Category: Philosophy of Living

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The Role Of Mindfulness In End Of Life Care

by vimhsadmin

Mindfulness assists people with their end of life process by giving them and their caregivers a tool they can use in order to be fully aware of the present moment and their own physical and mental states

[T]he Venerable Yin Kit (pictured above) has spent decades in hospitals, hospices, and homes, assisting people through their death. Through these experiences, her understanding of how to compassionately and wisely care for those dying and their families has changed as a result of constantly reflecting on what she experiences and what she learns as a Buddhist nun living in the West in the 21st century.

The end of life is a transformation from one physical existence to another existence. Similarly, mindfulness is a transformation of one mental existence into another mental existence.

Emphasis on mindfulness

Buddhist teachings have always emphasized the contemplation of death; a subject that engenders so much fear and worry for many. Mindfulness can take on a role  that  compliments advanced medical technology in end of life (EOL) care.

Mindfulness assists people with their end of life process by giving them and their caregivers a tool they can use in order to be fully aware of the present moment and their own physical and mental states. This allows them to settle into each moment and open up to a wider vision of the future.

With mindfulness, a dying person not only sees their physical changes, but also how their mind influences the perception and experience of their waning body. With an aware and balanced mind, a person is more able to cope with the vicissitudes and challenges that come with this stage of life and be at peace with these experiences. This in turns greatly helps to console the family, friends and care-givers.

Mindfulness also assists in opening pathways for healing relationships and positive life reviews. One can be more receptive and capable of planning for, dealing with and understanding the constantly changing physical and mental experiences and in the end, one’s own death.

The role of mindfulness in end of life care

Venerable Yin Kit speaks at The End of Life: Dying, Suicide, Death conference in Vancouver, November 2016

Venerable Yin Kit spoke about the role of mindfulness in end-of-life care at Simon Fraser University’s Vancouver campus on November 3, 2016. She was also a participant in a “praxis panel” that included Rabbi Laura D. Kaplan, veterinarian Dr. Jeff Berkshire, and counselor Hilda Fernandez.

Venerable Yin Kit, also known as “Sister Jessie”, has been a Buddhist nun since 1992 and is the spiritual leader of Po Lam Buddhist Association in Chilliwack, B.C. She is involved in leading numerous workshops teaching hospice care and hospital spiritual care in Hong Kong and in Canada. The Venerable is also the advisor to the Hong Kong SPGA Hospice program.

In 2005, Venerable Yin Kit established the Compassionate Centre for Health, a service for the Chinese-speaking community in the Greater-Vancouver area. This group has grown to over fifty active volunteers who visit senior homes and palliative care units at several sites. The Venerable has spent decades in hospitals, hospices, and homes, assisting people through their death. Through these experiences, her understanding of how to compassionately and wisely care for those dying and their families has changed as a result of constantly reflecting on what she experiences and what she learns as a Buddhist nun living in the West in the 21st century.

Dr. Jeff Birkshire, Rabbi Laura Kaplan, Venerable Yin Kit Sik, and moderator Hilda Fernandez
on the Praxis Panel at The End of Life: Dying, Suicide, Death (November 2016)

The End of Life: Dying, Suicide, Death

Simon Fraser University’s Institute for the Humanities hosted a conference in November 2016 called The End of Life: Dying, Suicide, Death. The conference was intended to provide space for pondering the complex and agonizing decisions regarding the end of life. Space for such conversations is especially needed given the 2015 decision of the Supreme Court of Canada declaring that the prohibition on physician-assisted dying infringes upon Section 7 of the Canadian Charter of Rights and Freedoms, and the introduction of Bill C-14 which has resulted in debate about who, when and in what circumstances an individual may make such a decision.

Speakers included academics, graduate students and practitioners who spoke from their own particular perspectives: legal, ethical, medical, and spiritual or religious. The presentations also drew upon insights from literature and art, some of humanity’s most treasured resources.

Complete Article HERE!

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Songs of farewell

In her new book, Hallowell Singers founder Kathy Leo tells how music comforts the dying, and offers lessons for the living

By Richard Henke

BRATTLEBORO—Kathy Leo, the founder and director of Hallowell Singers, last month published On the Breath of Song: the Practice of Bedside Singing for the Dying, a book that offers guidance and insight into the practice of singing for the dying and their families.

