Sixty-five days ago, on 11 June, colleagues from the TV programme Carte Blanche took a short video of Derek Watts reclining on a hospital bed.

Derek, investigative journalist and television presenter, speaking in a strong voice, tells us: “Another short hospital stay, but I am fine. I will be out of here soon.” He didn’t sound like a man who thought his death was around the corner.

He’d been ill for more than a year. In 2022, he was diagnosed with skin cancer, which later spread to his lungs. In March 2023, he was hospitalised for severe sepsis. The body goes into shock when fighting an infection, which can cause organ failure.

This week, he died, and the messages of tribute and condolences were many. I hope these offer comfort to his grieving family. I found myself thinking about the timeline, and it is only a few weeks since I watched that video clip.

I wondered how he chose to spend the time. We are all so very different – the choice of how to engage with imminent mortality varies hugely.

Eugene O’Kelly was 52 when he was diagnosed with cancer in May 2005. He was CEO of KPMG, the US accounting and consulting firm. By early June 2005, he had resigned. He tried a medical intervention, but it was soon clear there was no hope of remission. He’s described as a planner, and he proactively started to work out how he would spend the time remaining.

His book, Chasing Daylight: How My Forthcoming Death Transformed My Life, published posthumously, describes his intent. My recall of the book is that he thought about all his many relationships and categorised them – nearest and dearest, close friends and relatives, colleagues, acquaintances. He mapped them out and decided who he wanted to spend time with, while writing a memoir at the same time! His mapping seemed to start from outside circles, working towards spending the last period with the nearest and dearest in the middle. In my recall, his decline happened sooner than he’d expected, and he ran out of time. He died on 10 September, three and a half months after diagnosis. As I read his memoir, I noted, start with those closest to you; you must be prepared for the unexpected.

My coaching client, Adna Elba, had a very different approach. She arrived in my office saying: “I have breast cancer, I am currently in remission, but I do not know what time I will have, maybe a few months, a year, maybe two. But whatever the time is, I want to think about how I will live that time, and what I need to do to make sure that my affairs are in order.”

As she explored her innermost thoughts, it emerged that travelling with her 20-year-old was a serious wish. But illness for the self-employed, and Adna was self-employed, is often economically devastating. Her creative solution: “I’ll ask my mother for an early inheritance.”

I remember she also thought very carefully about her bequest list and made a list of her possessions, including paintings, jewellery, linen, and crockery. She wanted friends to have mementoes. She wanted her domestic worker and gardener to have household goods. The conversations were never morbid. They were fun to have, and there was an increasing sense of peace as more was discussed.

My late husband was in the death denial category of persons. Over almost four years from diagnosis to death – the focus was always on trying to outlive death, or at least ignoring it. However, it was not completely possible to ignore because days three and four after chemotherapy were awful. But my husband would have chemo on a Thursday so that the worst two days would happen over the weekend, and then he could go back to work on Monday!

His one acknowledgement, when told that all treatment avenues had been tried and henceforth, there were only palliative treatments to pursue, was when he very generously said: “Well, at least I’m leaving you while you are young enough to build another life.”

My memories of his last month (his end precipitated by a fall that broke his shoulder) were of a man becoming physically weaker, moving restlessly, not speaking much, sleeping sporadically, and not making much distinction between day and night. I wondered about his restlessness. Was it a symptom of “unfinished business?”

One of the professionals who had been treating him commented: “Too much focus on living – not enough focus on dying.”

That comment stayed with me. Dying is a rite of passage that lies ahead for all of us. In her poem, When Death Comes, Mary Oliver writes: “I want to step through the door full of curiosity, wondering…”

When a new life is about to arrive into the world, it is more and more common for people to hire birth doulas, post-partum doulas, and lactose consultants. It behoves us to consider that our departure from this world should receive similar careful support.

A couple of weeks ago, I attended a friend’s mother’s funeral. She described how peacefully and wholesomely her mother, Nomtuse, had prepared for her death. She wrote of how her mother had made everything so easy. Her mother had conversations. Everyone became aligned with what she wanted from family, from mothers’ union choir, and friends – and she even gave a letter to her priest.

Let’s loop back to the beginning: Derek Watts, Eugene O’Kelly, Adan Elba…

If you, the reader, were to contemplate having less than 100 days left on this earth – and that you could reasonably consider that for the last days you wouldn’t be in great shape or have an abundance of energy – then how would you choose to spend your time?

