Former Ottawa paramedic on his experience with death…

‘I’ve got a busload of people up here in my head’

J.P. Trottier in 2006, when he served with Ottawa Paramedic Service.

By Bruce Deachman

J.P. Trottier was with the Ottawa Paramedic Service for 36 years – 21 as a frontline paramedic and 15 as public information officer. He retired in January 2017.

“I don’t know how many deaths I’ve seen, but it’s in the hundreds. I remember one shift doing three vital-signs-absent calls in a row. That was a busy eight hours.

“You just never know where you’re going to be in five minutes. Are you going to be in the middle of a crime scene? Are you going to be in somebody’s living room, somebody with abdominal pain? Somebody having a heart attack?

“Sometimes, it’s just the daily grind. It can be very humdrum, and then all of a sudden your next shift will be just crazy. You’ll do a shooting, you’ll do an elderly gentleman who’s collapsed at home and his vital signs are absent, you’ll do a childbirth call … you’ll do a whole bunch of different things.”

“You have some really horrible moments in the job, and you have some absolutely spectacular moments. Paramedics have what they call the holy-shit call. They take a look at the person and they know they’re in trouble — that that person is in deep trouble and probably minutes from dying. We call that the holy-shit call. It’s like, get to work. And you can tell after a little bit of experience — you walk into a room and look at somebody. And then it becomes a bit mechanical; your training kicks in and you don’t really think about it. But when you see them like that and 10 minutes later you’ve given your medication and taken your vital signs, or your partner’s taking the vital signs and you’ve slapped the oxygen on them or maybe put in an IV and put the medication in when all the vital signs are OK and off you go. And 10 minutes later when they’re looking much better, it’s an amazing thing to see. It’s absolutely beautiful. It’s absolutely the best part of the job.”

“You don’t forget many of them. The difficult ones you don’t forget. I tell people that I’ve got a busload of people up here in my head, waiting to step out. It’s not being haunted; it’s just that you will never be able to forget that eight-year-old boy who played chicken with a train and lost. You’ll never be able to forget that. If anybody were to come to me and say, ‘Oh, I can handle it … ” Yeah, OK, maybe you can handle it differently than I can, but there’s no way you’re going to be able to forget that. The young boy who comes home from school for lunch and finds his mother dead upstairs because she put a shotgun in her mouth. You’ll never be able to forget that. Never. But they don’t haunt me.

“Very early in my career I had one of those horrible calls – it was a young girl, six or seven years old, crossing the street and was struck by a car. She died en route, and every time I drive by there, it’s like, ‘This is where it happened.’ And it’s no more than that. But they’re with you.”

“There’s that horrible side where you can’t help … they’re in a car crash, pinned, and the paramedics are trying to put the IV in and they’re doing a whole bunch of different things, and you’re waiting and waiting, and the blood pressure is coming down and down and down, and you can’t stem the bleeding because you can’t access where the injury is.

“So yeah, sometimes you can’t resuscitate them, and that’s the moment that you turn your attention to the family. They’re not the patients, you’re not there specifically for them or because of them, but all paramedics will do this; they will turn their attention to the family.

“I used to do presentations for career days at high schools, and they would ask what’s the most important thing about your character that would make you a good paramedic, and I would say two things. The first was that you really have to be a caring person, because that’s what you do. That’s your job, you’re caring for people — their emotional needs, their physical needs. And the second part is good communications skills. You must have good communications skills because of instances like this, where a family member has passed away and you need to inform them. And don’t use any jargon, don’t use any of that nonsense. ‘I’m sorry he passed away. We couldn’t do anything.’ And you don’t give them a lot of info, because they’ll forget most of it after you tell them.

“We have to be careful what we tell them, because they will remember that moment, forever. It really demands respect, and I don’t care if they’re gang members or whatever the case may be. We don’t care; it’s a patient and they have friends or family, and there’s a mother or father somewhere, maybe, or children, grandchildren or great-grandchildren, and all of them will be affected by this.”

