100 Things...

Today I attended a conference on end of life care at Franklin Memorial Hospital. This semester, I'm taking an independent study on palliative care and how to work with people who are at the end of their lives. While this is an incredibly sad topic, it is one that I find to be very important. Have you told your loved ones whether or not you wish to be kept alive on a ventilator if you ever get to that point? Have you told your family whether or not you would like extraordinary measures taken to save your life in the event of an accident or disease? Have you told them what you would like done with your body when you die? Well, maybe you should. Sure you may not be experiencing a life-threatening disease currently, but what if...? 

When one family member becomes unable to make their own medical decisions and other family members step up to make those decisions without knowing exactly what the person would have wanted can cause a great deal of unrest in the family. We don't want that, at least I certainly don't, at the end of my life. For that reason, I have an Advanced Directive that has a DNR / No Extraordinary Measures form, my views on being kept alive by a ventilator, the insertion of a feeding tube, etc. It also has information about what I would like to be done with my body when I die. For those of you who may be wondering, I wish to be cremated placed into a bio-urn that will use my ashes to fertilize the growth of a tree, then planted in a quiet place by the water. 

Now, I'm hoping that my death will not come anytime soon, but when it does, I know that I can go peacefully, knowing that my wishes will be respected. I would like to be able to decide when I die. For example, say that in some 60-odd years I develop a horrific form of cancer and I am diagnosed with six months to a year to live, if my doctor thinks that there is any chance that he or she may be able to prolong my life in a way that allows me to be happy and comfortable, I will do it. However, if this treatment fails, I would like to be able to choose when the treatment stops and I begin my journey into whatever comes next. 

I know this may seem quite morbid to most of you and maybe far too painful to read and conceptualize, but it's an important topic to discuss. The biggest takeaway is this: everyone is different and everyone may have different wishes, but it is on us, the able bodied care takers to do whatever is possible to ease the pain and follow through with the patients wishes. When it comes down to it, we all know when it is time to go. We all know when we've had enough. One of the biggest things that jumped out at me today at the conference was a section in a movie we watched called, "Consider the Conversation." I have posted the quote by Dr. Martin Welsh below:

“Imagine a list of 100 things you do most days. Some are routines, some are chores, and some are pleasurable. Get out of bed and walk to the bathroom. Kiss your wife. Answer the phone. Drive your car to work. Go play golf with your friends. Brush your teeth. Write a letter, lick and seal the envelope, and put a stamp on it. Hug your child. 

Of course, we do many more than 100 things a day, but for now, just imagine 100 things that are essential to the life you live. Now if you take away 1, you can still do 99. Is life worth living without being able to smell the roses in the garden? Of course it is. How about losing 2, or 7, or 23? Is life still worth living? Of course! But suppose you get to where you've lost, say, 90 things... and now with each one taken away, a bad one is added. You can no longer walk well, and you start falling, and it hurts. Your grip is gone, and you also suffer the ignominy of wetting your pants, because your bladder spasms. You can’t turn over in bed, and that also means you’ll get bedsores, unless someone turns you frequently. Life is still worth living, but you’re getting tired.

At some point, no matter who you are—or how strong, you can lose enough things that matter, and acquire enough negatives, that the burdens will outweigh the joys of being alive. This is the stage when, as a doctor, I would reassure my patients and their families that they had fought the good fight, and it was now okay to accept moving to the next phase."

Just think about that for a minute. Wouldn't it be nice to decide when to move on to the next phase? Sharing your wishes and hopes with your close loved ones is certainly a start. Pick someone you love and tell them what you want when you are coming to the end of your life. It will help you, certainly, but it will help them as well.