Some people avoid any discussion of death and dying, but I have always found the subject fascinating.

You are here one minute and gone the next. Very strange. And much harder for all those around you than it is for you, yourself. They are the ones who must cope with the strangeness of it all.

I was so fascinated with death and dying that I carried out a series of interviews about what it is like to work in end-of-life care. Put together, these ended up comprising a highly successful book.

It chronicles the experiences and views of a wide range of people who work with the dying, especially nurses, but many others including doctors, managers, therapists and a very reflective cook.

The Timing of Death

There are many issues that fascinate me, but one is the extent to which a dying person can control when he or she dies.

I had heard rumours before my research, but it confirmed that some people tend to wait for a particular event and can hold on surprisingly long when it is important.

And some others wait for the moment when their loved one is out of the room, presumably to avoid their distress, before letting go.

Long-Term Couples

But there is yet another intriguing discussion to be had on this subject. This is the apparent fact that long married couples can often die in close proximity to one another, within three months or less. Sometimes even weeks or days.

This is often commented on. My parents certainly did, dying aged 90 and 91 within three months of each other. I went from having a full set of parents to being an orphan, admittedly not a young one, as I was in my late 50s.

A good friend did the same thing not long ago. She was in her late 80s, her beloved husband of nearly 65 years had died, and she just lost all interest in living. She died quite soon afterwards.

You will perhaps know similar cases.

There are some very touching stories of married people dying within days – or even hours ­– of each other. People tend to find them heart-warming, reinforcing our romantic ideas about the power of love.

Is this all just a coincidence or is there an explanation for such patterns?

Research on Couples

Those who have researched this subject seem to think that there is a genuine phenomenon, termed the ‘widowhood effect’, so it is more than a coincidence. It is particularly common among men, i.e., widowers rather than widows.

It is also known as ‘dying of a broken heart’.

It is thought that the lives of bereaved spouses are upset so radically by the death of their partner that they are vulnerable to both physical and mental health issues.

Women are often more resilient, in part because they tend to have built up more close friends around them.

Women are also more likely to eat better, but both men and women tend to pay less attention to their food, because of loss of appetite and lack of companionship when eating.

None of which explains the rapid dying, since neither mental health problems nor poor diet lead directly to immediate death.

Anyone who wants to read further on this issue will find a reasonable summary of recent research here.

What Is Our ‘Take-Away?

Everyone wants to learn these days. If there is something important going on, they want to know the ‘take-away’.

This one seems a bit complicated.

Looking to your own life, you may want to ensure that your spouse has people who will provide company (and decent food) if you know you have a short life expectancy.

You may also want to be conscious of potential problems for yourself if your spouse dies first. As we get older, we do tend to think about these things a bit more.

Perhaps you know someone who has lost a spouse and could help them in this regard. You may want to gently offer some help, difficult as this can be.

But those working with grieving spouses will already appreciate the need for some companionship and good nutrition – they should be high up on their agenda.

Perhaps you can do more than be alert to the issue.

A version of this article was first published by SixtyandMe.com

I write frequently for an online women’s magazine called Sixty and Me. It  is a wonderful place for older women to learn how to look better, feel better, be a better person and get more out of life. But this article does none of these things.

Yet it is on a subject that I find so interesting, I want to share it with you. It is about some evidence that people who are seriously ill can – in some unclear way – determine the timing of their death.

The nature of the evidence

When carrying out long and deep interviews, it sometimes happens that the people being interviewed raise issues that were never part of the initial research.This is what happened when I undertook a series of interviews with nurses, doctors and others who worked in hospice care for a book on the subject. My principal interest was in their motivations for such work and its impact on their lives.

But in the course of such discussions, many referred to particular patients who they remembered well – and issues arising from their interaction. And one of these issues was this matter of the timing of deaths. All of the patients involved were necessarily gravely ill and in the process of dying, as that is why they were receiving hospice care.

Timing over a matter of days or weeks

The first phenomenon here was the ability of some patients to hold off dying until some particular event of importance to them had come to pass.

One nurse mentioned that a very ill man was expecting his family to come from Australia to see him in England. To her surprise, he managed to stay alive until their arrival and then, soon after, died. But there were others who were keen to see a granddaughter married or a new grandchild born, who also managed to stay alive until the event. There were said to be more deaths following certain holidays, such as Christmas.

No one interviewed had an explanation for these events, but they were stated as facts – and happened too often to be taken as mere coincidence.

Since undertaking this research, I noted that there has been some discussion of the timing of deaths in the course of a year. It seems that there are notably more deaths at the beginning of a new year than in the last days of the previous year, suggesting that dying people ‘hold on’ to see the new year arrive. Indeed, there was particular evidence of this at the turning of the Millennium. Evidently, there were strikingly more deaths in the first week of 2000 than in the last week of 1999, as reported in the Guardian Newspaper (17 January 2000). The Associate Director of the National Council on Aging, commenting on the noted ability of seriously ill people to hang on until a significant event, said “The mechanisms are something of a mystery but the phenomenon is very real.”

