09/26/16

Why you’ll always grieve for the ones you lost

The loss reminds us of love. That we loved, and that we were loved.

By Nivida Chandra

Grief is that which makes you feel like a giant void has been created inside of you. In its most awful form, it’s that feeling of having your most vital organs ripped out, and being commanded to live nonetheless.

Various “manuals” of grief will tell you more about how to feel when you’re grieving, including the famous five steps that you’ll go through, and also how long grief should last.

I lost my grandmother in June and some people have wondered openly how it’s still affecting me, three months later. I’m not offended, but it did surprise me enough to think about it. And so I began thinking about the expiration of grief.

The answer lies in understanding the difference between the end of our grief within, and end of grief as it appears to those around us. When thinking about presenting grief to others, I think of tears and rage. This is limited to the immediate aftermath of the loss.

As time passes, irrespective of whether we heal internally or not, the expectation is that the tears and rage transform into smiles and acceptance, supported by cliches on how life moves on. It’s almost as if, with time, we console others about how “fine” we are in the face of loss, and that they need not dig deep to find that right thing to say which will make us feel better.

I think this is because we all implicitly understand how uncomfortable people can feel in the face of someone else’s loss. This is not a good or bad thing, it just is.

While this discomfort is human and true, what is equally true is that it is compounded by a cultural dictation of quotas. People have quotas of how much of our grief they can and want to and should take. The “can” and “want” are prescribed by our personal relations and unique personalities

grief

As time passes, irrespective of whether we heal internally or not, the expectation is that the tears and rage transform into smiles and acceptance.

But the “should” is culturally granted by an unsaid hierarchy of losses. We learn in society what is a big loss, a small loss, and how to respond to different losses.

For instance, parental death warrants more grief, and therefore more support, than grandparental death. And nothing is worse than your child’s death. Similarly, loss of marriage allows for more grief and subsequent condolences than, say, losing a job.

People keep these in mind when deciding how to console and for how long. Beyond that, they wonder, they question sanity, therapists are sought and so on. And I get that. I do. As people we like to be happy, and if something or someone is not being able to achieve that or is dampening our own, we try to correct that.

I get it. But personal grief doesn’t follow these cultural norms. It just goes on and on, till time repairs it or memory obscures it. It’s indefinite. For those viewing someone else’s grief, it passes and people heal, but from the inside, it just changes from open declaration to silent acceptance. It doesn’t end, it just morphs into something more comfortable for others to witness.

How can grief end? When we’re grieving an irreparable loss, we’re faced with finality. Ironic as this may sound, finality doesn’t end. Loss is always final, endless.

I realised today that this endlessness, this feeling of never again, makes me entirely helpless. I’m powerless. This feeling flows from me to the one who’s trying to console me, creating in them the same powerlessness.

Just as we’re powerless against our loss, they’re powerless against our grief. The consolers resort to jokes, to helpful cliches (this too shall pass) and they’re not wrong, neither are they cruel. They’re just insufficient and they will remain so.

So I keep it within (and then find myself writing about it, so not doing a very good job of keeping it within). I grieve in my dreams. I grieve in my memories. But it’s not always so dramatic. I grieve while driving too. Or while writing.

It just manifests in all these private spaces, that’s all. I think a part of us doesn’t want the grief to go away. Because that might delegtimise, within our own heart, how very important that loss was.

The loss reminds us of love. That we loved, and that we were loved.

So I know that when you’re grieving, like me, you too would like to know when the persistent vacuuming of your insides will end. But we’re grieving finality, and we’re grieving the loss of love.

And I think that it doesn’t really end. We’ll always grieve, but maybe we’ll grieve a little less each day, till the grief itself becomes a painless memory, which we can hold on to forever.

Complete Article HERE!

09/25/16

Can sheer willpower keep patients alive in their dying hours?

By Bob Tedeschi

dying-hours

Marjorie Severance had lived 91 years, five months, and two weeks when, if you believe such things, she decided she could let herself die.

She had completed all of her funeral and memorial service plans. Her finances were set. “Gramma Marj,” as she was known to her many grandchildren and great-grandchildren, spent the last weeks of her life sprucing up her jewelry collection and choosing beneficiaries.

Her granddaughter, Jan Schultz, who was helping with the jewelry, was dragging her feet getting the two last rings fixed.

