When It’s All Up To You, You’re All Grown-Up*

Remember being sixteen, getting your driver’s licence and thinking you were all grown-up?

Maybe that feeling lasted until you lost your virginity. In fifteen minutes, you had been introduced to the mysteries of adulthood but were left wondering, “Is that all there is? Could there be more to being grown-up?”

And yes, there was.

Like the time you received your first paycheque and realized you were contributing to the Canada Pension Plan. You were barely out of your teens. Planning for your old age sounded very grown-up.

Then, when you cast your first ballot at the age of twenty-one, you realized that you were taking part in the affairs of the country. This had to be grown-up.

But no. There was still more.

After a time, you realized that ‘grown-up’ was an illusion. Yet, you continued to have these milestone moments of awareness when you married, bought your first house, and then again when you had your first child.

However, somewhere between that first child and that same child’s graduation from middle school, a parent became ill, and, like many before and after you, there was a meeting with the oncologist that went something like this: “We’re starting to lose control. Transfusions will not fix the white blood cells, and the risk of infection increases as they drop. The disease is becoming an acute leukemia, and given your age, there is not a lot we can do. In the meantime, we can get the red blood cells back up, and that will make you feel better. Your breathing will be easier. But we may have to move to twice-weekly transfusions. At this stage, we’re trying to hold it together as best we can. Why don’t you take the time before your next visit and decide how aggressively you want to treat this? We’ll gather more data and give you the space to think about your wishes.”

And that was when it hit you. “This is what it means to be grown-up.”

And if, like me, you regressed while your parent was ill, wanting to be the child who did not have to deal with adult situations, it was a wake-up call. Grown-ups drive, vote, give birth, pay taxes, buy a house, pay down the mortgage, raise children, and grown-ups help their parents exit this world.

No one told me as I grew up that I would be helping a parent through an illness, that I would be sitting with that parent as they drew their last breath. Or that I would be comforting the surviving parent. No one told me or showed me, so I wasn’t prepared. And I was a registered nurse. If I wasn’t ready, then who was?

It’s a familiar situation. A parent becomes ill; the prognosis is grim. And squeezed into those free moments amongst the competing demands of children, careers, marriage, and caregiving, they and we need to learn more than we ever wanted to know about dying.

But what if our society normalized dying and death just as we have done pregnancy and childbirth?

If we accepted dying and death to be part of the life cycle, palliative care would be introduced to high school health education classes.  Lessons about learning how to be present to and caring for someone who is gravely ill would co-exist with other content, like sex education. The minimal value of being present during the end stages of an illness is that it provides our children with a practice opportunity — long before they assume the mantle of family elder. At best, the experience of being present with several generations creates an opportunity for a family discussion about remembering, grieving, and preparing for end-of-life—while living each day to the fullest.

However, inclusion in high school curricula requires societal pre-cursors such as:

• Advance Directives for End-of-Life Care are discussed, written down, filed and communicated with the family physician. (About 52% of Canadians have had discussions with family or friends; 20% have a written advance care plan; 10% have had discussions with their health care practitioners. ¹)  
• Palliative care content is included in the curriculum of all medical and nursing schools. (There is still work to be done.)
• Palliative care services are well-funded and integrated into the health care system. (We’re not there yet.)

If we hope to fare better than our parents may have in their last weeks, days and moments, there is much work to be done, and it’s up to us because we are now the grown-ups.

A course sponsored by the Canadian Hospice Palliative Care Association, Last Aid^®, gives me hope that Canadians will begin to normalize dying and death just as we have pregnancy and childbirth. Last Aid^® is like First Aid for end-of-life. It’s the kind of course I’ve envisioned since Autumn’s Grace was published in 2013. This month, I’ll learn more about Last Aid^® as I’m introduced to the role of facilitator. What entices me about the program is that it’s preparatory. Much like pre-natal courses prepare novices to become guardians of a new life, Last Aid will help participants learn to care for someone whose life force is ebbing.

Just as the life cycle concept struck a chord with me early in my practice, Last Aid^® resonates now: Pre-natal care and end-of-life care create a virtuous circle, and I’m honoured to be part of the process.

_{*This blog post was first published on October 22, 2014. This post is an updated, edited version.}

 _{1.What do Canadians think of advanced care planning? Findings from an online opinion poll | BMJ Supportive & Palliative Care}

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^{Bonnie Lendrum is the author of Autumn’s Grace, the story of how one family manages the experience of palliative care with hope and humour despite sibling conflicts, generational pulls and career demands. Autumn’s Grace is a powerful commentary on the need for well-organized and well-funded palliative care in private homes and in residential hospices. It’s a gift to people who would like to be prepared as they help fulfill the final wishes of a family member or friend.} 

©2013-2025 Bonnie L. Lendrum | all rights reserved | 

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