The Four Words Nobody Likes to Hear

You’re Going to Die

You’re Going To Die is part open mic, part storytelling, centered around a more positive embrace of death.

By Emma Silvers

About two months ago, seated on a small airplane that was descending through a lightning storm on its way to land in Florence, Italy, I was 90 percent certain I was going to die.

My terror only lasted about 10 minutes—from the moment I saw the first flash in the dark outside the tiny window, through a half-dozen weightless-feeling, heart-stopping lurches, until the wheels touched down on the runway.

Which is to say, it was nothing compared to what the residents of Hawaii felt earlier this year when one click of the wrong button at a local government office sent warning of an imminent ballistic missile in an all-caps text message to everyone within state limits.

The mistake went uncorrected for 38 minutes—minutes in which, as a close friend who happened to be there for a wedding later told me, people did what anyone would do: panic and try to take shelter, yes, but also attempt to make peace with the inconceivable notion that there, on a previously unremarkable Saturday in January, they were about to die. Unable to assess the legitimacy of the threat, my friend called her parents and told them she loved them, then she and a few other wedding attendees headed for the beach. At the very least, they decided, they would die somewhere beautiful.

I can’t be alone in hitting a wall of cognitive dissonance when I try to think about death: it’s universal, an equalizer, one of the few absolute inevitabilities about the experience of being human (along with taxes, har har). And yet it’s also so personal, and unknowable: especially for those of us who don’t practice a religion with a sure-footed concept of the afterlife, what actually happens when we leave this mortal coil is the ultimate in unavoidable question marks. All of which makes it fantastically appealing to try to avoid the topic entirely—particularly if you live somewhere, like, say, America, that worships youth and the young.

But if the uptick in death-themed workshops and events geared toward young people is any indication, avoiding the topic of death is no longer working for a vast number of people.

“It’s a really a whole movement we’re seeing, in which people are asking different questions, having new conversations, saying they’re not satisfied with how death has been treated in our culture—which is, of course, to push it aside until you can’t anymore,” says Chelsea Coleman, a singer-songwriter and co-host of You’re Going to Die, an ongoing performance series in which participants are invited to share stories and songs about grief and loss. Coleman hosts the series’ first Oakland event this Wednesday, Sept. 26, at the Starline Social Club.

Founded in San Francisco in March 2009 by the writer Ned Buskirk, “YG2D” began as a monthly community open mic at the intimate, now-defunct venue Viracocha; it didn’t take long for the event to start regularly selling out. Buskirk soon restructured the night to highlight featured musicians at each event, eventually asking Coleman to join him as co-host.

Ned Buskirk founded You’re Going To Die in 2009.

Coleman attended her first event in 2012, shortly after the death of her grandfather, with whom she was very close. “I was with him when he died, and I wrote songs about it, so I was looking for an outlet to perform some heavy stuff,” says Coleman. “Often when you play at a bar, it’s like—sure, you can play songs about heartbreak, but ‘Here’s a song about my grandpa dying’ is really not the vibe most places.”

She was hooked after one show. “It was such a powerful space,” says Coleman. “Hearing other people speak and perform is always moving, but I also felt like what I was offering had more power there. In the past I had sometimes felt like what I was doing was a burden.”

“But people show up [at YG2D] because they want to have an emotional experience,” she says. “That changes everything.”

A selection from the You’re Going To Die Instagram feed, which offers regular reminders of the inevitable.

You’re Going To Die became a registered nonprofit in 2017. The organization has expanded swiftly in the last two years, forging new partnerships with prisons—including workshops and shows at San Quentin—and with hospice programs, in which volunteers visit with people who are dying to hear stories, and to write or play music with them. The events are spreading geographically as well, with workshops or shows planned for San Diego, Ohio and New York in the coming months.

In doing so, the nonprofit joins organizations like The Dinner Party, a grief support network for 20- and 30-somethings that began as a series of informal potlucks in LA; the network now includes meetups in the Bay Area, Washington, D.C. and New York. Death Salon, meanwhile, hosts pop-up events of academic discussion and performance organized by a group of medical historians, artists and funeral industry professionals who’ve positioned themselves at the forefront of the Death Positive Movement.

It’s tough, as an American, not to wonder if there’s some correlation between the growing call for such conversations and the events of the past two years—when macabre jokes about our president’s access to nuclear buttons have become part of daily life: one part gallows humor, two parts very real fear.

But for a vast number of Americans, of course, the reality of death is perhaps no closer than it ever felt before: black men and women contend with the reality that they might be killed every time they step out the door, for actions as simple as walking, driving or taking BART.  When a former coworker of mine, an activist and health care worker who was also a trans woman, died earlier this year, I felt (along with sadness for her family and close friends) a small sting of resignation: the numbers don’t lie. 

Coleman has a sense, however, that those not previously accustomed to considering death may have been moved in that direction by the “heightened” state of U.S. politics since 2016.

“I think a lot of people who have had the privilege of being in denial for a long time are starting to ask questions,” she says, as I flash on my brief lightning storm-induced terror. “A lot of communities haven’t had that privilege.”

Regardless of the timing, “I think things feel heavy right now for pretty much everyone, and it’s very clear to me that people are hungry for these kinds of conversations,” says Coleman, recalling the first YG2D event she hosted solo, without Buskirk. “I was nervous people weren’t going to want to talk, but from the moment we started, everyone wanted to tell stories.”

Oh, and keep that in mind if you’re heading to your first YG2D, as well. Coleman says some of the most powerful performances come from people who weren’t planning on performing. While the event has morphed over the years, the open-mic portion still makes up its bones. Audience members who’ve never sung or told stories publicly before quite frequently take the stage.

In other words, there’s perhaps something universal happening there as well. What would I do if I had 38 minutes to live? For a topic so commonplace, so obvious and so inevitable, people surprise themselves all the damn time.

Complete Article HERE!

Death Is Not An Emergency: How Recompose Is Redesigning The End of Life

Katrina Spade envisions more options for the end of life that draw on nature as a model. Spade was named a 2018 Ashoka Fellow for her groundbreaking work.

Ashoka

Katrina Spade wants to transform the U.S. funeral industry, making way for many more options for those facing death and for their families. She founded Recompose in 2017 to champion a dramatically new approach that reconnects death to natural cycles of life and engages people through meaningful participation. Ashoka’s Michael Zakaras caught up with Spade to learn more.

Michael Zakaras: What inspired your interest in the rituals and practices around death?  

Katrina Spade: I had a moment around age 30 when I realized I was mortal, and I became curious about what would happen to my physical body when I died. Because my family is not religious and most of my friends aren’t either, I thought, what will they do? And I discovered that there are really just two options in the U.S.: cremation and conventional burial. Both practices poison the planet — this struck me as the wrong punctuation for lives lived in harmony with nature.

Zakaras: Why do we have just these two options?

Spade: Much of it is convention, it’s just the way things have been done. Take modern embalming. Many people think of it as a centuries-old tradition — but it became popular in the U.S. only during the Civil War. A couple of enterprising young people invented and marketed it to soldiers on the battlefield as a way to get their bodies home to their families — for advance payment. They used arsenic instead of formaldehyde back then. Today’s funeral practices, and many of our laws, are based on the dual practices of selling caskets and embalming bodies from 150 years ago.

Zakaras: How big is the funeral industry today?

Spade: About $20 billion dollars, and it’s an interesting industry, with many funeral homes passed down generation to generation and a few large corporations that own a lot of funeral homes. One of the things that’s so interesting is the idea that every person can “own” a piece of land for eternity, in the form of a cemetery plot. This is not a sustainable model, especially for cities with space constraints.

Zakaras: That’s a good point. How much land would you need to bury everyone in, say, New York City?

Spade: We’d need over 200 million square feet of land, or 7.5 square miles! And besides the land use, cemeteries are filled with metal, wood, concrete, and embalming fluid, a known carcinogen.

