Living and Dying In Style

Some things are easier to talk about than others.

BY DR ERIC FAIRBANK

Anybody can talk about the weather, the rain (or lack thereof), the fierce winds, the unseasonably warm temperatures - all of these are safe, easy topics. Football is also a foolproof conversational gambit. The highs and lows of one particular team versus another can keep lively discussions going throughout the season and beyond. Other subjects are much more problematic and difficult to discuss. Take politics for instance. People are often reluctant to voice their views in case they cause offence or provoke an argument. Sex is also not an easy subject either (except among the young), as it is a matter of privacy between couples.

How about death as a conversation stopper? We all know that we are destined for death and that no exceptions are made, the legend of the Philosopher’s Stone notwithstanding. Despite the certainty of the matter, individuals willing to talk and prepare for death are definitely in the minority. Studies show that people with terminal illnesses are often eager to prepare for end of life but for various reasons do not make the most of their opportunities. The topic may be deliberately avoided to protect others from painful emotions such as anxiety and fear.

Or it may not be broached because the dying person is unsure how to open a dialogue in a topic that has become so taboo. Doctors and nurses may feel that to discuss death is to tarnish hope and make the management of patients more difficult. The result is that everyone waits for someone else to introduce the topic and so no one does.

The issue of death and dying needs to be dealt with so that life can be appreciated and experiences enjoyed to their fullest potential. In her song The Rose, Amanda McBroom says "It's the one who won't be taken/ who cannot seem to give, and the soul afraid of dying/ that never learns to live.” People confronting this issue are an inspiration to others as their open communications lead to a celebration of life.

Perhaps death is not so dreadful anyway. According to Carl Jung “What happens after death is so unspeakably glorious that our imagination and feelings do not suffice to form even an approximate conception of it.” While it may be true that the afterlife is beyond our comprehension and discussing it a futile exercise, it does not preclude us from preparing for death and the loss of a loved one. However, survivors of near death experiences often talk of a feeling of peace and seem to lose any previous fear of death. Ian Gawler, a survivor of what was almost terminal cancer, wonders if the moment of death may in fact be a moment of delight. He says “ Better than the best chocolate sundae you ever had, better than the dearest, happiest moment you hold in your memory…

The only thing that scares me about death is that I may come to it unprepared.” Preparation for death is well told in Tuesdays with Morrie by Mitch Albon. The book is the author’s account of conversations with his former professor, who is now dying of a progressive neurological disease. Every Tuesday becomes a lesson on Morrie’s philosophy of life and death. Morrie says we need to look for a certain peace with the idea of dying, it is part of life’s deal and only then can come peace with living and the finding of perfection in an average day.

Death is the great equaliser and it enables you to see life differently, to focus on its essentials and become aware of nature and all things spiritual. One of these essentials, says Morrie, is our relationships with each other. Relationships need to be negotiated in loving ways with room for both parties and with consideration for the situations others face as well as your own concerns. He quotes the poet Auden, “Love each other or perish.” Love is how you stay alive even after you are gone. Death ends a life not a relationship. On feeling sorry for yourself and mourning lost abilities, Morrie says set a daily limit, concentrating thoughts on the positive.

He says we need the ability to detach, particularly from emotions that might dominate our thinking such as fear, grief and pain. Experience those emotions, know them for what they are, but don’t let them control you. He encourages us to stand back and look at our lives without needing to be prodded by a life threatening illness. You must deal with any regrets otherwise the pain lingers on. Forgive yourself and others before it becomes too late. It’s never possible to go back, nor should you want to, says Morrie. As you grow older you naturally experience a change in your attitudes, see things from a different perspective and grapple with the big questions. In the same way, dying becomes a time of both growth and increased understanding.

Now that we are in fact talking about dying, it is possible to summarise the essentials of preparation for the end of life as follows:

• Know what to expect from your physical condition and be able to discuss any personal fears
  
• Appoint someone to have medical power of attorney so that in all circumstances decisions made about treatment are in accordance with your wishes
  
• Plan as far ahead as possible for care in the place of your choice, whether that is at home, in a hospice/palliative care unit or a hospital
  
• Make opportunities to resolve unfinished business, particularly in relationships with family and friends, and with respect to spiritual and religious matters.
  
• Say goodbye to important people and pets
  
• Remember personal accomplishments, a life review helps you find meaning and purpose and gives succeeding generations a sense of their place in the world
  
• Put legal and financial matters in order, particularly a will
  
• Perhaps give some thought to a funeral

There is always room for help. Surgeon Bernie Siegel says “in the absence of certainty there is nothing wrong with hope.” Plan for the worst but hope for the best. Be content with what is happening right now – this is the ultimate in doing it in style. Hope for healing which occurs when there is peace of mind. Healing goes beyond curing and may occur when being cured has proved impossible. Keep death in its place. Plan for dying and live in style.

Dr Eric Fairbank is the Director of Palliative Care at South West
Healthcare in Warrnambool, Victoria. He believes that preparation for death is a topic that needs to be better addressed in our society.