Happy happy joy joy….

Yeah…talking about death is a dark and depressing subject, right..? But maybe the issue is that for the most part, WE’VE chosen to make it that..

I always discuss death openly and honestly with my patients, in the hope to ‘normalise’ a ‘normal’ and unavoidable event..

I’m quite clear; there’s certainly times in life when death is NOT reasonable (I, for example, am not ready for death..). However, once we approach later life, have multiple co-morbidities, and become frailer and frailer, death is literally just around the corner so we should talk about it, plan for it, and be ready for it…

This BBC article  is a very open and interesting one on ’are we ready for death’.

It raises interesting key points and challenges in society; we kind of believe we are invincible and live forever because the advent of better treatments means the ‘quick’ deaths are really being cut back on… acute infections and heart attacks that would ‘snuff out life quickly’ still exist, but in much lower numbers. What’s left are the chronic/lingering conditions…

It seems these ‘delays’ are going to catch up on us….

So why am I posting this joyous topic on a snowy Saturday morning??

Well, it’s something I feel HUGELY passionate about because if you want to do something well, you kind of need to plan for it.

Ignoring and not talking about it REALLY isn’t planning for it… I see so many frail and elderly patients being ‘mistreated’ (not maliciously, but just inappropriately managed)because medics and relatives and careers and the patients themselves fail to admit they are dying, and managing the dying is vastly different to managing the ill.

Have a read of the BBC article, consider ‘normalising’ discussions about death and end of life planning, and, erm, have a nice day i guess!!

DrP

I quite agree.  I work in an environment that is partly palliative care.  Being open and discussing end of life care is important and its also important to know the wishes of the patients.  Some want to fight to the end, some want to slip away quickly and quietly.  Both views need to be catered for despite the views of the staff.

One aspect is most of us are not used to friends and family dying unlike a generation or two ago and death is often sanitised.  Pre war the bodies would often stay in the house until the funeral, now they are removed as soon as possible.  Also with the improvement in medicine early deaths are much less frequent so we have less experience of people dying

My plea is that you all get power of attorney and living wills in place now – especially if you have ageing parents.  this gives the staff the foundation to ensure end of life care is in accordance with the persons wishes and allows family members to take decisions when the patient is no longer able

so much to say, where to begin

I am totally on board, yet largely unable so far to have this discussion with my parents (80 and 76)  Both are in decent health currently – my Dad’s had NH lymphoma but is ‘cured’, mum has diabetes T2 and fibromyalgia but neithe rof those are likely to immediately see her off. Every time it comes up we just joke about stuff, like the undertaker who botched a friend’s funeral and how my mum definitely doesn’t want him when the time comes, as opposed to sensible stuff.

At the same time and sadly their neighbour has had cancer, been in ill health, moved out to hospice, and is now home ‘to die’ in the care of Sue Ryder. He’s had a couple of strokes, probably (no great sense going through the effort of scans to diagnose) and is through this and the morphine, basically vegetative – only flickers of consciousness now and then. They have withdrawn food and drink (he couldn’t take it anyway and no sense putting a tube in) and now waiting for either a big stroke or just to give up. Unfortunately, he just goes on and the nurses say that it could be days, or weeks.

So they have to face mortality in a form that is distressing for all involved. I know this opens a huge can of worms now for consent etc., but why we can offer the final kindness to a pet, but not to a human, I find vaguely inhumane. Especially as they have basically decided to let him die by ceasing feeding anyway, the fact he hasn’t ‘consented’ is neither here nor there.

Lastly – I’m a scientist and medical science is amazing, but I struggle almost ethically with some of this. We will all die, and all we are doing is kicking the can down the road. I’m not convinced we are really much better off, sure we have longer lives but do we have worse deaths as a result, pushing away the old killers to replace them by cancers and dementia and so on…..

Don’t know answers, this is almost just me venting.

It’s something that I think more about as time goes by..and while I know the end game is inevitable I’m nowhere near ready !

An average age of 79 for men is frightening ..have I really only got less than 20 years left ?

My main concern is that there is 17 year age difference between myself and my partner and we have only been together for 20 years ..to think that is all the time we might have left together saddens me ..not least because we have a ( nearly) 15 year old son ..I also have a 26 year old daughter from a previous relationship ..and I’m not a grandad yet!

We don’t really talk about this subject much ..Im still looking forward .. due to start a new part time job in one weeks time ( to run alongside my own business) which is as much about keeping me active as it is about the extra cash ..

Fitness wise ..I still feel ok ..out most weeks at least twice on the mountain bike..

The one thing that I don’t wish to be is a burden to my family who if fate deals the right hand have so much more living to do than myself ( given the age difference ) ..so when the clock stops ticking ..please make it quick !

Have a nice day yourself doc !😁

Interesting article. Like TJ I would reinforce the need for Power of Attorney but also planning for what you want to happen too. My parents are separated but have approached this in very different ways; and as both have now been diagnosed with dementia it is so much easier to work with them and the relevant medical support if you know how they feel and can act for them.