“I had a feeling that as soon as this was done, she’d be done,” Schultz recalled.

When a great-grandson visited her for supper at her assisted-living facility in Madison, Wis., earlier this month, Gramma Marj ushered him out early. The family laughed about it, but the next day she barely woke.

Schultz called Gramma Marj’s son in Texas and told him to get there fast. Then she told her grandmother that her son was on his way and would arrive the following day. Gramma Marj’s eyes stayed closed; she was alive but largely unresponsive.

The next day, her son arrived. She opened her eyes for him. And then, not long after, in the solitude of her room, Marjorie Severance passed away.

The question of whether Severance somehow prolonged her life will forever remain a mystery. But it is hardly a mystery that stands on its own.

Hospice and palliative care clinicians routinely see cases in which people who are nearing life’s end seem to will themselves to hold on until a certain point, after which time they let go.

And while some people hold on long enough to see a loved one, others seem to do the opposite, clinging to life until they are left alone.

Dr. Toby Campbell, an oncologist and palliative care specialist at the University of Wisconsin, Madison, said patients tend not to have a lot of control at the very end of their lives. But that doesn’t mean they don’t have any.

“People in end-of-life care wouldn’t bat an eye if you asked if they think people can, to a certain degree, control those final moments,” Campbell said. “We’d all say, ‘Well, yeah. Sure.’ But it’s inexplicable.”

If these well-timed deaths are anything but coincidental, medical scientists appear unlikely to be able to provide an explanation anytime soon. A body of scientific literature called “the will to live near death” explores questions at the fringe of this topic, but the research focuses more squarely on how one’s will to live might affect life expectancy.

When it comes to extending one’s life by hours, seemingly through sheer will, Campbell believes the dying “probably have some kind of hormonal stimulus that’s just a driver to keep them going. Then, when whatever event they were waiting for happens, the stimulus goes away, and there must be some kind of relaxing into it that then allows them to die.”

In one memorable experience, Campbell recalled three sisters who had gathered in the hospital room of their elderly mother after she’d suffered a stroke. One sister lived nearby and the others joined from out of town, holding vigil for several days.

The mother was unresponsive, and though her prognosis was grim, she wasn’t actively dying. “They were having really a lovely time bonding together, but then life was kind of moving on and in truth they were ready for mom to die,” Campbell said.

One morning, he told them that their mother might actually want to die — but not with them present. Some people deem the dying process too personal to share, while others don’t want to expose family members to the trauma of watching them go.

The sisters, Campbell said, ” immediately grabbed onto the idea, and right then, they said, ‘Mom, we’re going out for breakfast. We’ll be gone for two or three hours, and then we’re going to come back and see you. So if you need to be alone to do this, now’s a good time.’”

Campbell left the room. The sisters left soon after. Their mother died while they were gone.

“They were sad, of course,” he said. “But they felt like they had done right by her.”

Jan Schultz felt that way too. Her grandmother had worked her way from bank teller to vice president over a 40-year career in finance. She was a proud matriarch, both loving and deeply beloved. Schultz said it would have been out of character for Gramma Marj to die before her son arrived, and it would have been equally out of character for her to burden him or anyone else with the sight of her death.

So in retrospect, it was little surprise that when Gramma Marj’s son arrived, her condition noticeably changed.

“I could almost see a sense of calmness over her when he arrived,” Schultz said.

Gramma Marj opened her eyes for him. She heard him leave. And then, after he was gone, her heart went quiet.

Complete Article HERE!

09/24/16

Dying with a plan: Do not go unprepared into that good night

DUST IN THE WIND: The Carolina Memorial Sanctuary is an 11-acre conservation burial ground where bodies are buried in biodegradable vessels. Above, a funeral takes place at CMS, which is also a conservation easement and North Carolina's first conservation burial ground.

DUST IN THE WIND: The Carolina Memorial Sanctuary is an 11-acre conservation burial ground where bodies are buried in biodegradable vessels. Above, a funeral takes place at CMS, which is also a conservation easement and North Carolina’s first conservation burial ground.

by Dan Hesse

Spoiler alert: You’re going to die. You already know that, but how much preparation for the inevitable have you made?

Living in Buncombe County, we can expect to live for 79.2 years, according to the local Health & Human Services Department. In a county with a quarter-million people, about 2,315 pass annually, an average based on 11,579 deaths in the five-year period from 2008–12, per a study by the department. The top three causes of death during those five years was cancer (2,563), heart disease (2,513) and chronic lower respiratory disease (784).

