A Good Enough Death

“Katy Butler is the author of “The Art of Dying Well,” from which this essay was excerpted in Tricycle magazine. (C) 2019 Katy Butler.”

What does it look like to die well?

By Katy Butler

If someone you love has died in a hospital, you may have seen modern death at its worst: overly medicalized, impersonal, and filled with unnecessary suffering. The experience can be a bitter lesson in Buddha’s most basic teaching: the more we try to avoid suffering (including death), the worse we often make it.

Even though roughly half of Americans die in hospitals and other institutions, most of us yearn to die at home, and perhaps to experience our leavetaking as a sacred rite of passage rather than a technological flail. You don’t have to be a saint, or be wealthy, or have a Rolodex of influential names to die well. But you do need to prepare. It helps to be a member of at least one “tribe,” to have someone who cares deeply about you, and to have doctors who tell you necessary truths so that you can decide when to stop aggressive treatment and opt for hospice care. Then those who care for you can arrange the basics: privacy, cleanliness, and quiet, the removal of beeping technologies, and adequate pain control. They can listen and express their love, and provide the hands-on bedside care hospice doesn’t cover.

From then on, a more realistic hope for our caregivers, and for ourselves when we are dying, may not be an idealized “good death” by a well-behaved patient, but a “good enough death,” where we keep the dying as comfortable and pain-free as possible, and leave room for the beautiful and the transcendent—which may or may not occur.

Hospice professionals often warn against high expectations. Things will probably not go as planned, and there comes a point when radical acceptance is far more important than goal-oriented activity. They don’t like the idea, inherent in some notions of the “good death,” of expecting the dying to put on a final ritual performance for the living, one marked by beautiful last words, final reconciliations, philosophical acceptance of the coming of death, lack of fear, and a peaceful letting go.

“In It Together” by Nancy Borowick. Nancy Borowick’s photo series (January 2013 through December 2014) depicts the experiences of Howie and Laurel Borowick, partners for over 30 years, who found their lives consumed by doctor appointments and the shared challenges of chemotherapy.
“The Calm before the Storm”
“His and Hers”

“I don’t tell families at the outset that their experience can be life-affirming, and leave them with positive feelings and memories,” said hospice nurse Jerry Soucy. “I say instead that we’re going to do all we can to make the best of a difficult situation, because that’s what we confront. The positive feelings sometimes happen in the moment, but are more likely to be of comfort in the days and months after a death.” This is what it took, and how it looked, for the family of John Masterson.

John was an artist and sign painter, the ninth of ten children born to a devout Catholic couple in Davenport, Iowa. His mother died when he was 8, and he and two of his sisters spent nearly a year in an orphanage. He moved to Seattle in his twenties, earned a black belt in karate, started a sign-painting business, and converted to Nichiren Shoshu, the branch of Buddhism whose primary practice is chanting. He never left his house without intoning three times in Japanese Nam Myoho Renge Kyo (“I Honor the Impeccable Teachings of the Lotus Sutra”).

He was 57 and living alone, without health insurance, when he developed multiple myeloma, an incurable blood cancer. He didn’t have much money: he was the kind of person who would spend hours teaching a fellow artist how to apply gold leaf, while falling behind on his paid work. But thanks to his large extended family, his karate practice, and his fierce dedication to his religion, he was part of several tribes. He was devoted to his three children—each the result of a serious relationship with a different woman—and they loved him equally fiercely. His youngest sister, Anne, a nurse who had followed him to Seattle, said he had “an uncanny ability to piss people off but make them love him loyally forever.”

When he first started feeling exhausted and looking gaunt, John tried to cure himself with herbs and chanting. By the time Anne got him to a doctor, he had a tumor the size of a half grapefruit protruding from his breastbone. Myeloma is sometimes called a “smoldering” cancer, because it can lie dormant for years. By the time John’s was diagnosed, his was in flames.

Huge plasma cells were piling up in his bone marrow, while other rogue blood cells dissolved bone and dumped calcium into his bloodstream, damaging his kidneys and brain function. He grew too weak and confused to work or drive. Bills piled up and his house fell into foreclosure. Anne, who worked the evening shift at a local hospital, moved him into her house and drove him to various government offices to apply for food stamps, Social Security Disability, and Medicaid. She would frequently get up early to stand in line outside social services offices with his paperwork in a portable plastic file box.

Medicaid paid for the drug thalidomide, which cleared the calcium from John’s bloodstream and helped his brain and kidneys recover. A blood cancer specialist at the University of Washington Medical Center told him that a bone marrow transplant might buy him time, perhaps even years. But myeloma eventually returns; the transplant doesn’t cure it. The treatment would temporarily destroy his immune system, could kill him, and would require weeks of recovery in sterile isolation. John decided against it, and was equally adamant that he’d never go on dialysis.

After six months on thalidomide, John recovered enough to move into a government-subsidized studio apartment near Pike Place Market. He loved being on his own again and wandered the market making videos of street musicians, which he’d post on Facebook. But Anne now had to drive across town to shop, cook, and clean for him.

The health plateau lasted more than a year. But by the fall of 2010, John could no longer bear one of thalidomide’s most difficult side effects, agonizing neuropathic foot pain. When he stopped taking the drug, he knew that calcium would once again build up in his bloodstream, and that he was turning toward his death.

An older sister and brother flew out from Iowa to help Anne care for him. One sibling would spend the night, and another, or John’s oldest daughter, Keely, a law student, would spend the day.

Christmas came and went. His sister Irene returned to Iowa and was replaced by another Iowa sister, Dottie, a devout Catholic. In early January, John developed a urinary tract infection and became severely constipated and unable to pee. Anne took him to the University of Washington Medical Center for what turned out to be the last time. His kidneys were failing and his bones so eaten away by disease that when he sneezed, he broke several ribs. Before he left the hospital, John met with a hematologist, a blood specialist, who asked Anne to step briefly out of the room.

