Any regrets? Deal with them

A month before cancer finally claimed his life, Craig Royce told his family there was something he wanted to do — pick his own coffin.

Dr. Alex Jadad poses for a photo at the Toronto General Hospital. Jadad helps people come to terms with regret at the end of their lives.

A month before cancer finally claimed his life, Craig Royce told his family there was something he wanted to do — pick his own coffin.

His wife and daughter were mortified but, on a doctor’s advice, they didn’t stand in his way.

“That night I gave Dad a call and asked how it had gone,” says Royce’s daughter, Diana. “He said, ‘Well, I tried one out and I didn’t look so good. So I got in another and I looked a little bit better, but it wasn’t that comfortable. So I got into another one. I looked good and it was comfortable. I got that one.”

For a man with a passion for classic Thunderbirds, it was the sports car of caskets — sleek, shiny, a statement.

“It took me a while to realize he was teasing about trying them all out, but there are some moments you will never forget,” Diana says. “This one was so funny, it made you cry.”

Most important, it meant the family of the 74-year-old Milton, Ont., man had no regrets. They had let Royce man the driver’s seat of his own death — just as Dr. Alex Jadad had recommended.

Jadad, 46, calls himself a supportive care, rather than a palliative care, doctor. The head of Toronto’s Centre for Global eHealth Innovation and holder of the Rose Family Chair in Supportive Care at the University of Toronto, he doesn’t focus so much on disease and death as on hope and life.

In many ways, he is a throwback to the old family doctor who was a companion and a confidant.

Many times, that means helping those who are dying tackle something that can be more difficult than pain — regret.

“So often, I hear, ‘If I had known this was going to go so quickly, I would have devoted more time to what I enjoy. I was pursuing things that were silly — fame, promotions, money, recognition.”’

In a strange way, Jadad’s work is a modern take on A Christmas Carol.

“I’ve seen (critically ill) people in their 70s, some of them incredibly wealthy, pursuing the next deal. When I ask why, they say: ‘Because that’s what I’ve been doing all my life.’ I tell them, ‘It’s not too late. What makes you happiest — that’s what you need to focus on the most.”’

Those things can be shockingly simple — fishing, writing poetry, spending time with family.

But the regrets can be far more complex, ranging from the cruel (cheating on their wife with her best friend) to the criminal (stealing from their employer or keeping secrets from a business partner).

“These are incredibly deep and intense conversations,” Jadad says. “It’s not so much about right and wrong. It’s that people have a load on their shoulders. And some of them become determined to tell everybody, to go public. . . . I say, yes, you may want to do that, but you may want to look at the consequences first.”

He often helps patients compile a list of regrets, from least to more serious, and can act as a “mouthpiece or a mediator” to help the person navigate their way to redemption.

“This is not a time to flagellate yourself. It is a time to reflect. You cannot undo, but you can mend.”

Diana Royce sought Jadad’s advice after feeling overwhelmed by the medical system and the choices in her father’s final months of life.

It’s not that Craig had regrets — he was a beloved businessman who spent the weekend before his death last Nov. 11 saying goodbye to his many friends. But Diana wanted to be sure that she, her brother and her mother didn’t have any, either.

Jadad gave her these pointers:

l Respect the patient, their wishes and their right to make their own decisions — don’t take charge in an effort to “protect” them.

l Give them as much control as possible over what’s happening or about to happen. Be sure to talk about how and where they want to die (75 per cent of patients want to die at home, but 75 per cent die in hospital, Jadad says).

l Maximize their sources of joy — ask what makes them happy and then help them do it.

l Deal with regrets.

Jadad is bracing for the baby boomers — he suspects they will have far more regrets than their parents.

“We were the generation where two people worked, so we neglected our kids in one way or another. We outsourced or abdicated many of our (family) responsibilities. We were the generation that didn’t have enough, so that may have some consequences. We are the most affluent generation and many of us are going to realize that the most important things were free and we had them at our fingertips.”

Jadad practises what he preaches. He considers himself the CEO of his own life and has appointed a “board” — six family members and close friends, including his assistant Svjetlana Kovacevic — whose main job it is “to protect me from myself.”

Once a month, he sits down with his kids and then his wife to get a frank appraisal of how he’s doing.

They tell him if he has been working too much, not spending enough time having fun or focusing more on penning academic papers than the creative writing he loves.

Jadad credits his 15-year-old daughter Tamen with opening a frank family discussion about death — and life — when she was just seven and asked her father over the lunch: “What would you like us to do with your body when you die?”

Jadad thought for a second and said he would like his ashes spread “in the place where you think you’ve had the greatest fun with me.”

The girls agreed on a nearby conservation area where the family goes to hike and fly kites.

“There was no fear in that conversation. And it got me to know my kids better, too.

“I was blessed by my seven-year-old, and that reinforced my convictions about doing this at every opportunity, with the people I have the privilege to serve.”

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