On paper Dad ought really to have died in his mid 70s or early 80s.
He has already outlived his mother by 20 years and his father by 10 and is, in his own words, well passed his sell-by date. Thanks to the life-span lottery he is still going strong in his nineties, but I'm under no illusion about what’s ahead.
What I'm hoping for is a peaceful, at-home death, during our GP’s normal working hours so that he can register the death, making it as calm and straightforward as possible.
But should Dad be unlucky enough to die out of surgery hours, or at the weekend, or away from home, things may not be so easy.
Dad’s GP has suggested we have a DNR (Do Not Resuscitate) instruction in the house in case of an unsociable hours demise, when we might have to call an unfamiliar out of hours doctor or even the emergency services. He knows Dad well, and that the very last thing, the very last thing Dad would want is to be kept alive artificially.
It seems a good idea; particularly since my friend Carolyn told me that when she called for an ambulance after her Mum collapsed, she was asked if she was trying to resuscitate her. She said she wasn’t, because her Mum was actually dead. (Carolyn is a nurse and has experience of these things). At which point the call handler cautioned her that if she didn’t try to resuscitate her mother she might be implicated in her death.
The DNR instruction allows someone who is having an end of life cardiac arrest to get on with it uninterrupted. No intervention, no hospitalisation, no brutality. Of course if they have another kind of medical emergency - a fracture, an infection or even just a temperature – from which they can make a full recovery, then they will be treated in whatever way is necessary.
The DNR is simply to prevent the increasingly prevalent practice of trying to revive the dead for fear that, if you don’t, someone in the family will sue you. I’m pretty clear that in this family it would be the other way round. If Dad were to be dragged off to hospital unnecessarily, or given CPR to keep him alive when it is clearly his time to shuffle off this mortal coil, we would be going after the perpetrators for unwarranted cruelty.
According to the hospice movement 80% of us want to die at home, yet 50% of us will die in hospital – and what might otherwise be a natural and quiet departure at home becomes a life and death struggle in an ambulance or on a trolley in A&E.
Of course it’s only human nature to want to dial 999 when someone looks like they may be gasping their last, but I’m hoping I will be brave enough to override that instinct. I also need to make sure that everyone else who might be here with Dad knows the family’s wishes too, so that they don’t call an ambulance unnecessarily. Or that if they do, they must show the ambulance crew the DNR so that the paramedics know they can leave well alone, safe in the knowledge that they won’t be accused of negligence.
To be able to report that a loved one died peacefully in their sleep, that they didn’t suffer at the end, is important, and it's what all carers strive for. Not that the person who has died knows anything about it once they’ve gone, but the people left behind have to live with those last memories for the rest of their lives. So there’s a need to get as close as possible to a good death, for everyone. For me that would mean Dad being at home.
One of the inert siblings describes talk of the DNR document as 'grim' but I actually feel relieved that the form is in the house. Dad's wishes, and ours, are unambiguous, and incontrovertible. It takes away the burden of having to figure out, in the heat of the moment, what to do 'for the best'. And we have the paperwork - signed not by us but by Dad’s GP - to make it easy for everyone else to come to the same conclusion.
I think more people should be clear about these things. Much like funeral wishes. The one time you don’t want to have to make difficult decisions is in the grip of acute grief just after a death.
An aunt of mine asked my uncle - a doctor, who knew he was dying from cancer - whether he wanted to be buried or cremated. He told her 'I haven’t made up my mind yet' and died - having not made up his mind - two days later, leaving her to make a decision she was unsure of. If he had made that remark when he was well we would doubtless all have fallen about laughing but, given the circumstances, it wasn’t funny, it was actually rather unkind. And I think my cousins still have some misgivings about her eventual choice.
So let’s get all this difficult stuff out in the open and the decisions made before they have to be. I have already put in place the three important things - partly as an act of kindness to those left behind and partly because I would otherwise be leaving all the arrangements up to a combination of the inert siblings and my friends - I dread to think what they would end up doing!
So here is the holy trinity of last wishes:
* Carry a donor card – I do, and am happy for any bits of me that are still working to be passed on. It’s the ultimate recycling. I may even be able to give the gift of life to someone; something I wasn’t able to do during my lifetime.
* Make your funeral wishes known – I had great fun detailing my preferences and coming up with an order of service, precisely because the prospect of it actually happening is so remote. I can amend it when I like, but if I don’t have time, for whatever reason – I know I’m already good to go.
* Write a will. Even if you have no children and not much in the way of assets, it’s better to leave what you have to the people or charities that matter to you, rather than let the state decide who gets what, based on an archaic order of next-of-kin which may not reflect the closeness or otherwise of your relationships. It also means less money ends up in the hands of lawyers.
Once you’ve done those three things, you can forget about death and dying, and get on with living.
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