Timing over a matter of days

But hospice staff also noted that some people seemed to find the right moment to die. Several cited examples where patients died at just that moment when certain circumstances changed. A number seemed to want to die alone.

A large family, for example, had been spending a lot of time with their dying relative over a period of days. But at one point, one of the visitors needed to deal with their car and the entire family went to the car park for a few minutes. Strangely, this was the time when the patient suddenly died.  Another nurse told of a wife who asked her very anxious husband to go make her a cup of tea. At the time, she was not drinking or eating, but the husband, wanting to please her, went on that errand. Before he could come back, she had died.

It was thought that patients wanted to make their passing easier for their relatives.

We shall never know.

Lessons 

And what can we learn from these stories?

It is possible that they are all coincidences and one shouldn’t make too much of the issue.

But it is also possible that our internal make-up is much more complicated than we tend to think. Links between mind and body are little understood.

I happen to find it fascinating

This article was first published by SixtyandMe.com

Not long ago, my husband said rather casually to me, “I wish I knew when I was going to die.” An important wish, indeed. He is 81.

But his concern was neither spiritual nor existential. He was wondering whether it was worth his while to have a knee replacement operation.

The complex issues of being old

Finding ourselves in what are inevitably our later years has many different aspects. Some people bemoan the fact of being old, loathe the many vicissitudes of ageing and have a strong fear of death.

Not me. I have always focussed on the positive at whatever age I have found myself – and this includes right now, having turned 80. Indeed, I have written a .

But this doesn’t mean that everything is easy. We have less and less energy. Our memories fade. Our bodies begin to show their age in one way or another – or perhaps I should say in many ways altogether.

I tend to summarise this as ‘the wheels begin to fall off’.

The knee operation

Which brings me back to this knee.

As many readers will already know, knee operations are not at all easy. Some proportion go wrong (you end up worse off than when you started) and there is a long period of recovery and rehabilitation.  My husband’s thoughts were very sensible: “If I knew I was going to die in a year, it wouldn’t be worth all the trouble. But if I had ten years, it would be worth thinking about.”

And he is right. It is a difficult decision.  I would bet there are plenty of others in the same situation. Or wondering whether to move house. Or whether to embark on some other major undertaking.

All our lives, we are taught to weigh decisions carefully, taking into account the costs and benefits, including the time available.  Yet here we are with a key variable completely missing from the calculation.

I wish I had an answer, but I don’t.

Would you really want to know?

But his simple question sent a number of ripples into my mental pond. Would we really want to know our expected date of expiry?

Yes, there are some decisions where a clear date of departure from this earth would be useful.

You could make more sensible medical decisions. And perhaps some others. You would know exactly when your things needed to be in order. You could say your good-byes in good time.

But this is undoubtedly a slippery slope. How would it affect your day-to-day relationships? Or the activities you undertake?

Would you be out there trying to fulfil every longstanding wish, ticking off the items on the famous ‘bucket list’? Or would you simply turn your face to the wall some time in advance?

Or would you be the proverbial deer caught in the headlights – so much to do, so many people to see, not certain where to turn?

Socrates

It is strange the things that you remember. I distinctly remember my mother telling me, when still a teenager, about Socrates.

He had been condemned to death and was due to be administered a dose of hemlock (a known poison). While it was being prepared, he asked to be allowed to finish learning a particular melody on his flute.

On being asked why he wanted to do this, he was reputed to have said, “When else will I learn it?”

I don’t know if this is apocryphal, but it is a good story. Doing something meaningful until the very end.

This was first published by SixtyandMe.com.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Can you remember when you first heard these beginning lines from this famous poem by Dylan Thomas? Perhaps in high school? Or perhaps in college? It was published in the early 1950s and has remained one of his best-known poems for decades.

It had such ferocity, such passion. It swept many of us up in its simple words. No, of course, we will rage against the dying of the light. We wouldn’t imagine doing otherwise.

I don’t know about you, but I was young and romantic when I first heard this poem. It sounded so brave and so right.

If you hear Dylan Thomas reciting it, with his very musical Welsh voice, it is even more so.

But, in the light of our years of experience, is it so right after all?

Thinking about dying

Something made me think about this poem recently, and for the first time, I began to wonder whether I agreed with it anymore.

Those of you in your 60s may not think about dying all that much. It feels a long way away – unless you have some life-threatening disease or are closely involved with someone who does.

It’s the kind of thought we easily put away for another time, further down the line. Nothing to worry about now.

