WHEN IS IT TIME TO GO  Word Press asked that recently in one of their daily post prompts.  Mostly they meant, time to leave a party, or perhaps to stop trying.  The article below deals with a more difficult application of that question: when to stop trying to prolong life and to embrace death or at least stop futile efforts to delay the inevitable.   Like last week’s From the Down Hill Slope Post, this is a question we prefer to ignore, think about later, or wrap in faith or reincarnation and visions of a better world to come if we behave properly here and now.

Answering this aspect of the “When is it time to go” question is particularly difficult for those in the medical profession. Thinking of futile care is a mark of efforts to come to  grips with the difference between prolonging life and prolonging death.

Medicine is slowly facing the issue of futile care.

Once I though answering  this particular  question was not all that difficult.  That is a hallmark of youth.  My first lesson came in the form of a five-year old.  I met her while working at my first job after getting my master’s degree.  I was a medical social worker and one of my assignments was the Neurosurgical Unit at the Mary Fletcher Hospital, one of the University of Vermont’s Medical School’s teaching hospitals.  Nancy had been hit by a car while sledding and had suffered a massive head injury.  When I first saw her, she  lay in a bed breathing on her own, but otherwise in a coma or semi-coma.    For weeks, she remained curled in a fetal position mewing occasionally. mewing  more loudly in pain when the physical therapist stretched her muscles.  I started to pray for her death and wondered why the surgeons seemed so determined to keep her alive.  A year later I watched her walk out of the hospital, limping a little, but laughing and happy.  Big lesson.

Nevertheless, I also saw many patients whose suffering was futile and often un-necessarily prolonged.

Then of course,  attitudes about death change as you age.  To most children under the age of five, it is reversible; once we grasp reality better, we deny it could happen to us or embrace slogans like “Live fast, die young, and leave a good-looking corpse.  In time reality hits in the form of middle age and realizing “My life is probably half over.”  The early death of acquaintances and friends underscores the reality of what in time comes to us all.

Then, of course, illnesses and accidents shake our complacency.  For me a small stroke–undiagnosed but now seen by my doctors and I for what it was, atrial flutter caused not by the quaking heart of early love, and finally, the diagnosis of a blood disorder that used to kill, but now with the proper chemo-therapy has let me live half of the twenty years, my oncologist promised me.  That was ten years ago. and when first diagnosed I spent a number of months depressed by the knowledge that the cold hand of the Grim Reaper  was trying to gather me in.  Now twenty years has become only ten and as I take quite a few different medications to stay alive (More than five prescribed medications is considered one sign you are at higher risk of death than those who take fewer), s/he might grab me sooner.

The Existential Philosophers believe life is best lived knowing it ends all to soon.  The Buddhists preach “Be here now.”  My atheists friends say “This is all we have, better make the most of it.”  As for me, I don’t know and as with many people pretty far down the slope of life, death is now a scary and closer unknown.  I envy my friends with an easy faith that  they will leave this life for a better place.  I have hopes, but not certainty.  My hopes were born in a few experiences that have left me believing partially something goes on after our body gives up.

A friend describes her sister coming to her in a dream, saying good-bye.  She woke her husband and said, “My sister is dead.”  A half and hour later a phone call confirmed her sister had been killed in an automobile accident.

The night of my father’s death, I dreamt I visited his room to find his bed empty, but a radiant being standing in the room’s far corner.  “Your father asked me to wait and to tell you not to worry, he is okay.”

The third experience followed my mother’s death.  As I have talked about often, she and I had a sand paper relationship. I never felt I pleased her, no matter what I did or how hard I tried.   Following her death, what I can only describe as a loving spirit, hers I believe, hovered around me for three days letting me know that she had her own problems but loved me dearly.

So I have hope, but not certainty.  I do  agree with the Existentialists that life is sweeter when you know that it will end.  And I also know we need to find better answers to the question of when trying to prolong life has become prolonging death.  I know I don’t want to live in constant pain.  I don’t want to live when I cannot communicate my wishes.  I fear most being locked in a body with an active brain.  Elle editor Jean-Dominique Bauby ‘s courage and story as told in The Diving Bell and The Butterfly was inspiring, but not how I want to live.  He had had a stroke and could only communicate by blinking his left eye.  There are things in my mind worse than death.

STAYING STONG TIP  Live as if you were going to die tonight; plan as if you are going to live forever. As I said last week, have a will, a living will, and a pre-paid funeral plan.

Share, Care, and Stay Strong.

IMAGE: Website for  image: SciFi and Fantasy Art The Grim Reaper by Rina J. Claes,

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