Many people consider cremation to be a more sustainable choice, and its popularity is rising: by 2035 an estimated 80% of Americans will be cremated. But actually, cremation is an energy-intensive process that releases greenhouse gases and particulates, emitting more than 600 million lbs of CO2 annually.

Zakaras: So what’s the alternative?

Spade: With Recompose, we asked ourselves how we could use nature — which has totally perfected the life/death cycle — as a model for human death care. We developed a way to transform bodies into soil, so that with our last gesture we can give back to the earth and reconnect with the natural cycles. We’re also aiming to provide ritual, to help people have a more direct and conscious experience around this really important event. As hard as it can be, the end of one’s life is a profound moment — for ourselves and for the friends and families we leave behind.

Zakaras: If you are successful, what will look different in 10 years?

Spade: I’m hopeful that we will have many options for the end of life — from hospice care all the way through disposition. It won’t be the odd family who says, “Maybe we should have a home funeral” — it’ll be every family that says, “Okay, how are we approaching this? What feels right to us?” And it will be normal to ask: “What do I want my end of life to look like? What will happen to my body? Where do I want to be when I die?” These are things that should be up to us, but we’ve never really felt that we had the agency or the cultural support to decide them.

The funeral industry would like us to think that it’s difficult or impossible for us to care for our own after a death, but humans have been doing that for millennia. There are a lot of reasons to take back some of that work, the work of caring for the dead, because there’s so much beauty inherent in it and it’s such a personal thing.

Zakaras: Why is this a particularly important moment for this work?

Spade: There’s a growing realization of climate change, coupled with this incredible cohort of baby boomers — 10,000 Americans turn 65 every day — who are approaching the end of their life or seeing someone go through death and thinking, “Is this really the best we can do?” This is a generation that’s really good at saying “Wait a minute, we can do better than this.”

Zakaras: Do you ever get tired of talking about death?

Spade: I never do! We have such a long way to go, but a new relationship with death is totally possible. One of my favorite sayings is “Death is not an emergency.” This is a wonderful reminder that the very first thing we should do when someone dies is pause and take a deep breath and just be in the moment.

14 Death Festivals Around the World

By Lauren Cocking

Mexico isn’t the only country which sets a date with the dead.

Around the world, different countries, cultures, and religions have unique relationships with their dead. And yet, there are plenty of festivals of the dead—which take place over the course of days, or even months—that share spookily similar rituals. Think: offering food, cleaning tombstones, and thanking deceased loved ones for their care and guidance. Don’t let shared origin stories diminish the importance and significance of each one though—they’re all as fascinating as the last.

Hungry Ghost Festival

WHERE: China

China’s Hungry Ghost Festival—which has the best name I think I’ve ever heard—is actually a Hungry Ghost Month. In fact, only the final day of the month, when the boundary between life and death is most blurred, is known as the Hungry Ghost Festival, and Chinese Taoists and Buddhists mark the solemn occasion by  burning a lot of paper. Not only do they burn paper offerings—which signify the things living relatives wish to send to their deceased loved ones in the afterlife—they also release paper lanterns to help guide the spirits home.

Obon Festival

WHERE: Japan

The Obon (or just Bon) Festival is another Buddhist affair, and the Japanese equivalent of China’s Hungry Ghost celebrations (both take place on the fifteenth day of the seventh lunar month). However, the Japanese version is now usually celebrated on a fixed rather than fluctuating date, around mid-August. Depending where you are in Japan, you might see dances (like the Bon Odori), the release of floating lanterns, or bonfires marking the occasion, although visiting graveyards is a common countrywide ritual.

Chuseok

WHERE: North and South Korea

Unlike China and Japan, the Koreas honor their ancestors in the eighth lunar calendar month (roughly September/ October), in a celebration which also combines dance, food and general revelry over three days. The food, especially rice cakes called songpyeon, plays an important role, principally because thanks are also given to the deceased for their role in providing a good harvest. However, like other days of the dead around the world, graves are also cleaned and dances are also danced.

Samhain

WHERE: Celtic Peoples

Before Halloween (or All Hallows Eve) there was Samhain (or All Hallows), a Celtic tradition that admittedly has much in common with our present-day October 31 rituals. Take our fancy dress tendencies and giving of sweets for example. The day before Samhain, people thought that their ancestors returned from the afterlife to essentially press a giant reset button on the land and leave it empty just in time for winter. As a result, the night before (a.k.a. Halloween), they’d wear masks to blend in and leave food out for the returning souls. Sounds familiar, right?

Fiesta de las Ñatitas

WHERE: Bolivia

La Paz, Bolivia welcomes an unusual day of the dead ritual each November, as the Aymara people head to the central cemetery with their deceased loved ones’ skulls in tow. Displayed in boxes, and often adorned with flowers, the skulls are also given offerings (think: food and drink) in thanks for having watched out for their relatives from the realm of the dead over the course of the past year.

Gai Jatra

WHERE: Nepal

To catch a glimpse of the Nepalese Festival of the Cows (otherwise known as Gai Jatra), head to Kathmandu in August or September, where the eight-day affair is principally celebrated. Confused as to what a Festival of the Cows has to do with celebrating the dead? Cows are thought to help guide the deceased into the afterlife, so families with a recently departed loved one will guide a cow (or a boy dressed as a cow) through the streets to both honor and aid their deceased.

Qingming (a.k.a. Ancestors’ Day)

WHERE: China

Cleaning the tombs of the deceased forms a large part of China’s Ancestors’ or Tomb Sweeping Day, although consuming dumplings and flying kites are also important. Similarly, offering goods of value in the afterlife—such as tea and joss sticks—is also practiced on Qingming. It’s said that this memorial to the dead, which takes place in roughly mid-April, was established as a way to limit the previously overly-extravagant and all-too-regular ceremonies held in memory of the deceased.

Pchum Ben

WHERE: Cambodia

Pchum Ben, a 15-day-long ritual when the veil between living and dead realms is considered to be at its flimsiest, is celebrated countrywide in Cambodia. While the first 14 days, known as Kan Ben, are about remembrance, the fifteenth day—or, Pchum Ben Day—is when Cambodians gather en masse to celebrate. And, as with other festivals of the dead, food is offered to the souls of the departed, who it’s thought return to earth to both connect with their loved ones and atone for past sins.

Pitru Paksha

WHERE: Hindus around the world

Undefined by geographical bounds, Pitru Paksha is a Hindu festival which, like that of the Cambodian Pchum Ben, centers on praying and providing food for the deceased. However, Pitru Paksha lasts for 16, rather than 15 days, and those who take part apparently shouldn’t undertake new projects, remove hair, or eat garlic for the duration.

Radonitsa

WHERE: Russia, Belarus, and Ukraine

Radonitsa, the Russian Orthodox Church’s second-Tuesday-of-Easter memorial for the departed, stemmed out of a Slavic tradition which involved visiting graveyards and feasting with the dead. Nowadays, the rituals remain remarkably intact, as this joyful remembrance involves leaving Easter eggs on the tombstones of the deceased before dining beside them, as well as sometimes gifting presents to your in-laws.

Totensonntag

WHERE: Germany

For German Protestants, Totensonntag (a.k.a. Sunday of the Dead) is considered a day of remembrance, on which those who honor the occasion will typically pay a visit to the graves of their deceased loved ones. However, unlike some of the festivals of the dead mentioned so far, Totensonntag is a far more somber affair. In fact, it’s sometimes known as “Silent Day” and it’s actually forbidden to dance and play music in public in some parts.

Tiwah

WHERE: Indonesia

The beliefs of the Dayak Ngaju people of Central Kalimantan, Indonesia state that after death and the departure of a person’s soul, their body’s spirit remains on earth. In order to liberate that spirit and ensure they ascend to the highest level of heaven, it’s necessary to conduct a tiwah. Held anywhere from some months to years after a loved one is buried, the tiwah involves the exhumation and purification of bones and can be a prolonged event in which multiple families participate.

