When a doctor and patient disagree about care at the end of life

By Ravi Parikh

Sometimes, doctors and patients disagree about end-of-life care. I know, because it happened with me.

Not long ago, a frail-looking elderly patient appeared at my cardiac health clinic with a file full of hospitalizations stemming from a heart attack years before. He’d had three coronary stents put in, had had heart bypass surgery and was unable to walk for more than a block due to chest pain. I saw that a previous doctor had written “DNR” — do not resuscitate — in his chart, so I asked him to confirm his wishes.

No, he said, to my surprise. He actually wanted to be a “full code” — meaning that chest compressions, shocks and intubation were to be used if necessary to keep him alive.

I was taken aback. Someone had presumably told him that he would probably not survive a cardiac arrest even with cardiopulmonary resuscitation. (Only 1 out of 7 patients older than 80 do; this man was close to 90.)

“I don’t want anyone giving up on me,” he said. No matter how much I explained that CPR would probably only cause him to suffer longer without adding to his life, he remained adamant. He left my office visit with a yellow “full code” indicator in his chart instead of the red “DNR” one.

When I walked home that night, I couldn’t help thinking how badly our conversation had gone. I had discussed end-of-life planning with many patients, and usually we’d been able to come to decisions that made sense both medically and to the patient. But not this time.

Maybe I hadn’t explained the facts well enough; maybe there was a language barrier; or maybe he just didn’t trust me.

Medicare recently put in place new rules that will allow doctors to be reimbursed for discussing end-of-life preferences with patients.

Originally derailed by the “death panel” accusations of 2010, the measure has been hailed as a major victory toward a better, more transparent system of end-of-life care. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid Services, remarked that such advance-care planning discussions were important to promote “patient- and family-centered care.”

But sometimes these discussions are anything but patient-centered. That’s because what the doctor wants doesn’t always align with what the patient needs.

As a resident, I approach most end-of-life conversations with a narrow focus: Confirm a code status and get the name of an emergency contact person. “Do you want to be resuscitated if you lost your pulse?” “Do you want to have a breathing tube if you were unable to breathe on your own?” “Whom should we contact in case of an emergency?” I needed to document answers to those questions to finish my patient-chart note. With my pager ringing and admissions arriving, I usually didn’t have time for anything else.

The patients I speak to, however, want so much more out of their end-of-life conversations.

One of the most common questions I heard was “How long do I have?” Indeed, about half of patients desire some knowledge about prognosis when discussing the end of life. They also wanted to know whether their symptoms — pain and nausea, for example — would ever go away, and what options would allow them to be at home during their final days. One woman even asked whether someone could set up her deathbed along the same beach where she had grown up. I frequently can’t answer these questions.

Yet even these potentially frustrating conversations aren’t that common: While 8 in 10 people of all ages think it is important to talk to their doctor about their end-of-life wishes, fewer than 1 in 10 report actually having had these discussions. But there are two participants in those end-of-life conversations: patient and doctor. Unless each realizes what the other wants, both risk coming away from those conversations feeling uncomfortable or sensing that things had not gone well.

Before I saw my elderly heart patient for his next visit, I came across the website of the Conversation Project, a group dedicated to helping people discuss their wishes for end-of-life care. Led by health professionals, media, clergy and others, the Conversation Project has published a “Starter Kit” to help patients and health professionals prepare for end-of-life conversations. The guide first asks patients to fill in the blank: “What matters to me at the end of life is ______.” Subsequent steps are based on that answer.

More resources for advance-care planning exist. A nonprofit called ACP Decisions has created videos to help physicians explain emotionally charged end-of-life concepts such as CPR, hospice and feeding tubes. At my hospital, we have used simulated conversations with patient actors to help residents approach the end-of-life conversation.

So at my next meeting with my patient, rather than beginning the discussion around his code status, I asked what mattered most to him. Over the next five minutes, he explained how his great-granddaughter in Ethiopia had just been born. The family was flying to America next month, presumably to see my patient for the last time. Even if it meant receiving compressions or shocks, he wanted to make sure he was alive to see that baby. He remained a full code until our next visit, which was two months later, after his family had left. At this point, he decided to revert to DNR. We are discussing hospice care now.