Through the telling of true stories and over a decade of experience in song and spirit with the Hallowell hospice choir, Leo has written a guidebook for anyone offering end of life care or helping a loved one die.

“After many years of teaching workshops to newly forming or active hospice choirs, the decision to write a guidebook through personal experiences of being with the dying became clear,” writes Leo at the Hallowell website, www.hallowell-singers.org.

“On the Breath of Song is a way to get close to the bedside to explore your personal relationship with death and dying. It serves hospice singers, music therapists, chaplains, compassionate caregivers, hospice workers, and palliative care professionals.”

Birthing and dying

Although Leo has now been working with hospice care for over 15 years, she was a midwife in the Southern Vermont area for more than a decade before that. She didn’t find the change too great.

“You are in the same space: birthing and dying have similar energies,” she explains.

Shortly after Leo began her volunteer work for Brattleboro Area Hospice, musician Peter Amidon and others were invited to the bedside of a Putney woman under her hospice care to sing for two nights.

Leo writes about the experience: “In a small house on a back road in southern Vermont, a woman is dying at home surrounded by her loving family. It is a winter evening in 2003, a few days before Dinah’s last, a group of friends from the community and her church, gather around her bed to sing. She joins in. She mouths the words when her voice fails her …

“As we sing around her, Dinah is held up by her loving husband Fred, a daughter on either side of her. … [Hallowell Singers] formed after two visits to Dinah Breunig’s bedside in her home, her family welcoming and present, during the final days of her life on earth.”

Hallowell is a chorus of volunteer singers trained to practice the therapeutic art of singing for the dying. Based in Brattleboro, the chorus serves hospice clients through its affiliation with Brattleboro Area Hospice and the greater community by request.

Leo, who had been Dinah’s hospice volunteer, answered the call from Noree Ennis, the patient care Coordinator of Brattleboro Area Hospice at the time, to create and organize a “hospice choir” that would be available as a service to anyone who desired singing at the end of life as an offering of comfort.

Peter Amidon and Mary Cay Brass agreed to serve as musical directors.

‘Gifts of grace’

Almost 40 singers signed up to be trained and taught how to sing at the bedside of a dying person. Usually 4 to 6 singers go to the home of a man or woman in hospice care.

“We do not want to overwhelm the space,” Leo says. “We know how to make ourselves small in energy. Before we enter a home, we quiet ourselves internally, which can take a lot of work initially. Once there, we offer songs that are gifts of grace for everyone involved, the dying, their family and the singers.

“Beautiful things happen with music. Singing also creates a special space for a family to come closer with the dying. So much happens in this space that is rich with life, death, and mostly love.”

Leo explains that Hallowell doesn’t call these events performances, but rather, “sings.”

“We tell people not to applaud, that is not what we are here for,” she says.

The name for the Hallowell Singers comes from a song Brattleboro therapist Stephen Spitzer wrote about a friend from Hallowell, Maine, who died from a bee sting. “What he wrote so embodies the spirit of our mission that we took it as our title,” Leo says.

Since its inception in 2003, Hallowell has served hundreds of families in the Southern Vermont community.

“Little did we know at the time that as Hallowell grew and evolved, it would become a central ’practice’ in our lives, a way to learn how to live fully and with deep gratitude,” Leo writes. “Our songs and our quiet presence bring comfort and offer support to the dying. The response of those we sing for is often emotional and calming.”

Hallowell still works very closely with Brattleboro Area Hospice. “They are more like family, really, and they helped to shape and form us through support and training,” Leo confesses.

But Hallowell also has its own hospice training.

A careful approach

Leo felt the need to address specific issues that arise when singing at dying persons’ bedsides. Hallowell trainings deal with how to prepare for a sing, both individually and as a group, how to involve the family, and how to approach what Leo calls “the sacred space of dying.”

“We need to learn to enter and leave the space seamlessly,” she says.

Soon enough, the word about the special work that the Hallowell Singers were doing began to spread.

“We were asked if we could do a workshop on how to start a choir in Middlebury,” Leo says. Soon more groups were forming choirs that asked for Hallowell’s help.

“We have also helped to launch a still growing number of hospice choirs throughout the New England region and across the country by teaching workshops, offering guidance and counsel, and being available for continued support for developing hospice choirs,” Leo writes. “We are honored to be a strong model for the growing movement of the practice of bedside singing for the dying.”

