Month: November 2020

Posted on

Living the Ancient Greek Death

One needs to put oneself in the sandals of a dying Greek to understand the mind frame of the ancient Greeks and to understand why they did the things that they did. Also, one needs to live an ancient Greek death following all the rites of passage and the burial laws.

The first rite of passage, or prothesis, means laying out of the body.

By Robert Garland, Ph.D.

Putting Oneself in the Sandals of a Dying Greek

The ancient Greeks held certain ideas about death. One of the most characteristic motifs that people find on ancient Greek tombstones is the handshake between the living and dead. Both figures invariably exhibit a dignified calm. That’s what Greek tragedy is all about—looking death squarely in the eye. As a Greek, they knew that terrible things happen; and they knew, too, that by confronting them head-on, they’d be able to deal with them and get on with life. One could posit that the Greeks got it just right.

But one needs to put oneself in the sandals of a dying Greek to understand it. It’s an unpleasant thought, but there’s no escaping it if one wants to fully experience the other side of history.

The Role of a Physician in Death

Let’s assume one is dying in one’s home, surrounded by one’s relatives, including young children. There won’t be any physician at hand to give painkillers.

A physician may have offered treatment in the earlier stages of sickness, but once it became inevitable that there could only be one outcome, the medical profession had nothing to offer anymore.

It’s also extremely unlikely that a physician would be called in to put one out of one’s misery by euthanasia, a coined word of Greek etymology meaning ‘good death’, but which has no ancient Greek equivalent. In fact, the Hippocratic Oath, which was probably widely adopted, enjoined upon those physicians who took it “not to administer a poison to anybody who asked for one and not to propose such a course”. So let’s hope that one’s final illness is short and painless.

The Role of Gods in Death

The poet Keats has a wonderful line in Ode to a Nightingale: “I have been half in love with easeful death”. The Greeks conceived of easeful death in the form of the God Apollo, who came to strike them down with his so-called ‘gentle arrows’. That’s the best that he or any other of the gods had to offer. They certainly didn’t have any consolation to give someone.

In Euripides’ play the Hippolytus, when Hippolytus is dying, the goddess Artemis, to whom he has devoted himself exclusively all his life and with whom he’s had a very close relationship, bids him farewell. She explains to him that it’s not lawful for a deity to be present at the death because the pollution that a corpse releases would taint her.

The one god who may have taken some slight interest in the fate of the dying is the healing God Asclepius. When Socrates passes from this world to the next in Plato’s dialogue the Crito, he has this to say, “I owe a cock to Asclepius. See that it’s paid.” Cocks were sacrificed to Asclepius. Socrates may be indicating that Asclepius eased his passing, although it’s possible, too, that he’s merely suggesting philosophically that death is a ‘cure’ for life.

The First Rite of Passage: Prothesis

in ancient Greece, as soon as one died, the women in one’s family began keening and ululating so that everyone in the neighborhood knew of the individual’s demise. It was the women, too, who took charge of one’s body and prepared it for burial. They closed one’s mouth and eyes, tied a chin strap around one’s head and chin to prevent the jaw from sagging; they washed the whole body, anointed it with olive oil; they clothed the body and wrapped it in a winding sheet, leaving only one’s head exposed.

Then they laid the body on a couch with one’s head propped up on a pillow and one’s feet facing the door. After getting all this done, they sang dirges in one’s honor.

This is the scene that is depicted on the very earliest Greek vases with figurative decoration. It’s called the prothesis, which literally means the laying out of the body. It represents the first stage in the process that will take one from this world to the next, ‘from here to there’, as the Greeks put it. Meanwhile, relatives and friends would call at the house and join in the grieving.

The Second Rite of Passage: Ekphora

The second rite of passage is the ekphora. Ekphora means literally ‘the carrying out of one’s body’—specifically from one’s home to one’s place of burial. According to Athenian law, the ekphora had to take place within three days of one’s death, although in hot weather it’s likely that it would have taken place much sooner. The ekphora had to take place before sunrise so that it wouldn’t create a public nuisance.

If one was wealthy, one’s body would be transported in a cart or carriage drawn by horses. This scene is also depicted on the earliest vases with figurative decoration. Professional undertakers might also be employed to bear the corpse and break up the ground for burial. These professionals were known as ‘ladder men’ klimakophoroi, because they’d lay one’s body on a ladder, which they carried horizontally.

If professional undertakers were employed, they wouldn’t have any physical contact with the family members before this phase. The Greeks would have been shocked and appalled by the idea of handing over one’s body to professionals to prepare it for burial.

The Third Rite of Passage: Burial

It was one’s relatives who conducted the burial service. No priests were present either. Priests were debarred for exactly the same reason that Artemis absented herself from the dying Hippolytus, so as not to incur pollution. Because if they incurred pollution, they might transmit it to the gods.

Absolutely nothing is known about the details of the burial service. Truth be told, it’s not even known if there was a burial service as such. If any traditional words were spoken, they were not recorded. Both inhumation and cremation were practiced, although cremation, being more costly, was seen as more prestigious. If one was cremated, then one’s relatives would gather the ashes and place them in an urn, which they then would bury along with the grave gifts.

The commonest grave gift was pottery. In fact, that’s why so many high-quality Greek vases have survived intact—because they were placed intact in the ground.

Over time, however, the Greeks became more stingy. Chances are, if one died in the 4th century B.C., all one would get is a couple of oil flasks known as lêkythoi filled with olive oil—olive oil was regarded as a luxury item. Some Greeks, however, were so stingy that they purchased lêkythoi with a smaller internal container to save them the expense of filling the whole vase with oil. Supposedly, they thought the dead wouldn’t notice.