I no longer think that my first discussion with that patient was a failure. But it opened my eyes to how little I’d been listening. End-of-life discussions are opportunities to learn more, to start a conversation that we as doctors have been missing out on for quite a while. Once we listen enough to learn, maybe those “goals of care” discussions will start focusing on the goals of the patient, not the doctor.

Complete Article HERE!

On Why We Should Talk More About End-Of-Life Experiences

By Christopher Kerr, M.D., Ph.D.

In many ways, the end-of-life journey is a culmination of an integrative process that distills life into its finest moments. It is about revisiting and rewriting the life scripts we have been handed, whether by chance or by design. That said, the voices and experiences of dying patients matter. 

Dying is more than the suffering we either observe or experience. Within the obvious tragedy of dying are unseen processes that hold meaning. Dying is a time of transition that triggers a transformation of perspective and perception.

If those who are dying struggle to find words to capture their inner experiences, it is not because language fails them but because it falls short of the sense of awe and wonder that overcomes them. They experience a growing sense of connectedness and belonging. They begin to see not with their eyes but with their unlocked souls.

What it all means is that the best parts of living are never truly lost. I am reminded of this when elderly patients experience the return of the mother or father they lost in childhood; when soldiers speak of haunting battles; when children talk of dead animals returning to comfort them; and when women cradle babies long lost to their touch. This is when caution vanishes and courage prevails.

What matters is not so much what is seen but what is felt.

As poets and writers have reminded us throughout history, love endures. When the end draws near, time, age, and debility vanish to give way to an incredible affirmation of life. Dying is an experience that pulls us together by binding us to those who loved us from the start, those we lost along the way, and those who are returned to us in the end.

In the words of Thomas Jefferson, “I find that as I grow older, I love those most, whom I loved first.” The dying most often embark on a hopeful journey in which they are embraced one more time by those who once gave their lives meaning, while those who hurt them drift away. Death is also a form of final justice, one in which the scales are balanced by love and forgiveness.

Having witnessed so much death as a hospice doctor, I can’t say that I fully embrace the notion of a “good” death. There is no such thing as a good death, only good people. Death and dying are merely extensions of what came before; we die as we lived. This cannot always be reconciled with happiness or goodness, particularly if the balance of one’s life had little to do with either.

Despite the tragedy, being a hospice doctor is uplifting.

Although I am often saddened by the tragedy and trauma that so many have endured, I remain amazed by the strength of the human spirit in its endless quest to heal what’s harmed or broken. For those denied fulfillment and happiness in life, it may be in that struggle that hope and grace reside.

Dying may be isolating and even lonely, but patients often find comfort in spaces where they can continue to express themselves, connect with others, and still matter. Long after the battle to overcome illness is lost, the dying continue to fight, but they are not fighting against, only for and toward. They fight to have relevance, to find meaning—right up until their very last breath.

Why else would people, bedridden and fading, find it in themselves to share their stories? Not the embellished versions we typically tell, but the real stuff that comes from having lived and mattered—from hard-felt pains, deep secrets, and distant losses to enduring love and wisdom regained. These moments, measured in days and hours, are not motivated by the possibility of future gain. They constitute a wished-for and self-generated ending.

Illness and tragedy naturally demand that we look inward, an artifact of our fight for survival and our innate resistance against mortality. As sickness begins to overtake the drive to live, there is a shift. The dying continue to cherish life, but not for themselves—for others. They express concern for loved ones, in gestures of kindness and hope, even as they say goodbye. Buried within their stories is the same awe-inspiring message, repeated again and again.

During the end of life, people have faith that their voices, softened or at times silent, mattered. And that they would still be heard.

Complete Article HERE!

To My Relatives

By

Dear Relatives,

If you are reading this, I am dead. Or I am close to death. Or you have been snooping through my papers.