Last year was harder on us, though: 3,564 people died in Buncombe, the deputy registrar reports.

About 19 percent of Buncombe’s residents are 65 or older, according to 2015 U.S. census data — or 48,103 elders among a total population of 253,178. Of course, 65 is by no means the beginning of the end, nor does death target only the aged. In the five-year period covered by the above-cited study, we lost 170 people between the ages of 20 and 39, and 1,356 people between the ages of 40 and 64. And in 2015, we lost 176 people between the ages of 15 and 44 and 648 people between the ages of 45 and 64.

Given the ubiquitous and unavoidable nature of death, it seems that it should be an event we’d all plan for. But is it?

No one can confidently say that he will be living tomorrow — Euripides

Societal attitudes, traditions and responses toward death vary, but death is, well, as old as life. Carol Motley, founder of Bury Me Naturally Coffins and Caskets, says the advent of the Civil War and the resulting new practice of embalming was a catalyst for what American society now recognizes as a traditional funeral. “Before the war, you would dig a hole and put a body in it. During the Civil War, embalming tents became common at battlegrounds. You could get shipped home and not stink. And that was appealing,” she notes wryly.

Josh Slocum, executive director of the Funeral Consumers Alliance, agrees that the so-called traditional funeral is a relatively new concept. “We have a really short historical memory, but when you look back into the 19th century, what we now call a traditional funeral — the chemical embalming; the public display at a commercial place of business; mass-manufactured caskets; the Cadillac hearse to the cemetery — it didn’t come along until the last quarter of the 19th century,” he says. “It was a commercially created tradition.”

The FCA is a national nonprofit focused on raising awareness about consumer and legal rights when dealing with the funeral industry. “Most Americans, your own family, just a short period of time ago, was having a funeral where the body was washed at home, laid out at your home, in a coffin built by a local woodworker or by somebody in the backyard,” Slocum says. “That was the conventional burial. Burial in a sheet or wood box is as old as human history.”

Death is just another path, one that we all must take — J. R. R. Tolkien

While many people aren’t intentional about addressing their death, it’s a topic worth exploring, says Caroline Yongue, executive director of the Center for End of Life Transition. The interfaith organization helps people make decisions and provide instructions regarding what happens to their body after death. “North Carolina law says loved ones can act as funeral directors, so it is possible to bypass the funeral industry completely. But you would need to be prepared for death, to be prepared for what it takes to handle it yourself,” Yongue says. And planning ahead is key. “We’ve defaulted to the funeral industry in the last several decades, so people aren’t aware that they have their own legal rights,” she continues, noting that after a loved one dies, it’s difficult to know what to do if end-of-life decisions aren’t made beforehand.

In many cases the deceased hadn’t been intentional about declaring wishes for their funeral and what they want to happen to their body, according to Yongue. Yet, there’s a comfort in not having to make those tough choices immediately after the last breath is declared: “A nurse or social worker walks in the room and asks, ‘Which funeral home do you want me to call?’ And the funeral home is called because that’s the path of least resistance.”

Motley concurs, saying that even those at the end of their path neglect the inevitable. “I can’t believe how many people are terminally ill, die and then we have to overnight a casket. Most of the time that’s what happens; you’re dealing with everything but the obvious,” she notes. “There’s not a place in our societal life where we address it. You have to make a concerted effort to do it. It’s not part of church, school, anything. And it should be. We should go ahead and fill out our death certificate.” You can get a death certificate in person, online or via mail, from the Buncombe County Register of Deeds.

Juanita Igo, a case manager with the Buncombe County Council on Aging, says she often sees that conversation placed on the back burner because of day-to-day stressors. “We work with people who don’t have enough resources to pay for their rent, their medication. … So sometimes just getting through the day is what they’re working on,” she notes.

Igo recommends using the Five Wishes document provided by the nonprofit Aging With Dignity. The document will help you determine what you want in regard to various aspects of medical and social preferences for the end of your life. “You’re taking people through a conversation that’s more natural to them, about what they want to have happen. Participants do have to get the form notarized, but it gets people thinking about those things and starts the conversation,” she says.

It’s not just the elderly who die, Igo adds. “It might be something that comes up suddenly, so it’s good to start the conversation.”