Thursday of the Dead

WHERE: The Levant

In the Levant—a historical geographic region which includes many modern day, Eastern Mediterranean countries—Thursday of the Dead (sometimes known as Thursday of Secrets, Eggs or Sweetness) brings together Christian and Muslim traditions to honor the souls of the deceased around the Easter period. Typically celebrated in the morning, sweets and breads are traditionally doled out to children and those in need.

Día de Muertos

WHERE: Mexico and wider Latin America

You can’t talk about global festivals of the dead without throwing in at least a few references to Mexico and wider Latin America’s Día de Muertos festivities. On November 1 (Día de los Angelitos) and 2 (Día de Muertos), people from across Mexico pay homage to and celebrate the lives of their deceased loved ones by building altars and displaying sugar skulls, amongst other things. In Guatemala, giant kites are flown, while in Ecuador, the Kichwa people memorialize their deceased loved ones by visiting, cleaning, and eating at their gravesides.

Complete Article HERE!

‘Time to grieve.’

Victorian-era funeral rites carry lessons for today, St. Louis group says

Pallbearers carry one of two caskets to the grave site from the chapel during the Victorian-era funeral reenactment by the Mourning Society

By Nassim Benchaabane

Flowers weren’t just for decoration at Victorian-era wakes.

“They were having people over to view the body so they had to try to keep the odors to a minimum,” said Edna Dieterle, with the historical re-enactment group, the Mourning Society of St. Louis.

Dieterle, 61, spent Saturday at historic Bellefontaine Cemetery in black dress and veil, as one of several people re-enacting a vigil at the gravesite of the Lindells, a family of five wiped out in a single week by a cholera epidemic that struck the city nearly exactly 152 years ago.

Although other historical enthusiasts hold cemetery tours or storytelling events, the Mourning Society has spent the last five years teaching people about Victorian funeral customs by bringing those customs back to life.

Re-creating mid-19th-century funerals is a hobby for Dieterle and her fellow mourners, but it’s also a way to connect people with the past through a shared experience, death, which was a pervasive part of daily life back then due, in part, to epidemics and unsanitary living conditions.

“People think Victorians were so focused on death, but they had so much of it to deal with,” said Dieterle, a nurse whose interest in historical medicine led her to learn more about diseases, death and funeral etiquette. “It was such a common visitor to homes in the 1860s. They weren’t morbid people, it was just reality.”

The Mourning Society also re-creates Victorian-style wakes at 19th-century homes, showcasing Dieterle’s creepy collection of mementos: jewelry made with the hair or teeth of a lost loved one, photos of dead children dressed in their Sunday best, black-and-white china painted with graveyard scenes that say “The Orphans” or “Mother’s Grave.”

Some of that collection — including instruments once used to “bleed” sick patients and recipes for funeral biscuits — will be on display at the Mourning Society’s event Oct. 26 at the Campbell House Museum in downtown St. Louis. Visitors will take part in a re-creation of the wake for Robert Campbell, a prominent businessman who died Oct. 16, 1879, in the family home. The house, which has its original furnishings, will be dimly lit by candlelight to set the mood as attendees learn about another killer that haunted the Victorians: diphtheria.

The widow, played by Edna Dieterle, poses for a photo in the cemetery during the Victorian-era funeral reenactment by the Mourning Society

While October is prime time for the Mourning Society events, thanks to Halloween, members say their goal isn’t to spook spectators but to teach them.

“It has a somber atmosphere, but no one is jumping out of the coffin with a chainsaw,” said Katherine Kozemczak, another organizer with the Mourning Society.
“But if you think about it, dying of cholera is a pretty scary thing.”

Time to grieve

As opposed to current day, Victorian customs encouraged people to mourn their loved ones openly, intensely, and for elderly widows, permanently, Dieterle said.

They mimicked the United Kingdom’s Queen Victoria — the namesake of the era — who upon the death of her husband, Prince Albert, in 1861 from suspected typhoid fever, plunged into deep mourning and wore black the remaining four decades of her life. The long-lived monarch ruled from 1837-1901.

“They focused on the grief, whereas nowadays we sometimes give advice to just move on,” Dieterle said. “The Victorians gave them time to mourn, time to grieve and time to heal.”

Women in mourning would wear special clothing — black dresses, veils, gloves and shawls, in addition to carrying parasols to block out the sun — for several months, if not a year or more. Women who couldn’t afford to buy funeral wear would dye an old dress with tea to stain it brown or gray. Men would wear armbands or brooches they could affix to regular clothing.

The homes of those in mourning would have their doors covered with black fabric, which, like the clothing, signaled to passers-by not to disturb them and muffled the sharpness of a knock on the door if they did.

Pallbearers carry one of two caskets to the grave site from the chapel during the Victorian-era funeral reenactment by the Mourning Society

“Whereas now, if you lose a loved one, people don’t know,” Dieterle said. “We’ve all had it happen where someone you haven’t seen in a while comes up and asks you how you’ve been, and you don’t want to talk about it. They could avoid those awkward situations.”

They may give people goosebumps these days, but Dieterle says there is logic behind every Victorian funeral custom.

“To us, now, they’re very sad, but for them it helped them focus on their grief, and they felt it was an appropriate thing to do,” Dieterle said.

For example, photo shoots of dead loved ones?

“They might have been waiting for a special occasion to spend the money, and that might have been the special occasion, unfortunately,” she said.

Jewelry with something from a dead relative?

“I say all you moms in the group probably have a snippet of your baby’s first hair cut taped in a baby book,” Dieterle said. “They just took it one step further.”

Just as they are now, mourning customs were a stable hand guiding people through difficult times, especially during the cholera outbreaks, Dieterle said.

“There were so many people dying during this and people didn’t know what to do, but they had to get through it somehow,” she said.

The wake

For the first 24 hours after an apparent death in the Victorian Age, relatives would sit with the body day and night just to make sure the person was actually dead. Cholera, for example, would often make people so dehydrated that they wouldn’t have enough fluid in their veins to detect a pulse.

“The term ‘wake’ came from the experience of watching the body to make sure they didn’t wake up,” said John Avery, a retired funeral director who plays undertaker for the group. “Before there was embalming — which began during the Civil War — on occasion, someone would fall asleep and be thought to have died when in fact they may have gone into a coma.

“And people were very afraid of being buried alive, so they would have someone sit and watch.”

If the dead person didn’t come back to life, the family would then wash the body, using a special solution of vinegar and alum to keep the person’s skin taut and prevent it from discoloring. The hands-on involvement was part of the family’s grieving process, Avery said.

During the wake, the dead person was the life of the party. The body would be laid out on ice and adorned with flowers as the centerpiece of a candlelit room in which family and friends would gather.

A second funeral

At the Lindells’ second funeral, mourners and people interested in learning about the rituals gathered at Hotchkiss Chapel at the cemetery. Bob Ruby played hymns on the organ — “Abide with Me” for the procession, “Jesus Loves Me” during the service and “Nearer My God to Thee” for the recessional — while Tom Allen played the part of a minister.

The funeral re-creation began with the 23rd Psalm and included comforting words about everlasting life at a time of widespread sorrow. The sermon was written by Avery, a retired diaconal minister in the United Methodist Church, who led a procession to the family plot.

Pallbearers carried two antique coffins to the burial site. A white child’s coffin represented the one that held Peter Lindell, who died in infancy; a larger coffin was for his mother, Nancy. The service ended with more words of faith and comfort.

Funeral attendees and viewers arrive at the gravesite during the Victorian-era funeral reenactment by the Mourning Society

All five of the Lindells died of cholera within a week of each other and were buried Aug. 30, 1866, at Bellefontaine Cemetery. They were part of the family that owned property along the boulevard that now bears their name.

The cemetery was established after a severe cholera outbreak in 1849. During the 1866 epidemic, which killed more than 3,200 people, the cemetery buried 200 victims in August alone, said Daniel Fuller, cemetery event and volunteer coordinator.