Besides the numerous smaller workshops, for the past six years, Leo and Amidon have given a weekend “deepening workshop” once a year at the Rowe Center in Massachusetts.

“These are always well-attended, and people come from all over the country, even someone from New Zealand who wanted to start a Hallowell choir there,” Leo elaborates. “This movement, which began in Putney, now is spreading all over the world. Who can explain it? Perhaps it was just the right time, but it is pretty amazing.”

True stories of tenderness

Leo has often been exhorted to write a book offering guidance and insight into the practice of singing for the dying and their families.

“I first was asked to write up a guidebook years ago, but I kept telling everyone and myself, ‘It wasn’t the right time, it wasn’t time, it wasn’t time,’” she says.

But finally Leo realized that she had no real excuse for delay, and the result was On the Breath of Song.

Although the book is intended to help others working with hospice choirs, this is definitely not a book a rules. Instead, Leo says she has written a book of true stories filled with tenderness and emotion.

“Singing for the dying is intuitive, where strict rules have no place,” Leo says. “Consequently, when I came to write down all that I have learned over the years working with Hallowell, I realized that the best manner was through stories which inform the teaching. At the heart of these stories are the songs we sing, and the spirit of love we bring to this practice.”

Complete Article HERE!

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Boomers driving changes in end-of-life care

With ever more baby boomers entering their golden years, third party end-of-life planners may be in great demand over the next two decades, as people try to take more control over their care as they die.

By Candace Moody

The Baby Boomers have redefined every stage of life they passed through, changing the definition of what it meant to be young, middle aged and now, old. (Fifty is the new 30, and gray is the new black.) Finally, we’re working on the last frontier — death.

An enormous amount of health care spending is invested in the postponement of dying. Courtney Martin wrote in the New York Times last year: “According to the National Institute of Health, 5 percent of the most seriously ill Americans account for more than 50 percent of health care spending, with most costs incurred in the last year of life in hospital settings.”

The Baby Boom generation is becoming the largest group of elderly people the country has seen, and when we go, we want to go well.

End-of-life planning became a controversial part of the Affordable Care Act when vice presidential candidate Sarah Palin labeled the idea “death panels” in 2009. In 2015, the ACA once again proposed reimbursing doctors for having the discussion with patients. Some futurists predict that third party end-of-life planners may be in great demand over the next 20 years as people try to take more control over their care as they die.

Studies have shown that two-thirds of us would prefer to die at home, but most of us generally die in Intensive Care Units at hospitals, receiving care and medication that extends the quantity of time we live, but greatly reduces the quality of it. End-of-life planners can help individuals and their families create a plan that accounts for how and where someone will face the last few months of life: at home, in a hospital or in hospice.

End-of-life counseling can be delivered by a variety of professionals, including clergy and chaplains, financial planners, medical staff or attorneys. Some colleges now offer certifications for professionals who want to specialize in end-of-life care. The certifications are often part of a gerontology program, preparing students to offer advice on social, psychological, medical, financial, legal and spiritual issues related to care.

Florida-based Mediation Training Group offers training on how to mediate between elders and their adult children about issues such as driving, remaining at home or medical care. The continuing education credit program is aimed at psychologists and social workers who deal with these issues in their family practice; similar training is offered for family law attorneys.

Doulas are women who have traditionally been trained to provide information and physical and emotional support to women before and during childbirth. The International End of Life Doula Association (www.inelda.org) offers the INELDA certification, which requires 22 hours of training. Doulas must meet certain requirements, including character references, and must complete several vigils that are evaluated by staff.

End-of-life doulas focus on planning, conducting vigil during death, and reprocessing a death with loved ones afterwards to provide insight and comfort. They may work in hospice or other institutional settings or work independently. Both the University of Central Florida and University of South Florida offer graduate certificates in end-of-life care.

End-of-life counseling is a relatively new profession, so data on salaries is not broken out from a professional’s primary practice. Attorneys and social workers will offer end-of-life services, so their earnings will supplement their fees. According to prodoula.com, certified doulas charge up to $1,500 for their services and earn an average of $45,000 per year. If compassion is your strength, you may be able to turn dying into a living.

Complete Article HERE!

