This is the title of a wonderful book by Atul Gawande that I have been listening to (I love audiobooks, listen while you do other things).
Wow, I just pasted a link and Amazon did all the rest! Anyway…
The book is about medical and custodial care of the elderly and dying. I know, not everyone’s favorite subject but as many of us get to a certain age where the years ahead are fewer than the years behind, it definitely needs conversation and thought. That darn death rate continues to hover right at 100% and never wants to budge.
Medicine has done a lot to cure disease, fix injuries, and alleviate suffering. But, medicine is all about fixing the problem and when the problem is terminal and life ending, there is no fixing that. We need to look at that care from other angles, to enhance the quality of the last stages of life for the patient and the family.
Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee… someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind.
I’m a nurse. I’ve worked in hospitals, and then in home health where the majority of my work was with seniors. I’ve moonlighted in nursing homes and seen many in assisted living. More recently when I was in home health and there was more awareness, part of my job was to have the conversation. If we find you on the floor in big trouble do you want us to do everything, or nothing, or something in between? Have you talked with your family about this? If you couldn’t speak for yourself, who would you want to make decisions? What is important to you? What makes you happy to be living this life? How can we help you? Your family?
I have seen many cases of aggressive treatment to the very end. One reason I left the hospital, and nursing altogether for a while, I never want to see a code blue ever again. It’s traumatic, dehumanizing, and rarely has a good outcome. I threatened for years to tattoo DNR (do not resuscitate) on my chest. I lectured my kids when they were barely old enough to understand because of things I saw in the hospital.
I may be shortening my life by living in Panama. Maybe I won’t have access to the latest and greatest medicine has to offer (like I could afford it in the US anyway.) But, maybe I will have a longer life here, less stress, better food, clean air, good community ties, and a happy mind. We all want to make our own decisions, to live how we want to live. As a nurse I saw people do things contrary to their health and best interests, but that is their right. Do we keep people safe at the expense of allowing them to live their own lives? Do we take away so much of what makes life worth living? Thankfully there are innovative and caring people who are asking these questions and working hard to find better answers.
Anyway, read the book, have the conversations. As Jim Morrison said in Roadhouse Blues, the future is uncertain and the end is always near. But knowing that makes every day sweeter.
Kris another well written and thought about subject
you write the truth and have many good words of wisdom, and my hats off to you for all your work in your field, I don’t think I could do it, you rock I was diagnosed with dementia but have been on meds Aricept, Depakote and some other things family has said my memory has gotten better and I even feel better but not sure if I got so bad I had to have 24 hour care that I wouldn’t want to be a burden on my loved ones that’s why I am looking for a place in panama while my mind still is good its time to travel take care bye
I hope the meds continue to help and you have happy days and years ahead
just added it to my Christmas list. I am caught up on most of my reading, this looks like a good one. In addition to thinking about the medical issues, the other critical discussion must be about settling one’s affairs upon leaving this world. The survivors don’t need additional stress of figuring out what to do with your “stuff” once you are gone. Probably most of our arrivals were planned, the exit should get the same thinking.
Above all, this is my favorite quote:
– Do not take life too seriously. You will never get out of it alive. Elbert Hubbard
Another advantage of not having a lot of stuff. If we both get hit by a bus tomorrow, the musical equipment would go to other musicians we know, everything else to our friends and neighbors, and the house back to the landlord. But you are right. First of the year is my time to update our contacts and other necessary information so the kids know who to contact and what to do just in case.
As you know I had to return to the states because of my COPD. My new doctor has put me on something called Breo Ellipta and it has, honestly, changed the quality of my life for the better.
But as I get older, now 75, and watching those my age and younger dropping like flies one has to think about one’s own mortality. A good friend of mine, two years younger (Skip Williamson. Google him and check out his cartoons. He’s the only person I know in my life who rated an obit in the NY Times) bit the dust a couple of months ago. I spent my 75th b/d in Tallahassee Memorial Hospital and I had a DNR request. It I was younger and didn’t have the COPD I might not go that route, BUT…
I also gave my youngest brother power of attorney as my health watchdog. He’s a nurse practitioner and also runs the largest hospice organization in the state of North Carolina. I think I’m in good hands.
As the saying goes, “Don’t take life too serious. Nobody’s getting out alive.” And also…”Dying is the best part of living. That’s why they keep it till last.”
P.S. It was shocking when I returned here to see how many people smoke compared to Panama. When I’m at a bus stop and someone lights up I ask them, “Do you know who Keith Richards of the Rolling Stones is?” If they say they do then I say, “You know, for every one of those you smoke Gof takes an hour away from your life and gives it to Keith Richards!” Who would have bet 40 years ago that he’d still be alive and kicking today?
I sounds like you are in very good hands, and I totally agree with your decision. Spending your last days in ICU on a ventilator is not the way to go. I know people get saved, but in my 33 years of nursing I have not seen or met or heard of one single person who survived a code blue with any quality of life.
Keith Richards though, yes, who would have thought. He has brought a lot of joy to a lot of people, so good for him for sticking around for so long.
Oh, and the smoking. Now it feels strange to me to smell smoke. Have you seen what cigarettes cost in the US?? Crazy expensive! I used to get exasperated with some of my patients. They couldn’t eat well or buy their meds all the time, but they always managed to have cigarettes and Coke, in cans, name brand, no cheapo 2 liter bottles of the store brand.
I think people here can’t afford to smoke and are more health conscious than that.
Panama’s decision to not allow cigarettes to be on display was very wise. It cuts down on impulse buying for sure. Coming back to the states it was a shock to see the HUGE displays of smokes in stores. And this whole “vaping” thing is ridiculous. My dad, a smoker for decades, had told me, “the only way to quit smoking is to QUIT SMOKING.” Over the years I tried everything…patches, lozenges, gum (I’d smoke and chew it at the same time) even tried hypnosis. But the ONLY thing that works is to tough it out and go cold turkey.
It’s been five years or so since I quit. I remember how it happened but not exactly WHEN it happened. I’d stopped cigs and switched to cigars because I couldn’t inhale the cigars. Too strong. It was a rainy Sunday afternoon and I’d smoked my last cigar. I couldn’t go buy more because the place that made them over in Bugaba was closed and I WASN’T going to go out to the Chino in the downpour to buy a pack of cigs. So I just grit my teeth and got through the rest of the day. In the morning I decided to see if I could make it through the day without smoking. . . and then the next. It took about two weeks before the nicotine was out of my system and every day the urge to smoke got a little less. Unlike so many former smokers and non smokers it doesn’t bother me to be around people who are smoking. I remember in the old days I used to say…”Thank you for holding your breath while I smoke.”
I used to smoke too. I cut down until I was smoking 1-2/day, then quit entirely. It took determination but I was tired of being a slave to the smokes and I knew it was stupid for health reasons. Hard to believe it’s been over 20 years.
31 years here since my last cigarette. What I have learned about addiction is that one never stops quitting. You can not quit addiction, you can only continue to stop with each urge to give in. Richard is correct, refusing to smoke gets easier with time. I stopped drinking alcohol at the same time as a smoke and a beer go hand-in-hand. Saying no to both at the same time is easier. I am still an alcoholic probably but I’m a non-practicing one! 🙂
Good for you!