This is the fifth part of our series that started last Monday.  On death, dying, and preparing  for those days.

I am sure many of you are just like me.  We have no desire to spend the last days of our lives in a nursing home.  Or a hospital bed.  (I admit it, though, the latter option is one that I may not desire but it a most likely situation.)

No, I want to die in my own bed.  Living by myself if I am still unmarried or living with the one I love if I am lucky enough to cross that threshold.  And, of course, I want to die in my sleep when I am least prepared for it- in that I went to bed healthy, wealthy (or thinking so in my mind), and still wise (with a brain not wracked by Alzheimer’s)- before I reached my demise.

According to the Liz Hamel, Bryan Wu, and Mollyann Brodie  [ Kaiser Foundation (2017)], that’s the same dream that 71% of us have.  That is despite the fact that more than half of us die in nursing homes or hospitals,  of which 10% of us get dumped from one to the other over the last 3 days we walk this earth.

It gets worse.  Half of us die in pain- uncontrolled, unremitting pain.  Which means a peaceful death is not in the cards.

Here’s another problem to our reaching our dream.  Doctors assume we are willing to extend our lives until we receive no joy from doing so.  (How the heck do they know when we are or are not receiving joy from extending our lives?????)

And, that Kaiser study also revealed that we don’t want to add burdens to our family when we get ill, draining their finances.   So, extending our lives seems to be counter to this wish, as well.

All this means that WE need to define what we consider to be the quality of life we want.  And, we need to share that vision with our loved ones (or those to whom we trust our care when we can no longer voice our opinions).  Remember, also, that our “loved ones” may be the last person(s) to be making those decisions- since they will be overwrought with grief, when it is clear we are on our last legs.

It also means we need to share our thoughts with our physician.  So, he won’t impose his ideal (extending our lives until HE no longer thinks we are obtaining joy), but will employ our definition of same.  If your doctor doesn’t like your definition- or gives pushback, push him or her away and get another- now, while you are of sound mind and body.

If you are no longer sound of body (you may be seemingly so, but you do realize that once we are born, every moment after that is but a trajectory towards our demise), we need to have frank discussions of what will happen to us.  (Maybe it’s time you review Drs. Rockwood, Song, and Mitniski’s seminal paper on changes in relative fitness and frailty across the adult lifespan.)

It’s also important to ask our health care advisor or team this most important question: What’s the likely path my mildly chronic illness will take over the next days/weeks/months/years?

A graphical representation may help with this- because it may make clearer exactly how close we are to one side of the path or the other.  (There are three typical scenarios detailed below.)

We also should consider if a favorite picture, a chair, whatever will help us feel more comfortable when it’s our last days.   Because we can provide meaning- maybe even a sense of calmness to the room(s) where we will spend the last days of our life on earth. Maybe we should even have our doc work with the hospital (if that’s where we are) to turn off those confounded beeps, alarms, lights that populate hospital rooms, so we can maintain  a relatively calm aura about the room.

Here’s another thing to put into our planning.  Dying at home ain’t cheap!  It’s labor-intensive.  Even if we can get hospice help, we need to budget the money- and the manpower- to ‘enjoy’ this choice.   Sometimes, we get lucky.  (My friend, Arnold, who was ill in the hospital wanted to go home to die.  He got home- and died before the next day when hospice was going to make its first visit.)

Maybe it’s the time to present our blessing to your children.  Think of Yaakov (Jacob), charging his twelve children with their mission in life.

But, the time to plan these days is now.

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