On the “Good Death”, part 3

Hello again.  Today I’m going to finish up my little series on what a “good death” is (or isn’t).  I’m especially excited about this post because a) I’m going to talk about one of my favorite books, and b) while writing it I am forced to take a break from trying to figure out which summer camps to sign my kids up for. (Why must that be so complicated? And done so far in advance?  We just got more snow, for goodness sake.  Sigh.)

Anyway, last week I wrote about what Ira Byock, MD thought a good death was, and how to achieve that.  In that post I mentioned a string of difficult deaths that I was involved with, and how much I struggled with them.  I won’t go into details, but in the last of those deaths, the family, including the patient, had consistently refused to allow us to even bring up the possibility of her death, even though she was clearly dying.  She was very young, and there was a lot of anger and hope and denial.  At the last minute the family called 911 and she died en-route to the hospital.  I heard about that deaths via voice mail as I drove up to meet a dear friend (B, as a matter of fact) at a spa to celebrate my 40th birthday.  I thought about her death for the rest of the ride up there.  Her death joined me in my “waterfall bath,” my massage, and the steam room.  I kept trying to shove her death out of my head, or at least to keep it from hogging the tub, but it wouldn’t budge.  Not only did it not split the bill, but it didn’t even offer to leave a tip.  (This was my first spa experience.   And O-M-G, that stuff is pricey).

So, there I was, wrapped in a spa-issued fluffy white robe, drinking cucumber-infused water, mulling over her death, and trying to read my latest book club selection, which happened to be Being with Dying by the Buddhist monk Joan Halifax.  (Coincidentally, Ira Byock wrote the introduction).  I’m too cheap to buy books, so I kept trying to not drip on the library copy.  I am guessing I was the only person at the spa that day that was reading it, though I could be wrong.  I admit, a large part of me wanted to reach over and grab a moist copy of People, but I persevered.

I’m glad I did.  It took me a few weeks to get through it, but it saved me from being swallowed by my angst.  Halifax is a medical anthropologist who has spent a great deal of time with the dying.  Her book is about her approach to death as a Buddhist teacher, and is written for the dying, those that care for them, and anyone who might fall into one of those categories in the future (i.e., all of us).  In a nutshell, she posits that there is no such thing as a “good death.”  She talks about having the goal of “radical optimism”: not having expectations for any specific outcome.  According to her, there is no “good” or “bad” death.  She strives to set aside judgment and a sense of “knowing,” but to rather practice “not knowing.” She suggests that we as health care providers leave everything we know in the car before we visit our patients.  We are there to help people along on their journeys, to bear witness, but not to impose our beliefs or expectations on them.  Essentially, “it is what it is.” (I love how ubiquitous that phrase has become.)

What I found especially reassuring was that she feels that denying death, grieving death, defying death, accepting death, liberating death…are all legitimate approaches to death.   She even talks about how some people scream at the very end of life, and how we should reconsider automatically medicating them.  Perhaps they are angry, and they should be allowed to express that anger.

I’m far from an expert on Buddhism, though I have read some about it.  It appeals to me on a lot of levels, and if I had more time and didn’t strive to stay in my pj’s for the entire weekend (yep, I’m in them right now) I would probably pursue it more.  I’m not exactly unique in this.  Buddhism seems to be a bit trendy lately…I see a lot of folks wearing prayer beads, and it’s hard to know if they use them to pray or if it’s more of a fashion statement.   But what I love about Halifax’s book is how accepting it is of everyone’s experience at the end of life.  And as someone who is witness to a variety of different approaches to dying, I find that very reassuring.  Because a lot of people don’t have what a lot of us would deem a “good death.”  And, according to Halifax, that’s okay.

And, I’d agree with her.  After muddling through that series of less-than-ideal deaths, that’s what I came up with.  I now feel like everybody is on their own journey.   We as the hospice team come in at whatever point we come in, and our job is to provide whatever support or assistance that we can.  But the nature of that support is dictated by our patient, and the journey is the patient’s, not ours.  They may be denying their death, they may be angry about their death.  We can bear witness to that struggle.  We need to provide opportunities for them to talk honestly about how they feel.  They may not feel the way that we want them to feel.  Maybe with time they will come to that much-hoped for stage of “acceptance.”  But maybe they won’t.  That is for them to determine.

And, that is for us to accept.

At least, that’s my take on it.  What’s yours?  Don’t worry–I won’t judge you!

And, now to get back to walking that fine line between over-scheduling my children and leaving us with too much unstructured free time.  Ah, the joys of modern parenting…