Marilyn Heins: Talking about what you must: sex and death

Sex and death: Two tough topics to deal with. Yet parents must talk to their children about both. Most parents today are pretty savvy about early sexuality education and understand the importance of “The Talk.” We’ve have come a long way from answering early questions with evasions like “You’re too young.” Or fibs like “The stork brought you.”

“Talk 2” is about death, an inescapable part of life. We cannot protect children from the pain of losing a loved one or from worrying about their own death. But we can and must talk about this difficult topic. A child’s question may arise from the death of a person or a pet. Or when children hear about disasters, natural or man-made. My young son asked what was wrong with a Monarch butterfly he thwacked with a stick. We answered honestly and he cried because of what he had done.

I advise parents to answer questions about death honestly so the child realizes that death is a subject that can be talked about and that the parent is “askable.”

Avoid euphemisms. Don’t say that the dead person is asleep, or that God took grandpa, or that grandma went on a very long trip and is never coming back. Such explanations could make a child afraid of sleep, God, and travel. Talk with the child about your own belief systems but if you say grandpa is in heaven explain that his body is in a coffin in the ground to avoid confusion.

Children invariably ask “am I going to die?” and “what will happen to me if mommy or daddy dies?” Answer honestly but humanely: “everybody dies but you won’t die for a very long time. And there will always be someone to take care of you.”

Death is a painful reality. Best to deal with all painful realities the same way: be honest; model how to deal with painful feelings; encourage children to express their feelings; empower them to help in some way like making a sympathy card.

Dealing with and observing aging in my parents, my husband, and myself has taught me about the necessity of communicating end-of-life decisions. An inverted version of Talk 2 becomes important again. Children and parents need to talk.

My 87-year old father collapsed at home and was resuscitated by paramedics and on life support for a week before he mercifully died. I say mercifully because my mother had told the doctors to “do everything you can” so she was saved from what she called “pulling the plug.” They never talked about end-of-life decisions.

My mother was hospitalized at age 89 for abdominal pain due to a kidney blockage that required surgery. I flew to Boston to be with her. A young female resident asked my mother about her wishes if a rare complication occurred and she stopped breathing during the operation. I heard my mother say with determination, “Do everything you can, I want to live to be 100 like the Queen Mother.” My mother lived to be 99, so she almost made it.

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My husband and I felt very differently. We talked about our wishes and each signed a durable power of attorney and living will. We also spoke on several occasions with our children to make certain they knew and understood our wishes. As we got older, we told them about our inevitably increasing medical problems.

We each carried a piece of paper in our wallets (and sent it to each child.) It included our medications, medical insurance information, and names and contacts of all our physicians. I update mine whenever there is a change. I have also signed the orange-colored “pre-hospital medical directive” given to me by my physician. It reads, “In the event of cardiac or respiratory arrest I refuse any resuscitation measures.” This goes on the refrigerator door so emergency medical technicians do not start resuscitation.

In 2004, my husband developed a staggering gait and became quiet, not his usual gregarious self. His diagnosis was dementia. No cure, no treatment. I decided to keep him at home in familiar surroundings and ran a one-bed nursing home, the hardest task of my life, for three years.

Every time he had to be hospitalized for various problems he lost ground. On the last hospital visit I asked to speak to a social worker who recommended hospice care at home. Casa de la Luz staff, like magicians, quickly set up a room in our home with a hospital bed and all the other things we would need. Every hospice person we ever had any contact with was knowledgeable, kind, and understanding. When I hear anyone complain about the multiple failings of our health-care system, I interrupt to give my impassioned speech about the value and importance of hospice programs.

A week before he died, my husband grabbed my arm as I walked past his wheelchair. Due to his cognitive decline he said very little those days, but his words and meaning were very clear: “I don’t like this life.”

I answered, “I will miss you, but I understand.” I said it twice. The next day he would not get out of bed and refused all food and drink. The hospice nurse suggested I call the children. They arrived in time for him to smile and hold the hand of each clearly recognized child.

The day he died, after seven months of hospice care, I bent to kiss his cheek. He pushed himself up with surprising strength and kissed me ... a real kiss. I knew he was saying goodbye. He then curled up on his side in his favorite sleep position, not spread-eagled in a hospital bed with invasive tubes everywhere.

Encourage your parents to talk about their feelings and fears. Empower them to be in charge of their own lives. Make it clear you want them to tell you what their wishes are so you will not have to guess.

Show them this column.