Let me end my life in peace, surrounded by family

Ok, you caught me. I am mortal. After four score or so years, my body will fail and I will live no longer. Dust to dust. Not thrilled, but I expect most of you are the same. I have but two final requests. Let me end my life in peace, surrounded by family. Second, please, do not let me “pass”… I really want to die.

Like you, I have struggled through life and given my all. I deserve a final award. I do not want to “pass” like a “C” on the test. I want a better grade. I hope my end does not come whisking by another vehicle on the highway, giving meaning to “passing lane.” While I enjoy football, I get the willies thinking that in my final moment I will be tossed down the gridiron. Moreover, I do not wish to end, delivered like a kidney stone.  I do not want to pass. Let me die.

I feel sorry for sardines. Their death is scheduled. If you check the fine print on the can, there it is, the expiration date. I worried not long ago, because many people at the hospital were expiring. I thought there was a wave of manufacturer recalls. I checked my whole body in the mirror looking for that fatal number. Perhaps, I was about to come to an untimely end. Please do not let me expire. I want to die.

I shudder to think the affect on a five year old, told that her grandfather is just “taking his last sleep.” She may need sedatives or therapy the rest of her life.

The intensive care unit called the other night. One of my patients had a cardiac arrest and a Code Blue was called. A team of 11 doctors, and nurses worked for 43 minutes. The resident regretted to inform me after that gallant effort that they had “lost him.” I was shocked. How was that possible? I suspect he was taken with the used linen. I suggested checking the laundry bins. When I informed the family he was misplaced, they seemed distressed.  Please, I want to die.

At the end of my life I do not want to croak, pop my clogs, cross the Stygian ferry, go belly up, conk, drop off, fizzle out, finish, yield the ghost, go the way of the flesh, flame out, buy the farm, graver, dodo, join the majority, hop the twig, crap out, put on the pine box, fade, perish, shuffle off this mortal coil, peg out, pass in my chips, snuff it or kick the proverbial bucket.

Oh, and I definitely do not want to depart. Watch me during the funeral service. There is an infinitesimal chance that I will get up and leave the room. Allow me to die.

This one final absolute event deserves its own word. That clarity helps us face the harsh fact that corporeal life ends. To soften or blur that statement is to deny part of life itself. To manipulate truth is confusing and makes decisions hard. We cannot cope when we deny. In order to live well, we must understand life on Earth is finite. There is freedom in that knowledge.

When my life approaches its end, grant me dignity, respect and reward. I want to live. Therefore, let me die.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Anonymous

    I totally understand your disdain for euphemisms and some of your observations were hilarious (lost!). Call it like it is. One of the difficulties of our society is using words from wishful thinking in an attempt to create reality, or what they call spin in politics. Spin it however one wants, the end of life is still dying.

    Yet, when you do die, those still living might appreciate casting that fact in terms that give them hope that it is not the end absolutely speaking, and that they might rejoin you in the future. Dead is just dead, starkly true about the present. But words like “gone” or “departed” suggest a destination and something about the future, some element of comfort for the living. What do you think? 

    • http://twitter.com/DRSALWITZ James C Salwitz

      I guess in my experience I have seen euphemisms used in place of human connection.  I do not see the act of dying as being a statement about eternity, but a fact of life itself.  Therefore, if we can touch each other in deep and honest ways, maybe we can help just a little to go on.
      I appreciate your comment,
      jcs

  • barcabela

    Reality and humor go together :-) Thanks for sharing.

    • http://twitter.com/DRSALWITZ James C Salwitz

      I think the more serious your view of life, the more need there is for laughter.
      jcs

  • http://www.facebook.com/people/Ardella-Eagle/100003689610855 Ardella Eagle

    I just sat through a forensics ‘competition’ where the winning presentation was a moving rendition of “I Am A Person, Too” by Dawn Mazzola.  This is up there.  Would love to have your permission to hold this submission and to use in public speaking.

    • http://twitter.com/DRSALWITZ James C Salwitz

      I am flattered.  Please use this piece in anyway which might be of assistance.
      Thanks,
      jcs

  • http://www.facebook.com/coletteclark1 Colette Clark

    The reasons for the other words is that DYING is painful, for those left behind. Yes, we will all die. The english language has evolved to soften the absolutes of life and death. I remember in Human biology there are multiple words for excretion; defecation, mass peristalsis, evacuation,forget crapping, dumping, Sh–ing and whatever else the lay develop. I appreciate that you just want your obit to say you DIED.( Note to self, leave tacit instructions to survivors.”.) But don’t call everyone an idiot because they don’t like DIED.

