How To Die Healthy

He who sleeps here, when dying, mistaking the approach of death for the return of health, whispered with his latest breath, ‘I am better now.’ Let us believe, in spite of doubts and dogmas, of fears and tears, that these dear words are true of all the countless dead. Robert G. Ingersoll, Eulogy for his brother Ebon. Washington, DC, May 31, 1879.

INTRODUCTION – People are squeamish about death. It ranks with religion, politics and sex as topics to avoid in polite (and other) society. While most overcome the culturally-induced reluctance to think about it long enough to do a bit of estate planning (e.g., set out a will, maybe sign a donor card), little if any attention is given how to die.

DYING HEALTHY? – To die healthy means to live well, to the final moment of existence until, with a last breath, you think, murmur or say aloud, I feel better now, as spoke Robert Green Ingersoll (following the example of his brother Ebon) when he closed his eyes forevermore on July 21, 1899. Of course, not everyone gets much choice of how, when, why or where to die. Dying is not really a choice at all for most. Many of us die without graceful leave-takings largely due to not having planned such a thing. Those fortunate enough to avoid untimely ends who also devote attention to healthy living might welcome the availability of choices for a good death. No, this business of dying healthy is not as attractive as planning, managing and constantly fine-tuning a healthy life. However, all things considered, it might still be a worthy undertaking (pun intended).

We know from spending patterns publicized during the American health system reform debate that a vast amount of money is lavished on the final months of life. What is done to sustain life is not always in accord with the wishes of the dying. The quality of life during the last months (or even years) can be quite dreadful. Thus, those who value a wellness lifestyle might want to arrange things for when the end of life nears. When that time comes, they might thus be more willing to acknowledge the signs and less willing to entertain hopeless or distressing strategies of denial. They might be more likely to exercise a level of control for life quality during the final stage consistent with the lifestyle artistry managed when living well.

The sad fact is that very few people die healthy. Yes, a case can be made that it is possible to die healthy. The phrase is, of course, an oxymoron but, if construed in a defined fashion, is not a contradiction in terms. Yes, unless it is explained, die healthy might seem fortune-teller worthy as a good/bad combination. I was amused recently by the advice psychics offered an undercover New York Times reporter, Ariel Kaminer. On an assignment, Ms. Kaminer asked a motley collection of assorted soothsayers what to expect in 2010. Ms. Kaminer was told that she faced a year in which everything she sets out to accomplish will be realized although all her ambitions will be thwarted! My, that was helpful. Also, that while her love life will blossom like a flower, her romantic prospects are in serious trouble. And, while tremendous events will occur, nothing at all will happen. Ms. Kaminer concluded, I’m not making this up. I got it from the experts. (See Ariel Kaminer, The Future: Cloudy, With Platitudes, New York Times, December 31, 2009, p. 25.)

Yes, the phrase die healthy might, at first, seem preposterous, the kind of crazy talk psychics offer their moron customers who take seers seriously. But, please don’t too quickly put die healthy in this category! Instead, consider how I construe the phrase – from a REAL wellness perspective of functioning with reason while seeking exuberance and liberty.

DIE HEALTHY DEFINED – Die healthy means that, if you must die, and science suggests we carbon-based biped life forms mucking about on a small rock orbiting a giant fireball in the middle of nowhere must (thanks, Pat Condell), why not do it as sensibly and even healthfully as possible? That’s it – that’s what I mean by die healthy. (Warning: Long sentence ahead – take a deep breath!) Just as living well entails wise choices of disciplined habit patterns with a sound philosophy and conscious thinking that promotes a good measure of happiness, fulfillment, meaning, purpose, fun, joy, love, good health and the like, so too can death be approached in a fashion that increases desired processes while reducing undesired processes.

Surely the person who cares enough about quality of life to bother to shape and sustain a wellness lifestyle will also want to ponder and plan an equivalent wellness dying style. The process of doing so is the meaning of the phrase die healthy.

