TIME weather

Thanksgiving Travel Will Be Snarled by Snow

Bad Weather Driving
Dan Barnes—Getty Images

Roads north and west of I-95 will likely be blanketed by snow Wednesday night, and the National Weather Service says the New York area could see 6 to 10 in. of snow. Travelers should expect clogged roads and airport delays up and down the east coast into Thursday

Hate to break it to you, but if you are traveling anywhere on the East Coast this Thanksgiving, you may have a tough road ahead of you. Snow and ice is expected from New England to Georgia on Wednesday, which promises to snarl traffic on one of the busiest travel days of the year.

According to the Weather Channel, roads north and west of I-95 are likely to be blanketed by snow Wednesday night, and the National Weather Service says the New York area could see 6-10 inches of snow. Travelers should expect clogged roads and airport delays all up and down the eastern seaboard from Wednesday into Thursday morning.

Four-wheel drive is always something to be thankful for.

TIME tragedy

Ticket Waived for Teen Who Dozed at Wheel in Fatal Car Wreck

Five of his family members were killed in the accident

A ticket will be waived for a teen who dozed off at the wheel, causing a car crash that took the lives of five of his family members.

The Texas teen, whose name has not been released, said he fell asleep at the wheel of his family’s car around 10:30 p.m. on Wednesday. The family was driving through Louisiana at the time, on their way to Disney World in Florida for Thanksgiving.

The car hit the median and ultimately flipped, causing six of the eight people in the car to be ejected from the vehicle. Five of those family members died. They included parents Michael and Trudi Hardman, and kids Dakota Watson, 15, Kaci Hardman, 4, and Adam Hardman, 7.

The driver was initially issued a ticket for the accident, but that was then waived. “This young man has been punished enough,” Louisiana Fourth Judicial District Attorney Jerry Jones said, The News Star reports. “There is no need to add to his pain. The ticket will be dismissed.”

[The News Star]

TIME Family

Why Your Kids Don’t Thank You for Gifts

images by Tang Ming Tung;Getty Images/Flickr RM

And how to help them develop some gratitude

When we shop for holiday gifts, many of us look for things that will make our children happy. We can’t wait to hear their appreciative cries of “thank you! thank you!” once the wrapping gets ripped off.

But here’s a tip: Don’t count on it.

In this season for thanks and giving, even the most thoughtful children may not offer much gratitude for the gadgets, gizmos, and games they receive. And you’d be wise not expect it.

I’ve spent the last year living more gratefully because of a book I’m writing on the subject, so I’m confident that gratitude can make us happier, healthier, and even fitter. Seeing the world through grateful eyes can lower depression and improve sleep. It creates a pay-it-forward spirit that is good for the world. Encouraging children to write down events that made them grateful—and not just on Thanksgiving—can begin a habit that lasts a lifetime.

Read: What I’m Thankful For, by Nick Offernan, Wendy Davis and others

But gratitude for the endless stuff we buy them? All the research I’ve done has convinced me that it’s not going to happen. And there are several reasons why.

In one study, Yale’s assistant professor of psychology, Yarrow Dunham, found that 4- to 8-year old kids responded differently when given a gift they thought they earned versus one that was granted out of simple generosity. He called the earned gift an “exchange relationship.” The children were happy for the trinket but didn’t experience the deeper resonance of gratitude that might also make them more generous to others. The gift given for no reason, however, had a different emotional impact and the children showed thanks by being more likely to share candies they received in a follow-up game.

As parents, we don’t consider our holiday gifts an “exchange relationship” since we know the time, money, and effort we put in to buying them. But kids have a different view. One mom told me that when she asked her 16-year-old son to thank her for buying him a cellphone, he said, “But that’s what moms do, isn’t it?” He wasn’t being rude—just practical.

From a teenager’s vantage, it’s a parent’s responsibility to take care of the family, and playing Santa is part of the job. According to Dunham, “when teenagers code it that way, a gift is no longer something given freely and voluntarily”—it’s just mom and dad living up to their obligation. And who’s going to be grateful for parents doing what they’re supposed to do?

