A Jaws of Life trained paramedic out of Suffern, New York, treated car accident victims in the last minutes of life. Trapped victims often asked him if they were dying. At first he wanted to preserve their hopes to recover. Experience later taught him to answer them honestly. Accident after accident he attended, he began to notice a pattern. All those he worked to rescue, spoke of similar unmet desires when suddenly made aware of their imminent death.
Victims were often bleeding profusely, trapped; completely jigsawed into a vehicle, awaiting release. After arrival at the scene in minutes, firefighters work to spread and cut through layers of automobile joints and metal. Metal cutters roar, sparks fly as skilled paramedics urgently race the clock to stabilize hemodynamics (blood pressure, pulse) and free breathing; often with emergency tracheotomy. An IV is started STAT into whatever vascular route accessible.
Rather than feeling terror and panic as we may expect, these fully lucent victims, aware that their death was imminent, expressed in words at least one of three things:
- Regrets at how they spent their life and sincere wishes for forgiveness. 2. Concern that they would be forgotten with desire to be remembered. 3. Sense of having lived lives without meaning.
- Remarkably, these three desires expressed at the end of human life signal innate human needs: 1. Need for perfect union(forgiveness) 2. Need for remembrance(immortality) and 3. Need for meaning (unique purpose). The paramedic worked desperately to comfort every one of them before they passed.
How you would want your last words on earth to go to your family?
Accidental deaths are not infrequent. World Bank data show from the last year recorded (2019) show accidental death injury rate ranges by country and economic status. Recent statistics report accidental test comprise 4-5% of all deaths in Denmark and Croatia; 19% in El Salvador and Belize. The United States averages 7%. In the U.S. deaths by accident or injury ranks number 3 in all causes of death. This is higher by percentage in 2022 than dying from Alzheimer’s disease, stroke, other dementias, respiratory illness, kidney and liver diseases. Only cancer and heart disease rank higher than accidental death. The most common clinical history antecedent leading to nursing home admission is a recent accidental fall with fracture. On my hospice services, at
least 80% of my patients come admitted with clinical decline and hospice eligibility marked by a recent accidental fall.
Falls are very common. The third leading cause of death in United States is due to accidental injury, motor vehicle accidents, falls. Every day we live, every breath and every step we take throughout the 16/24 daylight hours we are subject to accidental falls. It's good to be aware. We sink our money into nutritional supplements, hormone cremes, powders and popular drinks promised to improve memory, promises to fix this or that.
What are we doing to eliminate our fall risk? Every time we go to the bathroom in the dark overnight or turn the ignition in the car we are taking a risk.
This is not to live in fear and stay home. This is to live smart. You don't invest in stock without doing the research. We are given one life and it comes with an expiration date. It is up to us to decide how to live this one big beautiful life.
Stop and think about your life. How does it look right in this moment? Think of yourself, your human person in its entirety: Heart. Mind. Soul. Strength. This four human categories correspond to: Relationships, Intellect, Purpose, Body. Perhaps you carry unmended relationships, misunderstandings, unresolved regrets, lack of meaningful pursuits? Postponed opportunities for charitable work? Loss of gait stability, muscle mass, overweight, underweight, insomnia, etc.
An attending physician had good advice for me early in my medical career that has guided my life. In addition to Monday through Friday hours, I was assigned weekend work performing autopsies alone with a morgue assistant called a “Diener.” Medical research at the time had described a new very dangerous virus in the United States. At the time in the late 80s, very early 1990s we didn’t know how the AIDS virus was transmitted. I was in a high risk position as I was handling tissues of possible virus victims. AIDS victims were often young people, in their 30s and 40s. Death came unexpectedly to family members. No cause of death was known thus autopsies were requested and performed at the large county hospital I was assigned to. These autopsies were particularly extensive with head to toe assessment involving dissection of the brain after removal of the scull cap, etc. I remember pausing once and looking up at the haze of ivory bone fragments swirling in the air of the basement autopsy suite. How is this virus transmitted? I wondered. We know certain viruses pass through latex gloves. My gloves were iron mesh for protection. I was told iron mesh wasn’t enough to keep out this virus.
The medical establishment was aware of a slow virus called Jacob Creutzfeldt disease, which is transmitted through brain tissue. The concern was the AIDS virus may be transmitted similarly. We simply did not know at the time how it was transmitted. I was also 3 months pregnant.
My supervising physician told me in his office one Monday, “Look Nancy. We don't know what that 42-year-old woman whom you did the autopsy Sunday died from. We are concerned she was infected with the AIDS virus as she had a fulminant pneumonia. “Did anything happen during that autopsy? Do you think you were exposed to any skin to skin or other tissue contact?” Eyes? Any goggles off, gloves off? Splashes? I remember cutting the skin over my MTP joint on a rib cage another day, but not this one. I thought I was all clear.
The kind doctor proceeded to tell me: “When all is said and done, people will not remember you from work, but your family will remember you. You were absent at home last weekend…. “You may want to avoid this high risk research for a time, at least until we know how this deadly virus is transmitted.” We have to consider you exposed to the virus and will need serial testing for one year.”
I submitted to the testing. For about two weeks I continued to expose myself to unknown tissues. AIDs virus transmission was aggressively researched during this time. The weight of the doctor’s advice became heavy over me. I took his advice to heart. This was a wise physician in his mid 60s, who obviously cared about my welfare beyond my ability to do the hours and hours of work required at that time.
The point this kind physician made was the companies we work for, the skills we can perform, and the people we work with will likely not remember us. We are easily replaced in our workplace. Our families are not replaced. It is critically important to give precious time to your family and closest friends. The valuable time that might otherwise be eaten up in extensive extended hours and hours of work. Work is a common addiction. I am guilty of it myself as I think I can fit in one more patient, one more hour, one more certification of terminal illness in this limited day.
Challenge: Take a moment to ask yourself a few probing questions.
- Have you thought about your life purpose? If you have, are you satisfied with this? Do you keep a journal of thoughts, notes? Is your purpose written down yet? Are you excited about your purpose? What is your passion
level in life right now? What experiences have convicted you in life? What have you learned? What can you teach?
- Do you live under a rule or way of life that is satisfying?
- Do you wish for something more in your life? What do you wish for? What does your heart desire?
- Are you ready to die? What would you like to do before this day comes? Are you willing to enter into the discussion and get ready?
- Let’s prepare answers to the questions the motor vehicle victims asked: a. What regrets can I start to mend this week? (forgiveness) b. How do I wish to be remembered by loved ones? (immortality) c. Does my life have meaning? (unique dignity and purpose)
- Nancy Miller-Johnson, MD #LiveSMOL
