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When Is Life Too Long?

Some hope to make a graceful exit. Others are in no hurry to leave

On my great-aunt Ruth's 90th birthday, after lobster and a blueberry pie she'd made herself, the birthday girl reached into her blouse, pulled out the soft breast prosthesis she'd worn since a mastectomy nearly 30 years before, and tossed it across the room to my husband's friend. "Catch this, honey!" Ruthie said, and he did, with that auto-reflex guy gesture of intercepting a football midair. When he realized what he'd done, his face flamed, exactly as she'd hoped it would. "I just wanted one more feel before I die," she said.

See also: Talking helps families with end-of-life decisions.

I think my mother snort-laughed a strawberry daiquiri. I looked at my great-aunt in wonder. "I want to be like her," I thought. Funny and fearless and life embracing. Yes, she was silver-haired and a little stooped, but she had a generous hand with mascara and lipstick. She cheated at canasta and swore when she lost. She had strong opinions, yet didn't act as if the world were ending when a younger person disagreed with her. I'd been sniveling about turning 40 that year, and suddenly I wasn't daunted by what lay ahead.

Two years later, Ruthie died of pneumonia, whispering to my mother in the ER, "Honey, this is just about enough." Minutes later, she was gone. How seamless it was, how graceful, how easy.

Or, at least, that's what I thought. When I said as much to my father, he gasped, "Are you kidding ?" Ruthie had lived with my parents at their lakeside home in New Hampshire since she turned 85, by which point she'd been widowed twice and outlived both of her children. "Not easy," Dad said. "When you kids weren't around, she fought us tooth and nail. She was the consummate survivor - she'd have tossed other folks out of the last Titanic lifeboat. We loved her, but she plain wore us out. I'm not going to do that to my kids, and you'd better not do it to yours, either."

A few years after that, his cancer went fast, seven months door-to-door. He died at 76. My mother's Alzheimer's was slower but just as definitive, and yes, trying to keep her with us and safe - in our home, on the planet - wore us out. Sorrow is about a hundred times heavier than a hospital bed. "We won't do that to you," my husband and I promised my son after Mom died at 85. But, of course, we might break that promise if, when the time comes, we don't have the ability to keep it.

Each generation grapples with end-of-life issues - our own, our parents', even, in some unthinkable cases, our children's - but each time it comes as breaking news. A recent flurry of prominent articles with subtitles such as "What I Learned From the Last Days of My Mom and Dad" and "A Son's Plea to Let His Mother Go" brought into stark relief the challenge of caring for intractably ill parents while coping with a labyrinthine and balky health care system, not to mention grief. Amid the voices coming at me when my parents were struggling, amid the paperwork and the oft-competing emotions of love and duty, it seemed I was asking myself, "When is enough enough?" How could I, or should I, decide for others? For that matter, how will I decide for myself? What's the last straw, the deal breaker, the ticket to ride? Have I learned enough, have I been clear enough, to help my loved ones when it's time for them to take this journey with me?

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Video Extra

Dr. Ira Byock, author of The Best Care Possible and Dying Well, discusses separating the medical aspects of end-of-life care from the individual’s personal experience.

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