Most of us avoid talking about death. The topic is not, well, the most pleasant one to address because, inevitably, it means a discussion about what happens before we breathe our last breath. Dying. That’s the part of the conversation where you say, “I hope I go in my sleep,” or “I hope it’s quick and painless.”

Since we can’t run away from dying or lock it up in a closet – sorry – I thought I’d share what Atul Gawande has to say about it in his latest book, Being Mortal. He takes an anxiety-producing topic and fearlessly broaches it through mind-boggling research and affecting stories. Though, I should warn you, the book is not emotionally easy to read. The stories come one after another: Alice’s frequent falls and car accident, Bella’s descent into blindness, Ruth’s stroke, Sarah’s lung cancer.

For much of history, death just happened. People literally dropped dead: you had a sore throat, and the next day you died. Our bodies didn’t “crumble” over time like they do now, thanks to advances in medical technology (28).  We have antibiotics, breathing machines, intravenous fluids, dialysis, chemotherapy. There is always one more drug, one more experimental therapy a physician can pull out of the medicine cabinet to keep you alive, even if it’s only for a few more weeks. Physicians, especially surgeons like Gawande, are trained to fix people. But, in doing so, are we causing more harm than good? Are we denying the aged, and terminally ill, sought after comfort?

But some people are willing to do anything – surgery, take pills – with the hope of maintaining independence, but, as Gawande says, “what do we do when it can no longer be sustained (23)?” Perhaps your parent has have lived on her own for the past fifty years, tending the garden, walking the dog, driving to the grocery store, and so on. But now, due to poor balance and a broken hip (FYI: about 350,00 Americans fall and break a hip every year), she can no longer engage in any of those activities. She can no longer safely cook her own meals or walk to the bathroom. She needs someone to be with her, 24/7. How do we keep the aging population safe while, at the same time, foster their independence? Who will be the one to care for our frail grandparents, parents, or spouses? These are just a few of the difficult questions that lack a single-dose answer.

Through interviews with patients, his dying father, other physicians, and proponents of institutional change, Gawande, and readers, learn that the “sustenance of the soul” is possible through imagination: community co-op living, mobile teams to check in on the elderly, and greenhouse living – long-term care facilities designed to look like a home (128). He debunks the myths of hospice – to do nothing and “let nature take its course (160).” If anything, hospice allows the aged and ill to live a bit longer in their own homes by fostering patient dignity and autonomy.

How all of this comes to fruition may not sound so simple, but Gawande guides us, with a cheat-sheet of questions to ask those who are dying:

1)   What do you understand about your illness, or prognosis?

2)   What are your fears? Goals?

3)   What do you care about?

4)   Given the circumstances, what trade-offs are you willing to make?

5)   If your health deteriorates, how would you like to spend your time, and whom do you want to make decisions for you?

Medicine is not only about repairing people’s hearts or fixing their broken bones.  It’s about maintaining an individual’s well being, emotionally and mentally. It’s about helping human beings live meaningfully by encouraging them to be the author’s of their own lives, up until the very last sentence.

Gawande, Atul. Being Mortal. New York: Metropolitan Books. 2014. Print.

I’m a prose writer, a memoirist, and essayist. I don’t pretend to be a poet, but I dabble in a bit of poetry here and there. I don’t adhere to meter, heptameter, hexameter, or iambic pentameter. I don’t write limericks, ballads, or sonnets. I write vers libre (free verse). I write to share the emotional truth.

Yellow – the most visible color.

Banana peels, tractors, raincoats, school buses, beach flags.

Highlighted words: scars, survivor’s guilt. Sticky notes on the refrigerator, on the bathroom mirror, scrawled with indelible ink: call psychologist, take antidepressant, Attend brain injury support group.

Flashing traffic lights: Slow Down. Double yellow lines: Do Not Pass. Diamond shaped signs: Road Closed Ahead. Rectangular signs: Highly Flammable. Children at Play. Watch for Bicyclists, Joggers – and pedestrians.

Caution tape – a reminder. Ten died. We survived the impact – of the speeding car. Sixty-three of us.

Yellow – the most visible color. In the dark. From a distance. Even from the corners of my eyes.

Be daring. Take a risk. Write a poem. And, please, share.

