Don’t wait — talk about end of life when you’re young and healthy

Published 1:30 am Sunday, August 12, 2018

At 99 years old, my friend Dixie is coming to the end of her life. She lives with her son and daughter-in-law who provide hospice care for her.

For the last seven years, I met with Dixie and her son for lunch every week. But now she can’t leave the house or walk unassisted. She sleeps most of the day, slips in and out of awareness and, slowly, but surely, her organs are shutting down.

She is like a candle flame that is flickering. Yet, surrounded by loved ones in a familiar environment, she is peaceful. While not unexpected, who is ever prepared for the death of a friend, a mother or a close relative?

Of course, her family hopes that she passes away in her sleep, during one of her many naps or overnight, and she probably will. Her wishes have been clear — no doctors, no hospitals and no medications outside of comfort care.

There is no treatment for very old age. While the spirit is strong, our body’s days are numbered. The quality of her life has been very slowly declining over the last several months.

While visiting my brother in Massachusetts recently, we scattered my mother’s ashes in his garden. She passed away four years ago, but it took us a while to be at the same place at the same time. I chanted an ancient Hebrew prayer, the Mourners Kaddish, while we spread her remains, and broke down in tears before I could finish. I think about my mother often and miss her terribly.

My mother, like Dixie, was fortunate. When she came to the natural end of her life, at 92, she was at home, with family. She died peacefully.

Sadly, many of us come to the end of our lives in a hospital — surrounded by tubes, electronic devices and strangers rather than friends and family. Dying can be a frightening experience. My father was in a skilled nursing facility when he passed away. He was only there for a little over a week, but at times he was very frightened.

He was losing control of his body, and the loss of control triggered intense anxiety. He was confused and would forget why he was in the facility. Ultimately, he died in his sleep. Both of my parents discussed with my brother and I, when they were well, what they wanted for end-of-life care.

It’s vitally important for adults to think about and plan for this eventuality. What life support are you willing to have? At one point, do you wish to have life support withdrawn? Who do you want to make decisions regarding your care if you are unable to express your intentions? What does quality of life mean to you?

My youngest daughter is my health-care proxy should my wife be unavailable. I have talked with both my wife and daughter about my wishes should I be in a vegetative state. I have confidence that they will do as I have asked.

It is better to have these conversations in middle to older age when you are well. Don’t wait! While my daughter was uncomfortable when we talked, she asked me questions about possible situations that could occur. What would I want her to do? Simply designating a health-care proxy is not enough — a discussion is just as important.

In our state, fill out a health-care proxy form and a physician orders for life-sustaining treatment (POLST) form. Make sure that your family and health-care provider have copies. Talk about your wishes while you are well — even if it’s a difficult discussion to start.

Here’s a link to the necessary forms from the Washington State Medical Association: wsma.org/advance-directives

Paul Schoenfeld is director of The Everett Clinic’s Center for Behavioral Health. His Family Talk Blog can be found at www.everettclinic.com/family-talk-blog.