A survey on people’s end of life wishes carried out by the California Health Care Foundation in late 2011 came up with the following findings:

67%: Making sure family is not burdened financially by my care;
66%: Being comfortable and without pain;
61%: Being at peace spiritually;
60%: Making sure family is not burdened by tough decisions about my care;
60%: Having loved ones around me;
58%: Being able to pay for the care I need;
57%: Making sure my wishes for medical care are followed;
55%: Not feeling alone;
44%: Having doctors and nurses who will respect my cultural beliefs and values;
36%: Living as long as possible;
33%: Being at home;
32%: Having a close relationship with my doctor.

The Foundation, in summarising the findings, says that there’s “a disconnect between what Californians want (a natural death at home) and reality.” The various poll answers, available in the pdf, prove this conclusively.

What’s true for Californians is true for older people in this country too, and in most developed nations facing the same issues of increasing numbers of old people, the taboo around discussing dying and death, and medical advances which make prolonging life in hospital more likely than a natural death at home.

So, how to make the end of life experience less a ‘disconnect’ with what people want and more a positive, comfortable and comforting experience?

Well, encouraging ailing older people and the terminally ill to have a personal death plan would be a great step forward. It would enable the patient, their loved ones, their medical professionals and, if appropriate, their ministers of faith, to discuss openly and honestly the end of life experience the patient wants, and if at all possible, deliver these wishes.

We have created a holistic death plan that covers the medical, physical, emotional, spiritual and practical issues, even down to who looks after the pets. Less prosaic are considerations such as the aromas the patient wants to smell, music to hear, people to be present, where the patient wants to end their life and, of course, the level of medical intervention.

If the adoption of death plans became widespread, far more people would have the end of life experience they, and their loved ones, want.

To make it easy, there’s a simple to complete template in the Lifebox section of My Last Song. Once filled in, in can be securely stored, updated and accessed by selected loved ones.

The more people who have their death plans, the more seriously they will be taken by the medical profession.

For the past 18 months I would call in to see my old friend Harry* on a Saturday or Sunday morning in his Clapham flat.

Our long friendship started when we were in our mid-20s. He and his first wife became very good friends to my wife and I, both fairly new to London, and they soon introduced us to their circle of friends.  Harry and I were particularly close thanks to our love of jazz and contemporary music which we listened to for hours two or three evenings a week.

The  seven or eight years of friendships, parties, holidays, dinners, pubs and clubs were the best years of our lives, ending when the ‘set’ drifted apart as kids came on the scene or couples split up.

Harry was even then, among a pretty hard living group, the heaviest drinker and user of recreational drugs.  He was also prone to attacks of depression which he put down to his childhood with a violent alcoholic father. It made Harry difficult to be with at times, irrationally angry towards those who loved him the most and prone to self-harm.

Following the failure of his first marriage, Harry’s life went slowly downhill, mainly due to his depression and alcoholism, though he and I kept in touch as he moved around London and then many years in Germany.

He had a zest and energy for life, when on good form, and gave wonderful parties always with new circles of interesting and delightful friends, and the rump of former social circles. Whether I saw him at these parties or just for a mid-day chat, he was always drinking, and he smoked 40 or 50 cigarettes a day.

This drinking and smoking continued throughout an unsuccessful marriage (his third I think) to a long suffering, warm German woman, and ten years of unemployed misery in Frankfurt. Unsurprisingly his physical and mental health deteriorated there and at the fourth or fifth attempt he finally came back to live first with a friend in Surrey and then on his own in a flat in South London.

I was shocked when I saw him, as the ravages of the drink and cigarettes had aged him terribly. One of the few things he brought back from Germany was a list of illnesses including emphysema, osteoporosis, myopathy and pulmonary oedema. The depression was far worse, sapping him of a will to live, to do nothing more than drink and smoke.

By this time Harry had fallen out with his two sisters (his only family) and most of his friends…so he asked me if I would visit him once or twice a week to get some shopping and clean the flat. As I was only a mile away, and still liked the old rogue, I agreed.

His shopping list always started with 200 Mayfair Smooth and three large bottles of gin and three bottles of tonic, a bottle of port and two bottles of wine.  There was not much in the way of healthy food.