As soon as the filling of the grave was done, they’d erect a grave marker over it. After completing the third and final rite of passage, all the mourners would return to the grieving home for a commemorative banquet.

The Burial Laws

Pottery was one of the most common grave gifts for the dead.

Since one’s corpse was regarded as a source of pollution—the Greek word for the pollution is miasma, which means much the same in English—one had to be buried outside the city walls. In the ancient Greece, burial within a settlement was extremely rare after the 8th century B.C. The same was true of Rome. The earliest Roman law code, the Law of the Twelve Tables, dated 450 B.C., contains the provision, “The dead shall not be buried or burnt inside the city.”

It is not certain, but the origins of the belief in pollution may be connected with a kind of primitive sense of hygiene. Dead one’s relatives and anyone else who had come into contact with the corpse were debarred from participation in any activities outside the home until the corpse had undergone purification.

Reintegration into the community for mourners didn’t take place until several weeks after the funeral. One’s relatives also had to take measures to prevent the polluting effect of one’s corpse from seeping into the community. That included providing a bowl of water brought from outside the house so that visitors could purify themselves on leaving.

Common Questions About Living the Ancient Greek Death

Q: What are the three stages of an ancient Greek funeral?

The three stages are the laying out or the prothesis, the funeral procession or the ekphora, and the burial or the Interment.

Q: How did the Greeks honor the dead?

Greeks honored the dead by following the three rites of passage, by building the tombs in Ceramicus, the Potter’s Quarter, and by offering the grave goods.

Q: How did Greeks prepare for the afterlife?

Greeks prepared for the afterlife by following the three rites of passage and offering the grave goods.

Q: What was the burial law in ancient Greece?

According to the burial law in ancient Greece, one had to be buried outside the city walls.

Complete Article ↪HERE↩!

Posted on

The Grief That Is, The Grief that is Coming

I have smelled grief on the air for years. The ache of loss, of losing, of having lost.

by Irisanya Moon

As the northern hemisphere moves into the winter, the wind blows in the reminder that so much will be lost. I’ve seen the posts of people I don’t know, but who are close to those I do, sharing stories of family members getting sick or dying of COVID.

It’s getting closer. Faster. The air is thicker with uncertainty.

Of realization that there is no one coming to save us from this virus.

Because there is no quick fix. There is no perfect protection.

(I know this is grim.)

I know these times are more dangerous because of the fear. I have seen it cause even the most steady folks to sway. Some to risky choices. Some to conspiracy.

I know I am in a moment that history will look back on and point out all of the wrongs.

But this is not a measured conversation where I can hide behind lovely words.

There are people dying.

Not Enough Space for the Names

I was on a social media page and someone talking about an altar with candles for the dead on their heart. And that there wasn’t enough space for all of the candles.

After all, more than 250,000 in the United States (and many more by the time this is posted) requires a large space. An impossibly large expanse of holding.

I want to light candles for all of you. I want to brighten this time with your names.

And I want to hold space for the ones who have watched. Watched loved ones die. Said goodbyes over video. Begged to be in the room only to be turned away.

Safety. Not you too.

What is Coming (Soon)

In the beginning, I read a lot about anticipatory grief. The knowing that loss is coming and not being able to stop it.

My heart remembers when my dad was diagnosed with COVID. And the days of blurry, fuzzy thinking. Trying to make decisions as a family about what we would do if…

Touch and go. Faith and fear.

Prayers. Offerings. Outbursts.

I have a stubborn heart, I know. I have clung to believing people are good overall. They will look out for each other. I’ve seen it. I have relationships that have proven it.

But when I look outside my carefully curated community…

I weep.

I am likely not sharing anything that hasn’t been said. I know there are many more that feel this way. Alone. Helpless. Quietly screaming.

Arguing with ‘friends’ on Facebook doesn’t help. Posting the millionth meme about wearing masks doesn’t ease the tension. Staying home only gives more space for the feelings to become louder.

There is grief around the corner. There is grief in the hallway. There is grief in the pillow underneath my head at night.

Because it is everywhere.

Building a Relationship with Grief (Before)

Whether you have lost or not, whether you have been impacted or not, the grief will be a tsunami. I have been holding back my own waves because I don’t know where they will crash. Into you? Into me? Across the yard?

I have taken to sitting with grief now. I see it as an unscreamed scream. An unhugged hug. The empty place into which love pours and pours and pours.

I sit and I ask grief what it needs.

I have an altar to grief. Where I sit. Where I have an amethyst. Where I have bones.

My heart holds an altar too. Memories live there.

I sit at the altar. Sometimes, I weep. Sometimes, I am silent. Sometimes, I sing.

Sometimes. Nothing comes. Time between time.

I write poems to grief. I write letters.

Even when the words feel empty or insignificant.

The Arrival of Grief

And I realize I am preparing for grief’s arrival. All of the ways I have pushed it back, saying that since I can’t grieve in community, I will be patient.

I will wait. I must wait.

It is the thing these moments require.

The space before.

But there are a lot of echoes waiting to be screamed screams.

I imagine you have come here for answers. For solutions. For spells. For prayers.

Me too.

I just show up for it. I make time for grief. Just as I would for any other relationship.

Just as I would for any other precious moment.

Again and again.

What do you need, grief?

What do you ask?

What do you ask of me?

I am not ready.

But sit beside me.

Tell me everything.

***

How are you preparing?

Complete Article ↪HERE↩!

Posted on

How Jews and Muslims are burying their coronavirus dead

By Daniel Burke

The women gently pour purifying water for the woman in the coffin. A soul on the threshold deserves the utmost care.

