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."

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?

Everything can change in an instant

A recent column in our newspaper gave me some food for thought. It talks about a man who was on a flight which was forced to land on the Hudson River. It is a good example of how things can change in an instant, and the thoughts that go through our heads during those seconds that seem like hours. Some things become so much clearer under that microscope of impending death. Our priorities in life jump to the top of the pile of thoughts.

Ten years ago, my car skidded on a curvy road, and all of a sudden, it turned in a complete circle and  then flipped over completely. While this was happening, my thoughts were racing. My brain was yelling, "I am not ready to die! I still have some important work to do! It is not time yet!" Fortunately, a nice bank of dirt stopped my car, I was wearing my seat belt, and I was able to climb out of my car without help. That brush with death re-focused my efforts to get that work done, but it also made me decide what was important.

We have all heard the phrase, "Carpe diem", or "Seize the day." To me, this means living every day to the fullest extent possible. It means making time to nurture myself, and balancing all the demands on my time, like work, family, exercise, and housework, with some time to relax and read a good book. As a "boomer" getting older, I know that I might have twenty to thirty more years to live, or maybe not. So I am developing my own "bucket list" that includes some travel. Since I am seizing the day, I will not wait until I retire to make that happen. I will travel a little bit every year.And I will stop to watch the birds a few minutes every day. Carpe diem.

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.