“I would often turn my attention to people’s rooms to give me an idea of the life they led. The older generation especially will have a lot of photographs on their dressers or in the bedroom. Even if I don’t know these people, it kind of puts you there. Look at the clothes they’re wearing. Look at the cars they were driving. It gives you a bit of a glance at their lives. There are pictures of their children and grandchildren. It kind of gives you a quick bio of them.

“The ones that really stand out for me are ones where someone’s standing next to a Spitfire, because you know they served. Did he fly planes? Was he in the war? Was he a mechanic? You can sometimes ask the family a little bit about them — you have to tread carefully there, because they may not take it very well. But in some instances I was able to ask the family. ‘Oh, he served?’ — because there’s a picture of him. ‘Yes, and he went to this battle and that battle,’ and of course they’re proud of that. And sometimes I take a minute to thank them for their service to their country. Sometimes you’ll see their medals on the wall, and you can talk about that a little bit.

“It can be fascinating. You don’t know about this person or the life they led, if they discovered a cure for something. You just never know.”

“Has my view of death changed over the years? Yes. I think just because of the sheer number of calls that we do with death and near-death … a patient you were able to get back from the grip of death that they were in. The shootings, the stabbings, the crib deaths — Sudden Infant Death Syndrome — for sure, gave me a better understanding of death. You’re more aware of death and what it means and why it happens, a little bit — we can never know why, really. But it gives you a better appreciation of it, and thus a better understanding of it.”

“You see a lot of circumstances. The suicides are sad. And you also see the murder-suicides, and those are weird. There was one I did where this man had custody of his child during the weekend, and he decided on Sunday night that the child was not going back home to his mother, and threw him off the balcony and then jumped himself.

“So you get to the scene and you’ve got this to deal with. And you only know the circumstances after the fact, but you have a damn good clue that at three o’clock in the morning, when the OC Transpo driver found him when going out to his shift, that the kid, maybe two or three years old, didn’t wake up fully dressed at three o’clock in the morning to jump off of the balcony. So now you’ve got that anger issue. You want to kill yourself? That’s somewhat understandable. But to take an innocent child away from his mother and his life? It’s just … it’s weird. There’s this brain storm happening there in your head, in my head, that’s very difficult to deal with and make sense of. So those are very difficult to do.

Complete Article HERE!

As seniors go into twilight years, some of them privately mull ‘rational suicide’

By Melissa Bailey

Ten residents slipped away from their retirement community one Sunday afternoon for a covert meeting in a grocery store cafe. They aimed to answer a taboo question: When they feel they have lived long enough, how can they carry out their own swift and peaceful death?

The seniors, who live in independent apartments at a high-end senior community near Philadelphia, showed no obvious signs of depression. They’re in their 70s and 80s and say they don’t intend to end their lives soon. But they say they want the option to take “preemptive action” before their health declines in their later years, particularly because of dementia.

More seniors are weighing the possibility of suicide, experts say, as the baby boomer generation — known for valuing autonomy and self-determination — reaches older age at a time when modern medicine can keep human bodies alive far longer than ever.

The group gathered a few months ago to meet with Dena Davis, a bioethics professor at Lehigh University who defends “rational suicide” — the idea that suicide can be a well-reasoned decision, not a result of emotional or psychological problems. Davis, 72, has been vocal about her desire to end her life rather than experience a slow decline because of dementia, as her mother did.

he concept of rational suicide is highly controversial; it runs counter to many societal norms, religious and moral convictions, and the efforts of suicide prevention workers who contend that every life is worth saving.

“The concern that I have at a social level is if we all agree that killing yourself is an acceptable, appropriate way to go, then there becomes a social norm around that, and it becomes easier to do, more common,” said Yeates Conwell, a psychiatrist specializing in geriatrics at the University of Rochester and a leading expert in elderly suicide. That’s particularly dangerous with older adults because of widespread ageist attitudes, he said.

As a society, we have a responsibility to care for people as they age, Conwell argued. Promoting rational suicide “creates the risk of a sense of obligation for older people to use that method rather than advocate for better care that addresses their concerns in other ways.”

