In any bookstore, you will find aisles and aisles of self-help books coaching us how to live more fully, how to embrace life with passion, and how to age in a way that we aren’t getting older! But how to die? Are you kidding me? DEPRESSING! But we desperately need a teacher in this area. Because each of us is eventually going to perish, and how nice it would be to have a few guidelines as we are getting close.
In their book, Handbook for Mortals: Guidance for People Facing Serious Illness, authors Joanne Lynn, MD, Joan Harrold, MD, and Janice Lynch Schuster, MFA discuss the topic of dying from several perspectives: living with serious illness, helping families make wise decisions, getting the help you need, controlling pain, planning ahead, and enduring loss. It is a comprehensive and informative handbook for anyone who is living with a crippling and/or terminal illness or for family members of a dying loved one.
I have the honor of interviewing the authors here and asking them more about this very important subject.
1. How can we help a person to die peacefully?
We each have a notion that a peaceful death would be more like nodding off—that we’d be quite old, and die quietly in our sleep. For most of us, though, that’s not how death will come. Instead, we will develop diseases and conditions with which we live for many months or years. These illnesses come with the certain knowledge that we are, after all, mortal beings.
People living with fatal diseases deserve to be comfortable, and most serious symptoms can be controlled with careful attention and thoughtful use of medications and other treatments. The Handbook gives patients and families basic guidance on what might work, what symptom relief to expect, and how to ask for – and plan for – having good care. Being physically comfortable does not ensure peaceful dying, but it usually does give the person some opportunities to deal with their emotional, spiritual, and relationship concerns.
Often, when we hear the news that a loved one is dying or seriously ill, we feel a sense of helplessness, that we simply don’t know what to say or do. We don’t have the language, or we’re afraid we’ll say the wrong thing. The fact is that we spend our lives loving others—and at the end of life, relying on what we know about loving and being loved can guide us. By being present—by listening to one another, through touch and comfort that are very human traits—we can help our loved ones to die peacefully.
We need to recognize that even when they are dying, people have hopes, dreams, aspirations, fears, memories, all of the things that make us human. Asking about, and honoring, those aspects of a person’s life is an important way to help him or her to die peacefully. Dying people often hope for seemingly small things—a good day, an hour with a friend, a chance to pray or engage in some ritual—and being present to those hopes can be a gift to your loved one. The Handbook actually includes a section on how to talk to a very sick person, and many readers have told us that it has given them the words to know what to do, how to act, and what to say.
2. How can a person productively process loss?
Near the end of life, people face many kinds of losses. People with serious illness face the loss of the future; they face the losses that come with illness, the physical decline that accompanies serious illness, such as changes in appearance or energy level. They may face the loss of independence, or the loss of dignity and privacy associated with becoming more dependent on others.
Enduring those losses can be difficult, but there are ways that people can cope and move forward. Each person will find his or her own path through loss. Some find comfort in ritual and prayer; others find comfort by spending time in the natural world or surrounded by family and friends. Others find meaning by pursuing daily activities, finishing projects, saying good-bye to loved ones. Many people cope by writing down their thoughts and feelings, or by engaging in life review activities that allow them to tell their story and to shape a legacy. The Handbook includes a chapter on enduring loss, which offers advice and support for people grieving their own dying, and for those they leave behind.
Many people have developed theories about grief, about the stages and processes that accompany it. Grief can encompass many quickly changing emotions, from anger and rage to depression and sorrow. These don’t always occur in a linear way, and people may go from one emotion to another for many months. Some people find it helpful to participate in bereavement counseling, or to join support groups of others who have suffered a similar loss. People experiencing complex grief, that is, grief that overwhelms their ability to function and live fully, may benefit from professional counseling.
3. What are some ways a dying loved one can ask for help?
Each person will have different needs and hopes that come from living with serious illness at the end of life. Some may need hands-on caregiving support: help with getting daily activities accomplished, such as cleaning up the house or paying bills or watching children. Some may want support for spiritual aspects of life, for finding ways to leave fully and meaningfully through to death. It can be very hard to ask for help, especially if you are an independent adult who’s used to juggling many tasks and responsibilities. The best way to ask for help is to recognize how willing people are to provide it. Your family and friends will want to help you, they will want to spend time with you and be supportive—asking for help may seem awkward, but you will find your requests to be welcome.
Your doctor can be a guide to resources in the community, and can point you to organizations that offer very particular kinds of help, from home health programs to hospice services. Your spiritual leader, your priest or minister or rabbi or imam, can work with you, too, and can guide you to resources and supports that your community has to offer.
Be honest with yourself and with those around you. Stay open to the life that is before you. Don’t let fears of being a burden on others prevent you from asking them for help and support; in allowing them to support and aid you, you are giving them a gift and an opportunity to express their love and gratitude for your presence in their lives.