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San Francisco Is At The Forefront Of Another Frontier: Care For Dying People

Volunteers make seasonal mandalas, a ritualistic symbol in Buddhism, out of flowers in the garden of the SF Zen Hospice Project’s Guest House.

by Jay Barmann

In large part due to the enormity of suffering and loss of life during the height of the AIDS epidemic here, San Francisco has emerged two decades later with new models for providing palliative and humanistic care at the end of life, one of the best of which is represented by the tiny San Francisco Zen Hospice Project in Hayes Valley. The hospice facility, in a Victorian on Page Street, grew out of the 54-year-old San Francisco Zen Center just up the street, and began in 1987 as a way for Zen Center members to care for young AIDS sufferers and provide them with a peaceful and comfortable death. (A similar organization, Maitri, sprung up around the same time near the Castro, and continues to this day.) As a new piece in the New York Times Magazine puts it, the Zen Hospice Project “originated as a kind of compassionate improvisation,” and it has served as inspiration and proving ground for Dr. B.J. Miller, a 45-year-old clinician at UCSF who has emerged as a passionate and charismatic advocate for a new kind of end-of-life care. As he tells the Times Mag, his goal, and that of the Zen Hospice Project, is to “de-pathologize death.”

Miller is unique as a spokesperson for this new type of palliative care in that he had his own brush with death early in life, and wears the scars from it very prominently. At the age of 19, while a sophomore at Princeton, he and a couple of friends went climbing on a New Jersey Transit commuter train after a night of drinking. When he reached the top of the train, an electrical current arced out of a charged wire into Miller’s metal wristwatch, sending 11,000 volts through his body and severely burning his arm and two legs. He would soon become a triple amputee, but the experience of being in the burn unit for months and talking himself back from near death profoundly changed how he saw life, especially when he went to medical school. It’s something he describes in a TED Talk from 2015 that’s garnered nearly five million views. In it he says “we are all patients,” using the definition of the word as “one who suffers,” and says he hopes to bring a design sensibility, “that is intention, and creativity, to the experience of dying.”

A year after the Brittany Maynard case gained national attention, around the time that California’s death-with-dignity law was passing through the state legislature in mid-2015, the Times first discovered Miller and the Zen Hospice Project, describing it as “a fascinating, small-scale experiment” in an age when end-of-life care typically falls to hospitals. Hospitals, however, are not programmatically designed to comfort and care for the needs of dying people — they’re designed to make people well and send them home — and families often panic in the face of death causing disruptions in the final months of a person’s life. While, as of 2015, 44.6 percent of all deaths took place in hospice settings, 40 percent of those patients only spent a few days there following stays in intensive care — meaning, as the Times put it, there’s “not enough time to take full advantage of the technique’s soothing possibilities.” Add to that figure the fact a 2013 study that found that more people are choosing to die at home, however they still are transported back and forth to hospitals three or more times in the final 90 days of their lives — time that would be better spent quietly with loved ones, or doing something pleasurable. Also, a hospice experience should free friends and family from the burden (and occasional trauma) of being caregivers, so that they can simply be there with the person who is dying.

That is the focus of the SF Zen Hospice Project’s Guest House: sensory pleasure. Patients are allowed to smoke, outdoors, if they wish. The smell of freshly baked cookies wafting through the house is a frequent one. People play musical instruments. And in a case described in detail in the new Times Mag piece, a 27-year-old man dying of mesothelioma, that care involved welcoming in the man’s throngs of friends, their Bud Light and their video games, decorating his room like a “late-20’s-dude’s room,” letting him go on one last Sunday sailing trip with his friends despite being in significant pain, and helping him plan a wedding for his best friends to be performed in the small garden next door to the Guest House. This all happened in the course of nine days, after which he would be dead. And the wedding went on anyway, and what followed, in the hospice Guest House, was a combination wedding reception-funeral, a celebration that was “mixed up, upside-down and unexpectedly joyful.” “It makes you happy for a place like the Guest House where such things can happen,” Miller tells the Times Mag, via a meeting with colleagues, “a roof where these things can coexist.”

Shortly thereafter Miller stepped down as executive director of the Zen Hospice Project in order to pursue related goals. He’s raising seed money for what he’s calling the Center for Dying and Living, a kind of design lab focused on new models for palliative care, and he’s co-writing a field guide to end-of-life care.

These days the Zen Hospice Project’s Guest House is still only six beds, two of which are reserved for UCSF patients, and the others funded through donations and sliding-scale fees from patients. In contrast to hospitals, which may charge thousands of dollars per day to house and care for a dying patient for an indeterminate period, stays at the Guest House cost the organization about $750 a day, proving that their model is not just better from a human standpoint, but also an economic one, even if traditional insurance does not tend to cover the cost of residential hospice.

