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Life After Avoidance

"In the sweet land of liberty we engage in magical thinking about our own deaths seemingly constantly, and yet are in complete denial that death is real."


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The key to American citizenship could be simpler. Forget the three branches of government. Never mind the history of democracy. In health care we can identify red, white and blue Americans with one question: Are you more likely to consider your responses to the zombie apocalypse, an alien invasion or a terrorist attack than you are to plan your own end of life care? Yes? Here’s a flag and pay your taxes.

It’s not that other countries face mortality any better than we do. Some do, many don’t. We’re all human. It’s just that here in the sweet land of liberty we engage in magical thinking about our own deaths seemingly constantly, and yet are in complete denial that death is real. My Liberian and Kenyan patients don’t talk about death better than my patients from Wisconsin or New Hampshire, but they also don’t have a video-game collection that would make Dante weep. The Swiss and Portuguese have their own avoidance issues but do they have “Would You Rather?” — a mortality obsessed party game that has nothing to do with death.

“Would You Rather?” in the version that was passed down to me through oral tradition is common in middle schools, bars and anywhere you find bored co-workers. It’s a simple enough role play game. I ask, “Would you rather spend your honeymoon with Mao Tse-tung or Joseph Stalin?” You must choose. You don’t get to say neither. But you do get to follow up by asking me if I would rather die of the black plague or by starvation at Jamestown.

In my waitressing years I could die in one shift by rhinoceros impaling, angry revolutionary mob, festering boils, Neanderthal clubbing, poisoned blow dart, and dragging by wagon train — all just to avoid one kiss from Pol Pot. It’s how we passed the time on a slow Monday while ladling clam chowder. But when the restaurant was confronted with the sudden death of a fellow waiter, we were all unprepared, bereft and speechless. Our crew had magical thinking galore and never once had we considered that we were actually mortal.

In casual conversations with family, friends and co-workers we plan for the lottery. We plan our guest appearance on Fallon. We plan trips to Dollywood, Everest — an ashram even. But not the emergency room, the intensive care unit, the extended rehabilitation facility. One quick perusal of statistics tells us a spot on Fallon is as likely as an alien invasion in most of our lives while end of life is a certainty, but few are the Sunday family suppers discussing our beliefs on dying.

Our medical system has tried to address this avoidance tendency. It’s difficult to sneeze with vigor and not be asked if you have an advanced medical directive. There’s an obvious problem with this approach. The asking without subsequent extensive education is about as useful as asking a thousand people on Brown’s Island if they have an ileostomy. Only 80 will know what it is, six will have it, and 200 will nod their heads to be personable in hopes of getting a free T-shirt.

Advance medical directives are only as good as our understanding of them. Hint: They aren’t wills, they have nothing to do with your bank account, and a do-not-resuscitate order isn’t necessarily part of them.

You won’t learn enough about advance medical directives here. One Back Page essay is too small to teach you about building a trusting relationship with another person with whom you can discuss end of life and after lengthy discussion give them your medical power of attorney to state your wishes if you’re unable. There isn’t nearly enough room to do much more than direct you to a website about making such decisions (nhdd.org) which explains advanced directives and gives you a draft with which to work.

I certainly don’t have enough of your attention and time to explain that all aspects need to be considered — not only breathing machines and artificial feeding tubes, but also antibiotics and IV fluids. Some people think: “See? This is why zombies are easier. You just have to decide: shovel, shotgun or baseball bat.” But would you rather make someone else you love suffer with a lifetime of not knowing if they abided by your wishes or just lay off the TV for a couple of afternoons in order to learn a bit about your own body and medical options and maybe catch up with your friendly personal physician. That’s all it takes to check this boring task off your bucket list. File it between kayaking and Natural Bridge and it can be done by September.

Then again, you don’t have to think about it. Really. Out of the 1,000 people who began this article, almost 800 already have moved on to cutting out Ed Harrington’s comic to put on their refrigerator. Eighty already will have all of their wishes known and documented. It’s the rest of you who are still reading: What would you rather do? S

Alane Miles is a hospice chaplain and the host of Death Club Radio, heard Thursdays at 12:30 p.m. on Richmond Independent Radio WRIR-FM 97.3 and online at wrir.org.

Opinions on the Back Page are those of the writer and not necessarily those of Style Weekly.



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