The End

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growtherapy.com slash ACAST. Availability and coverage vary by state and insurance plan. As Socrates said, philosophy is all about learning to die. The more we can face the fact that we're going to die, the richer our life can become. We can use death as a tool for living because...

There is only a limited amount of time that we're all given. We don't know what that time frame is. I think that's the last lesson you tell your kids. How are you going to pass on the last bit? And that's about how to die.

I'm Noelle McCarthy. This is A Wrinkle in Time. I should plan the funeral, I suppose, but it just seems so weird. That is weird. A podcast series about ageing. in a world that wants us to stay young. And there was only ever one place we were going to end up. I'm afraid of dying, and I think everybody is. I'm really afraid of not being here anymore. And I do that existential thought quite a bit when we're driving around the country of thinking...

This is all here before me, and this will all be here after me, and there's a part of me that can't bear it, that the world will just carry on being the world when I'm not in it. That makes me feel really sad. You have to know when is the time, and you've got to be prepared for that. And it's the next best and biggest adventure you'll ever have.

We've spent the last five episodes exploring the ageing process and the impact of living for longer than at any time in our history. You still have to live your life and have a good life. I think the great thing about getting old is that my wife is still beside me and we will grow old together to the day that one of us passes away. And time is going to run out eventually for all of us.

I know exactly where I will spend the end of my life. It is our house in the Hokianga on the deck. And I have said to my children, this couch here is where I will lie when I take my last breath. And that is exactly what will happen. Well, it better happen or they'll be in trouble. So this is the death episode. Like living.

Dying is something that happens to everyone. That said, I haven't had much experience with it. Growing up, my mother kept photos of our dead relatives on mass cards above the television. They watched me every day. while I watched Home and Away. She also made me kiss my grandfather in his casket. His skin felt waxy and he looked very handsome, like himself, but absent. Where did he go? I don't know.

Where will I go? Where will we go? Honestly, I hadn't given much thought to it. The prospect feels distant. I hadn't thought about an afterlife or about how I want to die or about what I would like to happen beforehand. Not until I started asking other people for this episode. I learned I'm not alone in this.

Death can seem like an abstract idea until it affects us directly. I guess when you get a terminal diagnosis, you have conversations with people that you've never, ever had before. Helen Kelly is in her early 50s. A former head of the Council of Trade Unions, she was diagnosed with terminal lung cancer last year. And so, you know, I've had conversations with people about dying and I'm very upfront with people that that's what's happening to me. And people are shocked by that, you know.

that you can be so open about it. So I say things like, well, I won't be here for the next election anyway. You know, I mean, things like that, which people are a bit like, oh, it's pretty out there. In this age of increasing longevity, where the next big anti-aging breakthrough may be just around the corner, you can see why death isn't something we're overly keen to talk or even to think about too much. always like this.

most civilisations throughout history looked on death as the teacher of life and gave us ways of thinking about it advances in medical science along with the decline of religion though have given us a very different relationship with our How has this affected our understanding of what it means to be human? Our age has taken the finality of death very much outside of the picture, taking it out of the picture.

render us rather childish and helpless when it comes to making mortality the ground of a meaningful existence. professor robert harrison from stanford university has been with us from the beginning in his book juvenescence he explains that by not placing the same value on maturity that we used to we've changed our relationship with death

and were poorer for it. Cultures generally have provided the protocols about mortality, often taking the form of religious creeds and religious practices and rituals. Philosophy, going back to Plato, as Socrates said, philosophy is all about learning to die while one lives so that living becomes...

A flowering into the moment where death comes as the culmination and fulfillment of life rather than its mere termination. Nowadays, we believe death is the mere termination of life rather than its fulfillment. In that sense, I think our experience of life becomes impoverished. I think everybody thinks in the back of their mind they might get a terminal illness, don't they? You know, every time you get a lump or something, we all go and get checked out and all of that.

I think in the back of our heads we haven't quite given up the concept that we're mortal. The more we can face the fact that we're going to die... The richer our life can become, we can use death as a tool for living because there is only a limited amount of time that we're all given. We don't know what that time frame is. Bronnie Ware is an Australian nurse.

In 2009, a blog post she wrote listing the five biggest regrets of her dying patients became an internet sensation. It's a best-selling book now in 27 languages. People were realising that... that they had allowed the influences of others, the opinions of others, to total up their self-worth. And so feeling like they didn't deserve to be happy and they were fitting the shoes that... Others had moulded for them as such. And as time decreased and they let go of...

all the day-to-day details, they realised that it had actually been their own choice to let others have that power over them. But it is a choice, and this is something that... that was repeated to me time and again, that why did I let that person have that power over me or why didn't I let myself take that holiday? Why did I stay in this, you know? awful marriage for 50 years and never get to travel. So they were all choices that came down to people not letting themselves be happy.

