When Joan and I wrote our book “The Story of Kennett” we focused on the first two acts of life - growing up and middle age. But Kennett wants to be good at everything, which includes growing old. Though we have a wonderful Senior Center and great support organizations with the Y and Library, I feel we don’t really even know how to talk about these issues.
Remember the third act is a tragedy for the most part. The hero (you) dies in the end and unless you are sure you are going to be run over by a bus in your old, but healthy 70’s, we’ve got to talk. It is understandable if you are reluctant to address the loss of your loved ones and your own life. But you need to plan for this third act; to have an end of life advanced medical directive, a DNR (Do Not Resuscitate), a will, an obituary and funeral plan. Think of this as a gift to your loved ones so they don’t have to think about these things and you don’t spend your life in a vegetative state on a ventilator or feeding tube for 9 years like Karen Ann Quinlan, unless that’s what you want.
Let’s start with a great book on the subject. And that’s not Tolstoy’s “The Death of Ivan Illych” which is used in Med Schools, but Atul Gawande’s “Being Mortal” which is the best modern treatise I have found on the subject and because his example is Alice Hobson, his grandmother-in-law. She was a wonderful Italian lady who “grew up in a rural Pennsylvania town known for its flower and mushroom farms. Her father was a flower farmer, growing carnations, marigolds, and dahlias, in acres of greenhouses.” Alice went off to college at the University of Delaware around the great depression. (Sound familiar?)
First of all Old Age has changed. When my grandmother was born, life expectation was less than 50 years and people didn’t usually live to be old. In her day, they lied about being older than they were and now we lie about being younger than we are. Plus we have medical advances that can keep a human body alive, but hold no hope of returning the patient to anything resembling a normal existence.
We have a running joke in our family that my oldest daughter has my DNR, because my wife is always willing to put down our animals about six months before I am. I can imagine being 78 and catching pneumonia and Jane telling the doctor “don’t let him suffer Doc, it’s his time.” I’m saying “NO! Cough cough wheeze, I think I can make it.” On top of that, 60% of the health care expenses that we have over our lifetime are spent in the last six months of our lives. The current default is to do everything possible to keep the body alive long after a life has been lost. That is why it is so important to have your wishes captured for the family and medical community. Keeping Grandma alive an extra few days so that Uncle Troy can get into town and see her “alive” one last time may not be what she wants, and it adds up to millions of dollars in medical costs.
However, it is not so much about money, but of quality of life. In a way my father and mother were lucky. My mother had kidney failure and was on hemodialysis for 18 years. Many people can’t handle dialysis for 18 months but she came from Christian Science stock and thought most of your health was in your head. Still she got to a point that she was breaking ribs by coughing because of her loss of calcium and one day she said that is enough after a treatment, “I’m ready.” Her doctor was angry at her and put her in the hospital and she just checked herself out. She could not get hospice because it was considered suicide. She was supposed to dialyze on Saturday morning, skipped it and passed away peacefully in her sleep Monday evening.
A famous quote from Herbert Marcuse is that the one essential freedom that we all have is the right “not to continue”. We should be able to manage our end of life experience with the minimum of pain and suffering. There is a powerful Netflix TV program staring Ricky Gervais called “After Life” where he portrays a man who loved his wife so much that after she died, the only thing that kept him going through the depression was knowing he could end his life at any time and do away with the pain.
A close friend of mine had lung failure and was suffocating. He didn’t want to continue to be a burden on himself and his family so he committed suicide, but he didn’t have any help from the health care community and it was ugly. This should never have to happen.
Some talk about the normalization of assisted dying as a bad idea, but I fell we are a long way from where we need to be in letting individuals have the freedom to make end of life decisions to manage pain and suffering when death is imminent. I’m a big fan of Compassion and Choices Pennsylvania, an organization committed to finding the optimum end of life experience for every Pennsylvanian.
So take some time to not just plan for retirement but post retirement. Check out Compassion and Choices. I am sure there will be some surprises and in all likelihood, you will need to follow plan B. You will have thought it through so the journey is as smooth as it can be for you and your family.