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.
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