I'm a pretty optimistic person and I make the best of the circumstances, so I'm hoping that... you know, I will keep living until I die, you know, that there'll be a very sudden change and that during that time I'll be able to do some of the things I like. I still, I can't do everything I like now, you know, I've lost some of the capacity to walk. I was a big...

I used to do a lot of exercise, can't really walk very far at all. So I've already lost some of the stuff that I like doing. I miss not ever being well. I mean, I'm having a great... time. You know, we call this a period of time. I've been sick for a year at the Cancer Party because people are coming to see us.

I mean, it's amazing. This generosity of New Zealanders and of my friends and family has been incredible, which would never have happened. You know, we've all connected with each other and stuff like that. The regrets that Bronnie collected were straightforward. So why does she think they... The blog itself is very honest and very simple because there wasn't that forethought of how it would be received.

Yeah, I think it's perhaps all of that, the honesty, the simplicity, but mostly that it gives people permission to actually make some changes and it's wisdom that's come from people who are at the end. And I have in the last few years lost a lot of friends in their 50s and 60s and 70s, friends and family. I realise how, you know, I...

Every moment, I know this is a tragic cliche, but every moment is actually quite, quite precious. So I do try to make as much of it count. I mean, having said that, I still spend just as much time being a couch potato and watching revolting television. sloughing around and lying in the sun and reading tragic books and magazines. But I do that because I enjoy it. So I want to spend as much time as I possibly can in this body, in this life, on this planet.

having fun. And I think I have peers who feel the same way. So there's a sort of element of us that we know we're going to grow old somewhat disgracefully. Let's break out the boo

One of the subjects of this podcast is the fact that we're living longer. Do you think that increased longevity puts us at a further distance from the end? The end is inevitable, but science and culture... can give us the message that you can put it off, you can live for longer, you can keep going. That's a fantastic question. Yes, yes, absolutely.

it's just further denial. It's like, oh, never mind, got another 10 years to deal with that, got another 20 years, I'll live till I'm 100 now instead of 80 or 70. So, yes, it just... further enhances the denial, unfortunately. denial may be understandable in a world where the focus is on staying young and vital where health is presented as something over which we can expect to have increasing amounts of control dying's almost a personal failure

a world where centenarians are doing 100 metre runs. Take a bio Ida Whelan who set a new record for a 100 metre dash in Philadelphia earlier this year. But there are other motivations for being in denial about death. Like love. Some people can't even tell their children or their parents that they love each other. So, you know, to actually go beyond, though, you know, that's just...

a level of emotional maturity that is too confronting for some people. So to go even beyond those words to actually say, let's get... down and dirty and talk about this real stuff. It's just too, not only too confronting, just too out of bounds for them. too painful, too foreign to even grasp the concept of it. And, yeah, that's just heartbreaking.

I think that's the last lesson you tell your kids. You tell your kids and teach your kids how to be good people, how to be decent people, how to be truthful to themselves and the world. But then the big lesson is... okay, how are you going to pass on the last bit? And that's about how to die. Now, that's a pretty good subject, and I have to tell my kids won't even, can't even contemplate me talking about that.

But I do bring it up and say, this is how I think it might go. You've got to tell your kids, I reckon, that it's okay and they've got to let you die. For one family, it took a confrontation with mortality to get that conversation started. With regard to uncomfortable conversations, unfortunately, this conversation about end of life and death and dying has been somewhat taboo in our culture. I think we've fallen prey to the cultural norms of, you know, don't talk about it, it won't happen.

Jennifer Brokaw is a doctor from San Francisco. She's also the daughter of one of America's best-known newsmen. In 2013, Tom Brokaw was diagnosed with multiple myeloma, a kind of blood cancer that's treatable but incurable. when I was 73 and I had to objectively deal with the realities of the consequences of aging and cancer. And because I looked at everything in life.

not just for me, but for the country and for others as well. So it really became a big part of my life, in part because of the conversations that I had been having with Jennifer about the decisions that... she had to make in the ER or the families had to go through. And it's the kind of thing that people generally are not very comfortable talking about, but we have to get comfortable talking about it because it's inevitable.

Since his diagnosis Tom and Jennifer have hosted a series of public talks where they speak frankly about the need for families to plan for the worst. It's easier to contemplate. these things when you're not facing something serious. In fact, you know, in the moment of getting a serious diagnosis, it's really the worst time you can bring it up.

The culture of the medical system and the industry is to allow people to believe that everything can be fixed on some level. And there's no discussion about the fact that really... What we offer people is just the ability to ward off further decline. Tom is in remission now. He says his diagnosis brought home how unprepared he was for the end of his life. all of our life practicing to live we haven't practiced to die so it's something that is a one-time wholly unique event

And there is no real preparation for it because we don't know what to expect. And I think that that helps people shy away from it. Is death hard? Is it hard to die for some people? It is. You know, it takes nine months for the body to form and it can take a long time for the body to break down as well. One of my darling patients, I walked in one morning and said, how are you going today? She said, oh.

