Art Buchwald: A Voice to Remember
Beth Ulrich, EdD, RN, CHE, FAAN, Editor

Art Buchwald, the Pulitzer Prize winning political satirist, died of renal failure on January 17, 2007. The voice he gave to the topics of death and dying in the last year of his life provide valuable information and lessons for all healthcare providers and for our patients.

In early February, 2006, Buchwald made the news across the country, having checked himself into a hospice to “be in a nice place for a few weeks and then die.” He had been diagnosed with end stage renal failure, in addition to his history of diabetes and heart failure, and had been on dialysis for about a month when he decided to stop. When asked how he made the decision to stop dialysis, he said that he evaluated the situation and “just didn’t want to do it any more” (Ratner, 2007). He had been told by his doctor that if he made the decision to stop dialysis, he would go into a coma in 2 to 3 weeks and die. He said it took him more than a week to convince his children, who initially objected to his decision (Grossman, 2006). Some friends also voiced their objections. “People,” he said “thought I should stay alive even if I didn’t feel good.” In an interview on NPR a few weeks after entering the hospice, Buchwald said he understood, “Nobody wants to lose you if they love you.” But, in the same interview, he also said, “I don’t want pain. I don’t want to be kept alive for the sake of being alive” (Rehm, 2006).

He loved the hospice and spoke highly of the care he received. Lots of people came to visit. He said he expected to just go quietly into the night and would wake up each morning and realize he was still alive. Five months after checking into the hospice, he checked out and went to his summer home on Martha’s Vineyard where the stream of visitors continued, much to his apparent delight, and where he saw his children and his grandchildren. He began to write again.

Throughout his time in the hospice, he had come to understand that “people are afraid of the mystery of death” and said he discovered “that it made people happy to share their fears and questions on the subject” (Ratner, 2007). He wrote a book, Too Soon To Say Goodbye, in which he described a process that kept repeating itself: he would talk about his situation and then his friends would begin to discuss their thoughts about death. He used his columns to open up the topic of death and dying and he urged people to name a surrogate for their healthcare decisions who would follow their wishes (Buchwald, 2006).
 
Art Buchwald died just a few weeks short of a year after he made the decision to stop dialysis. By then, he had, in his words, become “some sort of a celebrity for death” (Buchwald, 2007). In doing so, he had helped many people begin to voice their own thoughts and wishes about death and dying.

Lessons
There are many lessons we can learn from Art Buchwald’s last year. One that many nephrology nurses have experienced first hand is that predicting death is an inexact science. While few patients stay alive for a year after stopping dialysis, the time between stopping dialysis and stopping life can vary. We serve our patients best by providing information and support to them and to their families.

Another lesson is that the patient’s decision belongs to the patient. That’s often very difficult for nephrology nurses who know their patients so well and know their lives so intimately. We want them to want to live. But sometimes they don’t and we have to accept that it’s their decision, not ours.
 
As Buchwald showed the world, the time between deciding that you’re ready to die and dying can be filled with joy and happiness. Nurses are sometimes in the best position to create positive environments that also facilitate closure. Curing works to a point, but the last thing a patient knows is our caring.

Finally, as Buchwald found, if you open the conversation, many people want to talk about their feelings about death and dying. It’s not an easy subject to bring up and it’s one that many healthcare providers are not comfortable with. But, it is a discussion that needs to occur, especially when working with a patient population with a chronic disease such as ESRD that has numerous co-morbidities. Doing end-of-life planning and making final decisions both help people end their lives in a dignified manner.

As Art Buchwald said, “If you have to go, the way you go is a big deal” (Rehm, 2006).

Beth Ulrich, EdD, RN, CHE, FAAN
Editor
E-mail: BethUlrich@aol.com

References
Buchwald, A. (2006). Too soon to say goodbye. New York: Random House.

Buchwald, A. (2007). Art Buchwald: The last word. Video obituary. The New York Times. Retrieved February 26, 2007 from http://www.nytimes.com/packages/html/obituaries/ BUCHWALD_ FEATURE/blocker .html.

Grossman, C.L. (2006, March 29). Art Buchwald lives on, and that’s a reason to smile. USA Today. Retrieved February 26, 2007 from http://www.usatoday.com/life/people/2006-03-29-buchwald_x.htm.

Ratner, T. (2007). How Art Buchwald said goodbye. Nursing Spectrum. Retrieved February 26, 2007 from www.nurse.com.

Rehm, D. (2006, February 24). Interview with Art Buchwald. Washington, DC: National Public Radio.