Nearly half of the 87,000 people buried at Bellefontaine were interred from the Victorian Era to just before World War I, and much of the cemetery, dotted by towering, centuries-old trees, has remained virtually unchanged, Fuller said.

“That’s what makes the setting out here so good for this,” he said.

The Lindell family plot looks virtually the same as it did in 1866, though cemetery caretakers added plants on nearby graves to reflect Victorian tradition. Family plots back then would be outlined with plantings done by relatives, often ivy, which symbolized permanence; fragrant herbs such as sage and rosemary that invoked particular memories; and flowers, white for children’s graves to represent innocence, and red roses for love.

For people who missed the Mourning Society’s funeral re-creation Saturday, fear not. It will return the first Saturday of October next year, with a different theme.

While Mourning Society events may not be for everyone, there are those who return every year, Dieterle said.

“When you put it to life, you see schoolkids’ eyes light up, and they start asking all these questions about what they’re seeing in front of them,” she said. “They’re not going to get that out of a book.”

Complete Article HERE!

The Art of Dying Well

It’s been nearly two years since Colorado passed the End-of-Life Options Act. How has the controversial law affected Centennial Staters, and how, exactly, does one plan for a good death?

Merely Mortals

This is a story about death.

About how we in the United States—and maybe to a slightly lesser degree, here in Colorado and the West—tend to separate ourselves, emotionally and physically, from both the ugliness and the beauty of our inevitable ends. We don’t like to think about dying. We don’t like to deal with dying. And we certainly don’t like to talk about dying. Maybe that’s because acknowledging that human bodies are ephemeral short-circuits American brains groomed to (illogically) hope for a different outcome. Perhaps it’s also because the moment death becomes part of the public discourse, as it has in the Centennial State over the past several years, things can get uncomfortably personal and wildly contentious.

“As a society, we don’t do a great job of talking about being mortal. My secret hope is that this [new law] prompts talks about all options with dying.”

When Coloradans (with an assist from Compassion & Choices, a national nonprofit committed to expanding end-of-life options) got Proposition 106, aka the Colorado End-of-Life Options Act, on the ballot in 2016, there was plenty of pushback—from the Archdiocese of Denver, advocacy groups for the disabled, hospice directors, hospital administrators, and more physicians than one might think. But on November 8, 64.9 percent of voters OK’d the access-to-medical-aid-in-dying measure, making Colorado the fifth jurisdiction to approve the practice. (Oregon, California, Montana, Washington, Hawaii, Vermont, and Washington, D.C., have or are planning to enact similar laws.) Not everyone was happy, but if there’s one thing both opponents and supporters of the legislation can (mostly) agree on, it’s that the surrounding debate at least got people thinking about a very important part of life: death.

“As a society, we don’t do a great job of talking about being mortal,” says Dr. Dan Handel, a palliative medicine physician and the director of the medical-aid-in-dying service at Denver Health. “My secret hope is that this [new law] prompts talks about all options with dying.” We want to help get those conversations started. In the following pages, we explore everything from how to access the rights afforded in the Colorado End-of-Life Options Act to how we should reshape the ways we think about, plan for, and manage death. Why? “We’re all going to die,” says Dr. Cory Carroll, a Fort Collins family practice physician. “But in America, we have no idea what death is.” Our goal is to help you plan for a good death—whatever that means to you.

Death’s Having a Moment

Colorado’s end-of-life options legislation isn’t the only way in which Coloradans are taking charge of their own deaths. Some Centennial Staters have begun contemplating their ends with the help of death doulas. —Meghan Rabbitt

As the nation’s baby boomers age, our country is approaching a new milestone: more gravestones. Over the next few decades, deaths in America are projected to hit a historic high—more than 3.6 million by 2037, which is one million more RIPs than in 2015, according to the U.S. Census Bureau. Here in Colorado, home to Boulder’s Conscious Dying Institute, there are a growing number of “death doulas” trained to help us cross over on our own terms.

Death doulas offer planning and emotional support to the dying and their loved ones, and since 2013, the Conscious Dying Institute has trained more than 750. Unlike doctors, nurses, hospice workers, and other palliative-care practitioners who treat the dying, death doulas don’t play a medical role. In much the same way that birth doulas help pregnant women develop and stick to birth plans, death doulas help their clients come up with arrangements for how they want to exit this life. That might mean talking about what projects feel important to finish (like writing that book) or helping someone make amends with estranged family members or friends or determining how much medication someone wants administered at the end. “When people are dying, they want to be heard,” says Nicole Matarazzo, a Boulder-based death doula. “If a doula is present, she’ll be able to fully show up for the person who’s dying—and model that presence for family members.”

Over the past year, the Conscious Dying Institute has seen a noticeable jump in the number of Coloradans using its directory of doulas and inquiring about training. When she started working in end-of-life care in 1998, founder Tarron Estes (pictured) says no one had heard of death doulas. Now she’s getting roughly 25 calls a week. “More people are getting comfortable talking about death,” Estes says. “In cities like Denver, there’s a willingness to talk about topics that are taboo in other areas of the country.” Medical aid in dying is, of course, a prime example.

That embrace of the end might be just another part of what is becoming known as the “death-positive movement.” More than 314,000 people have downloaded a free starter packet from the Conversation Project, a nonprofit that gets people talking about their end-of-life wishes. And more than 6,700 “death cafes,” where people gather to talk about death over tea and cake, have popped up around the nation, including several in Colorado. Ready to make a date with death? The Denver Metro Death Cafe’s next meeting is on October 20.

Knocking On A Death Doula’s Door

What to look for in an end-of-life guide.

1. Ask to see a certificate of education and research the organization that provided the doula’s training. Look for curricula that involve at least some in-person instruction. For example, the Conscious Dying Institute’s eight-day, on-site training portion includes lectures, writing exercises, demonstrations, and partner practices. It’s also split into a three-day session and a five-day session, with a 10-week internship requirement between each on-site phase.

2. Compare fees. Death doulas in Colorado charge about $25 to $125 an hour and may offer a sliding scale based on their clients’ financial means.

3. Pay attention to the doula’s listening skills. The last thing you want as you prepare to cross over is someone who hasn’t been hearing you all along.

Ink Your Legacy

If a good death includes making sure your family is cared for, one of the greatest favors you can do for your loved ones is to provide a clear path to all of your worldly possessions. Putting in the time—and paperwork—to plan for the dissemination of all your stuff can save your family months of headaches, heartaches, and contentious probate battles. Not sure what kind of estate planning documents you need? We spoke with Kevin Millard, a Denver-based estate planning attorney, to help you get started.

If you don’t you care about who gets your stuff…
Great; then you probably don’t need a will. If you don’t have a will, your stuff—cars, jewelry, artwork, etc.—goes to your closest relative(s) under what are known as “intestate succession laws” (the laws that govern how your stuff is divided after your death). The state maintains very specific equations for different scenarios. For instance, if you die with a spouse and children from a previous relationship, your spouse gets the first $150,000 of your intestate property plus half of the remaining balance, and the descendants get everything else. Or, if you die with a spouse and living parents, your partner gets the first $300,000 of your intestate property and three-quarters of anything over that. Your parents get

If you do care about who gets your stuff and some of your “stuff” is minor children…
At the very least, you need a guardian appointment document to determine who will care for your children after your death. Physical custody is different from managing any money you might have set aside for your children. You can name one person to manage the money and another to actually care for your children. Also, if your selected guardian doesn’t live where you do, he or she gets to decide whether or not your kids have to move.

If your most valuable stuff is not really “stuff” at all, but more like life insurance policies, 401(k) plans, bank accounts, etc…
Then you’ve probably already designated who gets what by appointing a beneficiary for those things. Anything with a beneficiary—life insurance policies, payable-upon-death bank accounts, retirement plans, or property held in joint tenancy (e.g., your house)—does not get distributed according to intestate succession laws (the laws that govern how your stuff is divided after your death if you don’t have a will). It goes to the listed beneficiary. However, you might want to consider also designating a durable financial power of attorney to manage all of your accounts in the event you become incapacitated before you die. Ditto for a medical power of attorney.