“Funeral planning has to be a family conversation, the same way we have conversations about where to go to college, how much it will cost and how we will pay for it,” says Slocum. He believes there is a distinctly American fear of death that keeps the subject irrationally inaccessible. “We don’t even like to say the word. If you look at the obituaries, and there’s 10 people in it, I bet you eight of them didn’t even die. They passed away, they went home to Jesus, but, by God, they didn’t die,” says Slocum.

The Rev. Ed Hillman, president of the FCA of Western North Carolina, also sees death as a taboo subject that needs to be brought into the light. “We don’t like to think about our own mortality. I think there’s an innate fear of death in all of us, and we think that somehow by talking about it, it will bring it about — which is not rational,” he says. Hillman points out that it’s everyone’s responsibility to have “the talk,” and that despite its uncomfortable nature, engaging the conversation can save anguish after a death. Unfortunately, “[not having the talk] can put our next of kin in a place where they have to guess what we want and end up spending resources that they might not even have in trying to figure out what a deceased person actually wanted,” he says. “The more detailed the plans, the less the next of kin has to guess about what the deceased person would want.”

Slocum says it also makes financial sense to determine your burial/cremation arrangements ahead of time. He urges people to approach this planning the same way they look for a car: Shop around. “Prices of funeral homes in the same city are wildly different. People don’t expect this. When you shop for a stereo, you’re shopping for a difference of price of about 35 percent; we don’t expect prices on the same model to range from $500 to $2,000. Not true at funeral homes,” he says. “You will find funeral homes, within driving distance of where you’re sitting right now, charging $1,000 for simple cremation and ones charging about $4,000 for that simple cremation.” The FCA of Western North Carolina compiles information about funeral costs in 14 counties. In Buncombe, the cost of cremation ranges from $895 to $4,460; and the cost of burial ranges from $1,495 to $6,940, with varying distances the funeral home will transport the body.

Slocum and Hillman make it clear that the FCA isn’t against the funeral industry. As Hillman notes, “The vast majority of funeral homes are really wonderful services for people, though every once in a while there are things people just do not need.” And Slocum adds that’s why the FCA’s mission is to educate consumers about their rights. “The Federal Trade Commission has the Funeral Rule that gives consumers important rights. You have the right to get quotes over the phone. Every funeral home you visit and talk about funeral arrangements with is required by law to hand you a printed, itemized price list at the beginning of the conversation,” he says. “Funeral homes are allowed to provide packages but they are not allowed to deny you itemized choices, and that’s one of the best ways to control funeral costs.”

Further, “Caskets, no matter what they’re made out of or how well they’re constructed, none of them will ‘protect or preserve your body.’ None of them will keep out air, water and dirt. None of them will keep you from decomposing,” Slocum notes. “There are caskets out there that are marketed as sealed and protective. And people of otherwise good sense can be misled. You’re going to be just as dead in a $10,000 casket as you are in a $2,500 cardboard box.”

As a well-spent day brings happy sleep, so life well-lived brings happy death — Leonardo da Vinci

But if a cardboard box is OK with you, there are ways to have a natural burial here in Western North Carolina. Yongue also runs the Carolina Memorial Sanctuary, an 11-acre plot of land that is the state’s first conservation burial ground. CMS has a conservation easement, and its burial techniques incorporate the chemical-free, unembalmed body, inside a biodegradable vessel, into the landscaping. “We all have a body, and it’s got to get recycled somehow. If we are conscientious about it, we can do it in a green way that has the least amount of impact on the planet,” she says. “Because we’ve got a lot of bodies on the planet.”

Yongue also doesn’t have anything bad to say about the funeral home industry. “Somebody’s got to deal with the bodies, but it’s incredibly expensive. And because people aren’t prepared, oftentimes they spend a lot more money than they would have if they had prepared for death,” she says. However, she knows unorthodox methods don’t always resonate. “Home funerals are not for everybody. Our hope is people become more informed about what their options are.”

Ultimately, Yongue believes, it’s about conveying postlife wishes, regardless of what those might be. Otherwise, she says, “It’s like going on a vacation, but you don’t plan for it. It would be like going to Europe, and the day of your trip arrives, you don’t have your passport, your luggage isn’t packed.”