I'm still here. It's so hard to die. I'm sick of it. I just want to go. And at that stage, I think she was eating like one strawberry a day or half a grape. She just had no appetite left. but her body wasn't ready to go. And so her frustration was that she felt emotionally ready to go and couldn't do so. But then there's others whose bodies are deteriorating and they're still...

you know, talking about future plans and holidays and what they're going to do in the next few weeks and ordering new clothes that they're never going to wear. It's more in the back of my mind now. and also in part because of cancer, and I have friends who are dying. And so I am thinking again about what happens, how I will accept it when the time comes.

very, very hard to kind of come to grips with or to imagine because as I said earlier, I've had a lot of practice living but no practice dying. I should plan the funeral, I suppose. It just seems so weird. That is weird. But I might. I might get round to it. People will expect every minute to be jotted down, won't they? They might not stick to it. Your reputation as an organizer. Yeah, yeah, they might get their own back. I think you can tweet from the grave.

You can load them up and they can tweet after you've gone. You know how you can load them up to tweet two days later? I am tempted by that. None of us know ahead of time exactly how the end will play out. But we live in an era where it's possible to be kept alive by a machine, even when our brains have shut down. That makes it essential to talk.

not just about death but about what we want to happen before we die living wills or advance directives communicate a person's wishes if the point comes when they're no longer able to talk They're a way of lessening worry about losing control of decisions towards the end of life. A lot of people that I have done advanced care planning with have said in no uncertain terms that...

if they're no longer able to meaningfully interact with their loved ones or friends. And by that they mean, you know, contribute to the conversation or understand. really what's being said to them on a meaningful level. They no longer want to be fed. They no longer want to be kept alive in any way or receive any kind of medical treatments from there. point of view, their life has come to an end. We have to be realistic about what a meaningful life really is and what it means to be a full human.

And accept the fact that, you know, our brains sometimes die before our bodies do. And, you know, I think that we all accept that our brain is really our heart and soul of who we are. Sometimes you have to let the body die when the brain has already left. I put a submission in to the Lucretia Seals Select Committee. And I don't know whether we appear. I don't know whether they're going to invite us in to appear or not, but I would if they did.

Helen Kelly has made a submission to the Health Committee on Voluntary Euthanasia in New Zealand, which was set up after the death of lawyer Lucretia Seals. Lucretia Seals had a brain tumour and fought in court for the right to be able to die at a time of her own. choosing. She lived long enough to hear that the courts had denied her request.

It's a funny thing because I really believe in it and I think it's about maturity and being able to do it properly. I know there's big challenges. It's a huge ethical issue and I'm not downplaying that. And I don't resent people who have a different view than me on this issue. I think it's a really...

hard issue but I know that you can get a regime that works and I know that most people don't use it and I think I probably wouldn't use it in the end but having it available would be such a relief to know that if it really gets bad And there's proper safeguards in place that you could exit early, if you're exiting anyway.

Given the size of the ageing population globally and the projected massive costs of healthcare for that population, especially in the years immediately before death, when the chronic diseases associated with ageing, like dementia, set in. as well as the moral and philosophical arguments around whether it's right to prolong human suffering. Assisted dying and or voluntary euthanasia are subjects that are going to require continued thought and debate.

not just in New Zealand, but all over the world. It is beginning to be... It's extremely pressing and not being talked about at all. Hillary Clinton is the only presidential candidate that I've heard of who has address this on the campaign trail unless dad you know of somebody else I don't think Donald Trump is talking about it

Since her diagnosis, Helen Kelly has had to make a lot of decisions about how she wants to spend the time she has left. I went to see Atal Gawande, who's written the book Being Mortal, talking about... that we are mortal and that we a lot of us think we're immortal and certainly in the old you know in the 50s and 40s people knew they were going to die 30s they knew there's all sorts of ways they were going to die but now we sort of think we're immortal

Atul Gawande is a doctor and a staff writer for The New Yorker. His book, Being Mortal, is a personal and professional exploration of dilemmas around ageing and end of life care. He spoke at the Auckland Readers and Writers Festival. last year in conversation with David Galler, a specialist from Middlemore Hospital ICU. The room's packed, Ethel. This book has been an astonishing success. Have you been surprised by that?

shocked you know so it's a difficult book you know by chapter two I'm telling you about all the ways in which things go wrong in your body from the way your brain is shrinking inside your head to the The fact that by the time you're 40, the light is already fading that gets to your retina and how your teeth fall apart. I interviewed about 200 patients and families about their experience with aging.

terminal illness, and then interviewed dozens of, well, scores, really, of palliative care specialists, nursing home aides, hospice workers. And there were some people who were very good at knowing how to talk about these situations. And what they helped me understand was that everybody has priorities besides living longer. The great mistake we make in medicine.

