He who sleeps here, as he dies, mistaking the approach of death for the return of health, he whispered with his last breath, “I am well now.” Let us believe, in spite of doubts and dogmas, fears and tears, that these precious words are true for all the countless dead. Robert G. Ingersoll, Eulogy for his brother Ebon. Washington, D.C., May 31, 1879.
INTRODUCTION – People are squeamish about death. It stands with religion, politics and sex as topics to avoid in a polite (and different) society. While most overcome the culturally induced reluctance to think about it long enough to do a little estate planning (e.g. make a will, maybe sign a donor card), little or no thought is given to how to die.
DYING HEALTHY? – To die healthy means to live well, until the last moment of existence until, with a last breath, you think, mutter or say aloud: I feel better now, as Robert Green Ingersoll spoke (following his brother Ebon) then on July 21, 1899, he closed his eyes forever. Of course, not everyone has much choice about how, when, why or where to die. For most, dying is not a choice at all. Many of us die without a graceful farewell, largely because we didn’t plan such a thing. Those lucky enough to avoid an untimely end and also pay attention to healthy living could welcome the availability of choices for a good death. No, this business of dying healthy is not as attractive as planning, managing and constantly adjusting a healthy life. All things considered, though, it could still be a worthy venture (pun intended).
We know from spending patterns published during the US health reform debate that huge amounts of money are spent on the last months of life. What is done to maintain life is not always in accordance with the dying person’s wishes. The quality of life during the last months (or even years) can be quite bad. So those who value a wellness lifestyle may want to make arrangements for when the end of life approaches. When that time comes, they may be more willing to acknowledge the signs and less willing to engage in hopeless or distressing denial strategies. They are more likely to exert some degree of control over quality of life during the latter stage, in line with the lifestyle that is artsy when they live well.
The sad fact is that very few people die healthy. Yes, it can be argued that it is possible to die healthy. The phrase is, of course, an oxymoron, but when interpreted in a defined way it is not a contradiction in terms. Yes, unless explained, dying healthy may seem worthy of a fortune teller as a good/bad combination. I was recently amused by the advice psychics gave an undercover New York Times reporter, Ariel Kaminer. During an assignment, Mrs. Kaminer asked a motley crew of fortune tellers what to expect in 2010. Mrs. Kaminer was told that she is facing a year in which everything she set out to achieve will be realized, although all her ambitions will be thwarted! That was helpful. Also that while her love life will blossom like a flower, her romantic prospects are in serious trouble. And while great events will happen, nothing will happen at all. Mrs Kaminer concluded: I am not making this up. I got it from the experts. (See Ariel Kaminer, The Future: Cloudy, With Platitudes, New York Times, Dec. 31, 2009, 25.)
Yes, the phrase die healthy may seem ridiculous at first, the kind of silly talk psychics offer their idiotic clients who take seers seriously. But please don’t put those healthy in this category too quickly! Instead, consider how I interpret the phrase – from a REAL well-being perspective of functioning with mind as we seek exuberance and freedom.
DIE HEALTHY DEFINED – Dying well means that, if you must die, and the science suggests that we carbon-based bipedal lifeforms messing around on a small rock orbiting a giant fireball in the middle of nowhere (thanks, Pat Condell), why not do it as sensibly and even healthily as possible? That’s it – that’s what I mean by dying healthy. (Warning: long sentence ahead – take a deep breath!) Just as living well entails wise choices of disciplined habit patterns with sound philosophy and mindful thinking that promotes a good measure of happiness, fulfilment, meaning, purpose, fun, joy, love , good health and the like, so also death can be approached in a way that promotes desirable processes and reduces undesirable processes.
The person who cares enough about the quality of life to make the effort to shape and maintain a wellness lifestyle will certainly also want to consider and plan for a similar wellness dying style. The process of doing this is the meaning of the phrase die healthy.
