Two Books for Your Heart
When Blog Friends Go Missing

Last Acts of Kindness

Here we are, you and I, hanging out on a blog that states right at the top that it is about “what it's really like to get old” and yet we don't talk about death and dying – or hardly at all.

Among the reasons is habit – it is not the habit of our culture and it is all but taboo to talk about the end of life and there is a great deal of pressure to deny that death, in time, comes to all of us.

LastActSmall2 One of my objections to the unending barrage of the commercial and social pressure to remain young forever at any cost is that it denies the dignity of age. Judith Redwing Keyssar, in her book, Last Acts of Kindness, takes that thought a step further:

”Commercials and advertisements flood us with images and information about how to stay young, look young, and avoid the aging process,” she writes, “insinuating that if we don't age, perhaps we won't have to die.”

I agree and I'm pretty sure the purveyors of wrinkle creams, Botox and plastic surgery would deny it, but at bottom, when all the layers are peeled away, all those expensive products and procedures are exactly what Ms. Keyssar says – the denial of the inevitable. In doing so, as she points out in her book, we are trading the experience of the great mystery of life for anxiety and fear. It doesn't need to be that way.

Ms. Keyssar is the director of the Palliative Care Program of Jewish Family and Children's Service of the San Francisco Bay Area. She is a leader in the field of palliative care and, as she describes herself, “midwife to the dying.” I would add to the dying and their loved ones who are as much a part of this book as the dying.

In 27 true tales, Keyssar tells the personal stories of people she has worked with at the very end of their lives – in hospitals, in care facilities, at home, at ages ranging from youth to ancient, people ready to accept their deaths and others fighting until the last breath.

”For some,” writes Keyssar, “it is important to be holding a hand and for others it is important to leave this world alone. Every human is unique, and the stories of our deaths are as individual and poignant as the stories of our births and our lives.”

Last Acts of Kindness is an important book. The wide-ranging stories are compelling in themselves but Keyssar has a larger mission. She shows us the lessons the dying can teach us and she also answers the many questions we never want to ask or that others don't want to answers. And she urges us to plan.

“...making plans for your end of life care could be the greatest gift you can give your family and friends.”

I agree, but the stories are what propel the book along with Keyssar's interruptions to explain how disease develops or how the hospital procedures and medical technology function or the goals of medical personnel and some of the wisdom she has gained from more than 25 years of specializing in the needs of the dying.

Sometimes the stories are funny. Sue was a 42-year-old free spirit diagnosed with advanced breast cancer that had metastasized to her bones with pain that required increased amounts of morphine.

”Sue's room was always full of family,” writes Keyssar, “...and friends who circled her bed and changed, sang, prayed and meditated...

“Later that night after everyone had gone home, I sat at Sue's bedside, holding her hand. Her breathing was labored and irregular. Suddenly she took a big, deep breath, and I thought this was the end. I, too, took a long deep breath, when suddenly Sue gulped more air, opened her eyes, looked straight at me and said, 'I'm not dead yet?'”

Keyssar laughed, assuring Sue she was still in this world. Now some writers might end the story there and I can understand the urge to do that. But Keyssar doesn't let us off that easy.

”'I never imagined it would be this hard to die,' [Sue] said, a few stray tears rolling down her cheeks.

“'What is so hard about it?' I asked.

“Sue thought for a minute and then said, 'There is so much love in the room. Why would I want to leave that?'”

As Keyssar explains, additional morphine helped control the pain enough for Sue to say “meaningful goodbyes to all her friends and family” and within a day or so she died with just two people with her.

Many fine things are written in this book, as much a guide to living as to dying. It is also an impassioned call for changes to our health care system to better and more compassionately serve the dying and their families.

You can find out more about the book at Judith Redwing Keyssar's website and it is available at the usual online retail sources. I highly recommend it.

At The Elder Storytelling Place today, Lyn Burnstine: The Candy Store


I am just finishing a month-long intense training to be a hospice volunteer.Giving someone comfort during those last days and hours seems, to me, to be the most meaningful thing I can do with my life right now. As the daughter of an undertaker and someone who was present at the deaths of both my parents, I am in awe of the process of dying as some are in awe of the process of birth. I haven't read the book you are recommending, but it does sound like something everyone should read -- and as importantly, talk about. After all, it's where we are all headed. Of course, we should all live the fullest lives we can, while we can. Hospice helps the dying move out of that fullness with dignity and support. I haven't been assigned my first patient yet. I hope that I am able to be of some comfort to that person when the time comes. Perhaps we need more discussion here about your readers' perceptions and attitudes about dying.

Thanks for bringing up the subject of the inevitable fate of each of us. My husband and I joke around about death and dying, but we are also prepared. We each have a Living Will, have spoken with our families and have a plan for disposition of property. Doing so is a final act of love toward those left to deal with our death(s). I've tried to rid myself of "stuff" so someone doesn't have to just get a dumpster and deal with it as someone I know did. I plan to live into my 90's but there may be another plan I don't know about, so I need to be prepared. My Mother showed me the way.

At 80, my Mom close to 101, my
goal is to live as healthy and as long as Mom....

So far the only thing I have done is sign up for "whole body donation". I carry a card with the pertinent contact information. They will then collect the body, use what organs are viable, cremate the remains and send to designated next of kin.... NO COST to anyone! The name of the dot org company is "Science Care."

Getting my "stuff" organized and the will and won't part of distributing the remains of my earthly possessions has yet to be accomplished.... I am sorta waiting to be inspired maybe?

I would also recommend the documentary; Dying at Grace, an extraordinary film about the reality of dying.

Don't wait for an engraved invitation to get prepared. Heart attack or stroke can take you in an instant.

When I got the call that I had to go to Florida, because my Mother was not expected to live, I was shocked. In retrospect, I don't know why I was so "blindsided"..after all, she was 83. I guess it never really occurred to me that she could possibly die EVER. She could have been 100 and I wouldn't be ready. Fortunately for me I found a good book (like the one you described, I suspect). I read it cover to cover on the plane. I wish I could remember the name of it. The biggest message in that book was that dying people do not like to be told that they are not dying. They know they are. The author said that dying people should be allowed to talk about whatever they want...she called it giving them "psychological air"

Many thanks. I will follow up on this lead, because one of the few things that we can perhaps control is is how we leave. Though I hope to defer as long as possible, for me that seems particularly important. Much appreciated.

Thanks for saying this out loud. There is always a deafening silence about death and dying among elder peers and writers. I am 75 and remember daily that I am in the last period of my life and moving toward the final moment

A very dear friend of mine is dying. Perhaps today, perhaps a little later but not by much. It is thundering loudly this afternoon and in my prayers and thoughts I am imagining that all is getting ready for someone very important to arrive. And this from someone who does and doesn't 'believe'. This wonderful person will be sorely missed not only by his friends but by all the people he has so generously helped over the years. Isn't that the kind of memory we would all like to leave behind?

It is a very good idea to have a prepaid funeral plan. If you haven't checked lately, funerals can be shockingly expensive. Be sure to leave instructions with somebody. There are checklists online for the many details you need to include in these instructions, such as vital statistics for the death certificate and where you want to be buried.

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