Peter and I have been self isolating for six weeks today. Since January, we’ve been planning for the day when we would self-isolate, knowing full well the danger that the corona virus, now Covid-19, held for us…for society. We made our plans for the company, which we set in motion, and which is allowing us to operate with a skeleton crew on the ground and remotely for the rest of the company. Peter’s move over to the telemedicine platform with HouseCall last year was prescient, and he is conducting patient visits as usual. He continues to research and write prolifically, and he has been a beacon of light for thousands of us as he guides us through these uncharted waters.
Life has taken on a new normal, but for all of us, it’s important to remember that it is not. In the midst of the virus outbreak, we are all being forced to have a confrontation with mortality that can be frightening, painful, or easily avoided with the casual, “this can’t happen to me” attitude that we might adopt in our protected isolations.
Conversations with Death
I have to come clean…I’ve been having conversations with death for a while. Over the past 6 years as my role as carer and overseer of my sister has deepened, I’ve been acutely aware of the fragility of life. Initially, I was at a loss where to go to talk about this and what these conversations would even be like. I was lucky enough to stumble on the work of BJ Miller, the noted palliative care doctor, who’s remarkable Ted Talk stirred me to my soul.
At the time, Dr. Miller was the executive director of the Zen Hospice Center in San Francisco, and I learned about the Mindfulness Caregiving programs they offered. I flew out for a weekend of training, and this opened my world to a new way of looking at death, confronting my own as well as all those I loved. Powerful, moving, stirring and life transformative, and it set me off on an avocational exploration, which included taking seminars with Frank Otaseski, Joan Halifax, and culminated this past fall with enrolling in the End of Life Doula program at the University of Vermont. The course was led by Francesca Arnoldy, an end of life doula and the author of Cultivating the Doula Heart.
Don't Fear These Conversations
Throughout all of this work and research was a clear and consistent message:
Don’t let your fear of having the conversations about death keep you from talking about it. Allow yourself to feel raw and vulnerable as you confront what it would feel like to be meeting death – your own or that of one you love.
During this pandemic, more people are confronting death or the possibility of it, and it is important to be able to talk about it, make your plans for how you would want to be treated should it be you that is ill as well as encourage your loved ones to think about what they would want. Equally important is to have your wishes written down so that they are known. There are so many stories of people who are dying who are put through needlessly invasive procedures because they had not specified that they did not want extraordinary measures nor had they named a person who could be their health advocate.
Questions to Ask
Dr. Atul Gawande, renowned surgeon and writer, refers to five questions to ask as end of life nears. I’ve adapted them below in this time of Covid-19 and the worldwide pandemic we are living in, and these might be helpful to open up the beginning of an enriching conversation with yourself and your loved ones about life.
- What is your understanding of where you are with regards to Covid-19 and your chances of contracting the virus?
- What are your fears or worries for the future in the next month? Three months? Year?
- What are your goals and priorities for your life? Are you living your full potential? Any unrequited wishes that need to be brought to the surface, embraced, lived?
- What outcomes are unacceptable to you? What are you willing to sacrifice and not?
- What would a good day look like?
- If you were to be diagnosed with Covid-19, what medical treatment do you want to have? If hospitalized, do you want to be put on a ventilator if necessary?
- Do you have an Advanced Medical Directive that outlines your wishes should you be unable to speak for yourself?
- Have you named an individual you trust to speak for you if you are unable to speak for yourself?
- What do you want the world or your family or your dear friend to know about you and how you feel about them?
In many ways as I’ve considered these questions for myself, I see that the question is not so much confronting death, rather, it is confronting our lives. Do our lives give us joy and expression or are we operating on auto-pilot? There’s nothing like an emergency landing that forces a pilot to take control of the wheel, and if properly trained, she/he can guide the plane safely down. So too, it is with a pandemic. It shakes us to our core if we allow it, and forces us to look deeper at our lives.
Molding Your Relationship with Death
I have been so enriched by befriending death these past few years. Please don’t get me wrong. It scares me to think of it, and if I were to imagine my final breaths, I would deeply grieve leaving those I love and cherish most in the world. I have in place my advanced planning, so when the time comes, it will be on my terms and with the sense that I really did “knock a heck of a squeeze out of life” (paraphrasing the late poet and philosopher, John O’Donohue).
Take the first step. What would you want to say to those you love. Write it out, say it, live it. And then second, write out your wishes. There’s a great resource called The Five Wishes, which helps to craft your advanced directives if you don’t have them.
Third, and this is as equally important as the other two, live. Live fully, get a squeeze on life before life gets squeezed out of you.
Sending lots of love in this wild world we are living in.