If your stuff is worth millions…
In addition to a will, you should consider a trust. This can protect your estate from being included in lawsuits if you’re sued, and it can also ease some of the estate tax burden on your heirs. But if you’re worth millions, then you probably already have people on retainer who’ve told you this.

If your stuff isn’t worth millions…
You need a will if you want to make life easier for your heirs. (In Colorado, any estate valued at more than $65,000 must go through probate court—a process that takes many months to finalize because you cannot close an estate here until six months after a death certificate has been issued, which can take several days or even weeks.) The general rule in Colorado is that a will must be signed by two witnesses to be valid. If you go through the trouble of having it notarized, it becomes a self-proving will, which means the court doesn’t have to track down the witnesses to certify its validity. You can also handwrite and sign your will; that’s known as a holographic will and does not require witnesses—but it does come with a lot of hand cramps.

My Father’s Final Gift

When it came to preparing for the end of his life, my father planned for the worst, knowing that would be best for me. —Jerilyn Forsythe

It was June in Arizona, and it was hot inside my dad’s kitchen. The whole place smelled musty, the way old cabins do, and I watched as a swath of sunlight coming through the window illuminated lazy plumes of dust. My thoughts felt as clouded and untethered as the drifting specks. I had flown in from Denver the day before and driven more than 100 miles from Phoenix to collect some of my father’s things and bring them to the hospital, where he lay in a medically induced coma.

It had all happened so fast. I’d received a midnight call from a neurosurgeon in Phoenix—the same one who had done a fairly routine surgery to mend a break in my dad’s cervical spine a few weeks earlier. Somehow, the physician said, my father had accidentally undone the surgery, leaving two screws and a metal plate floating in his neck. The doctor explained that he had operated emergently on my dad, who would be under a heavy fentanyl drip—and a halo—until he stabilized.

Although my parents had been divorced since I was two years old, my mother was there to help me that afternoon in Dad’s cabin. Between coaching me through decisions like which of his T-shirts to pack and whether or not I should bring his reading glasses, she happened upon a navy blue three-ring binder, with a cover page that read “Last Will and Testament, Power of Attorney & Living Will for Larry Forsythe,” in his bedroom.

He had never told me about the binder, but my name graced nearly every page within it. On a durable financial power of attorney. On a durable medical power of attorney. On a living will. And on his last will and testament. My typically nonconformist dad had prepared a collection of legal files that would become my bible in the ensuing months.

During the roughly 16 weeks he was hospitalized, I would reread, reference, fax, scan, copy, and email those documents—particularly the powers of attorney—countless times. I also thought, on nearly as many occasions, how fortunate I was that my dad, who probably struggled to pay for a law firm to draw up the papers, had done so just a year before he was unexpectedly admitted to the hospital. Without his wishes committed to paper, I know I would not have been able to fully and confidently make decisions on his behalf. But, navy blue binder in hand, I was empowered to speak with authority to doctors, nurses, bank executives, and even the cable company, which would not have stopped the monthly payments that were dwindling his already heartbreakingly low bank account had I not been designated his financial power of attorney.

I always thought that having a sick or dying loved one meant hospital visits and flowers and tears—all of which is true—but I spent far more time on the phone with medical professionals, financial institutions, and social workers than I did crying. I imagine all of that strife would have been magnified dramatically had we not found that binder.

My dad died a year ago this month. His passing brought more challenges for me, but for a long time after, I silently thanked him for having the foresight to visit that estate planning law firm, for considering what I’d go through when he was no longer here. It was one of the last—and best—gifts he ever gave me.

Process Oriented

Navigating the myriad steps to legally access medical-aid-in-dying drugs can be an arduous undertaking already. Some obstacles, though, are making it even more frustrating for terminally ill patients and their families.

Step No. 1: Determine Eligibility

For a person to be eligible to receive care under the law, he or she must be 18 years or older; a resident of Colorado; terminally ill with six months or less to live; acting voluntarily; mentally capable of making medical decisions; and physically able to self-administer and ingest the lethal medications. All of these requirements must be documented by the patient and confirmed by the patient’s physician, who must agree to prescribe the medication.

Procedural Glitch: Because the law allows individual physicians to opt out of prescribing medical-aid-in-dying drugs for any reason and because some hospital systems and hospices have—in a potentially illegal move—decided not to allow their doctors to prescribe the meds, it is sometimes difficult for patients to find physicians willing to assist them.

Step No. 2: Present Oral And Written Requests

An individual must ask his or her physician for access to a medical-aid-in-dying prescription a total of three times. Two of the requests must be oral, in person, and separated by 15 days. The third must be written and comply with the conditions set in the law (signed and dated by the patient; signed by two witnesses who attest that the patient is mentally capable of making medical decisions, acting voluntarily, and not being coerced by anyone).
Procedural Glitch: Although mandatory waiting periods are required in all jurisdictions with medical-aid-in-dying laws, these requirements are especially challenging for patients in small towns or rural areas, where there might not be a doctor willing to participate for 100 miles. For terminally ill patients, making two long road trips to present oral requests can be next to impossible.

Step No. 3: Get A Referral To A Consulting Physician

The law requires that once a patient’s attending physician has received the appropriate requests and determined the patient has a terminal illness with a prognosis of less than six months to live, the doctor must refer the patient to another physician, who must agree with the diagnosis and prognosis as well as confirm that the patient is mentally capable, acting voluntarily, and not being coerced.

Procedural Glitch: Once again, difficulties with finding a willing physician can cause lengthy wait times.

Step No. 4: Fill The Prescription At A Pharmacy

Colorado’s medical-aid-in-dying law doesn’t stipulate which drug a physician must prescribe. There are multiple options, which your doctor should discuss with you. Depending on your insurance coverage (Medicare, Medicaid, and many insurance companies do not cover the drugs), as well as which hospital system your doctor works in, getting the medication can be as simple as filling a script for anything else.

Procedural Glitch: Not every hospital system will allow its on-site pharmacies to fill the prescriptions—HealthOne, for example, doesn’t. Corporate pharmacies, like Walgreens, and grocery-store-based pharmacies often will not fill or do not have the capability to fill the prescriptions. What’s more, Colorado pharmacists are able to opt out of filling the prescription for moral or religious reasons. That leaves doctors and patients in search of places to obtain the drugs once all of the other requirements have been fulfilled.

Step No. 5: Self-Administer The Medications

Although the time and place are mostly up to the patient, if he or she does decide to take the life-ending drugs, he or she must be physically able to do so independent of anyone else. Physical capability is something patients must consider, especially if their conditions are progressing quickly and could ultimately render them incapable of, for example, swallowing the medications.

Procedural Glitch: Depending on the drug that is prescribed and the pharmacy that fills it, patients and/or their families are sometimes put in the position of having to prepare the medication before it can be administered. Breaking open 100 tiny pill capsules and pouring the powder into a liquid can be taxing even under less stressful circumstances.

Step No. 6: Wait For The End

In most cases, medical-aid-in-dying patients fall asleep within minutes of drinking the medication and die within one to three hours. The law encourages doctors to tell their patients to have someone present when they ingest the lethal drugs.

Procedural Glitch: Although most doctors who prescribe the medication do not participate in the death, it is worth asking your physician or your hospice care organization in advance about what to do in the minutes immediately after your loved one has died at home, as 78.6 percent of Coloradans who received prescriptions for life-ending meds under the law and subsequently died (whether they ingested the drugs or not) did in 2017. Someone with the correct credentials will need to pronounce death and fill out the form necessary for a death certificate (cause of death is the underlying terminal illness, not death by suicide) before a funeral home can pick up the body.

Who’s In & Who’s Out?

A short breakdown of metro-area hospitals’ and health systems’ stances.

