Good Deaths and Bad Deaths: A Guide to a Graceful Ending

By Susan Watkins

This is not the first book about the struggle to die. But it is the first book about the whole journey, from start to finish. This is a guide to help families plan a graceful death. And make no mistake, it takes planning to avoid last days full of paperwork and machinery.
There are books about grieving, books about caretaking, books about hospice, and books about coping with conditions that have no cure. These books often start too late to provide true comfort. Demographer Susan Watkins wanted to cover every step of the process. Good Deaths and Bad Deaths shows how the elderly can go from alive and healthy, to dying gracefully at home with their family.

• Language: English
• Publisher: BookBaby
• Release date: Aug 3, 2020
• ISBN: 9781098308841

Book preview

© Susan Watkins 2020

ISBN: 978-1-09830-883-4

eBook ISBN: 978-109830-884-1

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

PREFACE

There are many books and articles about the end of life: books about grieving, books and articles about caretaking a loved one, books about hospice, books about coping with conditions that have no cure. Since I’m not a doctor, I read books and articles written by doctors. But I found only a few books and articles about how we, the elderly, could manage to go from here, alive and healthy, to dying a graceful death at home with our family.

I learned that this is not easy: there are many bumps in the road along the way. It takes a lot of planning so that we do not end up in a noisy hospital, hooked up with machinery to provide breath and nutrition in our final—often uncomfortable-days, pleading with a doctor to do something more; others will plead just let me go.

I hope that this book will be a guide to planning for a graceful ending.

When I retired from teaching at age 65, I didn’t know what to do with my time. I loved my life as an academic, teaching undergraduates and graduate students, and conducting research in Kenya and Malawi. By the time that research was finished, I was nearly 80. I didn’t expect to live that long: I had never bothered to comply with the rules of healthy eating, nor did I have a regimen of exercise. But as of now (82), I am still alive and healthy.

I knew, of course, that I would not live forever. How, I thought, could I have at least some control of the end of my life? How could I die gracefully, at home with my family? What are the bumps on the road to the end that will hinder a graceful ending?

I tried talking about planning for a graceful death with some of my friends who are about the same age as I am. This was not successful: they would say Aah, you’re too young to die. Which is ridiculous. What they meant is I don’t want to talk about dying.

The answer should be Yes, we have to plan for your ending ¹

Contents

CHAPTER 1:

The Pluses And Minuses Of Modern Medicine

CHAPTER 2:

What Can We Expect As We Travel Toward The End Of Life? Patients, Doctors And Families?

CHAPTER 3:

Paperwork

CHAPTER 4:

The Importance Of Family Support—Or Not-- When A Loved One Is Approaching The End Of Life

CHAPTER 5:

Good Deaths And Bad Deaths

CHAPTER 6:

The Individual And Collective Burdens Of Dementia

CHAPTER 6:

The Struggle To Die

The statistics on end-of-life are terrible.

An estimated 40 to 70 percent of dying patients unnecessarily suffer pain, 25 to 35 percent impose significant financial and personal burdens on their families, and 10 to 30 percent express preferences about the dying process that are disregarded by their healthcare providers. ² Even when the patient wants to die, some doctors insist on doing more and more—even if the patient herself wants to end her suffering.

I counted 17 bumps on the road to a graceful ending. So how could we plan to avoid these, such that we could die gracefully, at home with our family?

This book is meant to answer that question.

Not surprisingly, old people do not want to be old, nor do they want to be seen as old. In the 1950’s, Heinz—well known for its ketchup-- tried marketing "Senior Foods. This failed spectacularly, poisoning an entire category.

"The same is true for the emergency -response devices that were designed as a neck pendant that summons emergency services when pressed. It is simple and effective. The problem is that no one wants one…The entire penetration in the U.S. of the sixty-five plus market is less than four percent. And a German study showed that, when subscribers fell and remained on the floor for longer than five minutes, they failed to use their devices to summon help eighty-three percent of the time.

In other words, many older people would sooner thrash on the floor in distress than press a button—one that may summon assistance but whose real impact is to admit, I am old.³

A vivid illustration of the consequences of NOT planning for the end of life happened in my son-in-law’s family. I saw the end stage of his father’s life when my son-in-law and his brothers were visiting their father in a nursing home with round-the-clock care.

The father—I will call him Mark—was a highly regarded doctor in his field. When he retired, he continued with hobbies that kept him busy. When he and his wife could no longer manage living alone, they moved to a high-end residence. After a few years, his wife died of Alzheimer’s. Mark continued with his hobbies for several years.

When we visited Mark, he was in his 90’s, bed-ridden, a helper was feeding him, and he seemed to barely recognize his three adult children. If this proud man could have looked down from the clouds above, he would have been appalled at being spoon-fed and wearing diapers, and he would have been dismayed to have his three sons see him in that state, their last vision of him.

Years before, he had signed a document, a DNR (Do Not Resuscitate) in which a person states that healthcare providers should not perform cardiopulmonary resuscitation (restarting the heart) if his or her heart or breathing stops.

This, however, was not his problem: he had seriously infected foot. His three sons were at his bedside, but he had not told them before hand, in person and in documents, what he wanted them to do. They asked him Do you want to have surgery on your foot? He nodded yes. Or do you want to just have the wound cleaned and bandaged? Again, he nodded yes, leaving his sons uncertain about his wishes.

The experience of my son-in-law and his brothers led me to tell my family and physician how I would like to die—and how I would not- rather than leaving it to them to guess.

I learned that my son-in-law’s situation is not uncommon—there are many bumps on the road to the end of life—I counted 17 in this book. While many die of old age without hospitalization—their body just slowly shuts down—too often the end of life is marked by a sudden physical failure. Your frail 90-year-old mother is rushed to an ambulance that takes her to a hospital’s Intensive Care Unit, leaving your father and your children uncertain about whether she would have wanted heroic, often miserable, measures to keep her alive for a few more weeks or months—or whether she just would have wanted palliative care while nature takes its course—or both.

From day to day, I learned from reading and, by talking with friends and relatives, that those of us in my generation rarely want to talk–-or even think about-- our own dying: death is something that happens to others. Nor may our adult children want to talk about how we want to die—it can be a very difficult conversation. Parents may talk to their children about drugs or sex, but are uneasy about discussing inheritance. But, of course, all of us will die sooner-- or later, if we are lucky.

Some of us will go gracefully, like a woman who, after four rounds of chemotherapy, told her family that she was ready to go and died at home with her family around her. But others, like the elderly father of a friend, will fight until the very last minute, lying comatose in a bed