Read: 40 Inspiring Motivational Quotes About Gratitude

Asking our children to be grateful for gifts is sending the wrong message, anyway. Cornell psychology professor Tom Gilovich has found that people are more likely to be grateful for experiences than for material possessions. A family dinner, a songfest around the fireplace, or even a hike in the woods creates a spirit of gratitude that outlasts even the nicest Nintendo.

Parents may get exasperated when a teenager tosses a new cashmere sweater on the floor, and gratitude aside, and we do have the right to demand good manners. Children should know to say thank you (profusely) to every parent, child, aunt, and uncle who gives them something.

But kids can’t know how blessed they are unless they have a basis for comparison. And they don’t learn that by a parent complaining that they’re ungrateful. We need to give our children the gift of a wider world view. Take them to a soup kitchen instead of to the mall. Become the secret Santa for a needy family. Show by example that gratitude isn’t about stuff—which ultimately can’t make any of us happy anyway. It’s about realizing how lucky you are and paying your good fortune forward.

My favorite idea: Collect all the charitable appeals you get this time of year into a big basket and find a night when the whole family can sit down together to go through them. You set the budget for giving and the kids decide how it’s distributed. Going through each request, you have the opportunity to discuss with children and teens (and also your spouse) what it means to need a food bank or to live in a part of the world where there is no clean water. You can talk about teenagers who are caught in war zones or those suffering from disabilities. Then write the checks together or go online and make your contributions.

Once the conversation about gratitude gets started, it’s much easier to continue all year. Set up a family ritual at bedtime where kids describe three things that made them grateful. When kids go off to college, text them a picture each week of something that inspired your appreciation. Whether it’s a friend, a snowflake, or a sunset, the spirit of the photos will help you (and them) see the world differently.

Teaching children to focus on the positive and appreciate the good in their lives is perhaps the greatest gift we can give them. And we can all learn together that the things that really matter aren’t on sale at a department store.

So I hope my kids will thank me for the gifts I buy them this year. But gratitude? That needs more than wrapping paper and a bow.

TIME Aging

Taking Care: An Intimate Look at How Parkinson’s Disease Has Changed 1 Family’s Life

“Taking Care” is a series intimately covering the lives of caregivers and the people they care for. This month’s edition is on Parkinson’s Disease

When Eleanor Copeman was diagnosed with Parkinson’s disease, an incurable condition that gradually attacks the nervous system and impairs even simple movements, family life for the Copemans changed forever. The vibrant, joyful matriarch who loved cooking for her family became dependent on her husband Douglas and daughter Tammy for everything from preparing meals to getting dressed.

Now, almost a decade later, Eleanor also has dementia, which strikes 50-80% of people with Parkinson’s. The physical and emotional burdens of caretaking fall to the family.

Abby KraftowitzEleanor Copeman sweeps the porch outside the family home as her daughter rides her horse toward the house in Elkins, West Virginia, on July 14, 2012.

“Physically, taking care of someone with Parkinson’s is intense—you have to be on 24/7,” Tammy Copeman tells photographer Abby Kraftowitz, who has been documenting the Copemans’ lives since 2012. “I think it’s just a whole different level of love and loving your family.”

Douglas says he chose to take care of Eleanor at home to honor a promise he made to her 51 years ago when they first married.

Kraftowitz’s work offers a deep look into life inside one household touched by this chronic disease.

Abby Kraftowitz is a photographer based in New York City. You can follow her on Twitter @abbykraftowitz.

TIME health

New Crisis Line Aims to Help Transgender People at Risk of Suicide

On 2014's annual day of remembrance for transgender victims of violence, a new hotline is ready to field calls

On Nov. 20, people are gathering at events around the nation to read names of transgender people who have died in the past year in violent crimes. The descriptions on the website for the occasion, the annual Transgender Day of Remembrance, are chilling: “massive trauma, found dead in an alley,” “murdered and burned,” “gunshot to the back.” Transgender people, particularly transgender women, are subject to high rates of violence and harassment. A 2013 report found that 72% of homicide victims in LGBT-related hate crimes were transgender women of color.

