Your Exit Strategy
Helping People Plan Their Final Days©
Steve Jobs, Founder of Apple computer, knew his cancer was terminal when he said in the 2005 Stanford Commencement Address: “Remembering I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.” Steve Jobs, 1955 – 2011
Take a deep breath. Mentally put yourself in Steve Jobs shoes. What would you have said if you were in his circumstance? People like to talk about how they planned their vacation, or reasons why they chose a specific brand when buying a car, but when I ask “How much time have you spent preparing for your final days–what I’m calling your exit strategy?” I get stonewalled. My daughter used to raise her hands, saying “Stop! I’m not going to talk about this now. You may be ready to, but I’m not. Send me anything you want. I’ll print and file it.”
A few years ago our lives brushed tragedy: In their seventies, enjoying their vacation driving through Kansas, a car accident killed both parents of people we loved. A few years earlier, failing health caused them to relocate a thousand miles from their home, so their daughters’ families could help take care of them. Unfortunately, they’d never mentioned end-of-life issues, or prepared any legal papers. Can you imagine their shock, when two different hospitals in Kansas called with these dreaded words: “I’m sorry; your father was dead at the scene.” A few hours later, another call: “I’m sorry, we air-lifted your mother to our hospital, but her injuries were so massive, we couldn’t save her.” What if you suddenly became an orphan? Imagine the devastation, the double whammy to the six grandchildren who adored their grandparents. My daughter said, “Wow, Mom. I’m so relieved you’ve been planning ahead.”
I’ve never forgotten an equally bad tragedy which happened twenty years ago to my mom’s best friends. Invited for dinner at their daughter’s house, they first stopped to put flowers on their parents’ graves in the old church cemetery, in central Ohio. When the doorbell rang, Susan Rae wondered why her parents didn’t just walk in, as usual. Instead, a grim-faced State Policeman was staring at her. She later said, “I knew he didn’t want to be there: I didn’t want to hear what he would say.” Just as her parents turned onto a deserted two-lane highway, their car was rear-ended by a speeding truck. Both were killed instantly. Aren’t these true stories hard to wrap your mind around? Buying two caskets, planning a double funeral—and then, how do you pay for it? Have you ever considered the financial and emotional mess you’d leave behind if you died suddenly? What if you hadn’t taken the legal steps to protect your loved ones?
I’ve spent several years researching end-of-life issues. I believe we can become used to the idea of talking about death if we go slowly. Use Your Exit Strategy: Helping Families Plan Your Final Days for an overview; My Exit Strategy workbook as a road map. Choose which papers you need to complete first; let the momentum of tackling this difficult subject carry you forward to the next topic.
Are you wondering why I’m committed to writing, plus developing seminars on this topic? Here are my three easy answers:
- For at least twenty years before their deaths, I heard “Oh Lord, please take me home. I’m ready to go” as a daily plea from my mom and her sister, my favorite Aunt Mary. Ironically, they were in great health, enjoyed family visits to other states, traveled to the Holy Land, Australia, took a train to California to visit a cousin, plus a cruise to Alaska.
- A diagnosis of Stage IIIA breast cancer (May 2004) forced us, my new husband (Rob) and me to look death in the eyeball. Nobody said get your papers in order, but because I shared the same gene pool with my dad, Uncle Stanley and Uncle Jack, all cancer victims, I expected to die as quickly as they had.
- We came really close to the business end of a buzz-saw just before Christmas (2010) when Rob was rear-ended in a near fatal accident. Six weeks later, the huge bruise on his leg developed into cellulitis. After waiting six hours in the Emergency Room, at midnight he was admitted to the hospital in suburban Los Angeles. Imagine our shock when the doctor said: “Your husband has Acute Kidney Failure. His kidneys have shut down. We don’t know if it is because of the staph infection or the massive antibiotics we’ve administered, trying to kill the infection.” We were flabbergasted! After fourteen treatments in the hospital, I drove him to dialysis: three times a week, for three and a half months.
I didn’t know when I took the fifty hour training program at National Presbyterian Church to become a Stephen Minister in 1995 that it would turn into a lifetime avocation! It’s been an honor and a privilege to help people walk through a crisis, like a terminal illness or death in the family. But God always has other plans for our lives, doesn’t He? After I finished my chemo, radiation, plus half dozen surgeries, we rented my home in Bethesda, Maryland. In late June, 2005, while Rob drove our motorhome, I called friends to tell them: “We’re now vagabonds, heading out west. We’re full-time RVers!”
In August we arrived at our SOWER assignment at the Lone Tree Bible Ranch in Glendo, Wyoming. Spending a month on the prairie without radio, TV or cell service, allowed us to imagine life as the pioneers experienced it. On our final day, after the campers boarded their bus for the city, the staff saddled up our horses, led us out into the open plains. I’d not been on a horse for many years. I panicked when my saddle came loose. As I slid to his side, I experienced a flash-back to a similar episode with my friends’ runaway horse when we were teenagers. Would my high-pitched scream spook the horses? I pleaded with Rob: “Get one of the cowboys to help me, now!” As we approached a watering tank, my horse verified the old saying: you can lead a horse to water but you can’t make him drink. Guess he wasn’t thirsty.
We’ve stepped up our commitments to the Christian RV volunteer work we’d started in Florida, 2003 BC—Before Cancer. Physically, I could no longer do the Habitat for Humanity labor. Instead, we’ve done one to five months a year with the SOWER Ministry since 2004.* You’d be amazed at how the dedication of a small staff yields such positive results for their community. I flew back to Ohio in October 2006, and again in November 2007, to spend weeks taking care of my mom, after she had fallen and broken several ribs. One night while we were watching TV, I said: “Mom, don’t you think it’s time to talk about what you want to happen when you die?” We forgot about the television show and had a really good conversation. We were shocked at her sudden death, December 30, 2007.
