Were all going to die. Heres how to do it well

[Applause]

everybody wants to go to heaven

but nobody wants to die after 18 years

as a hospice chaplain

i can’t guarantee we’ll all go to heaven

but i can guarantee you

we’re all going to die some of us will

die better than others

personally i’d like to go like my 93

year old patient

who at the exact moment of death raised

her arms to heaven

and demanded those welcoming her pull

harder

modern medicine comfort care

is so advanced that we need not fear the

physical pain

that was once associated with dying

so what keeps us from a better death

why do so many of us think of death with

fear and anguish for some

it is the unknown the fear of the

unknown

others fear dying alone or in pain

some fear dying young or unexpectedly

but to have a better death

we really must make peace with death

preparing for death is one of the most

rational

rewarding acts of a lifetime

early in my hospice career i heard about

a large hospital

in los angeles where terminal patients

were warehoused in a large hospital

setting sterile and impersonal called

a red room patients were kept

comfortable

basic medical needs were met but the red

room

was just an antiseptic waiting room for

death

near that same time i read stephen

levine’s book

a year to live stephen spent more than

25 years working in hospice in hospital

settings

and on death row his words were

reassuring and hopeful

i began searching for the positive

aspects of death

i was struck by the similarities between

birth and death

one the beginning the other the ending

each an essential part of life

only a decade ago

a physician took charge of the

pregnancy and birth in a sterile and

personal environment

the mother was sedated the father was

isolated

and the family was excluded now

babies come into the world in

comfortable birthing suites

with the family included oftentimes

the family is attended by a midwife

with doctors and medical staff playing a

supporting role

in my position as a hospice chaplain

i assist at the end of life

just as a midwife in traditional sense

assists at the beginning of life

i help my patients imagine and design

a gentle and untroubled death similar to

the way

a midwife helps a family and a mother

design a

unique and joyous birth

that’s why i call myself a midwife

for souls

designing a better death begins with

looking at our fears about dying these

fears typically fall into

three categories fear of the

dying process fear of what

the moment of death is like and fear of

what comes after

let me share a few examples with you

at age 40

lisa had just completed her final round

of

chemotherapy her doctor called our

office to arrange for hospice care

when i visited with lisa i gently

explained to her

that she had only a few weeks to live

her response was but i don’t feel like

i’m dying

oh i know you don’t i said

but when you do go how would you like to

die

her response was immediate and decisive

she said i would like to die at night

and

just go dance in the stars

lisa’s family helped her realize her

wishes

her bed spread was printed with images

of the moon and the sun

her sheets showed the night sky

and her ceiling was decorated with

reflective stars

one week later it was night time

when lisa slipped away her family and

her friends were at peace

knowing that lisa had indeed gone to

dance in the stars

like many of us jim was afraid of

what comes after death jim was a veteran

of the vietnam war

and he felt guilty about the lives he

had taken and the

friends he had lost he chose hospice

early

in his diagnosis so we had time to

address those demons

during our months together i asked jim

what do you regret answering this

question

helped jim reframe his guilt and fear

he found new meaning in his military

service

he was at peace and lost his fear of

death

later jim’s wife told me those

conversations saved jim’s life

well no but maybe they had saved his

death

sometimes death comes unexpectedly

ken was a victim of a devastating

accident

he was rushed to the hospital and

diagnosed with

irreparable brain damage the only

choices

ken’s family had where when and

how to take him off life support

ken was lying in his hospital bed

intubated but looking robust and

seemed to just be sleeping with his

family gathered around his hospital bed

i stepped to his side and put my hand on

his arm

i spoke of his goodness his family

legacy

and his lifetime of service i encouraged

his family

to share their memories of ken

through laughter and tears they

reminisced

each expressing how ken had been a hero

in their lives

building on those stories i asked them

to consider

that their next story about ken would

not be about his life

but about his death

what would his hero’s death be like

the tender details of ken’s death were

designed with

purpose and dignity

ken’s obituary led with his family’s

view of his death it read

ken passed away quietly and peacefully

surrounded by family beautiful music

love and happiness for his new journey

using guided visualization and by

reframing expectations about death

patients and families can overcome their

fears

and reimagine death as a cause for

celebration

a reaffirmation of life a new birth

and so i ask you as i ask

my patients and my friends

what do you regret

what is left unsaid

and most importantly how

do you want to die

to look squarely at death to accept its

inevitability

to plan for ourselves and consider for

ourselves

and our loved ones a better death

gives us a better life right now

one of the most poignant descriptions of

this idea

came from matthew ricard a buddhist monk

his faith teaches that death

is a natural part of the life cycle

many people in modern western societies

are unprepared for death he states

in buddhism we think about death

all the time simply to give value

to every moment that passes by

in other words when we embrace our death

we embrace our humanity and we embrace

life

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