Tag Archives: die in peace

Windrum’s Never Say Die Rap Premiers at Ignite Denver (video)

Bart Windrum | December 11, 2012 - 4:25 pm
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On Wednesday 24 October 2012 at Denver’s Oriental Theatre I joined 14 other speakers at Ignite Denver 12 in presenting 5 minute talks called “sparks.” These highly structured presentations require 20 slides (of one’s own making) that auto advance every 15 seconds (you can’t control them yourself; no running one slide for 23 seconds and a following slide for 7). Preparing for these are very challenging under any circumstance (such as a single presentation thread), so what did I choose to do? Include two major new works within an end-of-life primer:
• Windrum’s Never Say Die Rap, a 2 minute rap about end-of-life craziness
• an early version of Windrum’s Matrix of Dying Terms (it wound up being v2; a fuller albeit truncated explanation of v3, the theoretically final version, is here).

Even though I flubbed my own rap lyrics several times—I had to run the rap a bit up-tempo to time it to 8 slides—on the whole I think it plays well enough. Plus, people attend Ignites for several reasons: to feel the spark of new ideas, and to ride the anticipatory edge of wondering if a presenter will crash and burn; to experience how speakers function in this brief, pressure-cooker presentation format. So here it is…all in all, about the shortest, tightest presentation of complex end-of-life matters possible. And…rap lyrics below.

(Inside joke note: my reference at 4:15 to end-of-life-landings GPS coordinates and a final geocache location that elicited some unanticipated laughter riffed off of an earlier presentation that night on Geocaching.)

For more Bart Windrum videos click here.

Windrum’s Never Say Die Rap

Want to die at peace got to die in peace
All of one piece say “pretty please”
Want to go in grace with a neutral face
We’re done this race—no gotta stay in place

Beyond ready to depart
Jump jack your bones and shock your heart
When you’re pickin pickin at the air
No bro ma’am you ain’t goin nowhere

There is an app for that
Windrum’s Never Say Die Rap

Independent thinker, no one’s rube
Shove in 1 2 3 4 5 tubes
With CDiff MRSA gurgle gurgle
And all I wanna do is cuddle and snuggle

There’s no app for that
Windrum’s Never Say Die Rap

And: in the annals of stupidity
death panels twist our talkin free
Can’t touch the sky, can’t see or be seen
Ain’t livin ain’t dyin don’t mean to be mean
When death comes knockin my clock tic tockin
Hey everybody: deus ex machina

Rap about that
Windrum’s Never Say Die Rap

Now it ain’t just medicine in our way
If you don’t talk, you don’t get no say
Call 911 when it’s time to pass
blockin our own path pain in our own ass

Take a number for that
Windrum’s Never Say Die Rap

Steve Price RN says dyin is dyin
his songs are cool; he ain’t lyin
Chart your glidepath while there’s time
to die at peace with minimal cryin
Study up, make some sense
of 21st century impediments
Time to grow up before we get old
There’s more to dyin than we’ve been told
Wishing won’t help us turn the page
So sixteen new terms to engage

I have a matrix for that
Windrum’s Never Say Die Rap
Windrum’s Never Say Die Rap

© 2012 Bart Windrum, Axiom Action LLC, and Bartholomewsic
Danger Zone loop by DJ Buzzword. Additional loop processing and orchestration by Bartholemewsic.
Hear also Awake, Steve Price, RN

Bart Windrum is a citizen end-of-life reform advocate.

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What Does Dying in Peace Require of Us?

Bart Windrum | July 20, 2012 - 8:30 am
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The Mayo Clinic has started an annual social media in healthcare conference. This time around Mayo is offering all-expenses paid scholarships, awarded on the judging of essays that make the cut after an initial round of social media likes and comments. My essay appears below. Some of what it contains I’ve written before in this blog. I include it here because encapsulating peaceful dying’s key aspects in 700 words is a helluva challenge—and because I’ve finally included some Rainer Maria Rilke verse in my writing. If you aren’t already familiar with The Sonnets To Orpheus, find the Stephen Mitchell translation and enjoy; they’re incomparable!

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Learning What It Really Takes To Die In Peace

I can think of no greater good than for providers and families to enact what dying peacefully requires of us. We all say we want to die in peace. Few do, according to the commonly accepted definition: “at home,” to which I add, “with the dog licking my fingers.”