A Kaiser Health News investigation in April found that older Americans — a few hundred per year, at least — are killing themselves while living in or transitioning to long-term care. Many cases KHN reviewed involved depression or mental illness. What’s not clear is how many of these suicides involve clear-minded people exercising what Davis would call a rational choice.

Suicide prevention experts contend that while it’s normal to think about death as we age, suicidal ideation is a sign that people need help. They argue that all suicides should be avoided by addressing mental health and helping seniors live a rich and fulfilling life.

But to Lois, the 86-year-old woman who organized the meeting outside Philadelphia, suicides by older Americans are not all tragedies. A widow with no children, Lois said she would rather end her own life than deteriorate slowly over seven years, as her mother did after she broke a hip at age 90. (Lois asked to be referred to by only her middle name so she would not be identified, given the sensitive topic.) In eight years living at her retirement community, Lois has encountered other residents who feel similarly about suicide. But because of stigma, she said, the conversations are usually kept quiet.

Lois insisted her group meet off-campus at Wegmans because of the “subversive” nature of the discussion. Supporting rational suicide, she said, clashes with the ethos of their continuing care retirement community, where seniors transition from independent apartments to assisted living to a nursing home as they age.

Seniors pay six figures to move into the bucolic campus, which includes an indoor heated pool, a concert hall and many acres of wooded trails. They are guaranteed housing, medical care, companionship and comfort for the rest of their lives.

“ We are saying, thank you very much, but that’s not what we’re looking for,” Lois said of her group.

Carolyn, a 72-year-old member of the group who also asked that her last name be withheld, said they live in a “fabulous place” where residents enjoy “a lot of agency.” But she and her 88-year-old husband also want the freedom to determine how they die.

A retired nurse, Carolyn said her views have been shaped in part by her experience with the HIV/AIDS epidemic. In the 1990s, she created a program that sent hospice volunteers to work with people dying of AIDS, which at the time was a death sentence.

She said many of the men kept a stockpile of lethal drugs on a dresser or bedside table. They would tell her, “When I’m ready, that’s what I’m going to do.” But as their condition grew worse, she said, they became too confused to follow through.

“I just saw so many people who were planning to have that quiet, peaceful ending when it came, and it just never came. The pills just got scattered. They lost the moment” when they had the wherewithal to end their own lives, she said.

Carolyn emphasized that she and her husband do not feel suicidal, nor do they have a specific plan to die on a certain date. But she said while she still has the ability, she wants to procure a lethal medication that would offer the option for a peaceful end in the future.

“Ideally, I would have in hand the pill, or the liquid or the injection,” she said.

New Jersey recently became the eighth state to allow medical aid in dying, which permits some patients to get a doctor’s prescription for lethal drugs. That method is restricted, however, to people with a terminal condition who are mentally competent and expected to die within six months

Patients who aren’t eligible for those laws would have to go to an “underground practice” to get lethal medication, said Timothy Quill, a palliative care physician at the University of Rochester School of Medicine. Quill became famous in the 1990s for publicly admitting that he gave a 45-year-old patient with leukemia sleeping pills so she could end her life. He said he has done so with only one other patient.

Quill said he considers suicide one option he may choose as he ages: “I would probably be a classic [case] — I’m used to being in charge of my life.” He said he might be able to adapt to a situation in which he became entirely dependent on the care of others, “but I’d like to be able to make that be a choice as opposed to a necessity.”

Suicide could be as rational a choice as a patient’s decision to end dialysis, after which they typically die within two weeks, he said. But when patients bring up suicide, he said, it should launch a serious conversation about what would make their life feel meaningful and their preferences for medical care at the end of life.

Clinicians have little training on how to handle conversations about rational suicide, said Meera Balasubramaniam, a geriatric psychiatrist at New York University School of Medicine who has written about the topic. She said her views are “evolving” on whether suicide by older adults who are not terminally ill can be a rational choice.

“One school of thought is that even mentioning the idea that this could be rational is an ageist concept,” she said. “It’s an important point to consider. But ignoring it and not talking about it also does not do our patients a favor, who are already talking about this or discussing this among themselves.”

