Tag Archive: Death and Dying


End of LifeMedical technology has forgotten death’s role and its importance. We have to be something more than extending time. Walking the halls of many hospitals, I found numerous people who want to share memories, exchange wisdom, and settle relationships, establish legacies, make peace with God, and ensure that those who are left behind will be okay.

They want to end their story on their own term. This role is among life’s most important, for both the dying and those left. I think we find more ways to deny patients this role. Over and over, medicine inflicts deep wounds into the end of life and then stands oblivious to the harm.

The tough issue is to recognize that the small fixes provided by technology do not change the larger picture. Therein, we fail to recognize that fixing specific problems may not fix the patient.

I have 14 years of experience as a healthcare consultant. The real sorrow is that we (family and friends) are unable to significantly impact nature’s course. In the end, we can only accept its education. A patient once highlighted his sorrow.

“I woke up this morning I couldn’t stand up. I couldn’t push the pillow up in the bed; couldn’t use a toothbrush; couldn’t pull my pants or socks on; and it’s hard getting to sit up. But the doctor told me I was doing great.”

Society threw medical technology at the man but failed to understand the patient’s biggest fears? How about concerns? What goals were most important? What trade-offs would the patient be willing to make?

For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. A seemingly happy life may be empty. A seemingly difficult life may be devoted to a great cause.

All of us have purposes larger than ourselves. Those are the conversations both the living and dying want to have.

Several days after seeing my father, I requested my mother get approval to see a counselor. “Doesn’t matter if you utilize the service. At least you have access to grief counseling should you choose.”

In her HMO, all counseling require preapproval. Accordingly, we made an appointment with her (and my father’s) primary care physician. Of course, the doctor preapproved the request. And while doing so, he mentioned that he’s personally seen several cases where 85 plus year-olds have recovered quite well from stroke. “Took several years,” he nodded. “But it can happen.”

I agree with him. I too, suppose, one can recover from the type of damage my father suffered. The reality is vastly different for 98% of 85 plus stroke patients. They are told, that with physical therapy, they would learn to walk again and return to their life. Most never will.

Most of us will be confined to wheelchairs and the rigidity of nursing home life. All privacy and control gone. We will awaken per schedule, bathed, and dressed per schedule, eat per schedule, watch television per schedule, and returned to sleep per schedule. The remainder of the last several years will be filled with a succession of roommates, never chosen, and jammed together like an incarcerated rat.

My father’s only crime? Being old. At one time in his life, my father had possibilities. Now he doesn’t. So, rather than thinking of something new and inventive for our elderly, we ban them from society by shuffling them off to brick corridors guarded by keypad locks and cameras.

I think the only way death becomes meaningful is to see oneself as part of something greater. Maybe there is a greater goal. If you do not find the ‘greater good,’ mortality is a horror show. As my body dies, I look at my father and wonder if I can find comfort in companionship, everyday routines, the taste of good food, the warmth of sunlight. Will I ever become less interested in the latest technology and more interested in simply being? It’s in my father’s frailty that I search my inner being and identify a purpose outside myself that makes living feel meaningful and worthwhile.

All journeys have the same ending–at a place nobody wants to go. Peaceful death during one’s sleep and swift catastrophic illnesses are exceptions. For most, death comes only after long medical struggle with an ultimately unstoppable condition—cancer, dementia, Parkinson’s, organ failure, or the accumulating debilities of age.

I still haven’t told my family of my tumor surgery, or the extensive osteoarthritis in my neck, back, knee, feet and hands. I haven’t said anything of my Parkinson’s diagnosis. I haven’t told them I’m dying.

Yet, I look at my father and outwardly admit I don’t want medicine to eat my flesh. I don’t want endless bouts of multiple chemotherapy regimens, last-ditch surgical procedures, experimental therapies, especially when the ultimate outcome is particularly clear. I would rather move on.

Moving on. That is the conversation we need. How can we gracefully move on from a world that refuses to let us go?

Oftentimes we choose badly. We barter on for the best opportunity to continue whatever morsel of time: strength, mental acuity and a life previously known just several weeks before. It is fantasy mind you. Yet we barter it all, even with the risk of a prolonged and terrible death–which is precisely what most will get.

Technically, the operation this old man received was a success. And two weeks later, the 88-year-old man and his 82-year-old wife, sat in the vascular surgeon’s office to hear the prognosis.

