TEDMED Explores Death As Dinner Conversation

Death. It’s not typically considered polite dinner conversation, but it was the topic of choice at seven dinners with TEDMED delegates and an assortment of grandparents, parents, close friends, co-workers, children and strangers.

Let's Have Dinner and Talk About Death

The dinners are part of a new project, Let’s Have Dinner and Talk about Death, which encourages people to “discuss the beauty, mystery, fears, hopes, and challenges of end of life decision making” in a setting that is comfortable and comforting—over dinner.

Chef Michael Hebb, a TEDMED 2013 speaker and founder of the project, urges families to have these discussions now, rather than waiting for a critical, life-threatening situation when emotions are high and time is short.

A New Yorker article from 2010, one of the three pieces of pre-dinner “homework” for TEDMED dinner attendees, reported on a national Coping with Cancer study showing that terminally ill cancer patients who received intensive care had a substantially worse quality of life in their last week than those who received no such interventions.

Some studies have found that the missing ingredient that often stands between a patient and a quality end of life is simply talking about goals and ideas for what end of life should be like before the time comes.

Other recommended listening before the dinners included a poignant—sometimes funny, sometimes heart-wrenching—interview with comedian Tig Notaro, who broke all social mores and opened up a critical dialogue by sharing her experience losing her mother and receiving a fatal cancer diagnosis as part of a live comedy standup act.

To help that difficult discussion along, Hebb offered a framework for the discussion, which others could use to guide their talks with family as well:
  1. Start with a sense of gratitude. Think of someone who is no longer with us, and how they made a difference in your life.
  2. Share the most powerful end of life experience you have witnessed—whether from up close or afar.
  3. What do your final days look like? Who is with you? Where are you? (“Are you at home, are you in a hospital, are you on safari in Kenya aloft in a hot air balloon with vintage champagne on ice?”)

For more about the project, visit www.deathoverdinner.org and follow #deathoverdinner.

The dinners followed a moving set of talks at TEDMED all focused on opening up an honest dialogue about death. Charity Tillemann-Dick, an accomplished opera singer who happens to be on her third set of lungs, urged the crowd to find immortality, in a way, by giving new life at death — through organ donation

Pulitzer Prize-winning journalist and author of The Cost of Hope, Amanda Bennett, recounted her experience with her husband’s last weeks and months. She said she and her husband truly believed that despite his diagnosis of severe bowel disease, if they worked hard enough, conducted enough research and found the right treatments — that her husband would never have to die. But Bennett proposed that quest represents not denial, but a powerful form of hope. And just maybe that hope serves a critical purpose in the struggle to comprehend and survive, so to speak, death.

This cultural approach to resisting death may not be unique, but it’s also not universal. Anthropologist Kelli Swazey offered a glimpse into the culture of the Torajan tribesmen, who spend their entire lives preparing for their deaths. Their comfort with death is so complete that they continue to live with the dead bodies of their expired kin during a transitional period before they can raise the money for mandatory elaborate burial rituals.

Michael Hebb closed the evening by leading attendees in a toast to death, summoning a feeling of gratitude for those we have lost.

Examined Lives: Truth at the end of life

By Elaine Waples

Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”

Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.

I have cancer that is incurable, aggressive, and has negligible survival odds. My chemotherapy is a long shot. I will leave a spouse, children, siblings and a life that I love and cherish. I cannot imagine existence without them.

I have read the books about stages of grief and end of life. But when all is said and done, truth is the great measure. The truth between doctor and patient when there is nothing else to be done. The truth between patient and family who want desperately to have a few more months or days and cannot. The truth between patient and friends who must accept and move on without bitterness. The truth between patient and spouse, partner, or caregiver who have waited for that moment and are helpless to change it.

Elaine Waples with her husband, Brian Klepper.

Of all things, the simple act of truth has become most important to my husband and me. We talk about my dying. It is a poignant, painful and sometimes funny honesty. We have done it after solemn consults with physicians, during long hospital stays, through gut-wrenching disappointments, and sometimes over toast and coffee on Sunday mornings.

We have learned to be forthright and unafraid of saying it out loud. We deal with small moments – planning vacations, making purchases, visiting family, entertaining old friends – in a sober and reflective way. Routine plans – Christmas with the family; the vacation cottage; an annual trip – become critical decisions. We discipline ourselves to push aside the things that are trivial. It becomes easy to ignore the cracks in the driveway and the clutter in the closet.

And we occasionally treat it with laughter although, perhaps to the horror of some, it is gallows humor. We joke that when I am gone, the piano, the house, the cars will all be his. We laugh and mimic Homer Simpson, believing he is doomed, reading a pamphlet headlined, “So You’re Going To Die.” It reminds us that we are in a real world where playfulness is a part of life.

There is no bucket list. There are no plans to see the great pyramids, kiss the Blarney Stone, or throw a party in Times Square. We look to the small things we have known for decades that have become precious to us now: a walk on the beach, a Saturday matinee movie, sharing a bowl of ice cream, holding hands as we go to sleep at night.

Details – advanced directives, the will, the attorney, the broker – are easy. These will help put affairs in order but they do not address relationships with the world and the people who inhabit it.

The hard things that tug at the heart and create the pain are the unbearable truths to parents that they will lose a child; to siblings that the person they’ve known their entire lives will be gone; to children that they must overcome and move on. They convey a clear and undeniable message to doctors that they must relinquish the desire to salvage, fix and prolong.

