How to have a good death

My job is a little wacky: I talk to dying people on the phone all day long. Sometimes it’s really depressing. Most of the time I deal with it by making really morbid jokes with my coworkers. Sometimes I deal with it by getting philosophical.

The dying people I talk to call my organization because they want to have a good death. I can tell them what their options are, some of the things they might want to plan for. We talk about what they hope never happens to them. I don’t tell them what a good death is, though–that’s a very personal choice, and not my place to tell a client. But I do end up thinking about it. I see a lot of people who die in exactly the way they hoped they wouldn’t, and other people who’s deaths are beautiful, transformational experiences for everyone who was able to witness it. I’m only 28; there’s a lot I don’t know about death and dying. But here’s what I do know, based on what I’ve seen, with the caveat that some of these things are things you can choose, while others sometimes are not.

  1. Accept that you’re going to die. It’s inevitable, folks. We can delay it, but it’s gonna happen. Life is a balancing act between putting off death and preparing for it. If you put too much effort into the first, there’ll be nothing left for the second.
  2. Accept that your health will decline. One of the hardest things for my clients to deal with is adjusting to not being able to do all the things they used to do. Some people have a harder time than others–someone who lives a 15 minute drive from everywhere they routinely go feels tremendously isolated when they can’t drive. Spend some time developing a sense of self beyond what you do. Who are you if you can’t pursue your mountain biking hobby? Who are you if you lose your eyesight and can’t read? I heard from someone the other day who felt that life was worth living as long as they had one big belly laugh every day–that’s the kind of identity I aspire to.
  3. Talk with your doctor(s). Find a doctor who is willing to be honest with you. Be blunt with your doctor, and encourage them to be blunt with you. Doctors are people too–most of them are just as afraid of talking about dying as everyone else. But you need your doctor to let you know when you have a terminal diagnosis. When treatment will help, and when it won’t. When it’s appropriate to enroll in hospice. When it’s not worth putting up with the side effects of whatever medication might help cure, and instead focus on your comfort and on your relationships with your loved ones.
  4. Talk with your loved ones. They’re going to be making medical decisions for you when you can’t make them for yourself. Spare them the pain of trying to figure out what you would have wanted. It’s never easy, but it is much easier to say, “Mom told me that she didn’t want to be kept alive by machines when there was no sign of brain activity; turn them off” than to say, “I think Mom wouldn’t have wanted to live this way, I only hope I’m doing the right thing.”
  5. Write down what you talked about. In most places this means having an Advance Directive. Writing down your wishes can mean less fighting between your family, your doctors, or any facility where you’re receiving treatment. It only kicks in when you’re no longer able to speak for yourself. But writing it down is really barely half the point–ideally it’s more of a place to start the conversation than to end it.
  6. Die in a safe, calm place, where you have control. This is rarely a hospital, or anywhere with beeping machines, people who need to check on you on their schedule and not yours. Dying is the one thing people have to do on their own body’s schedule. Maybe your space needs some modifications like a hospital bed, but have familiar sights and sounds and smells around you. Turn up or down the lights as you want to. Be able to eat your favorite meal, even if it’s only one bite.
  7. Die with friends around you. Or die alone. Some of my clients die in the middle of a party, with friends gathered in a circle around their bed singing them out. Some of my clients hang on in a coma until everyone leaves the room. Both are beautiful. My clients’ loved ones frequently tell me the client died like they lived.
  8. Die in hospice care. Hospice is great. Hospice is the best. Hospice will allow you to stay in your home, with less discomfort, longer than any other option. Hospice has resources to support your family. The second your doctor says you’re eligible, sign up for hospice.
  9. Feel satisfied with your life. Even for people whose deaths don’t go the way they hoped, if they’re okay with how they lived their life, it doesn’t matter as much. I don’t expect to be happy when I know I’m dying, but I hope to at least feel equanimity.
  10. Find meaning in death. For a long time I thought the way I’d most prefer to die would be to have a grand piano dropped on my head. Then I wanted to die like Moliere, dropping dead on stage with the audience applauding while playing a hypochondriac . One of my friends tells me I’m confusing awesome deaths with ironic deaths. I’m not so sure. Death too often feels pointless; it’d be nice to at least know your death makes a good story.

What do you think? How do you want to die? How do you never, ever want to die? Here’s hoping either will be *ptui ptui* a long, long time in the future.