Engage With Grace: Preparing for the End of a Life

PJ Hamel Health Guide
  • Originally Posted November 10, 2008. Updated November 27, 2008.


    Engage with Grace

    Image Credit: Engage with Grace


    My father died of cancer 4 years ago. He wanted to die at home, in the bed he and my mom had shared for nearly 60 years. So, helped by regular hospital visits to drain fluid from his chest—fluid that would eventually suffocate him—he stayed home.

    My mother, my brother, and I cared for him: feeding him, bathing him, bearing witness to his sorrow as this voluble man, this Irish politician, lost his voice. Hospice came for the final week; they rubbed his back, gave him pain medicine, told us what to expect as he got closer to the end.

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    Finally, I lay down in the bed next to him. I put my arms around him; told him I loved him. Said we’d see each other again, on the other side. Then I got up from the bed and left him for the last time. Left him, in my brother’s care.

    Four days later, he died. As he wished; in his bed, held by his wife.

    None of us can choose the time or manner of our natural death. But we can choose the place: our home, an extended care facility, even a hospital, if that’s our choice. And we can choose the medical interventions we want—or don’t.

    The problem is, most of us don’t make our choices known: to family, friends or, truth be told, sometimes even to ourselves.

    It’s estimated that nearly three-quarters of Americans would prefer to die at home, yet up to 50% of us die in the hospital. Seven out of 10 of us will die of a chronic illness. A Dartmouth College study, reported in The New York Times last spring, noted that Medicare costs for chronically ill patients in the last two years of life range between about $50,000 and $100,000. Dr. John Wennberg, the study’s chief author, noted that “Some chronically ill and dying Americans are receiving too much care—more than they and their families actually want or benefit from.”

    We don’t want to die in the hospital. Many of us don’t want extended medical intervention; it’s expensive, and prolongs a life we’re ready to leave. So why are so many of us undergoing heroic life-saving efforts for weeks, and finally dying in the hospital?

    Because we don’t make our wishes known. We’re afraid to talk about death; our own, or our loved ones’.

    That’s where Engage With Grace™ steps in. Engage With Grace/The One Slide Project, a California-based initiative, is spearheading a viral marketing campaign aimed at getting Americans to speak about end-of-life issues. Organizers Matthew Holt and Alexandra Drane are urging us to share The One Slide—a PowerPoint-type visual of five key end-of-life questions–with our colleagues at work, friends, and family.

    “Commit 2 minutes to present The One Slide at your next company meeting,” urges the group via its Web site. “Share the slide with loved ones over dinner. Be able to answer the questions for yourself, and for your loved ones. And encourage others to do the same. Get the conversation started.”

    “[We] have one goal: to help ensure that all of us—the people we care for—can end our lives in the same purposeful way we lived them.”

  • Visit engagewithgrace.org. Register and answer the five questions. Share The One Slide with your family, your friends, your team at work. Make your wishes known; and urge others to do the same.

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    If you can send a joke around the world via email, surely you can figure out how to talk to the people you care for most about the end of life: theirs, and yours. And if you need help starting the conversation, Engage With Grace.


    For another real-life account of discussing end of life issues, read Carol Bradley Bursack's post on Engage With Grace.

    Take a community poll on end of life discussions, and then learn about how others approach talking about life and death.


    Also read the Boston Globe's coverage of the Engage with Grace project.

Published On: November 26, 2008