Seneca on Busyness and the Art of Living Wide Rather Than Living Long
By Maria Popova
“How we spend our days,” Annie Dillard memorably wrote in her soul-stretching meditation on the life of presence, “is, of course, how we spend our lives.”And yet most of us spend our days in what Kierkegaard believed to be our greatest source of unhappiness — a refusal to recognize that “busy is a decision” and that presence is infinitely more rewarding than productivity. I frequently worry that being productive is the surest way to lull ourselves into a trance of passivity and busyness the greatest distraction from living, as we coast through our lives day after day, showing up for our obligations but being absent from our selves, mistaking the doing for the being.
Despite a steadily swelling human life expectancy, these concerns seem more urgent than ever — and yet they are hardly unique to our age. In fact, they go as far back as the record of human experience and endeavor. It is unsurprising, then, that the best treatment of the subject is also among the oldest: Roman philosopher Seneca’s spectacular 2,000-year-old treatise On the Shortness of Life (public library) — a poignant reminder of what we so deeply intuit yet so easily forget and so chronically fail to put into practice.
Seneca writes:
It is not that we have a short time to live, but that we waste a lot of it. Life is long enough, and a sufficiently generous amount has been given to us for the highest achievements if it were all well invested. But when it is wasted in heedless luxury and spent on no good activity, we are forced at last by death’s final constraint to realize that it has passed away before we knew it was passing. So it is: we are not given a short life but we make it short, and we are not ill-supplied but wasteful of it… Life is long if you know how to use it.
As an internal medicine physician practicing in a busy urban hospital setting, I care for people of all ages who have never considered their own mortality. Far too often, this results in an experience at the end of life that doesn’t embody the goals and values of the life they have lived. They suffer, and so do the people they love. It’s led me to question, why is this?
For the vast majority of human history, we have been thoughtful and intentional about death. Without the benefits of modern medicine, we cared for our family members at home when they became ill. When people died, they were laid out in the parlor of the home, surrounded by family, and ancient death rituals were performed. Death was an expected occurrence that was accepted and planned for. Our cultural understanding, at least in the West, began to deteriorate about a century ago as death became increasingly medicalized.
Despite our culture’s propensity to share just about everything, the idea of death remains a cultural taboo, keeping us from personal reflection, discussion with those we love, and planning ahead.
Why death is left out of the wellness conversation.
There are only two things we really know for sure: We are born, and we will die. As a culture, we invest in nutrition, exercise, and spiritual well-being as a means to live well—but a critical part of living well is dying well. A recognition of our own mortality can allow us to live an even more fulfilled life. We become better people who feel more grateful for our experiences every day.
While historically many people pondered death and the idea of an afterlife through the lens of religion, the growing number of Americans turning away from organized religion and seeking a hybrid spiritual identity invites us to actively explore other cultures’ practices around death, both past and present. Almost every philosophical and spiritual tradition encourages thinking regularly about death to not only reduce our fears but ultimately, to live a more authentic, meaningful, and even joyful life.
How to bring end-of-life discussions into the wellness movement.
No matter your spiritual or religious beliefs, here are six steps to take action toward living more comfortably with death:
1. Take time for personal reflection about what matters most to you.
Make it count, and make it a regular practice. I like using my birthday as an annual reminder to step back and reflect.
2. Recognize which relationships matter most to you.
Think about the one or two people in your life who you would want to speak for you if you were unable to speak for yourself, AND ask them to serve as your health care proxy.
3. Have a conversation about your values and priorities.
I like the card game Go Wish to help with this conversation. Go Wish has 35 cards with simple prompts about what might matter most if you are seriously ill or at the end of your life. The goal: to facilitate a conversation and prioritize what’s important so those who have to make decisions for you will know your wishes.
4. Document your wishes.
Do this in the form of an advanced health care directive or living will, and make sure your health care proxy has a copy.
5. Discuss your wishes with your health care provider.
You don’t need to wait for them to bring it up. You can start the conversation about your end-of-life preferences with your health care provider at your next visit.