When the ritual concludes, the body is ready for the earth, the soul for the afterlife.

But first the women, members of a Jewish burial society in Pittsburgh, must sing a final prayer.

They press the Mute button.

On Zoom their voices refuse to ring as one, so one singer takes the lead while the undertaker, who is Catholic, wraps the body in simple white shrouds.

D’Alessandro Funeral Home & Crematory occupies a building that has cared for the deceased and bereaved in Lawrenceville, Pennsylvania, since 1897. But this — a Catholic funeral director participating via Zoom in a centuries-old Jewish tradition — is likely a first, said Dustin D’Alessandro, the mortuary’s supervisor.

It’s preferable to perform the ritual in person, said Malke Frank, founder of New Community Chevra Kadisha of Greater Pittsburgh.

But many members of the burial society are elderly and fear entering a funeral home before there is a vaccine for Covid-19, the deadly illness caused by this coronavirus. Like so many other events during this pandemic, the taharah, the name for the ritual, is performed virtually, with a bit of ingenuity and help from undertakers.

While Frank and her fellow volunteers visualize washing and drying the body, D’Alessandro walks with them through the ritual step-by-step.

“We consider them partners in what we do,” said Frank.

Ancient rituals have been forced to change

Religious rites evolve over time, said David Zinner, president of Kavod v’Nichum, a national group for Chevra Kadishas, which is Hebrew for “sacred society.”

The resurgent pandemic, which has hammered the US with new urgency in recent weeks, has sent that evolution into hyperspeed.

While public health officials are still learning about how Covid-19 spreads, the CDC has said “it may be possible” that people could become infected by touching the body of someone who has died of the virus.

“We went from caring for a person’s body the way we have for four hundred years to suddenly not being able to do that anymore,” Zinner said.

The coronavirus has changed so much about how we live, it was inevitable that it would alter how we die as well. The graveside gatherings, shoulder-to-shoulder prayers, consoling hugs and timeworn rituals have been canceled or curtailed for fears of contagion.

Orthodox Jewish men move a wooden casket from a hearse at a funeral home on April 5, 2020 in the Brooklyn borough of New York City.

But grief abhors a vacuum. So traditions have been adapted, as clerics turn to emergency measures prescribed in their religious laws. That’s especially true of rituals, as in Judaism and Islam, that rely on touch and intimacy with the deceased. In some instances, funeral home directors and burial societies across the country are crossing religious lines to help perform the sacred rites of passage.

D’Alessandro, who has participated in 12 burial purifications, said Frank’s society taught him about the meaning behind the rituals, imparting a sense of their importance to the living and the dead.

“I’m glad they’re allowing me to do it, despite not having a background in Judaism,” said D’Alessandro. “It’s just an incredible thing to be a part of.”

He’s insisted on providing full Islamic burials

When Covid-19 raged through New York City earlier this year, Imtiaz Ahmed was proud that his was one of the few funeral homes that still offered ghusl, an Islamic purification ritual performed on the recently deceased. As in the Jewish tahara, the body is cleansed, usually by a close family member and burial expert, then dressed in simple white robes before it is buried.

It was quite a turnaround for the Pakistani-American, who used to drive a cab and was squeamish about touching dead bodies. Now, Ahmed says, he has a clear mission.

“Once Covid started I realized that I had made the right decision,” said Ahmed, 39, “because people need my help.”

A casket of a Muslim man who died from what was believed to be the coronavirus is prepared for burial at a busy Brooklyn funeral home on May 9, 2020.

But some of the employees at his Al-Rayyan Funeral Services in Brooklyn’s “Little Pakistan” neighborhood were more reluctant. Several quit, citing health conditions or fear of contagion, Ahmed said.

The Centers for Disease Control recommends taking precautions with rituals that involve touching the dead and urges funeral homes to suit up with proper protective equipment. It is not yet known whether dead bodies can transmit the disease, according to the CDC.

The Fiqh Council of North America, a group of scholars who offer opinions on Islamic law, said there are several alternatives to touching the bodies of Covid-19 victims. In a “worst case scenario,” the council said, Muslim leaders should adopt a different method of cleansing, using sand instead of water and not opening the body bag.

Others, such as Ahmed in Queens, consider Covid-19 victims martyrs, following the Prophet Muhammad’s teaching about believers who die in plagues.

“We believe that God forgives you for whatever you are not able to do,” said Yasir Qadhi, dean of academic affairs at the Islamic Seminary of America in Dallas and a member of the council of scholars. “If the government is asking you not to wash deceased bodies, as psychologically painful as that might be, it will not affect the deceased.”

Still, many Muslims feel guilty for not being able to provide full Islamic burials, said Dr. Edmund Tori, a medical doctor and president of the Islamic Society of Baltimore.

“When you modify the prayer, you are messing with something that is very, very dear to people,” said Tori, who said his society spent several months educating the community about changes to religious practices because of Covid-19.

Muslims in Baltimore were nearly as upset about alterations to the funeral prayers. In Islam, the funeral prayers, called janazah, are a communal obligation and typically draw large crowds to mosques.

Muslim funeral homes and mosques have tried to accommodate mourners by holding the prayers outdoors, in parking lots or other open spaces hospitable to social distancing.

But the desire and obligation to attend the prayers are so great, Tori said, that the Islamic Society of Baltimore has stopped sending funeral notifications — or sends them only to a small group of people close to the deceased.

When the architect of the Islamic Societies campus died of Covid-19, Tori said, leaders kept the news quiet, leading to some upset feelings.

“Let’s just say people were not happy,” said Tori. “Everyone wanted to be there. It took a lot for the community not to come.”

