Unit
18
Full Circle
End-of-Life Issues
Although health care in this country has made it possible for Americans to live longer and more active lives well into their late senior years, serious illness and death are as much a part of life as birth and living. With old age come chronic illnesses and serious diseases. Most of these can be treated with good medical care, but often they cannot be cured. When a loved one becomes ill with a serious and incurable disease, Americans often rely on the same support systems that they depended on during earlier, happier times: family and friends.
These support systems can help with important care decisions as we become sick or unable to take care of ourselves. There are many things to think about, and there are many services available to help someone facing end-of-life issues. Even people lucky enough to be with family may need some extra help.
As we age, many people begin to think about planning for these end-of-life issues. Family and friends can help by talking about the choices to be made. Very often a person will want to prepare a living will while he is still healthy. This allows the person to make choices now about what care he wants to have if he becomes seriously ill. For example, some people may decide that if their heart stops, they do not want medical professionals to make it start again. This is known as a DNR order. The living will is a legal document that must be followed. In the living will, a person can make very clear what medical procedures he will allow.
A living will can be very clear about what machines someone will allow in her care plan. Someone may decide that if she is no longer able to breathe on her own, then she does not want to be placed on a ventilator. She may state in the living will that she does not want a feeding tube.
A person can also create a legal document called Power of Attorney that will allow another person to make all medical decisions. If someone is so sick that she cannot express herself, then the person she chooses will make decisions about health care. This person is usually a family member or a friend who knows exactly what the person’s wishes are.
For someone facing the end of life, hospice care provides comfort and many services. A team of people will come to the home and make sure that the dying person is as comfortable as possible. The most important thing they hope to do is be sure the dying person has the best quality of life in the time he has left. The team includes doctors and nurses who will supervise any medical care. Because hospice care is for the dying, medical professionals are not focused on treating the illness; they are only concerned with making sure the person is comfortable and in no pain. Volunteers may help with taking care of the house and offering time off to family members who don’t want to leave their loved one alone. Most health insurance plans will cover hospice care.
This isn’t always an easy or happy subject to bring up, but it’s an important one that will make things easier when a serious illness happens.
DIALOGUE 1: TRACK 47
LIA: Alan, did you hear about my great-grandmother? You know that she’s been sick for a long time now. The doctors have diagnosed cancer. I’m afraid the prognosis is not very good.
ALAN: Yes, I did hear the news. I’m so sorry, Lia. How is she doing?
LIA: Well, you know my great-grandma. She’s doing just fine! We’re all feeling a little sad about the diagnosis, but Granny is very upbeat about it.
ALAN: Your grandmother’s mom has always been very sensible.
LIA: She started to get her affairs in order when she first got sick. And she is very clear that she doesn’t want to be on machines at the end of her life. We told her, “Granny, you could let the doctors who know medicine make this decision for you.” But Granny made a living will so she is the one deciding what kind of care she will get. Some of my aunts are a little upset. They think the doctors should do anything and everything to keep Granny alive, even if it means using machines to keep her lungs working.
ALAN: How about asking your aunts to talk to someone at the hospice center?
LIA: Right now they are too upset to think calmly.
ALAN: What about having them speak to the doctors again? Or, why don’t you call the chaplain at the hospital? Maybe he can help with their fears.
LIA: That’s a great idea. Maybe the chaplain can give them some comfort, so that they can see that what makes Granny comfortable is the most important thing.
