How to get ready for death

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It is life’s change agent. It clears out the old to make way for the new.
-Steve Jobs, in his 2005 speech to the graduating class at Stanford University

We’re uncomfortable with death in this country.  That’s my conclusion as a hospital chaplain who has worked with numerous patients and family members facing life-threatening illnesses or injuries.   In my experience, people generally accept that “death is the destination we all share,” as the late Steve Jobs put it, but the thought of our own particular death or the death of a loved one unsettles us.  And so we defend ourselves against the specter of death by denying its existence, trusting superstitiously that if we never speak its name, death will leave us alone.  (For example: I’ve heard many terminally ill patients ask:  “I wonder if I’m dying?” only to have a family member quickly cut them off with:  “Don’t talk like that!  You’re going to be just fine.”)

We also turn to doctors and medical care in the hope that the right physician, medication, treatment, or surgical procedure will make death optional rather than inevitable.  But death, of course can’t be made optional, even with the finest medical care or the most resolute denial of its existence. And in the meantime, our discomfort with death causes us to spend little or no time getting ready – emotionally, spiritually, or practically – for that inevitable day when our life will end.  As a result death too often catches us unprepared emotionally, spiritually and practically.  But it doesn’t have to be that way.  Rather than spending time and energy avoiding and denying death, it is prudent, practical, and, in my opinion, healthier to put time and energy into getting ready for death.  How does one do that?  Here are some suggestions:

How to get ready for death

  1. Start early.  Begin preparing when you’re young and healthy and death is, presumably, a long way off.  Don’t wait until you’re old and sick and death is just around the corner. Then it may be too late.
  1. Think about death – your own death, I mean – for a moment or two each day.  Ponder for those brief moments the possibility that this day might be your last.  Ask yourself: ‘Is there anything I need to say or do if today is my final day?’  Thinking about death like this isn’t morbid, as some believe.  The point isn’t to dwell on death but to take its reality seriously in order to live more fully.  Pondering your own inevitable death is an age-old practice, called “memento mori” (“remember that you will die”) that has helped people embrace life through the realization that they do not have all the time in the world.
  1. Remember that death is a part of life – a normal, natural, expected part of life.  It is life’s “change agent”, in the words of Steve Jobs, which “clears out the old to make way for the new”. There is, according to the ancient Biblical wisdom, recast for modern generations by Pete Seger and the Byrds, a time and season for everything under heaven – for birth and eventually also for death.
  1. Reject the superstitious belief, common in American culture, that thinking or talking about death makes it happen.  It doesn’t work that way.  We don’t open the door and let death in just by speaking its name.  Take comfort in the words of Fred Rogers (TV’s “Mr Rodgers”) who said, of talking to children about difficult subjects like death, “Whatever is mentionable is manageable.”  Yes.  Whatever we can talk about, we can deal with.
  1. Make a “bucket list” (what did we call it before that movie?) of things you want to do, places you want to go, experiences you want to have in the time you have left.  Work at checking things off the list.  Enjoy yourself along the way.  Realize that having a “bucket list” and working to get items checked off provides a subtle reminder that one day, maybe sooner, maybe later, yours will be kicked.
  1. If you are a praying person, use prayer, especially your bedtime prayers, as a way of preparing for death.  This too is an age-old practice that was once taught to children, as in the classic bedtime prayer:  Now I lay me down to sleep, I pray the Lord my soul to keep. If I should die before I wake, I pray the Lord my soul to take.”  You will be more adept at relaxing into the arms of the God to whom you pray as death approaches if you’ve practiced doing so each evening as you drift off to sleep.  John Henry Newman’s well-loved prayer is used by many for this purpose: O Lord, support us all the day long, until the shadows lengthen and the evening comes, the busy world is hushed, the fever of life is over, and our work done. Then, in your mercy, grant us safe lodging, a holy rest, and peace at the last. Amen. 
  1. Read a little poetry.  Poets have a unique and insightful way of helping us embrace the not-easily-embraceable truth that death will come, without fail, for each of us.  Some of my favorite poems on the subject are these:
  • The Death Deal” by Ron Padget.  The poet struggles against but eventually begins to look forward to his own eventual death.
  • “When Death Comes” by Mary Oliver, in which the poet voices her wish to live fully, with amazement, curiosity, and joy before death comes for her “like the hungry bear in autumn…”
  • And “The Last Thing” by the Irish poet Monk Gibbons.  The poet reminds us that death is an experience common to all people.  Thus we can approach death’s door bravely, trusting that “where so much greatness and gentleness have been already, you should be glad to follow.”
  1. Prepare an Advance Medical Directive.  This is a form designating someone to make medical care and treatment decisions on your behalf if you are ever too sick to speak for yourself.  You can also describe in this document the sort of medical care you want and do not want, especially as you come to the end of life.  A form like this helps your loved ones and caregivers know your wishes, preferences and values.  An Advance Medical Directive helps insure you get the care you particularly want.  Discuss your wishes with the person you designate as your health care agent.  File a copy of the completed form with your primary physician.  Every one of us should have an advance directive.
  1.  Say the most important things to the most important people in your life.  In his book, The Four Things That Matter Most, palliative care physician Ira Byock writes of how he learned from dying patients that the most important things to say to our loved ones before it’s too late are:
    • Please forgive me.
    • I forgive you.
    • Thank you.
    • I love you.