BUY REAL KETAMINE– Dying sucks. Very few people want to do it, no matter how sorry their situations, although there are a few ignoble exceptions. Need an example? How about the Islamic maniacs who somehow believe what seems beyond preposterous to most of us, namely, that three score and twelve virgin hotties await the martyr who blows himself up for Allah. Holy cow – is there any limit to the nonsense that can be embraced under the toxic cloud of revealed religion? None seems evident so far.

Back to dying healthy. As suggested, few do so but that can and ought to change. So, here are a few starter tips.

* Envision a good death. Think of someone you knew or read about who went off in a manner that has attractive possibilities. No, of course it’s not something you want to do, but since you must depart, in time, a plan or at least a few guidelines for the period leading up to the last moment should be considered.

* Tell your spouse, children and anyone else who will listen about your thoughts on the matter. Take legal steps to promote the chances that doctors and varied strangers who might become influential in your final days know your intentions and desires.

* Consider lining up a team of transition facilitators. Don’t you just love euphemisms? I mean, really, when your organs start shutting down and you can’t taste or even see your food, control your bowels – when you are steeped in dementia and experiencing congestive heart failure, kidney problems, a lot of pain, more delirium than normal and a great deal of agitation and, worst of all, no longer interested in sex, don’t you want someone or a team of experts to help you escape a bad situation rapidly getting worse?

* Along the lines of the last tip, don’t wait too long to learn about palliative sedation and the medications that can relieve unyielding suffering. These include but are not limited to lorazepam, midazolam, phenobarbital, scopolamine, ketaminer, morphine, methadone, fentanyl, propofol and sodium thiopental. Combinations of these drugs work even better.

So, there you go – that’s what it means to live so as to die healthy.. Not as upbeat as living a wellness lifestyle but since you can’t do that forever, it seems wise to mentally rehearse a wellness lifestyle-worthy curtain call.

Provided you believe you have a right to choose your own best way to die or, to use the more common euphemism, to pass comfortably, there is no good alternative to dying healthy.

Best wishes, live well and when you can’t anymore, well, let it go.And now, before ending this essay, I would like to share a response I got to these ideas from a close colleague of many years, columnist Bob Ludlow.

I have no problem signing on to your sage and timely advice. I say timely because even though I still feel like a spring chicken, sadly I’m not — far from it, in fact — and it’s time to stop procrastinating and confront the sober reality that no matter how good I feel now and how well I may function at the moment, I don’t have that many good years remaining before something pretty awful happens to my aging 70-year-old body or, Zeus forbid, my mind. So thank you for bringing this somewhat unpleasant topic to my attention with your usual wit, wisdom, and rationality. After all the years of working on the Bob Ludlow project, I was hoping to stop tweaking and just accept the far-from-perfect, but functional, results. Now your consciousness-raising has reminded me of unfinished business and prodded me to make a belated New Year’s resolution, which is: This year I will do the necessary research and then take appropriate steps to prepare for my approaching decline and failure. Hopefully, the decline portion will be delayed many years and then be brief, if not instantaneous. There is no point to unnecessary suffering, certainly not in a hopeless situation. So it behooves all of us to take those sensible and important steps you recommend in order to make the transition to everlasting oblivion as calm and uneventful — as healthy — as possible.

The idea of dying in the not-too-distant future doesn’t seem to bother me (not yet, anyway), and it probably won’t elicit great apprehension when the time comes. Alas, I can’t be certain about that. As the irrepressible Daniel Gilbert convincingly documents in his delightful and highly informative book, Stumbling on Happiness, human beings are incredibly inept at predicting how they will feel and act in given circumstances.

Like almost everyone, the idea of prolonged disability and/or pain bothers me a lot. If that should ever be my prognosis, I now feel I will prefer to check out early on my own terms. Of course Gilbert says I can’t know that’s how I’ll feel in those circumstances. But it’s a certainty I will want access, on demand, to the most potent pain-relief cocktail available.