09/11/2014 12:25 pm ET Updated Nov 11, 2014

When the End Is in Sight: Handling the Conversations, and Your Life

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This is the third part of a four-part series on death, life and decisions we face going forward into our final 20 or so years. (For the first two parts of the series, go to the Martha Nelson blog on The Huffington Post.) As Baby Boomers, we have led the way all of our lives. Now we will lead each other to the end of our days, like it or not. We need to talk about it, hard as it is, because talking together may help us to become enlightened as we head into the tunnel.

Nothing seems to shock us more than a diagnosis of cancer. I suspect it's terrifying because, deep inside, each of us knows it could happen to us. We pause when a friend or family member is stricken, our frightened minds turning to mush. Oh, no, we think. Am I next?

On the heels of this kind of news, we typically begin to analyze the lifestyle and health history of the cancer patients we know. Did they smoke? (Well, then, we say to ourselves, that's the key). Did they carry too much weight and eat comfort foods which were loaded with cheese, red meat and fat? (Well, then, we say, that's the reason). Did they fail to exercise, get regular check-ups, and participate in a full and active life? (Well, then, there's the culprit).

In fact, some do, some don't, and cancer still appears.

After hearing sad news, we often re-commit to a healthy lifestyle with the hope of warding off disease, while in the back of our minds we know people who smoked, drank a lot, ate steaks and potatoes loaded with bacon and sour cream, didn't exercise and lived into their late 80s and early 90s. It seems that all we can truly know about cancer and other life-threatening illnesses is that they strike when they're ready, without discrimination.

Most of us want to grow old so long as we aren't stuck in a wheelchair screaming for someone to come and take us out of the nursing home. Fortunately, many of us will live to a ripe old age. In fact, nonagenarians (90+ people) are the fastest growing age group in many parts of the world today: some two million 90+ live in the U.S. today, with a projected 10 to 12 million here in the next three decades. Nonagenarians will be the primary consumers of healthcare, and yet we don't know much about their aging bodies and minds.

For this reason, the longest study of the "oldest of the old," The 90+ Study, which began in 2003, was recently re-funded for several more years. The main goal of The 90+ Study is to determine the dominant factors of longevity. Here are some of the results from the study as of 2014:

• People who drink moderate amounts of alcohol or coffee live longer than those who abstain

• People in their 70s who are somewhat overweight live longer than normal or underweight people

• People who exercise and move around daily live longer, and the amount of time spent is important. The study shows that 15 minutes of exercise/movement provides benefit, 30 minutes provides more, and 45 minutes give us the most benefit. After 45 minutes, the benefits level off so that 45 minutes is just as beneficial as three hours, for instance. It wasn't necessary to do it all at once, or daily, either. The exercise data were measured by what was done daily over the course of a week.

It seems to me that this study is dispelling some of our healthy lifestyle myths while confirming others. Time will tell, as the research continues. For now, says the study's leader, listen to what your mother told you to do: Eat a balanced diet with a wide variety of fruits and vegetables (accent on variety), exercise, keep your mind active and you may be dancing at 90. Maybe.

Despite happy projections, we know that most of us will face a life-threatening diagnosis in the next ten to fifteen years. As we enter our late 60s and throughout our 70s and 80s, we know that something is going to kill us. Cancer, kidney failure, repercussions from diabetes, Parkinson's, strokes and heart disease, await us as we continue to age.

We realize that disease is just as much a part of our lives as wellness these days. Finally, we've reached the time when we must give serious thought and planning to how we will handle ourselves when the bad news comes.

What we all know for certain: The early days of a life-threatening diagnosis are devastating. Is there anyone among us who hasn't felt gut-wrenching sadness when we learn that a friend or family member has been given a deadly diagnosis and prognosis? Worse yet would be our disbelief and anger if that diagnosis/prognosis were ours. In both cases we'd want to scream, cry, turn back the day, shake our fists and make the illness disappear. But it won't.

After a period of time, which is as personal as the disease, reality is accepted and plans begin to take shape. Typically the first thing to sort out is how we'll tell our family and friends. There are as many ways to do that as there are people. Here are some ideas:

Set boundaries for yourself. You may want to tell no one, or everyone, or just some close family and friends. The most important thing to realize is that it is your choice and you can do whatever you want to do. Don't feel pressure to talk when you don't want to, or aren't ready to get into the details of your illness. "I am not comfortable talking about this right now," you may say. And that will be just fine.

Many decisions need to be made: You may want to wait until you're more settled in accepting your diagnosis before letting people know. You may want to engage family or friends face-to-face, or do it over the phone. You may designate someone else to tell people about your illness, and ask that they wait to hear from that particular person for additional updates. You may decide that you don't want visitors or phone calls. You may decide to pack your bags and stick your feet into the ocean and tell people you'll talk with them when you return, if you come back at all. Do what you want.

You may not want the whole neighborhood to hear the news in an email blast. If so, don't do it. If you want to wait until your time is closer to the end to discuss your death with your grandchildren, then wait. If you want people to stay away while you gather just your loved ones close to you in your final weeks and months, tell them to stay away. If you don't want another well-intentioned casserole coming through your front door, let people know. All of these messages can be delivered with kindness and gentleness. If people don't understand, then maybe someday, when it's their turn, they will. For now, they are not your job.

The essence of life facing death? Do what you want, for once in your life, and don't feel obligated, or guilty, if people are offended. Your only job is to embrace your life every second of each day.

When the time comes, plan your conversation. I'm not suggesting a scripted talk. But, depending on the people you're talking with (children, adults, close family, or friends vs. casual friends) you may want to tailor your conversation so that you give only the information they need and can handle. Children and grandchildren are particularly hard to deal with when it comes to this conversation. How you handle it all depends so much on your personality, history, emotional health, faith in yourself, or in a powerful God, or in the universe unfolding. Your closeness with these family members, and their ages, will help you to know how to talk with them. "I will do the best I can because I love you so much," you might say to a child, or grandchild. "Nothing will ever change that. But even with that much love, I may not be able to overcome this disease. But I won't be far away. I will be with you, always, in your heart." Sound corny? You might be surprised how good corny sounds in these situations.

Your grown children will want to know your plans. How do you want to work with this disease? Do you want to fight it with all of your might, or are you are more accepting of what is to come? Do you want to move into and embrace this unfolding of your life, or do you want push back hard? Do you want aggressive treatment, including experimental trial drugs when traditional treatments fail, or do you want to shorten your time in favor of pain medications that keep you functioning even though they won't make you well?

Those close to you will want to know this so that they may respect your wishes and love you right to the end. If need be, write it all down, but have an eraser handy because, after all of this great planning, you may change your mind sixty times from Thursday when you're looking at yourself in the mirror, knowing that the end is coming. Changing your mind is not a bad thing --- it's part of being alive.

Coming in Part 4: Living with the dying. With a diagnosis, life changes dramatically. The ill and the people who love them enter the world of the sick and dying, and it is a very different world. Normal life is suspended, the daily chores and small pleasures are replaced with doctor appointments, treatment centers, drug taking schedules, and trips to the pharmacy. Eating habits change, sleeping or not sleeping patterns alter our lives, and the world seems to have spun off into unknown territory. What to do?

Martha Nelson is an award-winning journalist and a former educator, nonprofit executive, chef, and musician. Her first novel, Black Chokeberry, was published in April 2012 and is available on, or at She currently is at work on a collection of short, and short-short stories, a children's series about the adventures of Lulu, Bart, and Charlie, her beloved dogs, and a new novel.