On this somber day, an organization based in the Bay Area is trying to get the word out that there’s a new resource available to fight what may be an even deadlier problem among transgender people: suicide.

According to the most definitive report on transgender issues in recent years, 41% of transgender people attempt to commit suicide, a statistic that doesn’t necessarily factor in successful attempts. That’s a number that the people behind Trans Lifeline (877-565-8860), a crisis hotline staffed entirely by transgender people, want to see decreased.

“There are a ton of suicide hotlines. There’s no shortage of them,” says Greta Martela, a software engineer and president of the organization that went live this month. “But it’s really difficult to get a person who isn’t trans to understand what it’s like to be trans.”

Empathy is a powerful emotion for people attempting to come to terms with being transgender. Many transgender people say they only had the courage to come out once they met someone else who was living a happy life as an openly transgender person, people Orange Is the New Black actress Laverne Cox calls “possibility models.”

Martela came out last year, as a 44-year-old parent. Before she did, she was plagued by anxiety and debilitating panic attacks. In the process of coming out, she called a suicide hotline. A man answered the phone, she says, and when she explained the trouble she was having, he just went quiet and told her to go to the hospital. “They had no idea how to deal with a trans woman,” she says. And when she got to the hospital seeking help, she had to explain what being transgender was to the hospital staff.

Her aim is to get people in crisis—whether that person is a suicidal, closeted teenager or the confused parent of a six-year-old—access to volunteers who can understand what they’re going through right away and direct them to more help wherever they are. “Those are the people I want to call the most,” Martela says of parents who are trying to understand what a child is going through. “Getting them good resources could spare their child a lifetime of pain.”

Right now, the corporation—which has applied for status as a non-profit—is a shoestring operation, fueled by open source software that allows Trans Lifeline to funnel calls to on-duty volunteers wherever they are. They’re raising funds for advertising to get their number out there, to people like Martela who couldn’t find anything like the hotline when she needed it. “There’s a body count associated with people not accepting trans people,” Martela told TIME in a previous interview for a cover story on transgender issues. “It’s costing lives.”

TIME Profiles

Meet the Woman Trying to Save Your Kids From Their Screens

Jefferson Pitcher Author and artist Keri Smith just released her latest book this fall, The Imaginary World Of ... (Perigee; 192 pages).

A conceptual artist and author is luring kids into questioning the world and appreciating every smell, texture and mystery in it

At 42, Keri Smith still writes to a pen pal. She deeply appreciates secret passageways. And she sometimes rolls dice to determine which way she walks down the street. That won’t surprise her readers who have followed instructions from her bestselling books like Wreck This Journal — a tome that asks “users” to cover the pages in dirty fingerprints, smells and drawings made by strangers.

What they might not know is that Smith, a rosy-cheeked Canadian now ensconced in Northampton, Mass., is secretly trying to spark a political movement with her whimsy. “What I’m doing is trying to get kids to pay attention, to look at the physical world more, and to question everything,” she says, leaning across a bowl of yellow heirloom tomatoes on her kitchen table. “I am trying to get kids out of the house and away from screens. Someone is needed in this culture to speak up and say this behavior is dysfunctional.”

Courtesy of Perigee

Out this fall is Smith’s 12th book (depending how you count books that often defy what a book should be), The Imaginary World Of … . Readers can complete the title with their name. Inside, they won’t find aspersions against the corporations Smith believes are “blandifying” the youth or commands to live without TV, as her family does. Instead they’ll be asked to make a list of things they’re drawn to: textures, people, sounds, colors. Then Smith will guide them through painting their own universe with that palette. Her unspoken message may be discovered along the way, if kids or adults notice their utopia didn’t include a Target parking lot or seven hours of media use per day.

In Wreck This Journal (2007), her best known work which now has more than 3 million copies in print worldwide, readers are asked to rip a page out, write a note on it and sneak it into someone’s pocket. In Guerilla Art Kit (2007), Smith presents a how-to guide on pastimes like seed-bombing, flashmobbing and situational graffiti. In How to Be An Explorer of the World (2008), she encourages readers to wander aimlessly until they have lost all sense of time and place. In Mess (2010) she instructs readers to bury the book, to do everything with the “wrong” hand for a day, and to take an existing mess and make it much, much bigger. Sometimes her fans turn those messes into more organized art.

