I had few moments of reminiscing my long stint of encountering the process of death. This is because today I had to attend three deaths within a matter of half an hour, a sort of record. Kumar Chandran (67), Vaidyanathan (72) and Gopal Rao (81). All of them died in my care home within an hour, as if it is an auspicious time for death. I am proud that myself and my fellow gerontologist, Ms. Soumya Nair had the privilege and mandate to see 1000’s of deaths at close quarters. This is why I want to talk about death, and more specifically, ‘Dying the right way’.
Padma Mamee wanted to be remembered as someone who didn’t give up. Harinathan Uncle said some of his favorite times were playing golf with his rotary club members. Eddie Uncle, though a chronic bachelor said he was the luckiest man in the world, as he had the company of three dogs. Narayan Mama summed it up this way: “You have a one-way ticket. Don’t waste it!” They were all nearing death. Some were old, some young.
On many occasions, they shared their biggest regrets, favorite memories and greatest loves. I wanted to know their perspective on their lives, their dreams and their deaths. The recurrent themes were not surprising. Many talked about gratitude, family, relationships. And, of course, love.
These days we're living longer and surviving more health scares, even in old age, due to the improvements in medical technology. Most of the lives I encountered had no plans in old age thereby encountering untold miseries. Most of the afflictions, hardships and agony are man made and there fore it could have been avoided if some preparation was there. Many of my long-term care patients came to the care facility by the quirk of fate, not by intent. But as the days pass by they all get used to the care and love they received at the care center. More important, perhaps, it is the need to ensure that they live a full, healthy, happy life that's low on stress, poor nutrition, sedentary behavior and medical interventions – and high on healthy eating, physical activity and preventive care.
Our health care system prevalent in the country try ‘preserving’ the life, knowingly well that of the futility of treatment disregarding the miseries inflicted on the patient and the out-of-control health care costs. Hospitals and Doctors conceal the truth about the treatment options and the real prognosis and ultimately the futility. Relatives narrate stories how the hospitals overcharge by inflated bills and end up paying to the tunes of couple of lakhs. You have the right to know the treatment options, the right to choose and the right to deny. Are we able to exercise our rights when it comes to long-term care. Ending on a sound note is what everyone look for in the fag end of their life.
We, as social gerontologists, actually have a different view; a perspective that suggests drugs and medical procedures that prolong life for a short time aren't the answer. We subscribe to the idea of a more natural death with appropriate care at the fag end, facilitating with soothing and comforting factors playing the vital role. We are the proponents of different school of thought, approaching death in a different way which suggests that you are less likely to die in a hospital, less likely to undergo surgery at the end of your lives and less likely to be admitted to intensive care compared to the general population. Imagine someone close to you is dying of a chronic disease – or even of natural causes (old age). How much effort – and time, and money, and emotion – should you, your loved ones and your health care team exert to prolong that life?
Is the death less worthy of our attention – remember, as the longevity increases, a person does not go gently, smiling sweetly, into adieu. ‘Dying sucks. Cancer, Alzheimer’s, Parkinson’s sucks’, Soumya, my colleague says form her experience facilitating hundreds of deaths in the past. ‘Try to mitigate the misery and not to let it rule you and take over everything’.
Before preparing this article, as part of my research, I have seen some videos uploaded in the you tube, one worthy of mentioning is ‘My last Days” (Zach Sobiech) series. I am happy that such videos are spurring conversions about death and dying and we need more discussions like this in our country. Majority of people say they hope to die at home, yet only 30 percent actually do (Few Lucky Ones), often because people, I say, ill prepared to plan until it’s too late. We spend billions of rupees on medical treatments in the last lap of our life, too often these treatments achieve nothing but leave patients too ravaged to say goodbye to the people they love. I call dying in distress.
Our ancient philosophers and even religions have taught us to accept the fact that disease, pain, and death are inevitabilities of the human condition. Straight, honest discussions about how to grapple with the darkest of realities—the kind Zach Sobiech shares—are helpful for people who are figuring out how to cope and for people who will eventually have to—which is pretty much all of us. We need good geriatric counselors for how to talk openly with doctors, nurses, caregivers, family, and friends about the worst of the worst ways that human bodies can go wrong.
With a growing elderly population everywhere and advances in medical treatment that prolong life (often without quality) for disease sufferers, more and more of us are facing head-on confrontations with mortality even before our own time comes. As a nation, we remain bad at talking about the most difficult facts of life—how we want to go, and what we want to be done about it. Many of us, myself included, have been schooled in an emotional style that prefers to stay away from the dark, icky facts of human life. And talking about sickness and death is undeniably difficult. My experience tells that it is definitely not possible in a hospital to die peacefully, and especially in an ICU set up.
Is it possible to have a “humane and honorable” death? YES, Very Much. Provided, we accept it’s reality and initiate an honorable exit plan.