 | Some older people enjoy giving away special belongings like jewelry while they are still healthy. They like to see people they love enjoy the item, and they are sure the person they want to have it will get it. |
 | It’s important to listen if someone wants to talk about plans for their death. No one wants to think about someone they love dying, but it may make the person feel better to discuss it. |
VOCABULARY
anything and everything: a strong way to say to look at all possible things to do
•belongings: things a person owns
bring up: mention a subject for discussion
•cancer: one of the main diseases that cause death in the United States
•chaplain: a religious professional who can advise and help people in difficult times
•chronic: describes something (usually a disease) that lasts for a very long time
•cured: healed; made better
depend on: trust that someone will be available if needed; rely on
•diagnosis: a decision about what the illness is
•DNR order: the short form of Do Not Resuscitate; a legal order that does not allow medical attempts to make someone’s heart or lungs work again
•end-of-life issues: things to face when death is near
•feeding tube: a way of giving food to someone who can’t eat
get one’s affairs in order: think about what needs to be done before one dies
•great-grandmother: great indicates the generation above, so a great-grandmother would be your grandmother’s mother
•hospice care: comfort care of a person who is dying
•incurable: cannot be healed or made better
•late senior years: when a person is in the late eighties or even nineties
•living will: a legal statement of a person’s wishes about emergency medical care
on one’s own: without help from anyone
•procedures: processes or steps to make something happen
•prognosis: an opinion about what is likely to happen with a disease
•quality of life: a person’s comfort and happiness in the time he or she has left to live
•rely on: trust that someone will be available if needed; depend on
•supervise: watch; check on
•support system: people who will be with you when you need them
•team: a group of trained people and volunteers
upbeat: feeling happy, even if there is bad news
•ventilator: a machine that breathes for the patient
 |
PRONUNCIATION POINTER |
There are three main ways to pronounce the /ch/ sound:
•ch as in church
•k as in kids (chronic)
•sh as in shop (chef)
GRAMMAR REMINDER 1: Making Suggestions
There are a few polite ways to make a suggestion about something. Remember we talked about using how about and why don’t you?
How about asking your aunts . . . ?
Why don’t you call the chaplain . . .?
Here are two others:
What about having them speak to the doctors?
Granny, you could let the doctors make this decision for you.
Funeral Customs
It’s the call we never want to get: In the middle of the night, the phone rings. A friend tells us that something terrible has happened. Her great-grandmother has just died. Many times this call is expected: Someone has been sick for a long time. Families who experience a loss become very busy making arrangements. Sometimes the person will have planned out a funeral in advance, but often it is the family who must make the funeral arrangements.
Most funerals are occasions for family and friends to meet, share memories of the person they have lost, and join in special services. Funeral homes will arrange to take care of the remains. They will prepare the body for a wake, if the family chooses. This is a common event in the United States. The body is laid in a casket, which is often open, for family and friends to have a final chance to say good-bye. This is known as a viewing. Not everyone is comfortable with this, however, and some families choose a closed coffin.
At a wake, the family is greeted by friends, who offer condolences on their loss. Close friends may arrange to send flowers to the funeral home for display, but often families will ask friends to make a donation to a charity instead. They may write in the obituary, “In lieu of flowers, please make a donation to a special charity.” There are usually visiting times for a day or two, and then there is a funeral service, followed by burial. The funeral is often a church service, but it is sometimes just prayers or a speaker at the cemetery. If there are no religious rites, then the casket will be brought right to the cemetery for interment.
Not all families choose burial of the body in a casket, however. Cremation is becoming a much more common choice. Often the visiting custom is the same, but sometimes there will be no service at the cemetery. Instead, the family may have a memorial service several months later. Often, they will display a special urn with the ashes of their loved one. There may be a church service, or prayers, or simply a ceremony for people to talk about their memories of the person. The urn will be kept in a family member’s home, or it will be buried in a cemetery. Some people will scatter the ashes in a favorite place. The funeral home will be able to tell you if you need special permission to do this.
During the wake period, neighbors and friends try to help in any way they can. It is common for friends to bring food to the house. This is a way to show sympathy for their neighbor’s loss. Some families like to celebrate. This is not a party, but a way to celebrate and honor the person’s life.
While this section describes the typical funeral customs, there are, of course, many different customs. Remember that the United States is made up of people with many religions and traditions, so funeral customs will also be different. For example, some people do not have a wake at all and believe it is important to bury the person within one day. Friends may visit at the home later.