In the wake of the Iraq and Afghanistan wars, we’ve learned more about post-traumatic stress disorder. But have you heard about post-traumatic growth (PTG)? Richard Tedeschi and Lawrence Calhoun, psychologists at the University of North Carolina in Charlotte, conceived the concept in the 1990s. PTG involves a positive psychological change that occurs after experiencing a traumatic event. PTG can be measured through what is called the PTG inventory. But each one of us copes differently, and who is likely to experience PTG depends on several factors, such as personality traits, mood, and gender. http://www.posttraumaticgrowth.com/what-is-ptg/

If you are interested in learning more about PTG, consider reading What Doesn’t Kill Us: A Guide to Overcoming Adversity and Moving Forward by Stephen Joseph: http://www.profstephenjoseph.com/

Here are some other resources that might be of interest:

Post-Traumatic Growth: Positive Changes in the Aftermath of Crisis. Richard Tedeschi, Crystal Park, Lawrence Calhoun. March 1998.

Super Survivors: The Surprising Link Between Suffering and Success. David B Feldman and Lee Daniel Kravetz. June 2014.

American Psychological Association: www.apa.org/post traumatic growth

In 2012, nearly half a million premature births occurred in the United States. An infant born before 37 weeks gestation is considered premature. Risk factors include: race, smoking, alcohol use, having delivered a previous pre-term infant, carrying multiple infants (twins, triplets), problems with the uterus or cervix, and chronic illnesses such as diabetes, asthma and kidney disease. www.cdc.gov/PrematureBirth

If you don’t already know, post-traumatic stress disorder is also considered a risk factor for premature births. In the largest study ever conducted, researchers at Stanford University Medical Center followed more than 16,000 infants delivered by female veterans. More than 3,000 premature births were delivered by mothers diagnosed with PTSD. Those diagnosed with PTSD in the year prior to delivery were found to be at thirty-five percent greater risk. The researchers factored in other issues, such as race, age, medical conditions, and alcohol and drug use. It’s worth noting that fifty percent of the women studied never went into combat, proving that the link between PTSD and delivering a premature infant is not exclusive to veterans. Civilian women are affected too. www.sciencedaily.com/2014/11/14

But how does PTSD contribute to premature births? Stress. Though the exact mechanism is not completely understood, higher than normal levels of stress hormones are released in those suffering from PTSD symptoms. The immune system then becomes suppressed, increasing the risk for infection, which increases the risk for premature birth. www.marchofdimes.org/pregnancy/stress

The good news: those who do not experience PTSD symptoms in the year before delivery are at the same risk for giving birth to a premature infant as those who do not have PTSD. For those who do suffer symptoms in the year prior to delivery, treatment is available. The Veterans Administration is using the results of the study in the care of pregnant women with PTSD. For pregnant civilians with PTSD, the good news is that you now know you are at risk, and can inform your obstetrician. There are some risk factors you might not be able to control – age and race for instance – but you can gain control over your PTSD. www.sciencedaily.com/2014/11/14

For a list of therapists, go to The National Board of Certified Counselors at: www.nbcc.org/counselorFind

This past weekend, in remembrance of Martin Luther King Jr, I attended a celebration in his honor at a local Unitarian church, where I was graced with the presence of Nontombi Naomi Tutu. In light of the recent deaths of Michael Brown in Ferguson, Eric Garner in New York City, and Tamir Rice in Cleveland, this event could not have come at a better time. People clapped and shouted “Right on!” as Tutu reminded us, in her mesmerizingly charismatic voice, “humanity is indivisible.”  She repeated this phrase again and again throughout her thirty-minute speech. She brought her own fears to the podium: because her son is seventeen, she said she doesn’t worry that he’ll go out and get into trouble; she worries what will happen to him because of the color of his skin. How many white parents worry that their sons will get shot because of the color of their skin?  Isn’t it correct to say that the black community is still not free, even though slavery ended one hundred fifty years ago in 1865?  They are not free in the sense that they must look both ways with extra caution when leaving the house. Unlike white people, especially white males, black people must work, often to no avail, toward privileged status. They earn less income than their white counterparts. Thirty- percent of black youth are unemployed (www.bloomberg.com/bernie-sanders). Tutu cautioned us, “Privilege costs you your humanity.” I gathered that she meant unearned privilege, as it makes us less aware, less empathetic perhaps. If humanity is indivisible then, as Tutu says, “We can only be free if we are all free.”

Before I left, I had the opportunity to thank Tutu for traveling to Vermont on a drab January day, for leaving me with vital words to chew on: “Injustice oppresses the oppressor at the same time it oppresses the oppressed.”

By the way, I even had the opportunity to hug her. She hugged me back and said, “I like hugs.”

What did you do on Martin Luther King Day that speaks to the indivisibility of humanity? (Indulging in sales does not count).