Death. The logical result of all life. And yet, we don’t give much thought to it, preferring instead to worry about things like traffic and whether our sports team won on Sunday. We’re such silly monkeys, aren’t we?
And yet, there it is. A hard truth that someday you and I will simply not be here. This conversation we’re having together in our heads via words and technology will dissipate into the ether, leaving no trace. All the opinions, experiences, judgments, beliefs, emotions, memories, thoughts, turmoils, joys, attachments, and sorrows—*poof*. And the sun will rise the very next day and billions of people all over the world won’t even know we’ve passed. And so it goes.
We have no control over it. But as Paleo adherents, we absolutely should consider planning the build-up to the final leap. Because the same logic that has made us skeptical of food companies, Big Pharma, and healthcare applies to the business of dying in this country. How bad is it? We’re now seeing a generation of doctors who are themselves facing death, and the majority of them wouldn’t want to go through the gauntlet of treatments. They are choosing otherwise, as this great article describes, and so should we.
Whether it’s crossed your mind consciously or not, a component of the Paleo diet is a promise to be free of many (if not all) the diseases of modern civilization: obesity, diabetes, high blood pressure, heart disease, cancer, Alzheimer’s. Chances are that you know someone who has developed a chronic condition before withering away and dying, and it ain’t pretty. As witnesses to the process, we get sucked into trying to do everything we can, so that even if we mistrust modern medicine, we pray that it can offer some relief. We get thrust into making decisions with little understanding of the consequences.
For some background here, my husband is an emergency physician. We happen to live in an area with a high number of retirees, which also means we have a large elderly population. He sees them in his department all the time. So let’s walk through a scenario here.
Let’s say you’re hanging out with Grandma when she passes out and hits her head on a table. She’s been mostly healthy up to now, save for a few medications for high blood pressure and sleep issues. You bring her into the emergency department unconscious and learn her life is in danger. The doctor comes to speak with you and asks you what sorts of measures you’re comfortable with. Of course, Grandma would want you to do everything you could, right? She was just giving her friends heck at her bridge game and baked a pie for the church function this past weekend. She obviously has more life to live.
Here’s what happens:
- Grandma’s clothes are cut away to expose her chest and she’s hooked up to monitors.
- She’s not breathing so well on her own, so they want to intubate her. First, she’s given medicine to paralyze her so she doesn’t have a reflex against the tube in her throat, at which point the clock is ticking, because the doctor only has a couple of minutes to get oxygen back into the patient. Then they insert a metal blade to pull her tongue up and out of the way, which can break teeth if it proves difficult to secure the airway. If all goes well, she gets a tube in her trachea.
- Her pulse is weak, so they initiate chest compressions. Several ribs break in the process. They still can’t get a great read on her pulse, so they insert a deep line to a central vein in her groin to measure it more accurately.
- Her heart rhythm is off track, so they administer adrenaline which can cause a stroke or heart attack. CLEAR! They shock her chest to get the rhythm back in line.
- A catheter goes into her urethra to drain the bladder.
- A tube goes down her nose into her stomach to get the air out from when they bagged air in before the intubation.
Luckily, she makes it through and Grandma is transferred to the ICU. While there for her three week recovery, she gets pneumonia and an infection at the site of her deep line insertion in the groin. After going home, Grandma is never the same. Her energy is 20% of what it was before. She has no appetite, no interest in her bridge game, and begins to look more and more frail every time you see her. There are several more frustrating visits to the emergency department when she’s weak, dizzy, and hallucinating. There are never any answers and only more prescriptions that seem to cause more complications than they’re worth. Finally, 8 months after her fall, Grandma dies in a hospital room after several strokes and another case of pneumonia.
As sad and gruesome as all of that is, that’s if you’re lucky. Grandma didn’t have diabetes, heart disease, Alzheimer’s, or any number of the chronic conditions that plague our elderly populations for years and necessitate extreme medical interventions like amputations, heart procedures, and massive amounts of medications with problems of their own. Taking Grandma to the hospital was the right thing to do in that instance. But oftentimes it’s not the right decision, and my husband sees many of these types of patients over and over with alarming frequency.
How does an American death in old age compare to a hunter-gatherer death in old age? Mark Sisson has a great run-down (here) on an important study conducted by Gurven and Kaplan which not only disproves that annoyingly persistent idea that hunter-gatherers lived short lives, but shows that large sections of their populations could reach 70+ years of age (bold his):
Second, Gurven and Kaplan show that “degenerative deaths are relatively few, confined largely to problems early in infancy.” Heart attacks and stroke “appear rare,” and the bulk of deaths occur when the person is sleeping and are free of obvious symptoms or pathology. Most “degenerative” deaths are attributed to “old age.” “Illness” is the main cause of death among all age groups and all populations, except for the pre-contact Ache (supreme hunters), and the authors break illness into different categories. The big killers were infectious respiratory diseases, things like pneumonia, bronchitis, and tuberculosis. Gastrointestinal illnesses also did a number on them, accounting for 5-18% of deaths, with diarrhea (probably stemming from parasites and coupled with malnutrition) taking the lion’s share.
So how would it differ? I’m vastly oversimplifying here, but without the access to therapies that extend the quantity of life (but rarely the quality), Grandma would take ill, linger for about 2 weeks while her family cared for her, and then pass quietly in her sleep.