It’s something the rest of the country, and the insurance industry, needs to consider, and maybe Dr. Miller will be the one to build it on a larger scale here in the Bay Area, before long.

Complete Article HERE!

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A life lesson in the death of a much-loved cat

By Tim Dick

[O]ur household had a late and unwelcome entry in the death toll of 2016. It came with Rocko, who scraped in with a departure on Friday. Granted, the death of a cat is of less moment to most than that of George Michael, and he was a celebrity only to those who knew him, but our wee furry guy managed to give us life lessons without the irritation of a life coach, and company without human complications.

His first life lesson to me was early rising. His day, and therefore mine, began with regularity at 5.30am with a gentle whisker brushed across my face, then the nudge of a cold nose if that didn’t work, then a bite to the nose if all else but mild violence failed to rouse the deliverer of his morning meal.

 


 

Once the irritation has passed that the cat alarm once again chose my side of the bed, and never the other, I was up, fed, and at work before most others, getting my stuff done, and setting up an early exit at the other end of the day. Rocko was a productivity booster devoid of mumbo-jumbo: get up early, do your work, go home.

His second lesson was to demonstrate the benefits of adequate insurance, by having no insurance. Pet insurance might sound faintly ridiculous, but having spent thousands on vet bills in the last two years, and unless you’re able to save for unknown future medical catastrophes, it’s a no-brainer. We’re now breaking even on the insured dog, but were too slow for the cat. It’s compulsory for any future pet.

Rocko the cat

His third lesson was the decision in which he took no part, but which was the right thing to do, and which is the law makes impossible for people: euthanasia.

Nearing Christmas, he became bloated, carrying lymphoma in his gut, heart disease, and a tumour on his liver. We decided to put him down, but delayed it a week or so. He didn’t make it that far, forcing the decision to euthanase after he’d collapsed at home.

I knew something bad was up when, for the first time, he didn’t shred my arms while being shoved in the cat carrier.

As he lay dying on the vet table, our sadness came tinged with relief that the law is gentle enough to allow vets to put down pets when their time has come. His suffering was exceptionally short, his end far more peaceful than we force some people to endure.

After the narrowest of defeats for a euthanasia bill in South Australia in November, the next test of whether politicians will allow people the same mercy as we afford our pets comes in Victoria later this year. The Andrews government said in December it would bring legislation to allow some dying adults to die sooner than they otherwise would.

The right will be restricted to those who have the capacity to make decisions, who are at the end of their lives because of a terminal illness. Two doctors will likely have to approve the prescription of a euthanasia drug, and patients unable to take the tablet themselves could be helped by a doctor.

It strikes the right balance between the right of the dying to avoid unnecessary pain, and protecting others from an unnecessarily hasty death. It merely adds another option for those at the end of their lives, rather than being pumped with morphine to dull the pain of a disease taking its course.

It would end that fake distinction between the legal form of hastening death known as passive euthanasia (like doctors turning off a life-support machine), and the form of hastening death known as active euthanasia (a doctor-provided pill or injection that causes death) which remains illegal across Australia even with the ardent wishes of the patient.

It’s now two days after we put Rocko down, and I am using the home computer without feline keyboard interference for the first time in years. On the screen, which I can see without having to peer around a cat head, is an e-book called Damage Done, a collection of personal essays compiled by Andrew Denton’s advocacy group, Go Gently Australia.

A short way in is an extraordinary death notice, published in The Age last year, which captures the need and urgency for voluntary euthanasia far better than I can. It speaks for itself: “Andrew Ross Carswell, a skilled musician, at times tedious intellectual, much loved friend of many, valued family member, and adored husband to Carolyne, died an unnecessarily protracted, distressing death on Sunday 13 March as a result of the continuing absence of legislation that could have otherwise allowed a man of his integrity experiencing the final stages of liver cancer peaceful, timely access to euthanasia. May he finally be able to enjoy the long sleep he had been anticipating and may the anti-euthanasia lobby collectively experience the tediously prolonged, objectionable demise they are so determined to impose on everyone else.”

Complete Article HERE!