Let’s assume that I am dead. I HEREBY REQUEST that you, my relatives and kin, carry out my wishes regarding the following:

MY LETTERS: As you will see in the garage, boxes No. 12 through 26 contain my letters. I have saved every letter I have ever received, including letters from collection agencies. Please go through the letters, reading each one, and divide them into important and unimportant letters.

I donate the important letters to you, my relatives, to divide fairly among yourselves. I urge you to go back through the “unimportant” letters and see if there might still be some important ones in there.

MY PETS: Please adopt and provide loving homes for my dogs, Snappy and Bitey; my cat, Sprayer; and my goldfish, Methuselah.

MY CLOTHING: Please help yourself to my suits. You will notice that, because of my unusual physique, the suit pants are size Extra Extra Large and Extra Extra Extra Large, while the suit jackets are size Tiny and Extra Tiny.

MY LIBRARY: Please donate my collection of books—all five of them—to the local library.

PORNO: Also, please donate my pornography collection (boxes 30 to 45) to the local library.

MY COINS: In the attic, you will find many, many quart jars of pennies. I’m not sure how many. Please spend these pennies on whatever you would like. You may want to cash them in at the bank. However, I’m told that banks will not accept pennies unless they are wrapped in coin wrappers. Maybe that could be a family project, to remember me by.

MY GUNS: As some of you know, I have many guns, scattered throughout the house. Most are loaded, so please be careful opening drawers, closets, and medicine cabinets.

MY PUSH LAWNMOWER: Please donate this to Goodwill, after first cleaning off all the bits of grass and dog poop that have got stuck on it over the years. Also, please sharpen the blades with the hand sharpener (somewhere in box 28). Oil and rebalance the wheels.

MY CAR: Sorry, but it’s still stuck in the surf at Party Beach. It’s yours if you can tow it out.

MY “MURDER”: Please send an anonymous letter to the police, claiming that my friend Don killed me.

MY SAFE-DEPOSIT BOX: Attached to this letter is a key. It is the key to my safe-deposit box. Take the key to the bank and open the box. Inside you will find another key. This is the spare key to the box. Take both keys to the bank officer in charge of safe-deposit boxes and close out the account. You may have to fill out some paperwork and pay for back rent.

TRAPDOOR: The trapdoor no longer works. I think the neighborhood kids broke it. Please cover the button with a piece of duct tape.

SKULL: As you’ve probably noticed, there is a human skull on the shelf in the dining room. This was sold to me as the skull of Khrushchev, the Russian leader. It was a damned lie! I don’t even think it’s Russian! Still, it’s pretty cool. First dibs gets it. (Suggestion: as a funny gag, put a cigarette between its teeth, like he’s smoking it.)

MY WIND CHIMES: As you know, I have more than a hundred wind chimes hanging down from the eaves of my house. Please help yourself. Unfortunately, some of the wind chimes have been damaged by the next-door neighbors.

MY REMAINS: Please have me cremated. Then form the ashes into the shape of me. Then deep-fry me. Then bury me with full military honors (even though I was never in the military).

MY HOUSE: A real-estate agent told me that my house, if it were totally renovated (plumbing, electrical, roof, etc.), and if the bats and raccoons and yellow jackets could be expelled from the attic, and if somehow the house’s “tilt” could be fixed, would sell for about what I paid for it forty years ago.

I smell another family project!

Complete Article HERE!

Working in Hospice Changed My Perspective on Death

“Like many physicians, I’d never considered that there might be more to death than an enemy to be fought.”

By

Tom was only forty when he arrived at Hospice Buffalo with end-stage AIDS. Unlike most of my patients, he was not surrounded by loved ones. Not a soul came to visit, ever. He was rather stoic, so I wondered if the absence of visitors was his choice rather than an indicator of his loneliness. Maybe that was his way of refusing to give death an audience.