Thankfully I’ve not yet had to deal directly with the end of life stages with close family members but feel it is always important to remember with medical interventions that just because we can doesn’t always mean we should! Maybe that’s a viewpoint that’s not always discussed?

As a vet it’s a discussion I have with my clients on an almost daily basis and agree honesty about prognosis and quality of life are vital to making the right decisions. I am aware that my views are not always shared by the clients and work to provide the best possible outcome for my patients.

I think prolonging life is the holy grail. So much effort is pumped into denying death it’s grace, and what we are all too often left with is the gross picture of tormented shells that would have otherwise seen a dignified end to their days. Medicine aims to prolong life, but the reality is actually a prolonged death. I’ve conversed with so many old folk who have just had enough with living & medical intervention but the pressure from loved family members to keep going as any other option is just too taboo.

(massively grey topic & other perspectives welcome)

I’ll take a look at your link later. Ta

As a vet.

I believe animals are better prepared for death by their owners than most family members would be.

Agreed the power of attorney is very important, my father has some symptoms of early onset dementia but it’s not too bad at the moment and FiL died from dementia very quickly.

Back to the OP I have a big problem with death but know I have to get my head around it, more so as I power through middle age so will probably give article a go (or may stick my head back in the sand:))

With two relatives on fairly clear pathways out (though perhaps with some time to go) there’s certainly been discussion here…Though it’s very much up those those dying to actually make their preparations and some just prefer not to for whatever reason!  Agree that prolonging life in a way we wouldn’t do to an animal and against the wishes of the victim is shameful. Not that it’s come to that (yet) here.

Tuesdays with Morrie, a made for TV film. Worth a watch.

I think I could cope with my own impending death much better than that of say, my mum and dad or a sibling.

No problems writing my own will (or a living will) but when my parents wanted to talk to me about theirs it was exceptionally difficult.

Errr… help me out here OP, in what way is that article interesting? What is it actually saying about death? All I’ve read is some pretty graphs and a vague call for increased provision of palliative care.

No shit Sherlock! If we are going to continue the current model of extending life beyond its natural length, then yes, more opioids are required if we want other people, such as tj to care for our elderly relatives. More pharmaceutical numbing assistance, more budget to be paid to those that control manufacture and supply.

I don’t have a ready answer, however, I do ask for us to have the one human right that we are denied, which is our own choice as to how and when we each draw our last breath.

Ive said before on here, I would like to have my own death day. Friends and family around, saying our farewells before I swallow a little red pill.

If you want to talk about death, let’s talk, but if you want to big up the current approach that appears to benefit no individual but rather faceless corporations and is often carried out by very caring and compassionate people doing the very best they can to minimise pain, discomfort and dignity, then carry on with linking to articles that just consume space on the internet.

slackalice

Errr… help me out here OP, in what way is that article interesting? What is it actually saying about death? All I’ve read is some pretty graphs and a vague call for increased provision of palliative care.

Thanks slackalice, I was just about to post something similar.  “BBC article” was enough to make me skeptical and and as you say, nothing interesting, some graphs and a statement of the obvious. If anyone wants to listen to a genuinely interesting discussion about the issues raised in the article take a listen to this podcast with Frank Ostaseki and Sam Harris. Ostaseski is a Buddhist teacher, international lecturer and a leading voice in end-of-life care. In 1987, he co-founded of the Zen Hospice Project, the first Buddhist hospice in America. In 2004, he created the Metta Institute to provide innovative educational programs and professional trainings that foster compassionate, mindfulness-based care.

https://samharris.org/podcasts/the-lessons-of-death/

Also on youtube

https://www.youtube.com/watch?v=es-yJoXEiXA&t=2s

Yeah I also didn’t get much out of the article but OTOH just having stuff like that written about regularly is probably a good thing.

As for wills/PoA/etc, if people won’t do them all you can do is shrug really and be prepared for the possibility of an unpleasant shitstorm to come. It is disappointing that people are prepared to be so selfish/thoughtless though and expect others to pick up the mess they leave.

Going by the national average, statistically I have 6 years to reach EOL so obviously I have given this some thought. My peers are dropping like flies now.

I have tried to have the “conversation” with my family but the subject gets changed. No one wants to talk about it.

At the moment my health is good despite some major setbacks over the years, and I hope and intend to live longer, but I’ve seen the realities of life, and over those we have no control.

Right now my main health concern is to remain able to ride my bike. At 70+ I have noticed a considerable loss of strength which started being noticeable in my early 60s, and am very much aware that I’m just one health episode or accident away from having to stop. It does mean I appreciate every outing that little bit extra.

I always joked I would put gears and suspension on my bike when I got old and frail and lately I have been selecting my 3 speed over a singlespeed for road work. No suspension on the mtb yet though. 🙂

As a national body the NHS is in a position to collect a huge body of statistics on the elderly over a few years which would give them data to be able to score our downward paths.

I’d like to know where I was on that path. It’s not morbid, it’s information that would help me make various decisions, like when to do my bike cull. 🙂

A frank discussion with my doctor is what I will want when the time gets close, not reassurance.