Completely Out
SCL Health
Centura Health
VA Eastern
Colorado Health Care System
Craig Hospital

In, With Caveats
HealthOne
Boulder Community Health

All In
Denver Health
UCHealth
Kaiser Permanente Colorado

Alternative Endings

An Oregon nonprofit is Colorado’s best aid-in-dying resource.

Although Oregon’s Compassion & Choices is best known here as the organization that helped push Proposition 106 onto Colorado’s November 2016 ballot, the nation’s oldest end-of-life-options nonprofit didn’t abandon the Centennial State after the initiative passed. “First, we help states enact the laws,” says Compassion & Choices’ Kat West, “then we stick around to help with implementation and make sure it’s successful.”

In Colorado, the rollout has been fairly fluid. Perfect? Certainly not. Fortunately, Compassion & Choices has been trying to smooth some of the wrinkles in the system. The biggest help so far might be its website. The nonprofit keeps its online content updated with everything a Coloradan needs to know about the state’s End-of-Life Options Act. Of particular note: the Find Care tool, which lists clinics and health systems that have adopted supportive policies, since finding participating physicians, hospitals, and pharmacies is still challenging. “Patients don’t have the time or energy to figure this out on their own,” West says. “We do it for them.”

Hospice Hurdles

Why some local hospices aren’t as involved in Colorado’s aid-in-dying process as you’d expect.

Despite what you might have heard, hospice is not a place where one goes to be euthanized. “That misconception is out there,” says Nate Lamkin, president of Pathways hospice in Northern Colorado. “We don’t want to perpetuate the thought that we’re in the business of putting people down. That’s not what we do.” That long-standing myth of hospice care is, in part, why many Colorado hospices have declined—potentially in violation of state law—to fully participate in the End-of-Life Options Act.

By and large, the mission of hospice—which is not necessarily a place, but a palliative approach to managing life-limiting illness—has always been to relieve patient suffering and to enhance quality of life without hastening or postponing death, Lamkin explains. “This law kind of goes in opposition to that ethos,” he says. To that end, like many other hospices, Pathways has taken a stance of neutrality: Pathways physicians cannot prescribe the life-ending medication, but the staff will support their patients—by attending deaths, by helping with documentation—who choose the option. “We are not participating by not prescribing,” Lamkin says. “But it is the law of the land, and we fully support those who choose medical aid in dying.”

Pathways is not alone in its abridged participation. Other large Front Range hospice care providers, like the Denver Hospice, have also either taken an arm’s-length stance on the practice or opted out entirely. End-of-life options advocacy nonprofit Compassion & Choices regards this as willful noncompliance, which could leave hospice providers exposed to legal action, especially considering that 92.9 percent of Colorado’s patients who died following the reception of a prescription for aid-in-dying meds in 2017 were using hospice care to ameliorate symptoms and make their deaths as comfortable as possible. But, says Compassion & Choices spokesperson Jessie Koerner, when hospices abstain from fully supporting medical aid in dying, it strips away Coloradans’ rights—rights to which the terminally ill are legally entitled.

 

Filling More Than Just Prescriptions

After spending years at a chain pharmacy, Denverite Dan Scales opened his own shop in Uptown so he could better serve his customers. 5280 spoke with him about being one of the few pharmacists in Colorado meeting the needs of medical-aid-in-dying patients.

5280: Of the roughly 70 medical-aid-in-dying prescriptions written in Colorado in 2017, Scales Pharmacy filled approximately 22 of them. Why so many?
Dan Scales: As a pharmacist, you have no obligation to fill a script that’s against your moral code. So there are many pharmacists who won’t fill the drugs. Also, many chain pharmacies—like Walgreens—don’t mix compounds, which means they can’t make the drug cocktail a lot of physicians prescribe. That leaves independent pharmacies like ours.

You don’t have any objections to the state’s End-of-Life Options Act?
I really believe we kinda drop the ball at the end of life. We do a poor job of allowing people to pass with dignity. I won’t lie, though: After filling the first couple of prescriptions, I did feel like I helped kill that person. I needed a drink. But talking with the families after helps.

You follow up with your patients’ families?
Yes. We ask them to call us after their loved one has passed. We want to know how it went, how the drugs worked, how long it took, was everything peaceful? I’d say about 30 percent call us to offer feedback. It helps us know how to better help the next person. You have to understand, this is not a normal prescription; we talk with these people a lot before we even hand them the drugs. We get to know them.

If you could change one thing about the process, what would it be?
It’s frustrating that there’s not more pharmacy participation in our state. We’re having to mail medications to the Western Slope because people can’t find the services they need.

Final Destination

She couldn’t travel with him this time, but a Lakewood woman supported her husband’s decision to go anyway.

They met online, way back in the fuzzy dial-up days of 1999. J and Susan* weren’t old, exactly, but at 50 and 49, respectively, they had both previously been married. They quickly learned they had a lot in common. They were both introverts. Each had an interest in photography. And they loved to travel, especially to far-flung places, like Antarctica. After about two years of dating, they got married in a courthouse in Denver. For the next 17 years, they saw the world together and were, Susan says, “a really great team.”

The team’s toughest test began in fall 2017. Susan says she should’ve known something was wrong when she asked J if he wanted to go on an Asia-Pacific cruise and he balked. Upon reflection, Susan realized J likely hadn’t been feeling well. “That hesitation was a clue,” she says. The diagnosis, which came in January 2018, was a devastating one: stage 3-plus esophageal cancer. It was, as Susan puts it, “a cancer with no happy ending.”

It would also be, Susan knew, a terribly difficult situation for J to manage. He had never been able to stand not being healthy; she was certain he wouldn’t tolerate being truly sick. And esophageal cancer makes one very, very sick. The tumors make swallowing food difficult, if not impossible. As a result, some sufferers lose weight at an uncontrollable clip. They can also experience chest pain and nasty bouts of acid reflux. J knew he was dying—and that he didn’t want to go on living if he could no longer shower or go to the bathroom alone or be reasonably mobile. He broached the topic of medical aid in dying with Susan in February. “Honestly, I had already thought about it,” she says, “so I told him I thought it was a great idea.”

As a Kaiser Permanente Colorado patient, J had access to—and full coverage for—the life-ending drugs. The process, Susan says, was lengthy but seamless. J got a prescription for secobarbital and pre-dose meds; they arrived by courier to their house in April. Having the drugs in hand gave J some peace. He wasn’t quite ready, but he knew he was in control of his own death. He would know it was time when he began to feel like his throat would be too tight to swallow the drugs—or when he became unable to care for himself.

That time came in late June. He was weakening, and he knew it. Having decided on a date, J had one last steak dinner with his family on the night before his death. “He was actually able to get a few bites down,” Susan says. “He was also able to have a nice, not-too-teary goodbye with his stepchildren. It was wonderful.”

Although she was immeasurably sad when she woke the next day, Susan says seeing the relief on J’s face that morning reinforced for her why medical-aid-in-dying laws are so important. She knew it was unequivocally the right decision for him—a solo trip into the unknown, but he was ready for it. At noon on June 25, J sat down on the couch and drank the secobarbital mixed with orange juice. “Then he hugged me,” Susan says, “and he said, ‘It’s working’ and fell asleep one minute later. It was really perfect. He did not suffer. It was all just like he wanted it.”
*Names have been altered to protect the family’s privacy.

Drug Stories

A numerical look at medical-aid-in-dying meds.

$3,000 to $5,000: Cost for a lethal dose of Seconal (secobarbital), one of the drugs doctors can prescribe. The price for the same amount of medication was less than $200 in 2009; the drugmaker has increased the cost dramatically since then. Many insurance companies will not cover the life-ending medication.

4: Drugs that pharmacists compound to make a lower-priced alternative to Seconal. The mixture of diazepam, morphine, digoxin, and propranolol, which is reportedly just as effective as Seconal, costs closer to $500 (pre-dose medications included).