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Give the gift that keeps on giving: straight talk on end-of-life care

By James Hoefler

‘Tis the season for gift giving and the odds are good that you received one you didn’t really want, like the proverbial gaudy tie, the useless kitchen contraption, or the itchy misshapen sweater. It’s the thought that counts, right?

When getting what you want — the right medical care at the end of your life — really matters, getting what you don’t want is the rule rather than the exception. I have studied end-of-life care for more than 25 years. Here are a few key points I’ve learned from my research and from extensive interviews with caregivers of all backgrounds and experiences:

  • The vast majority of Americans say they would prefer to die at home, surrounded by loved ones. But most of us die alone in a medical institution of some kind, fading away in a technological cocoon that could not be further from the setting most of us would prefer.
  • Most of us would like to face as little pain as possible at the end of our lives. Yet more than half of us suffer with moderate to severe pain and other completely controllable symptoms in our dying days.
  • Individuals who have experienced hospice care give it glowing reviews. Unfortunately, only about half of Americans are referred to hospice as death draws near, and many of those who enter hospice do so during the last few days of life, too late to take full advantage of all that it has to offer.
  • For those who are left behind, regrets and second-guessing all too often cloud the roles they played and the decisions they helped make about managing a loved one’s final days.

During this season of giving, what better gift could you give those you care for — and those who will care for you — than the peace of mind that comes with knowing the kind of care you and they want at the end of life? You don’t need a lawyer or a formal document to express these wishes: a simple conversation is actually best. In addition to giving peace of mind to those you love, such a conversation can substantially increase the chances you will get what you want at the end of life, all without spending a dime.

How can you remember to do this? Use as reminders any gifts you got this holiday season that you didn’t really want. Keep in mind that such gifts were given with the best of intentions. Well-intentioned but misguided choices about end-of-life care may be in your future unless you spend some time having heart-to-heart conversations with those you love about what is important to you when that time comes.

It’s important to have the same conversation with your doctor. Most doctors are no more comfortable talking about end-of-life care than you are, and all too often avoid the subject. So do them the favor of starting the conversation yourself — they will generally be relieved and more than willing to help walk you through the options.

Letting your loved ones know exactly what you want for that last big holiday and giving your doctor permission to talk about end-of-life options could end up being the best gift you ever give — and get.

Complete Article HERE!

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Looking Death in the Face

Mummy of Ramses II

By John Kaag and Clancy Martin

[R]amses II, also known as Ramses the Great, was born about 3,000 years ago and is widely regarded as the most powerful pharaoh of the Egyptian Empire. The Greeks called him Ozymandias. When he died in 1213 B.C.E., he left a series of temples and palaces that stretched from Syria to Lybia, and countless statues and monuments commemorating his impressive reign. By the 19th century, when European colonization reached Egypt, most of these statues were gone, and the ones that remained were in ruin. In 1816, the Italian archaeologist Giovanni Belzoni discovered a bust of Ramses and acquired it for the British Museum. This is when Ozymandias’s life, in one respect, truly began.

“Ozymandias,” perhaps the most famous sonnet Percy Byshe Shelley ever penned, was written in 1817, as the remains of the famous statue were slowly transported from the Middle East to England. Shelley imagines a traveler recounting a journey in a distant desert. Like Belzoni, Shelley’s character discovers a great bust, half-buried in the windswept sands. Next to the wreckage is a pedestal where the monument once stood. Inscribed in shallow letters on the slab of rock: “My name is Ozymandias, king of kings: Look on my works, ye Mighty, and despair!” Of course, as Shelley’s poem tells us, nothing remained of these works or the king of kings. Just sand.

The poem’s message is perennial: All of this will be over soon, faster than you think. Fame has a shadow — inevitable decline. The year 2016 has delivered a string of deaths that serve as bracing reminders of this inevitability: Prince, Nancy Reagan, David Bowie, Elie Wiesel, Bill Cunningham, Muhammad Ali, Gordie Howe, Merle Haggard, Patty Duke, John Glenn. Of course, it has also been a year that has ushered in a new empire and, simultaneously, the specter of apocalypse. The year’s end is a time to take account of kingdoms built, but also the sheer rapidity of their destruction. It is a chance to come to terms with the existential fragility that is overlooked in most of our waking hours and that must be faced even by the greatest among us.

We tend to defer the question of living or dying well until it’s too late to answer. This might be the scariest thing about death: coming to die only to discover, in Thoreau’s words, that we haven’t lived.