We need to explore the evolving concept of guardianship more deeply in modern families. I would like to use this column as a conversation starter to explore various aspects that need to be considered.

Two years ago, a close friend approached me and asked if I would be willing to act as a guardian for her son in the event of her passing. This request came after the sudden loss of the boy’s father due to an illness. Knowing that my friend’s siblings might assume this responsibility would naturally fall on their shoulders, I felt honoured that she entrusted me with such an important role.

I greatly admire my friend’s parenting values and the way she is raising her son. Ever since she asked me to be a guardian, I have made a conscious effort to spend quality time with him, including him in my holiday plans and even organising annual gatherings with his friends.

Recently, I enquired about whether my friend had discussed this decision with her sisters. To my surprise, she has not had the conversation. She has not completed the formal documentation that will be required by law. If a guardian is not nominated in writing, the court decides. My friend’s response left me feeling perplexed and uncertain about the situation.

In today’s rapidly changing world, the traditional notion of family has undergone a significant transformation. As we transition from the family dynamics defined by an extended family culture to a more nuclear family structure, important conversations around guardianship have emerged.

Social media regularly carries stories of parents tragically dying together on their way to work. Their young kids are left with a caretaker or relatives assuming the role of guardians who may have little or no knowledge of the parents’ values and aspirations for their children.

Traditionally, extended family members played a significant role in supporting and raising children. However, as dynamics change, young parents may find themselves considering alternatives to family members as potential guardians. Open conversations with immediate family can generate valuable insights and perspectives.

Consider these questions:
  • If you are parents, have you made decisions about who you want to look after your kid or kids in the event of an untimely death?
  • What factors are important to you in your choice? Values, parenting style, finance?
  • If you have chosen to nominate a guardian who is not your next of kin or even a blood relative, what conversations have you had with the immediate family for them to accept your choice?
  • If you have been nominated as a guardian, have you considered the implications, especially if the child or children are not blood relatives?
  • What are your concerns, if any, about taking on the responsibility of being a guardian?
  • What if you decided not to have children but have siblings who have children and they expect you to become their guardian? How do you navigate the decision of becoming a guardian while having made the choice not to have children of your own?

All the above questions are about children born biologically to their parents. I know other concerns arise when we consider families that adopted their children.

  • What unique challenges do families who adopted children face when it comes to discussing and planning for guardianship?
  • Do you feel there is a difference in the expectations placed on biological family members compared to adoptive family members when it comes to guardianship?

And, lastly, what about the children’s point of view?

  • Should you ensure that the children feel included and valued in the discussions about guardianship within the family?

I do not have a child, but I am in the process of adopting one. My family assumes there are biologically related children for whom I’m expected to take on caregiving and financial responsibilities, and there is little support for my wish to adopt. Furthermore, the conversations I initiated about the future of my would-be adopted child should something happen to me have been, frankly speaking, challenging, if not downright bruising. This leaves me deeply conflicted in my decision around guardianship for my future child.

I invite you to share your stories as we delve into the unique dynamics and considerations faced by parents when it comes to guardianship, as well as the challenges faced by guardians when they take on the parenting role.

By initiating these conversations around guardianship within various family structures, we can better understand the evolving nature of family dynamics and the complexities associated with choosing suitable guardians for our children.

This column serves as a conversation starter, encouraging readers to reflect on their own experiences and engage in further dialogue. Stay tuned for follow-up articles that will explore different perspectives and insights shared by our readers.

Remember, guardianship is a deeply personal and multifaceted topic. Let’s embrace the opportunity to exchange ideas and broaden our understanding of what it means to be a guardian in today’s world.

Can you imagine a situation where there’s a car accident, and a passenger dies instantly? In their wallet, there’s a card that says they’re a registered organ donor. The medical response team go into action, alerting hospitals with waiting lists of people hoping for a lifesaving or life-improving transplant.

Yes, seven is the popularised number. In terms of what is called “solid organ” transplants, we have seven, comprising two lungs, one heart, one liver, two kidneys, and one pancreas. But so many more of our body parts can make a difference in others’ lives, organs like your corneas, skin, bones, and heart valves.

How many people are on waiting lists? On average, four and a half thousand people in South Africa are on a waiting list. As few as 0.02% of the population are registered with the Organ Donor Foundation. As few as 600 transplant operations are done per year.

