Heart attack. Stroke. Car accident. Cancer. Dementia. ... While we all come into this world the same way, the ways we leave it are as individual as we are.

“Death can happen at the end of a trauma or horrible calamity on a spectrum all the way to peaceful with a chance to say goodbye,” said Ken Downey, a chaplain at Mercy Regional Medical Center. “Every journey is unique, every family system has its own culture.”

How we die in La Plata County has a lot to do with access to care, genetics, lifestyle, ethnic background and age on the physical side. Throw in dealing with varying faith backgrounds and family traditions on the spiritual and emotional side, and people who work with the dying and their families have learned to be flexible and humble.

“It’s like a dance, and you have to let them take the lead,” Downey said. “Everything happens here, we’ll see something new tomorrow.”

A numbers game

The statistics on death haven’t changed much through the years, with heart disease ranking as No. 1 in the nation, while cancer runs a close second. In La Plata County, those top two causes were reversed in 2011, the most recent numbers available from the Colorado Department of Public Health and Environment.

In the Community Health Assessment issued by San Juan Basin Health Department in June 2012, the two most fatal types were prostate and breast cancer.

Rounding off the top 10 in order in the county were unintentional injuries, including car accidents; chronic lower respiratory diseases; cerebrovascular diseases, such as strokes; Alzheimer’s disease; suicide; chronic liver disease and cirrhosis; kidney disease and failure; and diabetes.

But there are trends that are disturbing. While suicide as a cause of death ranks 10th on the list of common causes of death nationally, in Colorado it’s the seventh-most-common cause of death, with that ranking holding true in La Plata County, as well.

In 2012, Colorado reached a historic high in suicides, with 1,053 people taking their own lives.

“The state’s suicide death toll has been climbing for the past decade, giving Colorado one of the highest suicide rates in the nation,” said Dave Brendsel, a communications specialist with the Prevention Services Division of the state health department.

The 2012 rate was 19.7 suicides per 100,000 residents, a 15.8 percent increase compared with 2011, making Colorado the sixth-highest state for suicide rates.

Another trend is different death rates for Hispanic/Latino and Anglo populations. Hispanics, 11.8 percent of the county’s population, have a much lower life expectancy, almost 20 years lower than Anglos.

“Heart disease, cancer and stroke affect certain populations more than the general population,” said Liane Jollon, the new director of San Juan Basin Health. “And we recognize it’s a difference that’s not completely addressed by socioeconomic factors or access to care.”

The ranking of deaths from Alzheimer’s disease also is poised to increase as baby boomers reach their senior years. More than 110,000 Coloradans are expected to have Alzheimer’s by 2025, up from 49,000 in 2000. With 11.6 percent of the county’s population in the 65-plus range in the 2010 census, that level of increase is expected here, as well.

In La Plata County, statistics show we’re not living quite as long as residents in other parts of the country, with an average lifespan of 77.9 years for men and 82.2 years for women as of 2007. By comparison, the average lifespan nationally for men is 81.1 years, and for women 86 years.

‘Death and taxes’

“The only things certain in life are death and taxes,” Benjamin Franklin once famously said.

People who work around death often find Americans’ discomfort with the end of life at odds with the reality that everyone will die.

“Death is so much in people’s faces there,” Magyar said about his two years of ministering in Tanzania before coming to Mercy. “It’s considered unthinkable to name a child before they reach a year of age because it’s tempting the fates. Americans just don’t have the concept of the riskiness of life.”

Sometimes, Americans’ fear that talk of death is morbid or a taboo makes them laugh a little.

“Dear Americans,” he said, shaking his head, “we are all going to die. One day, people will eat potato salad in your honor.”

‘Don’t need to do it this way’

People who die suddenly don’t have much say in the circumstances surrounding their deaths. Those who have time to prepare have other options, and one of those is hospice care.

Hospice of Mercy has worked with almost 1,260 patients during the last 10 years.

“I was at a hospice conference, and I heard this wonderful way to describe what we do,” said medical social worker Crystal Harris. “It’s like watching the movie credits roll by, with the patient and their family as the stars and producers. We’re the final credits at the end, the behind-the-scenes support.”

