“Don’t bother to make any plans, You are already in the departure lounge just waiting for your flight to be called”
The above statement was made in jest by my young nephew, Martin J. Moses, in a different context. But it has always served to remind me that there will come a time in our lives when each one of us will have to face the reality that we have indeed entered the “departure lounge” and will be waiting to be called home. How we actually embark on this journey is, at best, unpredictable.
Over my more than 50 years practicing Medicine I have had, as you will expect, the great privilege of meeting and treating a large number of people. Many of these I was able to help, some of them I could not help, and yet there were others who, despite all my efforts, were disappointed at the outcome. But from all of them, on every occasion, the experience has enabled me to learn something useful and to change a little.
Nothing however, has been so life-changing to me and so rewarding, as those times when I shared the emotional and physical changes undergone by some of my patients as they faced and dealt with catastrophic and overwhelming news about themselves or their loved ones. Even after my many years of experience, I was never able to predict how they would choose to spend the remaining portion of their lives as they traveled the final journey, and equally important, to predict the reaction of the caregivers who willingly or otherwise, were called upon to help and participate.
Like the great majority of medical students, no one really took time to teach me the delicate art of caring for death and dying. As a result I became very good at diagnosing and treating my patients’ illnesses, but very uncomfortable when called upon to deal with the end-stages of life. It took multiple encounters, much trial and error, and repeated reference to the works of such pioneers as Dr. Elisabeth Kübler-Ross and Professor Balfour Blount, who have contributed so much to the understanding of this difficult and unpredictable period. Through their work and those of others, we are beginning to understand not only the stages of fear, grief and uncertainty experienced by the patient and family members, but more important, the significant role of the caregiver and family in the facilitation and relief of symptoms.
Even when forewarned, the final diagnosis of a terminal illness is always devastating news, both for patients and their family. Suddenly, the world is turned upside-down and like no other time before, there is need for reliable information and honest, realistic predictions. In the past, both physicians and family were encouraged to with hold the truth from the patient, assuming that doing so will remove the will to “fight”. Now we realize this is misguided and counter productive, since it served only to build a chasm between the patient and the loved ones and prevent any meaningful sharing and reconciliation.
In 2000, the Public Broadcasting System produced a 4-part series entitled “On our Own Terms” narrated by Bill Moyers, the accomplished and acclaimed journalist. It dealt in great detail with the emotional, spiritual and economic turmoil associated with terminal illness and explored the various movements towards improving the attitude to, and the care of the terminal patient. It examined, through interviews, the intimate experiences of patients, family, spiritual advisers and caregivers as they struggled through the turmoil of dealing with terminal disease. It examined in great detail the concepts of palliative care, hospice, home care and other end-of-life choices including physician-assisted suicide. It dealt with the legal and other barriers existing as well as the attempts to introduce the relevant changes. But above all, it reminded us of our need to find a balance between “Heroic treatment and Humane care”, as well as between “Dying, and Dying with Dignity.” It is a series well worth seeing over and over!
In the end, every one of us will be making that final journey and therefore it is incumbent upon each one of us to initiate our preparations. There is nothing wrong in expressing your wishes such as creating an advanced directive, securing a last will and testament, or recording specific instructions to special people. I try to use every opportunity to encourage my family, friends and patients to initiate general discussions on the subject as early and as often as possible. For it is only by talking, or better still, recording your ideas and your wishes as well as your hopes and dreams, can your family be guided in the correct direction and be provided with a sense of peace and comfort. We make a serious mistake by only beginning to think about this after we have received the final information. It should really be started and continued as early as possible and discussions maintained at regular periods.
Some of the best moments I have witnessed in my personal life and professional career have occurred with those people who have succeeded in coming to terms with themselves, their dying and their relationship with God, and have willingly surrendered. These people, instead of experiencing the intense feelings of anger, fear, regret and all the other feelings associated with loss and uncertainty, are able to spend the time available in resolving conflicts, cementing relationships and leaving a legacy of peace and love. Not only is the day to day trauma which is felt by the family and caregiver reduced, but the subsequent period of loss and mourning is significantly improved and above all, the deceased are left with a lasting memory more pleasant and more worthy of them and there life’s work.
…..This after all, is the best legacy they can leave behind, as they board their final flight home!
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The day which we fear as our last;
, but the birthday of eternity.
…….Seneca
At the end of life we will not be judged by
how many diplomas we have received,
or how much money we have made,
or how many great things we have done.
We will be judged by:
"I was hungry, and you gave me something to eat,
I was naked and you clothed me.
I was homeless, and you took me in."
……Mother Teresa of Calcutta
God pours life into death and Death into life,
without a drop being spilled.
…….Author Unknown
Watching a peaceful death of a human being reminds us of a falling star;
One of a million lights in a vast sky that flares up for a brief moment,
only to disappear into the endless night forever.
……..Elisabeth Kübler-Ross
We cannot banish dangers, but we can banish fears.
We must not demean life by standing in awe of death.
…….David Sarnoff
Let children walk with Nature,
Let them see the beautiful blendings
and communions of death and life,
their joyous inseparable unity,
as taught in woods and meadows,
plains and mountains and streams of our blessed star,
and they will learn that death is stingless indeed,
.......and as beautiful as life.
……John Muir
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