Why does a country like Spain have three times more donors than South Africa?

What do other countries do to get more people registered as donors?

The answer can be found in Spain’s policy and legislation; “You’re automatically in – unless you opt-out.”

Advocacy for such a policy has not been pursued in South Africa as it is seen as violating the constitutional principle of autonomy.

The United States has pursued a different strategy. When you complete the forms on the day you pass your test to get your driver’s license, you are also presented with the organ donation sign-up request. Over 40% of the United States adult population are registered donors. What holds us back from adopting this simple strategy in South Africa?

When I ask people what holds them back from registering as a donor, I get a variety of responses:

“I am too old. My body parts are of no use to anyone.”

“If a doctor knows you are a registered donor, will they be tempted to take less care of you?”

” When I die, it will be so hard for my grieving family. I don’t want them to have to deal with something else that might be very hard for them.”

“I’ve always thought of ‘from dust to dust’ and being buried as a whole person, with my ancestors. I can’t get my mind around being buried with parts of me missing.”

“I hope to die in my own bed, in my own home with family close by. I want a quiet and spiritual departure. I have a Do Not Resuscitate order. I have asked NOT to be taken to hospital. I am told that if you want to donate your organs you HAVE to die in hospital.”

The South African Organ donation website informs us of three conditions to comply with to become a donor:

• Under the age of 70

• In good health

• Clear of any predefined chronic diseases that might cause health complications for the recipients.

A mother’s friend in her nineties was saddened when her wish to donate her body was refused. She imagined it could, at least, be of use as a cadaver to students in a medical faculty. Since then, her daughter told me that she’s heard that there is ONE body part, SKIN, that can always be used, irrespective of age. Burn trauma units are said to always need the skin for skin grafts. Is this true? If so, should the organ donation website have age-related sign-up options?

A group of medical students at Stellenbosch University assess that lack of awareness is a significant factor among the youth, contributing to the low sign-up rate, especially in their age cohort. They created an organisation with an AI chatbot to answer your questions.

I opened their website and asked the question, “Over 70s? Can they still donate skin?”

I get an instant chat box response, saying, “Yes, as long as in good health and fulfilling all criteria for tissue donation.”

I’ll trust this to be accurate, as they’re endorsed by the Organ Donation Foundation and the South African Transplant Society. This is a great initiative – a serious support for those with technical questions.

In addition to this initiative, one other simple thing could be put in place.

How about we get an organ donation request whenever we obtain or renew our driver’s license? The USA figure that 40% of persons are registered donors is phenomenal. An RSA rate of 40% would surely reduce the number of 4 500 people waiting for transplants.

The cultural questions remain.

There’s a slow increase in the number of people opting for cremation. The cremation rate in the USA is currently 56%, having steadily increased over the years – in 1970, as many as 95% of Americans preferred to be buried. In South Africa, the highest cremation rate is in the Western Cape, standing at 12% of the deceased choosing this option, with lower rates in the rest of the country.

But if as many as 12% of us are willing for their bodies to become burnt remnants of our beings, why not sign up for some organs to be harvested first?

I hope to have the privilege of reaching elderliness, dying at home, and then being cremated. Does that rule me out completely? Is there any part of me that can still be used?

I better revisit the Save7 chatbot!

I’m currently witnessing the grieving of six people in my immediate circle. One is grieving after the loss of a beloved family dog, a longtime friend who has been a part of the family for years. Another is mourning after the loss of their trusted house manager, a person who played a significant role in their daily lives. There is also someone grieving after the tragic and untimely loss of their son, taken from them far too soon. And then there’s another person mourning their daughter after she died suddenly, leaving them with an unfillable void. Additionally, we have someone who just recently lost their father and another who is mourning their dear grandmother.

As grief educator David Kessler once said: “Each person’s grief is as unique as their fingerprint. But what everyone has in common is that no matter how they grieve, they share a need for their grief to be witnessed. That doesn’t mean needing someone to try to lessen it or reframe it for them. The need is for someone to be fully present to the magnitude of their loss without trying to point out the silver lining.”

Theirs is a deeply personal experience that they are going through differently. For three of them, social media has provided an outlet to share their grief openly and seek support from a wider community. However, as expected with these platforms, there is tension between their right to grieve openly and the need for privacy and boundaries.

