“One would think that the unexpected brings the most stress to our lives. However, psychologist say planned changes are even more disruptive than unplanned change. Somehow saying an event “just happened” is excused as an event from nature, from the mystery. We can fight such events them, ignore them, or accept them. But we know we can’t fix them or change them, so after the initial shock or disappointment, we move through the change in our own way. “Some of us find a way to rise the occasion. Yet, if we believe there’s something malicious at work, we fight it, fret over it, and never stop fussing, at least internally. That’s stress,” says Father Richard Rohr in his book Hope Against Darkness.
This is the dilemma that most of us face now as we approach death. Until the advent of antibiotics and respirators just after World War II, most people died unexpectedly and suddenly. Today, however, most of us will approach our death knowing about it over a long period of time. On average the dying person is directly faced with his/her own mortality from 3-8 years before actual death. The actively dying, which will be all of us some day, go though a period of being stripped of what defines them from their physicality to their mental ability often with at least some awareness.
So now we get to ask ourselves questions, “What does it mean to me to die a dignified death? How do I envision my death? What trade offs am I willing to make?”
It is of utmost importance to consider such questions long before we are forced. Medicine has become so advanced that it can keep offering testing and treatment until we are no more and we have died trying. This is the medicalization of death. Death is a natural event.
Our society doesn’t do death. Our pets get euthanized. Also although 80% of people desire to die at home, 60% die in the hospital and 20% nursing homes.
The definition of medicalization in Webster’s dictionary is “to view or treat as a medical concern, problem, or disorder.” Underneath this definition in Webster’s dictionary is a quote by Liam Hudson who states, “Those who seek to dispose of social problems by medicalizing them.” The Oxford dictionary states that medicalization is the same as to medicalize and provides the following definition, “Treat (something) as a medical problem, especially without justification.” Even the definitions of medicalization present the dilemma.
However, when a patient says, “Make me a guinea pig. You are my last hope. My chances are not zero, are they?” We, the medical professionals, may buckle. It is such words that haunt us, taunt us and turn us upside down and inside out. Such words touch our vulnerability and humanity.
While we, the medical professionals, ask ourselves how well does a frightened, desperate person starring death in the face understand what are all the possibilities involved in treating? Can there be a true understanding of the best or worst outcome scenarios? Can the question of “What are you willing to give up for more time?” ever truly be answered? Who and/or what determines which odds constitute a justifiable chance?
The truth is no one knows what the next moment holds, although our choices do impact the next moment. The truth is a honest offering of simply walking with another in the mystery, the unknowable, and the uncertain with an open and calm heart and honoring the decisions of the individual, which is, at least in part, the role of an Anamcara, or soul friend. In the Celtic tradition, all humans have an Anamcara who walks with him/her throughout his/her life.
What resonates most deeply is Frank Ostaseski’s approach to dying well:
- Mastery: pain management…including not only the physical, but the mental, emotional, and spiritual pain
- Meaning: what is valuable in life and living
- Mystery: letting go of meaning and entering land of unanswerable questions
- Mindfulness: being present with every aspect of every state of being.
What dying calls for is what real living calls for…trust…trust so deep that we can let go and be fully receptive concurrently.
What is possible? Perhaps it is possible to envision death as an opportunity, a new frontier, rather than solely as the enemy. Perhaps defining a natural death…seeing beauty in the changing form…is possible. How? Perhaps by talking about death and dying whenever the opportunity presents itself, and the sooner, the better. Imagining into alternative ways to age and die with family and friends. Have a party with the theme of “The Five Wishes.” For medical professionals, perhaps learning to embrace our own humanity and vulnerability, and in doing so, become wholesome and honoring partners to walk with patients in uncertainty.