reflection of her perspective on her work; as she says, “she feels so privileged to be with people at the end of their lives.” And any of us would be privileged to have her with us at that time.
Richard and Gretchen Dagget are facilitators for an organization called Honoring Choices, a nonprofit organization whose mission is to educate and assist adults in making health care plans and providing them the resources to have their choices honored. They recommend we follow a three-step program that provides guidance in planning for end of life.
1. Have a conversation with yourself about your choices.
2. Have a conversation with others and communicate those choices.
3. Prepare the appropriate documents to ensure your choices are honored.
So many people say they don’t want to “be a burden” to others at the end of their lives, but it is a burden not knowing a person’s desires! Echoing Dr. Turiano’s suggestion that we ask for the gift of time from our loved ones, they suggest we give family, spouse, health care proxy a copy of the book, “The Gift of Preparedness,” and they ended their presentation with a reminder of what Buddha said, “Unless you think about death, you can’t really live life.”
“We know we’re alive. We know we’re going to die. But we never want to talk about death.” That is how Sr. Rosemary Mulvihill, the final presenter, took the conversation in a spiritual direction and asked us to think about our personal concept of God. She told three stories of her experiences with dying family members, how those experiences reflected each person’s concept of God and how that concept influenced each end of life experience. As she says, “The type of God we have is very important.” Her great aunt saw God as Judge (“I don’t know what his judgment is going to be”). Her dear friend, a lapsed Catholic, sought a priest because she was angry at God for a personal tragedy she suffered; she saw her God as a Punisher for her religious lapse. Conversely, at the end of her life, Sr. Rosemary’s mother said, “I had a good life; I’m fine. I just want to see his face,” because her God was a Loving God. Three different concepts of God influenced each end of life experience. Sr. Rosemary reminds us that old age is an opportunity to “melt into God” and asks us, “Are we melting or resisting?” “How able are we to depend on God?” Perhaps if we realized that God is bigger and wider and greater than we can imagine and is “crazy about us,” it would help us to improve our relationship and our vision of God, which ultimately would influence every aspect of our lives. Lastly she told us that (in her opinion) at the end of our lives God will only judge us on one thing: How much did we love? Perhaps if we could love more—love ourselves and others more—it wouldn’t be so hard or fear-inducing to die. Sr. Rosemary ended by asking us a poignant question: “When you are passing over from life to death, who will be applauding most loudly for you when you arrive?” The answer is God.
As a result of attending this workshop, in the future when the subject of dying comes up, I will not say, “Can we talk about something else?” Rather, I will see the opportunity as a gift and know that it is a key to my “Living Well and Dying Well.”