Some very thoughtful posts.
I turn 59 in about a week so I am not that “old” age of 60 yet… So I am good.
Plus I need to see what my investments in my kids turns out like. That college tuition is expensive. I want to see the payoff now…
Such wonderful posts. Deep thoughts and loving stories.
I have always been interested the subjects of both death and dying. I contribute this
to the nine deaths of family and friends when I was ages 9-11. The youngest a 6 week old, as well as a friend age 8. The oldest a great grandparent and my father age 50.
All open casket (except the wee one) and a kiss on their cheek. I did not experience fear. It was fact of life to me, especially experiencing so many in such a short amount of time.
Two of the caskets were open in my grandmothers living room. I was sent to dust around the casket, which I did, and there was no fear.
I find discussions about this typically rich with people’s thoughts and memories.
I think about how dying of coronavirus would be as an experience and it is not a totally desirable way at all. Still, there are worse ways to die. Sadder ways. I do know that if it is a choice (not likely but this is a conversation not a reality show) between myself and a younger person I will be fine not receiving that treatment.
I was at a meeting last week and a nurse who works in ICU said that there are protocols in place regarding who has priority in the event of a shortage of equipment.
She did not say this is expected but in the event of. Got me to thinking.
Remember the Movie “Harold and Maude”? Her attitude always made me happy.
Physician here. Good grief- thank goodness the title did not include Covid19. The risks of death from this pandemic are still the elderly and immune compromised. 60 fits my defintion of old, I call 80 and over elderly.
H and I are over 65 and both physicians so have seen all sorts of life spans and reasons people live/die. We college age plus parents are reaching the stage in life where it is no longer an issue of who will raise the kids but enjoying fewer responsibilities. My mother died before any grandchildren, as did 3 of 4 of my grandparents so I don’t see that as a being too young marker. I don’t see millions of healthy, young people dying of the current virus like the influenza pandemic of 1918.
Yes, this stage of life is good for reflecting on life as we are closer to the end than the beginning of a usual long lived span. Yes, we have “been there, done that” for most of what we would like to experience. It is true that wisdom comes with age- it is not greater intelligence but so many life experiences to have had and draw upon. Knowing we won’t get to do everything and reconciling with so many decisions made over the course of decades that put us where we are now.
As physicians we are more likely to not to push for everything that can be done to attempt to prolong life when we know that terminal cancer or other illness exists.
Circling back to college. I know we let our kid have a good childhood instead of pushing academics and maxing out only on his intellectual giftedness. Hopefully most of you will give your kids that gift of childhood. A decade later it won’t matter if s/he went to Harvard or State U. They will choose how intense to be and how far to go.
I had long talks with both my daughters (both are physicians) about my end of life preferences. With D2 over the winter holidays, and with D1 just a couple of days ago.
They know what I want. (I have a DNR and DNI on record along with a refusal of many life prolonging, but non-curative procedures.) I and both my daughters are atheists. I feel this life is the only one we have so all of us need to make the best use of it we can during our lifespan. I’ve made arrangements to donate my body to the local medical school for use in its cadaver labs. My daughters know that too and respect my choice.
I am not afraid dying. I know it’s the inevitable end of all us and I would much prefer to die of pneumonia than to die like my mom did–only after years of progressively worsening dementia. She was always a very difficult person, but with dementia she became angry, combative, physically violent and extremely racist & bigoted, calling my husband and children unbelievably ugly names when they wanted to do is show her kindness.
D1 is a EM attending physician at major academic hospital in the NE. She is the one who will be making life & death triage decisions as the ER as our hospitals become overwhelmed. She is very humbled and and feeling bit overwhelmed by this grave responsibility. I cannot imagine how much of burden this will be for her, but I am humbled and grateful that they are people like her who are trying their hardest to do their best for each and every person comes into the ER–and all while risking her own health and perhaps even her own life to do so.
A physician friend pointed out that in the current situation, while there has been a great deal of guidance about what to do if you need to go to the hospital, there has been none about what to do if you’re in the most vulnerable category but choose not to be hospitalized. For instance, how can we keep someone already in end of life care who develops C-19 safe and comfortable without endangering caregivers and expending resources needed for patients for whom a full recovery is possible?
Hoping we get the end-of-life paperwork done before it’s needed. Am in serious denial about our risk, and remembering my mother’s admonition to always wear clean underwear “just in case.”
I’m more worried about losing my parents who are in their 80s, especially my mother, since my father has dementia, and I do not know how any of us kids will be able to take care of him, especially since simply losing my mother and having to move out of the house (which he still recognizes), may be enough to push him over the edge.
In this new reality, I hope it does not happen sooner than I had planned!