After I put away the shopping we usually chatted, listened to some music before I made my excuses,  his cigarette smoke making my eyes run and throat feel sore,  and unable to bear any longer the sound of accumulated phlegm gurgling in his throat.

Recently the amount of food he wanted decreased…he was losing weight, getting more and more depressed.  He sought medical help but then refused to go to hospital or GP appointments. I, and one or two other friends who saw him occasionally, told him he was drinking and smoking himself to death, to which he replied ‘Good, that’s my business not yours.’

Harry started going downhill more rapidly two or three weeks ago. I was very worried this Saturday when I visited him as he had lost a lot of weight and didn’t have the energy to get himself out of his easy chair. I told him I was going to take him to hospital or call an ambulance to get him admitted. He got very bad tempered and told me not to interfere. I said that I was going to come round tomorrow (Sunday) and come what may ensure he got to hospital.

I was too late. I opened the door to his flat at 12.15 yesterday and he was curled up on the floor, stone cold dead, his head resting on towels he had by his easy chair.

I called the police, and then the ‘emergency services’ took over…did an excellent job, contacted the coroner and organised for Harry to be taken by a local funeral director to the nearest mortuary. On the advice of the police I left his flat before the fd arrived.

The police found a few numbers on his mobile, and I had the numbers of other old friends, so yesterday afternoon and evening was spent telling people and discussing the tragedy that was Harry’s last few years. His funeral will be sparse but not completely lonely.

It’s likely that I’ll be involved in the funeral arrangements…Harry refused to discuss anything to do with his funeral or death, in effect a focus group of one who saw no point in My Last Song.

Even so, I’ll spend some time going through my memories of the music we used to listen to endlessly when in our 20s and 30s. There will be an appropriate last song for Harry, and those who attend the farewell will know why it’s been chosen.

*Not his real name. Those who know ‘Harry’ will know who this is about. I’ve also not named the wonderful people who shared parts of his life and were not always appreciated by Harry for their love and friendship.

I saw the other day a memorial message: ‘Gran will look down on us from heaven’. It made me wonder in a semi whimsical way, Where is heaven?

It isn’t ‘up there’ in the sense that somewhere between the earth and space is a place where God looks down, angels flutter around and saved souls swan around feeling happy, though the more active somewhat bored…how do you do occupy yourself for ‘eternity’?

Space missions to planets and amazingly powerful telescopes haven’t come across heaven, and thanks to scientific advance we’re discovering the vast limitless expanse of space. Heaven has still to be found above us, and our spirits will have to travel very fast to reach it if it’s further than we’ve discovered so far.

I might be proved wrong and a camera on board a rocket heading for the sun might shortly send back  pictures of endless rolling hills, clear streams, clean streets, stately homes and chateaux, cake shops, choirs singing and angels plucking at harps, rows of well stocked vegetarian food stalls, sandy beaches, warm calm seas, England winning Test matches, but I doubt it.

God’s up there, Christians have been told for many hundreds of years, along with a neat hierachy of semi human helpers: cherubims, seraphims, angels and saints with special privileges such as front row seats to hear the choirs and quality time discussing serious issues with God. Jesus is up there, at His right hand, as he rose from the dead and ascended to heaven.

Paintings and frescos have depicted these Elysium scenes in wonderfully realistic works of art down the centuries, their creators having no doubt that the firmament they were depicting was real, God and his crew were above us, we were being judged from on high, heaven was waiting for us if we believed, and who in those days before science provided more empirical answers, wouldn’t?

For Muslims, paradise is also tangible as a bounteous bejewelled garden where, notoriously, vast numbers of virgins wait to give solace to martyrs as they arrive.

This is now considered a mistranslation of the original ancient Arabic description, and a good thing too when you think of the moral ambiguity.  But it shows that Islam like Judaism, Christianity and most religions, has created a place with physical properties where our souls, spirits or reconstituted bodies are summoned when we die.

I try to get my head round this, but can’t. I conclude, not with any pleasure, that heaven doesn’t exist. If I accept it’s a metaphysical place, it simply confirms that this definition of heaven is a device used by religions to avoid the inconvenient truth that it’s not there.

This metaphysical destination for our souls by definition has no tangible location, no pearly gates, walls, clouds to sit on. It’s a place that religions create to reassure us that when we die there is more to follow if we are good and obey a God who has not only created where we live but where we’ll go next if we pass whatever test, given final sacraments or are part of the elect. There are all sorts of obtuse rules for our entry to paradise, not surprising really, as it adds to its mystery.

