Prepping for Death
Wisdom traditions, and more recently, the modern world of palliative care frequently draw upon the similarities between being born and dying. Just as we prepare for the birth of a new life into this world, I believe we can and should prepare for our exit from this world. However, our current society and the medical system do not encourage this or make it easy to do.
Sometimes, when people begin to realize and accept that they are nearing the end of their lives, they find they are alone in the effort to make their remaining days productive, meaningful, and comforting. With that in mind, I have created a list of five things to consider before dying. This is only a starting point, and it can, and should, be amended as each of us sees fit.
Item 1: Consider “Caeser’s things”
This is the list of things that most people consider when they are told “go home and get your affairs in order.” Although I struggle somewhat with the phrase, the intention is accurate. These are the practical items that need attention before we die: wills, insurance policies, financial and legal issues, etc. Most people are driven to address these tasks by the wish to protect their loved ones and to make the practical aspects of their demise less burdensome for those they leave behind.
Item 2: Consider Regrets
Unresolved regrets will cause disappointment and remorse. The sooner we can realize and accept our mortality, the more time we will have to address those issues which may cause us to have regrets. In the book “Regrets of the Dying,” author Bonnie Ware presents the following list of regrets that dying people shared. We can learn from their statements, and they can help us to focus us on actions we may wish to take now in order to avoid regrets when it’s too late to change things:
“I wish I had the courage to live a life true to myself, not the life others expected of me.”
“I wish I hadn’t worked so hard.”
“I wish I had the courage to express my feelings.”
“I wish I had stayed in touch with my friends.”
“I wish I had let myself be happier.”
In my experience, however, I have often heard regrets that simply deal with forgiveness. No matter the details or timing, no matter if it’s about forgiving or being forgiven, no matter if it is about us, others, or God, this regret can be healed in a moment at any point in our journey.
Item 3: Consider Legacy
Most of us will want to look back at our lives and feel we have made a difference to others or to the world in general. Sadly, some people’s lives are focused only on building and solidifying a legacy driven by ego and power; one that is self-centered and may be a way to deal with their fear of “being dead.” But the type of legacy that I am talking about is one that is founded on love and truly is about giving, sharing, and being part of a much larger community. A legacy like that can be created, developed, and enhanced even in the hours, days and weeks before death. Building such a legacy can take many forms and often requires the help of others. Some people create videos, or poems, or artwork that, after their death, will enhance and guide their loved ones. Some of the people I have worked with build a legacy by helping others to understand the dying process; I am privileged to work with medical students as they meet, engage with, and learn from patients receiving hospice care. The medical students show up to learn from the dying, and the dying willfully “teach,” leaving an important legacy that will impact the next generation of physicians. These types of legacy making require time and acceptance that life is nearing its end.
Item 4: Consider the Bucket List
The Bucket List is one way that society does (from a slant) acknowledge that life is limited and that we should remind ourselves of things we want to do, places we want to visit, people we want to meet or be with before it’s all over. However, many people I have cared for never made the time to address –or even create – their bucket lists. A bucket list can be the epitome of “kicking the can down the road.” So many of us never quite find the time to do what we say is important to us, often because we are so caught up in the tasks of daily life. Instead, we think we’ll magically have time to get to it at a clearly defined moment where we can forestall dying, smoothly transition to our bucket list, and then peacefully resume dying. My experience is that this scenario only rarely happens. My advice (which I have learned from scores of people facing the abyss) – is DON’T WAIT. Whatever might be on your list that is truly important to you, do now. Tomorrow is not guaranteed.
Item 5: Consider What Our Dying Can Teach Others
This might fit as part of Legacy, but because it is one of three pillars I believe are very important in the consideration of death – that the dying are our teachers, that WE are the medicine, and that dying is primarily a spiritual event --I think it’s worth making the opportunity to teach as we near death something to consider in addition to legacy. The lessons we offer can be verbal or written advice about what we have learned in our dying that is important to pass along to others. We could also offer them through being an example to others. The terms “grace” and “dignity” are often used as we witness the dying process, so the manner a dying person chooses to embody can be one of the most valuable lessons for those who pay attention. The kind of lives we have lived and the decisions we have made in our healthcare journey can also be instructive to those around us who witness our death.
Spiritual Healing
When I can, I ask a dying person “are you at peace?” I have never heard anyone respond, “I don’t know what you mean.” This question that has been studied by palliative care researchers and has been shown to be highly effective in allowing people to honestly share deeply existential distress. The answers can reflect a true sense of calm and readiness for death, deep faith, trust in a strong belief system, or sometimes anger. In asking this question, we are not offering answers or reassurance. Instead, we are simply and safely offering a space for understanding and, perhaps, healing to occur. Indeed, this question opens the door to one of the greatest gifts we can offer to someone on their deathbed: showing up as our perfectly imperfect selves (WE are the medicine). If a dying person has not prepped for death and is only beginning to understand that they are approaching the end of life, it may be healthcare providers or loved ones who can recognize the opportunity to create space for healing spiritual pain.
In my next post, I will share some thoughts about spiritual pain, how it manifests, and how we can approach it.