 My name is Larry Grimm. Welcome to Think Tech Hawaii and the program Don't Just Age, Engage. I am your host today and at the end of this time together you will have considered some factors that have to do with whether or not you will have a delightful death. Now I know that it seems like a strange topic and an awful lot of our programs on Think Tech Hawaii have to do with issues, community issues, cultural issues, social issues that we need to deal with and my program every other Tuesday here at two o'clock Hawaii time on the second Tuesday and fourth Tuesday of the month have to do with some of those or the third Tuesday of the month have to do with some of those internal dimensions of of aging and my my concern is that you don't get caught up in just sliding down down the slope of age into oblivion but that you are engaged in what can be the most creative and wonderful time of your life and so we're considering today the end game dying and it is very much a part of our conversation these days. How often how when I get up in the morning I take a look at the COVID-19 numbers. I wonder how many new cases are on Oahu and in the state of Hawaii. I wonder how many are hospitalized and of course I wonder how many are dying from COVID-19 disease of the from that from the virus that we're all engaged in combating. Not only that but we also have been very much aware in the past couple of weeks of some very important celebrities who have died that caught our attention long ago. We as baby boomer boomers grew up in our early years learning the comedy of Betty White and following her through her various incarnations and TV shows and then her marriage to to Alan Ludden. Betty White died she was two weeks or so in a few minutes short of a hundred-year birthday but I suggest that we give her that hundred years. She lived into her hundredth year and was living through it so yes Betty White was a hundred years old as far as I'm concerned and a remarkable spirit of a woman. We are reflecting can't go through Facebook pages without reflecting on Betty's accomplishments and her contributions to our society. Bishop Tutu for those of us who have been classically engaged in peacemaking social justice concerns particularly from a Christian point of view. Bishop Tutu died he too was in his 90s or late years and he we have been celebrating the contribution that he made and his words and in his spirit and his his wisdom and that we are grateful for all that that still lingers and continues on as an expression of of his convictions and spiritual life and his leadership in the church of Jesus Christ and then there's Dan Reeves those of us who have been football admirers are familiar with Dan Reeves and his contribution to the to the to the Cowboys Dallas Cowboys and to football in general John Madden another one and and as I list these I don't know about you but I'm very much aware of how I think oh this is here comes here comes death and dying moving in on me and indeed that's true for all of us when I got when I passed 65 I passed my retirement as a Presbyterian pastor in pastoral roles but I continued working as a minister in long-term care as a chaplain trained chaplain and in hospice care as professional trained chaplain and professional pastoral counselor and in that context I of course was very much confronted with the death and dying daily and there were times that I would walk into a room and I'd say oh I wonder if that's me in that bed preparing to die at this time and in this type of death I never know for sure of course but it becomes something that we're conscious of and and that's why I began to turn my attention to some questions about how to die I began I've read a lot and I've listened to many lectures particularly on YouTube from Alan Watts who was a who was a popular philosopher in the 60s 70s 80s even into the 90s in which and and dedicated as he was to integrating the philosophical orientation between Orientalism the Orient and Western Thinking and I found a rich rich exposure to some incredible insights about life and death and dying and I'll share a little bit about that with you today one of the things that that Alan Watts stressed was back in the 90s we need to have more people who will help us with have a delightful death and that kept caught my attention having a delightful death and I found that those people exist and they have been generated since the 70s across the world and across the globe in a professional manner and I want to share that with you a little bit today as some understanding of how you can have and we can all have a delightful death hospice care are the people that I'm talking about hospice care is built around four pains we call it Dom Cecily Saunders who originated the concept of hospice care in this nation brought it over from England identified four four pains that people have as they enter into this aging process in these last few months of life she said there were pains that were physical pain of course and most of us get dragged into aging through physical pains there were relational pains what how that impacted family life marriages the relationship to friends and the cultural attitudes that are born with in our society about death and dying not any of which I think on in general are too popular or too pleasant I think our social we have to come to terms with the fact that our society is afraid of dying and hates aging the third third area is the economics of course of healthcare living of continuing to live even into through the dying process and then fourth are the spiritual dimensions of the patient and their family life what are the spiritual beliefs the spiritual orientation the inner life the emotions and the content of those belief systems that inform people as they move towards death and dying I will have the privilege of sharing the spiritual dimensions with many many people in my hospice care as part of a an interdisciplinary team each patient that comes into hospice care and I was I served on Oahu with Bristol hospice and each patient that comes into hospice care has a assigned to them a physician a nurse a cna social worker and a spiritual caregiver so that all four of those all four of those pains the total pain is addressed and supported now what was the biggest obstacle to providing a delightful death well the biggest obstacle to providing a delightful death was in patients and family members who enrolled their family member with one week three days left in their dying process they didn't get to experience the total support the total system of support and a nurture that we offered and that began to trigger my thinking about about death and dying