All funerals are respectful of the person who has died and of the wishes of the family. Every family has special ideas about how they want to observe the death of someone they love.
DIALOGUE 2: TRACK 48
ALAN: Lia, I heard that your great-grandmother passed away. I’m so sorry.
LIA: Thanks, Alan. Yes, we’re all really sad about it, but we know that Granny was ready.
ALAN: Is there anything I can do?
LIA: Our neighbors have been wonderful about leaving us meals, so I don’t think there’s anything we need right now.
ALAN: Well, please accept my condolences. If you think of anything I can do to help your family, just let me know.
LIA: Thank you so much. If we need anything, I’ll let you know.
 | In many parts of the country, it is customary for all cars on a road to stop for a funeral procession. Often, a police car will flash its lights to stop all traffic. Cars in the funeral procession have their headlights on to show that they are part of the funeral. When all the cars have passed by, another police car will allow the normal traffic to begin again. |
 | Death is a part of life that sometimes makes people uncomfortable. Some people don’t even like to say the word die. To make it easier to discuss, people use many euphemisms. You will probably hear the following: He’s passed. She passed away. My grandmother passed on. All these phrases mean the same thing: Someone has died. |
VOCABULARY
•ashes: what is left after cremation
•body: what is left of the person after he or she has died
•burial: putting the body into the ground after the funeral
•casket: a special box, usually wood or metal, for the body
•cemetery: a place where people are buried
•charity: a group or organization that helps people in need
•coffin: another word for the casket
•condolences: feelings of sympathy or sadness for the friend’s loss
•cremation: a service where the body is burned instead of buried
•euphemism: a way to say something that avoids words that make people uncomfortable
•funeral: the final service for someone who has died
•funeral home: a special business that takes care of funeral services and cares for the person’s body
•headlights: the front lights of a car
•in lieu of: instead of (this is another French expression that we have adopted into English)
•interment: burial
•loss: what we feel when someone we love dies
•make a donation: give something (usually money) to a charity
•making arrangements: planning the funeral
•memorial service: a special service where friends may celebrate the person who has died
•obituary: a notice in the newspaper about someone’s death
passed, passed away, passed on: died
•procession: a line of people or cars in a special ceremony
•remains: the body of someone who has died
•rites: ceremonies
•scatter: let go in many directions with the wind
•sympathy: a feeling that shows that you know someone is suffering
•urn: a covered container like a jar or vase for the ashes of a cremated body
•viewing: a time to see the body for the last time
•visiting times: when people may visit the family at the funeral home
•wake: a service where the casket is in a special room where friends and family visit
GRAMMAR REMINDER 2: Expressions of Sympathy
These are some common ways to express sympathy when someone has died:
I’m so sorry about your loss.
You have my sympathy.
You have my condolences.
Your family is in my thoughts/prayers.
MORE FUN WITH IDIOMATIC EXPRESSIONS: Dying
Death is one of those taboos: things people don’t like to talk about or think about. Of course, it’s always serious when someone we love dies. But when talking about death in general, lots of people find that it helps to be casual or funny about it. You may hear some of these expressions, all of which mean to die, even if they don’t always refer to people.
•kick the bucket
He started shopping around for cars because his old one with the oil leak is about to kick the bucket.
•buy the farm
He could tell by the third chapter of the book that the main character was going to buy the farm before the end.
•meet one’s maker
The cowboy in the movie told the bad guy that he was about to meet his maker.
•push up daisies
Lots of people who talked about how safe smoking is are now pushing up daisies.
•bite the dust
She watched as each chicken was taken from the farm to be slaughtered for dinner. Each time, she said to her brother, “Oh, well. Another one bites the dust.”
Fun Fact!
We bet you didn’t think there could be a fun fact in this section. Well, there is. Although people don’t like to say the word die when they’re talking about death, they use the word and words related to death all the time in casual conversation: “My car died.” “The battery is dead.” “This play is boring me to death!”