ELDER MUSIC: Playing with Mr B
A Contradiction of Old Age

What Really Matters at the End of Life

Many years ago - even decades - when I was still quite young, I knew how I want to die. It hasn't changed and it isn't unique: I want to be conscious, clear-headed and pain-free so that I can concentrate, pay attention to the experience. We only get one go at death and I want to be aware of it.

Of course, there is no guarantee it will work out that way but there is a better chance than in the recent past. Many doctors are more honest than in our parents' and grandparents' day about prognoses, for example, and there are documents we can sign nowadays that direct how much medical and drug intervention we want at the end.

That is a help but all kinds of things can go wrong, or differently from what is anticipated in the documents, starting with an uncooperative body or mind.

Recently, I've been learning more about palliative care which is usually chosen at end of life but not always. There are uses for patients at other stages of life too. And, I had no idea until now that palliative care is a medical specialty.

As I was working my way through a variety of resources I arrived at an excellent, informative and fascinating TEDtalk from March 2015. The speaker is BJ Miller, a palliative care physician who works at the Zen Hospice Project in San Francisco.

As young as he is (well, as young he appears to me at my age 74), he is wise and thoughtful and filled with insight about healthcare which, he says, should “make life more wonderful than [just] less horrible” as it too often does, especially in hospitals.

It's hard to know if it is due to the traumatic injury he suffered while in college or if Dr. Miller was born an old soul but there are few others I know of who are as inspiring and comforting about death and dying – and living - as this man. (The video is about 20 minutes long.)


I agree about witnessing our own demise. People are aghast that I don't share their wish to die in my sleep. What? And miss a once-in-a-death time experience?

Loved the snowball story, Ronni. It reminds me of a couple of defining moments that I observed in Elder Brother's care, recently, following his cardiac arrest. On about Day 6 in the ICU, yet another cardiologist came into EB's room, strode to the window to throw open the blinds and announced, "No more doom and gloom. Get some of that sun in here!" That physician's demeanor made him a standout in the long line of physicians who had visited EB. Shortly, another in that long line appeared and chatted with EB about the lake that was to the north of the hospital - which EB could observe only by standing and walking to the window. What incentive that observation provided!

EB is doing well, my having left him about one week ago. (He lives alone, but has many close friends who live in the same town in Colorado.) Thanks for posting the TED talk!

Wonderful. Ronni, you've probably already read "Being Mortal" by Dr. Atul Gawande, a surgeon and New Yorker writer, but perhaps some of your readers haven't. It's the best thing I've ever read on this subject.

Yes, Jean, I've read Gawande's most recent book. Perhaps you recall from it that he, like me, did not know palliative care is a medical specialty.

I will read this more carefully tonight. I recorded "The Good Wife" since I couldn't watch it last night. I was watching it with one eye, reading blog posts and tweets with the other. One of the cases on "The Good Wife" was about "right to die". Timely TV story, don't you think Ronni?

Most moving TED talk and impressive human being! I also encourage all to read Atul Gawande's book, Being Mortal. This is our book club's selection for November and very thought provoking and hits close to home. Thanks for finding this video.

Wow, I want to watch this again so I can jot down some of the things he said. Eloquent.

While we all say that we would like to meet our demise in some form of painless consciousness, more often than not it does not work out that way. Mostly, you just want the pain to stop. The best we can hope for when the time comes is that we will be ready for it.

Thank you, Ronni. What an excellent talk! From the perspective of having my sister and mother receive hospice care before their deaths, I want to say how incredibly important it was for them to have that care. Dr. Miller's compassionate approach and all of the recommendations in this TED talk, Atul Gawanda's book, and the care hospice offers help the dying person immeasurably. We don't realize until later how much it helps the family and caregivers as well. Living or dying, we all need what Dr. Miller et al are talking about. Thank you again.

Dr. Miller is young, he was electrocuted at Princeton junction Dinky 1993 - 20 years old. I remember the news about a Princeton student got injured. Dinky is about 10 miles from I live. I told dr. Miller story to my husband.
Very interesting video.

A big hug with a big thank-you for today's posting. My husband and I have had the past pleasure of volunteering at a nearby Hospice. We have seen (dying but happy) clients bedded in adorable, home-like rooms, with comfy furniture around them for any visitor who claims it (family, friends, volunteers).

Talk about a time and place of comfort !!! Patients could request and receive any comfort food they desired. Pets were welcomed and we saw rooms accommodated with screen doors while allowing a cat or dog close to live with his owner. No chemo, but meds for easing pain ~~ music and laughter shared as needed.

I am thankful for having found your blog. I am grateful to live in a time when we can talk about death.

Very interesting--perhaps a bit too 'zen" for me and certainly NOT what most of us will experience at the end of life. Almost inevitably we will get caught up in the American healthcare system as it IS, not as we desire it to be. Possibly, positive changes and choices in the way we die will be there for succeeding generations. Personally, I'd still opt for a quick, unexpected, pain-free demise, but I realize that it may well not happen that way.

The hospice Pat volunteered at sounds terrific but I don't know of any such place--especially one that would accept me and my much-loved cats!.

Lots of pain meds and a chaser of psychedelics sounds to me like the best way of vanishing into the unity.

Every now and then a little video edges its way into my daydreaming head.

The video shows up when I am gardening.

Not just any gardening. Gardening is too soft a word.

Wrestling works.

So the video goes like this:

I examine a couple thirty year old shrubs in front of my house.

Shrubs that upon close examination, are dead inside and brown on the outside. Phoney overgrown shrubs that had their day.

So I go into the garage, select a pick axe, walk back to the done for shrubs and start chopping at the earth, as if clearing away everything not good with the world, to make way for new growth.

Sweating like a Montreal caleche horse, I can't dislodge the root ball.

Where is Popeye when I need him?

Like a stubborn politician, the shrub won't budge.

I wind up, grab the thing and pull it with all my might.


The root ball shoots out, hits me in the face, I do a backward flip, the likes of which no gym teacher ever got me to showcase, and then..


I die laughing.

Another door opens.

A voice..

"So, doctafill, hold this magic cat, close your eyes and tell us what you are planning to do with your second life."

"Take your time."

I am so very glad for this conversation. Thanks, Ronnie. Awhile ago, prompted by a similar posting, I offered my prose poem, "Ready or Not" to the Elder Storytelling Place for publication & was amazed to see a number of sympathetic responses. This is definitely a subject worth talking about.

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