Thursday, March 26, 2015

Death Dynamics


             Death is the destination we all share. No one has ever escaped it. 
          And that is as it should be, because Death is very likely the single 
          best invention of Life. It is Life's change agent. 
          It clears out the old to make way for the new. 
                    Steve Jobs

Death is “the termination of all biological functions in a living organism”, according to Wikipedia. The most common cause of human deaths in the world is heart disease, followed by stroke and other cerebrovascular diseases, and lower respiratory infections. (1)


Death is commonly considered sad or unpleasant, and is accompanied by anxiety, sorrow, grief, emotional pain, depression, sympathy, compassion, and solitude. The natural tendency is to avoid the thought of death because it makes people uncomfortable and even causes fear. Many consider the subject morbid. (2)

For most people, their own life experience seems open ended. There seems to be no reason why normal experiences cannot continue indefinitely. With this view death, no matter how inevitable, is the cancellation of an indefinitely extendible good life.

The value of life is not mere organic survival. Surviving in a coma is not appealing to anyone. Many consider premature death dreadful. Objectively, it is recognized that humans cannot live much more than about 100 years. So, one can only feel deprived of those years that one does not live long enough to enjoy.  (3)

Life after death

Ideas of the after-life and immortality are human constructs. Most religions teach that the immortal soul survives the body after physical death, which is comforting for many. Some say that the soul will live forever in either heaven or hell. Others suppose that after death the soul will reanimate in other life forms in an endless cycle of reincarnation. Atheists dispute the idea of a soul and are convinced that after death there is only nothingness.

Because understanding of life after death runs the gamut of human experience and cultural values, anthropologists conclude that man invented religion to explain life’s experiences and to offer solace from life’s troubles.

Longevity

Since 1900, life expectancy in America has jumped from age 47 to 80. This derives mostly from improved hygiene and nutrition; everything from heart surgery to antibiotics and drugs that combat most diseases. (4)

The primary construct of most modern cultures is to prolong life, and rapid medical advancements are extending human lifetimes. Even without new high-tech advances, the UN estimates that human life expectancy will approach 100 years over the next century.

The cover story of the February 23, 2015 issue of Time Magazine was, "This baby could live to be 142 years old". (5)

The question arises: would anyone want to live that long? The same question could have been asked in 1880, when life expectancy was only 40, about living to 75. And the same answers would be given: "Is it a good idea?" and  "Why would anyone want to live that long?" 

After about 60 many ailments come into play: Diabetes, arthritis, heart-disease, depression, Alzheimer's & dementia, Parkinson’s, hearing loss, incontinence, osteoporosis – the list goes on.

In the US, health care costs have grown faster than the economy as a whole – now 16% of GDP, compared to 9% in 1980. Consider this: 5% of the US population accounted for 50% of overall health care spending. 65% of medical expenses are for the elderly.

Most people are not philosophically, morally and socially ready to accept prolonged life. What will life be like when life is prolonged for those who can choose? People with a life expectancy of over 100 years are unlikely to retire at 65. If people knew they could live comfortably to 125, they’d likely have several careers.

Die at 75

Ezekiel J. Emanuel, an oncologist and bioethicist, wrote an article in The Atlantic, October 2014, headlined "Why I Hope to Die at 75".  Says Emanuel, when he reaches 75, he won’t actively end his life. But he will stop seeking medical treatments to actively prolong it: no cancer screenings or treatments after 75, no pacemaker or bypass surgery, no flu shots or antibiotics. (6) 

Emanuel is a vociferous opponent of euthanasia and assisted suicide. His essay is personal, about what he wants in his own life, how he wants to be remembered by his family and friends. He is 57; one wonders whether his views will change as he nears 75.
  
One must admire the blunt, unsentimental humanity with which Emanuel presents his case. Aging and death are realities in every life. No insurance policy, gym membership, or super food can fully protect us against a frightening, sad, depressing, or burdensome trajectory in our final days. These issues need to be discussed lovingly but plainly, long before these become immediately pressing.