These simple but profound statements have the power to repair rifts in relationships, make clear what is felt but often left unspoken, and draw us closer to our loved ones.  Dr. Byock notes that a great deal of money and medical resources are often expended at the end of life in order to give people the time and ability to finally speak these messages to a loved one.   Don’t wait until you’re on your deathbed to speak these important words to those dear to you.  Say them each day.  That way you’ll not come to the end of a day, much less the end of your life, with the messages that matter most left unspoken.

So there you have a few suggestions on getting ready for that inevitable day when your life will come to an end.  Pondering your own death needn’t be a gloomy or depressing task.  Instead, quite the contrary, it can fill you with a greater appreciation for how valuable a gift each new day is.  G.K. Chesterton once wrote, “The way to love anything is to realize that it might be lost.” Regularly remembering our mortality can help us love and treasure life.

Rob A. Ruff is Director of Chaplaincy Services, Regions Hospital.

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  • Anonymous

    “We all — in the end — die in medias res. In the middle of a story. Of many stories”
    elegant words from the eulogy to steve jobs by his sister

    • wendy nelligan

      A well-written and practical article. I think the keyword here is really Acceptance. Without Acceptance, it is very difficult to change your attitude, as in the example of rejecting the superstitious belief of speaking about death.

      Since my husband passed away, I no longer fear my own death. I watched him die. It was dreadful and it was beautiful. And I know he will be waiting for me when it’s my turn.

      Did we accept his impending death? No. We both denied it; could not speak about it. But it happened. Life happens and so does death.

  • Anonymous

    There is nothing to fear in death but the fear itself . When we die , the physical part is left but the spirit goes back home to more love than you can possibly imagine . End of sermon .

  • Anonymous

    “I’m not afraid of dying – I just don’t want to be there when it happens” ~~~~ Woody Allen

  • http://www.facebook.com/haneen.isleem Haneen Isleem

    I am afraid of death, and I think that it is something natural,but I dont think that I am ready for die, but it’s good advice for dealing with death. 

    Haneen.. 

  • http://twitter.com/DrBeckerSchutte Ann Becker-Schutte

    Thank you so much for your thoughtful perspective–as well as those incredibly practical steps you offered.  Each week on Thursdays, at 8:30 pm CST, a group of us use the Twitter hashtag #EOLchat to talk about death, dying, and how we can increase the level of comfort and conversation about these topics.  We’d love to have you stop by.

  • Anonymous

    Do you believe that the medical perception that the death of the patient simply reflects the defeat of the medical knowledge influences how the patient perceives death?  What do you believe the exercise of choice should be in the case of a mentally disabled individual?  Do you believe that the vulnerability that the patient experiences when sick is the impetus for searching spiritual answers?  If yes, don’t you believe that the Chaplin should have an established relationship with the patient so they are less anxious and more familiar with the concept of death.

  • http://twitter.com/RARuff59 Rob A. Ruff

    In response to katerinahurd:  Yes, the perception that death = medical failure can shade a patient’s perception of death.  Everything can’t be cured despite the finest medical treatments.  The medical enterprise needs to make it’s peace with death as much as patients do. 
    With mentally disabled individuals, as with anyone who’s not able to make their own medical decisions, decisions should be made compassionately on their behalf ideally by those who know the patient the best and can best represent the patient’s wishes, values, and preferences.
    Yes the vulnerability experienced by those who are sick is one of many factors that can prompt people to search, spiritually, for meaning, purpose and peace. 
    And yes, of course, I believe that chaplains should work with patients, especially the terminally ill, to provide comfort, counsel and companionship.  It’s what I do on a daily basis.  My article wasn’t intended to send the message that facing death is or should be a “do it yourself” enterprise.  If anything helps, having trusted loved ones, guides, and caregivers helps.  It can also help if, as I wrote in the article, we all begin preparing for death long before we need to.