In her discussions with patients, she said, she explores their fears about aging and dying and tries to offer hope and affirm the value of their life.

Conwell, the suicide prevention expert, said these conversations matter because “the balance between the wish to die and the wish to live is a dynamic one that shifts frequently, moment to moment, week to week.”

Carolyn, who has three children and four grandchildren, said conversations about suicide are often kept quiet for fear that involving a family member would implicate them in a crime. The seniors also don’t want to get their retirement community in trouble.

In some of the cases KHN reviewed, nursing homes have faced federal fines of up to tens of thousands of dollars for failing to prevent suicides on-site.

There’s “also just this hush-hush atmosphere of our culture,” Carolyn said. “Not wanting to deal with judgment — of others, or offend someone because they have different beliefs. It makes it hard to have open conversations.”

Carolyn said when she and her neighbors met at the cafe, she felt comforted by breaking the taboo.

“The most wonderful thing about it was being around a table with people that I knew where we could talk about it, and realize that we’re not alone,” Carolyn said. “To share our fears — like if we choose to use something, and it doesn’t quite do the job, and you’re comatose or impaired.”

At the meeting, many questions were practical, Lois said.

“We only get one crack at it,” Lois said. “Everyone wants to know what to do.”

Davis said she did not have practical answers. Her expertise lies in ethics, not the means.

Public opinion research has shown shifting opinions among doctors and the general public about hastening death. Nationally, 72 percent of Americans believe that doctors should be allowed by law to end a terminally ill patient’s life if the patient and his or her family request it, according to a 2018 Gallup poll.

Lois said she’s seeing societal attitudes begin to shift about rational suicide, which she sees as the outgrowth of a movement toward patient autonomy. Davis said she’d like to see polling on how many people share that opinion nationwide.

“It seems to me that there must be an awful lot of people in America who think the way I do,” Davis said. “Our beliefs are not respected. Nobody says, ‘Okay, how do we respect and facilitate the beliefs of somebody who wants to commit suicide rather than having dementia?’ ”

If you or someone you know has talked about contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week. People 60 and older can call the Institute on Aging’s 24-hour, toll-free Friendship Line at 800-971-0016. IOA also makes ongoing outreach calls to lonely older adults.

Complete Article HERE!

Solace after suicide…

My journey to forgiveness

by The Listener

For Katie Anders*, coping with suicide grief means remembering how her husband lived, not how he died.

Every suicide story that hits the headlines stirs the pain for those of us who have been bereaved by such a loss. The headlines are bigger and somehow more shocking when such high-profile names as Anthony Bourdain and Kate Spade join those of our loved ones. But the grief for those left is the same.

I lost the love of my life to suicide. He was middle-aged, very successful in his profession and loved by family and a wonderful group of friends.

Our communities have such a sense of helplessness and hopelessness in the face of suicides. It is in the crisis period leading up to a suicide that there is the chance for effective intervention, and yet there is little effective help.

And, yes, there is a still a stigma around mental health. For us, it meant we had to protect my husband’s reputation for when he returned to work. The professions are not a lot more enlightened than anyone else.

The crash happened one May day. I walked in on him sitting at his desk at work, and was shocked to find him weeping. He said, “I can’t do this any more.”

We visited our GP and at first it seemed like exhaustion; just plain burnout. We had just come back from three weeks’ travelling and he hadn’t slept well; he had returned to a mountain of work. It was a job he loved and in which he had quietly excelled. He was a gentle-natured man who worked in a world of ambitious colleagues and he had forged a different path to the top. He was respected by most, admired by many.

We quickly arranged for his work to be done by others and he took “stress leave”. Within weeks, it was clear the malevolent black dog of depression was stalking him. We did all the right things: exercise and a good diet. He had great support from loved ones. He began using antidepressants and sleeping tablets. We saw an occupational psychologist, who was enormously helpful. Yet still the black dog circled.

Weeks passed. Then one day I found him curled into himself on a chair, his back to me. I tried to engage him, but he wouldn’t look at me. I took his face in my hands, forcing him to meet my eyes. I demanded to know what he was thinking, but in reality I knew.

