Of a certain age...

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!