D is for Death. Death is inevitable.
There are few experiences in our lives which we absolutely know we will experience. Death is one of these. The problem is, we don't know when and no matter what our age or physical frailty, we always think we have more time to think about this.
I've often pondered my husband's last weeks of life. He had a diagnosis of cardiac myopothy and had been steadily deteriorating for months. He went to hospital because the visiting nurse said he was on the brink of cardiac failure. He spent a week flat on his back with a monitor on his heart and was at the top of the transplant list. He had surgery three times in that final week and was in cardiac intensive care. In spite of all this, it wasn't until two days before he died that I even considered the possibility he might not survive. Even when the call came and we rushed to the hospital, I was experiencing an enormous sense of unreality. I couldn't believe he was going to die.
True, he was only 55, but I have seen this reaction in much older people. Death makes us uncomfortable. We don't want to think about it.
I'm the same. I will fight with all that is in me to live to the fullest every day of my life. But when the time comes to die, I hope I will let go of life graciously.
A good death requires some planning, having uncomfortable conversations and making decisions before the event is upon you. Here are some considerations:
1) Death is inevitable, but pain is not. When someone is considered "end of life" (which is different from palliative) there should be no pain. None. By "end of life," I am talking about a short period of time when medical staff (and others) realise any further treatment is useless and death will come in the next few hours or at most, days. All medications other than treatment for pain are stopped. Nothing is given by mouth unless requested. Everything in the body is slowing down and ending its function. During this time, medical staff watch for any sign of discomfort. A groan, a grimace, or restlessness might mean the person is uncomfortable and pain medication should be given.
2) What about being sent to hospital? At what point do you want to stay where you live and not go to hospital for further treatment? What about CPR? At what point do you not want to be revived?
3) Where would you like to be when you die? Who do you want there? Would you like music, someone reading the Bible, family near? These are things you need to talk about.
4) What about afterwards? Do you want to be buried or cremated? A funeral or memorial or nothing? It is your final love-gift to your family to discuss what is important to you. If you are a care partner, you need to have this difficult discussion with your loved one.
One thing about death is always true. When it comes, it changes forever those left behind. As a care partner, you can ease some of the effects of this by thinking about these and other questions today.