We Do Have Choices

Aug 15, 2018

Having difficult discussions about death can be challenging. In Jane Holwerda's family, however, the conversations are the norm. Family members frequently ask, "May I have that after you die?"
Credit Wikimedia

Hello, Radio Readers! I’m Jane Holwerda from Dodge City, here to talk about aging, death and dying for our Fall 2018 book series.  

If you haven’t yet been given scary news about your health, it’s probably just a matter of time.  Dr. Atul Gawande’s Being Mortal: Medicine and What Matters in the End could be a step in preparing for conversations about treatments and procedures.

He writes extensively about health care, from his perspective as a surgeon as well as a professor at Harvard’s Medical School and at Harvard’s School of Public Health, Dr. Gawande directs Ariadne Labs, chairs the nonprofit LIfeBox, and just this past summer, was named CEO of a healthcare venture formed by the triumvirate of Amazon, JP Morgan Chase, and Berkshire Hathaway.  He seems qualified to offer us ways to think about the choices we may or may not have about the ways we die – shall we die at home,  with hospice and palliative care? Or in a hospital or long-term facility, intubated and respirated?  Can we color our final days in ways that are meaningful to us?

Yes, says Dr. Gawande, Yes, we do have choices to make about the ways we die. And his book includes several scenarios, based on actual cases he’s attended or observed. As a physician himself, Gawande holds physicians accountable for helping their patients understand not just the variety of treatments and procedures but their consequences. Gawande also charges each of us with knowing what it is we want most from our final days.  One of the key steps is being able to explore a few crucial questions – what are our biggest fears and concerns? What goals are most important to us, and what trade-offs are we willing to make? Another step is sharing our answers with our doctors and those who may be making decisions for us about our treatments.  These are challenging conversations to have, especially if talking about death and dying is difficult.

In my family, we have few qualms about talking about death. I’m not sure why - maybe because we’ve shared in the death and dying of so many kin. Many of us have also worked in health care.  It’s not that we embrace death or march eagerly towards it, but we get that it’s an eventuality. As proof of this, I offer for your consideration one of my favorite eccentricities of my family—we put dibs on objects well before their owners are done using them. This means that when you visit one of our houses, you might admire a vase, or an old table, or platter, and so you might simply ask, “Hey, can I have this when you die?”  

The typical response is, “Oh dear, I think it already has so-and-so’s name on it.  Sorry.”  And, if in checking – usually for a slip of paper taped to the bottom or back of the object, no name appears, then you’ll be invited to sign your name to it. Thus assuring your inheritance. 

Some observers, not related, neophytes to our family culture, have told me this practice of claiming goods feels morbid.  But for us, it’s a ritual that connects us, provide all kinds of humor, and it has, time and again, helped us to effectively bypass most of the bickering and hard feelings that in other families follows hard on the heels of funerals when the bereaved tend to want to hold on to the things identified with the dead – a belt buckle, a favorite book, a carving—a small thing worthy of sentiment, something by which to remember the dead. In my family, many emotional tugs-of-war have been resolved with one simple question:  “Is your name on it?” If it is, well, there you have it.    

Similarly, but of course, more seriously, Dr. Gawande’s advice that each of us talk with our care providers and families about how we want to spend our end-of-days will say a great deal about what we most value.  Knowing what we are willing to surrender to have that is one way to sort through medical treatments and procedures.  Gawande’s Being Mortal is a good read, humane and wise. 

For HPPR’s Radio Readers, I’m Jane Holwerda from Dodge City, Kansas.