Wow,” said Doctor S. “The stent looks great. The ultrasound shows the artery is wide open.”

The wife smiled. The man grunted.

We’ll see you in two months.”

The stroke was significant, and he never recovered. In skilled nursing, the old man could barely remember why he was there; he spoke his son’s name when shown a picture of his dog; he neither say his wife’s name nor his son’s; and looked frail.

That old man is my father.

As I tried to explain to my mother, he could not be cured. Deep down, she knew there was not a cure. But admitting as much and assisting him was beyond her capability. Maybe, just maybe, that stent operation would produce a ‘miracle.’

Death, of course, is not a failure. It’s normal. Throughout the last decade, I repeatedly told my mother that modern scientific and medical marvels can significantly alter the course of human life. We can now push the final moment of many diseases farther outward. People can live longer than any time in history. In doing so, we hide the deeper reality, that such significant extensions do not come without cost. Eventually, the end makes itself known, whether it be in the lungs, brain, spine, kidneys, or heart. From there, there is no cure.

We left the doctor’s office this past Thursday knowing we’d never see dad at home again. Instinctively, my father knew he would never see his favorite lap companion (his dog) and spend Sunday’s petting while simultaneously watching Tiger Woods try for another victory. And, I wondered in the past few nights whether my mother’s ‘miracle was more for her or for my father. She always believed dad was the outlier, the guy who’d have a major injury at ninety and by ninety-one, climb the Himalayas’. Giving up meant giving up the life they built. Now, could either endure.

How did America become a world where we either have to go down with the ship or cede complete control of our life to live in a nursing home? Television is filled with young doctors performing endless miracles. We perform medical procedures (like stents), pat ourselves on the back and dish off our elderly into some unknown distant nursing home.

The reality is that most suffer alone. We depend upon nature and chance. Maybe we toss in a few overly quoted scriptures and beg for a miracle. Instead, society knowingly banishes people to Medicare/Medicaid with little options … too poor … too frail … too senile … or too broken down.

I studied my father for one last moment. “Welcome to your future bitch,” life responded.

In the Elizabeth Kubler-Ross five stages of death, Depression is fourth. In this stage, one is likely to feel like withdrawing from life, feel numb, live in a fog, and not want to get out of bed. That wasn’t me. As subtle as it was, my stage was able to poke hole my otherwise stable façade.

To the normal reader, one may look at the event and say, “Why the fuss?” However, to all-knowing inner soul, it was “Reality bites.” At 4:38 PM, standing over a cutting board with knife in hand, ready to chop a white onion, my hand shook so bad I nearly couldn’t perform the task.  I looked like a construction worker using a jack hammer to cut vegetables.

Stage four started a few days ago with internal tremors in the legs and bradykinesia, a slowness of movement or impaired ability to move as commanded (like chopping vegetables. Frustrating, because I’ve spent a lot time making everything appear “normal.” Yet, I placed my knife on the kitchen counter, sat and in a chair and realized that I don’t know what normal is.

I had only a few weeks post-diagnosis before the Coronavirus struck hard and either forced everyone to place life on hold or work like crazy. Being in the later, I’ve kind of buried the deepest feelings. It was the first time I experienced any anxiety. In the several hours thereafter, I am beginning to understand something larger, bigger, and more determined is about to happen to me.

What if the façade fails and I must out myself? There are other things that take precedence over me. Certainly, my father’s stroke and potential death is significant. My mother’s care is critical, not to mention the subsequent estate settlement. Personally, I’ve had a tumor, multiple sclerosis, osteoarthritis, and now Parkinson’s.

As I sat looking out the window, I realized how tired I am. Tired of being sick. Tired of being in pain. Just plain tired. I suppose the fact that one’s body is trying to either make you miserable or kill you will, in fact, make one really depressed. I haven’t thought about mortality in any sense. I mean I have thought about it, maybe I haven’t processed it. Then again, we’ve all gone through some tough things–many a lot worse than I.

Outside of this moment in my life, I’ve been lucky. I’ve traveled well, seen places most will never see, had many a great love, and experienced God first hand. From a Buddhist perspective, what more could I ask? Sure, my hands and legs are beginning to fail, but I can write. And write I will.

As death approaches, Buddhists are taught to think about their holy writings. Focusing upon the Buddha’s teachings is supposed to bring good luck to a new existence. I will not focus upon superficial images of happiness, material and sensual pleasures, or technological innovation. At this point of my life, I am focusing upon whatever love available. I believe only true love will transcend death.

