03/26/17

Hospital volunteers unlock deep mysteries with dying patients

David Wynn, left, Edie Bennett, right, and Carolyn Lyon, center, are volunteers in the St. Joseph Hospital NODA program in Orange. No One Dies Alone is to provide a reassuring presence to patients who would otherwise be alone.

by DAVID WHITING

There is life and death and the in-between.

It is the in-between where hospital volunteers such as Edie Bennett and David Wynn make sure that no one dies alone.

Over nearly a decade of volunteering at St. Joseph Hospital of Orange, Bennett and Wynn have comforted people going gently into the night, endured sepsis many would run away from, even witnessed people crossing death’s door and suddenly reviving.

But perhaps there is nothing Bennett and Wynn say that is more comforting than hearing when someone is unresponsive humans connect on far deeper levels than you might expect.

It has to do with love. But sometimes it also has to do with jazz.

MOVEMENT OF LOVE

Family and friends gathering with someone near death is as old as humanity. But in the modern world, there is a raft of reasons dying patients face death alone.

Some have families too far away to arrive in time, some are homeless and without support, others are estranged from loved ones, some simply outlive everyone they know.

The No One Dies Alone movement traces its roots to a rainy Oregon night in 1986.

Sandra Clarke, a nurse at Sacred Heart Medical Center in Eugene, tended to an elderly dying man who asked, “Would you stay with me?’

Clarke was especially busy with six patients, according to reports, and promised she would soon be back. But by the time she returned, the man had passed on.

For years, the incident haunted Clarke. Eventually, she discussed with staff her idea of volunteers staying with dying patients. PeaceHealth, the corporate organization of Sacred Heart Medical Center, approved her vision and in 2001 No One Dies Alone was born.

Today, an estimated 200 hospitals are involved.

Wynn first thought about dying alone when he and his family happened to be in Las Vegas and a family member died while they were there. Later, he heard about No One Dies Alone through a hospital newsletter after being treated for a condition that nearly killed him. He recalled dark, sometimes scary nights when staff held his hand and comforted his worries away. “It was like I got hit on the head with a board.

“I don’t want to sound like ‘St. Dave,’ but I wanted to do something that made a difference.”

Busy with family, camping, skiing and a demanding job as an AT&T senior project manager, Wynn offered to volunteer. Soon, he was coaxed into coordinating the program.

That was nearly a decade ago.

DEEP CONNECTIONS

St. Joe’s, as the hospital is affectionately known, averages one dying alone incident a month. That may not sound like much, but keep in mind that death is unpredictable. Some people pass within a few hours, others linger for weeks — and some walk away.

Wynn recalls a woman dying one New Year’s Eve. On his way home from a ski trip with his wife, he agreed to answer the call thinking he would be home from the hospital before midnight.

But midnight stretched to 1 a.m., then 2 a.m., then 3 a.m. Dozing in a chair, Wynn woke to daylight and the woman sat bolt upright in bed asking, “Who are you?”

Wynn stammered he was simply there to keep her company.

Soon, the woman returned to her nursing home.

When a call goes out, an army of some 45 volunteers split into four-hour, round-the-clock shifts.

Wynn recalls his first patient, a woman in isolation dying of cancer. When he opened her door, the odor nearly knocked him over. He gathered himself, sat down, took a glove off and touched the woman’s arm to assure her that she was not alone.

“It’s not always pleasant. Sitting there for hours with a gown and mask on can be difficult,” Wynn, a 61-year-old Anaheim Hills resident, allows, “but every human being deserves to die with dignity.

“I think touch is very important.”

As Wynn talks, I think of my father holding my mother’s hand and caressing her arm just before Thanksgiving as she lay in a coma. As her heartbeat slowed, I too held her hand and gently kissed her forehead.

But I wondered whether we do these things to sooth our souls or for the souls of others.

Wynn is convinced communication — both sound and kinetic — goes back and forth regardless of the patient’s responsiveness.

“When I was non-responsive,” he says of his time as a patient, “I could still think, I was still aware.”

Volunteers talk, watch TV, listen to music with patients. “Each case,” Wynn explains, “takes on a life of their own. There’s a connection.”

Wynn learned one of his patients was a musician so Wynn played classical music. But the patient grew restless so Wynn turned off the music. Later, he learned the man was a jazz musician and Wynn played something off a 1959 Miles Davis album called “Kind of Blue.”