I was puzzled but, wanting to respect his privacy, did not inquire. Tom’s emaciated body showed traces of once-chiseled muscles. He had kept fit and was still quite young, which gave me hope. In light of his age and physical conditioning, I thought that his body would be more likely to respond positively to life-prolonging treatment. Not long after he was admitted, I went to the nurse’s station and decreed, “I think we can buy Tom some time. IV antibiotics and fluids should do it.”

The charge nurse, Nancy, had been at Hospice Buffalo for much longer than I had. She knew her job, and everyone looked up to her. She was also not one to mince words. Still, her response took me by surprise: “Too late. He’s dying.”

I said, “Oh really?”

She replied, “Yep. He’s been dreaming about his dead mother.” I chuckled awkwardly—equal parts disbelief and defensiveness. “I don’t remember that class from medical school,” I said.

Nancy did not miss a beat. “Son, you must have missed a lot of classes.”

I was a thirty-year-old cardiology fellow finishing my specialty training while working weekends at Hospice Buffalo to pay the bills. Nancy was an exceptional veteran nurse who had limited patience for young, idealistic doctors. She did what she always did when someone was out of their depth—she rolled her eyes.

I went about my business, mentally running through all the ways modern medicine could give Tom another few weeks or even months. He was riddled with infection, so we administered antibiotics. Because he was also severely dehydrated, I asked for a saline drip. I did all I could do as a doctor to prolong his life, but within forty-eight hours, Tom was dead.

Nancy had been right in her estimation of where he was on the downward slope. But how could she have known? Was it just pessimism, the numbing effect of having watched so many people die? Was she truly using a patient’s dream as a predictor of life-span? Nancy had worked in hospice for more than two decades. She was tuned in to aspects of dying I knew nothing about: its subjective dimensions. How patients experienced illness, particularly dying, had mostly been ignored throughout my training as a doctor.

Like many physicians, I’d never considered that there might be more to death than an enemy to be fought. I knew about blind intervention—doing everything possible to keep people conscious and breathing—but had little regard for the way any given individual might wish to die, or for the unavoidable truth that ultimately death is inevitable. Because it had not been part of my medical education, I failed to see how the subjective experience of dying could be relevant to my role as a doctor.

It was ultimately the remarkable incidence of pre-death dreams and visions among my dying patients that made me realize how significant a phenomenon this was, both at a clinical and a human level. As a hospice doctor, I have been at the bedsides of thousands of patients who, in the face of death, speak of love, meaning, and grace. They reveal that there is often hope beyond cure as they transition from a focus on treatment to notions of personal meaning. As illness advances, grace and grit collide and bring new insight to those dying and their loved ones, insight that is often paradoxically life-affirming. This experience includes pre-death dreams and visions that are manifestations of this time of integration and coming into oneself. These are powerful and stirring experiences that occur in the last days or hours of life and that constitute moments of genuine insight and vivid re-centering for patients. They often mark a clear transition from distress to acceptance, a sense of tranquility and wholeness for the dying. Patients consistently describe them as “more real than real,” and they are each as unique as the individual having them.

These end-of-life experiences are centered on personal histories, self-understanding, concrete relationships, and singular events. They are made of images and vignettes that emanate from each person’s life experiences rather than from abstract preoccupations with the great beyond. They are about a walk in the woods relived alongside a loving parent, car rides or fishing trips taken with close family members, or seemingly insignificant details such as the texture or color of a loved one’s dress, the feel of a horse’s velvety muzzle, or the rustling sound of a cottonwood’s shimmering leaves in the backyard of a childhood home. Long-lost loved ones come back to reassure; past wounds are healed; loose ends are tied; lifelong conflicts are revisited; forgiveness is achieved.

Doctors owe it to their patients to incorporate this awareness into our practice. End-of-life experiences ought to be recognized as evidence of the life-affirming and inspiring resilience of the human spirit that drives them. They are proof of humanity’s built-in, natural, and profoundly spiritual capacity for self-sustenance and self-healing, grace and hope. They help restore meaning at end of life and assist in reclaiming dying as a process in which patients have a say. They also benefit those left behind, the bereaved, who get relief from seeing their loved ones die with a sense of peace and closure.