6. Revisit your wishes annually.
As new circumstances arise or your health condition changes, review your wishes annually with your loved ones.
End-of-life wellness looks different for everyone. The goal is to identify what is most important to you, regularly check back in with yourself, and create a network of people who support your values. Give one of these steps a try today, and see how it goes. You might be surprised that by making choices about how you want to live and die, you feel inspired to live life to the fullest.
Fifty years ago, a physician was admitted to the hospital with stomach cancer. He wrote down in his own medical chart that he did not want CPR or to be connected to a breathing machine. His wishes were disregarded — he underwent CPR numerous times and was connected to a breathing machine until he died. Back then, not only were people treated in ways they did not want, many patients were also arbitrarily denied potentially lifesaving therapies.
Doctors decided who deserved to live or not: In one New York hospital, doctors put purple stickers on the charts of patients they determined would not receive CPR or other similar measures without the patients’ or their families’ knowledge. Decisions about life and death were subjective and opaque.
End of life care has considerably improved since then. Patient preferences now help direct physicians and nurses about what type of care they would want to receive. But 50 years into the future, we will look back on today and conclude that medicine was sorely lacking when it came to how we handle death.
Many in medicine, as well as patients and caregivers, continue to equate more procedures, more chemotherapy, and more intensive care with better care. Studies in patients with cancer and heart disease, the two greatest killers of mankind, show that patients receiving palliative care, which is an approach that focuses on quality rather than quantity of life, can actually live longer. While the goal of palliative care is to help people with a serious illness live as well as possible — physically, emotionally and spiritually — rather than as long as possible, some people receiving palliative care might also live longer since they avoid the complications associated with procedures, medications, and hospitalization
In addition, while medical advances have moved forward at blinding pace, the ethical discourse surrounding many technologies has not kept up. Take, for example, cardiac devices such as pacemakers and mechanical pumps that can be placed in the heart. Many patients with terminal illnesses who want to deactivate these devices find resistance from the health system, since some continue to equate deactivating them with euthanasia. We need to continue to make sure that even as technological advances blossom, patients remain at the center, and physicians continue to honor their wishes.
And while the palliative care specialty has greatly improved end-of-life care, too often, palliative care has been used as a way to avoid the culture change needed by all medical specialties to better handle death. Despite its many benefits, many patients and physicians are scared of “palliative care” because of its strong association with the end of life. Some have been compelled to change the title of their practices to “supportive care.” To many patients, the very name “palliative” implies that they will be abandoned, making them very reluctant to accept their services. The fact is that palliative care can, and should, be delivered to patients with serious illness alongside conventional care.
But the issues go beyond the name — one recent study showed that palliative care-led meetings with families of patients in intensive care units led to an increase in post-traumatic stress disorder symptoms among family members. Palliative care specialists are often consulted in tense situations when patients are critically ill, and they often have no prior relationship with patients or their families, who might be unprepared to have serious discussions with them. That’s why most of these difficult conversations should be delivered by the doctors and surgeons primarily responsible for treating the patients. One study estimated that by 2030, the ratio between palliative care specialists and eligible patients will be 1 to 26,000. Palliative care specialists cannot be entirely responsible for end-of-life care by themselves.
To emerge on the right side of history, the entire culture of medicine needs to be turned around. End-of-life care is not just palliative care’s business. It is everyone’s business, from emergency room doctors to primary care physicians. Physicians need to abandon outdated ideas that their role as healers is incompatible with helping patients die comfortably and on their own terms. Helping patients die well is as important as helping them live to the fullest.
She died at home, but it wasn’t the romantic scene found in movies, where the family held her hand and she simply closed her eyes. In reality, there was a night when she had diarrhea 12 times. In reality, every time she had to be moved she was in pain. This was how a caregiver described caring for her mother as she died at home to social scientists studying end-of-life decision-making.
In a new study, Jacquelyn Benson, assistant professor of human development and family science at the University of Missouri, found that home deaths can be physically and emotionally challenging, especially for caregivers.