The patient’s lips crinkled into a slight smile.

‘SACRED ENCOUNTERS’

When Bennett learned her father was in the hospital in Arizona, the retired lobbyist drove eight straight hours. But she just missed being there when dad was still alive.

The event prompted the 68-year-old Orange resident to volunteer. “You’re sharing the last stage of life’s journey,” Bennett offers. “For me there’s no more sacred an encounter.”

Both Bennett and Wynn remember every patient as if it were yesterday. One was a 26-year-old woman with a long-term disease Bennett had met at St. Joe’s the year before. Back then, the woman had a tattered stuffed animal. Bennett brought a playmate, a furry toy.

“She was sipping from a straw,” Bennett recalls, “lime Jell-O. I stroked her hair. She could have been my daughter.”

Bennett looked at the young woman and promised, “You will always be my angel.”

“Thank you,” the young woman said before slipping away.

“I still think of her,” Bennett allows, “and that was almost two years ago.”

Then there was the time when Bennett was with a dying woman gasping for air. Her breathing slowed to six breaths a minute. Soon, it was so quiet it appeared she was about to take her final breath.

Suddenly, the patient muttered something. Bennett couldn’t make it out. Another sound, “water.”

Within an hour, the patient sang, “Water, water.” Then she ate chocolate pudding. Soon, she was discharged.

“It’s rare,” Bennett says, “but it does happen.”

The mystery of the in-between.

Complete Article HERE!

03/25/17

Nursing my dying mother made me determined that everyone should have a ‘good’ death

By Adrienne Betteley

When my mum Joan died of oesophageal cancer in 2014, she was in the place she wanted to spend her last days – the spare bedroom at home – with me and my dad, Cliff, by her side.

I’d spent the last week in a camp bed next to Mum, wiping her lips and mopping her forehead as we shared memories.

On the night she died, she put her arm around me and said “Adrienne, I have to thank you for being the most wonderful daughter.” Afterwards, our district nurse made my dad a whisky and me a cup of tea as we said our final goodbyes.

Not without serious difficulty

Mum had a ‘good death’, but not without serious difficulties at times. I can’t help thinking it was my background as a district nurse that allowed her to die at home with her family. My experience meant I was listened to, and I pushed for her to get what she needed, such as acupuncture at the local hospice to relieve her crippling pain from arthritis. I knew what to expect and what conversations to have. We had early discussions about how she wanted to die (at home, not in hospital) and where (not next to Dad in their bed), which we call Advance Care Planning in the medical profession. At Macmillan, we believe that more needs to be done to ensure people are planning for their deaths, so their wishes – such as where they die – can be met.

Sadly, a death like my mum’s is denied to so many in this country. And I believe it would have been impossible for her too, had she not happened to have a nurse for a daughter. I had to fight to get her the care she desperately needed. Services are depleted, especially out of hours. You can’t choose when advanced cancer will cause you pain, but getting pain-relief at night or on weekends can be impossible. In her final days, there was no availability for a night sitter. Thankfully, I could be by her bedside, but had I not been, I’m convinced she would have died in hospital against her wishes.

Findings published in the British Medical Journal last week help explain why some people aren’t getting enough support when they are dying. Care for dying people varies hugely across different regions, both in how much money services are allocated and what care they offer. Figures suggested that, in most parts of the country, there are no specialist pain control teams, and, where they are in place, most operate only in normal working hours with no cover overnight. Until you’ve had a loved one in pain, with no way of providing them relief, it’s hard to appreciate the urgency of this situation.

Having a choice

Pain relief is the very least we should expect at the end of our lives. But it’s also important that, where possible, patients can die in a place of their choosing. We know that most people with advanced cancer would prefer to die at home, but not many of them actually do. Without round-the-clock community nursing, it’s hard to see how this will improve.

My days as a district nurse taught me that getting things right for people at the end of their life takes time. Decisions made about treatment affect how that person will spend their last months, weeks, hours, in this world. But time is something our overstretched workforce doesn’t have. Last month came another heart-breaking revelation – that over two thirds of nurses ‘don’t have time’ to care for dying patients. Is this really what we’ve come to? Something has to change.

Painless death must be priority

I know what a good death looks like, and that it is achievable. But to give everyone a chance to die without pain, and in the place they want to, care for dying people needs to be a priority across the country. As the NHS and local councils set out their plans to transform healthcare, it’s vitally important that they take into account how they will care for people at the end of their lives. At Macmillan, we’ll be monitoring these plans closely to make sure they do.