This subjective experience of dying is also a powerful reminder that beauty and love in human existence often manifest themselves when we least expect it. The patients who summon up comforting processes at life’s end are beset by symptoms of a failing body over which they have limited control. They are at their most frail and vulnerable, existing within suffering states of aching bones and hunger for air. Catheters, IVs, and pills may now be part of their every day, sometimes literally functioning as extensions of their bodies under the daily medical management that is their new and irreversible lot. They may experience various degrees of cognitive, psychological, and spiritual dissonance. Yet even as the inexorable march of time is taking its toll on their bodies and minds, many also have pre-death dreams and visions in the context of which they display remarkable awareness and mental sharpness.

Herein truly lies the paradox of dying: patients are often emotionally and spiritually alive, even enlightened, despite a precipitous physical deterioration. The physical and psychological toll of dying may be undeniable, but it is also what makes the emotional and spiritual changes brought about by end-of-life experiences border on the miraculous. Doing justice to end-of-life experiences means accounting for this paradox, one in which death and dying transcend physical decline and sadness to include spiritual awakening, beauty, and grace. Or, as the title character in the acclaimed Tuesdays with Morrie puts it, “Aging is not just decay, you know. It’s growth. It’s more than the negative that you’re going to die.” This is also true of the dying process, which often functions as a summing up, culmination, and capstone, an opportunity to recognize and celebrate our humanity in all its complexity and dignity rather than just as an ending.

Excerpted from DEATH IS BUT A DREAM by Christopher Kerr, MD, PhD and Carine Mardorossian, PhD. Published on February 11, 2020 by Avery, and imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2020 by William Hudson, LLC

Complete Article HERE!

A Year of Mourning and Reading

By

My grandmother died from metastatic breast cancer a little over a year ago. At nearly 93, her death was not a surprise, exactly, but I just never actually thought she would die, much less from the invasive cancer that she had overcome once before. Even her oncologist had told me at the beginning of her recurrence that the breast cancer wouldn’t kill her; old age or her heart disease would. We were wrong.

My grandmother was the last living grandparent I had. At the age of 38, I knew I was lucky to have any grandparents left. But when she died on January 30, 2019, I wasn’t prepared for the devastation that snuck in—gradually, and then very suddenly.

Grief can be decimating. But as everyone knows, time doesn’t stop for your pain. It doesn’t even slow down, no matter how much you want it to. The kid still needs to be washed and fed and taken to preschool, and you still have deadlines to meet, work to produce, and days to get through.

After my grandmother died (even a year later, those words just don’t look right; they can’t be right) it was hard to write non-work things, but one thing I was still able to do was read. I read and read and read. I read over 250 books in 2019. When my son went to bed for the night, I’d finish up any work from the day and then sit down with a book or three. On the page, I found escape. I found story and distraction.

When it had become clear that my grandmother was in her last weeks, I turned to Joan Didion, as I had in the past when other family members were dying. The Year of Magical Thinking and Blue Nights were familiar in their grief; in their measured examination of liminal spaces and how life changes in the ordinary instant.

In the past, being a medical/healthcare person and one who loves oncology, there’s a chance I would have dived into medical books. But this time, I just couldn’t. I had books come across my desk about hospice, a “good death,” and dying, and if I’m being honest, I would often really want to read these, but could rarely actually do it. A few months after my grandmother’s death, I read Edwidge Danticat’s slim volume of The Art of Death: Writing the Final Story. I wanted to know how to write about this—and this book was perfect. A mix of memoir, craft, and instruction, it was just the amount of each that I needed.