Anne does not know exactly what was said. But most UW doctors are well trained in difficult conversations, thanks to a morally responsible institutional culture on end-of-life issues. Doctors at UW do not simply present patients with retail options, like items on a menu, and expect them to blindly pick. Its doctors believe they have an obligation to use their clinical experience to act in their patients’ best interests, and they are not afraid of making frank recommendations against futile and painful end-of-life treatments. When the meeting was over, the doctor told Anne that her brother “wanted to let nature take its course.” He would enroll in hospice. Anne drove him home.

John knew he was dying. He told Anne that he wanted to “feel everything” about the process, even the pain. He took what she called “this Buddhist perspective that if he suffered he would wipe out his bad karma. I said, ‘Nah, that’s just bullshit. You’ve done nothing wrong. The idea that we’re sinners or have to suffer is ludicrous.’” She looked her brother in the eye. She knew she was going to be dispensing his medications when he no longer could, and she wasn’t going to let him suffer. She told him, ‘You’re not going to have a choice.’”

The drive to treatment takes half an hour, and Howie and Laurel Borowick take turns, resting and driving, depending on who’s getting treatment that day. “The Drive to Chemo”
In Laurel’s final moments, her family assured her that all would be OK.
“Last Touch”

Anne said she “set an intention”: not to resist her brother’s dying, but to give him the most gentle death possible and to just let things unfold. On January 15, her birthday, she and John and a gaggle of other family members walked down to Pike Place Market to get a coffee and celebrate. John was barely able to walk: Anne kept close to him so that she could grab him if he fell. It was the last time he left the house.

The next morning, a Sunday, while Anne was sitting with John at his worktable, he looked out the window and asked her, “Do you think I’ll die today?” Anne said, “Well, Sundays are good days to die, but no, I don’t think it’s today.” It was the last fully coherent conversation she had with him.

He spent most of his last nine days in bed, as his kidneys failed and he grew increasingly confused. He didn’t seem afraid, but he was sometimes grumpy. He had increasing difficulty finding words and craved celery, which he called “the green thing.” He would ask Anne to take him to the bathroom, and then forget what he was supposed to do there. His daughter Keely took a leave of absence from law school, and Anne did the same from her job at the hospital. Fellow artists, fellow chanters, former students to whom he’d taught karate, nephews, nieces, and sign-painting clients visited, and Anne would prop him up on pillows to greet them.

Anne managed things, but with a light hand. She didn’t vet visitors, and they came at all hours. If she needed to change his sheets or turn him, she would ask whoever was there to help her, and show them how. That way, she knew that other people were capable of caring for him when she wasn’t there. “The ones that have the hardest time [with death] wring their hands and think they don’t know what to do,” she said. “But we do know what to do. Just think: If it were my body, what would I want? One of the worst things, when we’re grieving, is the sense that I didn’t do enough,” she said. “But if you get in and help, you won’t have that sense of helplessness.”

Each day John ate and spoke less and slept more, until he lost consciousness and stopped speaking entirely. To keep him from developing bedsores, Anne would turn him from one side to the other every two hours, change his diaper if necessary, and clean him, with the help of whoever was in the room. He’d groan when she moved him, so about a half an hour beforehand, she’d crush morphine and Ativan pills, mix them with water as the hospice nurse had showed her, and drip them into John’s mouth.

One morning her distraught brother Steve accused her of “killing” John by giving him too much morphine—a common fear among relatives, who sometimes can’t bear to up the dose as pain gets worse. At that moment, the hospice nurse arrived by chance, and calmly and gently explained to Steve, “Your brother is dying, and this is what dying looks like.”

The death was communal. People flowed in and out, night and day, talking of what they loved about John and things that annoyed them, bringing food, flowers, candles, and photographs until John’s worktable looked like a crowded altar. Buddhists lit incense and chanted. Someone set up a phone tree, someone else made arrangements with a funeral home, and one of the Buddhists planned the memorial service.

Most of the organizing, however, fell to Anne. It may take a village to die well, but it also takes one strong person willing to take ownership—the human equivalent of the central pole holding up a circus tent. In the final two weeks, she was in almost superhuman motion. She leaned in, she said, “into an element of the universe that knows more than I know. I was making it up as I went along. People contributed and it became very rich.

“That’s not to say there weren’t times when it was phenomenally stressful. I was dealing with all the logistics, and with my own mixed emotions about my brother. I was flooded with memories of our very complicated relationship, and at the same time I knew my intention was that he be laid to rest in the most gentle way possible.”

Hospice was a quiet support in the background. Over the two years of his illness, John’s care had perfectly integrated the medical and the practical, shifting seamlessly from prolonging his life and improving his functioning— as thalidomide and the doctors at UW had done—to relieving his suffering and attending his dying, as the hospice nurses and those who loved him had done.

There were no demons under the bed or angels above the headboard. Nor were there beeping monitors and high-tech machines. His dying was labor-intensive, as are most home deaths, and it was not without conflict.

A few days before he died, two siblings beseeched Anne to call a priest to give John last rites in the Catholic church. “It was a point of love for my siblings. They were concerned that John was going to burn in hell,” Anne said. “But John hated priests.” In tears, Anne called the Seattle church that handled such requests, and the priest, after a brief conversation, asked her to put her sister Dottie on the phone. Yes, Dottie acknowledged, John was a Buddhist. No, he hadn’t requested the sacraments. Yes, his children were adamantly opposed. No, the priest told her, under the circumstances he couldn’t come. It wasn’t John’s wish.