Plus, a direct approach to death can have a positive effect on the living, Yongue posits. “If we walk around with death on our shoulder, we would be kinder, more compassionate, because everybody we see is going to die.”

Complete Article HERE!

09/23/16

The uplifting truth about end-of-life care

By Brandpoint

Preparing for end-of-life

When a loved one is critically ill, hearing that it’s time for hospice care can be devastating news. On top of the emotional upheaval of coping with a terminal illness, you may be unsure what hospice care really is — and believe it’s just an indication your loved one will likely pass away.

Yet the time your loved one spends in hospice care doesn’t have to be sad — for anyone. In fact, says Toni Norman, the senior director of hospice operations for Brookdale Senior Living, hospice can be a deeply rewarding time of great comfort for patients and their families.

“Hospice care is not about waiting for someone to die, and that’s unfortunately a very common misconception,” Norman says. “The goal of hospice is to provide to a patient, who has a life-limiting illness, the physical comfort and medical care they need to stay in their home for as long as possible, while at the same time supporting their caregivers. The hospice team helps families by educating, supporting and identifying any needs they have, ranging from chaplain support to finding mortuaries and veteran benefits.”

The decision to begin hospice care is a communal one, with the patient, caregivers, loved ones and medical professionals contributing to the dialogue. “A terminal diagnosis from a doctor usually begins the process of seeking hospice care,” Norman says. “Also, as a family member’s health begins to decline due to illness, conversations about end-of-life care are proactive and compassionate.”

Brookdale Senior Living’s hospice care providers often encounter common misconceptions about hospice care. Norman offers the truth behind some mistaken beliefs:

* Hospice is for the last few weeks of life. The hospice Medicare benefit is for the last six months, if the disease follows its normal course. “Most people who enter hospice have done so because they’ve received a diagnosis of a life-limiting illness,” Norman says. “But people who enter hospice often live longer, and with a better quality of life, than terminally ill people who do not go into hospice. Many are even able to come off hospice service if their condition improves.”

* Hospice means giving up. Hospice is actually a commitment to a high level of care for a loved one. “It means making them as comfortable and safe as possible so they may enjoy time with their loved ones for as long as possible,” Norman says.

* Patients are heavily medicated. Patients receive medication under strict physician guidelines, and caregivers closely monitor comfort care protocols so each patient’s pain and symptoms are uniquely managed.

* Hospice patients can no longer see their doctors. Patients can continue to see any of their previous doctors. Rather than taking anything away, hospice adds a layer of medical support.

* Hospice care ends when a patient dies. Because hospice cares for the patient’s caregivers and loved ones as well as the patient, hospice team members continue their support for 13 months after the patient passes away. The hospice team provides grief support for the families and will continue to work with them to address any lingering questions, and to help identify their needs.

“The hospice team is comprised of the assigned physician and nurses to provide the direct medical care to the patient, while a chaplain, social worker and bereavement counselor provide additional support and education to families and caregivers,” Norman says.

Hospice ideally occurs in a patient’s home, whether that’s a personal residence or assisted living community. It is a Medicare-reimbursed benefit, and most private insurance providers do also cover some hospice costs.

“End-of-life care isn’t just about taking pain medications to relieve symptoms until death,” Norman says. “It helps people gain emotional strength and carry on with daily life, while improving the quality of life. The goal is to help patients and their families make every remaining moment as comfortable and enriching as possible.”

Complete Article HERE!

09/22/16

Floating cemeteries and space burials: Asia’s futuristic take on death

By

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A floating cemetery in Hong Kong? – Floating cemeteries drifting along Hong Kong’s coastline could be the solution to the country’s lack of land space and aging population.

By 2050, one in every four people in Asia-Pacific will be over 60 years old, according to the United Nations.

At the same time, 188,000 people per day are flocking to urban areas, putting huge pressure on real estate.

With more people dying and less space available, architects and city planners are imagining bold and modern ways to bury the departed, which are both efficient and respectful.

From conveyor-belt columbarium to floating cemeteries and even space burials, the Asian funeral scene is undergoing an exhilarating transformation.

Death might be inevitable, but it doesn’t have to be predictable.

High-tech deaths

Japan has seen perhaps the most dramatic changes to its burial scene.

Since the Edo period (1603-1868), inherited rural graves and, more recently, urban cemetery spots have been passed down through the generations of a family.