At 77, I am in good health; I feel energetic and productive and still have places to visit on my “bucket-list”. But, as I watch friends and family grow old, with increasing aches and pains, debilitating ailments and memory loss, I sometimes wonder how I’ll fare as I approach my own end of life.

Death Cafe

According to a Pew survey, more than a quarter of American adults have given little or no thought to how they want doctors to handle medical treatment at the end of their lives. Another survey, found that 90% of Americans said it was important to talk about their own and their loved ones end-of-life wishes, but only 30 % have actually done that.

It seems that the emergence of Death Café fills the need. These have been taking place for several years, modeled on similar gatherings in European cities. People, mostly strangers, gather to snack, drink tea and have frank, open conversations about death. The objective is “to increase awareness of death with a view to helping people make the most of their (finite) lives”. (7)

I’ve attended a Death Café meeting near my home. There were about 50 people present, ranging from college students to recent retirees, with no preponderance of any age group. It was a group-directed discussion of death with no agenda, objectives or themes.  There were a couple of speakers and organizers who got us started, and then we split into smaller groups to facilitate personal discussions.

Death Café has spread throughout the world. Take a look at the web link I’ve provided; there is likely a regular meeting not far from where you live.

Death Over Dinner

Here’s another similar concept that is gaining momentum: Death over Dinner. The website says, “How we want to die – represents the most important and costly conversation America isn’t having. We have gathered dozens of medical and wellness leaders to cast an unflinching eye at end of life, and we have created an uplifting interactive adventure that transforms this seemingly difficult conversation into one of deep engagement, insight and empowerment. We invite you to gather friends and family and fill a table.” (8)

The first Death Over Dinner event took place January 2014, with 20,000 people downloading the starter kit and more than 1,500 registering their dinner parties.
“A lot of people (were) reluctant to talk about it beforehand,” says Ellen Goodman, who started her “Conversation Project” in 2010. “By the end of the dinners they’ve had some of the richest conversations they’d ever had.”

Dinner hosts can download a “Conversational Starter Kit” from the website, which includes questions like: Do you want to live as long as possible, no matter what; or is quality of life more important than quantity? Where do you want to receive end-of-life care, at home, at a nursing facility or a hospital? And what kinds of aggressive treatment would you want, or not want, such as resuscitation if your heart stops, breathing machines or feeding tubes? Most often, families confront these questions when it’s too late, in hospital emergency rooms or intensive-care units.

eDeath

Most of us probably have hundreds, maybe thousands of e-mails stored in computers, or on in the cloud. We likely have a Facebook page, or a Twitter account, and countless photos in a Dropbox album. All that information amounts to a digital profile of sorts.

This raises many questions: What happens to your online material after you die? What happens to your email, passwords, website, text messages? What will happen to your cyber presence after you’ve exited and your e-presence still lingers? It’s helpful to create an inventory of online accounts, to ensure your heirs know what's most important and where to find things.

In the early days of computers, people died with passwords in their heads and no one could access their files. When access to these files was critical, businesses would sometimes stop while they tried to figure it out. This is why programmers invented “death switches”. (9)

With a death switch, the computer prompts you for passwords once a week to make sure you are still alive. When you don't enter your password for some period of time, the computer deduces you are dead, and your passwords are automatically e-mailed to the second-in-command.

People have started to use death switches to reveal their bank account numbers to their heirs, to get the last word in arguments, to confess secrets that were unspeakable during their lifetime.

Death switches provide a good opportunity to say goodbye electronically. People program their computers to send e-mails announcing their own death. Imagine receiving an email like this, from a friend: "I'm dead now and I’d like to tell you things I've always wanted to say..." (10)

What happens to your online presence after your death is important. With Facebook, family members can choose one of two options: close the account, or convert it into a memorial profile. Facebook's policy states the company will never release login information to anyone other than the account holder, even after death. (11)

The Internet provides a place for people to express thoughts and feelings as they grieve a loss. Your social networking profile could become a spot where your friends and family can share memories of you. People who might not otherwise hear of your passing may learn of it through your profile page.

Let’s Engage

For this blog, I’m asking you to engage! Don’t just read passively.