Ten days after the family’s last walk through Pike Place Market, the hospice nurse examined John early one morning and said, “He won’t be here tomorrow.” She was seeing incontrovertible physical signs: John’s lips and fingertips were blue and mottled. He hadn’t opened his eyes in days. His breathing was labored and irregular, but still oddly rhythmic, and he looked peaceful. The hospice nurse left. Anne, helped by John’s daughter Keely and his sister Dottie, washed and turned John and gave him his meds. Then they sat by his side. Anne had her hand on his lap.

“It was January in Seattle,” Anne said. “The sun was coming through the window and we could hear the market below beginning to wake up. We were just the three of us, talking and sharing our stories about him and the things we loved and didn’t love, the things that had pissed us off but now we laughed about. I can’t ever, in words, express the sweetness of that moment.

“He just had this one-room apartment with a little half-wall before the kitchen. I walked over to put water on to make coffee, and Keely said, ‘His breathing’s changed.’”Anne stopped, ran over, sat on the bed, and lifted her brother to a sitting position. He was light. She held him close, and during his last three breaths she chanted Nam Myoho Renge Kyo, as her brother had always done, three times, whenever he left his house. “I was really almost mouth-to-mouth chanting, and he died in my arms,” she said. “We just held him, and then my sister Dottie said her prayers over him.”

Anne sat next to her brother and said, “John, I did well.”

“I know he would not have been able to orchestrate it any better than how it unfolded,” she said.

“It was a profound experience for me. I realized what a good death could be.”

Complete Article HERE!

Medical aid in dying is the ultimate religious freedom

Under current law, people who have made every life decision based on their personal values and faith suddenly become, due to a terminal illness, a victim of someone else’s theology. 

By Harlan Limpert

My Uncle Don died in his mid-60s after a two-year struggle with cancer. He was one of my favorites, an adult with whom I could discuss topics I couldn’t even mention to my parents. As a kid I’d often ride my bike to his home in Richfield with assurance of getting some cookies, Rice Krispies bars or a similarly unhealthful snack.

So when in college I learned he had lung cancer, I was heartbroken. Like so many cancer patients, he “fought the good fight” — chemo, surgery, radiation. Despite all the treatments, the disease was winning.

One day, after returning from one of countless doctor appointments, he walked into his bedroom, pulled out a gun and shot himself. My aunt, hearing the shot from the kitchen, lived another 20 years with that horrendous memory.

My uncle accepted some comfort care but would not succumb to the cancer robbing him of his humanity. He wanted to die as he had lived, on his own terms. But at that time, medical aid in dying (MAID) wasn’t legal. I have no doubt that, after realizing the futility of further treatment, Uncle Don would have taken advantage of MAID, which enables a mentally competent adult suffering from a terminal illness to request from their physician medication that will end life peacefully. Medical aid in dying has been legal in Oregon for 20 years since that state’s’ passage of its Death with Dignity law and is now legal in seven more states, including California.

Many of us know of someone suffering from a terminal illness. Most often they are willing to fight like hell for as long as possible but in the end pray for a gentle, painless death.

For decades, Gallup Polls have shown that a majority of Americans support medical aid in dying as an end-of-life option. Twenty state legislatures, including Minnesota’s, have introduced bills similar to Oregon’s Death with Dignity law. But, despite widespread support, lawmakers are reluctant to act. Why? Despite the overwhelming support of people of faith, some religious leaders are fighting it, insisting that Americans die by what they call a “natural death.” Suffering, they argue, is redemptive (“to change for the better”). Even the loved ones surrounding the dying person, it is believed, are changed — redeemed — by the experience.

Other people of faith — me included — see nothing redemptive about needless suffering. In fact, needless suffering is cruel and pointless. The proper religious response to suffering is to alleviate it, to show compassion to the one who is suffering. And there is nothing “natural” about being connected to numerous tubes injecting futile drugs into a dying person’s veins when that person would prefer her suffering to end. There is nothing natural about a respirator providing oxygen to a person whose clear intention was to have a good death, one surrounded by loved ones and absent of unnecessary suffering.

National Religious Freedom Day was Jan. 16. For at least 25 years, U.S. presidents have issued annual proclamations acknowledging and celebrating the many faiths that exist within our country. They have reminded us of our cherished legacy of religious liberty. They recall how Thomas Jefferson penned the Virginia Statute of Religious Freedom in 1786, which inspired the words of the First Amendment to the Constitution guaranteeing the free exercise of religion.

But when it comes to end-of-life care, an individual’s personal religious freedom is limited by current law. People who have made every life decision for decades based on their personal values and faith suddenly become, due to a terminal illness, a victim of someone else’s theology. The arena of life that is most personal and profound often has people with different religious values determine our options. At end of life, one’s personal values and spiritual beliefs ought to take priority over everything else.

Passing legislation to allow medical aid in dying in Minnesota will enable end-of-life options to be decided by an individual’s values and spiritual beliefs and no one else. Those who choose medical aid in dying can do so. Those who do not would not be affected.

As National Religious Freedom Day is celebrated, let us remember to honor religious freedom and show compassion to those wishing to end their suffering.

Complete Article HERE!

A Place for Death in the Life of the Church

What does faithful ministry look like in a church that sees more funerals than baptisms?

BY

I remember the first time I touched a dead body. It was at my grandfather’s funeral. You know the scene: attendants in boxy black suits, the cloying scent of flowers, tissue boxes, breath mints, dusty funeral parlor furniture. As the sad murmur of relatives droned all around, I stepped up to the coffin and quickly reached in to touch his embalmed hands, folded nicely on his belly. They felt like cold, soft leather.