“The realities of a home death experience present challenges for family members, especially those with limited resources and social support,” Benson said. “It is important that people understand that home death does not automatically equate a good death.”
In recent decades, there has been a groundswell of social movements championing the ideal of dying at home. According to the Centers for Disease Control and Prevention, home deaths in the U.S. increased nearly 30 percent from 2000 to 2014, while deaths in hospitals, nursing homes and long-term care communities dropped.
To study how home deaths might impact caregivers, Benson along with fellow MU researchers Benyamin Schwarz, Ruth Brent Tofle and Debra Parker Oliver, captured stories from caregivers to identify common themes surrounding the experiences of home deaths. Through the in-depth interviews, the researchers uncovered several themes that exposed the challenges that are often not included in conversations about dying at home. In some cases, challenges arose because there was uncertainty for the decision maker, and some caregivers were not prepared for making decisions regarding the end of a loved one’s life.
The researchers also found that financial resources and strong relationships can help in differentiating good deaths from bad ones. Researchers found that the “good” death experiences involved high levels of emotional support for the dying individuals and the caregivers, and that the place of death played less of a role.
“A few well-known sayings about home are relevant to our findings,” Benson said. “For instance, many people believe there is ‘no place like home,’ which suggests the physical space we call home is paramount when it comes to our comfort. However, another saying, ‘home is where the heart is’ suggests that the essence of home can be replicated in less familiar spaces. When making end-of-life decisions it is important to remember that death can be quite gruesome and that it might be easier on both the dying individual and the caregiver to make a plan that carries the concept of ‘home’ to wherever they might be.”
“The motivations and consequences of dying at home: family caregiver perspectives,” was published in a special issue of the Journal of Housing for the Elderly on Environments of Dying, Death, and Caregiving at End-of-Life. Benson served as guest editor for this special issue.
In the next installment of our occasional series Windows into Health Care, health reporter Kara Lofton spoke with hospice nurse Lori Carter. Carter has been a hospice nurse for 20 years. She said for her and for many of the hospice nurses she knows, the work is a calling. She said some of what she does is straight-up nursing — managing pain, dressing wounds, and addressing symptoms of end-stage disease. But the most subtle part of the job is helping families navigate one of the most intimate and emotional times of their lives.
LOFTON: For you, when you think about hospice and the work that you do and being called to it, what does that mean exactly to you?
CARTER: Just being with the patient and the family in the most emotional time of their life. Helping them give each other that last act of love. I appreciate and I feel honored that I am with that patient and that family during that time.
LOFTON: So some people, and I’ve heard especially in Appalachia, can have preconceived notions about what hospice is and what you actually do exactly. Explain to me what you do. What happens when you go into a home for the first time and how does that relationship form?
CARTER: Well, depending on, you know, what is going on with the patient and how early or late in the disease trajectory that we get them, you introduce yourself and…you listen. The big thing is you listen…You can find out f there is struggle already between what is happening with the patient and how the family is dealing with that. Of course, you know, we treat any symptoms that the patient has. I mean, my job I feel is [to be] the patient advocate and just trying to palliate those symptoms that they have inside [so] that they are comfortable.
I find out, you know, is there any things that they want to do before they die? You know, what are they able to do? And I try to facilitate that in any way that I can. I have a bag of ramps in my car right now, [in] that a patient wanted some ramps. I knew that would be the last time he got to eat ramps, so I went and dug some up.
LOFTON: Some people think of hospice as giving up so, to speak. When you hear that what is your reaction to that?
CARTER: I think it’s very sad. You know, we all are going to die. We all are. And, you know, normally the patients that we get — they have already fought for a very long time. This is the last act of love that you can give and, you know, it’s going to happen whether hospice is there or not. And they are most certainly not giving up. I mean, they’re getting ready to go down a path that they’ve never been down either.
LOFTON: Has this work changed how you think about death?
