Five years ago, I had the privilege of interviewing a group of vibrant, thoughtful people in their 70s, 80s and 90s who lived at Parkshore Senior Community in St. Louis Park. At the time, they were gathering in bold, almost defiant, fashion to dig deeply into a topic few want to talk about: death.
Or, more accurately, how to live robust and meaningful lives that still make room for important conversations, not just about living well, but dying well, too.
To inform their journey, they watched a PBS Frontline documentary, "Being Mortal," with Dr. Atul Gawande, held book clubs, asked questions of medical and legal experts, completed health care directives and did their best to soothe their worried adult children who really wished they'd talk about something else.
Their copious notes, evolving opinions and rich personal stories have been gathered in a new workbook titled "A Senior's Guide for Living Well and Dying Well: Conversations That Matter." Parkshore resident and the book's author, Dr. A. Stuart Hanson, shares why he hopes more of us will consider starting end-of-life conversations now.
Q: When I first met you, you posed three basic questions to your neighbors at Parkshore: "How do I want to live until I die?" "What matters most to me?" And, "How can I be sure my wishes are carried out?" Have those questions changed since then?
A: I might expand on those questions and be more specific now: "How do I live well as I age?" "How do I want to use the health care available to me?" "How do I create my legacy?"
Q: We're all going to die. Yet, Americans seem to believe we can outrun death. Why is that?
A: Many of our religious institutions focus on living well and a life after death. There is less emphasis on the end of our physical lives. Many of us avoid thinking intentionally about the end-of-life processes and what we want and don't want as our lives as we know them are coming to a close.
Q: Why was it important to create a workbook instead of a traditional textbook, encouraging people to write in the margins and even fill out forms, such as the advanced directive (living will)?
A: Many of us know we should "get our affairs in order" as we age, but we resist doing it. There are many barriers. Adult children and grandchildren don't want to talk about their loved ones leaving them. Too often, seniors and their families wait until a crisis forces decisions that are made hastily. Our workbook lays out the issues we have found important for us and makes practical suggestions on being intentional about our later years.
Q: What does "living well" mean to you now at age 85? Was it different 10 years ago? Twenty?
A: I am making plans to go to a hundred. I say, "If you don't know where you're going, you are not likely to get there." If I want to live another 15 years, I need to exercise regularly, eat well, sleep well, find meaningful activities, maintain relationships with family and friends, and maintain adequate financial resources. These are the principles I considered 10 years ago when I retired, 20 years ago when I decided to keep working for my main activity and 30 years ago when my wife retired and both our children were finishing their educations. Each of these decades placed a different emphasis on my six principles of living well.
Q: Do you think people who hammer out answers to these important questions when they're younger are better at facing death when it comes?
A: I try to live each day as though it may be my last. But I was not willing to accept that concept until I had finished my medical training and begun to ply my trade at 34. I think the sooner a person begins to think deeply about their life trajectory, the sooner they will find purpose in what they are doing, the sooner they will see hope for their future and the sooner they will accept their physical life ending.
Q: What's the biggest danger to people who don't, say, have wills or end-of-life preferences spelled out?
A: People who are not intentional about their life ending, and who avoid making their wishes known, leave a burden for their loved ones who will have to make decisions for which they are not prepared. These are decisions that can lead to serious and permanent resentment and family discord.
Q: How do you bring adult children into this conversation and why is it important to do so?
A: These are the "Conversations That Matter." The book makes suggestions on how to approach the subjects and who should be involved. Each family's situation is different and several actual experiences are given as examples.
Q: One of the most compelling questions you want us to ask is "Who am I?" What are you hoping to draw out of participants?
A: I would frame this as two questions. "What is the meaning of my life? And what is the meaning of my death?" We all have to consider these questions inwardly sometime in our lives, even if we deny them outwardly to others. The book attempts to stimulate self-appraisals in seniors and their families to make their living and their dying more intentional, more satisfying and less stressful.
Q: You also encourage the writing of "legacy letters," which are a way to share your values with progeny, but also to apologize for past regrets. Have you seen the latter work in practice?
A. We have held workshops for writing family or legacy letters. Feedback from participants has been uniformly positive and they say it has opened up discussions that had previously been avoided.
Q: The book tackles some of the more unpleasant realities of aging: memory loss, the blues, poor sleeping, falling, being a prime target for scams. What is joyful about getting old?
A: It is joyful to wake up in the morning knowing you have something worthwhile to do today, that you can move and nourish yourself, that you have family and friends who care about you, and that you have planned for what the future is sure to bring. Knowing how to deal with some of the stressors of elderhood makes them less frightening and manageable.
Q: How do people get your book?