Late October and we bring our dead out to play, the only time of year we're comfortable with death, or our images of it. Shiny white plastic skeletons bedeck front doors; the zombie apocalypse of walking dead chase us through haunted houses; we serve brains made of Jell-O and chew gum that looks like eyes. Death, come October, where is thy sting?! Bring it on.
Any other time of year, no one wants to contemplate death or the end of life, or what it will mean for ourselves and the people we love. Each year, more than 2 million Americans die, most of old age and bad diseases — and most, still, in hospitals, the place we all claim not to want to be at the end.
The reasons for this are varied — overly aggressive medical teams, families that cannot let go and the relentless hope that we are all, in fact, immortal. More than this, there is the fact that we simply do not discuss dying or the end of life. Nor do we care to know or admit that the lucky among us will grow old. Even the Boomers, who changed so much of the American landscape, have not succeeded in an elixir that will keep them forever young.
For years, leaders in the fields of aging and end-of-life care have encouraged and admonished us to talk about our wishes for the end of life, to make our living wills and advance directives, to tell our families precisely what we want. ("Just take me out and shoot me," as my mother has sometimes said, or, "Just pull the plug," is not an option. Period. Absent the passage of the Death with Dignity act in Maryland this year, suffering to the bitter end is what all Marylanders should anticipate.)
Even more to the point, the decisions people encounter as they approach the end are never as simple as turning off a machine, or deciding to stop "nutrition and hydration." A myriad of other decisions remain, from whether or not to treat an infection in a person who has advanced dementia, to how the family will cope with round-the-clock caregiving.
A host of programs is now available to help people have such conversations and, at long last, Medicare will now allow doctors to have them, too. Actually, will pay doctors to have them — they have always been allowed. From Ellen Goodman's "Conversation Project" to the grassroots "Death Cafes" to the "Five Wishes" program from Aging with Dignity, plenty of tools are available to help us.
But who wants to talk? And how to begin? Some experts recommend having the conversation at Thanksgiving, when families gather around a turkey and gorge on pumpkin pie. Others aim for April 15, with a nod to the inevitable death-and-taxes nature of American life.
But today, as I drove through my area, with its gravestone-covered front yards, its ghostly creatures suspended from trees, its vampires in its coffins, I began to think perhaps Halloween should be the day — not only to think of the dead, but of our ends. The holiday is known in Christian faiths as All Hallows' Eve, the night before the saints are celebrated on All Saints' Day and two nights before All Souls' Day, which commemorates the dead.
Perhaps in the midst of decorating our yards, searching for costumes, or filling up the candy bowl, we can try to take a moment or two to tell our partners or our adult children or even our doctors what we imagine we'd like to happen when we become sick enough to die. For those for whom such a conversation would leave sour taste in the mouth, we could offer a few mini-Snickers bars, and sing a round of "Monster Mash."
Janice Lynch Schuster (www.janicelynchschuster.com), a native and lifelong Marylander, is an essayist, artist and advocate for better care of the dying. She is the author of "Handbook for Mortals" (Oxford University Press) and lives in Riva. Twitter: @jlschuster827.