Those last few weeks with my mum were exhausting, but they were special and irreplaceable. Helping her in her final days with the people she loved, in the house she knew, was the most meaningful thing I’ve ever done. Caring how people die isn’t just about death, but about the value we place on life.

Complete Article HERE!

03/24/17

New research identifies a ‘sea of despair’ among white, working-class Americans

Princeton economists Angus Deaton and Anne Case continue to report on sickness and early death among white, middle-aged, working-class Americans.

Sickness and early death in the white working class could be rooted in poor job prospects for less-educated young people as they first enter the labor market, a situation that compounds over time through family dysfunction, social isolation, addiction, obesity and other pathologies, according to a study published Thursday by two prominent economists.

Anne Case and Angus Deaton garnered national headlines in 2015 when they reported that the death rate of midlife non-Hispanic white Americans had risen steadily since 1999 in contrast with the death rates of blacks, Hispanics and Europeans. Their new study extends the data by two years and shows that whatever is driving the mortality spike is not easing up.

VIDEO: Here’s what you need to know about the life expectancy drop

The two Princeton professors say the trend affects whites of both sexes and is happening nearly everywhere in the country. Education level is significant: People with a college degree report better health and happiness than those with only some college, who in turn are doing much better than those who never went.

Offering what they call a tentative but “plausible” explanation, they write that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a “cumulative disadvantage” over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease and suicide.

“Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline,” they conclude.

The study comes as Congress debates how to dismantle parts of the Affordable Care Act. Case and Deaton report that poor health is becoming more common for each new generation of middle-aged, less-educated white Americans. And they are going downhill faster.

In a teleconference with reporters this week, Case said the new research found a “sea of despair” across America. A striking feature is the rise in physical pain. The pattern does not follow short-term economic cycles but reflects a long-term disintegration of job prospects.

“You used to be able to get a really good job with a high school diploma. A job with on-the-job training, a job with benefits. You could expect to move up,” she said.

The nation’s obesity epidemic may be another sign of stress and physical pain, she continued: “People may want to soothe the beast. They may do that with alcohol, they may do that with drugs, they may do that with food.”

Similarly, Deaton cited suicide as an action that could be triggered not by a single event but by a cumulative series of disappointments: “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.”

The economists say that there is no obvious solution but that a starting point would be limiting the overuse of opioids, which killed more than 30,000 Americans in 2015.

The two will present their study on Friday at the Brookings Institution.

“Their paper documents some facts. What is the story behind those facts is a matter of speculation,” said Adriana Lleras-Muney, a University of California at Los Angeles economics professor, who will also speak at Brookings.

She noted that less-educated white Americans tend to be strikingly pessimistic when interviewed about their prospects.

“It’s just a background of continuous decline. You’re worse off than your parents,” Lleras-Muney said. “Whereas for Hispanics, or immigrants like myself” — she is from Colombia — “or blacks, yes, circumstances are bad, but they’ve been getting better.”

David Cutler, an economics professor at Harvard who also will be discussing the paper at Brookings, said the declining health of white, working-class Americans suggests that Republican plans to replace the Affordable Care Act are akin to bleeding a sick patient. As he put it, “Treat the fever by causing an even bigger fever.”

Whites continue to have longer life expectancy than African Americans and lower death rates, but that gap has narrowed since the late 1990s. The picture may have shifted again around the Great Recession, however: Graphs accompanying the new paper suggest that death rates for blacks with only a high school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites.

White men continue to die at higher rates than white women in every age group. But because women started with lower death rates, the recent mortality increase reflects a greater change in their likelihood of dying early. The numbers reported by Case and Deaton suggest that white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely.

Case and Deaton play down geography as a factor in the epidemic. Yet they note that white mortality rates fell in the biggest cities, were constant in big-city suburbs and rose in all other areas. The Washington Post’s analysis published last year highlighted the same geographical signature, with a break in death rates between the two most urban classifications (big cities and big-city suburbs) and the four less urban classifications, which The Post described as an urban-rural divide.

Last week, the Centers for Disease Control and Prevention published a report on U.S. suicides by level of urbanization between 1999 and 2015, a period in which 600,000 Americans took their own lives. The report showed rising rates in each of the six urbanization classifications but found “a geographic disparity” in which rates increased as urbanization decreased. That urban-rural divide appears to have widened, particularly in recent years, the CDC reported.