While social media can offer a platform for the expression of grief and where support can be received, it can be a breeding ground for negativity and hurtful comments. It’s disheartening to see individuals who are already in a vulnerable state being subjected to such cruelty.

Three weeks ago, the wife of a well-known South African international composer and producer shared a heartfelt photo on her Instagram account. The image depicted her sitting on the grave of her stepson, taken during a family visit to commemorate his birthday. However, this post was later deleted and replaced with an explanation as to why she had initially shared it. It became evident from her explanation that she had received harsh feedback in response to her expression of grief.

Although it is important to note that the couple’s recent announcement of their divorce may not be directly linked to this incident, it is possible that the negative reception of her emotional post played a role. Grieving is a deeply personal and complex process, and individuals often seek solace and support through various outlets, including social media.

1. Education

By raising awareness about the impact of hurtful comments on grieving individuals, we can help people understand the importance of empathy and sensitivity in online interactions. Educate others about the unique nature of grief and the need for compassion during these difficult times.

2. Encourage positive dialogue

Actively promote constructive and empathetic conversations surrounding grief. Encourage individuals to share their own experiences, offer support, and provide kind words to those who are grieving. This sets a positive tone and encourages others to do the same.

3. Moderate and report 

Online platforms should have clear guidelines against hate speech and harmful behaviour. Encourage individuals to report any hurtful comments or abusive behaviour they come across. Platforms should take swift action to remove such content and address the perpetrators accordingly.

4. Practise empathy 

Encourage individuals to put themselves in the shoes of the griever and imagine how hurtful comments may deepen their pain. Remind people to approach online interactions with empathy, kindness, and respect, even if they might not fully understand another person’s grief.

As social media continues to play a significant role in our lives, we must navigate the tension between the right to grieve openly and the need for privacy and boundaries. Respect for individual choices, empathy, and understanding are crucial in promoting a healthy online environment. Let’s foster a culture that values the diversity of grieving processes and commends those brave enough to share their vulnerability while also ensuring privacy and boundaries are respected.

The focus of this column is about how best we can live our lives by design and yet, at the same time, keep our inevitable mortality in our mind’s eye. That is the nub.

We also tap into what are current news stories that we can use as an entry point. Mapi used the story of the man who narrowly escaped death in the Johannesburg explosion. I used the court ruling on Aretha Franklin’s will to write about that topic.

Our quest is that readers will be called to action, to think about their lives and that their affairs are in order. That is the bigger arc of life and living it by design with clear intention.

Next year, for example, is a significant birthday year for me. How will we celebrate, and where and what is the budget?

But often, that “big stuff” is easier to design than my ordinary daily life. Unexpected things happen that can throw us off kilter. This week, I have been dealing with a fraud matter on my bank account – not yet resolved.

Like so many of us, I’ve been on business calls which have been interrupted by load shedding, and even though I have a backup modem, there is disruption to the rhythm and meeting discussions. Yesterday morning I needed to drive to a meeting. I had a flat tyre that needed attention. None of the above is life-threatening, all can be handled, but I get knocked off balance – like I forgot it was my turn to write the column this week!

I have never thought of myself as an anxious person. Covid and our worsening living conditions have changed that. I cannot live in a bubble. Load shedding, potholes, water outages, schoolgirls held up at gunpoint in my friend’s neighbourhood for their phones – the list could go on. I have joined the increasing worldwide statistic of people with general anxiety.

The body keeps the score! (that’s a book title). Nine months into our Covid-19 pandemic trauma, I started having eczema, which now advances and recedes. My skin tells me every day that I am living with anxiety. My skin has become the physical indicator of my internal state of well-being.

Our challenge? How can we live in our anxiety-provoking society as best as possible? 

At the beginning of this month, I asked my husband to sign up with me to do an online course called “The Art of Calm”. The six evening classes are being run by Martha Beck, an American author and life coach whose work I admire.

I want to share with you her exercise called: Sense Drenching – Stepping Off the Anxiety Spiral.

Step One: First, call to mind something that makes you anxious – not something terrifying – but that daily dose of anxiety that often happens to all of us as life happens! Notice how this feels in your body. In mine, I feel in it my gut. Find your words to describe the sensations you feel.

Now work with your senses:

-Taste: write down three things you love to taste.

-Hear: write down three things you love to hear.