We followed her instructions: “You can have the memorial service at my church, but do not bury my ashes with your father.” “What? Your name was chiseled into his gravestone in 1971! What should we do with your ashes?”
“I don’t care. I’ll be dead. It’s your problem” she replied with a stony and defiant glare.
Obedient to the end, we followed the Fifth Commandment: “Honor thy father and mother.” I’ll just say our footsteps in the snow vanished when the sun came out the next day. Where is my mommy? Only a handful of us really know.
While volunteering in Grants Pass, Oregon in October, 2010, my favorite Aunt Mary fell out of her bed in an Assisted Living Home. She refused surgery for a broken hip. Immediately, I booked a flight back to Ohio; prayed I’d have one more chance to tell her how much I loved her. She’d refused all nutrition, including a feeding tube. She’d been waiting a long time to be reunited with my Uncle Willard, her son Walt, plus my grandparents.
We were the last people to be with her before she lapsed into a coma. I’ll never forget the way she gripped my hands, smiled at me, with the twinkle in her eyes, as I kissed her and told her what a fantastic aunt she had been. She had a wonderful hospice nurse who explained the progression her dying would take, plus how they kept her pain-free. Aunt Mary had told her daughter-in-law she wanted an open casket for viewing hours at the local funeral home. I stayed on the sidelines: too many memories of my father lying so quietly in his open casket in 1971.
After her funeral, I resolved to learn more about how-to prepare for dying. After completing three months of volunteer work in Central Florida, at the end of January 2012, I decided to go full-time with my research. Rob agreed: “It’s your turn; I’ll continue volunteering, because wives don’t have to work if they don’t want to with the SOWER ministry.” I bought books; borrowed them from local libraries wherever Rob was volunteering. I’ve utilized my Stephen Ministry skills to work from a distance with other cancer survivors, plus the recently widowed. My new goal: Develop a competency to help people prepare for the end of life. Today it’s a work in progress!
For the past fifty years, innovations in pharmacology, medical technology have ignited a dual obsession: look younger, and extend your life. Who are we kidding? Humans are not immortal. Treatments to prolong life are the magic words for Medicare and insurance reimbursement. Ask your doctor, what will this new treatment do for me? Is it just to extend my life? Am I going to suffer because of it? Is it only available in a hospital? If something goes wrong, will I ever get back home?
Research indicates how your physician feels about death influences your treatment plan, and how much he/she will tell you about your prognosis. Ask your doctor to explain when hospice, palliative care are recommended. I heard the late Elizabeth Edwards say during an interview that she asked her children to raise their hands if they weren’t going to die. Then she told them about her breast cancer diagnosis. Three years later, the doctors told her it had metastasized to her liver; treatment would be unproductive. She died the following day.
The best time to talk about death and dying is when you are not. Right?
Will you look for quantity or quality of life as you approach your final days? If you don’t want to be isolated in an ICU (Intensive Care Unit) with all of your body parts hooked up to machines, then talk it over with your family now. This is what it means when they say: Get your papers in order. Figure out what’s most important to you. If you lose the capacity to speak or think, assign someone you trust to be your medical power of attorney. Make sure your family understands your wishes, and agrees to follow your directions. Arguments about what your family wants you to do or guilt feelings that might surface later, need to be worked out before you are dying, while you can still talk about these issues face-to-face.
I have given written orders for my family: “Never allow machines to keep me alive.” I’ve had a great life, and want my exit to be at home, pain free, listening to my favorite music, surrounded by family and friends. As an informed consumer, my medical power of attorney can refuse unnecessary tests, futile treatments if I can’t speak for myself. I’ve already told them: “Call hospice early, give them a chance to make me comfortable with palliative care. Don’t waste our national healthcare dollars on treatments to prolong my life if I have no chance of recovery. Save that money for someone in a crisis.” I’m not afraid to use the word “dying”—are you?
I want to help healthy adults between the ages of 30 and 70, sandwiched in between their children and elderly parents. At her website, www.thesandwichgeneration.com Carol Abaya has identified three types of Sandwich Generations:
- Traditional: Those sandwiched between aging parents who need care and/or help and their own children.
- Club Sandwich: Those in their 50s or 60s sandwiched between aging parents, adult children and grandchildren, or those in their 30s and 40s, with young children, aging parents and grandparents.
- Open Faced: Anyone else involved in elder care.
U.S. Census Bureau statistics indicate by 2030, the population of Americans aged 65 or older will double to over 70 million—just seventeen years from now. How old will you be in 2030? Rob will be 94, I’ll be 89. According to the Pew Research Center, just over one of every eight Americans, aged 40 to 60, is both raising a child and caring for a parent. Between seven to ten million adults are caring for their aging parents from a long distance. We’ll be looking at the impact of how your generation affects your attitudes, care-giving responsibilities, as reflected through the ground-breaking research by Strauss & Howe, in their book GENERATIONS:
|Generation X||(Gen X)||(1961–1981)|
|Millennial Generation||(Gen Y)||(1982–2004)|
|Homeland Generation||(Gen Z)||(2005-?)|
Perhaps we’ve been looking at the wrong end of the binoculars. Instead of trying to determine why people are afraid of death/dying, refuse to talk about it, or complete their paperwork, shouldn’t we also concentrate on the shorter view? How did you lead your life? What influence did you have in your family and community? What legacy are you leaving? Aren’t these questions just as important?
You can create an environment to make it fun, not morbid, by involving your family and friends as you weave together your own exit strategy. Then, whenever Heaven calls your number, grin like we plan to do, wave your arms and say, “Hey! I’m over here!” Aren’t we all eager to hear Him say, Well done, good and faithful servant.