My parents each endured three-week terminal hospitalizations; Mom (2004) after sudden respiratory collapse, Dad (2005) when he crashed medically after pacemaker eligibility testing, acquiring, in a Jayco 100 facility, fatal nosocomial urinary tract MRSA which migrated through his bloodstream. I was their proxy. My patient-family experienced those weeks as shocking and harmful, in ways small and large, intrinsic and extrinsic, from beginning to end. I then began what became a lay person’s root cause analysis resulting in a 2008 book, Notes from the Waiting Room, a Colorado reform initiative: “The Option to Die in Peace,” and recognition from the Institute for Healthcare Improvement.

What is the deepest loss that you have suffered?
If drinking is bitter, change yourself to wine.*

Rainer Maria Rilke’s verse regarding the nature of dying mystifies yet instructs. If our deepest loss is losing a loved one to a non-peaceful demise, but we want peace, what does it mean to “change yourself to wine”? To me it means deliberately becoming well versed in what’s required to manifest the oft-stated, rarely-achieved desire to die in peace. When our turn comes we will change ourselves to wine. How bitter or sweet that taste, that experience, depends upon how well we learn and apply what peaceful dying requires of us.

Be ahead of all parting, as though it already were
behind you, like the winter that has just gone by.**

To die peacefully we must prepare deeply, many seasons in advance. Unless we expose, understand, and reconcile modern realities, we won’t keep up with the throes of parting, let alone get ahead of them. Routine advance guidance from palliative medicine and hospice leaves us vulnerable to extrinsically painful demises after holding out too long. I keep attuned for, yet don’t hear—from literature, panelists, even from hospice doctors addressing public meetings—lessons I’ve learned that seem most crucial:

• Advocating when hospitalized requires 24/7/365 vigilance and cultivation of an ability to unearth what we don’t know we don’t know—and advocating is proactive, demanding, and vital.

• Peaceful dying requires that we know about and consider medical error as a direct cause of death. Although medical error ranks among the leading causes of death in America, even iconic dying trajectory charts don’t include it (so I added medical error as a fourth trajectory).

• Using life support technology is a slippery slope. People generally don’t know—and providers don’t timely advise—that the equipment used in emergencies is also used two other ways: during surgeries and as treatment, with nearly reflexive transitions between uses. Disclosure issues abound and pull-the-plug scenarios inevitably, achingly, result (I proxied through two).

• Human nature causes us to ignore our advance directives. We naively believe ADs will save us, like the Titanic passengers felt secure under a blanket of starry skies. Psychological studies confirm our tendency to over-resolve in the abstract yet acquiesce to life-support measures as a demise unfolds.

• Peaceful dying unfolds over weeks, not days. 35–45% of hospice patients are there for only four to seven days—the period of bodily active dying (Dad stayed four). These hospice users spend their weeks leading to death outside the palliative and hospice realms. It’s not peaceful out there.

Here, in the realm of decline, among momentary days,
be the crystal cup that shattered even as it rang.**

Losing a loved one shatters us. Our experience of their demise never dies. Remembrance rings on. Entering the glidepath to peaceful dying requires decisive orientation given lift by much foreknowledge. So I untangle and reweave, connect and share, present and publish nationally in my zeal to help fellow citizens obtain practical foreknowledge in enough time to absorb, reflect, and utilize it—for the greater good of many more peaceful demises.

The Sonnets to Orpheus, Rainer Maria Rilke, Stephen Mitchell translation, §II.XXIV;* §II.XIII;** §II.XIII.**

Bart Windrum is a citizen end-of-life reform advocate.

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When Novelists Focus on Dying in Peace

Bart Windrum | July 19, 2012 - 5:45 pm
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Today a gift arrived via email. Sandy Booth of Crossings Care Circle , providing home funeral guidance for people in and around Austin, Texas, attended conferences in 2011 and 2012 at which I presented. She sent me some excerpts from Wendell Berry’s 2005 novel, Hanna Coulter. I’m an ok writer, but Berry is a *writer*, as these ruminations on peaceful dying from various parts of the book so beautifully show:

I knew then what he had been doing. For a good while after he got sick, he thought he would just work it off the way he always had, he would get well. And then the truth came to him, and he faced it. After that, he was loitering, putting us off, giving himself a chance to be captured by his death before he could be captured by the doctors and the hospitals and the treatments and the tests and the rest of it. When he consented to go to the doctor he was only consenting for the rest of us to be told what he already knew. He was dying.

‘I have had a good life…I have liked it and am thankful for it. I don’t want to end of as a carcass for a bunch of carrion crows, each one taking his piece, and nobody in charge. I don’t want to be worn all to holes like an old shirt no good for rags.’