    • http://twitter.com/DRSALWITZ James C Salwitz

      I appreciate that insight. My main point is that the language we use frames not only the conversation, but how we feel and connect to each other. If we use idioms which do not express the depth of seriousness and pain which accompanies an event like dying, we limit our ability to support each other or recognize suffering. Thanks for the comment, jcs

  • Anonymous

    I am a Buddhist, and a hospice nurse. As a Buddhist, I am taught to meditate on death every day in order to be prepared for the inevitable, so that I may move in to my next life with the most positive energy I can muster, and master. As a hospice nurse, I experience death every day, and never sugar-coat what it is to any of my patients or their loved ones. I agree – death is death, and shouldn’t be shrouded in terms that mask it to be any other thing than what it is; the end of this corporeal stage of our spirits journey. The physical body is just a set of clothing for the spirit that inhabits this lifetime. Having said all that, I have also realized that death is different for everyone experiencing it, and for those left behind. I don’t believe it is okay to force a perspective about death on anyone. We will all get there, at some point. How we experience moving from this life to the next is as individual as the very life we lead.

    • http://twitter.com/DRSALWITZ James C Salwitz

      The spirit and flow of your life is a living example of facing and finding direction from the reality of death.  Thank you for that insight. 
      jcs

  • Anonymous

    James; It is my deepest hope that as an oncologist, you allow your patients to die, when it is time for them to die. In my experience as a hospice nurse, it is the oncologists that are the biggest offenders in not allowing their patients to die when they are ready. I get the drive to cure, and not give up. I hope you do too. Based on your blog post, I am thinking you are one of the few that do. Thank you for sharing your perspective.

    • http://twitter.com/DRSALWITZ James C Salwitz

      I have found as an Oncologist that by assisting patients transition from active medical intervention, through palliation, into terminal/hospice care, that it resulted in my patients getting more complete and balanced treatment.  Selfishly, that approach has helped me remain sane and compassionate, because I have found I always have something to offer, even at life’s end.
      Thanks,  jcs

  • Payne Hertz

    Good to have a sense of humor about existential termination syndrome and the euphemisms used to describe it. As the old saying goes, you come into this world crying, you should go out laughing.

    Speaking of euphemisms, when I die I do not wish to be under medical “care” in a “hospital,” as hospitals are about the most uncaring, inhospitable places I’ve ever experienced in this life. I do not wish to be “palliated” as I have spent a good chunk of my life having to “cover up” and make excuses for my pain. I do not want to go to a “hospice” as this is not a rest stop, but the end of the line.

    I want to choose the time, place and manner of my own death, and I want that death to be swift, sure and painless.  But that is a right denied to American citizens for some reason entirely related to profit, since end-of-life “care” is so lucrative. In capitalist culture, the pathological pursuit of profit is invariably sugar coated with invocations of “morality” and “freedom” and the false promise that “effective treatments” exist if only someone would care to offer them. But we are told that it would be “immoral” for citizens to enjoy the genuine freedom of making their own choices about death, rather than having them forced upon us by the medical system and the government.

    The debate should not be about what words we use to describe death, but the fact that we lack genuine freedom of choice when it comes to dying.

    • http://twitter.com/DRSALWITZ James C Salwitz

      Fantastic observations.  I would suggest per my original thesis that as long as euphemisms obscure reality, we will be unable to have the sort of frank conversation needed to arrive at the goal you suggest.
      jcs 

  • Anonymous

    Have you ever had the patient’s wishes challenged by family members?  On another blog, one doctor bowed to the demand from family members to ignore the patient’s notarized directive for “comfort measures only” to the “full intervention” because he (the hospital?) feared a lawsuit. How binding is a notarized advanced health care directive?  What would you do if a family member did indeed present such a challenge?