Smith knows it’s hard to muster the kind of abandon it takes to eat colorful candy and make “tongue paintings” in one of her books, if you’re not a carefree toddler. She was once a middle-class girl in the suburbs of Toronto, where her mother suffered from a brain tumor and a rather unhappy marriage. Fights would send Smith retreating to her room to draw. By high school, Smith had turned to more destructive tools, experimenting with drugs and cutting herself in an effort to cope with home life.

Her first muse on the road to success and inhibition came in the form of a teacher who reminded her that she found solace in art. On his advice, Smith entered the Ontario College of Art and Design as a mature student a few years after dropping out of high school, a place where she was given “the permission to do whatever.” The second was her husband, an experimental musician who moved into her small farmhouse in the town of Flesherton, Ontario (pop. 700) after they wed in 2004.

Jeff Pitcher, a California native, was unprepared for the dark days that last nearly half the year, and in a moment of stir-crazed desperation, he and a friend put on headphones, walked out into the snow and started wildly dancing on the side of the road to music no one else could hear. That exercise eventually became the documentary short The Winter of the Dance, a study of “shedding predictability” and returning to a child-like state. Eventually Pitcher convinced his wife to try ecstatic heel-shaking beside a busy street. “It was life-transforming,” Smith says. “You have to force yourself into a situation that is slightly uncomfortable, because when you come out the other side it is the most freeing thing imaginable.”

From that well sprung Smith’s obsession with the precise moment a person decides to do something they are hesitant to do — like jump off a dock into numb-cold water. And her books are training manuals that make people more willing to leap. Of course, not everyone takes kindly to her exercises, which repeatedly flip the bird at convention. “In order to be who you are as a human being, you need to be willing to upset people,” she says. Smith certainly has, almost being sued after young readers followed (now defunct) instructions to “burn this page” and rub a blank page on a dirty car (which can scratch up a vehicle fast).

Despite a few detractors, Smith has a bevy of loyal followers and gets flooded with thankful letters from recovering perfectionists, school teachers and unhappy teenage girls who have been drawn to harming themselves as she once was. “I think they respond to what was my healing process, my journey out of that bad place,” she says, a combination of art and looking outward through books. Smith is a big believer in books as therapy (so long as they’re not made for that purpose), just as she is a big believer in long strolls, playing with one’s food and clandestinely chalking inspirational quotes on sidewalks instead of playing video games.

Her way of thinking may be a hard sell to children weaned on the bright, cartoony, introverted stimulation of an iPad or to parents scrambling to get their kids into computer programming classes. But she says that to fight technology doesn’t necessitate being against it forever. She knows her two young kids will have computers. “You need it to be a part of society,” she says. “I’m just hoping my children will get enough of a foundation to remember what it was like before technology, how good that feels. Because I remember.”

TIME Family

Men Want to Remarry; Women Are ‘Meh’

Ojo Images—GettyImages

Nearly two thirds of ex-married men would consider doing it again

Americans, who have lost a little of their ardor for marriage, are still pretty game to remarry. About 40% of all the new marriages in 2013 were not first marriages and in half of those cases, both spouses had ridden in that rodeo before. And new analysis from Pew Research finds that men are much more enamored of remarriage than women are.

“Most currently divorced or widowed men are open to the idea of remarriage, but women in the same circumstances are less likely to be,” says the report, which draws on figures from a survey it conducted in May and June. Almost two thirds of men either want to remarry or would at least consider it, while fewer than a half of women would.

Screen Shot 2014-11-13 at 10.17.57 PM

Perhaps it’s not surprising then that more guys do get remarried than women. Almost two thirds of men who have been married before and got divorced or were widowed wed again, whereas only a smidgen more than half of the women do.