Facing death, though, is rarely simple. We avoid it because we can. It’s easier to think of “dying” as an adjective than a verb, as in a dying patient or one’s dying words. This allows us to pretend that dying is something that is going to happen in some distant future, at some other point in time, to some other person. But not to us. At least not right now. Not today, not tomorrow, not next week, not even next decade. A lifetime from now.

Dying, of course, corresponds exactly with what we prefer to call living. This is what Samuel Beckett meant when he observed that we “give birth astride the grave.” It is an existential realization that may seem to be the province of the very sick or very old. The elderly get to watch the young and oblivious squander their days, time that they now recognize as incredibly precious.

When dying finally delivers us to our unexpected, inevitable end, we would like to think that we’ve endured this arduous trial for a reason. Dying for something has a heroic ring to it. But really it’s the easiest thing in the world and has little to do with fame and fortune. When you wake up and eat your toast, you are dying for something. When you drive to work, you’re dying for something. When you exchange meaningless pleasantries with your colleagues, you’re dying for something. As surely as time passes, we human beings are dying for something. The trick to dying for something is picking the right something, day after week after precious year. And this is incredibly hard and decidedly not inevitable.

If we understand it correctly, the difficulty is this — that from the time we’re conscious adults, maybe even before that, we get to choose how we’re going to die. It is not that we get to choose whether we contract cancer or get hit by a bus (although certain choices make these eventualities more or less likely) but that, if we are relatively fortunate (meaning, if we do not have our freedom revoked by circumstance or a malevolent force we can’t control), we have a remarkable degree of choice about what to do, think and become in the meantime, about how we go about living, which means we have a remarkable degree of choice over how we go about our dying. The choice, like the end itself, is ultimately ours and ours alone. This is what Heidegger meant when he wrote that death is our “own-most possibility”: Like our freedom, death is ours and ours alone.

Thinking about all of our heroes and friends and loved ones who have died, we may try to genuinely understand that death is coming, and to be afraid. “A free man thinks of death least of all things,” Spinoza famously wrote, “and his wisdom is a meditation not of death but of life.” But we don’t even begin to think about life, not really, until we confront the fact that we are doing everything we can not to think about death. And perhaps we’re not so much afraid of dying, in the end, as of not living and dying well.

Everyday life has no shortage of things with which to waste our time: the pursuit of money, intelligence, beauty, power, fame. We all feel their draw. But the uncomfortable, claustrophobic truth is that dying for something like money or power tends not to be a choice at all. David Foster Wallace argued that for most of us dying in the pursuit of wealth or prestige is simply our “default setting.” The problem isn’t that we’re picking the wrong things to die for, but that we aren’t actually picking. We chose to live by proxy. We allow ourselves to remain in a psychological trap that prevents us from seeing what might be genuinely meaningful in our own lives. In doing so, we risk, according to Wallace, “going through (our) comfortable, prosperous, respectable adult life dead, unconscious, a slave to our heads and to (our) natural default setting of being uniquely, completely, imperially alone day in and day out.” We might call this the Ozymandias Trap — Look on my works, ye Mighty, and despair! — and be on guard against falling into it ourselves.

Most days we discover that we’re not quite up to the heroic task of extricating ourselves from the Ozymandias Trap. Others, we fear we’ve failed miserably. It is not realistic to love in the awareness that each day might be your last. But at least we can stop pretending that we will endure forever.

In Tolstoy’s famous story “The Death of Ivan Ilyich”, the dying hero reluctantly accepts his own mortality, albeit only once he can no longer avoid the truth:

It’s not a question of appendix or kidney, but of life and … death. Yes, life was there and now it is going, going and I cannot stop it. Yes. Why deceive myself? Isn’t it obvious to everyone but me that I’m dying … it may happen this moment. There was light and now there is darkness … When I am not, what will there be? There will be nothing …

Ivan Ilyich can’t pretend that he’s not dying. He recognizes what Ramses II apparently did not: With his death, there is no justification of his life, there is no proof of himself to leave behind, there are no monuments where he is going. He has lied to himself all of his life about the fact that he’s going to die.

In the end, Ivan is liberated from his self-deception. And we, too, can free ourselves from this delusion. As soon as today. Right now.

If we succeed, we may find that confronting the fact of our own impermanence can do something unexpected and remarkable — transform the very nature of how we live.

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