He didn’t want to be going someplace all the time for the sake of a hopeless hope. He wanted to die as himself out of his own life. He didn’t want his death to be the end of a technical process.

As I have told it over, the past visible in the present, the dead living still in their absence, this dream of time seems to come to rest in eternity. My mind, I think, has started to become, it is close to being, the room of love, where the absent are present, the dead are alive, time is eternal, and all creatures prosperous. The room of love is love that holds us all, and it is not ours. It goes back before we were born. It goes all the way back. It is Heaven’s. Or it is Heaven, and we are in it only by willingness.

Bart Windrum is a citizen end-of-life reform advocate.

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Windrum’s Way Out Haiku

Bart Windrum | May 28, 2012 - 11:26 pm
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Sometimes a little verse goes a longer way. Just in case you want to die in peace:

Bart Windrum is a citizen end-of-life reform advocate.

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Why Do We Buy Off-the-Shelf Dying?

Bart Windrum | April 9, 2012 - 10:24 am
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The following is a 750-word op-ed that originally appeared in the Boulder Daily Camera on 4.8.12. At first I didn’t think I could condense a day-long conversation into 1150 words (I mimicked the word count that paid freelance columnists get). I did—but papers really do enforce their word counts for you and me so that they can offer more voices overall. So I went at the 1150 words like a hacko-wacko, ripping sections out practically with abandon literally within several minutes. And was amazed at the end: a tight summation of the most salient things we need to know to orient ourselves towards a peaceful demise.

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Why Do We Buy Off-the-Shelf Dying?

Ninety percent of us say that we want to die in peace, at home. Most end-of-life guidance suggests only that we express our wishes to our loved ones and medical proxy, writing directives via two (of seven primary) related legal documents: an Advance Directive and a Durable Medical Power of Attorney.

These challenging actions are presented as, and believed to be, sufficient to secure a peaceful demise. It ain’t necessarily so. Conversations and directives are crucial steps everyone should take. Nonetheless, it’s easy to overshoot one’s exit to a peaceful demise due to chance, shifting events, errors, even design. To increase the likelihood of dying peacefully we must know things about which medicine knows but does not, perhaps cannot, advise us.

In 2004 my mother experienced sudden respiratory failure. She was quickly intubated, placed on a breathing ventilator in an ICU. She died there after 3 weeks, treatment having failed. Fifteen months later Dad wanted to return here from Florida to live near his children. He scootered himself into a hospital, accredited as among the country’s 100 best, for cardiac pacemaker eligibility testing. While there he contracted a hospital-acquired urinary tract MRSA infection which spread to his blood and painfully lodged in a wrist. Dad’s demise also took 3 weeks to unfold; days pass in confusion, “hospital time,” and awaiting diagnoses. Both hospitalizations were trouble-prone even with advance declarations decrying heroic treatment (a moving target).

Seeking to understand how and why we failed, I worked backward from the goal: to die in peace. Key things I’ve learned include:

• Medical anthropologist Sharon Kaufman has shown that “death is timed in hospitals” (And a Time to Die: How American Hospitals Shape the End of Life). All parties involved—providers, insurers, patient-families—play well-known roles that consistently unfold over 2 to 3 weeks despite myriad variables.

• Lay people think of resuscitation technology only as emergency intervention. It’s actually three things on a very slippery continuum: life support, standard operating procedure (literally, during surgery), and—this is the crux—treatment, whenever providers deem it so and we accept it as such. Medicine imposes first responder, surgical requirements, and bedside inclinations about this.

• Respected reports (Institute of Medicine, 1999; Healthgrades, 2004; U.S. Dept. of Health and Human Services, 2011) identify institutional medical error among America’s highest causes of death, and accelerating. The wrong error can put the kibosh on any patient-family’s advance planning.

• Failure to recognize medical milestones derails our wishes. During our last decades we utilize medicine repeatedly to restore quality of life and save life. When we understand that we’ve already engaged in heroic measures over 5–20 years we might not feel impelled to do so again at the risk of ruining our chance to die peacefully.

• You don’t have to slog through curative treatment to wait for a doctor to reluctantly suggest a palliative consult; you can ask for one anytime.

• Let hospital chaplains know you’re admitted, simply to get on their radar. They can readily intercede on our behalf, cutting through confusion we and our proxies typically experience—before crises intensify and drag on.

• Medical advocacy is much more than being a second pair of eyes and ears (that’s just witnessing). Take a workshop, or read, and learn how to succeed in this vital role.