SUMMARY TIPS TO DIE HEALTHY – Dying sucks. Very few people want to do it, no matter how bad their situation, although there are a few ignoble exceptions. Need an example? What about the Islamic maniacs who somehow believe what seems beyond ridiculous to most of us, namely that there are three twenty and twelve virgin delights waiting for the martyr who blows himself up for Allah. Holy cow – is there a limit to the nonsense that can be embraced under the poisonous cloud of revealed religion? None seems obvious so far.
Back to healthy dying. As suggested, few do, but that can and should change. So, here are a few starter tips.
* Imagine a good death. Think of someone you knew or read about who took off in a way that has attractive potential. No, of course it’s not something you want to do, but since you have to leave on time, you should consider a plan or at least some guidelines for the period leading up to the last minute.
* Tell your partner, children and anyone who will listen what you think about this matter. Take legal action to increase the chances that doctors and various strangers who may become influential in your last days know your intentions and desires.
* Consider assembling a team of transition counselors. Don’t you just like euphemisms? I mean, really, when your organs start to shut down and you can’t taste or even see your food, control your gut – when you’re steeped in dementia and experiencing congestive heart failure, kidney problems, a lot of pain, more delirium than usual and a lot of agitation and, worst of all, no longer interested in sex, don’t you want someone or a team of experts to help you escape a bad situation that will quickly get worse?
* Following on from the last tip, don’t delay learning about palliative sedation and the drugs that can ease unyielding suffering. These include, but are not limited to, lorazepam, midazolam, phenobarbital, scopolamine, ketaminer, morphine, methadone, fentanyl, propofol, and thiopental sodium. Combinations of these drugs work even better.
So there you go – that’s what it means to live healthy to die healthy. Not as cheerful as living a wellness lifestyle, but since you can’t do that forever it seems wise to mentally create a wellness lifestyle- to practice dignified curtain call.
Provided you believe you have the right to choose your own best way to die or, to use the more common euphemism, to die comfortably, there is no good alternative to dying healthy.
Best wishes, live well and if you can’t anymore, let it go. And now, before I end this essay, I’d like to share a response I got to these ideas from a close colleague I’ve worked with for many years, columnist Bob Ludlow.
I have no problem signing up for your wise and timely advice. I say on time because while I still feel like a spring chicken, unfortunately I’m not — far from it — and it’s time to stop procrastinating and face the sober reality that how well I feel right now also feel and how well I may function right now, I don’t have many good years left before something terrible happens to my aging 70 year old body or, Zeus forbid, my mind. So thank you for bringing this somewhat unpleasant subject to my attention with your usual wit, wisdom and rationality. After working on the Bob Ludlow project all these years, I was hoping to stop tweaking and just accept the far-from-perfect, but functional, results. Now your awakening has reminded me of unfinished business and prompted me to make a belated New Year’s resolution, which is: This year I will do the necessary research and then take appropriate steps to prepare for my impending decline and failure. Hopefully, the decay portion will be delayed for many years and then be short, if not instantaneous. There is no point in needless suffering, especially in a hopeless situation. So it behooves all of us to take those sensible and important steps you recommend to make the transition to eternal oblivion as calm and quiet—as healthy—as possible.
The idea of dying in the not-too-distant future doesn’t seem to bother me (not yet anyway), and it probably won’t cause much concern when the time comes. Unfortunately, I can’t be sure. As the irrepressible Daniel Gilbert convincingly documents in his delightful and highly informative book, Stumbling on Happiness, humans are incredibly incapable of predicting how they will feel and act in certain circumstances.
Like almost everyone, the idea of long-term disability and/or pain disturbs me greatly. If that were ever to be my prognosis, I now feel I’ll prefer to check out early on my own terms. Of course, Gilbert says I can’t know how I’ll feel in those circumstances. But it is a certainty that I want access to the most powerful pain-relieving cocktail available on demand.
Anyway, those are my preliminary thoughts on an issue I’ve neglected for too long. I look forward to deepening my understanding without becoming obsessive or morbid about it.