CLATSOP COUNTY, Ore. — Jeff Carlsen and his wife thought they were ready to have the conversation.
They’d been reading books about death and dying and thinking about how they wanted to approach this time of their life. They were older and the idea of their own mortality was becoming less abstract. They felt open and willing to address almost anything. Their Christian faith had them looking to eternity.
And, besides, thought Carlsen, the retired former director of the Cannon Beach Conference Center, they’d grappled with difficult things before and dealt with their own parents’ deaths.
But then they started talking through matters of their estate, power of attorney and the other legal and fiddly details with their kids.
“We thought, ‘Oh, that’s just straightforward,” Carlsen said. “You just talk about it and, you know, everybody’s on the same page and it all works out great. But,” he laughed, “not necessarily.”
Carlsen was one of the people former Clatsop County public health director Margo Lalich reached out to for feedback as she and others looked to found the North Coast EOL Collective.
The collective, created by three women with experience in health care and end-of-life care, launched in July and seeks to help people navigate death — and dying — in all its emotional, physical, medical and legal complexity.
For much of her career, Lalich says, she has fielded questions from people who are facing an end-of-life situation and who are wondering what they should do and where to go for support, care or information.
Even as ideas about how to approach the end-of-life period have evolved, resources remain limited on the North Coast. Most people will encounter only a medical model for addressing death and dying: palliative care or hospice.
They may not realize that there are numerous ways to confront the end or that the logistics are something worth contemplating and planning for well in advance, Lalich said.
The collective’s founders hope to help untangle the often complex and uncomfortable conversations around end-of-life preparation and decisions. The group is seeking to gather resources and educational opportunities together in one place.
They recently held an informational session and will host another in early August, seeking community input on what is most needed on the coast and what gaps the collective might best fill.
The collective offers a variety of consultation services around death, dying, grieving — some at no cost, others with fees attached. They plan to hold community “Death Cafes” where participants can talk as openly about death and dying as they might talk about other life milestones. The collective’s website includes links to books, talks, meditations, training and other things that may not be available on the coast but are available online or in nearby cities like Portland.
Co-founder Abby McNeil, a licensed clinical social worker who has worked in oncology and palliative care, wants people to realize there can be a lot more meaning, dignity and peace at the end of life.
“While it can be really painful and sad, there’s also beauty in it,” she said.
Lalich said the collective has been a vision for years, but the coronavirus pandemic reemphasized the need for such services.
McNeil agreed. She worked in health care in the county throughout the pandemic. A number of the deaths she saw were unexpected.
“People were dying alone, without family there, without the conversation,” she said, adding, “It was so heartbreaking to me that there were a lot of lives lost without that conversation.”
During the pandemic, Lalich returned to public health, resuming, temporarily, the role of county public health director, a position she had previously held from 2009 through 2013.
In calls to the Public Health Department during the pandemic, Lalich heard “incredible anxiety and fear of uncertainty from this looming threat that people didn’t understand.” It was a community confronting its mortality, she said.
“There were more calls than I can even count with questions about, ‘What if?’ What if, and how to navigate those conversations,” Lalich said.
“We come into this life and then we spend most of it trying to avoid our mortality when, in fact, it’s the one thing that we all share,” she added. “We will all die at some point in time and while it may not be welcome, it’s a reality.”
She thinks about all the careful thought people put into other milestones — the time and care of planning a wedding or preparing for the birth of a child.
“But we don’t do that when we think of this most significant event in our life, which is the end of it, the end of this physical life that we have,” she said.
With the collective, she hopes to normalize the conversation, the experience and the inevitable.