Preparing for end of life
My friend, Dixie, 99 years old, is coming to the end of her life. She lives with her son and daughter-in-law who are providing hospice care for her. For the last seven years, I had lunch with Dixie and her son every week at a local restaurant. But now, she can’t leave the house or walk unassisted. She sleeps most of the day, slips in and out of awareness, and slowly, but surely her organs are shutting down. She is like a candle flame that is flickering. Yet, surrounded by loved ones in a familiar environment, she is peaceful. While not unexpected, who is ever prepared for the death of a friend, a mother, or a close relative?
Of course, her family hopes that she passes away in her sleep, during one of her many naps or at night, and she probably will. Her wishes have been clear—no doctors, no hospitals, and no medications outside of comfort care. There is no treatment for very old age. While the spirit is strong, our body’s days are numbered. The quality of her life has been very slowly declining over the last several months.
Recently, while visiting my brother in Massachusetts, we scattered my mother’s ashes in his garden. She passed away four years ago, but it took us a while to be at the same place at the same time. I chanted an ancient Hebrew prayer, the Mourners Kaddish, while we spread her remains, and broke down in tears before I could finish. I think about my mother often and miss her terribly.
My mother, like Dixie, was fortunate. When she came to the natural end of her life, at 92, she was at home, with family. She died peacefully.
Sadly, many of us come to the end of our lives in a hospital—surrounded by tubes, electronic devices, and strangers rather than friends and family. Dying can be a frightening experience. My father was in a Skilled Nursing Facility (SNF) when he passed away. He was only there for a little over a week, but at times he was very frightened. He was losing control of his body and the loss of control triggered intense anxiety. He was confused, and forget why he was in the facility. Ultimately, he died in his sleep. Both of my parents discussed with my brother and me, when they were well, what they wanted for their end of life care.
It’s vitally important for adults to think about and plan for this eventuality. What life support are you willing to have? At one point do you wish to have life support withdrawn? Who do you want to make decisions regarding your care if you are unable to express your intention? What does quality of life mean to you?
My youngest daughter is my health care proxy should my wife be unavailable. I have talked with both my wife and daughter about my wishes should I be in a vegetative state. I have confidence that they will do as I have asked.
It is better to have these conversations in middle to older age when you are well. Don’t wait! While my daughter was uncomfortable when we talked, she asked me questions about possible situations that could occur. What would I want her to do? Simply designating a health care proxy is not enough—a discussion is just as important.
In our state, obtain a health care proxy form and a POLST form. Completing these and make sure that your family and health care provider has copies. Talk about your wishes while you are well—even if it’s a difficult discussion to start.
Here’s a link to the necessary forms from the Washington State Medical Association: https://wsma.org/advance-directives
The Everett Clinic offers Honoring Choices ®, a no-cost course to help you and your family with advanced care planning. Advance care planning is a process that helps you:
- Reflect on your values
- Choose a health care agent
- Explore goals for treatment
- Take the first steps toward completing an advance directive