But the cost of keeping a burial plot has skyrocketed in recent years. Today, a spot in prestigious Aoyama Cemetery, in Tokyo, costs $100,000, while even locker-style columbarium — called nokotsudo — can fetch $12,000 at a centrally located Buddhist temple.

Furthermore, with single households in Japanese on the rise, reliance on an inherited burial site is less practical.

The Ruriden Byakurengedo columbarium, in Tokyo’s famous shopping district of Shinjuku, is one high-tech alternative updated to suit modern life in Japan.

From the outside, Ruriden looks like a traditional Buddhist burial building with wooden doors and gracefully curving eaves.

But upon swiping an electronic pass card to enter, the doors swish open to unveil a dazzling display of 2,045 LED-lit Buddha statues. The relevant Buddha glows a different color, guiding each visitor to the niche that houses their loved one’s remains.

Not an incense stick or memorial plaque is in sight.

A niche here costs $7,379, including maintenance, and can be used for 30 years before the remains are moved to a communal area under the building, to make way for incoming remains.

For many elderly without children, this removes the worry about maintenance of their niche, or passing it on to the next generation.

“Japan’s population is declining due to a failing birthrate … it is getting difficult to hand over the family grave to the next generation,” Taijun Yajima, head priest of Kokokuji Buddhist Temple in Tokyo, which operates Ruriden, tells CNN.

“But the tradition and sentiment towards the deceased has not changed even we though use high tech solutions. This columbarium just meets the needs of the times.”

The Shinjuku Rurikoin Byakurengedo, in Tokyo, looks like a spaceship and acts like a smart library for ashes.

“The building doesn’t feel anything like a crematorium,” says Hikaru Suzuki, author of “The Price of Death: The Funeral Industry in Contemporary Japan.”

When you swipe the card, a machine automatically fetches the relevant ashes from an underground vault and transports them across a conveyor belt system to the appropriate room.

The compact building holds tens of thousands of urns, and does not require an inheritor or maintenance by a family member.

A sea of ideas

In Hong Kong, there is barely enough land for the living, let alone the dead.

Burial sites, therefore, are impractical and 90% of the population opts for cremation.

But even ashes need a home, and reserving a niche in a public columbarium has become akin to winning the lottery, with thousands of families on waiting lists to secure a tiny square foot of space, according to the Food and Environmental Hygiene Department (FEHD), which oversees these facilities.

Meanwhile, a private columbarium niche can cost over $100,000.

With about 50,000 deaths a year in Hong Kong — a city of 8 million people — there will be a shortage of 400,000 niches by 2023, according to the FEHD.

The “Floating Eternity” is a sea-faring cemetery aimed at relieving pressure on the city’s burial sites, and designed by local architectural firm Bread Studios.

“In Hong Kong, it’s traditional to visit our ancestors’ graves twice a year — at Ching Ming Festival, in April, and Chung Yeung Festival, in October,” says Paul Mui, design director at Bread Studio.

“It seems like a waste to reserve so much valuable land for places we only visit twice a year.”

The Floating Eternity, if built, would offer enough columbarium space to house the ashes of 370,000 people. The design incorporates cultural details, such as a positive feng shui design and bamboo gardens.

Lingering around the back of Hong Kong Island during off-season, the boat would dock in accessible spots for Ching Ming Festival, allowing relatives onboard to take part in traditional grave-sweeping activities.

Infinity and beyond

The Elysium Space service is taking off-land burials one step further, by launching ashes into orbit.

For $1,990 each, 100 families per rocket launch can send a 1-gram capsule of ashes into space. The satellite containing the capsules typically orbits the Earth for several months before blazing back into the atmosphere, like a shooting star.

“Space is not just about technology, it is a beautiful landscape that can be used to create poetic celebrations,” former NASA space system engineer Thomas Civeit, the founder of Elysium Space, tells CNN.

“Narratives about our souls traveling through the stars after we pass away already exist in Japan,” explains Civeit, adding that about 50% of the US-based company’s customers are Japanese.

The first launch departed from Kauai, Hawaii, in 2015, with another scheduled for this year.

Families can use an app to track the orbiting satellite, and even see it with the naked eye, if wearing binoculars.

“New practices like these don’t come out of the blue,” says Suzuki, also an adviser for Elysium Space

“The space burial is a culmination of technological possibilities and the younger generation’s desire to write a new story about the afterlife journey.”