Is it fair to expect medicine and hospice to explain all this? I don’t know. But they don’t, and we remain confused. So we buy “off-the-shelf dying”—troubled deaths so routine in medicine that they’ve become an experiential commodity (we don’t realize this because we’re not often in the market for dying). While we gratefully welcome palliative and hospice providers’ help, the unspoken subtext is that they’ll save us from dying badly. We risk that the saving will be incomplete—trying to soften an end of life train wreck because we’ve jumped the tracks despite our advance intentions. We must engineer our own train; to slow and exit onto a siding where palliative and hospice folks can help us disembark.

Thus far no part of medicine has found the words, will, wisdom, or bandwidth to convey all this to lay people in an advance package. We typically learn through bitter experience. “Don’t ask, don’t tell” makes for anguished deaths. Each of us can change that.

Bart Windrum is a citizen end-of-life reform advocate.

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RIP Dr. Peter Goodwin, author of Oregon’s Death With Dignity Act

Bart Windrum | March 15, 2012 - 5:22 pm
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On March 11 2012 Dr. Peter Goodwin ended his life under the law he helped create—the Oregon Death With Dignity Act. A short video interview with him is available here.

Self-directed dying, for those diagnosed by several physicians as terminal with 6 months or less to live, offers a peaceful demise to those who are dying from debilitating diseases that guarantee a languished, anguished end if taken to their bitter end. Dr. Goodwin did not go without regrets, but he did go peacefully—an outcome virtually all of us say we want, very few of us achieve, and fewer of us know how to increase the likelihood of attaining no matter where we live. This because we’re all too scared, or cowed, to talk, to think, to choose. So we wait. And wait…beyond the several late life hospitalizations and debilitations likely in store, until events grab us like the existential tornados I’ve experienced them to be during the hospitalized demises of each of my parents, despite advance directives suggesting they’d have rather experienced peace at their life’s close. Extracting oneself or a loved one from a late-life terminal medical crucible is difficult at best; it was impossible for my patient-family. The crucible is particularly awful when the patient-family is the subject of medical error and other systemic maltreatment.

Euphemisms abound for self-directed dying. The American right uses “death panels”. The press uses “physician assisted suicide” (although that third word is inaccurate once one is diagnosed as terminal). Doctors (be they curative, palliative, or hospice docs) who provide palliative sedation in sufficient doses to end life use the cover of St. Thomas Acquinas’s Principle of Double Effect, which says that dying is an acceptable outcome if the doctor’s primary intent is to relieve suffering. Dr. Tom Preston uses “patient-directed dying” in his book of the same name. I use “self-directed dying” because that places the ownership on how we close our lives where it rightfully belongs: in each our own hands.

That’s as it should be. And it’s a truly brave act to hold that choice close.

Bart Windrum is a citizen end-of-life reform advocate.

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Would You Like to Die in Peace?

Bart Windrum | March 18, 2011 - 7:01 am
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In order to achieve a peaceful death, patient-families, that is all of we citizens, actually need to do something. “Something” is a range of things comprising a bit of study and contemplation. I’ll share what I consider to be the most important aspects.

1. Become familiar with how we die in a technological society. Joanne Lynn summarizes the 3 basic trajectories representing, essentially, cardiac, cancer, and cognitive failures. Each trajectory is well-known (to providers) and unique from the others: cardiac is characterized by repeat downward spikes and recoveries; cancer by a generally sudden decline, and cognitive by the long slow decline. Until we recognize where we or family members are on the pathway, we’ll be caught by surprise in the crucible of what may turn out to be a terminal hospitalization. By definition, this is the antithesis of dying peacefully (see point 6 below). This includes understanding how death unfolds in hospitals as per Sharon Kaufmann (…And A Time To Die).

2. Understand the nature of applied resuscitation technology. This is a huge aspect that, in my experience, providers remain mute about with respect to informing patient-families. Lay people involved in our first or second family members’ demise think of resuscitation technology as exactly that: life-saving under duress. Clinicians use life support technology in two other ways: standard operating procedure during surgery, and treatment whenever they deem it so. SOP is relevant regarding the suspension of DNRs during surgery (required) and post-op for periods ranging from 2-48 hours depending upon the institution. This is generally fine but undisclosed until a surgical release form is presented—way too late in a treatment plan to qualify for informed consent for patient-families who may not want full-bore treatment. The real slippery slope is when life support technology morphs into ongoing treatment. Handholds here are hard to find, let alone grasp. Full understanding also requires disclosure of first-responder constraints and certain facility policies with respect to dishonoring DNRs. Medical Orders for Scope of Treatment (MOST) and similar forms are designed to remedy some of these incongruities.