    • http://twitter.com/DRSALWITZ James C Salwitz

      Great and complex question. Will definitely need to blog. In theory a properly executed AD is binding on the health care providers.  Unfortunately, often doctors will fold under pressure from the family in this situation.  The issue is that in order to enforce the AD, and override the family’s desires, in most states this will need to go to court and a Judge will need to order the AD enforced, appoint a proxy for health care decisions and/or side with the family.  The last will generally occur when the family can convincingly state they they are speaking for the true desires of the patient and that the AD was somehow wrong.  It is a tough nasty battle.  In our experience we have generally found that a series of meetings with the family, emphasizing the patients evident desires, can usually resolve the conflict.  The family needs to be reminded that it is their job to speak in the patient’s voice as the patient would have spoken, and not to insert their own needs.
      jcs

  • Maryann Long

    I’m on a personal crusade against “passing” and use “die”, “died”, “dead” and “death” at every opportunity.  I’ve been living in Australia for a few years and one of the amusing euphemistic usages here refers to attending a funeral, known as “farewelling” the dead person.  It’s a double whammy: “farewell” being used as a verb (ugh!), and the idea of the dead person being wished “farewell” into some next stage, as … what? ashes? compost?

    • http://twitter.com/DRSALWITZ James C Salwitz

      I was not aware of “farewelling.”  I have to agree that it is a particularly conflicted word.
      Thanks very much.
      jcs

  • Anonymous

    James, you’ve missed the point entirely and taken away our humanity in the process.  The way people express the fact that someone died, the words they use, communicates a lot more to the listener than merely someone died.  ”Passing away” is meant to convey an entirely different feeling to the listener than “he died.”  Nobody is wrong for using any words to describe anything because it is their humanity talking, part of that which separates us from all other living things.  If you want to die, that’s fine for you.  But depending on how I relate to you, what I know about you, how I feel about you and how I feel about the person I’m telling, I may use a different expression.  Because after you die, it isn’t about you anymore.  It’s about us dealing with your death.  For me, if I didn’t know you at all, I might say you died or was killed or you committed suicide or any other description I chose — the point being that I chose.  But people like you want to limit my ability to choose, my ability and my desire to communicate more than just the fact that someone died. My natural tendency to use all levels of communication to express myself.  You see, I understand that oncologists may need to compartmentalize their emotions and stick to very specific words to describe death so as not to become too involved.  I understand that they need to keep their emotions in check so they have something left for the rest of their patients.  Variations of “to die” are very clean for you.  Having said that, you can communicate many different feelings with those words.  Consider, “He…….died.”  Or, “(long sigh) He died.”  Or “(coldly) He died.”  What I’d love for you to respond to is what inside you makes you feel the need to tell me how I should communicate death?  Why does this whole thing bother you?  

    • http://twitter.com/DRSALWITZ James C Salwitz

      Interesting observation. I worry that by not being direct with people in pain, we deny them the opportunity to cope and communicate their suffering.  I also have noted that when we do not really want to reach out to others we use words which might obscure that touching.  Still, you are absolutely correct that we each have to find the words which work for our own needs.
      Thanks,
      jcs

  • Anonymous

    This IS a humane essay.  All those other words have nothing to do with feelings about the person who died. It probably has more to do with religious beliefs and acceptance by those who started using them. 

    I really like this post.  I think you put dying and death in an approachable way to discuss.  I hope I get the opportunity to use it as well (with credits) to educate people on the importance of advanced directives (aka  end-of-life instructions).      

    • http://twitter.com/DRSALWITZ James C Salwitz

      Thanks…I hope it helps.  There is some much healing to be made possible by honest discussions well before dying.  
      jcs

  • jeffmchpn

    This is an important essay that deserves a wider distribution. As first an oncology RN, then a hospice nurse, supervisor, clinical director, and then program director — and a family member who helped to nurse family members suffering from cancers and end stage dementia — I also hope this posting helps. For even as more patients in absolute terms  have even the tiniest “taste” of hospice care, those infamous “brink of death” vs. end of life referrals continue to drive down to median length of stay (on hospice care). I’ve worked briefly with Bernie Seagal when a manager at the CT Hospice, and he described assigning several of the residents he worked with in oncology to find how many euphemisms are used to indicate that someone has died. They came back with more than 200! Everything from someone being “lost”, to “kicking the bucket”, and everything in between. I used to forbid my staff to refer to a death as anything other than that — the death of someone we cared for. Woody Allen said it best when he stated: “I’m not afraid of dying. I just don’t want to be there when it happens!”

    • http://twitter.com/DRSALWITZ James C Salwitz, MD

      I think the connection you make between the euphamisms by which we hide death and late Hospice referrals, is really at the core.  Because we do not face reality we reap a harvest of fear and panic.
      Great thought.
      Thanks,
      jcs

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