More than half, 52 percent of Hospice of Mercy’s patients, were able to die at home, Mercy Home Health Care and Hospice Executive Director Tina Gallegos said.

“Most people don’t want to die in the hospital,” hospice registered nurse Karla Gardner said. “Their final wish is that they want to die at home. We had one patient who was from Mancos. It took all day to get him home to his bed to look out a certain window. He was home 10 or 15 minutes, and then he was gone.”

In fact, while many people die in the hospital each year, only 2 percent of patients in Mercy’s hospice care do so.

Many people also worry about dying alone.

“It doesn’t happen all that often,” said Ryan Phelps, owner of Hood Mortuary. “It usually only happens when someone doesn’t know they’re sick, or they haven’t told their family they’re sick.”

About 31 percent of hospice patients died in a nursing home or assisted-living facility, which can have benefits for the family, said registered nurse Sean Kelly from hospice.

“When the person is dying at home, the whole burden falls on the family,” he said. “They’re putting in hard work 24 hours a day. At the nursing home, we all know their loved one is getting the care they need.”

Most people think of hospice as a way to die, Gardner said, but it’s really about living.

“We had one gentleman who was with us for about a year, and he did everything he wanted to do,” she said. “If he’d been running back and forth to doctor’s appointments, the emergency room, the hospital, his last year wouldn’t have been nearly as good.”

That’s what Judith Aitken, who turns 90 in October, has found about the management of her heart condition. She signed up with hospice in April after repeated trips to the emergency room when she was having painful episodes.

“One of the doctors said, ‘You know, you don’t need to do it this way. Hospice can take care of this,’” Aitken said. “And he was right, it was too expensive, took too much time – my time and Connie’s (her daughter Constance Aitken) time.”

With weekly visits from Kelly and an occasional visit from Harris, Aitken is going about her life, keeping a toe in politics and having lunch with friends.

“I never thought I would live to be this old,” she said. “To see the year 2000 seemed impossible.”

Aitken’s husband of 62 years, Bob, died in 2011, and he was on hospice care for only three days before his passing. Aitken still misses him but has found family and friends to be enough support for her grief process.

For others, hospice offers up to 13 months of support after a loved one’s death.

‘A sacred mystery’

“There’s so much grief, sadness and beauty to death,” Magyar said. “The love is so apparent, and we are treading on holy ground. We don’t belong, but we’re invited in.”

A death in the family can bring out all the fractures in a family, and it can also provide a time to heal the stresses, the chaplains and social workers said.

Working as a chaplain at the hospital is different from working in hospice, Downey said.

“People come to the hospital and expect to get fixed up and go home,” he said. “In hospice, there’s an acceptance of the diagnosis.”

Both agreed it’s the deaths of the young that are the most stressful.

“It’s so gut-wrenching to see a little baby with a brain tumor,” Magyar said, “to watch the family come to terms with it, to try to bring comfort wherever comfort is possible.”

In the end, death is still a “sacred mystery,” he said.

“I had the privilege of being at the bedside of a little 91-year-old lady at her death with her adult daughter,” Magyar said. “The daughter whispered, ‘I wonder what it’s like.’ I whispered back, ‘I do, too.’”

abutler@durangoherald.com

Community Health Assessment (PDF)

In this series

Today: The various ways we die in La Plata County

Friday: Losing young people to car crashes and suicide

Inside

Handling death: Tips for family and friends who are around a dying person. 12A

Handling death

Chaplains Ken Downey and Josh Magyar from Mercy Regional Medical Center had some tips for family and friends who are around a dying person:

Don’t be afraid of death – in the midst of a difficult situation, lessons can be learned, so open your heart.

Don’t avoid the dying person or their grieving family because you’re afraid you’ll say the wrong thing. They won’t remember what you said, but they will remember that you came. We need each other when confronting death.

Talk to your loved one even if it looks as if they can’t respond.

Say what you wish you’d said earlier to your loved one.

It’s normal for family members to have fears and doubts. Sometimes it’s easier to talk about them with someone who’s not in your family.

It’s healthy to recognize that we’re finite.