again about the process that we go through and we many of us choose to feel as though we are not going to die and we're just going to go on living until death catches a spice of prize this is what I call the the emergency landing I was have a metaphor for that because when I was in Richmond Virginia in seminary I took a trip from Richmond Virginia to Raleigh North Carolina on what we call the puddle jumper so we were up high above the clouds flying down the the coast and in between the Appalachian Mountains and the and the coast and as you know from from our own experience here on a water there can be wide ranges of types of of weather experiences well this this one day it was very rainy we were flying above a cloud system all the way and we got over the the airport in Raleigh North Carolina and the and the pilot came on the PA system pilot said well we have thick thick coverage over the over the airport I can't just go down through it I have to wait until there's an opening and we we think there will be an opening soon so we'll cruise about and circle up above the clouds until that opening comes so they circled them so we did indeed circle above the clouds and an opening came and the pilot said I have an opening I'm going down and and he from that high high elevation just took a nose dive it seemed down through the opening that had come in the clouds just down to the all the way down to to a landing level the approach land a level and for me it was a white knuckle experience I grabbed those I grabbed those those uh seat grabbed that seat and held on dear life it felt like a roller coaster ride right from the top to the bottom many of us think death will do that to us we'll we'll catch us by surprise like we've got to go now and I'm going to deny it hold it off not prepare for it I'll just I'll just wait until that happens but there's another way to look at this and I call it the Oahu landing landing in Oahu planes who come into land that come into land in Oahu start a descent many many miles away and the descent is gradual and it's calm and it's peaceful and in fact it gives you a chance to look around and see the see the beauty of the island as you come in you're sitting at a window seat or to look at the ocean and that to me is is what I want to offer as a life coach which I do focusing on an extraordinary elderhood for you and as a life coach to have that end game there before us always and the approach be gradual and the approach to it be calm and the approach to it be well prepared for a delightful experience now what are some of the things that you can ask in order to have a delightful death the majority of us 80 to 90 percent of us over 60 want to die at home here on the island that means about 220 220 220 thousand of us want to die at home and because they're they're well in Hawaii in Hawaii they're 200 200 quarter of the population is as I understand it is over 65 and so we're looking at a large number of people who want to die at home what are we doing what are you doing to prepare again what I've said we found in hospice care because we had this rich assemblage of people with talents and abilities in these four areas of life and oftentimes didn't get to share those with the family members and the dying patient because they waited until last minute to enroll in hospice care but if you enroll in hospice care several miles out the approach is gradual and calm and the learning and the growth and the experience of life at this time of life is as remarkable and cannot be duplicated any place it becomes your experience of course it is your experience and it's a gift to you in my opinion that we all provide work to provide and and to and to by enhancing those that time of life now but what are some of the questions what are some of the ways to do that well one of the things that I think is important is to ask your physician some questions I'm going to ask my physician given what you know about my health about my patterns how do you imagine I am going to die am I going to contract COPD am I going to die of a fall am I going into a complications of obesity how do you imagine knowing what you know about me I will die now interesting interestingly we are in an era age with an incredibly beneficial age of technology because all the record keeping goes into one chart at least for me I'm I'm part of the my chart system with the queen's medical system and all of my doctor I have three doctors that have made input into this one chart and I can view the chart I can about view all the test results that come from various blood panels I can view all of my comments from the physicians that are noted in the chart and keep on track and keep track of it and most importantly my primary care physician who's an internal medicine doc can look at those and follow those and she gets a sense of the patterns that I follow and so here's all this wonderful information available to us available to her because of the technology of the age and I would suggest to you that if you have not benefited from that yet that you find a way that you can either through one of the hospital connections or or on the island straw or or or the queens and just ask your physician how can you get the information how can we get the information in a centralized way and then ask them what how do you see me die now physicians are of course devoted to the living physicians are devoted to healing and it may be that one of the things that you'll first encounter is a resistance to talking about it by your physician because the physician wants to focus on what's going to give you life thank god that's true but also is if you see that you're dying as part of your living it does also something that has to do with life and living delight delightful death process is what I am hopeful that you will be able to do so what how do you see me dying doc how do you from the patterns that I have shown you imagine my last days my last hours there are ways that we can anticipate how that will be for instance in hospice care we have had guidelines um with regard to the dying process and if you look I have a the first one I would like to put up for us to look at is um several months out from the dying process we can see some some things in the pattern of of uh succumbing to disease by the way Dr. Louise Aronson in her book Elderhood has said that no one dies from old age we die from disease we die from falls a lot of men die at the foot of a ladder because they think they should be up there cleaning out their cleaning out their uh gutters but uh but if we if we are indeed have some sort of disease then we can anticipate some of the effects of that disease on