As time went on, I read some books about death and cancer. Sunita Puri’s book about becoming a palliative care physician, That Good Night: Life and Medicine in the Eleventh Hour, was a fascinating read. I approached it as research for a potential project, so I was able to read it with a bit of detachment. The Undying by Anne Boyer, a memoir about breast cancer, was a bit harder to read. The prose itself is brilliant and strong, and I often had to pause and think about what I had just read. But it also cut a bit close to the bone, and I took much longer to read this one than I normally would have. Once More We Saw Stars, by Jayson Greene, was a book that I gravitated to early on, but when the ARC arrived, I was consumed with ambivalence. It took weeks to get through the first 20 pages. As the mother of a toddler, as someone still reeling from the loss of a loved one—it may not have been the best choice of a read just then. But I was eventually able to steel myself and get through, and it was a deeply raw, haunting book that I still think about today. I found threads of connection in it and held on.

I was sent a copy of In the Time of the Butterflies, by Julia Alvarez when the 25th anniversary edition was released. I’d somehow never read Alvarez before. The story about living under a dictator, political tyranny, and rebellion felt especially necessary, and her prose is gorgeous, with the characters well-drawn and pulling you in. Every time I put this book down, I resented having to leave the pages and rejoin the outside world. It was a much-needed escape.

I read memoirs that turned the genre on its head like Ordinary Girls by Jaquira Diaz,  How We Fight for Our Lives by Saeed Jones, and Girl on Film by Cecil Castellucci. I read genre-defying, beautiful books like PET by Akwaeke Emezi and quietly haunting novels like The Last True Poets of the Sea by Julia Drake. I would read and reread sentences and pages of these books because the prose was so precise and cutting, or because it was so inventive and tumbled off my tongue, creating whole worlds in my head as I moved through the stories. Life was packed onto every single page of so many books I read this year, and maybe there’s something to that when you’re dealing with grief—seeing pages that can barely contain the story of a life reminds you of how much living there’s still to be done.

Looking at my reading in 2019, I read many fantastic books—books that took me out of my comfort zone and made me think. But I also used books as escape and distraction. If I was reading, I couldn’t dwell on how much I missed my grandmother and wished she could see what my son was doing now. I couldn’t think about how much I missed going to dinner with her multiple times a week, or how many times I would go to call her and then realize it was useless. Does this diminish the books I read this year? I’m not sure. I think I’d be better focused now than I was last year, and I plan on rereading some of my favorites to see what I might have missed the first time around. But reading, as it always has been, was a balm. It helped me get through a difficult year. For that, for the stories I savored and the characters I met and things I learned, I am grateful.

Complete Article HERE!

‘Talking Out Loud’ About Sex After Loss

Author Joan Price’s new book focuses on intimacy after grief

Author Joan Price

By Tina Antolini

In the difficult months after her husband Robert’s death, Joan Price found herself confronted with a veritable mountain of self-help books about grieving. None of them touched on the subject that would preoccupy her for the coming decade: What about sex?

Price is a sex educator, with an emphasis on older people, so perhaps she was primed for this question. But others have noticed this glaring absence in the literature of grieving, too. “The unspoken message, as I received it: keep your mouths shut about sex,” writes Alice Radosh in Modern Loss: Candid Conversations about Grief. “I turned to self-help books for widows, and found that there, too, discussions about sex were pretty much nonexistent.”

Price is used to older people’s sex lives being ignored. “I call it the ‘ick factor’ our society has,” she tells me, when I meet her near her Northern California home. “Eww: old people having sex, wrinkly sex!” she giggles to herself. Price says this ageist notion prevents older people from enjoying their sexuality, a vital part of being human, however old one is.

“We have internalized this ‘ick factor,’” she says. “We see ourselves as undesirable, as over the hill. We see ourselves as needing to say goodbye to sex when things don’t work the way they used to.” And therein lies Joan Price’s mission: to “talk out loud about senior sex,” even in life’s hardest moments. Her new book, Sex After Grief: Navigating Your Sexuality After Losing Your Beloved, seeks to fill the void in grieving literature.

A Life-Changing Love Affair

Seeing Price now, you’d have little external indication that she spent years struggling with the weight of bereavement. The first word I think of when I meet her is “spritely.” Just shy of five feet tall, Price has a twinkle of a laugh that frequently punctuates our conversation, and a playful, vibrant sense of fashion. Her fingernails are painted the purple of grape candy, and she’s wearing dangly earrings of bright, geometric shapes.

