Our ride into the sunset
by Dr Nihal D Amerasekera
“Media vita in morte sumus”
- In the midst of life, we are in death. This is the first line of a Gregorian
chant circa 1300. This rings true now as it did all those years ago. Presently
we battle through our lives in the midst of Covid-19. For septuagenarians like
myself, in the autumn of our lives, there are many other pitfalls just around
the corner.
At any age we all lust for
longevity. Although we all will face it someday, our aversion to talk about
death is universal. This is partly due to the fear of the unknown and also not
wanting to tempt fate. During my childhood, grim legends were abound, and tales
were told of death, devils and the darkness of hell. These daunting images
continue to colour my thoughts even now. It is true there is little point in
talking about death when we are young and healthy. The scene changes
irrevocably when we become septuagenarians. This is the time to bite the bullet and face
reality while still able to enjoy the good life.
Life expectancy has risen
considerably in our lifetime. Perhaps, professionally, we have helped to make
this happen. In the United Kingdom, the life expectancy for men is 79 and for
Women 82. Living longer has many benefits. It is indeed so wonderful to see our
own grandchildren grow-up and perhaps also to see their children too. But there
is a price to be paid while the years take their toll on us. The sudden deaths
that took away our parents and our grandparents don’t happen anymore. We just
live longer. Our bodies continue to wither away as the years pass. A fistful of
tablets and an earful of advice keep us going. The joints continue to creak and
the backaches as we trundle along. I can feel the gradual decline and the loss of
energy as the months' pass. I am not as steady on my feet as I was last year. Gravity
is gradually trying to take over when I walk or try to maintain my erect
posture for long. These issues that are rather trivial now will only get worse
with time. If I live long enough I will need help for walking, feeding and
ablutions. This may be with a carer at home or in an institution. This requires
careful thought and judicious planning.
Life must have an end. A rapid
exit is everyone’s dream. Unlike for the previous generations, the end for us
may not be swift. Cancers or degenerative nervous diseases like strokes, dementia
and Parkinsonism are some of the common ways to exit this world. Departing this
life is never pleasant. Then again, we will need help in the way of a carer or
be confined to an institution. These issues need careful planning now when we
are compos mentis. Importantly the family should be
consulted. They must be aware of our choices that may have significant
financial implications. We must remember it is their pain and burden too. They
must have the information to discuss with us the feasibility of our plans.
To plan ahead we must make an
informed choice. For this, the doctors must provide us with the information with
honesty. Thankfully, in the new millennium, the conceit and the patronising pomposity
that existed in the medical profession has largely melted away. This has resulted
in far better rapport between the doctor and the patient. When confronted with
a terminal illness we need to know the prognosis, the positive and negative
implications of treatment and also of having no treatment. It is invaluable to
weigh up the implications of a range of alternatives, some of which may be “off
the menu”, before making a choice.
It is wise to leave written
instructions as to our care including treatments we do not want to have. This
is legally binding and is called the Advance Decision to Refuse Treatment
(A living will). I know some have instructions not to be resuscitated. Some
want all treatment stopped including antibiotics. We can also allow someone
else to make the decisions for us when we can’t. This is called the Legal
Power of Attorney. Some cancer patients do not want any treatment. They do
not wish to prolong life not wanting the stress and struggle of radiotherapy
and chemotherapy and its many unpleasant side effects. It is imperative the
doctor should discuss the quality of life on treatment. Many others show great
resilience and courage in continuing and completing the treatment schedule and
we respect their choice.
If terminally ill I should have
the right to end my life. This issue has come into prominence in the UK in
several high-profile cases of Motor Neurone Disease and Multiple Sclerosis that
went to the Supreme Court. Adequate safeguards must be built in for this. In the UK
there has been a shift in common morality for euthanasia and assisted suicide both
of which are illegal under English law. Some go to Dignitas in Switzerland, a
place for assisted suicide, to end their lives. Ending one’s life is the last
resort. The National Health Service provides good palliative care as well as providing
psychological, social and spiritual support.
The answers to the many questions
that arise and the solutions to the many problems that surface will vary
according to our personal circumstances. It is paramount that the wishes of the
patients and their relatives are respected. I am merely raising awareness to a
common problem we will all face sooner or later. As I write I know of 90-year-olds,
like Queen Elizabeth II and the Duke of Edinburgh, who are still smiling,
enjoying life and their families. But they are no doubt in the minority. Some may still have the old fashioned, laid-back
and carefree attitude thinking “Que sera sera” Whatever will
be will be!! This may just leave our loved ones in the dark about an issue
which may be long and protracted and financially draining.
Making that final journey to exit from this world is something we must all do in
the fullness of time. This challenging journey may take from a few days to a
few months. Professional medical input is vital during this period to remain
free of pain and to receive psychological support. We must leave behind the
sadness and regrets of the past, taking with us only those happy and joyful
memories. In the lonely waking hours, one may wish to walk with God for comfort
and support or focus the mind on meditation and mindfulness. Some receive
comfort from the “Mozart effect” of listening to soothing classical music.
There is a lot of helpful advice available from professionals, carers and
institutions to reach that final destination with dignity.
As much as there is no holding
back the night, there is no hope of a second dawn. I feel we leave this earth
never to return again. I seek the wisdom of that great Roman Poet Horace "NON OMNIS MORIAR" (Not
all of me will die). Our children and grandchildren are shaped by
the genes they inherit from us. They smile and laugh like us and even may
think like us at times. They will carry our baton into the future.
As septuagenarians,
our minds are much calmer now. There is no burning ambition or desire to chase
money or position. We have done our caring for our progeny. Once we have made
our choices for our parting it is so important we must return to our regular
routine. It serves no purpose to dwell on death and dying. We will deal with it
when it comes. It is so true we will not pass this way again. So enjoy the beauty
of nature, the birds and the bees and the company of family and friends. It
is only then we can sing that famous song “Que sera sera”.
Here are my
best wishes for a happy and peaceful journey's end with poise and dignity.