Life certainly gets busy sometimes. I am working full-time again and sometimes it seems impossible to find time to cook and especially to write in my blog. Unfortunately, cooking at home is still the healthiest way to eat. So I try to plan a week's meals, and go to the grocery store with a list so I have the ingredients I need.

I am also getting a box of fresh local produce delivered to my door once a week by The Farm Table. They even have recipes for all the interesting veggies they put in my box. It forces me to cook good vegetables almost every day. And they are sending many greens that are either not readily available in the grocery store, cost too much, or look too wilted.

So I have been doing some research on the greens and learning which ones are good raw in salads. Kale is my new favorite lettuce. This article comparing greens is amazing! Have you ever tried greens in your smoothie? Also amazing!

I have been urging everyone to write an advanced directive, but recently, I realized that it is hard to have it with you when you need it. Whenever you are admitted to a hospital, even for outpatient surgery, they ask if you have an advanced directive. How many of us can remember to bring it with us? And of course if you have an accident, you certainly don't have it with you. Thus far I have found two ways to store it on the internet. One website, My Directives, will guide you through writing one that is compatible with state guidelines. Then you can print out a card and carry it with you, so any hospital could access that record of your advanced directive.

There is also a Virginia Registry that will store your advanced directive. You can download a form, fill it out, and then save it in the Virginia Registry. Many people think you need an attorney for an advanced directive, but Virginia has made it easy to use a form and register it. If you know what you want, fill in the form, sign and date it and have two witnesses sign it. You do not need a notary or an attorney. If you are not sure about what you want, call me. I can explain what therms mean, and help you look at your own values, so you can verbalize your desires.

"Can't we have lunch instead?" is the response one daughter gave, when her mother brought up the conversation about end-of-life care. Recently, I brought up the topic at my relatives' house. Fortunately, I plunged ahead with the topic for at least 5 minutes, before someone said, "Can we talk about something more pleasant now?" It might be easier to talk about sex!!
Ellen Goodman, a writer for the Washington Post, co-founded The Conversation Project which provides a starter kit to help people get going on this conversation. They commissioned a survey, and found that 9 in 10 Americans think it is important to discuss end-of-life care wishes, but less than 3 in 10 have actually done so. Many people say it is too soon to talk about it, but it is "too soon until it is too late."

Aging gracefully

Here's to growing older! A friend in his eighties says, "Growing old is not for the faint-hearted." I just read a piece in the New Yorker by Roger Angell, now in his eighties. Since growing older is inevitable, let's embrace it.

Having a choice

There was a nice opinion piece in our local paper. It inspired me to write a letter to the editor, entitled "Have that dying wishes conversation today." What do you think? Ready to start a conversation?

No one wants to think about dying, much less talk about it. Putting off the conversation means that we never talk about it. So many people do not die the way they want. Consider this fact: Seventy percent of people want to die at home, but seventy percent die in the hospital, according to The Conversation Project. These pictures reminded me of some of the differences between the home and the hospital. Everyone should have that choice, but sometimes a person with a terminal condition cannot speak for themselves, and they have never expressed their desires to family members.

No one wants to burden their family members with making decisions for them. Unfortunately, when decisions need to be made in the intensive care unit about withdrawal or withholding of treatment, studies suggest that less than 5% of patients are able to participate in the decision-making process. Almost all states have a legal form that a  person can fill out to express their wishes, and name a medical power of attorney. In fact, The Conversation Project reports that 82% of people say it is important to put their wishes in writing, but only 23 % have an advanced directive or Living Will.

Why can't we talk about death? It is not a disease that we catch by talking about it. As Alexandra Drane pointed out, "Talking about sex won't make you pregnant and talking about death won't kill you." Maybe we just need to change our perspective. Aren't we really talking about how we want to live up until the moment we die?

It seems like there are a few important events in our life: marriages, births, and deaths. We all prepare for births and marriages for months in advance, hire wedding planners and doulas, and have long discussions with various family members about our choices. The only thing about end-of-life decisions is that the date is unknown, though it is inevitable. With the uncertainty of when it will happen, it seems like we ought to be prepared.

I am spending a few days in beautiful snowy mountains. Our host shared his story of the miracles of modern medicine. He had open heart surgery to replace a valve. Because of complications during the surgery, he was in a coma after the surgery. Tests showed that he still had brain activity, and he was in good health before the surgery. Fortunately, his advanced directive guided his wife in what they should do next. He was in a coma for four days before he awoke. He also had suffered a small stroke after the surgery. Now, after some physical therapy, he is living a normal life, full of activity, like Nordic skiing. His medical care helped him survive the complications of surgery, and his advanced directive guided the medical team and his wife to continue life support, because he did not have severe brain damage.

On the other hand, another friend (that I will call Jane) shared the story of her mother’s death last year. Jane’s mother, at an advanced age, developed a terminal disease. She ended her days in the hospital, unable to breathe on her own. She was on a ventilator for ten days before she died. Jane now realizes how unnecessary and traumatic it was for her mother and the whole family. She has two siblings and it was very difficult for them to make decisions about her mother’s care. Their mother had no advanced directive, and they did not know what she wanted to do. There was no hope that she would get better. Jane really felt that her mother should have let them know what she wanted before the family had to make end-of-life decisions. Leaving your family to make these decisions can be very cruel. Advanced directives are only used when you are unable to make your own decisions, and they clarify your wishes for your loved ones.