There are lots of possible reasons for the gender discrepancy. Women tend to live longer, so they may outlast all their potential suitors. Or, since women now have more economic freedom than they did 50 years ago, they may feel less need for a partner. And while women still bear the bulk of the home care duties, once liberated, they may feel disinclined to enter into another legally binding agreement to look after somebody else.

However, the Pew analysis seems to suggest that the guys are being the shrewder partners, at least financially. “On key economic measures, remarried adults fare better than their currently divorced counterparts and about as well as those in their first marriages,” says the report, which gets its figures from analyzing American Community Survey data. Only 7% of people who are remarried live in poverty, compared to 19% of people who are divorced and still single. “Homeownership, which often reflects wealth, is also much higher for the remarried than the divorced—79% versus 58%.”

Of course, it may not be that the spouses are more financially stable because they are married. It might be that more financially stable people are in a better position to attract partners, build sturdy relationships and get married.

Slightly less than a quarter of all people who are married in the U.S. today are actually remarried people. Fifty years ago, they only represented about 13% of married people. In the same half century, marriage has fallen quite markedly out of favor among the young. But so far, the majority of people who have tried it are willing to give it another go.

TIME career

Being Rich Is Not a Priority for Women, Survey Shows

In a global survey, a majority of women did not list wealth as their top goal

When women are asked to imagine success, becoming extremely wealthy is not the first thing that comes into their minds. Instead, across countries and continents, mothers, daughters and wives are more concerned about financial security for their families.

That’s one of the main findings of a survey of women and men ages 21 to 69 in the United States, United Kingdom, China and Brazil. While economic concerns among both sexes continue to decline, most respondents are still worried about just getting by.

Nearly 80% of women said they’d rather have more money than power or sex in their lives, according to the survey, which was backed by public relations firm FleishmanHillard and Hearst media. Yet a deeper dive suggests the drive behind the money is for security as opposed to excelling financially.

The results have dramatic implications on not just women’s ability to accrue wealth, but also on financial planners. Women are expected to earn $18 trillion in the U.S. this year — 50% more than they earned five years ago. On a global level, by 2030, women will control two-thirds of our nation’s wealth. As taking smart risks with their money falls to the wayside in place of more practical bets like planning a family trip or going out to eat, women are less likely to invest their money.

What’s more is that women feel increasingly untrustworthy of financial institutions. Only about a third of women surveyed in the U.S. said they were loyal to one financial services company. That figured dropped to just 16% among women in the U.K. Also, more than half of women in the U.S., U.K. and China reported to be “overwhelmed” by the products and choices available today for financial services.

The cautious and overwhelmed attitude toward financial planners breeds an attitude of self-reliance, says Steve Kraus, senior vice president and chief insights officer Ipsos MediaCT’s audience measurement group, the third-party organization that conducted the report’s research. This leads women to believe that saving their money for a rainy day is better than taking it to a big bad bank.

“It is men who are more likely to say that they want to start spending again, and it is men that are most likely to say that I am going to invest in the coming months,” says Kraus. “There is not a lot of trust in financial brands right now, and we see growing numbers of women feel more self-reliant.”

Eve Ellis, a financial adviser with the Matterhorn Group at Morgan Stanley Wealth Management, says it is too easy to generalize among an entire group of women about their attitudes toward financial planning and investing. Yet she has seen some women, in their desire for financial security, be overly cautious in their investment choices.

“Sadly, investors who are too cautious as they invest in the markets may miss opportunities to achieve the very security they seek,” she said. “The old credo too often stands true: No risk, no gain.”

The report did include a silver lining for financial planners looking to recruit more female clients. More than ever since the end of the Great Recession, women are thinking longterm about their financial strategy. Some 75% of women would opt out of a significant promotion if their child could get into a top college. This gives financial advisors a clue of how to talk to women about their future.

Fidelity is the most-trusted financial services brand among American women, according to the report. Kristen Robinson, senior vice president of women and young investors for personal investing at Fidelity, said women are looking for a holistic approach to investing. Partly to solve the common problem of feeling overwhelmed by investment choices, Robinson said the company is also working to increase its visibility among professional women by hosting more educational workshops.