Thus, for a person who has awareness of death, every moment becomes a lesson in death and a lesson of love. Every moment should be viewed as being infinitely precious, and we should make the utmost effort to use our time to the best advantage.

There are a haunting feeling untold numbers of Americans who must decide whether to risk Coronavirus (COVID) infection while traveling to see a parent dying from natural causes. Such experiences are reminders of the unanticipated scope of the suffering caused by COVID. 

Sons and daughters are forced to make risky choices, either by love or distance. Should they be allowed to visit? And will they be the exception, the one who can travel across and not become infected?

Three days ago, the call I’d been expecting for several years came. After a long battle of successive mini-strokes, my father’s time is nearing an end. The latest stroke occurred Monday morning, and cost my father the use of his left side as well as other functions, but his humor remains. There aren’t any good options, damned if you do something, damned if you don’t.

It’s a natural part of life,” said the neurologist doctor.

I know. Losing a parent is inevitable, and it isn’t easy,” I replied. 

In the COVID world, it’s hard to describe how complicated such a decision is. If I travel, I could carry the virus to my mother, age 82. If I don’t go, I presume my name will be added to the immortal “primadonna list” for not being concerned enough to say a final farewell. There isn’t a safe choice, except for one: don’t travel.

The COVID pandemic has had a profound effect on grieving. Many who’ve lost loved ones have been unable to be at the bedside as their loved one passed. Death becomes remote. There’s no herd immunity for COVID. There’s no airplane, taxi, bus, boat, or other vehicles that can guarantee a barrier from the virus. Likewise, COVID cannot be segregated from my mother or others.

I looked up to God and muttered, “I probably will not be able to say goodbye.

Like my father, people have been dying alone for centuries. Some have no close friends or families. Distance separates others. In those cases, a volunteer may be able to sit with them during their last moments. My father has two people sitting with him, each taking a twelve-hour shift, holding his hand, and asking them what they loved most. It’s a service I will be forever grateful.

My father always said no one dies alone. After his near-death experience twenty years ago, my father said there were two sets of angels: ‘Helpers’ and ‘Takers.’ Helpers are those that assist those in need during trying times. Takers are those that help those move into the hereafter.

My Lord, can you be with him?” I prayed

I am with all who suffer. I am with your father.

Not a second later, “I will go and stay with him,” Ms. K. said.

I’m convinced my father has a volunteer, God, and a Helper. I presume he’ll have a Taker soon enough. That alone provides enormous comfort. I hope we’re all just as lucky.

I’m seven months into a twenty-four-month sentence, seven months since I read my diagnosis online. As I continually move onward into autumn – life’s autumn – I’ve come upon a couple conclusions: Time flies quickly, and dying’s not easy.

It’s hard not to realize just how the days are numbered. Correction, how my days are numbered. The days of my youth are unrecognizable. High school remains a distant memory. College dreams faded like over-ripened flower petals. And friendships have come and gone like freshly evaporated dew found of a desert morn. 

I am sympathetic to the ‘unaware.’ Working in healthcare has left me surprised at how many are both shocked and unprepared. Most of us aren’t ready for death. Heavy sighs and universal comments follow death, “I always thought we (substitute wife, father, husband, son, daughter, etc.) had more time.”

I’ll admit it hasn’t been easy. Much to my disillusionment, both pain and number of bad days have increased by the month. Between work and disease management, there’s been little comfort, little space to dwell in the emotional realm, and thoughts of reconciling conversation gave way to pain medication.

Yesterday I looked at my calendar and froze. Seven months post-diagnosis, even I thought I’d more time. 

However, here’s lessons I’ve learned thus far.