5: Ounces of solution (drugs in powder form that are dissolved in a liquid) a medical-aid-in-dying patient must ingest within about five to 10 minutes.

2: Pre-dose medications—haloperidol to calm nerves and decrease nausea and metoclopramide to act as an anti-vomiting agent—patients usually take about an hour before ingesting the fatal drugs.

10 to 20: Minutes it typically takes after the meds are ingested for a patient to fall asleep; death generally follows within one to three hours.

Uncomfortable Silence

Just because roughly 65 percent of voters approved Colorado’s End-of-Life Options Act in 2016 doesn’t mean Centennial Staters are completely at ease with the idea of the big sleep. Just ask these health care professionals and death-industry veterans.

“In a perfect world, I think one should be with family at the end. There are benefits of sitting with a dying person. Compassion means ‘to suffer with.’ Sometimes that suffering isn’t physical; it’s emotional. A lot of healing can happen at the end.”
—Dr. Michelle Stanford, pediatrician, Centennial

“If people’s existential needs and pain are addressed—things they need to talk to their doctors and family about—natural death can be a beautiful thing. It doesn’t have to be scary. In American society, we don’t talk about death and dying. It’s because we fear it. We are afraid of the anticipated pain, of having to be cared for. In other cultures, there is more family support and there is no thought of being a burden. This is a part of life, part of what should naturally happen.”
—Dr. Thomas Perille, internal medicine, Denver

Doctors don’t die like our patients do. We restrict health care at the end of our lives. My colleagues don’t do the intensive care unit and prolonged death. We, as doctors, are not doing a good job helping patients with this part of their lives. Dying in a hospital is the worst thing ever. There is an amazing difference dying at home around friends and family.”
—Dr. Cory Carroll, family practice physician, Fort Collins

“Most people are unprepared for what needs to happen when a death occurs. Those who choose to lean toward the pain with meaningful ritual or ceremony are the ones I see months later who are moving through this process toward healing. The ones who think that grief is something that occurs between our ears are the ones who struggle the most. Sadly, we live in a society and a culture where grieving and the authentic expression of emotion is sometimes looked down upon.”
—John Horan, president and CEO of Horan & McConaty Funeral Service, Denver

We only die once, so let’s do it right. When death happens, whether it’s our own or a loved one or someone we know, it’s not just their death that we’re acknowledging, but it’s life that we are all acknowledging. I think it’s helpful and healthy to honor death because in doing so, we are helping to celebrate life.”
—Brian Henderson, funeral celebrant, Denver

63 Percentage of Americans, 18 years or older, who die in hospitals and other institutional settings, like long-term care facilities and hospices. In 1949, however, statistics show that only 49.5 percent of deaths occurred in institutions. Because death in the home has become more uncommon, experts say, few Americans have direct experience with the dying process and that separation has, in part, led us to fear, misunderstand, and essentially ignore the end of life as an important stage of life itself.

Sources: Centers for Disease Control and Prevention; American Psychological Association

Another Shoulder To Lean On

Front Range support groups that can make bereavement more bearable. —Will Jarvis

Healthy Self. Healthy Life.

This two-therapist firm offers support sessions specifically for those in their 20s and 30s as well as an anticipatory grief gathering called Facing The Long Road. This latter group—which focuses on helping 19- to 36-year-olds manage the despair and caregiving duties that can come with having a parent with a terminal illness—zeroes in on a demographic whose busy lives often get in the way of their well-being. Cost: $35/session

The Compassionate Friends

The premise behind the Compassionate Friends, a 49-year-old international organization, is that only other bereaved parents can understand the pain of losing a child. Today, the group gathers parents, grandparents, and family members and encourages peer-to-peer healing in monthly sessions. Six Front Range chapters provide safe places for those struggling with loss to share coping mechanisms and ways to find a new normal.
Cost: Free

Judi’s House

Childhood traumas, such as losing a sibling or a close relative, can be especially challenging to overcome. That’s why this nonprofit, housed two blocks from City Park, has trained clinicians on staff to help both children and families dealing with grief. Its 10-week structured programs put kids in groups of five to 10 other children, and the organization provides a free dinner before each weekly meeting—giving anguished families one less thing to worry about.
Cost: Free

What Remains

While there are myriad ways to die, in Colorado there are only a few methods by which your body can (legally) be disposed: entombment, burial, cremation, or removal from the state. We spoke with Centennial State funeral homes and cemeteries to understand the options. Just remember: Colorado law says the written wishes of the deceased must be followed, so discuss what you want with your family ahead of time so they aren’t surprised.

Burial

Typical cost: From about $5,000 for a casket and full funeral service, plus about $5,000 for cemetery fees (plot, headstone, etc.)
What you need to know: In Colorado, a funeral home cannot move forward with a burial (or cremation or transportation across state lines) until a death certificate is on file with the county and state, which normally takes a few days. The funeral home will need information like social security numbers and the deceased’s mother’s maiden name to begin the process. Further, state law requires that if a body is not going to be buried or cremated within 24 hours, it must be either embalmed (using chemicals as a preservative) or refrigerated, so make sure your loved ones know what you prefer. Your family can opt to have your body prepared at a funeral home and then brought home for a viewing or service, though. Finally, federal law mandates that your family be given pricing details about caskets, cemetery fees, and the like before they make a decision, so they are prepared for the costs.

Cremation

Typical cost: From about $600 for transportation, refrigeration, and cremation; additional fees for urns, memorials, and/or funeral services
What you need to know: Choosing cremation does not preclude having a funeral; many people opt to have funeral services and then have the body cremated. (In this case, you’ll still need a casket, but you can rent one instead of purchasing it.) Once you’ve gone the ashes-to-ashes route, you can’t be scattered willy-nilly on federal land, in part because straight cremains are not healthy for plants. For example, your family will need to apply for a free permit—which stipulates how and where ashes can be spread—if you’d like to have your cremains placed inside Rocky Mountain National Park. The most popular national park in Colorado got more than 180 such requests last year.

Green Burial

Typical cost: From about $1,500
What you need to know: Only one Colorado cemetery (Crestone Cemetery) and handful of funeral homes (like Fort Collins’ Goes Funeral Care & Crematory) have applied for and been certified by the Green Burial Council. That doesn’t mean there aren’t various shades of “green” burial available throughout Colorado, though, at places such as Littleton’s Seven Stones Chatfield—Botanical Garden Cemetery and Lafayette’s the Natural Funeral. Among the greener ways to go: avoid embalming (so the harmful chemicals don’t seep into the ground upon decomposition); opt for a simple shroud or biodegradable casket; have your grave be dug by hand, instead of with machinery, which comes with a carbon footprint; or select a cemetery or cremation garden that uses environmentally friendlier plants for landscaping (for example, Seven Stones uses rhizomatous tall fescue for its meadow, which requires less water to maintain).

Complete Article HERE!

‘Why I filmed a man take his final breath’

Steven Eastwood [L] was invited by Alan to film him as he died
By Helen Bushby

The old man lies in the hospital bed, drawing his last, rattling breath as he fades away from life.

The film camera, positioned just next to him, keeps rolling. We see the nurses move him to another room before they gently clean his body.

“Nobody wants to die but it’s a natural thing, we are biologically determined to die,” says documentary maker Steven Eastwood.

His film, Island, lays bare the dying process by filming four people with terminal illnesses.

Roy’s end of life care was tenderly shown

“Death is seen as a shameful thing – we think we’re a progressive society, but we repress and deny death,” Steven says.

“We’re no better than the Victorians.”

He was a quiet onlooker during the last year of his subjects’ lives, filming them in their homes before they became part of the daily rhythms of life in a hospice.

“To say you don’t want it to happen, you’re putting off facing something,” he says.

Mary talked a lot about her medical treatment during the film

“We need better death awareness to be more familiar with our mortality. I don’t think that’s ghoulish.”

The documentary came about after Fabrica, a gallery in Brighton, commissioned a film about end of life.