Complete Article HERE!

03/23/17

A Death in the I.C.U.

By

On a recent night, I watched a man with terminal cancer die in the intensive care unit.

He was intubated. Meds ran through intravenous catheters in his bruised arms. Outside his room, alarms beeped. On the face of it, this death was precisely the kind we are told to avoid. But I think that for him, the I.C.U. was actually a good place to be.

My patient had thought he was healthy until a few months before, when the cough that wouldn’t go away turned out to be cancer in his lungs. Chemo slowed it down, but there would be no cure, his doctors told him. He was 75, and the cancer had spread to his lymph nodes and bones.

But he was living at home, eating the foods he liked, chatting with his wife. He went along that way until one day he spiked a fever and his cough worsened. The doctors in the emergency room sent him up to the I.C.U. And there we were, standing around the bed, as his breath grew ragged, wondering whether we could make him better.

Maybe with a few days of antibiotics, we could get him back home. Maybe. If we were to push ahead, with the hope that he would improve, he would need to be intubated. I turned to his wife.

She knew that he didn’t want to linger in a machine-enabled purgatory. But he would choose to undergo our interventions if there was a chance he could get well enough to return home, to be with her and the family, for whatever time he had remaining. We would take the chance.

I called the anesthesiologists. My patient’s wife held his hand as they sedated and paralyzed him so that they could place a breathing tube down his throat.

And with that, a man with a terminal illness ended up in the I.C.U., intubated, maybe dying. We know the numbers. More than 80 percent of people say they would prefer to die at home, and yet more than half of them die here in the hospital, surrounded by noise and strange smells and tubes and machines.

It’s a message that I continue to hear: Dying in an I.C.U. is a bad death that occurs when communication and understanding break down, while dying at home is a success. There is some truth to this. I have seen many men and women, bald and withered and suffering, tethered to machines that serve only to prolong an end that is inevitable.

But to cast an I.C.U. death as the negative outcome of poor communication and decision-making is too simple. Intensive care at the end of life is very often fluid, our treatments and decisions nuanced. Consider another patient, a frail man in his 80s, also with lung cancer, whose oncologist had told him he had maybe a month, at most. As his breathing grew more labored, he ended up in the I.C.U. We could not cure him — his doctors knew that, and he did, too. But perhaps we could help. We supported his breathing with high levels of oxygen, while we drained the fluid around his lung and gave him intravenous diuretics. We subjected him to the stress of the I.C.U. and a procedure, yes, but his breathing improved, not enough for him to go home again, but enough for him to be able to return to the general medical floor of the hospital. Some might argue that his story exemplifies what is wrong with our system, an example of an invasive, resource-intensive intervention in the last few weeks of life. And yet, seeing him sitting up in bed and able to take a deep breath, I considered his treatment a success — even if it bought him only days.

A procedure or an I.C.U. stay at the end of life can be a gamble. There are times when it ends the way we hope, with a treated infection, a return home. But there are times when it does not, and often, we do not know what is possible from the start. So we explain this uncertainty, and we continue to evaluate new treatment decisions with patients and their families in the context of their goals. And when the burden of disease grows too great, with further interventions more likely to cause harm than benefit, our focus can shift toward comfort. Navigating that shift is part of our training, too.

There my 75-year-old patient lay, intubated in the I.C.U. At first, the antibiotics seemed to be working, and he seemed to be getting a little bit better. We told his wife this, and she looked hopeful. But a few days passed, and then a week. He could not breathe without the ventilator. In a small conference room off the I.C.U., we told his wife that we were sorry. We had treated the pneumonia but because of the cancer, her husband’s lungs were too weak to recover. He was not going to get home. But we could maintain his dignity here, in the I.C.U., as he died. We promised her.

That night, we shut off the monitors inside his room. The screens went dark. My patient’s nurse increased the dose of his morphine drip. The respiratory therapist stepped in and removed the breathing tube. My patient breathed quickly for a moment, a little gasp, and then the morphine hit him and his breaths quieted.

We brought in his wife and two children, who gathered by the bedside. We slid shut the glass doors. From outside the room, I watched them stand there. I watched the monitors that remained on outside the room, holding my own breath as my patient’s heart rate slowed, then stilled completely. Inside his room it was quiet. There were no alarms. Through the curtains, I saw the shadow of my patient’s wife as she hunched over and began to cry, and her daughter leaned over to hold her.

