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“I'm the one that's got to die when it's time for me to die, so let me live my life the way I want to.”
—Jimi Hendrix, Jimi Hendrix - Axis: Bold as Love
“I wish it need not have happened in my time," said Frodo.
"So do I," said Gandalf, "and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”
—J.R.R. Tolkien, The Fellowship of the Ring
It is the nature of things for death to be relatively invisible. So much dies around us that we do not see—ants and worms that die underground, the cellular structures that die, the creatures that die in the forests or in the ocean. We are sometimes disturbed to see a large dead animal beside the highway because we are not used to seeing these deaths.
A century ago, by age fifty a person often had experienced numerous losses: his parents, aunts and uncles, brothers and sisters, and possibly a spouse and some children. Life then was a succession of funerals. People were born in the home, married in the home, and died at home. Loss by death is less visual now and often takes place in a hospital or nursing home. This makes the process of dying seem more exceptional than it is. Think of the enormity of scale—there are now more than 7.8 billion people on earth and in 120 years all 7.8 billion will be dead. Death is finality in their present form for all living things. Why do we hide it from our children and ourselves?
The emotions of a dying person are complex and contradictory. The Greek dramatist Euripides observed this five centuries before Christ. “God, these old men!” he wrote, “How they pray for death! How heavy they find this life in the slow drag of days! And yet, when Death comes near them, You will not find one who will rise and walk with him, not one whose years are still a burden to him.” Is it the same today?
In the United States today, the central anxiety is not as likely to be fear of either Hell or natural death or dread of some philosophical nonbeing as it is to be a visceral terror of a living catastrophe with bodily mutilation, including loss of mind, or emotional abandonment. Those who survive have choices about how they treat this dying person.
Some years ago, psychiatrist Dr. Elisabeth Kubler-Ross published On Death and Dying and other books on various issues related to death. She identified a sequence of five emotions as stages of dying: denial, anger, bargaining, depression, and finally acceptance. Since then we have found that these emotions usually do not occur in this tidy order and some may keep recurring or not occur at all. The important thing is to recognize and to respond to the dying person experiencing these emotions. Commonly, the closer people get to death the less their fear of death and the greater is their acceptance.
Hospice care is the process and philosophy of allowing a dying person to spend their last days in a dignified peaceful way. Mme. Jeanne Garnier used the term hospice for the care of terminally ill people in Lyon, France in 1842. When the end of life is inevitable, hospice care in a facility or in a person’s home may provide relief of suffering, pain, and distress.
More likely than not, people will die in a manner characteristic of the way they lived, particularly as they lived in the most stressful times of their lives. Their previous coping mechanisms are a clue to the way they will react to terminal illness and approaching death. If they have coped effectively with earlier stresses, they are less likely to be depressed or anxious now.
One of the most pernicious misconceptions is that dying people do not want to know they are dying. But repeatedly, most patients say that they do want to know. When people learn they are terminal, they may intensely wish not for a whole new chance in life but for just a little more time to be with loved ones. As their activity is drastically reduced, they may grow into a calm and peaceful rest with heightened enjoyment of nature or of the simplest acts of kindness.
In the past, when people died at home, it was considered a solemn duty to inform them they were dying so they could prepare for death in numerous practical and spiritual ways as well as to say farewell. Today, there are still many such benefits of a preparation for death. A richly rewarding preparation for death sometimes is called anticipatory grieving or life review. The wisdom in this process is not new. Repeatedly in folklore, there occurs a belief that before one dies, one must remember and relive one’s whole personal history.
To enable a terminal patient to share this is truly a gift of love. If you are the terminal person you have the pleasure of recalling many life experiences. You also reinforce and leave behind memories of shared experiences by talking with family and friends. In this process, a final image of you as a person to be remembered is reconstructed.
If you are not housebound, you might make final visits to places that were significant in your life. You can take care of unfinished business, straighten out old family quarrels and structure your remaining future. You also can develop a picture of how the people close to you will go on without you. Not everyone can do all this because of pain or suffering from advanced dementia. But the potential comfort and psychic benefits to both the dying and the surviving are very great when the dying process is humane.
