When you think of Joan Rivers, any number of great lines come to mind (my personal favorite is her rant against housework: "You make the beds, you do the dishes and six months later you have to start all over again"). But perhaps her best lines included powerful advice on aging, articulating our wishes, and dying well.
Volunteers of America released several public service announcements featuring Joan and her daughter Melissa entitled, "No Matter Who You Are, It's Not Easy Talking About Aging." After announcing, "Getting old is horrible," and complaining that the only men to hit on her are undertakers, Joan gave straight talk about the need to discuss what can be a taboo subject: getting older and, yes, dying. As the mother-daughter duo ham it up -- Melissa covering her ears and singing "lalalalala" as Joan insists that she listen -- they go straight to the heart about the difficulty of discussing aging and end of life. As Joan exclaims in the 30-second announcement, "You've got to understand what's going to happen, you've got to understand my needs, you've got to understand my wants!" Then pointing a finger at the camera, Joan implores, "Talk to your family about aging even if they are not ready to listen."
While we can only read between the lines of the sad news when Joan was rushed to the hospital after an outpatient procedure and then was in and out of intensive care, it appears she and her daughter at some earlier time had "that conversation." The tip-off was a statement issued by Melissa that, "My mother has been moved out of intensive care and into a private room where she is being kept comfortable." Based upon the utmost dignity with which Melissa handled her mother's crisis, I believe Joan practiced what she preached by planning for her end-of-life care.
The recipe for excellent end-of-life preparation is the "Three Ds" -- deciding, discussing and documenting:
• Decide how you wish to be treated if you are unable to speak on your own behalf
• Discuss your wishes with loved ones in advance
• Document your wishes in an advance directive
Initiating that conversation is never easy, but the simple "Bridge to Recovery Test" can help. Consider this scenario: If you are hit by a bus and the emergency room physician tells your family you are in critical condition, but with a ventilator, feeding tube, IVs, medications, and good medical care and rehabilitation you will recover, you and your family would want that extensive treatment because it would be the bridge to your recovery. However, if the doctor explains that you will not recover no matter what is done, there is no "bridge to recovery," so you and your family might decide not to pursue aggressive treatment and to let nature take its course with a dignified, peaceful death.
Although the topic of end-of-life may seem difficult to broach, it is harder in the long run not having these conversations. Take advantage of current events such as Joan Rivers' death, a funeral, a movie, book, or this article to initiate conversations with loved ones. Examples of how to start a conversation include: "Dad, Aunt Elsie told me she wants to be cremated. Have you thought about what you would like?" "Do you have any special requests at the end of life?" "I'd never want to live on a ventilator like Uncle Chet, would you?"
Once the discussion takes place, it's imperative that our wishes are documented in an advance directive, a legal document completed in advance to direct our healthcare if we are unable to speak on our own behalf. (Caring Connections, a program of the National Hospice and Palliative Care Organization, makes free advance directives available online with instructions on how to complete them www.caringinfo.org.)
With the "Three Ds" comes peace of mind for the day that we might not want to think about, but must still prepare for. As Joan, herself, commented, "I'm not worried about dying... it's getting there." We trust she got there peacefully.