What is a good death?


GoodGravestoneMy beloved neighbor Joanne was 87 years old when her son found her dead in the hallway of her old farmhouse on Monday. They’d gone to a funeral together that morning — a younger relative had died of pancreatic cancer — and after lunch he’d dropped her off at home. When he returned later that afternoon, she was gone.

I wasn’t home at the time, so I missed the commotion on our dead-end road, where the Joanne’s family farm occupied the final spot — the anchor to our small, rural neighborhood. When I received the news the next morning, I was so shaken that I hung up the phone in haste, unable to talk through my tears.

Joanne had been seeming a little foggy-headed and newly frail in recent months, but she’d been so resilient over the years that I’d assumed she had several more years in her. Her death came as a shock, and even as I write this I can’t believe it’s real.

I want to comfort myself with the notion that hers was a good death, but I’m not even sure what that means. She’d lived a full life and her decline was sudden, rather than prolonged, like her husband Mack’s had been. Isn’t that what we all want? One day you’re fine, the next you’re gone — no time to linger in the ugly in-between.

Having witnessed a loved one slowly succumb to cancer, I can say with confidence that when my time comes, I’d prefer to be hit by a bus — in an instant, it’s lights out, no prolonged suffering or regret. But most of us don’t get to choose, and even if we try to plan in advance, it’s impossible to anticipate real life.

I’ve been a witness several times to discussions between hospice workers and dying people or their families, and the most striking thing I’ve noticed is how inadequate these theoretical discussions can be. A few years ago, the dear mother of one of my most cherished friends was felled by a stroke while skiing on a perfect, blue sky day. She was 76 years old, and had lived each of those years to their fullest.

Present such a scenario — dying in your 70’s while doing something you love with your family — and many would deem it an ideal death. And yet, even a death as “good” as this one is hardly uncomplicated or easy. My friend’s mother didn’t die just then on the ski slope, but was taken to a hospital where machines kept her alive while the family gathered to decide what to do next.

These life decisions are never as simple as they seem in the abstract. In this case, the dying matriarch had recently lost her granddaughter to a tragic accident, and her oldest daughter, the girl’s mother, lived abroad — a day’s travel away. To face the unspeakable loss of a child and then your mother in such quick sequence was unbearable and the family asked doctors to keep mother alive long enough so that her daughter could bid farewell while she was still there in the flesh. It’s the kind of life-extension that might seem pointless in the hypothetical — had she been asked to check a box saying whether she’d want such life-extending measures,  she might have said no — but in practice it’s surely what she would have wanted.

Few people desire extreme measures in theory, but when it comes to the actual letting go, there’s no way to ever feel fully prepared. As my friend told me when I arrived at the hospital that day, you never wake up in the morning thinking, this is the day my mother will die.

Which leads to the issue that makes defining a “good death” so difficult — whose perspective are we talking about? From the dying person’s point of view, having it end on ski slope in the middle of a perfect ski day might seem ideal, but for the faraway daughter, the technology that kept mom alive love long enough to say goodbye was a godsend.

My neighbor Joanne had begun what seemed like a slow decline, and I was starting to worry what would happen when she could no longer care for herself. Her sudden, unexpected death feels like a blessing for having saved her the burden of needing care she didn’t want, yet it pains me to think of her lying in the hallway, alone, stricken and gasping for breath. I wish someone had been there to comfort her as she left this life, and, for myself, I long to hear her laugh one more time. This is where the concept of a good death meets its limit — as much as it may limit suffering for the departed, it can’t put a dent into grief.



Image: by curran.kelleher via Flickr

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9 thoughts on “What is a good death?

  1. You raise an important issue when you talk of perspective. Most of us would appreciate a quick death without a prior decline, but sudden deaths are much harder on those left behind.

    If it’s any comfort, your neighbor might not have been aware of her impending demise and might not have been lying there “gasping for breath”. A fatal heart attack or stroke can be quick and painless. And in the end, we all die alone.

  2. As a current hospice doctor and previous ICU doc, I can tell you that the chance to say good-bye, I love you, and I’m sorry…..is a gift to both the dying and their survivors. Pain and other symptoms at end of life CAN be managed to permit a gentle, natural death in those lucky enough to have to chance to look back and give thanks.

  3. I worked in neurosurgical and general anesthesia before my now grown children were born. As the hospice and ICU doctor above states end of life pain can be managed. Perhaps family relationships can be healed. Certainly saying-good bye is important.
    Yet, in the hospital and now, I rather focus on the living. Finding ways to remember shared experiences, build understanding and honor the past without being chained to it seem to me the better focus of those affectded by sudden death.
    I now work in human and civil rights, where there are far too many very bad deaths. If we can find a way to talk about the difficult topics, including our shared human frailty and vulnerability, I hope someday we can have less of those bad and violently painful deaths. Thank you for brining up the topic. My thoughts are with you in your time of loss.

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