Quotes on Aging and Mortality Related Issues

Virginia Morris
- Talking About Death
Virginia Morris
Morris Book

Writing on the Subject of:

Writing on the Subject of:

On being comfortable talking and learning about death

What's interesting is that once you overcome your initial repulsion for this subject, learning about death really isn't scary, depressing, or dangerous. Although obsessing blindly about death is horrifying, learning about it is empowering. The thought of death will always fill us with dread. There is no escaping that. But the fear is less paralyzing, less blinding, when we have knowledge, when we can talk openly about it, and when we discover that we actually have the power to reshape it, to make it a more loving and rich experience.

 

On coming to value time

When we move beyond the fear, however, the picture takes on a different shape. For what could make life more valuable than the simple fact that it is limited? What could make living more miraculous, more dizzyingly joyful, then the mere knowledge that we don't get to live it forever?

On the change in where we die today:

Although 90 percent of people say they want to die at home (according to two Gallup polls), nearly 80 percent of people die in hospitals, nursing homes, and other institutions.

On the patients loss of influence once hospitalized and in an ICU:

According to one major study, shortly before death, about 40 percent of hospitalized patients spend 10 days or more in an intensive care unit, where the lights are brighter, the noises louder, and the intrusions more frequent.  They are distanced from family and often separated from their primary care doctor, who has been replaced like a specialist or by a doctor assigned by a nursing home, a person with whom they have no relationship.  They have little control over their care, their daily life, their sleep habits, their meals, or even whether the window is opened or the curtain drawn.

On the reality of the difficult time dying patients may experience and the need for planned pain management:

...researchers found that 50 percent of patients were conscious prior to death, and of those, half were reported to be in moderate to severe pain most of the time.  In addition to their pain patients typically were overcome by intense fatigue.

On what we face psychologically at our time of death:

For a majority of people, dying is not only prolonged and needlessly painful, it is also lonely and frightening.  In the hospital, patients were demeaned by the power and complexity of the institution and the technology they are in there are dehumanized by a web of tubes, wires, and intravenous lines, and they are invaded regularly by hospital staff to take blood samples and check monitors and medications at all hours of the day and night.  Patients often become depressed and anxious, symptoms that are often left untreated.  The trouble is, physical pain exacerbates psychological pain, and vice a versa, so the patient is drawn into a downward spiral of deepening depression, distress, and pain.

On spiritual opportunities after confronting death:

Given the chance, people who are terminally ill often develop a profound spirituality, come to terms with their pasts, and forgive others and themselves for any wrongdoing.  Some go even further, developing a heightened creativity; they start to write poetry or paint pictures or spin pots.  And they find themselves flooded with love and a vivid appreciation of life.  After all, there is no longer any pretense that life is limitless, no time for trivial undertakings or superficial relationships.  In confronting death, these people embrace life and gained extraordinary strength, clarity, and artistry.  They are like the leaves that dangle green all summer long and then suddenly take on brilliant, fiery Hughes Jess before they drop from the branches and float gently to the ground.

On death's power to keep us present:

Dennis Potter, the English writer, talked about this clarity shortly before his own death from pancreatic cancer at age 58.  "In a perverse sort of way," he said in a televised interview, "I'm almost serene.  I can celebrate life.  Things are both more trivial than they ever were in more important than they ever were.  The ’now-ness’ of everything is absolutely wondrous," he said, describing the color, texture, and sent of some lilac blossoms that had bloomed outside his window.  "There is no way of telling you. You have to experience it. But the glory of it. The comfort of it. The reassurance. You see the present tense, Boy, do you see it and boy, can you celebrate it.

On how we all deal with death individually:

We also have to realize that most deaths are neither one extreme or the other, celebratory or intolerable, but rather a mix of many things.  Even the very best deaths are communal at some moments in extremely lonely at others.  Death may be accepted at some times during the process and a night at others.  Or it may be acknowledged, but only in unspoken waves, or only with certain people, or only in reference to certain subjects.