3. Clarify that the absolutely necessary step of creating a suite of what I call Power Documents, including advance directives (ADs) is nonetheless just a first step. They provide a safety net. Living with no power documents is like driving blindfolded. However ADs are to a peaceful demise as clear skies were to the Titanic: a false sense of security. The iceberg lurks below depths and it’s all to easy (and common) to crash into it in the crucible of an apparently sudden terminal hospitalization where we end up trying to parse advance directives given new realities. Personal work around ADs is not in their creation but rather when interpreting and using them. ADs are a legal necessity and a midlife abstract starting point. ADs in advanced age are likely to serve as personal Constitutions.

4. Recognize when heroic action really begins. If we give zero thought to the matter, when in the crucible of a critical hospitalization with terminal overtones we’ll tend to hang on too long to curative efforts. I’ve been there—twice, with each of my parents. This is a helluva time and place to first deal with the nature of heroic action (I call it heroicism, a lesser form of heroism). If one considers the dying trajectories mentioned above, it’s easy to see—through felt experience—that heroicism begins years or decades earlier, when we first engage in cure for serious conditions. Just because mighty treatments are everyday events in the clinic and more or less mundane (heart repair) doesn’t mean they are non-heroic for people undergoing them. My father’s period of heroicism began 19 years before he died, with his first bypass. This, in my ponderings, is a profound aspect of “doing something” to increase the likelihood of dying in peace. Understanding heroicism is basic math; choosing how to die is advanced calculus. Yet no one teaches or learns the basics, so of course we suffer, patient-families and clinicians, with almost every death.

5. Distinguish between suicide (the taking of a viable life) and patient-directed dying (Tom Preston’s most-apt phrase) or physician-assisted dying (Compassion and Choices’ phrase, less apt in my opinion although I understand the impetus for choosing it). Reject the phrase “physician-assisted suicide” for devising and choosing a peaceful exit when terminal. Definitions of terminal may vary in terms of prognosticated time left (a highly inexact forecasting).

6. Stop enabling medical paternalism. Americans give mental lip service to the iconic notion of independence but refuse to do the work related to enabling our own peaceful demises. Until citizens belly up to our own end of life bar we will require provider paternalism. Providers, under their own duress (they’ve seen hundreds of times what we first encounter and experience a handful of times) try to pick up our slack—and bless ‘em for their inclination. Here we have a terrible double-bind: providers know we all must talk, and feel the conversational vacuum so strongly that they are now trying to take on the added burden of initiating The Talk. On the one hand, medical/ethical disclosure requires this—and I believe providers shoulder 51% of the responsibility to talk because they are more experienced than patent-families. On the other hand, patient-families (that’s all of us) actually have 100% responsibility to initiate The Talk—after all, it’s our lives and deaths. By willfully denying every aspect of dying and death we present as grown babies. This spans the generations, from 20-somethings to 50-somethings to 80-somethings. So doctors’ double bind is that they’re dammed if they initiate The Talk and dammed if they don’t. My heart goes out to them even as the slow burn of my experience of my father’s hospitalized demise continues to stoke this advocacy work.

©2010 Bart Windrum and Axiom Action LLC. All Rights Reserved.

Bart Windrum is a citizen end-of-life reform advocate.

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Off-the-Shelf Dying, or, Be Your Own “Death Panel”

Bart Windrum | December 28, 2010 - 7:05 pm
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It’s back: that scary phrase, that bald lie: “death panel.” As in, “the United States government will enact or enable panels of bureaucrats who will withhold medical treatment from your grandma or grandpa and let them instead die.” This was a (failed) provision of 2010′s healthcare reform act; now the accusers say that death panels are resurrected by executive fiat.

What’s back by executive regulation is reimbursement of medical providers for their time and expertise in consulting with patients regarding end of life choices and strategizing—this time only for Medicare patients, not for younger people who may be nearing death.

Hmmm. Would you rather keep waiting —say until, on some umpteenth hospital roulette ride, as you crash through those double doors strapped to a gurney—to begin examining matters pertaining to dying and death in the 21st century?

Something else is back: a very straight-talking Bart Windrum. About once a year something trips my trigger enough to cause me to sharpen my verbal edge. Folks, some things are simply too important to beat around the bush about. How we end our lives on Earth is one of them.

