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So, You Want to Make Your Bucket List? Where and When to Start

2015; Lippincott Williams & Wilkins; Volume: 136; Issue: 5 Linguagem: Inglês

10.1097/prs.0000000000001719

1529-4242

Rod J. Rohrich,

Empathy and Medical Education

And in the end, the love you take is equal to the love you make. —The Beatles One of my good friends died today. On the day I started writing this, I had just visited him in the hospital; and now he is dead. This caused me to reflect on how fragile and short life is on this Earth. One day you can be fine and think you will live forever; the next day you may be facing death. My friend was seemingly perfectly healthy—then he received a diagnosis of a fatal disease and, 2 weeks later, he died. As they say, "when your number is up, it's up." But "they" were clearly still alive when they said that. It's also largely understood that it's healthy to "be ready" for this inevitability. I don't know if my friend was ready; I know his family was not. His passing made me think, "Am I ready?" In so, so many ways, I am not ready. But how could we ever be? Are we ever really ready to die or let go? If we live our lives like there is no tomorrow or every day as if it were our last day on Earth, how long would we survive in the first place? And what kind of life would that be? I've thrown caution to the wind strategically at certain points in my life, and taken risks based on the premise that "I'm only here once." Some of them paid off, some of them didn't. But, I sure thought that I was one of the ones living life to the fullest in my career and with my family and, in theory, that should make me "ready" to go; and then I watched my friend die and reality hit me in the face! So, how does one get ready? When do you even start to think about your own death? The answer, always, is "now." Talking about death, considering death, and planning for death is one of the healthiest ways to live. Sometimes "YOLO" (you only live once) grand and often hyperbolic or dangerous gestures help people feel alive, such as sky diving, or running with the bulls (which I did in Pamplona years ago!). As thrilling as those experiences can be in the moment, in my experience, they are merely Band-Aids to help one forget about death; but truly talking about it, facing it in the calm of your living room is the best way to "get ready." It is often seen as very "un-American" culturally to talk about one's own death; ignoring it works fine and ends in the same result. But, there is a town in Wisconsin where everybody talks about death. Over 95 percent of the people in this town have advance directives or other documents describing their death plans compared with the 30 percent national average.1 These people in the small town are "ready" and can focus on living. My parents are both in their late 80s and still both enjoying life very much; that said, they have planned for their deaths for years. Their cemetery plots and tombstones are all selected and ready to go, except for the date of departure. My mother has gone to the extreme of putting a label under each chair and table to indicate who she'd like to receive each heirloom. It may seem kind of eerie or macabre, but it is very realistic and healthy too. My parents took these steps years ago and, like the people in that Wisconsin town, have been able to move on, and live on, long after the "paperwork and planning of death" was done. When I turned 61 this last year, I must say I didn't even think about it as life-changing much or a milestone of any sort. But when you analyze it realistic terms—an American man now lives to age 762—I realize that I am statistically approaching the "over the hill" status; but that doesn't mean that it's all downhill from here. Now that I am in the latter- but better- half of my life, and if I continue to be lucky and healthy, I need to capitalize on the benefit of all that I have learned and get ready. Like my parents, I have talked about death and planned for it in legal terms so that my wishes once I'm gone will be fulfilled, regarding organ donation, my will, and my last testament. That's the hard part. Now, I can focus on fulfilling my wishes while I'm still alive. I want to do that which I have not yet done rather than just continue to do the same things over and over. That would be a truly maddening way to go. The legal paperwork is done, and now it's time to look at the fun stuff: the "bucket list." For those of you not familiar with the term, it simply refers to a list of things one should do before they "kick the bucket" or die. This phrase was popularized recently by a Hollywood movie starring Morgan Freeman and Jack Nicholson, both of whom—I'm happy to say—I'm still much younger than. But, I—and our culture at large—have been pondering the proverbial bucket list for much longer. I always say "the cup of life is always better too full, not half empty." I was taught and have taught my students to live life to the fullest: you work hard and you play hard. However, I have not always adhered to my own advice on "playing hard" during my adult life. It may be time to do so. It is truly difficult to let go and not work so much; you build a career over decades of study, hard work, and dedication. But, if all things were just, the career should not come at the expense of enjoying life with friends and family. Managing this work-life balance has always been a challenge, and will only continue to get more difficult as technologies blend the lines further and further.3 How do hard-working physicians and plastic surgeons like myself let go of things which used to be of the utmost importance, like traveling to lecture, operating globally, and writing a few more articles? These are important tasks and vital to our careers, but how important are they in the true scheme of life and what really matters? With age comes increased wisdom (I hope!)