In the meantime the best advice is to look after that lump of meat you inhabit. If you don’t, there’s years of grey misery ahead from what I’ve seen in my contemporaries.

the captain.  some folk do not want to face it / admit they are dying and the conversations around POA / living wills are very hard.

Do not judge those you do not know

Odd isn’t it, I thought I’d never see past 36… yet I’m still here tapping away.

I am prepared for death, always have been. Will sorted, open conversation with immediate family and choices of where to be scattered.. I am sitting in one location right now.

Parent (father no longer here) going through old age rather gracefully, yet still suffering with T2 and age related smoking disease.. already had the talk and will sorted.

I think loosing my father to cancer (2 remissions, then that was it) a long time ago prepared us for the onset of death.

But mostly it’s becuse I have a fatalistic pragmatic approach to death, you are here for a short time only.. no second chances, live your life as you see fit and try to enjoy it.

Once it’s over, it’s over.

I see no reason to prolong life past it’s own natural conclusion, there is a reason some live long and some live short lives. We have little effect on the outcome, and prolonged intervention invariably brings with it all sorts of social and family issues best not embarked upon.

IMO

If you have somebody with a terminal illness or you even have worries and concerns around somebody’s demise, even your own, phone your local hospice. Talk to them because they will talk to you and they have so much understanding, knowledge… help. There is so much more to a hospice than going there to die.

Apologies for the shameless plug. I’ll just put this here. I think it’s a scandal that hospice’s are charities but that’s a rant for another day.

https://singletrackworld.com/forum/topic/twin-towers-sponsorship-with-a-difference-4/

Powerful post slackalice and completely agree with all that you say.  Having just a couple of days ago attended a funeral I have no hesitation in choosing how and when, having the means to do so obviously.

There’s a quote by Mark Twain, forgive me if this isn’t 100% correct:

“I fear not death, I was dead for billions of years before I was born, and I shall be dead for billions of years after death”

First, you’re not alive, you’re born, you live, you die, you’re not alive again…  What’s the problem with that?

Thanks for posting DrP. My mum is I think coming to her end. She was living in her house until just before Christmas, then had a fall and broke her hip. We arranged for her to be discharged to an old peoples home where she still is. She’s had several more falls and was back to hospital with a cut that needed stitching after another fall.

She’s seen a lot of her friends die already and is completely ready for death. She’s in constant pain, can no longer see to read and has multiple other problems. She’s basically worn out.

My brother and I are also accepting that she’s on the way out. The only weird thing is other people asking how she is – people don’t seem to think that acknowledging mortality is acceptable.

My mum has a living will that I am the executor for [ interesting title] when i asked why me she said your brother is too soft to make the hard decisions.

Lots of chats about  what do in x scenario so that I will be able to decide what she wants. I hope to god I am strong enough to do the right thing/what she wanted when the time comes. She has a background in palliative care. I did not find it that hard a chat though I think I will find it hard to do some of it – if i get dementia find a nice home , leave me there never visit being the hardest one.  The reality is , and I am at an age when all my friends parents are in various states of aging/dying we are all likely to see our parents live to a ripe old age with all the complications that come with it. best to know and plan for this, shitty though it will be.

An average age of 79 for men is frightening ..have I really only got less than 20 years left ?

Probably not – can’t remember the stats but that’ll most likely be the mean average  – all the ages people were when they died / number of people. That’s one of the misnomers of the middle ages – so many died in childhood that it really pulled the average down.  If you survived to say 10, then you’d probably have a decent life expectancy thereafter.  It’s the same here, having got to the age you are, probably indicates you have an ‘above average’ number of years left.

The mode – most ‘popular’ age to die will be higher. The median will be lower.

Lies, damn lies and statistics.

At the WI we’ve been trying to encourage people to talk about their last wishes, making wills, and death in general, to keep the stigma at bay and make it more acceptable to talk about such things.

Many people say we’ve ‘lost’ our mother, or our mother has ‘passed away’. It would be far better if we said they had died. Shocking I know, but it’s what has happened.

I personally was shocked when watching a recent BBC programme called ‘trust me I’m a doctor’. In this particular episode they were interviewing a woman from ‘NICE’. She said that millions of pounds of NHS money is spent on prolonging the lives of elderly people by 3 months on average. This was mainly for loved ones and relatives.  I didn’t know how I felt about this at first. Then I thought about how that money would be better spent on young patients to get them medication (someone such as bullheart for example).

The future for younger generations could look grim as obesity levels are rising. Lack of exercise and bad diets take their toll. But that’s a discussion for another day.

The future for younger generations could look grim as obesity levels are rising. Lack of exercise and bad diets take their toll. But that’s a discussion for another day.

Well actually, that’s a pressing issue for right now, if not this exact thread. Diabetes and obesity related illnesses are going to destroy health care and/or cripple the economies of countries which provide it to their citizens. our elders deserve care and respect in later life but if we don’t figure out a way to get people in their 20s and 30s to eat healthily and get off their arses there’s going to be chaos.