That was when death was still an anomaly to me, an outlier. Now it has become familiar, a recurring pattern in recent weeks and months. For the past several years, I’ve served as a pastor in a suburban parish, an evangelical who made his home in a mainline church. I don’t run the show, since I’m a lay pastor, but I’ve been there for most of the funerals. In the past few years we’ve had almost 40 in our parish. Those are a lot of faces I won’t get to see any more on Sunday mornings. Death is no longer a stranger to me; it is a regular part of my life.

This has been one of the more difficult parts of being a pastor, seeing people who faithfully served our Lord over decades take ill and start a steep decline. These deaths don’t have the shock of tragedy, of teenagers hit by cars or babies born without breath. Still, the dull ache of sorrow is there.

It wasn’t always this way for me. I grew up in a thriving megachurch (by Canadian standards, anyways), and I took it for granted that slowly and surely our congregation would continue to expand. And it did, all through my teen years. As I looked out over the congregation on Sunday mornings, I could see a diverse group of people from ages 15 to 60. But children were most often annexed to their age-appropriate ministries, seniors were few and far between, and funerals were not a constant. The bulk of our congregants were in the prime of life.

Later, when I began my pastoral ministry in a congregation that skewed to those over 65, I became frustrated as our church struggled to thrive. Growth no longer just seemed to happen. And though we saw many young families drawn deeper into the life of Christ, we also lost many veteran saints. I learned to care for the very young as our nursery filled up, and I learned to walk with the aging as they lost the strength to sit in our pews.

Though I looked longingly at congregations that seemed to expand effortlessly, I learned to love the slow work of pastoring a struggling congregation. I took in the beauty of a woman in her 80s dancing with toddlers and singing worship songs. And I remember the 70th wedding anniversary of a couple that faithfully attended worship for just as many years. These quiet miracles don’t have the same luster as other “vibrant” ministries I’ve been a part of, but nonetheless, they witness to the patience and love of God. I came to appreciate the church as the body of Christ formed of the whole people of God, from young to old—even those heading to their graves.

Pastoring an Aging Congregation

Death does not fall outside the life of Christ’s Body; it is a threshold through which we all must walk. Recognizing death as part of our common Christian life allows for a more expansive vision of God’s redemption, which begins the day we are conceived and carries us into our dying

I’ve come to appreciate my close experiences with death. When I look at large, booming churches or hip, thriving church plants, I wonder if their pastors experience the regular privilege of burying octogenarians. I’m glad for these growing churches, insofar as people are having encounters with Christ and his Word. I wish so many of the churches in my denomination would thrive like that. Yet I’m learning to appreciate aging congregations like my own in which the whole community of faith mourns with the death of each faithful servant.

I recently read Kate Bowler’s book, Everything Happens for a Reason: And Other Lies I’ve Loved. Bowler was diagnosed with stage IV colon cancer at age 35. She was enjoying a vibrant career, academic success, and a wonderful home with her husband and toddler. The news of her cancer seemed to crush all of that. Life had to be put on hold for chemo, rest, and preparation for dying.

She writes in her memoir about churches in which blessings come as the direct result of fierce faith. She writes, “The prosperity gospel is a theodicy, an explanation for the problem of evil. It is an answer to the questions that take our lives apart. … The prosperity gospel looks at the world as it is and promises a solution. It guarantees that faith will always make a way.” Bowler writes that she tacitly held to a tamer form of prosperity gospel logic. She expected that, if she followed Jesus, things would go pretty well because God loves her and wants her to have a good life.

I often find myself believing the same thing about my church: if we worship Jesus and do his will, he will bless us with new members and increased vitality. Stagnant membership and death in the congregation feel like punishments for lack of faith.

But God throws wrenches in the wheels of our theological systems. We get fired. We get divorced. We get sick. We die.

Our local congregations lose their liveliness. They suffer from conflicts. They struggle to raise funds. They shrink

Christians believe that “death is swallowed up in victory” (Isa. 25:8, 1 Cor. 15:54). Our faith is built upon the fact that Christ has died, Christ is risen, and Christ will come again. But our experience of death is not always so straightforward. Our sojourn still leads to our bodies being cremated or placed in a coffin.

Helping People Reckon with Death

In many churches I’ve attended, death was pushed to the margins. It was treated like an interruption to God’s work in the world, not as an instrument by which God draws people more fully into his own life. I’m not saying we should love death—after all, it’s still “the last enemy” (1 Cor. 15:26). But part of living as disciples is learning to die well.

Ephraim Radner, professor of historical theology at Wycliffe College, writes,

“To die well” is to locate what is good somewhere outside our control—in the God who gives and receives our lives. It is also to allow that alien goodness, the goodness of God’s transcendent superintendence over life and its temporal duration, to inform the very meaning of our vulnerability to illness, suffering, and death.

In other words, by embracing death in our churches, we allow our creator to give meaning to our human weakness.

Stanley Hauerwas notes in God, Medicine, and Suffering that Western culture shifted from preparing Christians to die well in the medieval period to franticly attempting to cure us from death in contemporary society. He writes, “We have no communal sense of a good death, and as a result death threatens us, since it represents our absolute loneliness.” According to Hauerwas, we need to learn once again how to grapple with our mortality.

Stories like Bowler’s, then, make me wonder about the kind of church we ought to be. What might it mean to be a church where people regularly come face to face with death? How can we present the gospel in a way that changes hearts, but also ministers to people whose earthly lives will never return to “normal?”

One way in which pastors can deal with death is by talking about it openly in sermons and in conversation. I remember talking with a friend who has since passed away from cancer. He told me that many of the Christians he encountered didn’t want him to talk about the possibility of death. They wanted him to stay positive, focusing on things he could do to get better. He knew that he wouldn’t, but he felt the pressure to stay positive for the sake of others. When I talked frankly with him about the possibility of death, he seemed to breathe easier. In naming death, he allowed the grace of God to come to him even there.