But as we grow older, into our 70s and beyond, we begin to think about a lot of things, including dying.

We are aware of friends dying, not to mention many others around us. We notice that the obituary pages are full of people younger than us.

It makes us begin to ponder how we will cope with this last challenge.

Attitudes to dying

I have spent some time over my life thinking about dying for two reasons.

First, 30 years ago, I wrote a book based on interviews with young people with HIV/AIDS, back when the diagnosis was essentially a death sentence.

The men and women interviewed were incredibly inspiring. They were not generally raging at their situation, as Dylan Thomas urges them to, but were doing their best to live as well as they could for the limited time they had left.

And they were remarkably concerned for others. Many were involved in support groups for other people with the disease. Not surprisingly, those with children were particularly concerned to ensure that they would be well looked after.

I found them all very moving and, indeed, wise. I called the book Wise Before their Time.

Caring for the dying

Secondly, roughly 15 years ago, I wrote another book based on interviews with nurses, doctors and many others looking after the dying in two hospices.

They, too, were inspiring but for another reason. They were very thoughtful of the needs of the dying people in their care – and did their very best to respond to them.

For instance, they helped hospice patients to write important letters to family members or encouraged them to make their peace with key people in their lives.

They also went the extra mile to respond to patient requests. One man, for instance, said he wanted to die under a tree and when the time came, he was taken outside to a tree.

The atmosphere in the hospices I have visited is always very tranquil. Peaceful – certainly not full of rage.

Dylan Thomas revisited

Which brings me back to whether I would really want to rage against the dying of the light.

The simple answer is no.

Yes, I want to live life to the fullest for as long as I can, but when the time comes, I hope I will meet my end in a spirit of tranquillity.

I hope I will have said all the important things that need to be said and feel at peace with myself.

This will make my dying so much easier for family and friends, not to mention my husband if he is still here.

But it will also make it easier for me.

This article was first published by SixtyandMe.com (see https://sixtyandme.com/how-we-die/)

I heard an expression the other day that stopped me in my tracks. It had the ring of a famous saying, although that turned out not to be the case. But more importantly, it had some real profundity. It said, simply, “Life ends in the middle of a sentence.”

Getting your life in order

Life ending in the middle of a sentence basically means that the end of life is not tidy. And, I suspect, that is absolutely right.

The issue is essentially about getting – or not getting – your life “in order.” How many times have people spoken to you about this? It is one of those phrases that people start to use once they are over a certain age.

And those of us who have reached that certain age also begin to think about it. When the end comes, as it must someday, we want to be ready.

This sense of readiness can be about your mental state­ – making peace with yourself and others – or it can be about your things and your activities. It is the latter I want to address here.

Some people may have already met this readiness goal. They will have carefully downsized both where they live and what they own.

In the process, they will have sorted all those old papers, with many thrown away and the important ones carefully organised. Their books will have been sorted and cut down to a minimum.

More significantly, they will have handed down all the precious memory-filled items that they wanted to ensure landed in the hands of a particular daughter or son. Or, perhaps, grandchild or, indeed, friend. They will have read through their last will and made sure it is in a safe place.

In sum, all that stuff that seems to accumulate over the years will have been substantially reduced. Everything will be in its place.

The process of ‘cleaning up’ after their demise will be easy. They will have left no mess behind. Congratulations are due.

Real life

But is it really that easy? Can most of us be quite so fully organised? We may have tidy plans and a wish to do the right thing, but I question whether we can ever have such orderly lives. And, most importantly, would we wish to do so?

The image of everything being in its rightful place suggests that we have had our lunch, tidied up, put the plates away and are sitting quietly in an armchair waiting for the Grim Reaper to knock on the door.

In truth, life is not like that. We all have projects of one kind or another. For me, it is writing; for others it may be painting or knitting a special outfit for a grandchild or planning the next holiday.

Human beings don’t often put their feet up and wait. They get restless, they mooch around, and they get themselves stuck into something that interests them.

Even if they don’t have exact plans, they may well have dreams. This came home to me very vividly when I was looking after a man who was dying of AIDS roughly 30 years ago. We were writing a book together about living with AIDS and had become good friends.

He had done comparatively well, living longer than anyone expected, but his body was beginning to let him down. As someone active in the AIDS community, he was well aware of his situation. I helped him out where I could.

Among the errands, he asked of me was to post a letter, together with a coupon, to a company offering a free trip to the Caribbean to a lucky winner in several months’ time. I remember walking to the nearest post box wondering why I was doing this obviously pointless task.

But I knew that such dreams were part of what was keeping him alive. In fact, he died two weeks later.

My own experience

Although I would dearly love to know that my life was “in order,” I have not yet tackled this process. I keep thinking about downsizing, but like St. Augustine and chastity, I say, “Oh Lord, not yet.”