Complete Article HERE!

09/21/16

How doctors are failing us in death

Never mind assisted-dying, our health care system needs to change the way it deals with the natural end of life

By

Mohamed Dhanani, left, with his father-in-law Ijaz Ahmad at a wedding last year. "The eight different doctors who treated my father-in-law all had different ideas about what (his wishes not to be life support) meant, and how involved the family should be in making treatment decisions," writes Mohamed Dhanani. "This inconsistency — the waiting, the arguing, the feeling of powerlessness — was our family’s worst experience with a health care system of which we are so often proud."

Mohamed Dhanani, left, with his father-in-law Ijaz Ahmad at a wedding last year. “The eight different doctors who treated my father-in-law all had different ideas about what (his wishes not to be life support) meant, and how involved the family should be in making treatment decisions,” writes Mohamed Dhanani. “This inconsistency — the waiting, the arguing, the feeling of powerlessness — was our family’s worst experience with a health care system of which we are so often proud.”

I’ve spent much of my career in the health care field, but it took a very personal experience to drive home just how poorly prepared health care providers are to help us through the one certain life-experience that awaits us all: death.

It happened in a hospital in southern Ontario. My father-in-law, Ijaz Ahmad, who lived with insulin-dependent diabetes for 35 years, went into the hospital for a partial foot amputation due to a bone infection.

Prior to surgery, a routine diagnostic test was performed requiring dye to be inserted into his bloodstream. After the surgery, the dye put him into kidney failure while it was being metabolized. Within a day of the surgery all of his organs started to fail and he was put on life support for what we were told would be two to three days so his organs could rest and strengthen — after which, we were told, “the doctors would bring him back.”

He spent the next 18 days on life support. And what became clear over that long 18-day ordeal is that what had clearly become the end of his life would have been unnecessarily prolonged depending on which of the eight doctors we interacted with was treating him that day.

Like so many families who have had the difficult but essential conversation with an aging parent around their end-of-life wishes, we had spoken with him about his wishes. He was clear he did not want to be on life support.

The eight doctors who treated my father-in-law all had different ideas about what those wishes meant, and how involved the family should be in making treatment decisions. This inconsistency — the waiting, the arguing, the feeling of powerlessness — was our family’s worst experience with a health care system of which we are so often proud.

Some of the doctors acknowledged his wishes but said life support was an essential part of the treatment plan; it was just a temporary measure to aid in his recovery. Others made very little effort to consult with us, and another outright refused! Another doctor assured us he would “bounce back,” though nurses told us this was increasingly unlikely and that the doctor was prone to sugar-coating discussions with families.

Because of this inconsistency, different members of my family were hearing different things — and that made it even more difficult for us to make a decision we all felt comfortable with. Finally, I pulled aside the latest doctor treating my father-in-law and asked him for an absolutely frank and direct discussion. Only then were we able to make an informed decision that respected my father-in-law’s wishes and provided as much comfort as possible to our family.

On my father-in-law’s 18th day on life support, and on what was to be the final day of his life, a new doctor was treating him. This doctor had trained and practiced in the U.K., and had only recently started to work in Ontario. His European training and experience gave him a different perspective on end-of-life care, and one for which we were grateful.

In Europe, the societal conversation on end-of-life care is more advanced than in Canada — they have grappled publicly with these essential issues of decision-making in health care for many years, and physicians have therefore become more comfortable discussing end-of-life decisions with their patients and families.

Not only is this an essential conversation we need to normalize as families and as a society, it is something our health care system must take on as an essential part of its work. All doctors must be trained to discuss end-of-life care in a direct and compassionate way with patients and their families. This will only become more important as people live longer, and as their health issues become more complex as they reach the end of their lives.

Over the last few years, Canadians have engaged in an impassioned debate on assisted death, a debate that culminated in landmark — and controversial — legislation in Parliament. But assisted death is just a small part of the issue.

As my family’s experience illustrates, end-of-life care and the difficult discussions surrounding that care are too inconsistent — inconsistent between institutions and inconsistent between doctors within a single hospital. It is something we can and must fix.

Surrounded by family and friends my father-in-law peacefully passed away within minutes of removing the breathing tube. He was 66 years old. May his soul rest in eternal peace.

Complete Article HERE!

09/20/16

Do You Want to Be Awake For Your Death?