and in society, is that we don't necessarily recognise that people have priorities in their life besides living longer. Atao Gawande paints a very important picture that doctors can over-treat you and make you sick. and that if you've only got a little while to live, that period of time could be much more pleasant without the treatment. It doesn't make that much difference, and you can be kept well.

talk to people and say goodbye to people and participate in things while you're still alive. And those are the conversations that I'm having with my doctors now. It's always a toss-up. What would this do to me? What can I do? How would it work? As someone who knows that she's dying, Helen Kelly has a different perspective on ageing. I would have liked to have gone into Parliament at some point. I obviously thought I'd outlive my mother.

Yeah, I mean I think everybody plans, thinks about their old age, but I don't think anybody takes it for granted. That must be hard for your mother, is it? Oh yeah. Do you have those conversations with her? She knows what's going on, but she doesn't want any of those conversations, yeah. But there are people who do want to have those conversations. My mum lives in a Reesheim.

And so I regularly go there and talk to everybody around and all that. It's a massive place. But the conversations have always been more superficial. Now they've got a place to open with me. Because they know who I am. And we have these amazing conversations. And we talk about where they are, you know, because they're in a rest home, and where would they like to be. They're very interested in cannabis. Because they're sore.

And honestly, they can't cope with those strong, strong pain relief. And their children have told them, you should be taking cannabis, you know. So they're saying, where are you getting the cannabis from? Helen's illness has turned her into a campaigner for medical use of cannabis. I've got tumours. In fact, I've just been told why my hip is so sore. It's growing, just growing like crazy. And it works.

You know, it just eases the pain. Some people say it's got medical benefits as well in terms of anti-inflammatories and things like that. Maybe that's why it works, actually. But I'm taking it for pain. Maybe it's not surprising that Helen Kelly is having deeper conversations with older people since her diagnosis. Old age brings us closer to the end of life. And maybe there's a shared fraternity between those of us looking death in the face.

It's a hard reality to engage with, unless it's one's own reality, or should that be until it's one's own reality.

But the popularity of books like Being Mortal and Regrets of the Dying illustrates the hunger we have to engage with death and the vacuum that exists around the subject now compared to other times in history. We are the beneficiaries of a highly successful set of institutions and a political order, social order, as well as scientific revolutions that have been.

enabled us to go on enhancing our lives and benefiting from the increasing youthfulness that the society confers upon us. The danger in my view is that One forgets the lessons of maturity and adulthood. And above all, you know, what it means to become responsible for one's own mortality, where death is indefinitely. one, it can very easily disappear from the horizon of one's lived experience. And one finds that when the time comes, one is like a child vis-a-vis this.

the irreducible fact of human existence, which is death. By denying the inevitability of what's to come, you know, you can sort of cruise along and think you've got all the time in the world, or you just don't realise... just how precious the gift of time is until you're exposed to death through family or friends or someone close or through your own terminal illness. And what comes next, if anything? I've thought about my...

you know, reasons for being an atheist a lot in my life and talked about it. Obviously it's the sort of thing you debate and stuff and you know, that's just what I believe. I'm an atheist, yeah, I don't believe in any further life or super being or anything. And nothing's going to change that. I was raised Catholic, so I grew up with a belief that I'd go to heaven. Where that might be or what that might look like, I don't know. Like I said at the start...

I don't really think about it. When it comes to my own death I've tried to keep a mental balancing act going while making this series. On the one hand death is useful at pulling life into focus. It's so much easier to pay attention, to enjoy every moment when you think about not being here. On the other hand, I'm a bit like Michelle at the beginning of this episode.

overwhelmed by existential sadness at the thought of a world that will keep turning without me in it. But I'm part of the world now, and that connection makes the thought of death less scary. The force that through the green fuse drives the flower, drives my green age, that blasts the roots of trees is my destroyer. And I am dumb. To tell the crooked rose, my youth is bent by the same wintry fever. Dylan Thomas was only 19 when he wrote those lines. He died when he was only 39.

Ageing is part of living. So is dying. And life is what we know. Even if the best is yet to come and heaven is waiting. Life is home. It's the biggest leap we take. stepping out of it. When a lot of people say, how are you? And you'll say, oh yeah, I'm all right, and I'm doing okay. And they'll want you to tell them that you're going to get better. They'll say, but you're going to be all right, aren't you?

And it's just not right to say, yeah, yeah, I'm going to be fine. So I do say, not really, but I'm all right at the moment. And they leave it at that. But it's interesting. They want a reassurance that I'm onto it. From holiday hosting to unforgettable gifts, Omaha Steaks delivers the world's best steak experience. Gift family and friends USDA certified tender steaks, juicy burgers, cozy and convenient comfort meals, and so much more.

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