  • Regardless of how I hide my illness, I realize dying has an impact. When I look at my family, it’s hard to believe my father remains alive and will quite possibly outlive me. I will never fully understand how my departure will impact the family who remains.
  • Forget dreams. Live every day. I had visions of becoming a great writer. I didn’t become a great writer. I rely upon spell check, and grammar checkers like cars need gas. Without those modern assets, my college English teacher would concur that I, in essence, “Suck.” Yet, I write my blog notes when I can. And through it, I lived my dream versus dreaming of it.
  • I once entertained thoughts of saving the world. Throughout my years of life, only once did I receive an award for bravery. In truth, my part felt pretty much overrated. I never placed myself in jeopardy. Why? Simply because we were trained to mitigate the risks. Instead, I honored the men and women who did save the world. Walking among the graves of a national military cemetery in the Midwest, I found true saviors – men and women so much braver than I. 
  • Remain joyful for the gifts received: the many moments of fun, the travel, the cultures, love of others, and the food. But I leave others with insightful, loving thoughts. In turn, I hope they help pay it forward. Take care of the people in your life, and they’ll take care of you.
  • Believe in yourself. Don’t wait on others to accomplish something positive. If you write, write for yourself. If you’re music, be the harmony of notes others need to hear. 
  • Do not fail waiting for someone to drag you out of a ditch. You are just as good as anyone else.
  • Sometimes, you must turn a deaf ear to what others say is impossible. 
  • Don’t be afraid to get back on the bus. A mother once sent her son off to school on the bus. After returning home, the doorbell rang. Opening the door, the mother saw her son. 

What are you doing here?” 

I’m quitting school. It’s too hard, boring, and long.” 

The mother frowned, “That’s life, now get back on the bus.

Regardless what life tosses, get back on the bus. Embrace the days. They are all you’ve got. Rather than keep our heads above water, surviving but not “living,” Focus on living.

I reached for the blood pressure kit after being woken early by a racing heart. 3:47 AM flashed as my wrist blood pressure monitor beeped through its cycle. In less than a minute, 98 beats per minutes flashed, followed by 168 systolic and 87 diastolic. Should my BP have increased, I might be at increased risk.

I downed some medications, leaned against the bathroom sink. A momentary look at the toilet produced a soft laugh. “What if I die while using the toilet?” I muttered. A greater laugh ensued thinking of the poor slob who found me sitting on a toilet at the very moment I checked out. Hell of an obituary though, ‘Great guy, bad aim.’

By 9:15 AM my blood pressure had stablized to 117 systolic and 67 diastolic with 57 beats per minute.

Staring at the world from my dining room table, I asked a two-word question, “What’s next?” Having worked in the medical arena for the past decade, there were only a few people who wanted to hear how the patient was honestly doing. Most want to hear hope, courage, and positivity, not how unlikely the chances one would survive or how to live well during the process. For patients like me, there are no breakthroughs. There is no last-minute precision medicine or gene therapy. Such dialogue is written for only made-for-television movies.

I made one attempt to tell a close friend last night of my diagnosis.

Hey Cara,” I started. “I stopped to have some medical tests run late last week.

And of course, you’re doing great.

Well,” I sighed.

Interrupting, “You know my ankle is still bothering me from when I tripped six weeks ago. I have an appointment on Monday. Should I keep it?

Why not?

Because,” she whined, “I am starting to feel better. I know I complained about it, but I believe it’s getting better.

Then cancel.”

Oh well,” she continued. “I still think there’s some swelling. And it hurts if I push on it. But I have to pay a copay and the copay for x-rays. Medical stuff, always robbing anything, supposedly to help the people they serve.

I gave up.

What’s next has been highly contested for several hours. I could complete my 2019 Income Tax Return. Then again, would the effort prove valuable if I die April 14th? There is a humorous part of my soul that wants to die without doing taxes. Or maybe, I would complete them, but not mail it. When the tax man cometh, he will find a handwritten ‘Post-It-Note’ at the top of my folder, “I left $50,000 in the …” An additional ‘Post-It-Note’ underneath would continue, “If you go to my computer, you will find I deleted my browser history …” Those words in and of itself might keep them busy for months.

Many Buddhist teachings and quotes find their way into things, but they sometimes come across as nonsensical phrases meant to sound obscure. There is meaning behind the quotes. Many lessons remain useful today. When I write of all the things I thought, what’s next was answered in one somewhat silly Buddhist quote.

Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.”

Many of us are caught in the results of what we’re working toward or the way things will be when we finally achieve something. Truth is, that getting to where you want to go, being successful or even receiving a prognosis of a terminal disease doesn’t mean the work you’re called to do goes away. Up until the transition, I will probably do many of the same things I did before my diagnosis. If I cannot continue the mission called to do, if I can’t take on the simple tasks as best as I can, how can I conquer bigger things God requests?

Do your work. Do it well, and regardless of whether the message is a success or downright depressing, do it again. It’s all about being in the moment.

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