We are enthusiastic season ticket holders to The California Shakespeare Theater in Orinda California. The production of Romeo and Juliet by William Shakespeare in this season is superb. Go see it if you can! The Director, Shana Cooper, brought an element of mime to the production which really underscored the love story. Even more, she brought this perspective, "Romeo and Juliet is not a story about the stars controlling our destinies - it’s about the urges and vulnerabilities of being human." This makes me think of our ultimate vulnerability - death.
Even though the parents of Romeo and Juliet could not have predicted their children’s passion nor their tragic deaths, they could see some early warning signs. We too, can sense and prepare when life sends us early warning signs to be prepared for our own or a loved one’s death.
The first early warning sign occurred on the day of their births. A live birth is a 100% guarantee that death will follow at some point. Between that first breath and our last, we all look for meaning in our lives. Yet, something about the birth and death experience offers us the potential for experiencing a sacred moment. Our spirit’s release from the earth is a sacred time; as sacred as the morning dew on a new soul loosed upon the earth in birth.
A bit like the Nurse who cared for and loved Juliet, even though she was not her own family; I find that I am like a "midwife unto heaven’s gates" for many of my clients. This makes me ponder the experience we will all face. I find a kind of comfort, hope, and joy in seeing the sacred surrounding us in our final breaths.
What is the nature of this experience? According to the Kaiser Permanente, Palliative Care group, our experience of dying is quite different today than it was for people 100 years ago. Instead of an expected, yet quick event; we now approach death as if we can forever order a pill to avoid it. As Dr. Robert A. Johnson likes to point out, "People used to just die! Now,
we .....
are.....
dying..........."
The course of dying is often a slow progression. This means that if we make it to our 75th birthday, in 90% of the cases, there are early warning signs to death. Only 10% - 15% of diseases create a sudden death, the kind where we just fall asleep and die.
All other disease trajectories provide some clues that we need to use to help us prepare for this event before we have lost the ability to make medical, financial and spiritual decisions. At a recent East Bay PFAC meeting, Kathy E. Dalziel, RN, MSN with Kaiser Permanente, Palliative Care Group, pointed out over 50% of the patients were incapable of making their own medical choices in the time leading up to their death.
According to palliative care providers, 60% - 65% of Americans will enter death after either mild cognitive impairment has begun or an initial major organ system failure has left the elderly patient weaker for a period of time1.
40% of Americans will die due to dementia or mental frailty; normally within 10 years of initial presentation of mild cognitive impairment or within 6 - 8 years of an actual dementia diagnosis2.
20% - 25% of Americans will enter death within 2 - 5 years of initial and ongoing major organ system failure3.
20% - 25% of Americans will expire due to the onset of an incurable cancer. Decline may be over a few years, but often within just a few months4.
For young people, like Romeo & Juliet, when death occurs, it is more often sudden or due to external causes - homicide, accident or suicide. Thankfully, the percentage of deaths in those under age 24 has been shrinking with increased medical knowledge and protections. Today, more parents of teens use a pretty good early warning system which could have been used by Romeo or Juliet’s parents to avert their tragedy. They encourage their children to talk to them.
Take Stock & Talk
On the other hand 73.5% of the deaths in the U.S. in 2011 were experienced by people 65 years or older 5. These were most often due to cancer, heart disease, chronic respiratory or liver conditions. These diseases give us the "gift" of talking with our loved ones about what is on our hearts.
With the average age expectancy at 78.7 years, if you are over the age of 65, don’t wait to review your written wishes.
Make sure you exercise your choice to have the loved one or person of your choosing available to you during this time. Once you begin to see some of the early warning signs if disease or mental incapacity begins to impair your life, talk to your loved ones about your wishes and what you might need. Don’t let our culture’s current perspectives on death keep you in denial. Instead, find someone to help you navigate this conversation with your family.
If you do not have a nearby family member who can serve your needs, you may benefit from talking with us about what a professional fiduciary can offer. Having a ready, willing and able health agent and qualified financial agent is crucial to reducing your worries and increasing your peace.
At each decade, review your estate plan. After you turn 75 years old, take stock of your circle of care regularly. If needed, choose a licensed agent and advocate to help you navigate through your own end of life choices. Our fiduciaries are trained in a unique LegacyMapping™ process to walk alongside you and help you to discover and document your wishes, needs and choices.
Footnotes:
1, 2, 3, 4 - Lynne, Joanne, Kaiser Permanente, Palliative Care Disease Trajectories.
5 Miniño AM. Death in the United States, 2011. NCHS data brief, no 115. Hyattsville, MD: National Center for Health Statistics. 2013.