We talk about illness and aging as “battles”; to die is to lose these battles. But staying alive is a battle we all lose eventually—some quickly, some slowly—so we might as well invite God’s presence into our dying. In the cross we understand our living and our dying. What better place to learn this than the church? Who better to initiate these conversations than pastors? Sure, I want my church to be dynamic, vibrant, growing; I pray to God for this. But I also want to cultivate a church where people can reckon with death, worshiping a savior who won his victory hanging from nails pinned to a wooden cross.

Complete Article HERE!

Let’s talk about pain

In an increasingly secularised society, suffering noisily beats suffering in silence

By Michael Cook

“I feel your pain,” Bill Clinton told an AIDS activist in the 1992 presidential campaign. Well, he probably didn’t. Pain is notoriously subjective and hard to measure. Some patients take the dentist’s drill without an anaesthetic; most of us would rather die.

In the 19th and early 20th Centuries doctors speculated why some groups were more sensitive. Their answers reflected the cultural and racial prejudices of the era. One popular theory was that less civilised groups were both less sensitive to pain and more expressive when they experienced it. Doctors contrasted stalwart, stoic Britons with degenerate, weeping dark-skinned people.

A contrasting theory was that civilisation was making people soft. The father of modern neurology, Silas Weir Mitchell, wrote in 1892 that “in our process of being civilized we have won, I suspect, intensified capacity to suffer. The savage does not feel pain as we do: nor as we examine the descending scale of life do animals seem to have the acuteness of pain-sense at which we have arrived.”

Today the opioid epidemic makes the study of differential rates of pain more urgent than it ever was. Current research seems to indicate that Americans in lower socio-economic groups experience more pain.

“If you’re looking at all pain – mild, moderate and severe combined – you do see a difference across socioeconomic groups. And other studies have shown that,” says University at Buffalo medical sociologist Hanna Grol-Prokopczyk. “But if you look at the most severe pain, which happens to be the pain most associated with disability and death, then the socioeconomically disadvantaged are much, much more likely to experience it.”

It’s also relevant in the debate over assisted suicide. Remember Brittany Maynard, the 29-year-old woman whose assisted suicide in Oregon sent a powerful message to Californians to legalise assisted suicide? Shortly before dying, she said, “I don’t want to die. But I am dying. Death with dignity is the phrase I’m comfortable using. I am choosing to go in a way that is with less suffering and less pain.” Pain, or even the prospect of pain, is often regarded as sufficient reason to ask a doctor’s help in committing suicide.

From the point of view of a utilitarian, an increasingly popular philosophy, any pain might be enough to justify suicide. Indeed, the pessimistic South African philosopher David Benatar argues that “a life filled with good and containing only the most minute amounts of bad – a life of utter bliss adulterated only by the pain of a single pin-prick – is worse than no life at all” (Better Never to Have Been: The Harm of Coming into Existence, 2008).

Coming at pain from a different perspective, linguistics expert David Johnson, of Kennesaw State University, in Georgia, has opened up another line of research. In an article in the Interdisciplinary Journal of Research on Religion he charted the frequency of the words “pain” and “hurt” since the year 1800 in four linguistic databases: Google Books Corpus, Corpus of Contemporary American English, Corpus of Historical American English, and Time Magazine Corpus. What he found was a sharp increase in “pain language” in American English since the 1960s. And over the same period words like “religion” and “God” and related concepts like “mortification”, “patience”, “dread”, and “sin” declined steeply.

Why? It is impossible to propose a definitive answer based on word usage, but Johnson’s investigation points at some intriguing lines of inquiry. His theory is that “this growth parallels the era when language related to the divine was in sharp decline”. In other words, a much greater willingness to talk about pain is correlated to a decrease in religious motivation for enduring pain.

… increasing American secularism plays a significant role. After all, the dilemma of the co- existence of pain and a good God is an eternal problem. To suffer in silence is lauded as the appropriate Christian response to pain. And there is a long Christian tradition of promoting suffering in silence … 

But with the increasing secularization in 20th and 21st century American society, notions of Christian stoic piety evaporated; thus, people discuss their pain more. And why not? If suffering in silence is not meritorious nor does it assist in religious redemption, then, like [the Greek mythological figure] Philoctetes, sufferers should complain all they want. If for no other reason, it might make them feel better. Interestingly, the data presented above does show an increase in pain, particularly since the 1960s in American English, which coincides with the same era when language related to the divine was in sharp decline.

This is hardly a watertight proof that secularism is responsible for our increasing sensitivity to suffering, but it sems like a plausible explanation. The central symbol of Christianity is the Cross, two crossed beams of wood with a man who claimed to be God nailed to them. It is, in other words, a religion which purports to explain the mystery of suffering by asking us to contemplate the example of God himself. Secularism’s answer to inescapable pain is “stuff happens” or “life’s a bitch and then you die”.

The ancient wisdom of mankind –Christian, Muslim, Buddhist or Hindu — is that we can bear any suffering if we find meaning in it. But without meaning, all we can do is talk about it. Endlessly. As Johnson points out, if “proscriptions against complaining or even discussing pain are removed, the modern American sees little reason to withhold discussion of pain.”

Complete Article HERE!

More to dying than meets the eye

Those who work with dying people are familiar with patients seeing long deceased loved ones, angelic beings, even hearing music and comforting voices as the patient nears death. Deathbed phenomena have been documented in the days, weeks, and months before death since the 1500s. Often confused with hallucinations, deathbed phenomena can bring comfort to patients and caregivers if those involved know what they are experiencing. This talk will explain deathbed phenomena and present on-going research about the topic. Accounts from the dying and bedside witnesses will be shared.

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.

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What Is a Good Death?

