DEALING WITH DEATH - EntornoInteligente / The trinidad Guardian / “The only two things for sure in life are taxes and death” and taxes are certainly on our minds now the oil and gas money is running out.

Unfortunately death is not. Violence perhaps, but not death. We fraid death and try to stay away from it. Yet, fear of death may be the source of everything distinctively human, from phobias to religion.

Try as you want to keep it away, death is always near us, always at the back of our minds, whenever our children are sick, when we drive, watch the news, lime in the office, go to sleep at night, everywhere, and especially at the funerals Trinis love to attend.

It’s ironic that we fraid death but love funerals. It’s the social aspect of course as well as the opportunity to congratulate ourselves, “she gone but I here!”

And death is particularly close to people who live in small islands. Sometimes it seems not a week goes by without getting a call saying, “you hear who gone?” Or “Larry dead! Nah! I just see him down town. We talk. He was well. Yes, boy. Just so, he take in. Dey didn’t even have time to say goodbye!”

Yet death from illness is shrouded in secrecy. The cause of death is almost always hidden. Code words are used. He died after a long and debilitating illness. Cancer. He just “drop down.” Stroke. They find him dead in the morning. Heart attack. He was only 35 and was sickly. HIV.

How people die, the misery, the pain, the loss of dignity, the poor end-of-life care, the uncomfortableness of it all is never exposed.

According to last week’s Economist, 56 million or so people die each year, eight thousand of them in T&T, a drop, except to those living here.

A century ago, most deaths occurred at home. Now, a survey of 45 rich countries by the WHO shows that fewer than a third are.

As death has been hidden away in hospitals and nursing homes, it has become less familiar and harder to talk about.

Another reason is longer life. Until the 20th century the average human lived about as long as a chimpanzee.

Over the past four generations, science and economic growth has increased the average lifespan more than over the previous 8,000.

In 1900 global life expectancy at birth was about 32 years, little more than at the dawn of agriculture. It is now 72 years.

In large part, that is a result of lower infant and child mortality, paediatricians doing their job: a century ago about a third of children died before their fifth birthday. But it is also because adults live longer.

Today a 32-year-old Trinbagonian can expect to live for another 40 years or so.

Yet an unintended consequence has been to turn dying into a medical experience. It’s should be a living experience.

Death mostly comes by stealth. Only about a fifth of deaths are sudden, for example a heart attack. Another fifth follow a swift decline, as with some cancer patients, who stay fairly active until their final few weeks. But three-fifths come after years of relapse and recovery. They involve a “slow, progressive deterioration of function.”

People in rich countries can spend eight to ten years seriously ill at the end of life and it’s rising in poorer countries.

The figures are startling. In 2015 chronic dying accounted for more than three-quarters of mortality in China. In 1990 the share was just a half.

WHO predicts that rates of cancer and heart disease in Sub-Saharan Africa will more than double by 2030.

As late as 1990 half of deaths worldwide were caused by chronic diseases, mostly related to overeating ie eating sugar-rich, processed junk; in 2015 the share was two-thirds.

Most deaths in rich countries follow years of uneven deterioration. Roughly two-thirds happen in a hospital or nursing home. They often come after a “crescendo of desperate treatment.”

Nearly a third of Americans who die after 65 will have spent time in an intensive-care unit in their final three months of life. Almost a fifth undergo surgery in their last month.

Many deaths are preceded by a surge of treatment, often pointless.

A survey of doctors in Japan found that 90 per cent expected that patients with tubes inserted into their windpipes would never recover. Yet a fifth of patients who die in the country’s hospitals have been intubated.

An eighth of Americans receive chemotherapy in their final fortnight, despite it offering no benefit at such a late stage.

Nearly a third of elderly Americans undergo surgery during their final year; eight per cent do so in their last week!

Polls find that most people in good health hope that, when the time comes, they will die at home. Few, when asked about their hopes for their final days, say that their priority is to live as long as possible. They want to die free from pain, at peace, and surrounded by loved ones for whom they are not a burden.

Yet we continue to avoid having discussions about death and more so, about our own death.

Of course, most people feel dread when they contemplate their mortality. But honest and open conversations with the dying should be as much a part of modern medicine as prescribing drugs or vaccinating.

A better death means a better life, right until the end.

Dying, to death, is part of our lives now. Better to decide now how you want to go, before a hospital, a nursing home or an ungrateful family decide for you.


Con Información de The trinidad Guardian

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