In the end: A practical guide to dying

PART A

The final journey

The world’s an inn, and death the journey’s end.

John Dryden

We might imagine dying as travelling towards the end of life. As we begin to prepare by thinking and talking about it, we can gather ideas from other people around the world and throughout time.

We will see that humans have always wondered about the mystery of death, found ways to explain it and remembered those who came before.

In Part A, we look at how dying fits into living, and investigate various ideas about death.

In this part:

• Dying as part of life (Chapter 1)

• Ideas about death (Chapter 2)

CHAPTER 1

Dying as part of life

We no longer know how to die.

Richard Flanagan

In this chapter:

• Thinking about dying and death

• Talking about dying and death

Dying is an act of living. It is a process that happens in the final stages of life. We don’t experience death, but we are likely to experience dying.

If we are lucky, most of our other ‘acts of living’ are pleasurable. We can hope for the same with dying.

Reading this book and making some decisions are the first steps towards dying well.

THINKING ABOUT DYING AND DEATH

Why should you think about dying and death?

We are all born, and we all die. Dying is a normal part of life, but we hope it won’t be soon. Finding out that you don’t have long to live can be terrifying. Most people aren’t prepared for that.

The idea of death can be so frightening that a lot of people don’t want to think about it. It’s understandable that some of us choose to simply let dying and death come to us, without reflecting on our lives or what we could do to die well.

You might feel afraid, anxious, despairing, angry, helpless or even relieved. Or you might deny it. Some people want to know absolutely everything right away. Other people need time to absorb the news.

Dying does not have to be a scary, traumatic event. You can turn it into something that you have anticipated and thought about. You can decide to let others know what your treatment preferences are, in case a time comes when you can’t tell them.

Often, when someone is preparing for death, they look at their life and see it from a new perspective. This can bring anger, remorse and fear, along with happiness and joy.

Thinking about your life may spur you to put right things that are causing you regret, or to complete any unfinished business. You might find it easier to think about what you will leave behind, plan how best to spend your last days, and then put those plans into action.

We don’t have a choice about how we are born, but we can choose how we prepare for dying and death. If you can see dying as the final part of your life’s journey, you can give it the place it deserves in your discussions and planning.

TALKING ABOUT DYING AND DEATH

Honest discussions about dying and death are not a waste of time.

Most deaths come at the end of a lengthy decline, with lots of warning. Others come with little or no warning. This is why it is a good idea to think now about how you would like to be remembered, what you’d like to happen to your body, and what you will leave behind.

We’re born with lots of instincts and reflexes, but most of us don’t know how to live and die well.

Melbourne oncologist Dr Ranjana Srivastava OAM writes in her book A better death, ‘Our mortality is guaranteed but, sadly, conversations about dying aren’t.’ Why is this? Dr Srivastava lists several reasons:

• Patients don’t want to discuss dying.

• Many people today believe that every problem has an instant solution and every illness has a quick fix.

• For doctors, bringing patients back to the truth – that we are all mortal – is a major discussion. It takes time and therefore money, and may turn patients against them. No one minds a doctor ordering an extra test, but many complain about those who say there is nothing more they can do.

If you can talk about dying and death, you will feel more prepared. If you can move past the shock and fear and accept that your life will end, you will be able to make the most of each remaining day. After all, everyone has a limited number of days and months and years. How best can you spend this time?

Why we should talk about dying

Lots of people don’t want to think or talk about dying until it is too late.

One hospital study found that 77 per cent of patients (with an average age of 79) had their first recorded end-of-life discussion just three days before their death. In emergency department admissions, 82 per cent of these patients (average age of 82) still had no written end-of-life discussion or review when they were discharged.

Over the last few decades, advances in technology have transformed medical care. Treatments that used to be risky are now standard practice. This gives us more time to spend with our family and friends, but it might not be quality time. You might end up being kept alive with intrusive technology because your family aren’t sure what you would have chosen for yourself or how you would have preferred to die.

Talking about dying may be very hard for you and your family. It is even difficult for many health professionals. But now, more than ever, these conversations are vital.

CHAPTER 2

Ideas about death

Life is short and one’s place in the world is small.

Atul Gawande

In this chapter:

• Death in other times

• Different cultural approaches to death

• Dying and death in popular culture

Human beings have always realised that death is inevitable, and different societies have found different ways to respond to this knowledge.