And that was it. A man with metastatic cancer had died in the I.C.U.

Complete Article HERE!

03/22/17

I went to a death cafe to learn how to talk to dying patients

Medical students do not learn how to talk about death. Junior doctors are forced to learn on the job – and that isn’t fair on patients or families

‘Death cafes aren’t a solution to lack of teaching, but all medical students should attend one.’

By Isabella Laws

It is taboo in British culture to talk about death. We say someone has “passed away”, “kicked the bucket” or “left us” – anything to avoid even using the word. This has consequences. While 70% of people wish to die at home, half of us will actually die in hospital. Our reluctance to talk about death and make our wishes known is part of the reason for this.

So I didn’t expect to enjoy visiting a death cafe. As soon as I arrived, I knew I had made the right decision, however. The room hummed with a low level of chatter, and I felt prepared to practise talking about death and dying.

On that particular morning there were six of us in the cafe: two academic psychologists, a woman who had lost her husband in her early 30s, a grief counsellor and a man who had had a near-death experience. There was also a group leader, although the conversation was completely unstructured save for initial introductions – and the proviso that everything we discussed must be about death.

Death cafes were founded in the UK in 2011, inspired by a Swiss model, and the aim is simple: to increase awareness and openness about death with a view to helping people make the most of their (finite) lives. There are now more than 4,000 cafes held around the UK, Europe and north America.

After the death cafe, I couldn’t believe that I had spent two hours talking exclusively about dying. It was satisfying to talk to others who were honest about their experiences and fears. Nearly everyone regretted not speaking more frankly about it with their parents before they died. They also worried about raising the topic with their children: who should raise it? When is the right time? What if they shut the conversation down? One woman asked the group what kind of legacy we each wanted to leave behind. She worried that she had not been close to her family and they would not remember her in the way she wanted when she dies.

I was by far the youngest person there. This is unsurprising – people in their 20s don’t often think about death. I went because there is a fundamental lack of teaching at medical school to prepare you for the fact that this is something I will have to deal with every day as a doctor. In six years of study, I will have had just one small group session on “breaking bad news”. Yet as soon as I am qualified, I will be expected to talk about death and dying to patients and their loved ones on a daily basis. Last year, I saw a doctor only months out of medical school comfort a woman after her husband’s death. The same would be expected of me in just over a year’s time – and I was not ready.

In 2000, an average of 20 hours (pdf) were dedicated to palliative care teaching at medical school. I certainly haven’t experienced any increase on that figure, 17 years later.

I have witnessed good practice during my training, but there have also been times when I wished I wasn’t in the room. Last year, while sitting in on a neurology clinic, I watched as a patient was told they had motor neurone disease. Their face went blank and pale with shock, but the doctor seemed oblivious and launched into a monologue about the patient’s treatment options and prognosis. I sat in the corner of the room, powerless to intervene. Without teaching doctors effective communication skills as students, how can we be expected to fare any better?

A survey of junior doctors by the Royal College of Physicians of Edinburgh in 2013 found that only half felt prepared for communicating with dying patients and their families. This figure rose to 70% for their clinical trainers.

This lack of teaching lets down not just students, but patients too. A lack of guidance means junior doctors are forced to learn on the job. Undoubtedly, they will improve in time. The patients and families who experience unsatisfactory or even upsetting communication along the way are simply collateral damage.

Death cafes aren’t a solution to lack of teaching, but I think they make a good start. All medical students should attend one. It’s something all of us, without exception, will be affected by. Only through practising these skills can we hope to be effective and sensitive communicators when the time comes for us to break bad news.

 Complete Article HERE!

03/21/17

How to live and learn from great loss

Julia Samuel specialises in helping people cope when a loved one dies. Joanna Moorhead finds out how we can stop feeling awkward and uncertain about death – and why we should talk honestly about grief

Julia Samuel … ‘Death disrupts the complex and finely tuned balance in a family, so everything has to be -reorganised.’

By

Phil and Annette were on their way to the mortuary when Julia Samuel phoned. Their daughter Amber, aged four, had drowned in a swimming pool, and they were going to see her body. Not many people would have called them at that moment; not many people would have dared to encroach on such raw and traumatic grief. But Julia, a friend of a friend of the couple, is a psychotherapist who specialises in dealing with loss. She knows that, when people are in the throes of overwhelming grief, sharing the pain is the only thing that can make even the tiniest difference.

