We plan for weddings. We plan for honeymoons. We plan for births and have baby showers to gather clothing, toys and furniture. We plan our education and our careers. We plan for our retirement. We even plan for our families after we're gone.And while we're doing all that planning, we tiptoe around the elephant in our living room.Stopping to address that elephant, our own dying and the dying of those close to us, is what former Burlington Free-Press columnist Stephen P. Kiernan writes about in "Last Rights: Rescuing the End of Life From the Medical System."Kiernan begins by describing how death has changed in America in just 30 years. A man shoveling December snow in 1976 might feel pain in his chest. But when he falls into the snow, there is no 911 emergency response and the EMTs bring no defibrillators when they arrive, too late, in their ambulance.Thirty years later, Kiernan reports, deaths by heart attack have dropped by 40 percent, because of advances in communication, transportation, training and medicine. Similar progress has been made in prolonging the lives of stroke and accident victims, which leads Kiernan to conclude, "The way we die has been utterly altered. Today people's dying occurs gradually, from sicknesses that take their lives by degrees."What is happening — the changes in how we live and how we die — is of course, not new.
And it is this change in death from the abrupt, accidental and violent, to a gradual process for so many that interests Kiernan. "Rights" describes that change and "its implications for doctors and families, its significance for the people you love and one day for you."Kiernan learned of these changes and their implications the hard and personal way. His father died in a coma, hooked up to various devices in the Boston hospital he had been airlifted to from Cape Cod. The last words Kiernan's father said to him, five days before he had a stroke, were "I am not proud of you."Responding to his father's illness, Kiernan saw himself and his siblings as representatives of a larger sad reality. "We were textbook cases of the American approach to death. We were completely unprepared, unschooled and unassisted."Some years later, however, when his mother is dying of cancer, the Kiernan family is able to apply the lesson they learned watching their father die — "We learned how to help a loved one die well."Kiernan writes about all that he learned between the death of his father and the death of his mother. He learns about the training of doctors, the concept of Hospice, the intricacies of insurance, the dynamics of families facing loss. And what he learned, such as "medicine and love are not the same thing," is valuable to all of us.This is not just a book about death and dying. It's a book about living more effectively, even joyously, by recognizing the inevitable experience most of us try to ignore.
Kiernan encourages us to plan and tells us what to consider as we approach that elephant, because there "are options and opportunities; there are choices."