So why are we denied the same privilege? The way our culture is set up, you can be brought up on charges for reckless endangerment, elderly abuse, or criminal neglect if you try to manage outside the system of nursing homes, hospitals, or social services. Just as there’s an entire industry making billions of dollars from shilling processed foods with government backing, which then refers you to the gigantic pharmaceutical-healthcare complex, there’s also a huge industry that benefits from the business of dying in this country.
One of the main problems, one that can be addressed within each of us personally, is that we are removed from the natural processes of death, and therefore lack the experience to deal with it. Just over a century ago, people often nursed the dying and buried the dead on their own. Now it’s illegal to do so. Illness was common and there was little real relief to be expected. Trauma occurred and someone had to reset bones and sockets. There was nowhere to go and nobody to do the work for you. Every human culture has had ceremonies for dealing with the dead in their own way.
I’m not saying we all need to volunteer at a mortuary to get in touch with death, but the first step is to consider this a practical matter. It’s not a matter of if, but when. It may come gently, it may not. It may be prolonged and painful, or swift and over before you know it. We may have warning and a chance to make things right or not. Work on easing your fear around it. However it happens, the result is the same for the dead. The rest is for the living to sort out.
As for the medical establishment, it takes preparation in order to navigate the system in a way that won’t prolong suffering or subject us to unnecessary tests and procedures. I never understood the role of labor and delivery doulas for pregnant women until I was a pregnant woman myself staring down the barrel of some complex possibilities. Anyone who’s been through an emergency will understand this—when the chips are down, decisions have to be made. If something had happened to me during delivery, my husband—even though he’s an ER doc—would be too invested in my care to think critically about medical decision-making. And yet, that’s what we’re asking people to do all the time, to make big decisions with very little information or understanding under stressful conditions. What we need now are medical doulas for everyone, people trained in medical decision-making who can steer you in the direction of your goals.
We have a healthcare system flooded with patients with complicated, chronic medical problems. These people have emergencies all the time. Medical interventions can extend their time here, but we need to start asking whether it’s worth the pain, suffering, and—yes—the cost. Is there a better way? This has to be decided on a case-by-case basis, and you can start by deciding for yourself and preparing in the event you need to make those decisions for someone else.
So what can we do?
- Make your wishes known to family and anyone who might be in a position to make decisions about your healthcare. Put it in writing with a Do Not Resuscitate order, advance directive, and/or a living will. When/if you develop a terminal condition, discuss your plans with your doctor. Unfortunately, none of this guarantees those wishes will be carried out.
- Even if you’re young, now is the time to think about this. Economic times are tough, but do your best to plan for a financial future that may require thousands of dollars a month in care. Don’t expect your 401(k) or Medicare to cover this stuff.
- Find ways to get more comfortable with the idea of death. Volunteer at a nursing home or hospice. If you have a church, offer to visit members of your congregation who are ill at home or in the hospital. If you have a friend who is a caregiver, offer to help in small ways like bringing meals or hanging out for 2 hours once a week with the person they’re caring for so they can get out of the house for some alone time. Look into the philosophies and religions that talk about death. Yoga and Buddhism both have a lot to say about this. The last pose of a yoga class, Sivasana, translates to “corpse pose.” The idea of letting go is merely practice for death—the ultimate letting go.
- Just as we go outside the norm with our chosen way of eating, so we must in regards to choosing a death. Be prepared to go to the mat for the wishes of the person in your care. Make sure you have your legal ducks in a row so your decisions won’t be questioned.
- If you’re in the position of making decisions for another, become well-versed in their illness and ways to manage it. Consider attending their doctor’s appointments or having a line of communication with the doctor (will require permission from the patient).
- Realize you can deny treatment at any time. A friend of mine has a 94-year-old father who recently went through a rough patch of hallucinations, and the doctors suggested an MRI. For what?! To stress out a confused, old man by poking him with needles and sticking his head in a giant, noisy magnetic tube? Even if they found something, chances are they wouldn’t operate because he wouldn’t survive the surgery. An MRI can’t tell us that he’s lived a wonderful, long life and enjoys his close relationship with his son. He should be allowed to live out his days in peace.
- Look into alternatives. Hospice, respite care, and resources that allow people to age in their homes with assistance.
- If someone in your care is in a nursing home, be sure they understand your wishes and that they consult you before making any calls. Nursing homes are big offenders of calling ambulances for every little problem and they accept zero responsibility.
- Death With Dignity
- Caring Connections
- Hospice Information
- Age in Place
- Jane Brody’s Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life
- National Caregivers Library
- Sacred Dying Foundation
- Green Burial Council
- Home Funeral Directory
EDIT: I just wanted to add here that I’m not against medical treatment for conditions. When the patient is younger or the prognosis better, there is a lot of information to weigh and these are complex decisions to be made. For example, as a young mother, if I were to receive a cancer diagnosis, I would probably do some research, try a cancer starvation diet, and then look into therapies from there. There’s just too much at stake for me right now to not consider conventional treatments. Western medicine has made great strides in a few areas and is still in infancy in so many others. The burden is on us as consumers of healthcare to decide as best we can for ourselves.