This group provides ‘midwives for the soul’

Zinner, the president of the national group for Chevra Kadishas, said the risks are too high for Jewish burial societies to perform the ritual purifications in person.

The live people in the room, not the deceased body, pose the greater danger, he said. Taharahs are often performed in small rooms, with people working and singing in close proximity.

“We have to recognize that the risk is high,” Zinner said, “and we have to wait until it’s reduced.”

Instead, Zinner recommends “spiritual taharas” like the virtual service in Pennsylvania.

But the Chevra Kadisha of Greater Washington, near the nation’s capital, is continuing to conduct in-person purification rituals, said Devorah Grayson, leader of the women’s section. (Women wash and dress women; men do the same for men.)

Grayson said her society has consulted with the National Institutes of Health and CDC and volunteers wear masks, face shields, two gowns and pairs of gloves, rain boots and disposable shoe coverings. Still, 35-45% of the society’s volunteers will not perform the ritual in person.

Grayson compared participating in the ritual to going grocery shopping in the pandemic.

“The first time I did it,” she said, “it was terrifying.”

But Grayson, who belongs to the Orthodox strand of Judaism, said she feels a holy obligation to help Jews on the threshold between this world and the next. One name for burial society volunteers is “midwives for the soul.”

When souls meet God, Grayson said, they should be dressed with dignity — pandemic or not.

And so, the volunteers will continue to perform the rituals. They have survived plagues before.

When the body is properly prepared, Grayson will help place it in the coffin, adding a little soil from Israel, and softly close the lid. The midwife’s job is over, and now the soul’s must begin.

Complete Article ↪HERE↩!

Posted on

The “good death” revolution

—Companion animal euthanasia in the modern age

Home euthanasia sets a peaceful, more relaxed tone.

A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team

By Kathleen Cooney, DVM, CHPV, CCFP

Animal euthanasia has come a long way in the past 15 years. With the increased attention given to the human-animal bond, particularly during COVID; the emotional complexity of animals; and the recent and welcomed focus on veterinary wellness, the importance of a good death has risen to center stage. In forward-thinking veterinary practices, the euthanasia appointment is no longer an unpleasant burden in the day, but rather a rare gem of connectedness and intimacy so many of us look for in our professional lives. It provides teams the chance to slow down, to listen to stories, to take deep breaths in quiet reflection in an otherwise chaotic schedule. Euthanasia, while sad and heartbreaking, can lead to rich personal satisfaction when performed well. When love is at the heart of our work, the veterinary profession finds peace, even when life is lost.

Good euthanasia has evolved past the simple “one step” of giving an injection. It orbits around consistent components such as the right timing, compassionate staff, skillful techniques, and loved ones gathered close. The focus has been shifting to ensure the pet’s last moments are comfortable and peaceful, rather than just getting it over with as soon as possible—quality over quickness, in most cases. When it comes to euthanasia, if it’s worth doing, it’s worth doing right, especially since there are no do-overs.

To understand the scope of the “good death” revolution, we need to explore some key game-changing influences that have brought about the shift. The first worth mentioning is the attention paid by the American Veterinary Medical Association (AVMA) and other governing bodies to euthanasia techniques and animal welfare. Numerous revisions have been made to AVMA’s Guidelines for the Euthanasia of Animals, most recently in 2020. The document highlights the value and significance of proper technique choices and the ethical considerations we all must weigh, regardless of the species in question. Are they perfect? No, but they are extremely well-thought-out and closely match peer-reviewed literature. They will improve as research progresses and as society dictates.

A second influencer then has to be society’s demand on veterinary professionals to deliver a death worthy of the life itself. It is well understood pet owners largely view their animals as family members or loving companions. As evidenced further on in this article, loving pet owners regularly view the euthanasia appointment as a modest funeral. More and more are seeking those special touches that pay added respect for their companion.

As a home-euthanasia specialist, I’ve had many families over the years attend the euthanasia of their pet wearing suits and ties. Even though no one would see them, they dressed up to honor the life and the loss. Jessica Pierce, PhD, bioethicist and purveyor of the good death revolution, advocates for what she refers to as the sixth freedom: the freedom to die a good death. She adds this freedom to the already well-known five freedoms of animal welfare. “A good death is one that is free of unnecessary pain, suffering, and fear; it is peaceful; and it takes place in the presence of compassionate witnesses. It is, above all, a death that is allowed its full meaning.” The euthanasia of a family pet is significant and for many, will be their first experience with death.

A third major influence was/is the recognition by many in the veterinary profession that death needed to be more meaningful. The kind of experience we are talking about here is one that leaves the entire veterinary team feeling they provided the best medicine possible and supported the client throughout. Approximately 20 years ago, a small number of veterinarians and technicians throughout North America found just how enriching full devotion to the euthanasia experience can be. They shifted their appointments to focus on the bond as much as the act of euthanasia itself.

Early adopters had numerous things in common. They:

  • Took time to preplan and provide highly individualized care
  • Increased euthanasia appointment times
  • Offered home services
  • Provided sedation or anesthesia to all pet patients
  • Elevated bereavement support

In return for these specialty touches, clients showered them with thank you cards and told other pet owners about the wonderful care they had received. Through eventual collective sharing of their successes in advanced euthanasia work, other veterinary professionals joined in and the modern revolution began. Since 2011, at least seven books have been written focusing entirely on companion animal euthanasia (or contain chapters on the subject), more end-of-life care guidelines are available, and the number of pet bereavement organizations has skyrocketed. Today, there are more and more veterinarians specializing in euthanasia work, many of which offer animal hospice services as well. Animal hospice is a philosophy of care aimed at providing emotional and medical support for the dying pet and caregivers. As of early 2020, the International Association for Animal Hospice and Palliative Care (IAAHPC) touts more than 800 members, a number sure to grow in the coming years.

