Have an Agenda

Whether death comes slowly or without warning, it is best to be prepared.

By John Dunlop (MA ’03)

When I started medical school in the late sixties, sudden death was the rule of the day. Chicago would have a heavy snowstorm. The stalwart would go out to shovel snow and keel over, the heart unable to handle the strain. If someone were nearby, they would run to the nearest phone, call the fire department. Firefighters would arrive to take the sufferer to the hospital, performing mouth-to-mouth resuscitation on the way. But little could actually be done to preserve the person’s life until he or she was inside the emergency room. Most commonly, the victim was DOA (dead on arrival). Sudden death having claimed yet another victim. Thankfully, this course of events doesn’t occur as often today because of a well-known telephone number: 911.

Whether you look at the statistics for heart attack, stroke, gun shot wounds, or car accidents, sudden death is less common. More and more of us will need to adjust to our deaths coming slowly and gradually. This will not be easy, since modern people prefer their lives to end quickly; we tend to fear the process of dying more than we do death. A century and a half ago, people feared the opposite, preferring a slow rather than quick death. The Anglican Book of Common Prayer includes the line “Lord prevent us from sudden death.” Apparently, people of the past believed that dying slowly had rewards that a sudden death did not, advantages that those of us today would do well to reclaim.

If we are to have a good death, we must have a clear understanding of the things that need to be done before we die. To make this point when I am speaking to groups about aging and dying, I often ask them to list four of the most important events that have occurred between the time they were born and the present. Most can do that rather easily. Then I ask them to list four of the most important things that must take place between the present and when they will die. That is more challenging. Certainly it can be tragic to receive a terminal diagnosis and know you are near life’s end. But despite the dreadfulness, this time can be quite meaningful if you know
what you need to accomplish during it.

I realize I am being somewhat idealistic in making these suggestions. Our individual circumstances may be different, and what each of us needs to do may be unique. Still, I urge my patients to think through their personal agendas and to use their final days and hours to do what is most crucial for them.

Though gradual death is on the increase, it is far from universal. Deaths tend to come in three different ways. First, death can approach gradually, pursuing a steady and relentless course. The time of death can be at least somewhat predictable. Many cancers and Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis), for example, cause this kind of death. It is important to understand that even these gradual deaths tend to occur more quickly than doctors and patients first expect. The fact is that most doctors predict that patients will have three to five times as many days till death than they actually experience. Second, deaths can come suddenly, without warning.

Third, deaths can come as the result of diseases that we can control for a long time with today’s medicine but that will eventually be fatal. Albert was told eight years before his death that he had a very weak heart and that this condition would eventually take his life. He was an ideal patient and cooperated fully with his cardiologist. His deterioration was slow, and in spite of knowing how weak his heart was, everyone expected him to keep on going like the Energizer Bunny—until the day his wife found him collapsed in the bathroom.
Dead! Albert knew death was coming but had no idea when. In that sense, even a gradual death can be sudden.

The possibility of sudden death makes it imperative that all of us work on completing the agenda now, so that if death were to overtake us unexpectedly, we would be prepared. The third scenario is equally difficult. I have learned that when the initial diagnosis is made, some careful thought should be given to the agenda we are about to discuss. Go ahead and have the serious talks about death and dying. But then it is okay to leave it there. Get out and live; enjoy each day knowing that whenever the end comes, you will be prepared.

John Dunlop is an adjunct professor at Trinity. He practices geriatric medicine in Zion. This article is excerpted from his book, Finishing Well to the Glory of God: Strategies from a Christian Physician (Crossway, 2011).