I’m assuming most of the people reading this are medics or related so when I ask the question: “have you seen someone die?” Most will say yes.
But if you haven’t, considering it comes to everybody, if you die in a hospital, which most of us do. Then it’s not necessarily going to be that pleasant.
In the western world dying is anathema it seems. Something to fight to the bitter end. And that bitter end is where the problem lies.
If you’re in a hospital and have a medicalised death, blood taking, tubes in your nose and your bladder, prolonging the inevitable, trying to control pain or discomfort, or having symptoms that can’t be controlled. It’s not the way to do it. Hospitals are aimed at prolonging life, something they do too well in many instances.
The hardest bit, it seems about death, is talking about it. And yet it is the most important conversation you’ll never have. I comprehend fully if you don’t understand the conversation or what exactly the conversation it is that you’re supposed to have. The dying bit is easy, the ultimate end is just that. You just stop. How you get to that point is the vital bit.
The rough average age of death in the western world is 82. But you don’t generally just drop dead. The process of dying takes, on the whole, about two years. One trip to hospital weakens you a bit, and then another illness a few months or a year later takes a bit more, then you find you need some help at home, then something else comes along and maybe residential care looms or worse still a nursing home. And then finally death in its myriad forms. This sounds grim and it can be. Especially in our diluted families of the 21st century and a care system that isn’t remunerated or supported like it should be.
What if you come to hospital for an operation? Depending on your health state then it’s very safe to have an operation these days. Our mortality and morbidity calculators regularly surprise me with a much lower prediction of issues than my experience would predict. But once you are over 75 your body’s physiological reserve to cope with injury and illness falls precipitously. What does that mean though? About 1 in 20 people having major surgery will have a complication that leads to death.
What they didn’t tell you though, unless you’ve been properly pre-assessed for your operation, is how that actually happens.
Well say you have a heart attack or a stroke or get pneumonia or a lung clot. And your body reacts badly to it in some increasingly complex medical way, and we start to treat you but the treatment isn’t really working, and we start to support an organ system with fluids, or oxygen, or drugs to support your blood pressure. And then at 0200 one morning when you are exhausted and confused perhaps, a doctor pitches up and asks do you want to go to intensive care? And what you hear is “do you want to live?” And of course you say yes I want to live, I want to live forever – don’t we all?
So you are put into a medical coma and a tube put into your lungs to take over your breathing. And the treatment either works or it doesn’t (approximately 70% of all comers to ICU survive). But a 7-10 day stint in ICU is just that, a week. The real hard work comes after. Weeks or months of recovery and perhaps that dreaded discharge to a care facility of some type.
Or perhaps you have a lung clot or a heart attack and your heart stops beating? After 10 mins of good cardiopulmonary resuscitation your chance of meaningful survival falls of a cliff. (If it happens in a hospital) So sure do CPR on me but if you get to 15 mins then call it. I’m not interested to find out the result after that.
But nobody ever mentioned that, after all 19 out of 20 people sail through their operation. And that’s just a post-operative complication after elective surgery. If you come for an emergency surgery the odds change. If you’ve been unwell for many years the odds change. If you have become frail through illness or disuse – the odds change.
So instead of having to make a decision on a life or death subject at 0200 having never considered it before and believe me most haven’t. Perhaps have a look at an Advance Care Directive – a conversation with family or GP that realistically looks at what you’d want to happen to you if you got into the above scenario. Or if you collapsed at home and nobody knows what you want to happen to you. Tell your family, because they are the first people we talk to about your wishes. And it’s a terrible thing to have to ask a family who doesn’t know the answer. The default will be “do everything” when perhaps everything is worse than a natural death.
And last you might be reading this thinking but I’m young it’s not relevant. Well I really hope you’re right, I really do. But bad things happen to young people. Have you got a will? Where will your money go? Will it go to who it should? How will the world know? Will your other half have enough to live. What if both of you go and you haven’t made a plan for what will happen to your children?
Now I live away from my blood relatives – I have a will, my wife knows exactly what will happen if I die (she’ll be laughing all the way to the bank!) if we both die the kids know who they’re going to end up with, they know who will come and collect them and how long it’ll be before they end up with people they know. Those people know they’re getting our whole estate.
My wife knows that I’d rather just be switched off than survive a significant neurological injury or high percentage burns. She knows who to call so that decision doesn’t lie solely with her. She knows that she will be legally able to make those decisions on my behalf if I can’t (guardianship) and make financial decisions if I can’t (power of attorney).
So why do I write this? Because we don’t talk about death. The vast majority of people don’t plan to die and we should. It’s inevitable after all.
If you want to prolong the inevitable start moving now. Literally start moving. The single biggest determinant of healthy longevity is regular physical exercise. And while we’re at it the single biggest determinant of healthy psychological longevity is friends. Hang out with people you like and who like you…