Anne Pecenka is blunt, forthright and unambiguous about her future. At 81, she knows exactly why she's been admitted to Chilliwack's Cascade Hospice Residence.
The cancer that has spread to her brain is going to kill her, but it hasn't slowed her mental faculties down.
"I know it's a fact of life and we all have to go sooner or later," she said. "I'm not sorry that I'm here. I've got a very good attitude and I can deal with things."
She can, and she has. While health-care officials urge people to make their end-of-life wishes clear to their families, confronting one's own mortality can prompt procrastination.
Pecenka, though, did things right. While she says only God will decide when she dies, she will leave little to her son Frank's imagination when it comes to her personal wishes.
"Before she was anywhere near hospice, she started to work on a little manila folder with her wants and desires," Frank said. When she entered the hospice, Anne handed that folder to Frank.
Now, when the time comes, Frank is confident his mother will be in charge of her own care.
"It definitely doesn't leave you with a whole lot of decisions to make," he said.
And that's a good thing.
Cancer and heart disease biggest killers
In many respects, Pecenka's death will take place in a very 21st century manner.
Since the 1950s, the life expectancy of Canadians has increased by 10 years. Today, Canadians can expect to live, on average, for 81 years.
And those longer lives are reflected in changes in how, and where, we die.
In 2010, the most recent full year for which statistics are available, 678 people died in Chilliwack. Accidental and sudden deaths might get the most media coverage, but they comprise just a tiny proportion of fatalities. (Car crashes, poisonings, fires, drownings and murders accounted for just 10 deaths in 2010).
Cancer and heart disease were by far the biggest killers, with other age-related illnesses and diseases comprising most of the rest.
Not only is productive life being
prolonged, but so too is the course of dying. It's not uncommon, now, for the mind to deteriorate significantly, while the body is still functioning. Modern medicine can save the life of a person who in another era would have died-but the mind or body may severely limit a survivor's quality of life.
Our longer lives pose new problems that society didn't have to deal with a century ago. But we are slowly reacting to these changes led, in part, by organizations like the Chilliwack Hospice Society.
Most hospice societies trace their roots back only to the 1980s and 90s and began by focusing on supporting palliative care, which was mainly delivered in hospitals. The start of the 2000s saw societies around B.C. open brand new hospice residences dedicated exclusively for the terminally ill and their families. Chilliwack's Cascade Hospice opened in 2007. (While most B.C. hospices are operated by a society, the Cascade residence is operated and run by Baltic Properties, with the Chilliwack Hospice Society providing volunteer services for residents.) Today, the residences have come to be seen as offering the gold standard for end-of-life care.
The growing number of hospices reflect changes in where we are dying.
In 1994, a study found that four in five people died in hospital. In Chilliwack, however, less than half of the 667 deaths in Fraser Health's 2010-11 fiscal year occurred at Chilliwack General Hospital. (No statistics were available on how many of the remaining deaths occurred at the Cascade Hospice.)
Hospices have also helped to broaden the conversation surrounding dying. Yet despite their efforts and despite the fact that we have longer than ever to contemplate our demise, death is still one of the least talked about subjects in our culture.
That's a problem, says Cari Hoffman, Fraser Health's project co-ordinator for advanced care planning, because improved health care means that we often outlive our ability to direct our own care.
Life can now be prolonged through feeding tubes and respiratory machines. But there is a wide range of feelings about how such instruments should be used.
Hoffman says conversations about end-of-life care should take place "when we are healthy and capable." Everyone should have such discussions, but they're even more important for those living with chronic illnesses like diabetes.
Often it will fall to an elderly couple's children to start such conversations.
"Parents don't like to talk to their adult children about this because they feel like they're burdening them."
But with half of all people unable to make deathbed decisions, Hoffman says having children or other decision-makers have to guess at their parents's wishes is even more of a burden.
For instance, to say God will take you when He decides sounds simple, but it can create confusion in a medical setting.
"Those are very general statements and we have to talk to people about what that means to them," Hoffman said.
And after having those conversations, Hoffman says it's important to put it down in writing, as Anne Pecenka did.
Sorted things out
Pecenka had been living in a retirement residence with her husband, who has Alzheimer's, when she took a fall and found herself in the hospital for a week. She was released, but a little more than a month later, Pecenka fell again.
Told she would require 24-hour care, and with her cancer progressing, Pecenka decided to take advantage of hospice care.
She has no regrets about her decision.
While life expectancy has been increasing for more than a century, it's only relatively recently that-instead of just trying to further forestall the inevitable-we've begun trying to improve end-of-life care and comfort.
Hospice homes are one answer for this new challenge. Fraser Health's hospital-and home-care-based palliative care programs also offer support.
Shortly before she first spoke to the Times in September, the Pecenka family convened in the Hospice dining room for Frank's birthday. There are other perks-friendly volunteers, a comforting atmosphere and a relaxation program that can put a tired person right to sleep.
"Those people are just amazing," Pecenka said. "I don't know what they have in their hands.
"The people in here are very nice. Everybody's trying to make you very comfortable," she continued. "You get the best care you can think of."
While part of the family has been reluctant to talk about Anne's inevitable death, Frank's side has been more open about the situation. It comes partially because Frank has been through the situation before: both his sister-in-law and one of his best friends died in hospice. But it also likely comes from Anne's calm demeanor.
"I don't really think that I have a problem. I sorted things out the way I need to see it," she said. "I wrote things down, as I needed to see to them, I passed them onto my son that will have to take care of things."
"Some people need fancy funerals to be happy. I don't need that. I'm quite happy if my family gets together and has a nice meal and talk about me."
With a laugh, she disclosed one more request:
"If they don't have anything nice to say, they can keep their mouth shut."