Have you ever thought about how much really goes into a euthanasia appointment? If you start to explore all the components of a good death experience, it’s no wonder euthanasia appointments are lengthening.

Here is a list of 14 essential components of companion animal euthanasia as developed by the Companion Animal Euthanasia Training Academy (CAETA).* Spelling out “good euthanasia,” each aspires to minimize stress for the pet, provide emotional support for the caregiver, and streamline the actions of the veterinary team.

G: Grief support materials provided
Examples: Printed pet loss guides, books, or direct links to online resources.

O: Outline caregiver and pet preferences
Examples: Talk about what’s important to the caregiver and pet. Match what they need.

O: Offer privacy before and after death
Examples: Make sure a family has time to be alone with their pet if requested.

D: Deliver proper technique
Examples: Always use the most efficient and appropriate technique based on the pet’s health and available supplies.

E: Establish rapport
Examples: Slow down and emotionally connect with the caregiver and pet before proceeding.

U: Use of pre-euthanasia sedation or anesthesia
Examples: Sleep before euthanasia reduces anxiety and pain, and increases technique options.

T: Thorough, complete consent
Examples: Every euthanasia must be properly documented in records.

H: Helpful and compassionate personnel   
Examples: Engage staff to assist who are naturally empathetic. The use of a “euthanasia attendant” is strongly encouraged (more about this later).

A: Adequate time
Examples: Slow down, block out enough time to complete all 14 components.

N: Narrate the process
Examples: Describe what each step of the process looks like, being mindful to keep language simple and uncomplicated.

A: Avoid pain and anxiety   
Examples: Be gentle when handling the pet, use sedation whenever possible, and go slow to reduce anxiety.

S: Safe space to gather   
Examples: Consider using a quiet room in the hospital or performing the euthanasia at home.

I: Inclusion of loved ones
Examples: Talk to caregivers about who should to be there, including other household pets bonded to the one being euthanized.

A: Assistance with body care   
Examples: Preplan with families around what’s important to them and carry out their wishes as if the pet were your own.

In addition to veterinarians carrying out the medical act of euthanasia, vital support staff help ensure everything goes well. Empathetic veterinary technicians, veterinary social workers, assistants, receptionists, and grief support personnel work together to ensure the pet is Fear Free and the client is carefully looked after. CAETA advocates for use of what it calls the euthanasia attendant. This person is responsible for guiding the family unit through the appointment from beginning to end. While many people may be involved in the pet’s care, one consistent person increases the likelihood that everything flows smoothly.

If you’ve been watching for change, you’re sure to have noticed the increase in specialty mobile euthanasia services around the world. According to online directory In Home Pet Euthanasia, nearly 600 mobile services have been listed since 2009 as providing home euthanasia services in Canada, the U.S., and England. Nearly 80 percent specialize in euthanasia work or the broader field of animal hospice, including euthanasia services. The shift toward home euthanasia is well-founded and necessary for many families. Pets feel safer at home. And for loving owners, being at home for their pet’s euthanasia provides them privacy and reduces the challenges of driving and interacting with others while in the midst of grief.

A good death is achieved by advocating for, and acting on, what is safest for the pet and what is most meaningful for the caregiver.

Home euthanasia has proven extremely rewarding work for those who offer it. It’s also gaining in popularity, with one service reporting its team of veterinarians assisted upward of 50,000 pets in the home setting in 2019. That’s an impressive number and indicates the trend of home euthanasia is here to stay.

Like any other progressive movement, advanced euthanasia did not happen overnight. And there are lingering obstacles that continue to stifle necessary change. Number one is the old paradigm that if it’s not broke, don’t fix it. It can be hard for veterinary teams to make lasting change around euthanasia. Reshaping a hospital’s culture takes time and commitment, but it can be done and done well.

Consider the following steps to create lasting change:

  • Dedicate one month a year to euthanasia-related discussions
  • Get everyone’s input on desired improvements
  • Create a euthanasia manual and refer to it regularly
  • Hold euthanasia rounds to review successes/challenges
  • Have multiple team members obtain advanced euthanasia training

These days, the veterinary profession recognizes the value of appropriate self-care. In this respect, self-care with regard to euthanasia begins long before the appointment. It is becoming standard practice to discuss a veterinary team member’s professional limits around euthanasia. North American Veterinary Community (NAVC) and the Human Animal Bond Research Institute (HABRI) human animal bond certification program focuses on this concept in its euthanasia module. It describes how veterinary teams should take time to determine who enjoys (yes, enjoys) euthanasia work, to write down how many euthanasias one can help in a day, week, etc., and how the team plans to practice self-care. Examples include team outings, fun food days, and setting limits on the amount of time worked in a day. The likelihood of compassion fatigue is high if care is not properly taken from the onset of euthanasia-related work.

As far as we’ve come, there is always room for growth. New techniques, improved euthanasia education opportunities, and better client support tools are on the horizon. We continue to hone our skills around gentle animal handling and pay increased attention to where we gather for euthanasia. This has never been truer than during the COVID pandemic. Veterinary teams have shifted the delivery of care, ensuring euthanasia remains an essential procedure. Creative approaches to preplanning, social distancing, technique selection, and appointment timing have played vital roles in protecting the human-animal bond. The veterinary profession dealt with these necessary modifications swiftly and compassionately. And it’s important to mention that while this article has been focused on euthanasia, death is a process, not always just a moment in time. Good death also refers to the meaningful journey leading up to death, be it natural or via active euthanasia. In the words of Benjamin Franklin, “Well done is better than well said.” To help the good death revolution flourish, we must act accordingly. A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team. If you haven’t already, how will you join the revolution?