—or at least it's supposed to, at any rate. I am proud to say that in my years, I have learned the meaning of life, for me anyway: a few, really good friends; a family with whom you have built and shared your life; and the amassed memories of what you did with and for those dear people, and for yourself too. My good friend is gone. All of us, too, will one day be gone. This "wake-up call" spurred by my friend's death has led me to finally write down my personal take on the bucket list, which I share willingly and eagerly with you to inspire you to do the same, and so you'll hold me to this list as I aim to accomplish the following and more in my next decades of life, God willing. I am well aware that not everyone has the same means to accomplish all of their desires. I don't either—I'd love to go into space, but that is not likely. That said, I think you'll find that while some of my list requires some means, most of them cost nothing; and those items on my list seem, to me, to be among the most important. PERSONAL BUCKET LIST Do more travel just for fun with family. I'd love to visit the Galapagos, travel Europe, and do an African photo safari. But more importantly, I aim to travel with the intent to see the world and learn something about the culture, rather than just attend another meeting where I go to a great location and stay at a great hotel but never get beyond the convention center doors! Visit and speak to my parents and people that really matter to me every day or at least every week. I am lucky that my parents are both still alive and healthy in North Dakota—you have to be tough to live there all your life! Learn another language: Spanish. l grew up speaking German, but that is not as helpful to me in Texas as it was where I grew up in North Dakota, where most people still speak German! Work harder and consciously to surround myself with positive people, including patients, co-workers, and friends—the others deplete you of your life energy, and who needs that? Don't miss the opportunity to catch good live concerts, or see them again, such as Fleetwood Mac, the Rolling Stones, and the Eagles. I regret never seeing BB King perform; I don't want to miss the chance to experience and share music I love with my friends and family. Make physical fitness a true priority, like work and play. I have had a recent scare with neck pain that has changed how I protect my neck and spine. I pledge to practice staying flexible as I age. Too many of us spend the physical peak of our lives on the couch. When you hit 40, 50, 60, and beyond, you'll dream of what you could have done. Become a better husband and father and human being by focusing on what is truly important—my wife and kids and my closest friends! These people will be at your funeral and will remember you and carry your legacy in their hearts and minds; cultivate your relationships with them now and every day. Not a novel idea, I know, but it is too easy to say you do this without actually doing it. Actions always speak louder than words in life. Don't be afraid to say "I love you" to the people that really care about me and I about them. Buy a blank greeting card and tell these people how I feel by filling the card with my own words. When you're old, you won't care if your love wasn't returned—only that you made it known how you felt. I now call and speak to my aging parents two or three times per week and make it a point to tell them how much I appreciate and love them. That was not always the easiest thing to do early in my life, as I am of German-Russian upbringing—it was just not discussed or talked about when I was growing up in North Dakota on a ranch. Stop caring too much about what other people think. In 10 years or less, you won't give a damn about any of those people you once worried so much about. Support others' dreams over my own. I am working on this every day; I am enjoying and love seeing what my children want to be and dream to be. So I am supporting their dreams, which is a beautiful thing, and by doing so, I feel like I am shining brighter as well. Be more patient and slow down when it counts. I always feel that I am not moving fast enough. No one ever said "I should have spent more time in the office" at the end of life! Let it go. I stopped holding grudges over 15 years ago and it was a true epiphany for me, especially with those I love. What's the point of reliving the anger over and over? It is meaningless. Give back more to humanity, to our family and our community, my patients and globally. I want to use my Foundation to help make my community better. Ask questions of older relatives. I regret not asking my grandparents more questions about their lives and what was important to them before they died. Most of us realize too late what an awesome resource our parents and grandparents are. Hang out more with my two rapidly growing children if they will have me now. I don't want the "Cat's in the Cradle" song to remind them of me! Soon, you'll realize your children went from wanting to play with you to wanting you out of their room in the blink of an eye. Take more risks in doing something new like taking a dance class, tuning up that old guitar, picking up a paintbrush, and just seeing what happens. Knowing that you took a leap of faith at least once—even if you fell flat on your face—will be a great comfort when you're old. Live each day one day at a time. "Live like each day like it's your last day on earth" to me doesn't mean anything too extreme; it means to truly appreciate and live every minute. Notice and appreciate what you're doing and the world around you. Stop worrying. It does not help anyway! As Tom Petty sang, "Most things I worry about never happen anyway." Make and leave life on earth having done enough to make a true difference in at least one person's life. Be kind and forgiving to everyone. It is free and easy, no matter what! I am learning this is good for my soul. It can be hard to see in the beginning, but eventually it becomes clear that every moment on this earth—from the mundane to the amazing—is a gift that we're all so incredibly lucky to share. If you feel inspired to do so, talk about life and death and get that all planned out like those people in Wisconsin and my parents. Then, make a list of the things you want to do with the rest of your life. The rest of your life begins today … every day. The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time. —Mark Twain ACKNOWLEDGMENT I would like to thank Aaron Weinstein for assistance gathering the opening and closing quotations and for providing copyediting.