By Chris Bodenner

 

 

Jennie Dear has an evocative piece for us examining the scant evidence that scientists have so far about the mysterious threshold between life and death—what the body goes through and how a person subjectively feels it, both in terms of pain and hallucinations:

“A lot of cardiac-arrest survivors describe that during their unconscious period, they have this amazing experience in their brain,” [neuroscientist Jimo Borjigin] says. “They see lights and then they describe the experience as ‘realer than real.’” She realized the sudden release of neurochemicals might help to explain this feeling. … Most of the patients interviewed [for a study at a hospice center], 88 percent, had at least one dream or vision.

One reader says of Dear’s ostensibly morbid piece (“What It Feels Like to Die”): “The article is comforting in a way I did not anticipate.” Another reader agrees:

I kissed my dad goodbye on the forehead right before he died. He smiled briefly. So, this article was some comfort in maybe explaining that smile of his.

This next reader also lost her father:

I remember when my dad was dying, and my mom forbade any of us from telling him that he was dying. I thought that that was terribly selfish on her part, and I told my husband that if I were dying I would want to know.

When my mom passed away, she was “treated” to the experience of my sisters bitterly arguing as to who was the favorite. (I knew I wasn’t and just held her hand.) My husband got my sisters to stop. Finally, the doctors came in and actually said she had permission to die … Mom was like that; you had to have permission in her mind for everything.

My dear husband is gone now, and I just hope that when I go, I’ll be thinking of him.

That reader’s line—“if I were dying I would want to know”—prompted a question in my mind I’ve long answered in the affirmative: “Do you want to be awake for your death and know it’s coming?” The conventional wisdom says most people prefer to die in their sleep, but, as long as there’s no intense pain involved, sleeping seems like a disappointing way to experience one of the most profound parts of life—it’s ending. And whenever I think of that question, I’m reminded of these lyrics from Björk’s “Hyperballad”:

I imagine what my body would sound like
Slamming against those rocks

And when it lands
Will my eyes be closed or open?

Would you rather be sleep or awake? How exactly would you prefer to die? What’s the ideal situation? Email hello@theatlantic.com if you’d like to share.

Back to a few more stories from readers regarding the death of a loved one. This memory is particularly poignant:

Twelve months ago, my 33-year-old daughter Phoebe began to die from metastatic melanoma. Over the next 10 weeks at a hospital in Melbourne, she went through each of the experiences outlined in Jennie Dear’s article. During this time, Phoebe asked her nurse how would she know when she was about to actually die. Donna told her that something would happen and she would know—both vague and oddly specific, but Phoebe was satisfied.

A week before her death, having gotten her pain under control, Phoebe was at home to say goodbye to her animals, clean out her cupboards, and give away her possessions. She was standing in the yard throwing a ball for the dog when she suddenly sat down, as I watched from the kitchen. I’m sure she realized as she collapsed to the bench that her time had come. I doubt that there could be a lonelier moment in a person’s life.

She didn’t speak again. Her hearing and hand gestures reduced over a few days to squeezing, then nothing but breathing quietly. Her brother-in-law, who was with her at the end, said she simply stopped breathing.

Each person’s death is different, so I found Dear’s article comforting in a way I did not anticipate.

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One more reader for now:

My father was put into hospice, and all his meds were stopped. He “recovered” and lived another six months. After they “kicked him out” of hospice, he and I spent a lot of quality time together. When the end came, he was ready even though he could no longer speak. The hospice nurse came and looked at all the meds and found that while we still had the liquid morphine, we no longer had the Ativan, so we ordered a stat delivery from the pharmacist.

Giving morphine to a dying person can feel a lot like murder, and listening to the death rattle is more distressing than listening to a crying infant, but I think that the death experience is far worse for the person attending the death than for the one who is dying.

The Ativan was given to my father late in this process, but that was the drug which provided him with joy and relief. Shortly after he received the drug, I believe I witnessed him greeting his mother who had died 40 years ago.

My father then developed what is called a Cheyne-Stokes respiration; he would breath rapidly for a few minutes and then stop breathing. He resumed breathing like clockwork at 65 seconds from his previous breath. This lasted for hours. His last breath sounded much like a laugh, and I thought it was his way of saying good-bye.

I thought the event would be gruesome, but it was a special bonding experience which has helped me to reduce my fear of dying.

Complete Article HERE!