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Meeting Death at the Front Door

by Nina 

by Melina Meza

"Research shows that most Americans do not die well, which is to say they do not die the way they say they want to — at home, surrounded by the people who love them. According to data from Medicare, only a third of patients die this way. More than 50 percent spend their final days in hospitals, often in intensive care units, tethered to machines and feeding tubes, or in nursing homes.” —Dan Gorenstein from “How Doctors Die”

Yesterday I heard a very moving piece  How Doctors Die on NPR that made me think again about an issue close to my heart: being able to face death with courage.

My mother died of breast cancer at age 85, and she was able to die with hospice care at home without any invasive procedures, any time in a nursing home or being “tethered” to any machines. Because I was talking to her doctors for her and coordinating her care, I can testify that this was only possible because my mother was clear-eyed about her condition and was willing to admit she had a terminal condition. In fact, one of the requirements for beginning hospice care is for the patient to agree to no more potentially “curative” treatments (hospice provides comfort care only). So this means being willing to face the fact that you are dying.

The piece on NPR and the companion piece in the New York Times article How Doctors Die: Showing Others the Way made the same point. The doctors in the article were able to choose the way they died—and lived while they were in the process of dying—because their medical knowledge helped them face the truth of their situations. Realizing that her condition had become terminal, Dr. McKinley decided to turn down more treatment and to begin hospice care.

"What Dr. McKinley wanted was time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean. But most of all, she wanted “a little more time being me and not being somebody else.” So, she turned down more treatment and began hospice care, the point at which the medical fight to extend life gives way to creating the best quality of life for the time that is left."—Dan Gorenstein

While some people do very much want to die in a hospital, I believe that most of us do not. And to make that happen, either for ourselves or for our loved ones, we must be as clear-eyed and honest with ourselves as my mother and the doctors portrayed by NPR and the New York Times were. That takes a lot of courage.

"BRAVE. You hear that word a lot when people are sick. It’s all about the fight, the survival instinct, the courage. But when Dr. Elizabeth D. McKinley’s family and friends talk about bravery, it is not so much about the way Dr. McKinley, a 53-year-old internist from Cleveland, battled breast cancer for 17 years. It is about the courage she has shown in doing something so few of us are able to do: stop fighting." —Dan Gorenstein

How can yoga help you be brave? Of course I can’t write about my own death, but I did help both my parents die at home (and have all the clear-eyed conversations that entailed), so I know it is a very stressful process. So I expect that stress management, of whatever kind works for you, would be valuable. I tried to stay as calm as possible when I was helping my mother and found myself every day doing very long sessions of Legs Up the Wall pose combined with breath work (extended exhalation). And sometimes when I’m doing my breath work these days, I consider that this is a practice I will probably have access to until the very end. For information on various options for stress management, see The Relaxation Response and Yoga. Anxiety—which is fear of things to come—can also be a problem, and yoga can help soothe you when you’re anxious. Baxter and I have done a whole series of posts on anxiety, so see Yoga Solutions for Anxiety and check the index on the right side of the blog under the label "anxiety."

I also hope that yoga philosophy will come to my aid. The Yoga Sutras actually describes abhinivesha or “clinging to life” as one of the impediments to samadhi, describing it as inherent tendency.

Yoga Sutra 11.9 [The tendency] of clinging affects even the wise; it is an inherent tendency.  —trans. by Edwin Bryant

But the Yoga Sutras also tells us that truthfulness (the yama satya) is a crucial part of yoga practice. This is one aspect of the universal “great vow” that is the second branch of yoga.

Yoga Sutra 2. 36 When one is established in truthfulness, one ensures the fruitions of actions. —trans. by Edwin Bryant

And it seems that truthfulness—being willing to hear the truth as well as to tell it—will help you face your death and die the way you want to, and to be able to help your loved ones as they die. Just the other day a friend told me how she was trying to help a friend of hers who was dying. “But he won’t admit it to himself,” she told me. “And that makes it impossible for his friends to help him."

So it's my feeling that you have face the truth yourself. That you have to tell your family the truth. That you have to insist your doctors—and your loved ones—tell you the truth. And if you are helping someone else who is dying, facing the truth about their condition will allow you to provide them with the help they need.

In the audio version I heard, Dr. McKinley called her approach to her impending death as “Meeting Death at the Front Door.” Besides being able to do the things you love as you age (see Being Able to Do What You Love), isn’t an essential part of healthy aging being able to die the way you want?

"The front door at Dr. McKinley‘s big house was wide open recently. Friends and caregivers came and went. Her hospice bed sat in the living room. Since she stopped treatment, she was spending her time writing, being with her family, gazing at her plants. Dr. McKinley knew she was going to die, and she knew how she wanted it to go.

“It’s not a decision I would change,” Dr. McKinley said. “If you asked me 700 times I wouldn’t change it, because it is the right one for me.”

Dr. McKinley died Nov. 9, at home, where she wanted to be." —Dan Gorenstein

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