“Women work very hard to make progress in so many ways. Yet only when they have the ability to control their own financial futures will they realize the full extent of their true power,” Fidelity CEO Abby Johnson and President of Personal Investing Kathy Murphy wrote in the October 6th issue of Fortune.

This article originally appeared on Fortune.com

TIME Parenting

What We Can Learn From the Lena Dunham Debacle

Lena Dunham at her book launch for 'Not That Kind Of Girl' on Oct. 31, 2014 in London, England.
Stuart C. Wilson—Getty Images Lena Dunham at her book launch for 'Not That Kind Of Girl' on Oct. 31, 2014 in London, England.

While I'm not sure that this unfortunate lapse in judgment should be a teachable moment, it does illustrate a need for a broader discussion about children and sexually harmful behavior

xojane

This story originally appeared on xoJane.com.

I know, I know: you’re already tired of the Lena Dunham conversation.

I can’t blame you. It has been a seemingly endless conga line of vitriolic, ill-conceived thinkpieces that do little to advance the discussion. The National Review’s Kevin Williamson wants you to shame and pity her. Salon’s Mary Elizabeth Williams wants people to stop calling Dunham an abuser and taking her out of context. Katie McDonough hates that Dunham detractors are ignoring her sister’s perspective. Dunham herself considers the scandal a right-wing smear campaign and is threatening to sue Truth Revolt, the conservative outlet that broke the story. The conversations currently happening on social media aren’t much different; a number of high-profile feminists and celebrities are taking to Twitter to defend Dunham, dismissing the encounter as childhood curiosity.

By now, you’ve already seen the disturbing excerpt from Dunham’s New York Times’ bestseller, “Not That Kind Of Girl.” If you haven’t, the passage is one quick Google search away. In it, she describes how she would bribe her baby sister with affection. It comes off as predatory and abusive, and naturally, people were alarmed. It is handled with all the finesse of a bad sketch comedy writer. It’s the type of thing that no decent editor should ever, ever greenlight.

On one hand, I can understand the vigorous defense: Lena Dunham is, quite possibly, the most accessible and relatable feminist celebrity in recent history. She’s a Girl-Powered Everywoman who abashedly lays herself bare, literally and figuratively, for the world to see. She isn’t model-thin or classically beautiful. And she is rarely, if ever, apologetic about how she lives her life. Ideally, she is the Fourth Wave Prototype.

But no hero is without imperfection, and when said hero messes up on a nuclear level, it’s okay to not only acknowledge it, but to hold the hero accountable for their actions. We don’t have a problem with doing it when it’s Woody Allen, or Roman Polanski, or Chris Brown; it’s always easier to call out the folks we don’t like. But mainstream feminism’s outright refusal to even approach this objectively alienates those of us who identify as abuse survivors, and it reinforces the idea that certain people can get away with bad behavior if the others really, really, really like them a lot.

While I’m not sure if I’m comfortable with the idea that this unfortunate lapse in judgment should be a teachable moment, it does illustrate a need for a broader discussion about children and sexually harmful behavior.

According to Stop It Now!, a non-profit that focuses on child abuse prevention, over a third of all sexual abuse is committed by someone under the age of 18. (My abuser, a family friend, was 17.) A child using tricks and manipulation to gain sexual favors from another may not even realize that she’s engaging in harmful behavior, and it doesn’t necessarily mean that the child will have a predilection for sexual violence. Still, Stop It Now! suggests that professional help is the best route for any child struggling with impulse issues.

It wasn’t until the week before I left for college that I told my mother what had happened with that family friend, but there were definitely warning signs along the way. One particular incident involved a seven year-old me “acting out” with a couple of other kids in my afterschool program, and I hated getting undressed for anything. But I was too afraid to tell my mother because didn’t want her to fall out with one of her dearest friends. Though she was an abuse survivor herself, she probably wouldn’t have known what to look for, or what to do besides ripping off the boy’s genitalia and throwing it in Lake Michigan.