-See: write down three things you love to see.

-Smell: write down three things to love to smell.

-Skin: write down three things you love to feel against your skin.

Now imagine a scenario where you weave in at least one of each of the three things that you chose for each of your senses. “I am watching a sunset, sipping cold white wine. The smell of the food on the braai is making my mouth water. The last of the sun rays feel warm on my skin. I hear my husband’s footsteps, and he greets me with words I love to hear.”

Notice how you feel now. Describe it. “I am feeling calmer.”

Martha Beck writes: “Compare this with the anxious feeling you wrote down at the beginning. I hope you enjoyed your little vacation from anxiety.

“When we feel anxious, it often seems impossible to calm down. The truth, however, is that we can drop our anxiety quickly by focusing on positive sense perceptions. If you would like a break from anxiety, do the exercise. Focus all your attention on it, for just a minute or two.”

It is three weeks now since I did this exercise after the first class. I sometimes wake up at night and think about things that are bothering me. The last couple of weeks, when this happened, I invited myself to think of my favourite tastes, sounds, smells, touch, and sight.

I have had such fun identifying favourites, conjuring up the scenarios. And I have fallen back to sleep calmly.

We live in an age of anxiety. The statistics of people seeing doctors about depression and anxiety are increasing. Our anxieties are based on reality. Anxiety can knock us off balance.

From a place of acceptance, we need more skills that will help us better navigate our anxiety. Sense drenching –  I’d never heard of it. It’s so easy. Try it.

Near-death experiences have long fascinated and intrigued people, often providing profound insights into the fragility and preciousness of life.

From viral videos capturing miraculous escapes from disaster to personal accounts of individuals who have come face-to-face with mortality, these encounters with death offer us valuable lessons about the value of life and the choices we make.

When I hear these stories, the reality that life can be taken away in just one moment hits me hard.

One recent example that comes to mind is the story of a Johannesburg man who narrowly escaped death in an underground blast just this week.

Amazed at his miraculous survival, many shared his story on social media, captivated by the sheer luck that allowed him to cheat death.

These videos often go viral as people ponder the mysteries of fate, contemplating the question of why some are spared while others are not.

I can’t count the times I have watched the video of the Wednesday afternoon explosion, but I hope he is reminded of his blessing and the opportunity for him to continue to live his one life.

The first thing that came to mind when the flying minibus narrowly missed him was: “Boy, you must thank your maker, whoever you perceive him to be, and find your purpose because you have just been spared another day on planet earth.”

What happens to those who cheat death? Do they simply go back to their normal lives, or does the experience leave a lasting impact?

This question lingers in the minds of many, sparking speculation and curiosity about what lies beyond the brink of death.

Some believe that these close encounters with mortality serve as a wake-up call, forcing individuals to reevaluate their priorities and make meaningful changes in their lives.

Allow me to share my own personal experience that sheds light on the transformative power of near-death encounters. In 2016, I found myself lying in an intensive care unit at Waterfall Hospital after being diagnosed with acute renal failure.

The seriousness of my condition was further magnified by the death of the person next to me, a constant reminder of the fragility of our existence.

At that moment, I truly believed that my time with my maker was drawing near. I remember directing my sister where to find my checklist for checking out, that’s LoveLegacyDignity’s Purple File.

I mumbled something about funeral policies, the rituals I wanted and a funeral programme.

A month after I was discharged, I recorded a video explicitly stating my end-of-life wishes, and I completed my living will!

It was also during this harrowing time that I realised the immense value of every breath we take, every moment we spend with loved ones, and every opportunity we have to pursue our dreams.

It made me contemplate the choices I had made, the relationships I had nurtured, and the impact I had left on the world.

It was a humbling experience that reshaped my perspective on life and propelled me to live each day to its fullest.

Reflecting on these “I almost died” encounters, we often find stories of individuals who have emerged from the brink of death with a newfound zest for life.

Near-death experiences provide us with invaluable insights into the fragility of life and the importance of seizing every opportunity.

From viral videos that capture miraculous escapes to personal encounters with mortality, these encounters force us to confront our own mortality and reevaluate our priorities.

My own experience in the ICU taught me to cherish every breath and actively pursue a life of purpose and meaning. As we hear more stories of those who have cheated death, let us remember the lessons they teach us: that life is a precious gift, and it is up to us to make the most of it.