This is an exercise that has helped me to consider my own feelings about death. You are in good health, but are informed that you have one week to live; you will die next Sunday, at noon. Answer the following questions – for yourself, or directly via the blog.

  1. What will you do immediately? Will you quit your job? Will you tell your family?
  2. Will you stay home? Or, will you travel to see loved ones?
  3. Will you get your affairs in order? Or leave that for your family to do?
  4. What will you do on your last Saturday? Will you sleep well that night?
  5. Who will you choose to be with on Sunday morning, a few hours before noon?
  6. What will you do in the hours or minutes before noon? Walk on the beach? Lie in bed and wait?
  7. Do these reflections bother you? Or help you to understand yourself? 
Please express your views on your own “death dynamics” directly via the blog.

Reflection

Finally, here is a very simple question: How long do YOU yourself expect and want to live? (12)

References
  
  1. Wikipedia on “Death”: http://goo.gl/BiaB3o
  2. Why Do We Avoid The Subject Of Death? http://goo.gl/wWaLUp
  3. New Scientist – Death topics: http://goo.gl/FXQIHC
  4. Life expectancy in the USA hits a record high: http://goo.gl/FWq3f0
  5. Responses to Time, “Baby will live to be 142”: http://goo.gl/emTEht
  6. Why I Hope to Die at 75: http://goo.gl/vbubA8
  7. Death Café: http://goo.gl/IiTxEL
  8. Death Over Dinner: http://goo.gl/OqM105
  9. A brief history of death switches: http://goo.gl/KQPtos
  10. Wired – Communicate From Beyond the Grave: http://goo.gl/6anIuk
  11. Facebook rolls out feature for users when they die: http://goo.gl/4EwByL
  12. How Long Do You Want to Live? http://goo.gl/G1GZOQ 

Jim Pinto
Carlsbad, CA.
USA
26 March 2015

32 comments:

  1. One guy escaped it, but he had to die first... and it was a nasty death...

    I'm ready, any time, at 67, but I'd like to make it to 97.

    Unlike some of the recommendations, I will continue with my healthcare, post 75... I'm a republican !

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    1. Jim, I'm 77 - 10 years ahead of you. I'd like to make to whenever, as long as I have good health.

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  2. Good thoughts, Jim. Like many, I'll probably put off thinking and planning for death until I get some acute terminal condition. And if I die suddenly, like many, it will be up to my family to piece things together.

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    1. I suppose, the main reason to think about it is to save your family the problems that may come up.

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  3. Interesting thoughts. (Got to thinking that we don't talk often enough since I quit my job!) Also important thoughts.

    Planning ahead saves additional grief for survivors--an ultimately unselfish act. I spent many hours sorting out my dad's and my grandmother's affairs when they passed away. Although it's a good point--I should write down my usernames/passwords somewhere so that my online accounts can be accessed.

    As a Christian and contemplative (who has had "mystical" experiences), I have definite views on life after death. I've even thought about it from a quantum physics point of view--but that's going too far!!

    Also, the exercise of thinking about what you'd do if you know for sure that you only have a short period to live is a great way to define what is most important to you. It is time at that very point to decide to devote more of your time to those things rather than just wasting away in front of a TV.

    Cheers.

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    1. Gary: This triggered our talk. I'm interested in your "quantum physics" point of view. I have a friend who believes in "many parallel universes" - though I haven't quite figued that out yet.

      Yes, the "engage" exercise is to get thinking bout it, rather than simply avoid the subject. It's good to consider the inevitable end-of-life we all face.

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  4. I'd like to plan death as I plan life - discuss it openly and freely with family and friends. There are many great examples of 'how to die'. One that comes to mind was the death of journalist Tony Snow a few years ago. His was a very public death, as he was a very public person. How he chose to live out his days was interesting in that it was his choice - its easy to 'google' it. I hope the end will bring me closer to what I loved in life and expose the false expectations that the culture imposed on me. A little like George Carlin - if he was a technology manager :)

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    1. Gary, you are indeed blessed to feel that you can discuss death openly and freely. I did look up Tony Snow, as you suggested - he died at 53, or colon cancer.