At 76, her calendar is filled with giving talks on sexuality, reviewing sex toys for her blog and teaching a bi-weekly line dancing class at a local fitness center.

It was at that line dancing class that a couple of decades ago, Price met the man who would become her husband, an artist named Robert Rice. “He walked in, and I forgot how to breathe,” she tells me. “As soon as he started moving his hips, I lost my place in the dance I was teaching. I just couldn’t take my eyes off this man.”

Price was in her late fifties at the time, already in her second career, having left a job teaching high school for one writing about fitness. The last thing she expected was a life-changing love affair. The blossoming of her romance with Robert nurtured yet another new area of work for her: writing about sex.

“It was an amazing revelation because sex was fantastic with him, but it was not the same as younger-age sex,” she says. “There was much slower arousal… It just took a lot of earnest effort on his part… It was very different. But I was feeling that sex at our age was better, that that wasn’t a defect.”

She wrote a first book, Better Than I Ever Expected: Straight Talk About Sex After Sixty, celebrating that discovery. A second book, Naked at Our Age, sought to answer the questions and resolve problems that older people were experiencing in their sex lives, from what position to use when pained by arthritic joints to a definition of sex that didn’t center orgasm as the only worthwhile goal.

It was when she was just starting to write that book, that Rice was diagnosed with cancer. “I put a hold on everything,” she says. When he died in 2008, Price was completely undone.

“I thought because I knew Robert was dying, that I was getting prepared for it,” she says. “You can’t prepare for that. You cannot know how that bludgeons your brain and your heart. It was all I could do to remember to brush my teeth.”

She would cry all day, pull herself together to drive to the health club, and teach her line-dancing class. Then she’d resume crying in the locker room, and weep all the way home.

A Difficult Subject to Discuss

For months, Price writes, her sexuality was dormant. That period of deep grief was followed by the fits and starts of trying to find her way into a new version of her romantic and sex life. This became the fodder for Sex After Grief. Price wanted to give other grievers a manual for navigating the tangle of experiences they might have.

“Some people feel frenetic sexual energy and yearn for a sexual outlet right away,” she writes. “Some start dating immediately, some gradually, some not ever. Some withdraw from sexual possibility. Some share their bodies but not their hearts. Many give themselves sexual release to the fantasy of their lost loved one.” All of these different responses are normal, Price insists. There isn’t one right way to move through it.

In keeping with the absence of sex in the literature of grief, there’s been very little scientific research into it, either. One of the few studies of “sexual bereavement,” as its authors term it, came out in 2017 in the journal Sexual and Reproductive Health Matters.

The study revealed that 72% of respondents (who were women age 55 and older) anticipated missing sex with their partner, and that 67% would want to initiate a discussion with a friend about it. But there was also a disconnect: 67% reported that it’d be difficult to discuss sex with a friend whose partner had died, attributing that difficulty to embarrassment.

Price addresses that embarrassment head-on in her new book. She dives into the thicket of myths and taboos of sexuality after loss — from questions of loyalty to one’s deceased partner to how long grieving should last — offering readers scripts for how to respond to advice that doesn’t resonate with their experience.

“Because in the moment, you know, you think, ‘Oh my gosh, am I supposed to take that on?’” she tells me. “’Am I supposed to be embarrassed? Am I supposed to be shamed? Am I doing the wrong thing? Am I doing grief wrong?’ You’re not doing grief wrong.”

Price’s message is clear: our sex lives don’t have to end as we get older, or when our partner dies. Whether we’re having partnered sex or not, she advocates, our sexual selves continue.

The book delves into the practicalities of solo sex, as well as various approaches for dating and different relationship models for older people who may not want to follow a marriage with another long-term relationship, but still want to remain sexually active.

Price is an advocate for thinking about a trusted “friends-with-benefits” arrangement, and quotes a 2013 “Singles in America” study from Match.com that revealed 58% of single men and 50% of single women had had one, including one in three people in their 70s.