Ideas about dying and death have also changed through the ages, shaped by religion, culture and ethics. They are still changing today, with an added influence – advances in medical sciences.

DEATH IN OTHER TIMES

Since the beginning of time, we have buried our dead, mourned their passing and marked their journey into whatever comes next with rituals and celebrations.

Neanderthals are our closest ancient human relatives. They lived from about 400,000 to 40,000 years ago. Recent research has uncovered the many ways Neanderthals dealt with death, from depositing bodies in their final resting places to taking them apart. They grieved by spending time with the body – grooming or handling it in other ways, or eating some parts. They modified bones to use as tools, vessels or art, and marked them in ways that show they ritually removed the flesh and organs before burial.

Many ancient human cultures told stories of divine figures who died tragically and were then miraculously restored to life. People connected these gods and goddesses with fertility and the harvest. Their annual return from death symbolised the rebirth that comes in spring.

In Ancient Egypt, bodies were preserved so they could journey through the underworld before continuing their earthly life. For the Ancient Romans, funerals were lavish affairs that people saved for.

In nineteenth-century Britain, mourning became a cult. Elaborate rules dictated what people could wear after a monarch or relative died. The rules were less strict in Australia. Back then, taboos were the reverse of our modern ones – children were kept away from any mention of birth or sex, but they witnessed death, sat at deathbeds and helped prepare the body for burial.

DIFFERENT CULTURAL APPROACHES TO DEATH

Cultural and religious practices shape many distinct rituals around dying and death.

Australia’s Aboriginal peoples have varying death ceremonies or ‘sorry business’, according to their language group. In general, funerals are a community affair that can take days or weeks or even months. People gather together and share the sorrow, allowing their grief to heal slowly. The person’s spirit can return and cause mischief if the person is not put to rest properly, so people try not to disturb it. They don’t speak or write the name of the departed, or keep or display photographs.

Mexico’s Día de los Muertos (Day of the Dead) is a colourful, noisy two-day holiday. It’s believed that the passageway is open between the spirit and living worlds at this time, so the living and dead can be reunited. Families decorate graves, cook favourite foods and create altars for offerings to honour their departed family members.

In New Orleans, jazz funerals with brass bands fill the streets with music that celebrates the person’s life as much as mourning their death. After the funeral service, a cavalcade parades from the site of the funeral to the cemetery. Musicians, funeral directors, family and friends of the dead lead the crowd, everyone marching to the beat of the brass band.

Indonesian funerals guarantee the proper passage of the spirit to the afterworld. It’s widely believed that the deceased may influence the living in various ways, and many Indonesians are spooked by the idea of ghosts who dwell in cemeteries.

In China, where most people have no religious affiliation, mourners dress in white and wrap their heads in white cloths. Qingming or Tomb-sweeping Day, observed by Han Chinese, is a public holiday when people visit the graves of ancestors to make offerings and pray to the dead. In Ghost Month, the spirits of the dead come out from the lower realm. People who die during this time aren’t buried until the next month.

See ‘Religion’ in Chapter 5 for more information about religious practices.

DYING AND DEATH IN POPULAR CULTURE

An increasing number of Australians do not identify with any religion. Outside a religious context, although birth, love and bereavement are widely discussed, death is not. The way that death is presented in popular culture tends to sensationalise and trivialise it. This means that many people have inaccurate and unrealistic ideas about death.

Films and comics contain many stories of characters who never really die. For superheroes, zombies and the undead, death is an obstacle that can be overcome.

In fact, a fight with death is at the heart of every classic hero story. The most thrilling stories are the ones in which the hero cheats death, either by a miracle or with the help of supernatural powers. In Greek mythology, Perseus cheated death when he vanquished Medusa, the snake-haired gorgon who turned anyone who looked at her to stone. Wonder Woman, Batman, James Bond and Luke Skywalker miraculously escape certain death, over and over again.

Many people identify with heroes and beloved characters, so the death of a character may leave a void that shakes their sense of identity. Scriptwriters find this out quickly when they mess with it. The talking dog Brian in Family Guy was killed in a car crash, but there was such a backlash from fans that he was brought back a month later. JK Rowling, the author of the Harry Potter books, apologised for killing off Severus