Complete Article ↪HERE↩!

Posted on

Hospice: An Option at the End of Life

There were no needles, no tubes, no catheters and no machines. My father-in-law’s death from cancer was as peaceful, as possible.

By Maria Otero

Rather than spend his last days in a cold hospital room surrounded by strangers, Pablo died March 8, 2018, at home in hospice. He was surrounded by his children, grandchildren listening to rancheras (folk songs) and corridos (ballads) by Mexican singers Vicente Fernandez, Rocio Durcal, including his favorite tune by Jose Alfredo Jimenez’s ranchera La Mano de Dios (God’s Hand) as he held my husband Jorge’s hand in prayer.

Pablo was a former migrant worker, a Catholic, grounded to his faith to the very end. He was going through excruciating pain in his back and bones. In less than four weeks, we went from celebrating his 79th birthday to mourning his painful death from cancer.

My suegro (father-in-law) had been dealing with some other kind of unrelated health issues for probably a year. He had endured agonizing test after test, and he was a trooper. We found out that he had cancer, and it was shocking. Some of us were in disbelief, maybe denial, so we couldn’t really grasp that we have limited time with him.

Doctors gave us two options: A biopsy to determine where the cancer was located or hospice.

We chose hospice.

November is National Hospice and Palliative Care Month and an opportune time to bring to light this option at the end of life. It is also a good time to clear out some of the misconceptions among the Latino/Hispanic community of this service that provides compassionate medical care at the end of life.

Hospice is not a physical location. It is an interdisciplinary team approach to treatment that includes expert medical care, comprehensive pain management, and emotional and spiritual support. This service enables patients and families to focus on living as fully as possible despite a life-limiting illness. Caring for the whole person allows the hospice team to address each patient’s unique needs and challenges. This includes understanding and respecting each patient’s culture, family traditions and beliefs.

Hospice is almost always provided in the patient’s home, but arrangements can be made for it to be provided wherever the patient is most comfortable, such as in the home of a family member or friend. Hospice services are also provided in hospice facilities, skilled nursing facilities, assisted living facilities, hospitals and long-term care facilities.

As a native New Mexican, I’m well aware how hard it is for my Hispanic/Latinos to talk about death. Preparing for death is more critical than ever, especially because Hispanics and people of color are dying at a disproportionate rate from the coronavirus compared to other Americans.

Compassion & Choices created a free online bilingual COVID-19 toolkit available at CompassionAndChoices.org to help people understand their end-of-life care options.

Creating an advance directive is something every person should do.

And there is–literally–not a more critical time to do it.

It has been almost two years since Grandpa Pablo closed his eyes forever. Just this month, we honored my suegro’s memory with a beautiful altar during our annual Day of Dead celebration. I hugged my husband and reminded him of those last precious and blessed moments we spent at home with his dad.

Hospice was the best choice we made for my suegro. They made sure we got the emotional and calming support needed during those very tough last five weeks. Our family cried in silence as my husband hugged and kissed his father’s forehead for the last time.

My suegro took his last breath that Thursday night at 10:12 p.m. He knew he was loved. And we were at peace.

In Memory of Pablo Otero.

Complete Article ↪HERE↩!

Posted on

Are you prepared to die?

I am, and that’s the right way to live.

Barry Owen, my friend and former partner, hiking in California in 2017. In his final weeks, Owen completed the necessary to-dos in preparation of his death. He died a year after his diagnosis of pancreatic cancer.

By Steven Petrow

I am prepared to die.

No, I’m not suffering from a terminal disease (as far as I know). Nor have I been infected with the novel coronavirus that causes covid-19. But thanks mainly to the pandemic I have been motivated to complete about 90 percent of the necessary steps for end-of-life planning. I have taken note of the nearly 202,000 Americans who have died unexpectedly from covid-19 or its complications in the past seven months.

Most of these people, it’s fair to say, were not planning on a sudden death. Many died alone in hospitals, and too often they didn’t have the opportunity to bid loved ones farewell. Caring.com reported that before the pandemic hit, fewer than half those 55 and older had completed estate-planning documents (such as a will, a living will, and designating a medical power of attorney). Among those 18 to 34, it was a paltry 16 percent.

The No. 1 reason for everyone: I haven’t gotten around to it.

Covid-19 has claimed the lives of several people I know in recent months; sadly, they weren’t the only deaths in my personal and aging circle. Barry Owen, 67, a friend and former partner, died of pancreatic cancer in May, a year after being diagnosed. Shortly after being told he had Stage 4 of the disease, he posted on his Caring Bridge site, “To borrow a line from ‘Grass,’ a favorite childhood poem by Carl Sandburg: ‘What place is this? Where are we now?’ ”

That question — “Where are we now?” — resonated for me as the pandemic spread unabated. Who knows when the bell will toll for thee?

Actually, I’m not alone in having jump-started my death planning.

Recently, the New York Times reported on just such a “boom” due to the pandemic. So many questions. Who do I want to act as my medical power of attorney? Why do I need a living will? Do I want to be cremated or not? What songs do I want played at my funeral?

Not surprisingly, there are now new Web services — with checklists — specifically for this kind of planning. One of them, Lantern, whose mission is to be “the single source of guidance for navigating life before and after a death,” reported a more than 120 percent increase in users since the beginning of the pandemic.

With the obituary pages growing ever thicker these days, I’m reminded of the nadir of the HIV epidemic when gay men dropped out of sight only to turn up in a death notice soon after. In 1986, at age 29, I’d been given an AIDS diagnosis, then synonymous with a death sentence. Fortunately, it turned out the doctors had erred in making my diagnosis. But during those weeks when I feared dying, I began to make an end-of-life plan.

