As an emergency physician, not a work day went by when I did not see someone transition out of their body. As we discussed our day over dinner, our family we would inevitably arrive at a discussion of illness, injury, and death. These discussions were always appropriate for the age and experience of those at the table. My children grew up thinking discussion of death, and our wishes, was normal; and it was in our house.
My parents both had advanced directives. My mother-in-law decided to discontinue her cancer treatments and die at home, long before hospice. My sister and brother-in-law have asked me to be their medical power of attorney.
My daughter, now an internist, initiates a discussion of having a ‘natural death’ with each of her patients at their first visit. She sits for her palliative care boards next month.
I still initiate an end of life discussion at every opportunity I get. I am a member of the American College of Emergency Physicians Palliative Care Section and have recently volunteered to be trained as a facilitator for the POST/POLST program [POLST (Physician Orders for Life-Sustaining Treatment) is a form that states what kind care, if any, a person wants at end of life.]
42 years ago, my husband and I made the decision to discontinue resuscitation of our newborn daughter, a decision we were marginally prepared for due to our discussions, not to my training. A decision, we, to this day, know was the right one.
All 5 of my grandchildren raise animals. They see and discuss mating, birth, and death on a daily basis. We discuss with them the fact that we are getting old; my husband’s heart attack and how lucky we are to still have him around because doctors could unblock his heart arteries and put in a stent; and how quality, not quantity of life is what matters. We talk about people who died, our parents, grandparents, daughter, and other people the children know or see in our pictures. As we divest of our books and ‘antiques’ we explain we want them to be enjoyed, now while we can give them to those who would most appreciate them.
We teach birthing classes to mothers and fathers. Americans take driver’s ed, study for SATs, go to months or years of school or training to be good at what we do, whatever our chosen field. Why then do we neglect discussing the one experience we will all share, end of life and a natural death? After all, we each get one of them!
I am so glad that, at 67 and 68, my husband and I know we will not squander precious medical care dollars, that we will die in the presence of our loved ones, and will not be subjected to any unnecessary, painful medical procedures. We will get compassionate pain control, needed emotional and physical support, and die with quiet dignity because that is our choice.
I spent the last 40 years helping develop a system to help people live. Now, I am working to see that that system is also allowed to let people die, if that is their choice.
We cannot chose how we are born, but we can choose how we die. But, only if we have the right discussions with our loved ones and physicians; put our words onto paper; and educate EMS, the ED, the medical profession, the politicians, and the lawyers to respect the individual’s right to chose to have a natural death