Most people have no say in when they die. But almost everyone has a say in how they die.
The key, as difficult as it may be, is planning ahead.
“I’ve worked with some amazing people that have confronted some pretty unimaginable things,” said Dr. Michele Reiss, the Pittsburgh-based therapist who worked with Randy Pausch (author of “The Last Lecture”) and his wife, Jai. “We can learn from these heroes.”
Reiss has chronicled many of these stories in her book “Lessons in Loss and Living.” The book also includes helpful strategies for those facing a serious illness, and to grieving family members.
Working with Randy and Jai Pausch inspired Reiss to write her book, she said.
Pausch was a professor of computer science, human computer interaction and design at Carnegie Mellon University. Diagnosed with pancreatic cancer in his mid-40s, he died 18 months later on July 25, 2008, leaving behind his wife and three young children.
Yet Pausch maintained a positive attitude throughout his illness, according to Reiss, because he always remembered his blessings.
“He was able to understand that the proverbial cup is always half empty and half full,” she said. “He never lost sight of the half full part.”
Although not everyone is a born optimist, Reiss believes one can train oneself to appreciate the good in life, even in the face of death. She recommends maintaining a “gratitude journal” as a tool for keeping a positive outlook.
“Once a day, write down three to five things you are grateful for,” she said. “They can be little things. And writing it down is better than just thinking it. If you write it down regularly, you start to train your brain to think that way.”
Having prioritized the important things in life can also help ease the dying process, Reiss said. And one should not wait until one is dying to do so.
“Somewhere in this life — long before serious issues arise — we should not lose sight of what is truly important to us,” she said. “And what is most important to us is usually people. You would hate to wake up one day, and wish you had spent your life differently.”
Achieving closure with loved ones can be crucial in lending comfort to those who are dying, said Ralph Capone, medical director of the Sivitz Jewish Hospice. To that end, it is sometimes best to choose hospice care, providing an opportunity to spend meaningful time with their family and friends, rather than dying in a hospital while undergoing extreme life-prolonging treatments.
The goal of hospice is to provide symptom management, Capone said, not to hasten the dying process. At hospice, the emotional, spiritual, and psychological needs of a patient are treated, and pain management is provided. Hospice care is not curative.
“We have to recognize the limits of technology, and recognize when technology is no longer serving the patient,” Capone said. “Treating human life with dignity is important until the end,” he said.
In the Middle Ages, Capone noted, people died slowly at home, giving them time to make their final peace with family members and friends, and to have closure.
“Today, we’re robbed of that opportunity,” he said. “And for many patients, it’s important to have that closure.”
“Closure,” in fact, is the name of a five-year initiative, sponsored by the Jewish Healthcare Foundation, to help facilitate planning for the end of life, and to educate people about the various end-of-life options available to them.
“Our overall goal is to change people’s expectations for care at the end of life,” said Nancy Zionts, chief program officer for the JHF.
“Closure,” which can be found at closure.org, provides tools and resources for families, allowing them to be proactive in planning for the death of loved ones.
“It’s mostly about conversations,” said Zionts, emphasizing that people should to talk about what they want and don’t want at the end of life. “It’s really important that families think about these issues when they are not in a crisis situation.”
Like Capone, Zionts believes that life-prolonging technology can rob people of a comfortable and peaceful end-of-life experience.
“Often, we cure someone to death,” she said, adding that most people, if given the choice, would not wish to die attached to machines in a hospital.
Hospice and palliative care are what people want when they are dying, Zionts said, but these choices need to be discussed before a death is imminent.
“People need to know they have a right to direct their own care, and to even refuse care,” Zionts said. “Sometimes they find out too late that they could’ve been more of a player in their own life — and death.”
(Toby Tabachnick can be reached at firstname.lastname@example.org.)