Talking about death is hard. And usually it’s really, really hard. Maybe it’s because—much like the process of dying itself—it requires us to be vulnerable, to be honest, to come to terms with a denial we engage with, to varying degrees, our whole lives.

“Death happens to everybody, yet somehow we’re surprised by it,” says hospice and palliative care specialist BJ Miller, MD. “I’m shocked at how many patients and family members have not only had to deal with the pain of sickness and loss, but on top of that they feel bad for feeling bad. They’re ashamed to be dying, ashamed to be sick. There’s a horrible unnecessary suffering that we heap on ourselves and each other for nothing.”

The more intimate we get with the idea of dying, the closer we come to folding it into the fabric of our daily lives, the better off we’ll all be, Miller says. Advice on how to die well is really no more than advice on how to live well, with that unavoidable reality in mind.

A Q&A with Dr. BJ Miller, MD

Q
What is a good death?
A

It’s a deeply subjective question, and the best way I can answer objectively it is to say a good death is one that’s in keeping with who you are as a person; a good death is consonant with your life and your personality.

For example, most people say they want to die at home, that they want to be free from pain. That usually means not having a bunch of medical interventions happening at the end. Effort is put toward comfort instead. But I also know plenty of people who say, “No, no, no. I’m the kind of guy who wants to go down swinging,” or “I’m looking for a miracle,” or whatever it is. And for them, a good death may very well be in the ICU with all sorts of interventions happening, anything that’s going to give them a chance, because they see themselves as fighters and they want to go out fighting.


Q
What’s the role of hope in dying?
A

Hope is a beautiful, powerful, and very useful force. It’s what gets most of us out of the bed in the morning. It’s not a question of whether or not you have hope; the question’s more: What do you hope for? The work is harnessing your hope for something that’s attainable or for something that serves you.

When I’m talking to a patient, and I ask them, “What do you hope for?” If they say, “Well, I hope to live forever,” we can label that a miracle pretty safely. I can say, “I’ll hope for that, too, but if we don’t get that, and if time is shorter than you want, then what do you hope for?” Because hope needs to be qualified. So they’ll say, “Ah, well, if I’m not going to be around much longer, well, then I really hope to make it to my grandson’s graduation in the summer,” or “I really hope to get through the World Series,” or whatever it is.

It’s tempting to say that hope is this thing that you either have or you don’t have. That when you don’t have it, then that’s like giving up or letting go. But it’s not. You can hope and understand you’re dying at the same time. It’s very possible when someone comes to terms with the fact that they’re dying soon, that they hope for a painless death, or they hope to die on a certain day. Those are realistic hopes; it’s a matter of channeling that big force.


Q
In what ways is our health care system not equipped to handle dying well?
A

In the last hundred or so years, what’s become the norm for end-of-life care in the West is a very medicalized death. Hospitals and doctors have become arbiters of death; it used to be a much more mystical thing involving nature and family and culture. But of late, medicine in all of its power has co-opted the subject, and so most people look to their doctors and hospitals as places that forestall death.

We’re spending a lot of time—when it’s precious—in the hospital or at a doctor’s office. You spend a lot of time navigating medications. You’re spending a lot of time hanging on every word the doctor says. That’s a problem in that it’s not really what most of us want. But it goes that way because we’re afraid to confront the truth. We’re afraid to talk about it, so we all end up in a default mode. The default mode is in the hospital with a bunch of tubes and medicines and someone keeping your body alive at any cost. That has become the default death, and that’s not what most people would consider a good death.


Q
How do you approach that conversation of getting someone to accept the reality of their sickness and also the uncertainty that might come with it?
A

It’s really hard, and it’s a really complicated dynamic. Most people don’t want to hear that they’re dying, so they don’t listen to their doctors, and most doctors don’t want to tell people that they’re dying.

Because people aren’t primed to hear it, and doctors aren’t primed to say it, what happens is there’s this little complicit dance between doctors and patients and family members. Everyone just kind of tries to scare one another off, so they don’t mention death and they instead lean on euphemisms. You’d be shocked at how many well-educated, thoughtful people come toward the end of their life and find themselves surprised that they’re dying.

A palliative care doctor starts the conversation by getting a sense of where the patient is. What’s their understanding of their illness? I typically invite a conversation with open-ended questions, like “Well, tell me about what’s important to you. Tell me about what you would let go of to live longer.” I get to know the person. When I feel safe with them and we’re speaking the same language, then I can broach the subject of time, and I can say, “Well, you know, because of X, Y, or Z diagnosis, whatever else it is, at some point this disease is not likely to be curable, and we’re going to have to turn our attention to the fact of death. Let’s prepare for it. Let’s plan for it.”

This is where death and life go together very helpfully: The way to prepare for death is to live the life you want. If you start talking to someone about how they want to die, you usually end up landing on how they want to live until they die. That’s a much less scary conversation. It’s a much more compelling conversation for people, too, and it’s more accurate.


Q
What matters to most people at the very end?
A

There are consistent themes around this, which we know from both data and experience:

  • Comfort is important. Very few people are interested in suffering. Some people are, but most people want to be free from pain.
  • Most people want to be surrounded by friends and family. They want to be either at home or at a place they call home, a place of their choosing; some people are in the hospital for months, and that becomes their home. The people around them become their family.
  • Most people are spiritual and have some relationship to a creator, so most people want to be at peace with their god, to be at peace spiritually.
  • Most people also want to leave their family with as little burden as possible, so that means financial planning, etc. It’s very important to people that they not be a burden to their family unnecessarily.

