A version of this article was published on the cover of the Jefferson Monthly. Text and photos reprinted with permission. On a sunny day last March over a hundred mostly gray-haired older people file into an auditorium at the Smullin Health Education Center. A large screen behind the stage projects the afternoon’s agenda: HAVING THE CONVERSATION. On stage are two empty armchairs, violet with pale blue dots, a white rug, and a hospital gurney. On the gurney lies a manikin, its hairless head resting incongruously against a flowered pillow. For some reason I find this detail heartbreaking. We are gathering in this dimly lit high-ceilinged lecture hall to talk about death, a subject most Americans under sixty would rather avoid and most Americans over sixty aren’t sure how to broach with their loved ones. I hunker down in my seat, trying to make myself smaller. I am attending this event as a journalist but I am already flooded with grief. In November 2011 my mother had a massive brain hemorrhage. At 73, she was healthy and fit, sitting at the computer in her third floor home office writing a letter of recommendation for a former graduate student. A friend saw her biking earlier that day. Perhaps to the post office, where she had mailed a package to me: a hand-embroidered shirt from Mexico, where she had just been lecturing about microbiology. That afternoon, seemingly out of nowhere, a vessel in her brain exploded. She cried out and fell heavily to the floor. By the time the EMTs arrived, my mother could not speak, the right side of her body becoming paralyzed from the bleeding going on inside her brain. John Forsyth, M.D., is a retired cardiologist who wants to help families plan for and cope with these kinds of catastrophic events. Dr. Forsyth, who introduces the program, is the co-founder and chair of COHO, a non-profit project in southern Oregon that helps facilitate conversations about dying. COHO stands for “Choosing Options, Honoring Options.” This organization believes that communication about the end of life is one of the keys to having a dignified death based on personal preferences. “We are more than our flesh and bones,” explains Susan Hearn, Executive Director of Southern Oregon Friends of Hospice who also works with COHO, when I spend two hours interviewing her two weeks earlier. She tells me that most people at the end of life die four ways: from sudden death, from cancer, from chronic disease, and/or from frailty and dementia. Much has advanced in modern medicine, she notes, but as the satiric paper “The Onion” has pointed out, the world death rate among humans remains constant at 100 percent. Susan invites me to attend some of COHO’s community events, which are usually free (a donation is suggested), to better understand the organization’s mission. “The more you talk, the more opportunity you have for meaning and growth, and figuring out what’s important about your life,” Susan says. WITH AND WITHOUT THE CONVERSATION In order to illustrate just how imperative it is to talk about death before a loved one dies, COHO presents two skits. In the first, an older woman (played by Shirley Patton) walks onto the stage. “I thought there’d be time for everything,” she says wistfully. Then her tone grows playful. “That’s me in the bed. I look pretty good, don’t I? I never looked my age.” Her daughter comes onstage next, wringing her hands and badmouthing her brother. The distraught son—late because he stopped at the bar on his way—can’t bear to let go. He wants to continue as many life-sustaining interventions as possible and he belligerently tells his sister their mom is too young to die. At the same time we hear the dying mother’s thoughts in a voice-over. Though she cannot speak to her children she hears everything they say, shrieking with frustration as they bicker and ignore her. The antagonism between brother and sister makes my skin prickle. No mother wants to die thinking her children will never see or talk to each other again, the dying woman wails to the audience. The second skit is the same scene with the same characters that begins the same way. But there is a crucial difference: Though Shirley still lies dying on the hospital gurney and though there is still some tension between her children, the three have already had a conversation (“the conversation”) about their mom’s end of life. “We need to give our mom a death she can be proud of,” the daughter (played by Eve Smyth) muses to herself, “that’s the only thing we can do for her.” “I know what you want,” she continues, talking directly to the manikin, “but it still won’t be easy.” This time Shirley, the dying woman, is the most important person in the room. Her son (played by Peter Quince) and daughter cope with their grief differently, and the son is still full of bluster and misery, but they have already talked to their mother about her wishes and know what they need to do to honor them. Instead of anger, feelings of love, sorrow, and forgiveness permeate the imaginary hospital room. It’s not just hard for families to have these kinds of end-of-life conversations, it is hard for doctors too. “In medical school and in five years of post training, we never received any education about end-of-life conversations,” explains Dr. Forsyth. “We were meant to feel guilt if we could not produce a cure.” He tells the audience he believes medical school training is changing and that medical students today are more encouraged to have discussions about end-of-life issues with their patients and their patients’ families. Others aren’t quite so optimistic. “Recently a hospital in the U.S. launched a ‘Cheat death!’ tag line,” Peg Sandeen, Executive Director of Death with Dignity National Center, writes me in an email. “Physicians regularly and aggressively treat disease, but rarely discuss the dying process.” Others point out that today’s medical students are still
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