our bodies in the dying process so there's one to two months out from death itself we can anticipate one to several months down what what what what we will be able to see in ourselves and uh and our loved ones there's a kind of withdrawal from the world and from other people desire to be more alone and uh in fact Elizabeth Kubler Ross said this experience of can be an experience of depression in which people turn their backs literally on their family members you'll walk into the room to visit your loved one who's dying and he or she may say I don't want to I just don't want to talk I don't want to be with you today so yes going back to our list a withdrawal from the world there's a decrease in food intake this can bother us a loved one's a great deal because we you know eating food and receiving food is a way of feeling loved but there's a decreased food intake that we go through then going back again Eric to the list we sleep more increase sleep there's a withdrawal inside itself and there's just less overall communication with with those around us one to three one to three months we'll see that kind of pattern begin to emerge and for and even for me being a gregarious person who likes to talk with brands and family I could easily feel as though you know I'm doing something wrong it's not fair but it's not something wrong it's just the way it is just the way I need to to pull back now as we get closer the next in with one or two weeks we'll see some other things so what we may feel disoriented and agitated we may be talking with unseen family members who have died and gone before us there may be some confusion and some picking at close blood pressure decreases pulse increases or decreases skin color changes we may find ourselves more pale or blue respiration irregularity set in congestion and sleeping but responding complaints about the body being tired and heavy again no eating taking a little fluid a body temperature can be extremes hot or cold so we see that how we are able to begin to track in in ourselves as we get close to the dying experience how the body responds to these different in these different ways finally and when there's a few days hours or days the there's an increase of the one or two week signs there's a surge of energy can happen one one thing that I remember is one one of my family one of my church members came to church one I was very ill came out of the hospital and came to church Sunday night and she said oh I just feel so wonderful I feel exuberant and then she died the next Thursday sometimes there's that peak of energy before the final dying days and depression can set in blood pressure out guys eyes can get glassy tearing half open irregular breathing stopping and starting a kind of apnea anti-breathing restlessness or else no no activity at all decrease urine output may we may may stool in the bed and things that will embarrass us certainly if we're as we have cognizance now during this time of course palliative care is active and if you ask for palliative care you ask for or morphine and other drugs that will keep you from hurting and this will give family members some frustrations because it becomes more difficult to communicate finally in the final hours of death the dying process there's we begin to breathe like a fish out of water and we fall asleep and can't be awakened now I put this up if you if you'd like to have this list send me an email and I'll be glad to to send that list to you it can be helpful in monitoring how family members are doing as they go through the dying process but I had one one patient who said I'm an engineer I want to know what to expect and I gave him this list and he was so thrilled because he could say I'm doing this I can see myself doing this and doing this so he used it to monitor himself but also this is to emphasize I want to emphasize with you how important it is to have this long approach lengthened approach so that you have time to do the conversations and time to experience the joys and celebrations of life well lived together with family members and friends so how my physician how am I going to die how do you see me dying at this point if I taking away the possibility of COVID maybe taking away the possibility of of of of an accident excuse me of accidental death so and then we have other plans things to go through about about our our home site how do we want to stock our home how do we want to prepare there you can talk these things over with the social worker with with the chaplain you can talk these things over with a deaf doula if you want to hire a deaf doula to come help plan and one of the things that I enjoyed tremendously was an experience of dying with one of my patients who had opted for the our care our choice our care use of medically assisted death she had planned it so that all friends had come together she had one friend who did a hula I read a poem some others just remembered her and they were there and then finally toasted with champagne before she took the medically medical assistance and and died herself it was truly a delightful death but this can be planned according to to your wishes on a long range view of dying and that's what we're trying to foster that's what I try to foster ultimately the most important thing is your inner orientation what do you believe about death and dying one of my favorite quotes from John Dunne who was a minister and Scottish minister in the 1700s is that poem death be not proud I have just a a quick snippet of that poem here to share with you death be not proud eric death be not proud though some have called the mighty and dreadful for thou art not thou art not so for those whom thou thinkest thou dost overthrow die not for death nor death hence thou kill me so part of the process of preparation is identifying how you feel and what are your orientations towards death and dying you and life beyond death there are plenty of people who share with us their experiences of death beyond dying and life beyond death and for you to look at their experience is is a rich way of understanding your own positions uh some some cultures think if we talk about dying that we'll bring on our death I don't believe that um I think talking about death is a way of experiencing life more fully how can I talk with my friends there are passages and ways uh systems available to have conversations with families I use living will five wish five wishes friends this is a wonderful experience I come back every two weeks to look at the inner life spiritual dimensions of aging so because I want you not just to age but to engage aloha and have a wonderful two weeks I'll see you here again in two weeks