Q
Why do you think as a culture we find it so challenging to talk about death and dying?
A

You can kind of tell that America is a young place, in part by the way we handle aging and death. We’re terrified of it. Most cultures have been dealing with this a long, long time and have made peace with death as a part of life. Instead of falling back on institutional cultural ritualized knowledge, we’ve outsourced dying to medicine. We leave one another feeling like we’re incompetent at dying, when in fact, we have it in us. We’re just too far removed from it.

In the last 170 years or so, as a society—especially in the health care industry—we’ve been in a long romance with innovation and technology. We believe if you hang in long enough and you work hard enough, everything is solvable. That we can invent our way through anything. You hear people talk, and you realize somehow they’ve absorbed this idea that death is optional, when in fact, of course, it’s not. I notice in my practice when I’m dealing with someone who lives on a farm, someone who is close to nature and its cycles, that they know that death is a part of life. Inherently. They’re around it all day, every day, whether it’s slaughtering an animal or raking up leaves. They haven’t removed themselves from nature’s cycles, so death makes total sense to them. Those of us who are living more technologically driven lives often lose that intuition, that gut feel, and so nature surprises us. Nature scares us.

Part of the problem, too, is what one of my colleagues calls the “medical-industrial complex”: Health care is an enormous business in this country. As long as we decide to consider health care a business and not a civil right, it’s subject to all the fickleness of capitalism and it requires marketing. When I see hospitals advertised to the public as the place where miracles happen, a place where anything’s possible, you know, that’s an advertisement. That’s marketing. That’s not real. We’re not incentivized to be honest with one another in this way.


Q
How can you stay in the world and retain a sense of purpose toward the end of life? How much does that matter?
A

This question of purpose is related to the question of being a burden, and both come up a lot. First, let’s all get better at being vulnerable because we are vulnerable. If you’re in the course of a normal life, any one of us is going to be a burden to someone sometime. It’s just not possible to only give care and not need to receive it. Getting more savvy with needing one another is one way to turn down the pain.

We can also learn to repurpose ourselves. I meet people often who have had a single kind of career or place within their family their whole lives. They’ve had this monolithic role, and as soon as they can no longer perform that role, they lose their sense of purpose. They have nowhere else to go, they have no other interests, they don’t believe they can repurpose themselves, and they lose touch with reality really quick. This is one of the ways we die before we actually die.

But you can find that purpose again, in a different way. I’m working with a family right now, and the mother, she’s about seventy years old, and she’s been a teacher much of her life. She’s been the one in the family who’s always giving care. Now it’s her turn to receive care, and she’s really struggling, and she’s not good at it. She’s gone seventy years without needing much from others, and it shows. In her mind, she’s lost her role as the caregiver. So what we’ve been doing of late is saying, “How can we repurpose your life as a teacher? What can you teach your grandchildren now?” We’re learning she can teach her grandchildren a lot about death. She can teach her grandchildren a lot about being vulnerable and the courage it takes to be vulnerable. She can teach her kids how to communicate with someone who’s suffering. These are enormous lessons, and all of a sudden, she doesn’t feel like she’s being stripped of everything important to her. She’s seeing that she still has some creative life in her and she can take old skills and reapply them in this new way.

Purpose is a powerful force, but there’s value in life beyond purpose. In America, life is all about productivity. You know you’re relevant in this society as long as you can produce, and as your ability to produce reigns, so does your employment and worth. Aging then becomes this process of getting out of the way, and that’s pretty lame. It’s on all of us to see that there’s something bigger to life than our jobs or our single role or whatever it is—life is much more interesting than that. We are much more interesting than that. Another way to help one another repurpose is to actually let go of the need to be so dang productive. Get in touch with the mystery of life and the power of just being at all. That, I find, is a very, very useful thing for people who feel purpose is slipping through their fingers.


Q
What advice do you have for family members or loved ones who are helping with end-of-life care?
A

There are so many layers to this: There are practical burdens, emotional burdens, financial burdens. All need addressing.

Hospice is an incredible service that can dramatically unburden the family. When your health is failing and you need more help with the activities of daily living, family members can step in to do that, or perhaps it’s time to hire a home health aide. But very often what ends up happening is people wait too long to invite hospice into their homes, because they wait way too long to face this reality, and then it’s too late to do much. So one piece of advice I stress to everyone is to think about home health care and hospice early. Even if you think death is years away but are still dealing with a serious illness, call hospice sooner rather than later. Just request an informational interview. Get a sense of what they can do and broach the subject as part of your planning. You don’t have to sign up anytime soon.

The other big emotional piece is to fold death into our view of reality so that we don’t feel guilty that Mom’s dying. It’s always amazing to me how many creative ways we find to feel horrible. I watch family members blame themselves for the death of a loved one all the time, even though there’s nothing that could be done to forestall it. We view death as a failure, and families end up absorbing that sense of failure. It’s heartbreaking. And if there’s one thing we can’t fail at, it’s death. You are going to die. There is no failing.

We all need to get a lot more savvy with grief. Grief is around us all the time. We’re always losing something. A relationship, hair, body parts. Loss is all over the place, and our American way is to kind of pull yourself up by the bootstraps. There’s something to that, but we’ve got to get better at just letting ourselves feel sad. We have to give one another more space for grieving. Grief is just the other side of the coin of love. If you didn’t love someone, it wouldn’t be so hard to lose them. Acknowledge that. Work with it. Let yourself feel it. That will help everybody involved.

We also need to push our human resources programs to help with caregiver education for family members or generous bereavement time off. That’s a big piece of this puzzle if we as a society are going to die better.


Q
You’ve spoken before about your own brush with death and becoming a triple amputee. How does that experience inform your work?
A

Most of us have a kind of a haphazard view of reality that may not include illness or death. Illness and death can end up feeling like this foreign invader, despite the reality that they’re natural processes. My own trauma and illness gave me a wider view of the world that includes that reality, so that I wasn’t ashamed to be disabled. I was normal to be disabled. It helped me understand I was a human being for whom things go wrong. A human being for whom the body dies. That is the most normal thing in the world.