‘You’re Not Making Any Kind of Commitment You Can’t Reverse’

She writes about how she kept two journals: one to chronicle the difficulties of grieving and another to record treasured memories that kept her husband alive for her. She writes about feeling out her own personal timetable for when to start having sex again, and with whom.

Price had some false starts, which she found instructive. “If you don’t know if you’re ready to date, it’s okay to try it and then put dating on hold if it feels wrong,” she writes. “You’re not making any kind of commitment you can’t reverse. The same is true for sex. You can explore, then change your mind at any point.”

Price’s own story is one of persistence, of refusing to allow society’s derision of aging bodies to stop her from enjoying her own and of not allowing even the tremendous loss of her loving partner to stop her from engaging with her sexual self. The story, she says, is always continuing.

In the past couple of years, it’s had yet another twist. Price put up a profile on OKCupid, and, after more than a few disappointing dates, she met a retired anthropologist named Mac Marshall who lived nearby. Marshall had recently lost his long-term partner to illness. They shared their grief stories amidst a flurry of other information on their early dates, and in emails.

Price dedicates Sex After Grief  both to her husband Robert, “who lives in my memory and in my heart,” and to Mac, “who shows me that joy is possible after grief.”

Complete Article HERE!

Does Marijuana Have A Place In Hospice?

A new study found that 87% of Americans support the use of medical marijuana as a treatment option for terminally ill patients.

By Kate-Madonna Hindes

As Americans continue to age, hospices are exploring new ways to bring peace and calm to the often slow and painful process of end-of-life care. According to the CDC, in 2015, an estimated 1.4 million individuals on Medicare were patients in a hospice setting.

Quadrupling in size in the last twenty years, hospices are investing in creating a patient-centric approach that dismantles beliefs that hospices are cold, and unfeeling institutions. From massage to aromatherapy, some hospices are offering new additions to their programs including music and integrating family into meaningful experiences. While many hospices are focused on offering a thoughtful quality of care, many end-of-life-care specialists are also advocating for marijuana.

MorseLife recently unveiled a 2019 study focused on advances in hospice care and found changing attitudes on medical marijuana. They cited that, “87% of Americans support the use of medical marijuana as a treatment option for terminally ill patients, with nearly three in five Americans (58%) expressing strong support.”

The American Academy of Hospice and Palliative Medicine recently shared a video on how hospices can integrate medical marijuana into care, heralding more change in the market to accepting marijuana as a part of a patient’s care plan.

Pathways Home Health advocates for marijuana in hospice care, stating:

“Marijuana is used in the hospice care setting to ease spiritual and existential suffering, with some studies showing an important therapeutic role for patients faced with the despair of a terminal illness, as well as the loss of function that accompanies it. A mild euphoria or sense of well-being can ease a patient’s mind, body and spirit as they come to terms with their fate.”

Stuck in political limbo

While some hospice programs are embracing medical cannabis, some are facing uncertainty about whether or not to allow medical marijuana, even when it’s legal inside their particular state. With an ever-expanding list of states that allow marijuana both medically and recreationally, hospices are taking an evidence-based, risk-management-forward approach to ensure they comply legally and ethically.

Changing attitudes are allowing for researchers to gain more insight and information regarding the role cannabis and CBD can both play in hospice and palliative care settings. Published in the Journal of Palliative Medicine, an October 2019 study focused on the responses of over 300 palliative care professionals from over 40 states on the use of medical cannabis. The study found “overwhelming support” for the use of medical cannabis in a hospice setting:

Regardless of legal status, hospice staff members were overwhelmingly in agreement that MC (medical cannabis) is appropriate for hospice patients to have access to and use.

Citing barriers such as legal status, clinical safety, and societal influence, the study believes opportunities exist to better support hospice providers and patients with education, research and policies that elevate the use of medical cannabis.

With new patients entering hospice every day and both clinicians and doctors looking to supplement old pain medicines with newer more effective treatments, marijuana will remain a top topic for years to come.

Complete Article HERE!