I have thrown away a lot of papers, given away many books, and made some lists that will make life easier for my children when they come to cope with my death.

But I have not yet moved from a large house, suitable for when my children were home, and still own a lot of things that should properly be moved elsewhere.

More importantly, I have numerous projects still to go. I am nearly finished with one book and am planning another. There are books I want to read.

My family photographs are in a mess and need to be sorted if those who remain behind want to know who was who. A long list of things To Be Done sits on my desk.

And there are aims for the future that will never get finished. I want to see my grandsons grow up and find out what they choose to do with their lives. If I live long enough, I will feel the same about any potential great-grandchildren. So, there is no end ever in sight.

We don’t stop until we are stopped. At that point, we will be in the middle of loads of things. There will always be a long To Do list. In short, we will be in the middle of a sentence.

And this is how it should be.

A version of this article can be found in my book, The Granny Who Stands on her Head: Reflections on growing older (see getbook.at/Stands-on-Head)

It was first published on SixtyandMe.com (See https://sixtyandme.com/getting-your-life-in-order-before-it-ends-too-soon-can-it-ever-be-accomplished/)

“I’ve had my three score years and ten. I really can’t complain – all the rest is extra.” These are the words of my father a few years before he died.

The number these days – probably even then – might not be exactly right when calculating the average life span, but the attitude is spot on.

When it comes to living, we all want more, more, more. But I think we should be pleased when we get those extra years of life. They should be valued and savoured as much as the years before.

But my father had a much more serious problem than simply dying – he was deeply concerned for the welfare of my mother, who had vascular dementia.

If he died first, who would look after her when he was gone?

Older People

Many of us older people these days find ourselves in the role of carers (or ‘caretakers’ in the US). There is the occasional carer for a parent – the children of all those centenarians, after all, are not exactly young.

But much more common are the older people caring for a spouse with a serious disease or disability. They slowly aged together and one of them became afflicted with some problem or other.

The remaining spouse generally does what he or she can for a period. If things become too difficult to manage, the overwhelmingly stressful decision may be taken to put them into a care or nursing home of some sort.

But this doesn’t take away the problem. All the worries of who will visit and care about them and how the ill or disabled person will manage in the case of their death still remain.

In my father’s case, the situation was eased because they lived in a retirement community and, when he could no longer cope, my mother was moved to the ‘assisted living’ – and later, the ‘nursing care’ – part of the same complex.

Moreover, he had hired a wonderfully attentive woman to see to her needs for some hours every day. She helped my mother to dress, talked to her endlessly and took her out for walks.

She had a marvellous combination of practicality, good sense and great warmth. She undoubtedly eased the lives of both my parents in their last years.

And yet this did not solve my father’s problem of dying before my mother.

He broached this issue with my brother and myself on several occasions, and we assured him we would continue to do what we could – and to pay for the extra help for as long as it was needed.

Other people with disabilities

I had already been very familiar with this problem. Many years ago, I had carried out some research on the problem of parents of adult sons and daughters with what are now called learning disabilities.

Many of the parents were in their late 70s and 80s and many of their ‘children’ were aged 50 and above. The study was ostensibly about what they saw as the best housing arrangements once their son or daughter moved from the family home.

But it soon became clear that the real issues that worried these parents were emotional – not practical – ones.

First, the tremendous family bond meant that they didn’t want their son or daughter to move away to be helped by anyone else. They feared that no one would love them or care for them in the same way.

And second, they were deeply, deeply worried about what would happen after they were gone.

This was probably the most emotionally stressful of any of the research I ever undertook, with highly emotive interviews often ending with tears.

My colleague and I felt that we had no easy answers, but it was important to raise the question, which had been largely hidden. By bringing it out in the open, we hoped that both parents – and the professionals who worked with them – could begin to make appropriate and thoughtful decisions.

We published a book called Letting Go, which got some attention at the time (1989) but is long out of print. I should mention that the book has not been updated since it was published, so if you manage to find a copy, please do bear that in mind.

The problem of dying

I want to come back full circle to where I began. As we age, we naturally begin to think about death and its implications for ourselves.

This is normal – and healthy ­– and I hope everyone can find their own peace.

But spare a thought for those who have that additional worry of what will happen to someone they love when they are gone. They are the ones for whom we must have the utmost sympathy.

Postscript

My father did die first. But my mother died only three months later. We continued to pay for her companion, who was enormously helpful to the end.

At my father’s request, we gave her an extra sum after my mother’s death in thanks for her devotion to my mother.

And I learned some years later that she used this sum to pay for nursing training, got her diploma and has since become a nurse, a lifelong ambition.

This article was first published on SixtyandMe.com