It helped me see myself in my patients and my patients in me. It’s easier for me to empathize with people who are sick and near the end because I’ve been there myself to some degree. But you don’t need to lose three limbs to relate; suffering and illness and death are hard subjects, but at the most basic level, they unite us. We all have some relationship them, and therefore we all have a lot in common.

I’m also aware that because I’m obviously disabled, I think patients, as a rule, give me some credit. I feel like I have an easier time getting to a trusting place with patients. If you take one look at my body, you know I’ve been in the bed, and I do think that is actually a great advantage for me in the work I do.


Q
Have you ever felt as though you’ve failed a patient?
A

To be clear, most days I spend a fair amount of time talking myself out of hating myself, you know, just like most people. I’m deeply, deeply aware of all the things I can’t do or didn’t do today, or that patient I didn’t call in time before they died, or you name it. There is a long daily list of things I have to spend a moment reconciling. Usually it relates to some form of communication: I didn’t quite find a way to break through; I didn’t quite find a way to help them feel safe; I didn’t quite find a way for them to feel seen or understood my me.


Q
How can spirituality help someone come to terms with death?
A

It depends how you define spirituality, but I might define it as a connecting force that we cannot see but have faith is there. That somehow, we’re tied into some creative force that is much larger than ourselves and that is all-encompassing and all-inclusive. If you have a spiritual framework, it’s easier for you to yield to death because you know even in your death you’re still part of something beautiful or enormous. That sense of belonging can do so much for us.

When I found myself near death, and thinking about these things and revisiting my spirituality, it became clear to me that I would be very sad to die. I don’t want to die yet. But what matters even more to me than my life or death is the fact that I exist at all, that life exists at all, and I get to feel part of that, and my death is part of that.


Q
Can art play a role as well?
A

So much of life and death is so powerful and so huge. There’s just so much more to the world and life than what we can find in a word, so the arts can help us kind of get in touch with these larger threads, these larger forces, these things we can’t quite see or feel, a little bit like spirituality.

Expressing yourself artistically can be therapeutic, too. For people going through illness or the dying process, if they’re able to get in touch with their creative impulse and make something from their experiences, that’s an amazing way for them to participate in their life and in their illness. To turn their suffering into grist…something to paint with, essentially. It’s just very rich and fertile ground.

With architecture and design, the way we cultivate our built environment has such power in terms of how we experience life. Standing in a beautiful museum can make you feel things you wouldn’t otherwise and can help you pay attention to things that are really difficult. I would love to see the arts get more involved with the heath care infrastructure so that hospitals and nursing homes are places where you’d actually want to be, places that are beautiful or stimulating. The arts provoke the life in you, and that’s very powerful when the goal is to really live until you die.


Q
How do you recommend preparing for death?
A

Explore a hospice and palliative care program as early as possible. Ask your doctor about it. Research local hospice agencies. There’s a website called getpalliativecare.org, where you enter your zip code and it’ll show you your options. Of course, some programs are better than others, but as a rule, these services are designed to help you suffer less, help you find meaning in your life, and help you live a full life.

Even when you’re feeling exhausted and you just want to hand yourself over to a doctor, you need to find a way to advocate for yourself. Otherwise you’re going to end up in the default mode in the health care system, and that’s going to mean ICU and machines and all sorts of things that you may not want. Your doctor is there to help you, and you need to work with them. But push your doctor: Ask them about palliative care, and if they say, “Oh, you don’t need palliative care,” ask why not. Or if you think you want to prepare with hospice, ask your doctor about hospice. What do they think about hospice? Is now a good time to start it? If they say you don’t need hospice, ask, “Why not? When would I?” Between the medical system and the training that goes into it, understand you need to advocate upstream. You’re pushing a rock up the hill.

Anywhere along the way, start saving money, period. The number one cause of personal bankruptcy in this country is health care costs, and the bulk of those people who go bankrupt because of heath care costs had health insurance. I don’t think people realize even if you have insurance, there are costs that are going to come up that you would never imagine, so if you have any capacity, just start saving. You’re going to need money toward the end of life. You’re going to need money to navigate illness.

Whether it’s in yourself or with someone you care about, reward vulnerability. Be vulnerable. Go toward it. Be with people and yourself when you’re suffering. It takes courage to be vulnerable, to get help and to give help. When it comes to your time, it’s important that you’ve learned how to receive care.

Then there’s the biggest one: Dying ain’t easy, but it’s going to happen, and there’s a lot of beauty in it. The fact that we die is exactly what makes life precious in the first place. You don’t have to love death, but try to have some relationship with it. Think about it. Contemplate it. As soon as you start doing that, the sooner you start making decisions you can live with, and you’ll avoid stockpiling a bunch of regrets. People who don’t think about death just end up assuming they’re going to live forever, until it’s too late to live that life they wanted to lead.


BJ Miller

BJ Miller, MD is a hospice and palliative care specialist who sees patients in the Cancer Symptom Management Service of the UCSF Helen Diller Family Comprehensive Cancer Center. After studying art history as an undergraduate at Princeton University, he worked for several years for art and disability-rights nonprofit organizations before earning a medical degree at UCSF. He completed an internal medicine residency at Cottage Hospital in Santa Barbara, where he was chief resident, and a fellowship in hospice and palliative medicine at Harvard Medical School, working at the Massachusetts General Hospital and Dana-Farber Cancer Institute. His forthcoming book with coauthor Shoshana Berger, a practical and emotional guide to dying called The Beginner’s Guide to the End, is due out from Simon & Schuster in 2019.

Complete Article HERE!