CARTER: It most certainly has. My family was not the type that, you know, went to funerals all the time…I came into hospice blind, really. And I quickly learned that it is a special experience. You have to believe that quality of life is better than quantity.
And I tell you how I cope with things is I will walk into a home, and I will look…there’s always pictures on the walls of, you know, families. And I will look at those. I always do. And I can see what that patient looked like, and how robust they were, and how happy they were. And then I see the patient now, and that actually helps me know what I need to do and how I need to direct the family into what’s happening. You know where they are in this, this experience that they’re getting ready to have.
LOFTON: One of the things I think is interesting about hearing conversations around hospice, especially from providers in hospice, is that we hear a lot about a nursing shortage and yet, and like nursing turnover in hospitals. But hospice seems to have lower turnover rates. And people who become nurses in hospice tend to stay around despite being around death all the time, essentially. Why do you think that is?
CARTER: I think it is a calling. I think you do realize that it’s a special kind of nursing — you fall so much in love with what you do, and the families, and the patients. And I cannot imagine doing anything else. I don’t think it is for every nurse. I don’t. I think that you have a special belief and you want that special relationship with the patient and the family. I worked in the hospital and some nurses think that’s great, and that’s wonderful for them. But I didn’t feel, for me, that I could give the care — and the personal care, maybe I should say — that I wanted to. I just didn’t feel that I could do that. And with hospice, I can.
LOFTON: Does working with people at the end of life change how you live your life now?
CARTER: It does. You know, I have heard so many times from patients: ‘You know, I wish I would have done this or I wish I would have done that.’ I hear of their regrets. I see families and patients try to get over, you know, maybe they had been estranged, child had been estranged from a parent or, you know, a parent left and now they’re, they’re trying to make amends. I think …it’s taught me that I need to ask for forgiveness, not to have regrets, say what I need to say to my loved ones. So that when that time comes, you won’t have those regrets and those losses.
LOFTON: When you hear about things that people wish they had done, are there any themes that stand out to you that lots of people kind of have regrets with at the end of life?
CARTER: Oh, I think a lot of times it’s ‘I should have took that trip.’ ‘I shouldn’t have worked so much.’ ‘I should have spent more time with children or spouses.’ It’s those types of things that, you know, they wish they would have done. Things that may happen in life and you really don’t give it a second thought at the time. It seems to come back at the end of life, no matter how trivial it is — you, you remember, ‘I should have said this’ or ‘I should have done that.’ But hopefully for the most part, I think, you know, they may say those things. But again, it’s usually not big, huge things.
LOFTON: Over the last 20 years that you’ve been working in hospice, how has it changed?
CARTER: Well, when I first started, no one knew what it was. And now it is more mainstream. I think people are more, they understand more, what is happening. It — death — is not shunned like it used to be, you know. People talk about it more. Unfortunately with our drug problem, it has caused some problems for us. I have to count pills every time I go. I have to watch neighbors coming over to visit — we have to find a [secure] place to put the medicine. It used to be able to sit beside the bed, but it can’t do that anymore.
LOFTON: As more young people leave the state, are you seeing [a] smaller family group surrounding a patient at the end of life?
CARTER: I am. And I’m seeing, you know, a lot of times it’s the 90-year-old spouse trying to take care of the 90-year-old husband or wife. Family seems to live out of state a lot of times, and it has definitely caused some problems. Fortunately, we also have a long-term care team. And if the patient needs to be placed, they can still have hospice care. But there’s definitely a lot of family that are not local anymore…they’re looking to hire caregivers, [but] they might not be able to afford caregivers. In that case, we just try to ramp up our visits, and try to pull in anyone that we can possibly pull in to assist that family.
Creative and emotionally healthy funerals are making waves in communities that value personal choices, resourcefulness and good old wholesome naturalness, but for reasons of expense they also appeal to blue collar workers.
Ashleigh Martin is a part-time director at the parlour.
“We’re about empowering families to make the choices they need to make to have a beautiful funeral,” she said.
“There’s definitely a need in our community for people to be able to have affordable funerals that are authentic.”
