Just about all teenagers experience “the talk” at some point in their evolution from child to adult. “The talk” is something that parents dread – and as I recall from my own young teen years – we dreaded it just as much. Of course “the talk” was on a topic no one liked to talk about: Sex.
As we Baby Boomers are aging, with most of us in our 50s and 60s now, there is another conversation we are being encouraged to have – both with our very elderly parents and perhaps with each other. This topic too, is one that none of us like to broach: Death.
Death and sex – the two “untouchable” conversations that are the bookends of our lives – are two critical topics which, if we understand them and embrace them as a life-long part of our life’s experience, can provide us with a rich and rewarding beginning of adulthood as well as an end to this particular lifetime.
In a recent Wall Street Journal article (End-of-Life Talk Proposed a New Medicare Benefit, Thursday, July 9, 2015, pg. A3), we learn that the federal government really wants doctors to talk to us about end-of-life issues. In fact, they are now offering to pay health-care providers for the time they spend talking to Medicare beneficiaries, i.e. the elderly and the terminally ill, about these issues. A new rule was proposed on July 8 would “reimburse doctors, nurse practitioners and some others in the health industry for discussions about end-of-life care, which was championed last year in a report by the Institute of Medicine, an independent advisory board.”
Some topics of these conversations, said the WSJ article, would be the type of care one wishes to receive at the end of life. Do you want doctors to pull out all the stops? Do everything possible to keep you breathing no matter what the cost to your family or the system? (We all know the “system” has put limits on just how far it will go to pay to keep an elderly, terminally ill person alive.) If you want some treatment, what might that entail? Pain medication to be kept comfortable? Palliative care? Hospice care?
From my experience both as a one-time hospice volunteer and a friend to those who’ve lost loved ones, what one says they want when they are healthy and enjoying life and what they actually want when illness, pain and suffering, and being bedridden becomes a way of life, are often two radically different things.
I’m not sure that paying a health-care provider for his/her time to talk to people about end-of-life issues – about the dying process and death itself – will improve the situation that the elderly and terminally ill find themselves when everyone knows that the specter of leaving one’s physical body is eminent. Obviously, death is always just one breath away. The second we take our very first breath as a new-born baby, we are on the path to death. In fact, the leading cause of death is birth! Yet, very few people (Buddhist practitioners and Hindus would be the exceptions) ever think about their own death on a daily or at least a regular, basis.
Are doctors really the right people to talk about death to their patients? It’s been just over a decade since my significant other – the love of my life, my “split-apart” – died of esophageal cancer. He chose only surgery, declined chemotherapy in order to maintain a high quality of life and his health. He lived 18 months, worked up until a month before he died, and taught all of us who knew and loved him great lessons about living with death and dying. He did that with compassion for those of us who were saddened by his situation, and with great humor!
One day, while having a group luncheon with his sales team at a local restaurant, he listened as people perused the menu, talking about what to eat. “I’m on the South Beach diet,” said one of his colleagues. Another said she was on another type of diet, and still another noted he was doing the gluten-free diet. Brent then noted that he too, was on a diet – “it doesn’t have any ‘t’ in it,” he said in a quite dead-pan manner. Everyone stopped and stared at him, as it took them a few seconds to “get it.” Brent began laughing, and of course all of his colleagues also began laughing. They all appreciated his great sense of humor, which the cancer had never diminished. Laughter truly is the best medicine, even if it is not a cure!
Brent’s cancer next appeared in a lump on his left temple so the doctor recommended he see a radiologist for some radiation treatment so that he wouldn’t be uncomfortable during his last months.
The radiologist that was recommended to him was Jewish by religious tradition, and by his own admission had a difficult time dealing with death. He was sort of quiet and downbeat, and while he deals with death on a daily basis, I got the feeling that he doesn’t ever really deal with it. We began talking about religion because before he came into the room to talk to Brent and I we’d been engaged in our usual chatting and laughing. That was something he was not accustomed to hearing from his patients.
This doctor asked us where we got our unusual attitude toward death and dying, and we explained to him that I, as a Buddhist practitioner, and Brent as a “go with the flow” kind of guy, believed in embracing all as the Path. He admitted to us that he didn’t believe much in life after death, and certainly not in reincarnation. After he explained the treatment process to Brent, he asked me to help him understand the Buddhist way of thinking about life and death. We sat there for quite some time while I gave the “Cliff Notes” version of Buddhism as I understood and practiced it. The doctor became very interested in the difference in our attitudes versus what he was used to dealing with in his office.
Interestingly, a few months later, this doctor told us he had been to a lecture by a Buddhist monk at the local Mayo Clinic, and had begun reading books on the Buddhist philosophy of life and death. It was helping him to understand things in a way he never had before, and he thanked us for taking the time to talk with him during our first meeting. From that experience, I really wonder just how equipped doctors really are when it comes to talking with their patients about end-of-life issues.
Dr. Kevin Haselhorst is an emergency room doctor at a local hospital. A few years ago he self- published a book titled Wishes to Die For, a book that helps people understand how important end-of-life issues are and how they can develop a healthcare directive so that doctors, hospitals, and even the person’s family (who Dr. Haselhorst says are often more difficult to deal with than the actual patient) know what the person wishes for themselves in terms of how they want to die.
Dr. Haselhorst even calls for a Universal Healthcare Directive that goes throughout one’s life from prenatal care, preventive care, onward to advanced care when one becomes ill, to palliative care for incurable disease and end-stage disease. He then takes it one step further to Omega care – care in which one goes with the flow and “fate makes the decisions” and humility comes into focus.
In a lecture I attended, Dr. Haselhorst said, “Suffering is admirable when there is a cause to get better, not when there is no hope.” His personal end-of-life philosophy is: “Leave well enough alone until I’m sick enough to die.”
Doctors, some by their own admission, are often incapable of talking to people about end-of-life issues, particularly death. Much of that has to do with the idea that we have developed that if a patient dies, someone or the illness-care system, has failed. Dying is not a failure – it’s a natural part of living. Even if they get paid by Medicare to provide “the talk,” that might not make them any better at it because very few people – even doctors – want to talk about death.