But being a grief professional does not endow special powers. When Phil answered the phone, Julia would have liked to be able to say something that would make it all better. But she knew nothing could do that, so she said the only thing she could. “I am terribly sorry to hear that your daughter, Amber, has died; I’m sorry that such a devastating thing has happened to you. How can I help?”

Twenty-five years as a grief psychotherapist has taught Julia a great deal about the human condition – because when you focus on grief you focus on life, and loss exposes everything that matters about a person and their strengths and weaknesses. When someone dies, it reveals the faultlines in the bereaved family, even the deepest, most hidden ones. If you know about loss, you know about family, and about love, survival, resilience and strength. If you know about loss, you know about life.

But there is a paradox at the centre of loss, and it is this. Grief is the most intense pain there is, and we will do anything to avoid pain. So we run away from it; we run away from our own grief, and we run away from others’ grief.

And yet, says Julia, running away from it means we will never recover from it. Embracing it, moving through its agony, and allowing ourselves to just be while it washes over us, is the only way to survive it; because we have to feel the worst of it in order to let it change us, and then we can start to find out who we are going to be in the wake of it.

This is the message at the heart of Julia’s new book, Grief Works. “If you ignore grief and push it down, you can live and you can even function, but you will live a very narrow emotional life because you are using so much emotional energy to cope,” she says when we meet.

“Everything in your psyche will be squashed down, and that means small things can trigger a much bigger kind of effect. The fact is, you have to do the work of grieving. You have to let it run its course. Pain is the agent of change; pain is what allows you to change, it’s what enables you to reach a new reality.”

Her book traces the journeys of many of the bereaved people she has walked alongside; she describes how she has wept and mourned with them. “I let clients know that what they’re saying has an impact on me: I tell them when I feel shocked or sad or upset,” she says.

“I talk about our relationship: the relationship I have with them is in service of them. I say what I feel when I think it’s useful to share it.”

One of the many moving stories in her book is that of Bill and Sally, whose 13-year-old son, Matthew, died of a rare virus. Sally tells Julia that losing her son has made her, too, feel dead. She no longer has any expectations of life; she does not want to go on living. “I said quite plainly that, although she was giving up on herself, I refused to; I would fight for her. I held the whisper hidden somewhere within her that said, ‘I want to live’.”

Julia, in her 50s, a mother of four grownup children and a grandmother of four, is slight, vivacious and fun: time with her feels charged with life, and you can’t help feeling that must be helpful for those clients who, like Sally, have lost sight of the joy of being alive. Julia is as interested in asking questions as in answering them; and her questions to me surround something that I have experienced but she never has, which is a traumatic loss.

There are two sorts of loss, says Julia: expected loss and traumatic loss. And perhaps strangely, for one in her profession, her own losses have all been expected ones. Her father died, but he was 87 (“I was sad and I grieved, but it was not a traumatic loss”); her interest in bereavement sprang from her involvement with the charity Birthright, now Wellbeing of Women, which made her aware of the pain of losing a baby, although she wonders whether she was unconsciously influenced by the fact that her parents had lost three parents and three siblings by the time they were 25. “Everything seemed OK, but now when I think back I’m aware of some unresolved grief.”

Almost her only personal experience of a shocking, out-of-nowhere, loss was that of the figure whose death brought loss closer to millions, and perhaps even changed how the British deal with it: Julia was a close friend of Princess Diana, a connection that was echoed when she was asked by William and Kate to be a godmother to Prince George in 2013. That is, she says, a very joyful role – lots of fun, and the chance to enjoy the little boy as he grows up – but she doesn’t want to say much about it or about Diana, save that she agrees that her death did make a difference to the nation’s approach to grief.

So, too, she says, did other major shifts of history, especially the first and second world wars. “Our parents, the parents of people of my generation, were the generation that couldn’t afford to grieve. They were parented by survivors of the first world war: they simply had to survive, whereas we have the luxury of being able to deal with it differently.”

Having said that, and despite the public outpouring of grief after Diana’s death, she doesn’t think most people are sufficiently aware of the impact a traumatic bereavement has, the ripples it leaves or how long they persist. As someone who experienced a traumatic loss at the age of nine, when my three-year-old sister was killed in a road accident, I have to agree with her analysis. It is 44 years since that death, and the shockwaves still reverberate in my family: everyone is different because of it, and the next generation has been touched by it in ways that are too subtle for them to fully understand.