I didn’t get far. I got only as far as engaging a lawyer to draw up a will when I learned that my lesion was not Kaposi’s sarcoma, one of the cancers associated with AIDS. No longer facing an untimely death, I put my head back in the sand — which is to say I stopped responding to his emails — and the lawyer actually fired me as an unresponsive client. When I pleaded for one more chance, he gave it to me and I completed my first “Last Will and Testament,” and a living will, too, that detailed what medical treatments I wanted — and would forgo — if I could no longer give consent myself.

In 2006, I added a codicil to that first will when I bought a house with my partner, Jim. Oh, and I designated him as my medical power of attorney, bumping my sister down to the “backup” position.

Still, as I crossed the threshold to 50 and then again to 60, I made no other plans. In 2018, a year after Jim and I legally separated (we’d married in 2013), a new lawyer castigated me for taking no action. By leaving things as they were, my soon-to-be-ex would still inherit my part of our house equity (rather than my siblings) and he’d be making life and death decisions for me in the event I was incapacitated. (Yikes!)

Again, I found myself stuck in denial — over the failed marriage, and that like everyone else I’d die one day, too.

By nature I am a procrastinator, but this pandemic — all those deaths — has forced a new reality on me. In recent months, I’ve taken various steps to make sure I’m ready — or at least “readier” — for what my friend and literary agent Richard Pine likes to call, “The End.”

My will and living will are now updated. (I got rid of all mention of my ex in estate finances or end-of-life decisions.) In our family cemetery plot, I’ve chosen my place, and there are new notes in a manila folder for a memorial service and an obituary, although I’ve not actually written a draft like other really well-prepared friends I know. With a nod to Leona Helmsley and her much-spoiled Maltese, my new puppy will go to previously agreed-on guardians, along with a crate, some kibble and some money to cover future costs.

If anything, like others these days, I’ve come to understand the importance of getting one’s affairs in order. Greg Brock, 67 and a retired journalist, frets about having unfinished business, especially after his sister “dropped dead” a year ago.

“It was a shock, and her children were left with so many headaches with her estate, including no funeral plans,” he said.

Since then Brock has vowed to get his “act together, starting with the end.” He has bought a grave­site and is now ordering the headstone, which he admits “will be weird.” He hopes that looking at his headstone will spur him on “to organize other aspects of my life.” Good luck, friend.

I’m impressed by those I know who have such lofty but wise intentions: To set things in order sooner than later. But “why do today what I can do tomorrow?” has long been one of my favorite mantras.

Well, I’ve now ditched that aphorism, thanks to Marie Kondo, author of the best-selling “The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing.” I’ve gone though much of my stuff — applying her “delight test” — jettisoning and donating shirts and sheets, pots and pans, and bed linens and bandannas. (Although, had I known the pandemic would be still with us, I would have saved all those old bandannas to be used as masks/face coverings.)

The pandemic has also prompted me to say things I might not otherwise have. I’ve been making it a point to acknowledge those whom I love in a forthright manner, which has brought about reciprocal responses.

At the outset of the pandemic, I emailed Barry Owen a short note; at the time he appeared to be holding steady. I reminded him of our mutual friend, Denise Kessler, and explained that about the time she turned 90, we both “began ending all of our conversations with “I love you.” She and I continued that ritual until two weeks before she died at age 98, I wrote Barry, ending with the same message to him, “I love you.”

In his reply, he updated me on his condition. “No news is good news, which is to say, I’m still here.” He explained that he and Dan, his husband, “speak frankly with each other about death and what is it called? Oh yeah, end-of-life planning. But we don’t dwell on my condition or the future. We live our shared lives as normally as possible.”

And then he signed the email, “Love, Barry.”

In his final weeks, Barry completed the necessary to-dos in preparation of his death, his husband told me. And then he died, a year after his diagnosis, and a week after his first wedding anniversary.

By the time of his death, three months into the pandemic, I had finished my own death planning. I am prepared — but not ready to go.

Where to get help online

For those who need help getting started, here are some resources:

●Lantern (lantern.co) is a free website with checklists and articles about end-of-life preparations.

Everplans (everplans.com) is a subscription-based online product for creating, organizing and storing your end-of-life plan.

The Conversation Project (theconversationproject.org) is a website focused on helping people talk about their wishes for end-of-life care.

Complete Article ↪HERE↩!

Posted on

‘To be in a room with that much love

— it’s priceless’

by RACHEL SUN

Anne Ross doesn’t think about death the same way she used to.

As a volunteer hospice worker for over a decade, she said, the work profoundly impacted the way she views, and talks about, death.

Anne hadn’t planned to volunteer when she was first introduced to hospice, she said. When she first stepped foot into Bonner Community Hospice over 11 years ago, it was with her mother-in-law — a woman who had recently experienced a loss in California.

“I just couldn’t believe how compassionate they were,” she said. “I had suffered some loss in my life, a husband and a fiance, and I had never received any kind of grief support. So to see this in action, I definitely wanted to be a part of it.”

Often, hospice has a bad connotation said Tami Feyen, RN hospice manager. Despite offering a wide variety of services to people with terminal ailments and their families, hospice is often overlooked.

“I know a lot of people think ‘wow, hospice, that’s dark. You know, who would ever want to [do that], or find joy in that,’” Tami said. “But the reality is, it is really beautiful. It is just such a gift to be able to be at someone’s bedside, and work with them through the process of their decision making and seeing those things that are most important to them come forward and be executed as they move through their journey.”