The London-based film-maker’s proposal was accepted, and he managed to get access to film in a hospice on the Isle of Wight.

He speaks fondly of his time there, saying: “These are four people I really cared about – Alan, Roy, Mary and Jamie; three were in their 80s and one was in his 40s.”

Steven regularly made the five-hour journey to the hospice, including the boat trip to the island, which features in the slow, often hypnotic imagery of the documentary and its trailer.

He made the film after having “two quite significant bereavements – my mother-in-law and my best friend, who was the same age as me.

“So I realised I didn’t know very much about what palliative care is.”

Steven thinks we need to face the reality of death, make it part of our daily existence, so it’s less frightening.

The Isle of Wight’s scenery makes up many of the film’s quiet moments

“I think we all have an existential fear – ‘if I see someone I love who’s died, it’ll be too traumatic, it’ll replace all the images I have of them, I’ll never be able to unsee it, somehow it’ll hurt me’.

“But for me it isn’t the case, being with someone after dying, with that intimacy. I found it quite empowering and peaceful.”

He has huge admiration for the people who work in hospices, and hopes his film can “celebrate and show what palliative care is”.

“The most radical, extraordinary people in our society are the least visible,” he says.

“They’re the carers. And the care we receive at the end of our lives is extraordinary.

Steven Eastwood admires nurses working in palliative care, such as the one pictured with Alan

“These hospices which people have anxiety about going into – they’re not morbid, sterile spaces, they’re places of life.”

He says that after one of the screenings of Island, a stranger approached him, saying it had made him “less afraid of dying”.

Steven adds: “It’s not an ambition of mine, but if you can sit through the film and at the end feel uplifted, if you can make some kind of peace with something that will happen to all of us, then that’s a good thing.”

He speaks fondly about all his subjects, talking at length about Alan, whose death we see at the start of the film. Alan died of cancer.

‘He was living to smoke’

“Alan had chain-smoked since he was 16 and he smoked in the hospice with a nurse lighting his cigarette. But he wasn’t dying of a smoking-related cancer.

“This is part of what palliative care is – helping someone smoke until they die.

“The doctors felt that if he hadn’t been smoking he would have died several weeks earlier – he was living to smoke.”

Alan invited him to film his last moments.

The film shows many poignant moments

“The second time I met Alan, we had a connection, he said, ‘I think you’d like to stay with me all the way through and I think that would be great’.

“He wanted to do something radical with his death, he felt quite radical about his life.

“He believed our tissue is just a vehicle and we translate into something else.

“As far as he was concerned, there was no self-consciousness around his image, he thought participating was a way of marking something of his philosophy. He became my movie star, he was like my Burt Lancaster.”

Steven recalls watching Alan die.

‘Bliss in his eyes as he died’

“His death was a long, running out of breaths. It was very peaceful and very beautiful and I felt really moved by it. I didn’t feel sad. He was really ready to die.”

Alan told Steven he had seen a man die when he was just 19, during active service in the forces in North Africa. His commanding officer was shot, and died in his arms.

“He held this man and said, ‘I saw bliss in his eyes as he died, and I knew that what we are experiencing now is not it, there’s more’.

“So for him, his death was the thing he’d been waiting for. We can’t all ask for that.”

Steven acknowledges that of course deaths can be sudden or premature, such as Jamie’s.

Jamie was in his 40s when he died

“Jamie had stage 4 stomach cancer and had a young family, his attachment to his daughter was so incredible.

“He wanted to die in the best way he could with his daughter, so he involved her in everything, talked about his treatment, about what it was going to be like when he’s not there.

“He’s the person who I get upset thinking about.”

The film has been used to help medics in handling end of life care, and Steven and his producer are partnered with Sussex NHS trust.

“We’ve run two sessions with trainee doctors, to use the film as a means to talk about how we speak around death and dying, and how we talk to patients.”

He’s also keen to attract a young audience as he says people in their 20s are the “biggest death deniers”.

Steven talks about the pressure to be “productive, youthful, to look good”.

Other cultures, such as Mexico’s, take a more colourful approach to death with Day of the Dead

“This idea that we’re terminal and have an end is too much. I’ve spoken to young people who think about their late life and say, ‘oh I just want to take a pill to end it, when I’m no longer viable I switch myself off’.

“I do think it’s challenging to confront your own mortality.”

Steven, who also volunteers at his local hospice, thinks other cultures handle death better than we do, saying in Ireland “you see a more sustained grieving process and more familiarity being around the body”.

He also talks about Latin America and Asia, where they have “a completely different attitude towards the dying process”.

Mexico’s Day of the Dead celebrates and remembers family ancestors

“I think we need better education – we are finite, our bodies do decay, and I’ve made my peace with that.

“I hope the film can return us to some extent to our biological bodies, and say yes, everybody will die, most people will die in this way, in their 70s or 80s from either heart disease or cancer, and the care will be extraordinary.

“I don’t find that a burdensome thought. I felt poorly informed, and now I feel better informed by making the film – I hope that it will do that for people.

“We die and we don’t have to turn it into some kind of sanctum, it’s life. And I think Alan showed me that, so yeah, I was very, very fortunate to be invited to film him.”

Complete Article HERE!

Limited English may mean less-gentle death in ICU

By Lisa Rapaport

Death for patients in U.S. intensive care units may look a lot different for people with limited English proficiency than for native speakers, a large study suggests.

About 8.5 percent of U.S. adults don’t speak English as their primary language, researchers note in Mayo Clinic Proceedings. While communication is crucial for decision-making at the end of life, it’s not been clear how language skills might influence the type of care dying patients receive.

For the current study, researchers examined data on 27,523 patients admitted to intensive care units (ICUs) in a large academic hospital over a three-year period. The total included 779 people, or about 3 percent, with limited English proficiency.

Death rates in the ICUs were the same no matter what language patients spoke most fluently, averaging 2.8 percent for both native speakers and those with limited English proficiency.

But among patients who died in the ICU, those with limited English proficiency were 62 percent less likely to have orders for comfort care before they died, and they took an average of 19 days longer to transition from active treatment to only measures designed to ease pain and suffering. Non-English speakers were also 26 percent more likely to be placed on breathing machines and 36 percent more likely to be put in restraints.

Patients with limited English proficiency were 38 percent less likely than native speakers to formally request what’s known as a do-not-resuscitate (DNR) order when they entered the ICU. A DNR tells hospital staff not to take measures to revive them if their heart stops working.

Non-English speakers were also 77 percent less likely to have an “advance directive,” a legal document that spells out what type of care patients want and who should make decisions on their behalf when they’re no longer able to communicate.

“This study shows that the end of life care that patients with limited English proficiency receive is different than for those who do not have language barrier,” said lead author Dr. Amelia Barwise of the Mayo Clinic in Rochester, Minnesota.

“This may be because more patients with limited English proficiency have an authentic desire to die with more aggressive medical therapies or that communication or other barriers prevent health care teams from optimally assessing and implementing a less aggressive approach for dying patients with limited English proficiency,” Barwise said by email.

The differences persisted even after the study team accounted for other factors that can independently impact care at the end of life like race, religion and age.

The study wasn’t a controlled experiment designed to prove how language abilities might directly impact care at the end of life. Another limitation is that it looked at a single hospital and might not reflect what happens elsewhere.

Even so, the findings resonate with other research suggesting that limited English skills can influence how patients are treated, said Dr. Gary Winzelberg, a researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.

“Patients with limited English proficiency are less likely to have advance directives because these documents were not designed for patients with low health literacy or patients from diverse cultural backgrounds,” Winzelberg said by email.

Interpreters can help.

“Families should insist on having an interpreter present during family meetings and other communication during which patients’ condition and care options are discussed,” Winzelberg added. “If an interpreter cannot be physically present, there are alternatives including connecting to an interpreter by phone – families should not be asked to serve as interpreters.”

Complete Article HERE!