We are all terminal. We just don’t have the exact date on our Google calendar or any other calendar. But eventually, our ship will sail with us on board throwing kisses to loved ones, metaphorically. But one thing has changed, how long it’s taking to unwind the line from the hitch.
Learning of a friend’s cancer, your mind goes to your wardrobe wondering if your only black suit still fits. At least, it’s how my mind responds. Not anymore. Dreaded test results no longer mean shopping for a coffin. Heart disease and cancer diagnoses now lead to treatments tailored to meet specific conditions, if you have the right insurance and live close to a progressive hospital or health center. Even a stroke may not mean that living as you know it is over, although it’s a big mountain to climb. After a shock and a period of “why me,” eventually, many of us continue to enjoy our lives with an emotional acceptance of what is.
Curious to learn more, I set out to discover how people are dying. Are there universal paths and who has studied (If I can think it, someone has studied it. ) the most common ways life ends?
Yvonne McMaster is an Australian palliative care physician I follow on Twitter. She is one of about a hundred people who tweet interesting insights into what’s happening in their field. In an interview (medium.com), relying on the work of another physician (Joanne Lynn), Yvonne explains four ways people tend to die. Both women are crusaders for supporting people’s right to live well until the last moment and die with dignity.
Using simple graphs, McMaster explains, “There are four ways people tend to die,” The H line represents Health, and the T stands for Time.
The first graph is a person in good health until something unexpected happens, such as a heart attack or a victim of a fatal shooting. Three examples in our family fall into this category: Tim’s grandfather (in his forties) died in a car accident, our daughter, Andrea (28), drowned, my cousin, Helga (6), died of burns caused from playing with candles. Yvonne points out that not many people die this way, going from full health to zero.
The second graph, or second way people die, most of us recognize. You have a disease, cancer for example, and experience only a slight decline until the disease starts wearing you down quickly. Yvonne’s words, “all in all, it’s not a bad way to go, especially if you have good palliative care.” You can enjoy your life as before. A decade ago, I was diagnosed with Sarcoidosis; small granulomas had made several of my organs their home. Treated aggressively, I came out on the other side, ready to dance. Sometimes, a disease can strike back with a vengeance, and you no longer have the resources to fight it off. According to Yvonne, 20 percent of us die this way.
The third slope’s prominent characteristics are the deep caverns. This graph represents chronic conditions that cause nasty occurrences over time, ones that often require hospitalization. But you never really recover from them. Emphysema, organ failures, and many others fit in this category. Death is likely to happen during one of the dips. Twenty-five percent of us are in this category.
The last trajectory is the most common. The body wears down, you become frailer, and you die after some physiological challenge, influenza, infection, or a broken bone. It’s also possible that you endure a mix of all the above graphs.
“Palliative care is a tricky thing to explain to people,” Yvonne explains. “I think it’s because it runs so contra to our ideas about medicine and what doctors do. Throughout our lives, we see the counterpart—curative care—played out in the form of surgeries, procedures, therapies (like chemotherapy or immunotherapy), and various other medical interventions that fight or fix the direct cause of an illness.”
Palliative care isn’t a funeral business, curative care, or a geriatric physician. It’s supportive medicine. It’s specialized therapy in the form of symptom-controlling medication, rehabilitation (that doesn’t cure), and counseling to make it easier to cope. Curative care cures. Palliative care makes you feel better. It’s Alka-Seltzer for an upset stomach and throat lozenges for a sore throat.
Volunteering for Hospice of Michigan, I saw first hand how people’s lives shrunk. First, Brenda (nursing home) stopped wanting me to wheel her outside. I taught her how to “knit” hats using a wheel. It brought her great joy. Each time I visited, she showed me the hats she’d knitted, and we chatted and knitted together. She told me about her childhood and her life as a mother and wife. Then she no longer wanted to go outside. It was too hot or too cold. She stopped knitting. She ate and drank less and an hour would go by and I was the only one talking. I learned to sit in silence with Brenda. Then her sleep hours outnumbered her waking hours. There was a period, perhaps two weeks, I could best describe as Brenda slipping in and out of consciousness. It was as if staying awake was too much effort for her. Her interest in food or water was gone. Then one afternoon, Brenda’s bed was empty.
At the age of 72, Yvonne’s mother was diagnosed with breast cancer. By the time she was 76, in spite of radiotherapy and hormone treatment, her condition had worsened considerably. Yvonne cared for her at home, adjusting her morphine and meds to match her level of pain. “Mum had two good years after that,” she says. “And because we all knew what was coming, she did a rather delightful thing. She gave away little gifts and treasures to old friends and colleagues. And she phoned up her lifelong contacts to tell them she was dying, to thank them for their years of friendship, and to say a heartfelt goodbye.”
Hearing stories of friends’ final weeks (sometimes months and years), shuffled between emergency rooms, hospitals, sent home, back in emergency, then a nursing home, sounds horrid. Understanding how the final chapter is likely to be written empowers and lessens the fear.
I plan to die in my home, and I say that with a history of a reasonably high percentage of following through on my plans. I’ll have a little bell to chime for Tim. There is no passion to be found playing small, settling for a life that is less than you are capable of living, Nelson Mandela is quoted saying. It holds true for death as well. A good death shouldn’t be a foreign concept we tiptoe around. We know what it is. It’s to live as long as we can, with enough time to say good-bye, as painlessly as possible, with quick medical assistance when needed.