On searching out your own fears of death:

Whatever your own fears and dreads and concerns are, tease them out, one by one, examine them carefully, try to address them, and then revisit them at another time, for they will change.

 

On the quality of end-of-life care at hospitals:

Hospitals are not set up to provide good end-of-life care, but things are improving, and with an assertive effort, you might find some reasonable amount of comfort and peace.

On the need for spiritual comfort at the time of death:

We must not know the body and then neglect the soul, or suffering at the end of life extends well beyond physical discomfort, and dying well involves more than dying free of pain.

On being open with patients about illness:

...people have the right to information about their own health. They need to know what's happening so that they can make decisions about how they will proceed. And they need the option of discussing the truth with their loved ones so that they can pursue any goals they might have, and began to except what is happening.

The irony is, the patient does no in virtually every case, no matter what is said or unsaid, the patient knows the truth -- in fact, knows it better than anyone else.

On when to conclude we should no longer prolong death:

We are in a new era in which we must decide not simply whether to quit, but when to quit. We are not just deciding whether or not to prolong death, but how we might make the most of the end of life. We are not simply deciding whether or not to keep a dying person on a ventilator, but whether we will accept the ventilator in the first place, whether we will proceed with the treatment, or whether we will even call an ambulance when things get rough. In other words, we are no longer deciding simply whether life is sustainable, but whether it is desirable.

On determing that an illness is terminal:

The problem is that the question is rarely so black and white. Dying is a complicated affair that involves multiple shades of gray. As Madison has developed more weapons, more ways of battling disease and keeping people alive, and more ways of fighting disturbing side effects, the question of when to stop has become more and more confusing. Quite often, there is no definitive moment when invasive procedures should be abandoned for palliative care, no unmistakable border between beneficial and futile, no turning point when a person goes from "living" to "dying." Today, people can live for years with terminal illness, suffering occasional scrapes with death and then rebounding.

On the decision to remove life support:

When we take a terminally ill patient off life support, we are not "pulling the plug," we are "freeing" the patient to die. We are "releasing"her from excessive technology and the invasive treatments. When we allow death to happen, we are not killing people, we are caring for them. We are loving them. We are respecting nature and all that life and death are about. We are taking them from medicine's iron grip, swaddling them in our arms, kissing their ashen cheeks, and, as we summoned all of our strength, giving them the most generous gift of all: we are letting them go. This is not an act of murder. It is an act of love.

On physicians and their hesitancy to talk of death:

Doctors often tiptoe around the subject of death, talking instead about long-term survival rates, remission, and effective treatments. They talk about patients who have "expired" and diseases that are "not compatible with life." (I have actually heard that expression used more than once.) They blame patients for not wanting to talk about death and often it is the after was avoiding the subject.

On why doctors are not attuned to the best end-of-life care.

Doctors are only human. They are dealing with their own fears of death, and their own ignorance about and-of-life care. They are responding to cues from individual patients and their families, and they are also responding to strong pressures from society to treat, to save, to do more. The way doctors deal with patients and families reflects years of training, established medical routines, growing fiscal pressures, and a system that values in invasive, life-sustaining treatments over time-consuming palliative care and counseling.

On medical specilization and how it narrows the doctor's human perspective:

After medical school, students began their "residency," which is on-the-job training. they choose a medical specialty, and then often a subspecialty, learning about cancer, for example,and then cancer of the blood and then treatments for specific type of leukemia. As they zero in on a field of medicine and that a specific disease, organ, or mode of treatment, they move further away from any sort of holistic approach they know about laparoscopy or radiation or transplantation. They learn what's new and what's hot. They become human microscopes, focusing in on the minute and, in the process, sometimes losing sight of the whole.

On our role in patient care at the end of life:

Finally, we have to appreciate our own role in shaping this passage. The role is not limited to asking questions and making sure a patient's treatment preferences are respected. We have two open ourselves to the experience, the whole experience, taking part in it fully, so that the final act of life is not only merciful, but loving.