The metaphysical definition of heaven has another problem for me. If heaven isn’t a physical entity, does it have a timespan? Put another way, if heaven doesn’t exist as a place, does it exist in time? When did this metaphysical heaven start to host spirits and souls? At what stage in our evolution did man have a soul? Were we only given souls when we understood the nature of our relationship with God, or when He started his relationship with us?

I don’t believe we started from Adam and Eve, so when during our evolution were we advanced enough in God’s eyes to qualify for entry to heaven? Was heaven rather lonely for the first few thousand years, and is it not uncomfortably overcrowded now?

Silly questions I know, for if it’s a metaphysical place; it’s neither empty nor full, it’s not a real place.

The more I think about it, the less chance I have of  finding heaven.

Mark Easton, the BBC’s Home Editor, has rightly emphasised the importance of having friends or ‘company’ as an important factor in improving our health and increasing our longevity.

He decided to dig a bit deeper when the No 10 adviser said that loneliness is probably more dangerous to our health in retirement than smoking, to look at the research that underpinned that statement.

It is, as you’ll see if you clicked the link, pretty detailed and obtuse research which can be reduced to those with stronger social relationships had a 50 per cent increased likelihood of survival than those who lived more solitary lives.

Easton points out that research going back 30 years also showed that loneliness, or lack of social interaction, resulted in higher rates of mortality than expected.

These findings come under the heading of common sense. Humans have evolved as social creatures. Working and living together has enabled our survival and success. Being alone, not through choice but by circumstance we would rather avoid, makes us miserable, lethargic, demotivated and vulnerable.

He makes the point that if the evidence, not to mention our common sense understanding of our need for community and company, proves that loneliness is a ‘killer’, we should do more to prevent it.

Now whether it’s the job of the Government to try to make older people have more friends is doubtful. But they should give greater support to charities such as Contact the Elderly and Independent Age whose excellent schemes to reduce elderly isolation are underfunded.

They should also use the Big Society Network to create more intergenerational contact projects which will encourage young people to befriend older people and coach them to be more computer confident…and less lonely through use of the internet. The older people can impart their wisdom and knowledge to their younger friends who, in some cases, will be less likely to join gangs or participate in petty crime.

We at My Last Song are encouraged that the issues facing older people are now being seriously considered, whether it be funding their care, understanding how they want to die, giving them the send-off  they want and helping them living longer, healthier and happier lives.

Why is this important? Just look at the demographics of this country (and indeed the US where the research was carried out)…the 70 year old plus group is the fastest growing with almost 7 million people aged 70 and over by 2015 in England alone. There will be far more than this in the US. Their needs must be taken seriously.

Congratulations to the University of Nottingham, Dying Matters and the National End of Life Care Programme for producing the excellent Planning for your future care publication.

It is written in simple, positive prose and covers all aspects of Advance Care Planning including what is the most difficult aspect, ‘Opening the conversation’.  The tone for the leaflet is set in this telling phrase: ‘Not everyone will choose to engage in such a conversation and that is fine. However, talking and planning ahead means that your wishes are more likely to be known by others.’

I was particularly pleased that the leaflet covered wishes and preferences, and that these included some of the end of life experience defined in the My Last Song ‘death plan.’  Planning for your future care suggests where you want to be, who you want to be with, types of treatment, ‘how you like to do things,’ with examples such as sleeping with the light on or having a shower instead of a bath.

If you, or an ailing loved one,  want to have a ‘good death’ instead of a lonely, frightening end of life, then read Planning for your future care and act on its advice. To make the end of life experience as good as it can be,  fill in your own personal death plan, a template for which is available in the My Last Song Lifebox.

The wishes and preferences are more holistic, covering the music you want to hear; the smells you want surrounding you; the food and drink you wish to taste; the sensations you want your body to feel, such as caressing, massaging, stroking; what you want to see, such as a lovely view or your favourite photographs; how you want to look – clothes, make up, hair style; and ensuring the practical issues are resolved so you have no concerns.

By involving loved ones, doctors and if appropriate ministers of religion or spiritual advisers, having a death plan will go a considerable way to ensuring, if possible, the death is as comfortable and comforting as possible.