      Yes, our culture brings many false expectations which make avoid the subject of the inevitable end.

      I loved the way George Carlin talked about death (and everything else). Here's a quote: “The most unfair thing about life is the way it ends. I mean, life is tough. It takes up a lot of your time. What do you get at the end of it? A Death! What’s that, a bonus?"

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  5. Perhaps for many of us, wisdom comes late. Since you quoted Steve Jobs, I will add to that. These thoughts have helped me "Think Different".

    "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.

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  6. Thank you for your beautiful questions. My answers ~ I'd bring the family together and my dear love, spend time, kiss them, touch them, love them and say goodbye...they know my wishes, and they already have anything of mine they wanted. They know I've been over...so, I'd make quick arrangements to give my things away. In a clean quiet place go into meditation...and leave. Life actually never ends. I've been...and I know. Keeping a clear, simple mind and knowing mind is everything....ahhh..how fortunate and blessed. What an adventure we each and all have here...how blessed we are to have touched each other. ra

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    1. Your answer to the questions were wise, beautiful and engaging. Thank you!

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  7. Thanks Jim, great thoughts as always. I'm often reminded that no one gets out of here alive.

    For myself I've come to understand that as we get older the passage of time seems to accelerate, the last 10 years feels like 2 or 3 at most. I'm 57 now and perhaps the most liberating idea is that I've stopped worrying about what other people think of me and started to live life with the knob twisted up as far as it will go...

    I think of it as 'before I was a born I knew nothing, when I'm gone I'll know nothing' and that's it. Many of the religions suggest that there is life after death but I've come to realise that the belief has more to do with some parts of the human race being unable to face up to the facts that we are here on our own and when our time comes to depart there will be nothing there just as it was before we were born.

    Now I'm happy with that, content even, so it's only the manner of ones departure that's going to matter.

    I have documented my personal affairs, passwords etc so that when my loved ones and executors get to tidy up the loose ends I won't have left a horrendous mess....smile.

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    1. Thanks, John!

      Yes, we'll all die, and can be happy and joyful in the uncertain length of time we have left. I'm 77 now, and in good health, and learning to be a better person everyday.

      You and I are blessed, indeed!

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  8. What will you do immediately? Contact family and friends for a get together party to celebrate the life I have lived. Will you quit your job? Yes
    Will you stay home?Probably not but would see the places I enjoy with my wife hopefully.
    Will you get your affairs in order? Estate Planning is done
    What will you do on your last Saturday? Will you sleep well that night? Yes
    Who will you choose to be with on Sunday morning, a few hours before noon?My wife
    What will you do in the hours or minutes before noon? Walk on the beach? this sounds good with my wife at the same place we were married.
    Do these reflections bother you? Not at all. Or help you to understand yourself? I am content with my life and the choices I have made; though all were not the best but I learned from them all. Sweet dreams

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    1. I appreciate your responses to all the questions.

      Yes, one learns from everything, as long as one lives.

      Sweet dreams for you too, dear frined!

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  9. A must read:


    Being Mortal: Medicine and What Matters in the End
    Book by Atul Gawande

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    1. Phil, thanks for the good book suggestion!

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  10. Responses to your questions:

    1. What will you do immediately? Will you quit your job? Will you tell your family?

    Luckily, I have no job. Of course I shall tell my family—and anyone else who will listen.


    2. Will you stay home? Or, will you travel to see loved ones?

    I’ll stay home.


    3. Will you get your affairs in order? Or leave that for your family to do?

    I’ll do whatever I can to get my affairs in order, to relieve others.


    4. What will you do on your last Saturday? Will you sleep well that night?

    A bottle of French wine will help. Sleep well? Of course.


    5. Who will you choose to be with on Sunday morning, a few hours before noon?

    It is best, I think, to be alone to go into that dark night.


    6. What will you do in the hours or minutes before noon? Walk on the beach? Lie in bed and wait?

    Not important. The life beyond this life is more important. One can say that the afterlife is a figment of religious thinkers, but too many have been there and come back to think it fiction.


