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?

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.”

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 Save7.org 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!

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:

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.