Let’s talk about death.

On Saturday I had the privilege to have lunch with my 93 year old friend and her daughter. Mrs. F spent her life in service of others, starting the first association for people living with different abilities in then South West Africa. It was known as “Kreupelsorg” – care for the crippled. The organisation grew, and many of us will remember the little figurine of a girl in leg braces with crutches, holding a money box for donations. When they moved to South Africa, Mrs. F became involved as a volunteer with the ACVV as an active member making a difference in the lives of children and older people in need. Selfless. Stoic. Getting in and out of the car is now a battle, cutting her food takes huge effort. A mind as sharp as a razor, she takes a sip of her wine and confesses that her prayer at night is to not wake up in the morning. She has lived a full life, and is now ready to go. (As another 90 year old told me recently, the only thing on her bucket list now is to get to heaven.) Mrs. F’s daughter and I immediately want to convince her that we do not want her to go. She still has so much to offer, we are so in awe of her presence, etc. And suddenly I realise how selfish we are, and what pressure we put on Mrs. F by not respecting and acknowledging her feelings. Why is it so difficult for us to acknowledge the fact that she has indeed come to the end of her life? That she deserves to pass on, to leave this world, to die in peace? Why do we insist on trying to convince her of our needs, our inability to gracefully accept and acknowledge the end of life? Why can we not have the conversation of death? Mrs. F apparently has numerous boxes of “stuff” that needs to be sorted. I think (what the hell do I know…) that her daughter should help her to start sorting things out. To say “ok Mom, I acknowledge and respect your wish to die. Let’s start making plans…” Yes, this is not an easy conversation. Yes, it almost feels like a betrayal to say “I hear that you want to die, and I accept it”. Would it not make life a lot simpler if we can prepare for our death when we know that it is time to go? Unpack and sort out all the stuff that we have in storage, tell those around us what to do with it. Tell them how we would like our memorial service to be. Many are denied the preparation. My aunt who recently got killed by a truck while crossing the road could not have this discussion, leaving a family devastated and unprepared. Many older people want to die, they tell us this in no uncertain terms. Maybe it is time that we change the discourse. Say “yes, I hear you. How can I help to make it easier for you?” (And of course I do not mean actively killing them!). To give them the reassurance that you are ok with their wish, to give them the permission, grant them the autonomy, talk to them about their feelings, tell them how sad it will be. But that we stop pretending not to hear them when they say that they are ready to die. We are so focussed on “person centered care” in life. Let us focus on a person centered death, start to make it easier for people who have come to the end of their lives to let go, to not make them feel guilty to want to leave this world. Let us walk the path with them, making sure that they feel loved and comforted right up to the end.

More on death..

How unprepared we are for death. In the past month I have had my aunt killed by a truck in the main road of Knysna, this week a beautiful friend commit suicide, a very close friend given twelve months to live after a cancer diagnosis, another close friend telling me that at 93 all she wants is to die, and another friend who turned 90 on Friday says that all that is left on her bucket list is to go to heaven. I am aware of the language we use to make it sound less final – “she has passed away” or “he is no longer with us”. The word “dead” does not come easy, somehow. It is not a topic of conversation for the fireside. In fact, we are so uncomfortable talking about it that we mostly avoid talking about it all. Like giving birth, death has become completely medicalised, with most older people dying in hospital. (And whilst I thought that to be a terrible thing, my friend who is now preparing for her own death tells me that she would prefer to die in hospital, where she does not have to be in control. A sterile place that will not so starkly and painfully remind her of who and what she leaves behind.) Does the way we engage with death say anything about the way we live? I think it does, somehow. The way that we engage with the planet is indicative of our attitude of superiority and defiance towards Life. We think we are in charge, we “take control” of nature, we assume we have sussed it out. Have we…? No, we have no idea. With all our grandiose knowledge, artificial intelligence and bio-engineering, death is still our master. We will all die. Maybe in a hundred years’ time someone will have figured out how to circumvent death, but not in our lifetime. If there is one thing that we can be sure of, it is that we will die. The more I learn of longevity, the more it troubles me. Why are we so obsessed with a long life? Is it really something that it so precious that we should attain it at all costs? Do we not realise that the planet is overcrowded, that the longer we live the more we will deplete the natural resources? Have we figured out the good life? At 85, my Dad is on his annual motorbike trip into the deep Karoo. My beloved Lynn at the age of 97 was the life and soul of the party. My mother-in-law, turning 80 in a few days time, is in Cancun on holiday where she paraglided yesterday. I know many remarkable old people. However, I also know thousands of people who are not doing well with old age. Colostomies, nasogastric and PEG tubes, permanent oxygen, loneliness and depression. Is old age really something to aspire to, at all costs? Is it the ultimate achievement to grow old? If so, what did we achieve? All the talk about “successful” ageing makes me wonder to what extent we really have control over the ageing process. We all know very healthy, intellectual people who develop dementia. We know about the smokers who live to 100, lungs intact. Maybe it is time to start looking at the way we enter and exit life. More natural births and more natural deaths. Maybe it is time we give words to the exit, give it more thought, discuss it more openly, ask more questions about it, think more deeply about it. From my years of reading it is clear that death, like birth, is possibly the most wonderful experience of transcendence. Perhaps it is our indoctrination about “life after death” that makes it difficult to really discuss our fears and anxieties about death. Heaven or hell? Reincarnation? The end? I suppose our thoughts of the afterlife will predict our attitude to death. Again, I know of staunch christians who fear death and hang on for dear life (literally and figuratively speaking), of spiritual individuals who cannot let go. Atheist and agnostics alike who simply cannot transcend. Years ago I worked in a convent in Johannesburg with a group of really old nuns. Somehow, the nuns never became “bed ridden”. (I hate the word – sounds like being “flea ridden” of “disease ridden”, and prefer the phrase “living in bed”.) They went about their daily routine with stoic rhythm, even when they were quite frail. We all knew that when one of the nuns decided not to get up in the morning that their death is imminent. A few days later, they would quietly die. No fuss, no big deal. I have found the same with people living with dementia who would decide to stop eating and to stop taking their medication. They wanted to die. We would offer them meals, prepare their favourite food, offer their medication on time. Yet, they would refuse, and within a few days they would die. We should honour the will to die, talk about it, give expression to its magnificence, explore its mysticism.