The words and idea of death panels as a descriptor with regard to paying providers to share what they know about dying and death is callous. Fabricated B.S. But let’s use the phrase a little bit anyway, since it’s here and we’re all familiar with it.

I’ve served on two death panels. As a family member and then medical proxy, during each of my parents’ three-week terminal hospitalizations. It’s not fun, I guarantee it. And, it’s inescapable. If you don’t do it for yourself, in advance, from time to time, circling closer to medical decisions as your life inevitably spirals towards its natural close, then who will do it? Your spouse or kids? Do you really want them to make such a choice for you? How about the hospital staff and loosely cojoined group of doctors on call for your myriad physical ailments (chances are you’ll have multiple serious-to-life-threatening problems at advanced age)?

Panel: a small group of people brought together to discuss, investigate, or decide on a particular matter (Apple e-Dictionary). The first three people to serve on each of our death panels ought to be “me, myself, and I.” Or, are you waiting for that last gurney ride to begin mulling over how you’d like to exit the planet?

We all say we want to die “in peace” (translation: “at home,” which may or may not be achievable by all). “At home” infers “not wired up,” by which I mean with IV drips, tubes, and serial invasive treatment while awaiting a miracle for an 80 to 90 year old body that medical technology has already successfully kept alive for several *decades* longer on a scale never seen before in history.

OK, what have you done to increase the likelihood that you will die in peace? By “die in peace” I do not mean the moment of death, but rather one’s demise—the overall process and time during which we die. This could range from minutes to years, but for practical purposes I think weeks to months is an appropriate time frame.

How often do you want to roll the dice? Doing so is available to all of us, assuming we’re insured (and at age 65 each of are, under Medicare). From what I’ve seen and experienced, medical dice rolling at advanced age is very dangerous and enormously stressful. If you lose, chances are high that you will not die in peace—at home, unwired (and, I like to add, with the dog licking your fingers). Near the end, the very process of medical dice rolling is the antithesis of dying peacefully.

Do you know that 80–90% of Americans say “I want to die in peace?” My interpretation of available data is that 15–25% of us achieve that goal. Here’s the breakdown:
• 50% die in hospitals
• 20% die in nursing homes
• 35% of those using hospice enter hospice so late (4-7 days before dying) as to indicate that they’ve essentially experienced their demise elsewhere (institutions); they enter hospice for the final period around what’s known as “active dying.” Sorry; 1/2–1 week in hospice is not quite enough, in my opinion and experience, for a patient-family to peacefully experience a demise—especially if those 4 days come on the heels of aggressive treatment and the dying loved one ends up comatose and uncommunicative.

Afraid of dying? Afraid of dying in pain? Afraid of dying not-at-peace? Does anyone think that doing *nothing* about it will provide your preferred outcome?

I call an unexamined demise that unfolds institutionally an off-the-shelf death. As in, boxed and labelled. You might as well hit the store, ambulate down the Death aisle, pick a box type, look for your name on one, and check out. It’ll be there for you, I guarantee it—unless you become your own “death panel.”

Try it! Start reading, learning, reflecting, talking. Find the many books describing how death unfolds medically, in hospitals, how medicine fails thousands (see my book’s bibliography of recommended reading, and see its post-publication expanded bibliography here).

Medicine is our tool, not our savior. I think that rigidly attempting to grab extended life when that life is ending is greedy—especially in light of how many years (decades!) longer many of us now live. Years in which we personally benefit, our families benefit, our communities benefit. Even the IRS benefits! If you choose to be life-greedy, you are gambling against dying in peace. Typically, the “house” wins…

So, in direct terms, our choices are these:
• Hold out for the miracle
• Buy an off-the-shelf death (a mindless, unexamined, default pathway according to the default rules and moires of the technological medical workplace)
• Let someone else be your death panel; saddle your spouse or your kids with this awful choice, or let providers choose your outcome
• Be your own death panel. Map the overall contours of your preferred demise years before you expect to encounter it. Add details to the map periodically. Clue your family and providers as to your inclinations.

Die in peace. And, as I write in Notes from the Waiting Room: Managing a Loved One’s End of Life Hospitalization, rest in PEACE: Patient Ethical Alternative Care Elective—a healthcare reform proposal I set forth in Colorado, 2008. PEACE need not be enacted as legislation in order to serve; anyone can enact PEACE for themselves. The resources are out there a plenty.

Bart Windrum is a citizen end-of-life reform advocate.

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