I definitely don’t want to live long enough to lose my mind, like my poor mother did, in looking at the multi-year slope downward, I am not sure which place I would have chosen as the end. Definitely would have wanted to skip her last 18 months, as did she, asking us to help her die 
Other than that, my kids know I feel very strongly about end of life decisions, forms are signed, kids are informed. Grandma’s downhill spiral gave us many chances to consider and discuss it. I, too, have arranged for my body to go to DD’s med school.
I also truly hope I can toilet myself to the end, that was a sad thing to help both MIL and Mom with. Perhaps a bidet would ease that, oh wait, they are likely now all sold out due to COVID19 TP sales.
Great thoughts Sue22.
I have many thoughts about how we actually take care of anyone we love who is dying without care through this epidemic. I have asked my Doc family if, legal here, a faster dead–death and dying–will be possible. I have, out of curiosity and my own need to know such things, if the virus dies if it get through cremation(it does) and what the funeral homes and agents will be going through.
I appreciate thoughts such as somemom and being able to toilet ourselves. The truth is the more we can talk and share the better as we are in this together. I know I so appreciate the honest answers here.
And thanks and hugs to WOWM’s D.
I’m less scared of the idea of being dead, and more scared of the suffering that often precedes it.
Neither one of my parents had an easy time of it their last months/years.
@calmom ,
Thank you for your very thoughtful post.
I am usually reminded that life is short when I hear news that the people I know well (relatives, friends, classmates) who were my age or younger have died. I guess it hits “closer to home” this way.
I hope to retire with a full pension. That means working for 6-7 more years. I sure hope I don’t drop dead before or shoetly after my retirement. But one never knows.
Technically you do not need any paperwork to establish your end-of-life- directives. All you need to do is to express your wishes to your healthcare provider orally in the presence of at least one witness. Your decision will be noted on your chart.
Having it in writing is useful and makes things cleaner, but it isn’t a requirement.
@WayOutWestMom : Wouldn’t end of life directives requirements vary by state & by type of directive ?
No, the patient has to right to specify what types of care they are willing to receive at any time so long as they are mentally competent and over age 18. They can also change their mind at anytime and revoke their previous consent for/refusal of treatment. (Again, this can be done orally in the presence of a witness and their healthcare provider.)
Final directives written in one state will be honored in another. (At least among physicians, how lawyers feel about this may be an entirely different story.)
I had assumed that directive requirements varied from state to state–like specifics about wills did, but both my physician Ds corrected me.
However if a patient has expressed no clear final wishes, and either is mentally incompetent or is unable to communicate, then these decisions are left up to whoever holds their POA for healthcare or their next-of-kin.
This is why it’s vitally important for family members to have these discussions before a family member becomes critically ill.
Some types of directives are legal in some states, while illegal in other states.
Too many exceptions to discuss, but for starters euthanasia / assisted suicide is not legal in most states.
Like WOWMom, one of my kids is an ED doc, in Seattle no less. I expect to have some further in depth conversations after any crisis has passed to see if there are new opinions to consider about death.
I will say, I always thought I would be a person who could be pretty matter of fact about death and I was able to advocate for my mother to have the least intervention possible, I had no issues with that, but her asking for us to help her die. I could not do that to/for her, not in a proactive way. I could advocate for no life prolonging treatments, I could advocate for hospice, but I could not actually help her kill herself other than discussing how some older people (an aunt of ours did) stop eating and drinking and die that way. But I was not going to feed her pills etc and she was not of sound mind to go through any state authorized assisted suicide. It leaves me of mixed mind on the subject and makes me want to tell me kids to be watchful and discuss as soon as we think I am losing it mentally (if I ever do.)
The whole assisted suicide thing is something to which I have to give more thought. I am all in favor of people having that option, but did not feel comfortable making it happen when she could not and we had never discussed it quite to that point.
RE: assisted suicide.
My FIL had terminal cancer (metastatic mesotheliomoma) with a prognosis of less than 6 months to live. He was in his right mind and repeatedly expressed a desire to die. (I think he was tired of life, after losing both his wife and only child. He was also afraid of the pain that his cancer would bring.) He wanted a gun–which I refused to provide, (I don’t own one and was not going to buy a gun just so he could kill himself) but I did research suicide options and provided them to him. I also offered to move with him to Oregon and care for him for as long as necessary–either until he met the legal requirements for assisted suicide there or died–whichever came first. I had absolutely no compunctions about it.
My D’s SO was telling me at Christmas how his mother has set aside a sum of money for her entire immediate family to go to Switzerland where she will be able to end her own life. She is at high risk for developing Alzheimer’s and she doesn’t want to live (or die) that way. She says once she feels that her QOL is not what she wants it to be and she is no longer able to live her life as she wants, she wants her family to honor her wishes to let her end her life.
My relative chose to have sublingual morphine tablets to help “ease her breathing,” which allowed her to die on her own terms. She had stage 4 cancer, which had metastasized and was causing her pain and discomfort, with death imminent.
@WayOutWestMom the love and courage in your post #57 is inspiring.