How traumatic losses shape the future of a family is a subject of great interest to Julia; so, too is the way men and women deal with loss differently. Men, she says, tend to want to move on, to make plans, to focus on new horizons. Women, on the other hand, want to spend more time remembering the person who has died; they want to immerse themselves in the pain. But the fact is, she says, that each can learn from the other. “You have to do both things: you have to have time when you grieve, and time when you have a break from the grief. You can create circumstances where you grieve, and circumstances where you move on; so men and women can help one another. He can help her go for a walk to the park or to a gallery, and she can help him talk about how he feels and express some of his loss.”

The problems set in when one individual fails to understand the pattern of grief in the other; they think of them as selfish or that they don’t care enough, but it isn’t about that – it’s about different ways of coping. Grieving is an intensely individual and usually incredibly lonely experience, which can make it a particularly difficult time in a family, where a group of people will be going through something sparked by the same event, but is in each case very different.

The way to cope, says Julia, is to be open in communicating how you are feeling to others in your family. “The families that fare best are able to share their feelings openly. Death disrupts the complex and finely tuned balance in a family, so everything has to be reorganised – and being open helps with that process.”

At the beginning, and this is especially true of a traumatic loss, the grief is all-consuming: but over time, says Julia, you find you are starting to live again. The mistake some make, though, is believing they can go back to being the way they were.

“Some people say, ‘This isn’t going to change us.’ But that’s not how it is: and it’s when you recognise that bereavement is a life-shattering experience, and that you have to grieve and rebuild, that you can move on positively into a new phase of life.

“You don’t forget the person who’s gone; you can never do that, and you should not worry that you’re going to. But you fold them, and their loss, into the new person you become; and maybe that, in the end, is the greatest tribute any of us can make to anyone who has died.”

Eight ways that family and friends can help

Listening. Be a friend who is prepared to give their time, to listen and to acknowledge the extent of your friend’s loss. Listening is the key. Bear witness, and allow your friend to be upset, to be confused and contradictory, or to say nothing at all. Every time they tell their story once more, or are allowed to say how important the person who has died was, the burden of carrying their pain on their own is incrementally a little lighter.

It’s not about you. Follow the mourner’s lead: they may not want to talk about their grief right now, or even with you. It is good to say something to acknowledge their loss, but then let them have the control they need (they had none over the death), to choose to talk or not. If they ask you to come and be with them, and want to talk openly to you, go. If they truly do not want you to visit, and do not want to deal with it at that particular time, don’t force it on them. Don’t confuse your need to speak or call or be in contact, with your friend’s need.

Acknowledgment. Death isn’t catching, but those who are bereaved might think so, judging by the fear they see in other people’s eyes. People are frightened about whether to come forward, about what to say, about saying the wrong thing – so, in the end, they say nothing. All of that comes from a belief that whatever you say should make things better, that you should have enough wisdom to make the pain more bearable. But you can’t. Nor do you need to. Being kind enough to dare to acknowledge them and their situation is good enough.

Offering to be there if they need you, suggesting that they should be the one to ring you, is probably asking too much of your friend at this time. It is better if you take the initiative and make contact, and then follow their lead: they may want to see or speak with you – or not. Often, people don’t make contact because they feel they don’t know the bereaved person well enough. If you are erring one way or the other, better to err on the side of making contact.

Practical help. Doing practical things is often what really makes a difference. Don’t say, “Let me know if I can help”; actually do something helpful. At the beginning of a bereavement, there may be a lot of people around, so bringing food may be the best thing you can do. Taking food around for longer than the initial crisis is rare, and therefore particularly appreciated.

Honesty. Be honest. Honesty is comforting and easy to deal with. There is a direct cleanness to honesty that cuts through much of the complex messiness of grief, and this can come as an enormous relief to people.

Also, be honest about what you actually can do rather than covering up because you feel guilty about what you can’t. Be specific: say, “I’m going to come round for half an hour” or “I’ll come on Tuesday”; don’t say, “I’ll come whenever you want, tell me, and I’ll be there”, and then find you can’t deliver on that offer.

Be sensitive. While being honest is important, so is being sensitive. Promiscuous honesty is not a good idea. Be aware of showing too openly that your life is trotting along happily, as that can feel like rubbing their nose in your happiness.

