Too busy too die

The unexamined life is not worth living – Plato

There are obstacles to dignity at the end of life.  Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation.  In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives.  In other words, we are simply too busy to die.

We barely have enough time to take care of our families and get through our normal day-to-day existence. We spend our lives sprinting from fast food restaurants, down high velocity freeways, to hectic jobs, through rushed relationships and finally grab too little sedated sleep, before we pick up the race again.  Gaps, during which we might reflect, are filled with electro-grout via high speed Internet in dozens of shades, be it email, tweet, face or video. We live without self-reflection, life contemplation or honest communication.  On this level five whitewater raft journey, the complex issues, presented at life’s end, are often left behind.

Even social events, such as major holidays, which should give time to interact about critical and sensitive issues, become a blur of structured activity and overwhelming stimulation so that we do not take the time to talk and reflect. Never, until we are in the throws of crisis, do we try to discuss emotional issues or our desires for the future.  Therefore, when a complex medical problem occurs and we have not taken the time to prepare, we must make decisions while exhausted and frightened.

Stimulated by fear and duplicating the rest of life we find ourselves rushing through the disease process and unable to contemplate critical decisions with care.  Used to living at a hectic pace we dash from doctor to doctor, test to test and finally treatment to treatment. We may ignore the possibility that there are other alternatives, and perhaps there is the choice not to treat.  Because of our cultural need to move quickly, we may not take the necessary moment to pause and fully consider.

For me there are two lessons to be learned.  The first is take the time, especially when you are healthy and life is “in control,” to discuss and prepare.  How would you or your family manage? Who would take care of whom?  What do they want?  How far would they push?  What about money?  Even one or two quiet family together hours at the kitchen table, so that everyone can speak and listen, can save major strife during a future time of health care chaos.

The second lesson is that when the terrible does happen, as it will to every family, pace yourself.  In the absence of a true medical emergency such as trauma, heart attack or acute leukemia, there is usually time to learn, consider and plan.  Work together as a family, get good information from doctors, seek second opinions and move forward carefully.  Take the time to be in control, try not to let the events rush you forward.

Such planning is easy to say, hard too do, but methodical communication and reflection can prevent much suffering and confusion.  Which leaves the primary question for us all; if we are too busy to die, are we too busy to live?





  • Nice reflections on life in general and good practical lessons.
    • James Salwitz, MD
      Thanks very much. jcs
  • Ray Nolan
    Great advise, i'll add it to my list of things to do this morning. Seriously it was good to read. A while back my chorus sang a negro spiritual called "Ain't got time to die"......
    • James Salwitz, MD
      There is indeed a perverse paradox clogging up email with a blog about too much email. Thanks for the support, jcs
  • Eileen Burns McNally, RN
    You are so on target with this. I encourage my patients to have advance directives and keep them available in my office. I will also give them a copy of your post.. Thank you..
    • James Salwitz, MD
      I, like you, see so often that unnecessary suffering and futile care are the natural result of not preparing. Thanks for the comment, jcs
  • I recently did hospice care for my cat who was a companion for more than 20 years. I did not discuss it with very many people because I don't think they would understand why I would take the "time" to do hospice. In the end I was very fearful of her having seizures and uncontrollable pain that I took her in for euthanasia. She had renal failure. During that time I pondered what if we had euthanasia for people. It makes sense to me. But then I thought how many people would take their loved one in and have them "put down" just because they did not have time for hospice. I wondered too how many people take their animals in for the same reasons. They just don't have time for death.
    • James Salwitz, MD
      I am very sorry to learn of the death of your cat. The lost of any family member or friend can be devastating. As I type this Sophie,our puggle, is making me mistype, as she always does, by pushing against my arm. I fuss at her and tell her she is being annoying. I do not think she understands. I would miss her terribly if she were gone. I find your observation very thought provoking and disturbing and unfortunately you are probably right. I had not thought of the "convienience" side of euthanasia and at some level I suspect that, even at a subconscious level, people are capable of taking that short cut. When our cat died of a mouth tumor I slept with him on the kitchen floor during his last hours, making sure he was comfortable. My wife and I had a great difficulty with the idea of "putting him down." Still not certain if I did the right thing. jcs
      • Thank you Dr. Salwitz, Before my cat Annie got into her final days a good friend of mine suggested that I do something - and my sense was it was to make my life easier. But I love my pets and feel so responsible for them. Annie was always in charge and wanted things her way. I fed her water from a spoon vs giving her fluids. Not because I could not give her fluids. She lost her ability to walk as the kidney disease worsened. And I wasn't going to prolong her misery. Yet she kept trying to survive and we really bonded while she got weaker and more reliant on me. I slept next to Annie for a week on the couch. I wanted her to die peacefully at home but everything I read and one holistic vet who came out for a home visit warned me that seizures were very likely. And I watched my mother have seizures in her final week of life. It kind of burns into your brain and for a long while becomes your last unpleasant memory. So I did what I felt was right for Annie. All animals and people are not the same. We have to make individual choices. If you try to do the right thing for the person or animal - that is all you can do. And one other final thought. There is a monastery in my area which provides very peaceful grounds and retreats to the public. I have visited quite often and become friends with several of the brothers. I learned quite a few years ago that they believe in euthanasia for people - though they can not practice it. Thank you for allowing me to express my feelings and for your blog. Pam
        • James Salwitz, MD
          For me it is an honor. Thank you, jcs

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