But most of all, the truths we come to know lie in the depth and clarity of our bonds. For me, this is reflected in the conversations with my husband, the beloved person in my world. I want him to go on with life; to find someone to share it with; to help the children as they struggle with the loss; to remember the laughter and how much we loved each other. That is all I have left to give him.

And for that I extract a bittersweet promise that he will make me laugh until the end, that
we will hold hands every night, that we will share the ice cream, that we will always talk
about what is happening, and that I will die with him beside me.

It is the dignity, the finality, and the truth at the end of life.

Click here to read more about and to share your thoughts on the Great Challenge of Coming to Grips with End-of-Life Care.

Today at TEDMED: Two live online events and three new speakers

TEDMED will host two live, online events today to discuss Great Challenges of health and medicine:  Addressing Healthcare Costs and Payment Systems from 1-2pm EST; and Coming to Grips with End-of-Life Care from 3:30-4:30 EST.

Join us for an informal, moderated discussions on these Great Challenges. Share your thoughts and quiz the Team – we’ll answer selected questions on-air. You can also submit questions and share your perspective with the community via Twitter, tagging your tweets with #GreatChallenges.  Follow TEDMED on Google Plus to get started, or join on TEDMED.com.

We’ve also announced three new speakers for TEDMED 2013:  Victor Wang of GeriJoy, Inc., which creates virtual companions for seniors; Zubin Damania (aka ZDoggmd), Director of Healthcare Development for Downtown Project Las Vegas and a standup comedian who mercilessly pokes fun at the foibles of our medical system; and Sara Horowitz, founder and Executive Director of Freelancers Union.

Click here to see our speaker roster to date, and here to apply to TEDMED.

Health’s Great Challenges are hot topics this week

At TEDMED 2012, conference Delegates and TEDMED Live attendees voted to choose the top 20 Great Challenges, the most pressing, pervasive and complex issues the nation is grappling with in health and medicine. They chose well, apparently. Conversation on many of the Challenges — the goal of the program — was lively both among the TEDMED community at at large, including features on blogs and in major news media.

David Mayer, MD, vice president of Quality and Safety for MedStar Health, wrote about Challenge #5, Eliminating Medical Errors, on his blog, “as this is a problem that persists despite the hard work of many of us who have dedicated our careers trying to prevent,” he writes. Educating students and residents is critical to reducing error, he says, not only to hit the ground running with good training, but in offering fresh perspectives on the issue. A Forbes.com contributor, Kare Anderson, made waves with the piece, How Hospitals Can Stop Killing So Many Patients. Medical errors are the third leading cause of death in the country, she cites, and suggests that patients demand accountability and transparency, and then do as much comparison shopping as possible before selecting a hospital. We’ve heard it before: We spend more time shopping for a television than for a doctor, even though the stakes are, of course, incalculably higher.

End-of-life Care, Challenge #3, garnered much attention thanks to an op-ed by Bill Keller in The New York Times, “How to Die.” Keller wrote about an in-hospital hospice protocol in the U.K. that offer an alternative to the sometimes invasive and painful, and often fruitless measures, that accompany our last days here in the U.S. End-of-life care is a huge cost issue, Keller writes:

“….a quarter or more of Medicare costs are incurred in the last year of life, which suggests that we are squandering a fortune to buy a few weeks or months of a life spent hooked to machinery and consumed by fear and discomfort.”

Yet we should approach dying with dignity more out of concerts for the patient and his or her family, he says — a kinder way of death — than out of fiscal prudence, which will ultimately make palliative care more popular and culturally acceptable for the American public as well. On a brighter note, TEDMED’s new consulting clinical editor Pritpal Tamber, M.D., director of Optimising Clinical Knowledge — which helps organizations implement established clinical know-how — wrote on his blog wrote about what’s needed on all fronts to manage these daunting hurdles we face:  an inspiration immersion, leading to a badly needed healthcare reinvention.  Welcome, Pritpal!

Can we head off the dementia tsunami?

By 2050 there will be some 25 million Alzheimer’s patients, adding to the burden of care of our aging population, and bringing a colossal personal, medical and economic impact.

Jeffrey Cummings of the Cleveland Clinic Lou Ruvo Center for Brain Health, Richard Payne of the Duke Divinity School, and Gregory Petsko of Brandeis University sat down with Lisa Witter of Fenton to talk over the issue, one of TEDMED’s Great Challenges in health and medicine. Where is the science on Alzheimer’s?  Are there ways to prevent it?  And how can we better prepare caregivers?

What do you think we should be doing now to prep for what Cummings calls  “the unacceptable future?”  Share your thoughts on the interactive Great Challenges web site.

Share your thoughts: How can we better manage end-of-life care?

Modern medicine has extended the life expectancies of many terminally ill Americans. In turn, prolonging lives can mean incurring more intensive care and the associated costs.

In 2010, Medicare paid $55 billion for doctor and hospital bills during the last two months of patients’ lives. Quality end-of-life care requires balancing the input of doctors, families and patients themselves. And making crucial end-of-life decisions can take physical and emotional tolls on patients and their loved ones.

How should we help people manage end-of-life care choices to maximize individual well-being and minimize social cost? Ask experts and join our interactive conversation now on how to manage this Great Challenge in health and medicine.