The other day, one of the college kids at the rink asked me about my job. When I told her I worked in oncology, she replied, “Wow, that must be hard. How do you deal with it?” I answered almost immediately:

“I talk about a lot of death with people.”

And this is true. Though I may not always see a person take their final breaths, I am often caring for people in their final weeks, days, or even hours. It is sad, but that isn’t always what I am focused on. What’s more pressing to me is the family, how they are coping (or not), their level of preparation, their level of understanding what the patient actually wants in their final days, and their willingness to accept that sometimes, there are no more options. The only option left is to love. It is the tension between holding on and letting go that draws me to patients at the end of life. The pull between giving up and fighting, between what the patient needs and what they want, the pull between family members. It’s the realization that, perhaps, they never took the time to figure out what the dying person’s wishes truly were.

Oncology has highlighted for me that most people do not talk about death enough. We just don’t have enough frank conversations about our wishes surrounding death, or the wishes of others. This is not morbid or taboo, this is a fact of life- we will all die. Just like we will celebrate birthdays, marriages, and birth, we can also celebrate the culmination of life. Whether we live for 5 years, 55 years, or 95 years, our lives will be the longest thing we ever do, something my father said to me long ago. I believe that the same vigor we bring to these other milestones in life should be brought to conversations about crafting the ends of lives to reflect our wishes and preserve our dignity.

After Kobe Bryant died, I saw an outpouring of grief over his and his daughter’s lives cut short from the helicopter crash. People all across social media spread their “thoughts and prayers,” but I had to wonder, what was everyone thinking about? Were they thinking about his wife and remaining daughters, and the horrific new norm that they were completely unprepared for and now had to live with? Were they thinking of themselves, and what their spouses or children might do if they were to meet an untimely fate? Perhaps both. I wondered too, did anyone go and talk with their children about what would happen if a parent died? Would they tell them that they would go live with their uncles in Delaware? Because I always knew that was the plan for us, and while I would have never wished that in a million years, there was a comfort in knowing that my parents had thought about me and Jake, and had planned for us to live our lives with loving and equally wacky relatives. This was never morbid to me, it made me feel safe.

Did anyone stop and think about what they would want at the end of their life, if given a choice? I recognize that most people don’t walk down the street contemplating intubation or not, but it seems that only once we are reminded of our mortality do we ruminate about these things. What is it that is actually important? Do we want to fight to the very end, despite the side effects? Do we want to prioritize normalcy for as long as possible? Do we want to endure clinical trials for the sake of aiding in the future of research? Do we just want to stay at the beach as long as possible? When we are fighting for days to live, how do we want to live them, and with who?

I don’t ask these questions to make you sad. I ask because perhaps, they could help you to live. Maybe once we prioritize the things that *truly* matter, the people and feelings we want to carry to the end of life, we can have better clarity NOW on what is important. Perhaps, by pondering the ends of lives, we can find more joy and intentionality in the parts we are living right now. When I think about death, and my work in oncology in this light, I find that it’s far happier a place than I could have imagined.

WTF do you want at the end?