Stop It Now! has a checklist for parents and caregivers to know the signs. Here are a few:

  • Has nightmares or other sleep problems without an explanation
  • Seems distracted or distant at odd times
  • Has a sudden change in eating habits
  • Refuses to eat
  • Loses or drastically increases appetite
  • Has trouble swallowing
  • Sudden mood swings: rage, fear, insecurity or withdrawal
  • Leaves “clues” that seem likely to provoke a discussion about sexual issues
  • Writes, draws, plays or dreams of sexual or frightening images
  • Develops new or unusual fear of certain people or places
  • Refuses to talk about a secret shared with an adult or older child
  • Talks about a new older friend
  • Suddenly has money, toys or other gifts without reason
  • Thinks of self or body as repulsive, dirty or bad
  • Exhibits adult-like sexual behaviors, language and knowledge

Also, trusting your gut could make all the difference, according to the site. Most parents expect their children to come to them when they’re being abused and that rarely happens, which contributes to denial, along with common misunderstandings about sexual abuse, says Stop It Now! Speaking up is the best form of prevention.

The Dunham debate will probably rage on for the weeks and months to come, and people will continue to rehash and regurgitate eveything that’s already been said. But the silver lining, as I see it, is that we will finally be able to talk about this in a more thoughtful, productive way. And, hopefully, spare some children a lot of pain.

Jamie Nesbitt Golden is a journalist originally from Chicago.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

We Talk So Much About ‘Natural Birth’—When Can We Discuss Natural Death?

Getty Images

We can keep people alive to the point that their lives have almost no value, but doctors tend not to be trained to address the subject of mortality with their patients

xojane

This story originally appeared on xoJane.com.

Call it a run of bad luck, but I’ve had to watch a few people die lately. First, my grandmother descended into dementia and finally faded away. Then, my mother battled leukemia and lost her life to its treatment. Next, a great aunt died at age 102 in her home, very peacefully. And now I take care of my 92-year-old grandfather, and his time is drawing near.

In the six years since I had my son, I’ve watched my kid grow up while I’ve watched the rest of my family grow down. My son went from being wheeled in a stroller to toddling to walking. My elders went from walking to falling to wheelchairs.

Poised as I am between the beginning and the end of life, I had to ask myself, why do people talk so much about natural birth but not much about natural death? My friends with babies spent inordinate amounts of time discussing how and where to have them. Should they give birth in a hospital or in a kiddie pool? Should they use pain killing drugs or not? Google “natural birth,” and you’ll be treated to YouTube videos of moms popping out kids in the woods, heated debates about homebirth’s merits and dangers, and tons and tons of books, blogs, and so on.

A Google search on “natural death” doesn’t turn up much. Searching “hospice” brings up boilerplate readings, more about spiritual advice than concrete decision-making about end of life care.

I won’t start a debate here about the best way to give birth; it will suffice to say that being born is one of the most dangerous things you’ll ever do. But the risk of death when you die is… well, there’s no risk anymore. It’s 100% inevitable. Still, we don’t talk about it quite as much.

At least, I thought no one was talking about it, until, while doing some research to write this piece, I discovered and devoured Atul Gawande’s book, “Being Mortal.” Reviews are just coming out now, praising this book all over the place, and the praise is deserved.

The question I was struggling with is a big one. What is “natural death,” with all the advances of modern medicine? We can keep people alive to the point that their lives have almost no value, but doctors tend not to be trained to address the subject of mortality with their patients. Decision-making at the end becomes very difficult, as I can tell you from too much experience.

Gawande characterizes one type of doctor, the “information doctor,” who gives options but doesn’t truly explain what each means. That resonated with me. My mother consulted two oncologists, who gave different treatment paths but no accurate big picture.

What Mom’s doctors avoided telling us was that acute myeloid leukemia had her backed into a corner. She would not gain any meaningful additional days through treatment. Her only choices were how to make the best use of her remaining days. She certainly would have lived longer, and arguably better, without chemotherapy.

