Our ride into the sunset

by Dr Nihal D Amerasekera

I am writing this as a septuagenarian. Having worked most of my professional life in England my thoughts are coloured by the laws and healthcare in the UK. The fundamentals and the basic principles of my message will ring true wherever in the world one lives.

“Media vita in morte sumus” – In the midst of life we are in death. This is the first line of a Gregorian chant circa 1300. This rings true now as it did all those years ago. Presently we battle through our lives in the midst of Covid-19. For septuagenarians like myself, in the autumn of our lives, there are many other pitfalls that lurk just around the corner.

At any age we all lust for longevity. Although we all will face it someday, our aversion to talk about death is universal. This is partly due to the fear of the unknown and also not wanting to tempt fate. During my childhood grim legends abounded and tales were told of death, devils and the darkness of hell. These daunting images continue to colour my thoughts even now. It is true there is little point in talking about death when we are young and healthy. The scene changes irrevocably when we become septuagenarians. This is the time to bite the bullet and face reality while still able to enjoy the good life.

Life expectancy has risen considerably in our lifetime. Perhaps, professionally, we have helped to make this happen. In the United Kingdom the life expectancy for men is 79 and for Women 82. Living longer has many benefits. It is indeed so wonderful to see our own grandchildren grow-up and perhaps also to see their children too. But there is a price to be paid while the years take their toll on us. The sudden deaths that took away our parents and our grandparents don’t happen anymore. We just live longer.

Our bodies continue to wither away as the years pass. A fistful of tablets and an earful of advice keep us going. The joints continue to creak and the back aches as we trundle along. I can feel the gradual decline and the loss of energy as the months pass. I am not as steady on my feet as I was last year. Gravity is gradually trying to take over when I walk or try to maintain my erect posture for long. These issues that are rather trivial now will only get worse with time. If I live long enough I will need help for walking, feeding and ablutions. This may be with a carer at home or in an institution. This requires careful thought and judicious planning.

Life must have an end. A rapid exit is everyone’s dream. Unlike for the previous generations the end for us may not be swift. Cancers or degenerative nervous diseases like strokes, dementia and Parkinsonism are some of the common ways to exit this world. Departing this life is never pleasant. Then again we will need help in the way of a carer or be confined to an institution. These issues need careful planning now when we are compos mentis. Importantly the family should be consulted. They must be aware of our choices that may have significant financial implications. We must remember it is their pain and burden too. They must have the information to discuss with us the feasibility of our plans.

To plan ahead we must make an informed choice. For this the doctors must provide us with the information with frankness and honesty. Thankfully, in the new millennium, the conceit and the patronising pomposity that existed in the medical profession has large melted away. This has resulted in far better rapport between the doctor and the patient. When confronted with a terminal illness we need to know the prognosis, the positive and negative implications of treatment and also of having no treatment. Before making a choice It is essential to weigh up the implications of a range of alternatives, some of which may be “off the menu”.

It is wise to leave written instructions as to our care including treatments we do not want to have. This is legally binding and is called the Advance Decision to Refuse Treatment (A living will). I know some have instructions not to be resuscitated. Some want all treatment stopped including antibiotics. We can also allow someone else to make the decisions for us when we can’t. This is called the Legal Power of Attorney. Some cancer patients do not want any treatment. They do not wish to prolong life not wanting the stress and struggle of radiotherapy and chemotherapy and its many unpleasant side effects. It is imperative the doctor should discuss the quality of life on treatment. Many others show great resilience and courage in continuing and completing the treatment schedule and we respect their choice.

If terminally ill I should have the right to end my life. This issue has come into prominence in the UK in several high-profile cases of Motor Neurone Disease and Multiple Sclerosis that reached the Supreme Court. Adequate safeguards must be built in for this. In the UK there has been a shift in common morality for euthanasia and assisted suicide both of which are illegal under English law. Some go to Dignitas in Switzerland, a place for assisted suicide, to end their lives. Ending one’s life is a last resort. The National Health Service provides good palliative care as well as providing psychological, social and spiritual support.

The answers to the many questions that arise and the solutions to the many problems that surface will vary according to our personal circumstances. It is paramount that the wishes of the patients and their relatives are respected. I am merely raising awareness to a common problem we will all face sooner or later. As I write I know of 90 year olds, like Queen Elizabeth II and the Duke of Edinburgh, who are still smiling, enjoying life and their families. But they are no doubt in the minority. Some still cling to the old fashioned, laid-back and carefree mindset “Que sera sera” – Whatever will be will be!! This may just leave our loved ones in the dark about an issue which may be long and protracted and financially draining.

Making that final journey to exit from this world is something we must all do in the fullness of time. This challenging journey may take from a few days to a few months. Professional medical input is vital during this period to remain free of pain and to receive psychological and physical support. We must leave behind the sadness and regrets of the past, taking with us only those happy and joyful memories. In the lonely waking hours one may wish to walk with God for comfort and support or focus the mind on meditation and mindfulness. Some receive comfort from the “Mozart effect” of listening to soothing classical music. There is a lot of helpful advice available from professionals, carers and institutions to reach that final destination with dignity.

As much as there is no holding back the night, there is no hope of a second dawn. I feel we leave this earth never to return again. I seek the wisdom of that great Roman Poet Horace “NON OMNIS MORIAR” (Not all of me will die). Our children and grandchildren are shaped by the genes they inherit from us. They smile and laugh like us and even may think like us at times. They will carry our baton into the future.

For septuagenarians, their minds are much calmer now. There is no burning ambition or desire to chase money or position. We have done our caring for our progeny. Once we have made our choices for our parting it is so important to return to our regular routine. It serves no purpose to dwell on death and dying. We will deal with it when it comes. It is so true we will not pass this way again. So enjoy the beauty of nature, the charm of the countryside and seeing the birds and the bees. The company of family and friends will continue to bring us joy.  It is only then we can dare to sing that famous song “Que sera sera” .

Here are my best wishes for a happy and peaceful journeys end.