The role of hospice

Most clients who come into hospice care are individuals with a terminal diagnosis of six months or less to live. Clients are often referred by their doctors, and hospice services are covered by Medicare and Medicaid and many private insurances.

The range of services hospice offers go far beyond what many people might expect, Tami said. Some include help with pain management or caregiving. But another role of hospice, she said, is to help clients make the most of their time and help fulfill final wishes.

“We’ve had a tattoo party, someone who always wanted to get a tattoo, and the means to do that was not something that she had,” she said. “We’ve had people go on a last boat ride on Lake Pend Oreille, because that’s where their heart and soul is.”

Other times, she said, the hospice reunited estranged families and helped people share final moments with their parents. The work isn’t just comfort care, she said.

“There’s a lot of psychosocial, spiritual, emotional support that goes into our care,” she said. “It’s truly the most unique specialty that I could ever think of being involved in.”

Stories from hospice care

On Anne’s first hospice case, she said, she came to spend time with an elderly man in an assisted living facility. His daughter had requested hospice care, although her father’s physical needs were already taken care of. So, Anne said, she would visit, and the two would watch golf on television.

“I wasn’t really sure why I was there, because obviously, they have a staff,” she said. “One time when I left, he said, ‘I enjoyed you today.’ And we had hardly spoken, but just having a person, you know, a presence there … that connection [makes a difference].”

Recently, Anne said, hospice helped people in her own life. Only a few weeks ago her aunt, who lived in Chicago, passed, she said. But before she did, a hospice with similar services to Bonner General’s helped her make the most of her last few months.

“My mom and my aunts all had a happy hour at five o’clock, a cocktail party, where they had a drink and [had] some fancy hors d’oeuvres. And they had an early Thanksgiving,” Anne said. “My sister arranged a Zoom cocktail party where all of her nieces and nephews got to see her and she got to ask us all questions. And she and her sisters usually would go up to northern Wisconsin in the fall to see the colors. And this year, the sisters came to her house and they had a fish fry, a prime rib dinner, and played games and laughed. And that was the weekend before she passed away.”

Mary Faux, a local resident, said her husband received hospice care after a referral from his doctor.

“I thought, he’s just saying that, my husband is going to live,” she said. “That was a Tuesday, and hospice came several times in the 11 days that he lived.”

During that time, she said, the staff helped her, her husband, and her daughter immensely.

“It made his death more tolerable,” she said. “Even if you feel like he’s not going to die immediately or even within six months, the comfort that they bring to you is so rewarding.”

Rusty McKitrick, a home health aide and staff member, also came to the hospice after seeing their work firsthand. One particular patient she helped, a young man with cancer, stands out.

“He was fairly young, his wife and he had been fighting this for quite some time. They were very hopeful that the cancer — they had beat it, that the cancer was gone after the last surgery. He was in therapy doing very well, and all of a sudden he hit a wall and took a spiral downwards,” she said. “He was had been sitting in a recliner for two days, in too much pain, his wife couldn’t get him out of the recliner. So we were able to get his pain under control. Get him out of the recliner. And he was comfortable and happy by the time I left. Joking, telling jokes, just really being able to be part of his family and do things. It made me feel good to be part of that.”

The work can be heartbreaking, Rusty said. But it’s also incredibly meaningful, to her as much as the people she helps.

“I think they probably impact my life and give my life meaning as much as I do them. They’re just — they will always be a part of my life, whether they’re here or not, [and] I will always remember them,” she said.

Serving the community

Every year, Bonner General Hospice serves about 150 clients through end-of-life care, Tami said.

Right now, it is often being used almost as an emergency service, she said.

“So many people aren’t seeing their providers right now,” she said. “So what we’re seeing right now, with ever more increase, is very, very end of life referrals the last hours the last days. And that’s so unfortunate because that person and that family do not get to really journey through their end of life in a healthy way.”

When hospice is brought in earlier, she said, there can be big benefits to families as much as the patient.

Tami recalled a young mother years ago who was dying of cancer and wanted to leave messages for her four children as they grew up. She had lost the ability to write, and so the hospice stepped in.

“We just kind of developed a means to have her record her letters to her kids in her own voice,” Tami said. “This is way back when, and I know we could do it so easy now, but it was kind of a feat back then. And so having that gift to her children was really pretty awesome.”

In addition to the roughly 150 clients, the nonprofit hospice also serves around 700 community members a year through grief and bereavement programs. They also host camp for children who have lost loved ones, and both group and one-on-one counseling free to the community, regardless of whether someone has been connected with hospice before.

Anne, who took one of the grief classes with her daughter a few years ago, said the program helped them both talk more openly about her late husband’s passing.

“[It] had a profound effect on our relationship and the way we viewed his death,” she said.

‘A good death’

Not every story is happy, Anne said. People suffer tragic deaths. But the support they get from hospice can help people have control over how they live the rest of their life, and help families to find peace.

Before coming to the hospice, Anne said, she didn’t talk about death so openly. Death, she said, was only something sad. During the last decade, she said, her work with the hospice has shifted that perspective.

“[Years ago], my first husband passed away, and he died in a hospital. And I had a dear friend with me. And after he died, she said, ‘I’ve never been at a death, but it is just as beautiful as birth.’ And I thought she was crazy … I didn’t see it. But now that I’ve been working with hospice, I see it clearly. It’s all about the love, you know, in a room where this family is just loving this person as they leave their lives,” Anne said. “We commemorate all these special occasions in our lives. birth, first day of school, graduation, marriage, anniversaries, but nobody talks about a good death. Maybe that sounds morbid, but to be in a room with that much love — it’s priceless.”

Complete Article ↪HERE↩!