I can only see this now in retrospect, because I did not know what questions to ask when I needed to ask them. Even as a lifelong nurse, neither did Mom. She opted for aggressive treatment, which killed her very quickly. Chemotherapy weakened her immune system, and a fungal infection took over her lungs. She died on a respirator, in a way she would not ever have wanted, while searching for a cure. Only now do I understand that there simply was no cure for her. She was not a good candidate for aggressive treatment, due to numerous other health issues. She would have done better to live out her remaining few months peacefully, but she went suddenly, and the effect was traumatic for us all.

Living with my grandfather has made me consider my own old age and how I will spend it, should I be so lucky. Gramps won’t have a “natural death,” either, since he’s been essentially kept alive artificially for decades by medicine, from his pacemaker to the 20 medications he takes every day to keep his lungs absorbing oxygen properly, his insulin levels normal, his blood thin enough not to cause another stroke or heart attack, his gout at bay, the fluid from building up in his ankles, his Parkinson’s from advancing too quickly, his kidneys functioning, and his colon pooping regularly. He can no longer pig out on potatoes (too much potassium), eat cake (too much sugar), or have more than a smidgeon of wine per day. He can’t walk anymore. He needs help doing everything, from dressing to eating to toileting. (It’s really only when we’re very young and when we’re very old that we use toilet as a verb.)

All of that would drive me absolutely bananas. I wouldn’t want to live that way. Given a choice between old age and cake as means to my end, I choose cake! Give me some chocolate frosting and a martini, and I’ll live 20 fewer years. Anyway, that’s what I think now. Maybe I won’t feel the same when I have grandkids.

My grandfather, on the other hand, loves his life. He loves waking up, having coffee, and reading the paper. He loves going to the park and watching the dog. He loves “Judge Judy” and “Dateline.” He loves listening to classical music. For him, life is still worthwhile. He may not have long, but he’s going out in style — his style. If you have spent your life in a recliner, watching TV, old age isn’t so bad. I’m not being sarcastic; I think his outlook is pretty great. I don’t share his values, but with lifting the remote control as his only exercise, Gramps made it to 92. Who can argue with success?

Still, even for Grandpa, things will get to a point when medical interventions don’t make sense anymore. He has filled out an advance directive, so I know he doesn’t want to end up on life support. But there are other matters to consider when one gets old. Recently, his doctors advised him to have a prostate procedure. He went through with it, but it did no good at all. He pees on himself even more than before. Why did he have this pointless surgery, at the age of 92, when his other health issues are probably going to end things fairly soon? It didn’t make sense to me, and that is the kind of stuff you have to start to think about when you are old. Do you want to be in the hospital ANY longer than necessary when you might not have much time left? At a certain point, it’s better to just let nature take its course.

After reading Gawande’s book — which I’d recommend to anyone who, you know, might be planning to die someday — I stopped thinking about my grandfather’s medical care as much, and am focusing on trying to fill the time we have with meaningful activities. I watch football with him. I wheel him over to the park. He has a music therapist through his hospice program, and he plays the flute with her sometimes. Before this book, I was always dragging him to the next critical medical appointment and ordering his prescriptions and talking to doctors. I do that less now. Now I try to hang out with the guy. I think he’s feeling that the end is near, too, because he’s less anxious lately. He sleeps more. We’ll get to the cardiologist and the podiatrist soon, but eh, is it really something to stress out about, when it’s a nice day outside?

We’re looking more at how to make the next months or year or two as comfortable and meaningful as possible, rather than trying to “fix” a bunch of physical problems that are ultimately unfixable. Surgery for comfort is one thing, but in the end, our bodies just wear out. It’s coming, there’s no fighting it, and sometimes medicine just makes it worse than it needs to be.

As it turns out, doctors agree. Physicians tend to die with less treatment than the rest of us, because they know the limits of their practice. Recent coverage of Brittany Maynard shows us that end of life choices are definitely on the minds of the public now.

But most of us will not resort to taking our own lives in the face of a swift terminal illness. For most of us, the decline will be more gradual. If you are lucky enough not to die a sudden death, the end is slow and there are some terrible decisions along the way. So it’s worth thinking about how we exit—and it is as important, and can be as meaningful, as how we enter.

Julie Cross is a screenwriter and graduate of UCLA Film School.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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