I have tried promoting palliative care through the usual channels - rounds, evening talks, teaching medical students. What I was really trying to do was make people see death as part of life, as it was before technology removed it from our common experience and made us think that we could defy and deny it.
In the best sense, death is not outside life. It is an event that leads us to find meaning in life and its experiences. I tried to get this message out in a hospital pamphlet for patients faced with a life-threatening illness. But the reading level for all pamphlets in my hospital is set at the sixth grade. Palliative - the word I needed to use in every other sentence - turned out to be a high school word, eliminating it from contention. I considered replacing it with "life-threatening," but the word itself is frightening. I pondered "death-securing" illness. But no, I'm stuck on "palliative." I looked up its meaning and saw that it is derived from the Latin word for cloaking or masking. My thesaurus tells me that other words with a meaning similar include coat, robe or outer garment. This prompts a different strategy.
Perhaps I could turn death and dying into a fashion statement to get people's attention. Would Calvin Klein be interested? They already have a perfume called Eternity. Surely a generation that is so conscious of the body and perfecting its shape would take to a line of clothing for the afterlife. It would certainly bring the open-casket funeral back in vogue.
The next step, of course, would be to change attitudes toward caskets. In North America they have been referred to as "pine pyjamas" and "wooden overcoats" or "wooden suit," but in Ghana people are buried in built-to-order caskets shaped like cars or boats. Your favourite vehicle in life becomes your mode of transport to the afterlife.
What would North Americans choose? Many of us are now cremated, but it would be difficult to fit a replica car in the furnace. A trendy cardboard box might be just the ticket. I immediately think of pizza boxes. And if I were in the advertising business, I would promote end-of-life advertising on those boxes. Advertising is so much a part of our lives that it seems only fitting to use it here. Besides, it would help defray the high costs of leaving this world.
To be truly fashionable, of course, I would have to convince famous people to come on board and help make death "cool." People would listen if celebrities pointed out that reconciliation and finding a meaning at the end of life is hip. But no one talks about it. Perhaps if rappers used some slang words for dying it would revolutionize dying. I can hear Public Enemy and Puff Daddy spouting the merits of a "dirt nap" or "celestial discharge." Unfortunately, most baby boomers - the ones now starting to consider end-of-life issues - aren't connoisseurs of rap music, but I recently read that music at funerals is starting to take a modern turn, with songs like Every Breath You Take by The Police and My Heart Will Go On by Céline Dion being the current rage. My hope is that the "you" and "my" in these songs refer to the grieving loved ones left behind; if I am wrong, we really have taken death denial to a new level.
After much consideration I have finally hit upon one method of promoting death as the completion to life - a death-and-dying trade show. My kids gave me the best name, Death Fest, after my favourite, Deathpo (after Expo, get it?), was rejected because it could be mistaken for a speech impediment. The best trade shows teach you about products, and if the advertising is really appealing you buy into the concept then and there. The trade show would demonstrate that good symptom management by a team of health care professionals allows people to devote their remaining energy to embracing the life of mind, heart and spirit.
When I told my colleagues about the plan they laughed nervously. I then asked a few of my dying patients about it and they laughed as well, but not nervously. By now, dying had become familiar to them. They liked the trade-show concept. After all, they really want and need to talk about dying. They want to know how to live fully, with laughter and tears, until they die. They want to meet death in peace, not in fear.
If death and dying are eventually seen as just another essential part of life, then perhaps those of us who provide palliative care could be known by our own slang term, and I could use the slang in our hospital pamphlets, for it would certainly be at the proper reading level. Perhaps the death dream team? Celestial travel agents? Afterlife outfitters?
Suggestions are welcome.