Be in it for the long haul. Try to remember to make contact and be supportive after everyone else has gone. Usually three months following the death, people get back to their lives, as they should. But it is by no means over for the person who is bereaved. Sending a text or popping by can be hugely supportive.

Writing. Letters, cards, texts or emails: it doesn’t matter what you write – all are extremely helpful. It is better, however, to say that you don’t want a reply, because some people simply can’t respond. And it is never too late to send them. It is a welcome surprise to receive a card much later, because it is when everyone else has forgotten and your friend is still grieving.

When you do write, try to make it personal and avoid tired cliches such as, “She’s had a good innings” or “Better to have loved and lost”, because they are trite and in some way diminish the personal importance of this very loved person who has died.

You don’t need to go into long explanations of why the person has died or theological explorations about death; just be loving and personal, warm and acknowledging.

Complete Article HERE!

03/20/17

How to talk about death and funeral planning

Death and funeral planning are not subjects most people enjoy talking about. Although we know that it will eventually come to us all, it is human nature to avoid discussing our own mortality and it’s easy to convince ourselves that we don’t need to worry until much, much later in our lives.

Sadly, thousands of people die every year without ever making any arrangements for their funeral, leaving grieving families to plan and pay for this without any clear understanding of their wishes.

Why express final wishes?

No one can know exactly when they will die, so taking the time now to talk about your wishes for your funeral makes sense for everyone, whether you are just starting out in life or enjoying a peaceful retirement.

According to a 2015 Comres survey on ‘Public Opinions to Death and Dying’, eight out of 10 British people say they have strong wishes for the end of their life and more than two thirds of us think that if people were more comfortable talking about dying, it would be easier to have our end-of-life wishes met.

The same survey showed that less than 20 percent of us have actually asked our nearest and dearest about their end-of-life wishes.

Graham Jones, director at Sun Life, discussing the insurer’s latest ‘Cost of Dying’ report, said it’s not just details like what flowers to have. “A third of those organising a funeral had no idea whether the deceased would have wanted to be buried or cremated,” he said.

End of life plans and making them known

The reality is accepting that it’s important to have the conversation with your loved ones and knowing how to raise the issue are two very different things. There’s no easy way to say ‘I’ve been having a think about what I want to happen when I die’.

Rather than springing it on unsuspecting family and friends, it might help to raise your own funeral wishes in relation to the passing of a friend or even a celebrity.  If you are met with a refusal to discuss it, try to point out that it won’t be any easier if you die without anyone knowing what you wanted for your funeral and beyond.

Talking about dying doesn’t make it happen and can bring peace of mind, allowing us to relax knowing that our plans are understood and, when the time comes, our loved ones will know exactly what to do.

“We all need to get better at discussing our end of life plans, including our funeral plans,” said Claire Henry, chief executive of the Dying Matters Coalition. “It gives us peace of mind to know we’ve made and shared our plans, and it makes life easier for our loved ones to know they are giving us the perfect send-off we want.”

Reduce financial burden and stress by planning ahead

By planning ahead, you can help to ease the emotional and the financial burden on loved ones at a very difficult time. One of the best ways to make sure that your family and friends are not left to pay for your funeral is to consider a funeral plan.

Pre-paid funeral plans make sure you have the funeral you want, planned and paid for in advance. When you purchase your plan, a local funeral director is appointed to take care of your requirements and to make sure that your family receives personal service when it really counts.

A pre-paid funeral plan gives you the opportunity to pre-arrange your burial or cremation, choose your coffin and specify transport. With your wishes laid out and a local funeral director appointed all your loved ones have to do when the time comes is make one phone call to the chosen funeral director.

Save by fixing funeral costs

A pre-paid funeral plan not only gives you control of your funeral arrangements, it also allows you to pay for your funeral director’s services included in the plan at today’s prices despite constantly rising costs.

According to the SunLife Cost of Dying Report 2015, in 2004, the average cost of a funeral was £1,920. Today it is £3,897, and at that rate of increase, in another 10 years, the average cost of a funeral could be more than £7,000.

With a pre-paid funeral, you ensure your wishes are shared with your loved ones and in turn, it provides you with peace of mind that your funeral will not burden your loved ones and guarantees that your funeral director’s costs will be covered, even if you stick around for decades.

Complete Article HERE!