    7. Do these reflections bother you? Or help you to understand yourself?

    No bother. Important to handle this while able.

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    1. Jack, we've known each other for a long time, and you'e always beeb a wise, happy and contented man!

      Thank you for your answers to all the questions! Yes, it's important to think on these things while able.

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  11. Thanks for raising this important subject, Jim.

    We can begin to live now if we lighten the load. By doing a Life's Review now and focusing on letting go of our harmful (and often unconscious) attachments.

    Forgive ourselves of real or imagined transgressions. We cannot undue our mistakes. Most were necessary to help us grow. Worrying about yesterday drains the Life Force from our bodies.

    Forgive others. Drop the grudges that steal our breath away. In the first few moments of this process, we feel lighter and full of energy.

    Ask for forgiveness of the living and the dead. A biggie. Oh, the ego resists this one more fiercely than the others. Feel compassion for those who cannot let go of their anger and carry these weighty chains around each day.

    Take on a work larger than yourself. The ego will be terribly offended since he is the only thing that exists. When really he doesn't exist at all except in our little heads. A calling to help others frees us from the grave of our pettiness and opens us to the infinite universe of possibilities.

    Take care of the paperwork: the medical and financial. The passwords and goodbye wishes. Our precious documents and pictures and stuff. Tidy up the store. This is an act of loving kindness to one and all.

    Life will be larger and lighter. Death will be easier..not easy...but easier.

    This short list could take the rest of our lives whether measured in days or in decades. It is simple yet very difficult to do. Start now. Enjoy the benefits. Life is waiting for you.

    Enjoy the journey.

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    1. Thanks, Papa Jimbo, for the bright and breezy comments! And the wonderful advice.

      I read and re-read your comments. Thank you!

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  12. On The Passing of a Friend’s Loved One

    In our community of the four score and more
    A member’s passing brings on thoughts galore
    Was the passing quite abrupt or painfully slow
    A ratio of grief and relief; we may never know

    To the surviving partner, we stammer and hesitate
    We offer condolences—attempt to commiserate
    But from recent family losses; we may extrapolate
    A likely deep-felt wish from any departing mate

    Couples bridge the topic of the ultimate event
    Plans are more in order as we become further bent
    So! A mate’s likely request as that last breath is gone
    Is hope that the lifelong partner will simply carry on

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    1. Thanks for the beautiful poem, Ken Ball!

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  13. Jim, your subject of death is applicable to the widest possible audience; every living soul. It is the one truly democratic event in the life of every living human. All eventually die without prejudice or preference as to race, nationality, color, ethnicity, or national origin or for that matter without regard to religious inclination. We all receive death without signing up for any government program. Death is the one personal event that no power can deprive us of.

    Trying to be factual for the Christian readers who assert that even Jesus had to die before he ascended to Heaven, they must be referred to Second Kings 2:11 which relate Elijah going to Heaven in a fiery chariot and the good book later says Elisha accompanied him.
    Modern theologians quibble over Elijah arriving at Heaven before Jesus got there to create the place. Nothing in religion seems to go without controversy.

    Jim, many of the questions you have posed has been answered in my earlier life. My first wife Barbara and I were advised that she had only a few months to live at age 32. How should we navigate the last few months while final life and death preparations were made with a six year old daughter looking on? The ravages of brain tumors become obvious, even to a six year old, in the final weeks.

    We kept our daily schedules outwardly in tact with as much together time with our daughter as possible. Burial sites were selected and funeral arrangements made without our daughter. Those events that made Barbara sad, I took care of alone. Her only other living relatives were her father and a brother which she decided could visit her during the last few weeks since they lived near the hospital. We all slept well the last night as our daughter had gone to visit her favorite grandmother. The June morning broke bright and clear as all was well with the world. Barbara had died in her sleep without pain. I went over to grandmother’s house to tell my daughter that her mother had died. Lots of tears flowed in that conversation.

    Your questions are more pertinent for folks that are not in close personal relationships at the time of their demise. Most old folks, like me at 83, are free to select death options to suit ourselves. I like what I am doing in retirement and would keep on doing it up to the last day. I would sleep well the night before, rise early for a good breakfast with friends and party until the grim reaper arrived.

