Friday, October 9, 2015

A better way of dying

The novelist Richard Ford, writing in the New York Times soon after 9/11, contrasted the enormity of the terrorist attacks with the intimacy of his father’s death when Ford was sixteen years old. Ford had woken to his mother’s pleading voice, trying to shake Ford’s father into consciousness.
 “‘Daddy, Daddy, wake up,’” Ford recalled saying. “I could smell his large, sweaty body, feel his flaccid self, loose-limbed and malleable, his cheeks and mouth relaxed. He had quit gasping. I tried to open his mouth with my fingers and breathe in air. I tried to push down hard on his chest. I tried to move him. I put my arms around his shoulders and shook him. I heard my mother say, ‘Oh, God, no, no, no.’ And I felt dread and terror, love and ferocity, confusion, physical exertion, a need for greater ingenuity, for greater efficiency, and I felt failure. In short, I experienced all the small and large coefficients of a son's unswerving love.”
The passage is similar to something I came across by Elisabeth Kübler-Ross, who in 1969 published her influential book On Death and Dying. At one point, Kübler-Ross describes the fatal injury to a farmer in Switzerland who had fallen out of a tree. Kübler-Ross was a child at the time, and she later commented on the stoic calm of the dying man.
“He asked simply to die at home, a wish that was granted without questioning. He called his daughters into the bedroom and spoke with each one of them alone for a few minutes. He arranged his affairs quietly, though he was in great pain, and distributed his belongings and his land, none of which was to be split until his wife should follow him into death. He also asked each of his children to share the work, duties and tasks that he had carried on until the time of the accident. He asked his friends to visit him once more, to bid good-bye to them. Although I was a small child at the time, he did not exclude me or my siblings. We were allowed to share in the preparations of the family just as we were permitted to grieve with them until he died. When he did die, he was left at home, in his own beloved home which he had built, and among his friends and neighbors who went to take a last look at him where he lay in the midst of flowers in the place he had lived in and loved so much. In that country today there is still no make-believe slumber room, no embalming, no false makeup to pretend sleep.”
Since On Death and Dying was published forty-six years ago, much has changed in American health care. Advances in medical technology continue to extend many lives. But these advances come at a significant cost. End-of-life expenses, in particular, can be obscenely high, and dignity is sometimes sacrificed. In “Seven Keys to a Good Death,” an article published on the Berkeley, Calif.-based website, Greater Good: The Science of a Meaningful Life, Charles Garfield recounts an experience he had with a friend who was terminally ill.
“Near the end of his life,” Garfield writes, “he had reached a place of equanimity about dying. But instead of honoring his wishes for a peaceful death, his doctors ordered aggressive chemotherapy, which did nothing to halt the cancer. The treatments caused him immense suffering, rendering him unable to sleep, eat or converse with family and friends as he was dying.”
My dad, who died of congestive heart failure in his late eighties, had the good fortune of dying in the home he had lived in for forty-five years. He died in late March, amid pleasant early-spring weather, and, in his last days he had the consolation of not just his loved ones and his Catholic faith but his familiar surroundings, which included a view of Bellingham Bay, the body of water he  traversed in his fishing boat thousands of times.
My dad died in 2004, when I was forty-two, and I pretty much took it for granted that, barring some terrible accident, I too would live into old age. But it is always foolish to assume that one is exempt from bad luck.
Greg O’Brien, a prominent figure in the Massachusetts Alzheimer’s community and author of On Pluto: Inside the Mind of Alzheimer's, also has been diagnosed with stage-3 prostate cancer, a disease that he does not intend to have treated. His logic strikes me as airtight. No one wants to enter into the fog of advanced dementia, a place that might as well be festooned with signs proclaiming, “Abandon hope, ye who enter here.”


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