View from the Doorway

Betsy Barton, Senior Associate for Learning and Research at Transitions LifeCare, authored ‘View from the Doorway’ to present her final takeaways from our January book club series. If you have any final thoughts or discussion questions, we encourage you to leave a comment below or on our Instagram!

In Being Mortal, Atul Gawande writes eloquently about the choices we now face if we have a serious illness or are facing the end of our life. Unlike 100 years ago, in the United States, we as a group are these days most likely to die after the course of a long illness rather than after infection, injury, or short sudden illness.

Now, I’m not a doctor, and I don’t even play one on TV. So, my default viewpoint is always that of a family member, or a person who is likely to be a patient in that bed, eventually. In other words, my viewpoint.

In chapter eight, Gawande writes about courage: “I am leery of suggesting the idea that endings are controllable. No one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either. Courage is the strength to recognize both realities.”

And therein is the catch with thinking ahead of time about what our wishes would be if we were to be experiencing a serious illness. On the one hand, it is beneficial to think about what we’d want. To have the hard conversations with our loved ones. To not just talk about our wishes, but to write them down, in a Living Will such as the Five Wishes form (and have it notarized please, with two witnesses, in NC. And make sure it’s in your medical file). It increases the chance that decisions will be made that align with our values, priorities, and wishes.

On the other hand, we have limited control over what eventually happens – physics and biology and accident ultimately have their way. One of my mentors, Dr. Richard Payne, used to say to me “Betsy, we can think and talk about these things as much as we want, but we never really know what we are going to do until we’re facing it ourselves.” Until we’re standing in that doorway.

Does that mean it doesn’t make sense to think about, and to talk about our health care wishes with our loved ones? Of course not. But I suggest that we do it with a sense of holding the opposites here – we are not in control, ultimately, but we are not helpless either. We need to stand in the mystery, with courage to recognize both realities.

As I gaze down the long hallway to that door – I’m not in the doorway yet, at least as far as I know – I find that living in that mystery helps me to live life more fully. By pondering my own life’s end, I think about what does quality of life mean to me? And then that leads me to think not about (hopefully) decades from now, but what about next month? Next week? Tomorrow? What about today? What lessons have I learned that I can I incorporate into my life right here, right now?

And when, one day, I am standing in that doorway myself, I think I’ll be more educated about options; I’ll be more clear about what’s important to me. I’ll have already had those tough conversations with my daughter, and we can stand in the mystery together. But I won’t really know until I get there, will I? I’m okay with that.