A New Difficulty for Mankind: How to Die

This holiday weekend is a time when many people gather with those they love and trust the most.  It is traditionally a time of fun, laughter, warm feelings, and full tummies.

It can also be a rare opportunity to speak in-person with the most beloved people in your life about an incredibly important topic, and that is end-of-life health care decisions.  I know, I know, that is not what anyone wants to do.  Personally, I am not convinced this weekend is the ideal time, given all of the other emotions and events that tend to swirl in the mix of family Thanksgiving traditions.

But it is a good time to think, I am certain about that.  Look around the table, the living room, the front porch.  Do you know what your parents want at the end of their lives?  Does your partner know what you want if the worst should come unexpectedly?  It is crucial now that we deal with a monumental change that grips modern life.  I found the following line from an excellent article in The New Yorker  by Atul Gawande to present the issue in a nutshell:

(My patient) was unmarried and without children. So I sat with her sisters in the I.C.U. family room to talk about whether we should proceed with the amputation and the tracheotomy. “Is she dying?” one of the sisters asked me. I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.

Until fairly recently, dying was a rapid event.  It was rare to know one was facing terminal illness much before the end.  Today’s health care environment brings many opportunities and much hope in many cases, but it has a side as dark and disturbing as anything I’ve ever read in the bleakest novels.

Dr. Gawande’s article is difficult to read, especially for those of us who have seen people we love battle on through Gulag-like regimens of “care.”  The good news is that I see more friends who are ill choosing to die at home, with the human touch of the most important people in their lives.  They can do this because they made the decision to establish a living will, and to communicate with their family and friends before anything happened.

I am participating today and through the rest of the weekend in the blogger rally created and supported by Engage With Grace – a movement aimed at making sure all of us understand , communicate, and have honored our end-of-life wishes.  I especially am grateful to my friend Bob Coffield for this opportunity.  His Health Care Law Blog is recognized nationally as one of the finest resources for current law and policy issues affecting health care.  (He’s also a Twitter maniac.  You can follow him @bobcoffield.)

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started.  In the spirit of Esse Diem‘s commitment to Read Think Speak Write, I hope you will take the opportunity to do each of those things around this critically important issue.


As I am still puzzling over a recent “event” I experienced on Twitter, I thought I’d blog it out and see what anyone else thinks.  The event was an emotional backlash to one of the posts on Esse Diem from a new follower on my Twitter account.  As he followed me first, I naively assumed he had positive intent. 

Twitter: The etiquette is unwritten, but it is real.

Positive intent for me does not equate with agreeing with everything I express; in fact, some of the most helpful comments I get from readers of this blog have been critiques and questions about my thought process and conclusions.  This Twitter thing was something different. 

Rather than ask questions on the blog, this fellow retweeted my post with nearly hysterical questions, accusations, and sarcasm.  There were lots of exclamation points and question marks.  He managed to focus on one illustration of a larger argument and avoid the real point of the post.  In essence, rather than engage me directly he chose to advertise me to his followers as a nitwit.  When I asked him about it later he told me he was not upset — which is odd, because he certainly came across as very stirred up and angry.  I would not like to encounter him when he is actually troubled. 

I’ve since spent a little time trying to figure out why he uses Twitter, and I detect a pattern of doing to others what he did to me.  He likes to follow people he doesn’t agree with and then use that connection to try to discredit the ideas rather than to build rapport and understanding.  In fairness to him, this is a common use of Twitter among many people; it’s also disappointing, but it is a risk people take when they publicly “own” their work, especially online. 

This is not a media empire (yet).  It is one thing to RT (retweet) faceless corporations with whom you never have a prayer of actually communicating and hashtagging their tweets with smart aleck phrases.  And this is the United States of America — anyone is free to RT my tweets and label them any way they choose.  That is the game, and if you don’t know it when you engage you will learn it sooner or later.  It does seem, though, that when individuals engage there ought to still be an understood environment of respect everyone can reasonably anticipate.  It seems even more reasonable to expect this from others who live in your tiny state of 1.8 million people. 

If you are looking for accounts that demonstrate the very best professional execution of Twitter, I can recommend @bobcofffield (health care law blogger + local interest advocacy), @createwv (statewide grassroots organization), @CartneyWV (social media strategy + politics + fashion), @DanSchawbel (big time millenial personal branding), @lineberg (personal + marketing + fitness), @DUKEPress (academia + publishing + humor) and @mistygirlph (social media + reciprocity) for starters.  Each of these people have figured out what they want to do with Twitter, and they do it well.  They all use Twitter differently, but they are each professional, organized, and effective. 

There are many great accounts, and it is worthwhile to follow people who know what they are doing and just watch and learn.  Much of what you can learn is style-driven as much or more than content-driven — how do you feel when you read their tweets?  What words in tweets make you bother to read or RT versus just scan by?  A great tweet just today from @mistygirlph included “15 Reasons to Love Twitter,” with number 14 being “Receive kindness and love 24-7.”  A-HEM……….. 

As a professional, I like Twitter because it is an opportunity to discover new people who can teach me things and to find new resources that can enrich my life.  I also like the general environment of civility and etiquette.  It’s odd, but it’s pervasive in my favorite accounts.  Lots of please and thank you, lots of credit given to others and return favors delivered.  It’s a community of strange P’s and Q’s.  But in a world that has lost nearly all of those kinds of things, it’s a pocket of politeness and professionalism that I enjoy.  

Of course, I was never following John Mayer .  It pays to choose wisely.