    Being a non-believer, I expect about the same afterlife as Mark Twain (Samuel Langhorn Clemens) which I will paraphrase here. Upon my death I expect to return to the place from which I resided before life and to the best of my recollections it was not an undesirable place.

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    1. Yes, Rodger, death will inevitably arrive for every one of us. Some people avoid thinking about it, but they will eventually face it.

      At 83, you are indeed blessed to be as happy and healthy and well occupied as you are. Enjoy the present, dear friend!

      Enjoyed your Mark Twain quote!

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  14. To me death is not morbid and I have no problem discussing it. However it is very sad for those of us who are left alone without our better-half. I know this well having lost two husbands. The only reason I don't want to marry again is that I cannot bear to lose another one.

    As for my own life, i want to keep what is left of it as happy as possible. This entails doing all that I can to keep healthy. Fortunately for me, I come from a long-lived family. Grandpa died at 96 and my Dad was only 90, but he was a smoker.

    When it is time to go I think of my great Grandmother. She was living alone in a large house, went out to enjoy her flower garden at age 98, and simply fell over and died. The mailman found her while making his deliveries.

    But then there is always the possibility that I could come down with something horrible like Lou Gherig's disease. So I recently talked to my doctor about his willingness to help me with assisted suicide should that happen. He obliged, as this is legal in both Washington and Oregon. Only two doctors have to claim that the illness is terminal.

    About your question of "How long do you want to live." I might say 105 right now, but then again I might wish to change my mind when that time came around. It would probably depend on what shape I was in at 105.

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    1. Thanks for sharing!

      Yes, it very much depends on how our health is as we grow older. I've seen a lot of old people, with various debilitating illnesses - far beyond living a happy life, but our medical system keeps them alive. On the other hand, I've seen a beautiful, vibrant old lady who surprised me by saying (proudly) that she was 100 years old.

      Living to 105 may be a good thought, but you're right - depends what shape you're in.

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  15. I received this email but do not know who wrote it; I wish I knew so that I could thank them. It is so appropriate for this subject.
    Enjoy!

    The Train

    At birth we boarded the train and met our parents, and we believe they will always travel on our side. However, at some station our parents will step down from the train, leaving us on this journey alone.
    As time goes by, other people will board the train; and they will be significant i.e. our siblings, friends, children, and even the love of your life. Many will step down and leave a permanent vacuum. Others will go so unnoticed that we don't realize they vacated their seats.
    This train ride will be full of joy, sorrow, fantasy, expectations, hellos, goodbyes, and farewells. Success consists of having a good relationship with all passengers requiring that we give the best of ourselves.
    The mystery to everyone is: We do not know at which station we ourselves will step down. So, we must live in the best way, love, forgive, and offer the best of who we are. It is important to do this because when the time comes for us to step down and leave our seat empty we should leave behind beautiful memories for those who will continue to travel on the train of life.
    I wish you a joyful journey on the train of life. Reap success and give lots of love. More importantly, thank God for the journey.
    Lastly, I thank you for being one of the passengers on my train.

    ~Christina

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    1. Thank you, Christina, for sharing this, and for being one of the passengers on my train of life!

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  16. LA Times Sunday Magazine Section "The California Sunday Magazine" had a fascinating article - Death Re-designed:
    https://stories.californiasunday.com/2015-04-05/death-redesigned

    A well-known design firm, a corporate executive, and a hospice director work on the idea for a software app that will allow a person to make good preparations for death and provide structured information for family and loved ones to make arrangements. Excellent narrative on how the idea developed.

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  17. This was related to me by my sister:

    A good friend, fairly old lady, was dying, and her friends and family were gathered, singing. As she was laying there, very peacefully, my hand was under her back, because she seemed to want to get up. She turned, looked directly at me and said, "I have died." She did not say, "I am dying". As I continued to comfort her, she smiled as she looked up and said with a smile, "The door is closed and the gate is open. I have died". And then, about 5 minutes later, she died, very peacefully.

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