Of a certain age...

Last updated 4/15/2014 at Noon

My best friend just had her second mastectomy last week. In the last two years, she's had her gall bladder removed, a lumpectomy, a mastectomy and now this one. She says the good news is that she's lost 20 pounds and can see her toes again!

She has several messages on her cell phone asking her to call another oncologist for follow-up. She's procrastinating. "It's not in my lymph nodes so I'm not going for radiation or chemo," she says. "I'm done with the medical stuff." She insists she's going to eat better, exercise more, take up yoga and meditation, and try to be as healthy as possible until she dies. She's contemplating an artistic tattoo to obscure her now breastless chest.

That's the rub. You can go through all the treatments and deal with all the side-effects of them - sick as a dog and wanting to die most of the time. You maybe get a few good months and then it comes back with a vengeance and you die anyway. The outcome is the same. The difference is the quality of life in between.

This doesn't have anything to do with age. My friend is five years younger than I am. It can happen to us at any time in our lives. We have jobs to get to, children to raise, relationships to deal with, bills to pay, retirement to plan for, and then suddenly we have to make these decisions about what we want and don't want because we are diagnosed with a serious illness or have a life-threatening accident.

I had a stage IV melanoma a while back. Had the Moh's surgery, no problems, no lymph-node involvement. That follow-up oncologist wanted to do radiation and possibly chemo, but I said no thanks. I've been in remission for almost eight years. That doesn't mean it won't still come back. One or two spots, I'd probably have them removed but that with a vengeance thing ... not so much. I'll start planning for the end of my days.

I don't have a problem with dying. I did that once. Drowned. It was a fantastic journey home and back again. I expect it to be the same the next time, only without the back again, so I look forward to moving on to what comes next ... because I know there's a next. Of course I'll miss my family and friends, but I know I'll see them again soon.

My concern is more about what will happen to me while I'm still in a body. I refuse to put up with Alzheimer's. Any inkling of that and I'm making my going-away party plans before I forget how! I've filled out my advance healthcare directive and appointed a non-family member as my healthcare representative so my children don't have to make any decisions. They don't want to talk about it so I sent them their copies and included a video of me telling them my decisions about what I want and don't want. I'd opt for a heart attack over a prolonged illness, but if it were an illness, I'd be working on the paperwork for physician aid-in-dying the moment I got that six-months-to-live

diagnosis.

So how does one decide what they want at the end of their life? It has to be based on one's own beliefs and values, not forced on you by someone else's biases. Talk to your family, your doctor, your spiritual advisor, search your soul, search the Internet ... meditate, pray, talk to God or a tree. Educate yourself about the process. There are some good videos out these days about death and dying-"Consider the Conversation," "How to Die in Oregon," "The Day I Died: The mind, the brain, and near-death experiences." The more you know, the better decisions you can make about your own healthcare at the end of life.

Today is April 16, National Healthcare Decisions Day: Think about it!

April 16 is Healthcare Decisions Day

Planning a vacation is fun. Planning a wedding is exciting. Planning a meeting is important. Planning for your future healthcare is critical.

Now that your income taxes are behind you, April 16, National Healthcare Decisions Day, is a reminder to revisit your advance healthcare directive or finally fill one out to assure that your wishes for end-of-life care are carried out when needed. This is not just for seniors or people with a terminal illness; anyone over 18 needs to have an advance healthcare directive in place.

On this day, a coalition of more than 100 national organizations mobilizes to talk to as many Americans as possible about getting their future healthcare wishes written down, and expressing those wishes to their loved ones and healthcare providers. That means making sure you have an advance directive, which includes a living will, describing treatment you want and don't want, and a durable power of attorney designating the person who will speak for you if you are unable to do so.

As much as we would like to hope all will go according to plan, the circumstances of our death may be completely out of our control. A tragic accident, a sudden heart attack - we are suddenly at the mercy of other people, often strangers, making life-or-death decisions about us. If you have talked to your doctor, and filled out and registered a POLST (physicians orders for life sustaining treatment), it will help avoid unwanted invasive, life-saving procedures in an ambulance or emergency room.

If you haven't shared your wishes about resuscitation, hydration, blood transfusions, antibiotics, pacemakers, stents, amputations, being kept alive on a ventilator, your family members are going to be asked to make those decisions without knowing what you really want.

Whether you want everything done or nothing done or whatever your limits are, if you don't designate a healthcare representative and discuss your wishes, and fill out an advance directive ahead of any life-threatening event, you have no control over what will be done to your body while you are unconscious or what your family will be going through trying to make decisions about what you would have wanted or not wanted.

Studies have shown that families who face these tragedies after having had "the conversation" with their loved one are less traumatized after losing their loved one than those who never had any discussions about what their loved one wanted in a life-or-death situation.