Since its inception in 2016, the community-run organisation has guided over 300 families and loved ones through their losses.
The parlour offers a multitude of services that assist people to have memorable personalised ceremonies, the latest trend in the industry is bio-degradable woven wicker coffins, handmade in the Byron Shire.
Dignity in death
The not-for-profit is changing the way communities look at death and dying, empowering families to make the choices they need to make, to have a beautiful funeral.
many years and conceived a new business model by combining funerals with music and art.
The model looks at affordability and encourages people to “own” the experience, to take back their power in the face of death.
“We empower and guide people to have a meaningful, beautiful, send off,” Ms Martin said.
Malika Elizabeth is a local musician whose involvement with the establishment extends to directing and singing in the organisation’s community choir, and acting occasionally as a celebrant.
“She’s a visionary when it comes to community and bringing people together,” Ms Elizabeth said.
“She’s created a space for people just to be with each other, to be with their emotions, and to join together in commonality.”
Grassroots ethos
Unlike wooden or cardboard caskets, the woven caskets offered at Tender Funerals are perfect for hand-decorating with ribbons and other personalised items.
“They [clients] just want something unique and different that they can personalise as well by putting flowers on it or weaving through it,” Ms Martin said.
“We know if it is getting buried that it will break down quickly and won’t leach any harmful chemicals into the earth.”
After working in traditional for-profit homes, Ms Martin said that at Tender Funerals it is not about upselling to grieving families.
“It’s very much about thinking about what we can do differently and what we can do to give meaningful tokens back to our families,” she said.
Art for health’s sake
The grassroots ethos is intertwined through every detail of the business, from the handmade and decorated wicker caskets to a fortnightly community sewing circle run by the group.
Tender’s artist-in-residence Michell Elliot illuminates the cyclical nature of life and death with those in grief using muslin and donated funeral flowers.
The colourful cloth she creates is then used as shrouds for bodies, encouraging creative expression to farewell loved ones.
“I think that if clients choose to shroud somebody with one of our tender cloths that it’s done with love, and I think that’s a really beautiful thing,” Ms Martin said.
Ms Elliot also assists in providing a safe space program at the parlour for people to come together, grieve, share stories and sew.
The parlour facilitates a safe meditative space created through the arts for people to connect with their emotions to heal.
“When people feel that maybe they don’t want to see their loved ones being prepared for burial, or they don’t know what to do, how to feel, just sitting and sewing quietly allows those feelings to come, to be processed and to shift and move,” Ms Elliot said.
Music, art and funerals naturally go together
The organisation is also home to an in-house choir.
On Thursday evenings at the old fire station, people come together to sing songs of life, songs of death and songs of love.
Choir directors Jodi Phillis and Malika Elizabeth have sung at grave sides, in memorial services and during intimate preparation times.
They said they feel honoured to be at every funeral they attend.
“These elements go together naturally with us because we are musical people, but I think in a community like Port Kembla, where people just aren’t aware that this stuff can actually be available to them, it might be something people just don’t think of,” Ms Phillis said.
“That they can have live music to celebrate the life of the loved one they lost.
According to Ms Phillis the business model adopted by Tender Funerals relies on two fundamental aspects.
“One, to bring the sacred power of music and art into the community, especially for people who aren’t religious but still want to celebrate the life of the deceased,” she said.
“The other really strong element is supporting the arts.”
Selecting the soundtrack for a particular event can be a collaborative experience.
“Generally, families will have an idea of what music will be best for their loved one, but sometimes we make suggestions,” Ms Phillis said.
“It’s kind of whatever works really.”
“We all have the feeling that music is a spiritual thing,” Ms Phillis said.
“It comes out of us, it’s linked with the heavens, it’s what fills in the gap in the air.
“If anything is going to reach our loved one, it’s going to be music.”
At this point in time Tender’s business model is focussed on the Port Kembla premises, but having survived two years of operations, their success indicates a community movement towards an organic, not-for-profit model, with plans to expand.