He had reached a tipping point. We urgently needed more expertise. An acquaintance who was a good psychiatrist agreed to see him immediately (and privately).

I was determinedly optimistic we would get through it. We were a “lucky couple” whose marriage had fulfilled each of us. We laughed a lot and loved a lot. We had lovely children, now grown and forging their own lives. Many saw our marriage as one of the successful ones; we both thought so, too.

His promise to me that he wouldn’t act on his thoughts seemed to be enough to hold him back from the edge – that and the increasingly heavy doses of medication he needed. We began cognitive behavioural therapy (CBT) with another psychologist.

A few weeks later, things seemed to be moving in the right direction until some odd things started to happen. The medication had tipped him into a manic state, so he had to withdraw from all the antidepressants. The psychiatrist felt that a prior serious head injury had probably caused the manic response, so mood-stabilising drugs were required.

Some normalcy began to return to our lives. My husband continued his programme of health and fitness and after a few weeks, he seemed well enough to return to work for short periods. We breathed easier.

But then an emotionally stressful event occurred: he was desperately concerned about someone close who was in strife overseas. His sleep was seriously disrupted and he was very worried. The depression was renewing its grip and as the antidepressants were now contraindicated, we were at a loss for effective solutions.

The psychiatrist hoped that since the relapse was in its early stages, we could work to stop its progression by using mindfulness meditation and more CBT and counselling. He was very low, but again, he reiterated his promise to me.

Three days later, he was dead. The black dog’s work was done.

*The writer’s name has been changed.

Questions and guilt

On the night he died, I sat at his bedside, shattered by the horrific development, the crashing grief threatening to crush us all. I was full of confusing questions and guilt. How could he have done this? How could he have walked past me as I slept and not woken me and sought my help?

Sometime in the wee hours, I decided to write him a final letter. And as I began, some things crystallised. I needed to forgive him before we let him go. I read him my letter aloud, then later repeated the words at his funeral. That night, wracked with the deepest pain, I told him, “The man who did this thing was a man in the grip of a fierce depression. It was the depression that broke the promise, not the man that we love. That’s why, distraught as I am, I have to forgive you, because all that I know and have experienced of you through all the years tells me that you never wanted to hurt us, never wanted to leave us.”

Some months later, I heard someone (also bereaved by suicide) on a radio programme put it very succinctly: her husband hadn’t been leaving her or her children, he was leaving himself.

Years before, I had read Elisabeth Kübler-Ross’ book On Death and Dying and, later, I trained and worked as a volunteer with terminally ill people, and learnt about bereavement support.

It’s accepted now that work around the stages and processes of grief was too rigid. Each grief experience is unique and people don’t necessarily experience all the stages or go through them in any particular order. For example, while others felt anger at my husband, I never have. Even pathetic attempts to somehow manufacture anger failed. How could I be angry at someone so broken?

In the aftermath, I felt the deepest sadness for him, for his loss, for all that he would never get to experience. I felt devastatingly sad for our kids. But for me, the grieving process was delayed by my upbringing. It held messages of “Don’t you feel sorry for yourself” and “Pick yourself up and get on with it”.

It took a long time to let myself feel the full devastation of my own loss. The numbing effects of shock meant that I walked around in a world that felt surreal, that simply couldn’t be true. This wasn’t how our love story was supposed to end. We were supposed to grow old together, travel, have grandchildren.

Tortuous paths

Suicide grief holds so many “If only …” and “What if …” questions. What if I had heard him get out of bed? What if I had handcuffed him to me to keep him safe? What if he had slept through those darkest hours before dawn and woken to sunshine?

The “what ifs” are where the self-torture lies. I felt so guilty that I struggled to want to live. Sometimes I still feel surprised that I didn’t die of the brokenness I felt.

Logic says there is no useful purpose in following these tortuous paths. But some years on, they still come into my mind and I speak to those thoughts as firmly and logically as I can.

I learnt a lot from my counsellor about self-forgiveness. It is more of a journey than a destination. Someone spoke to me about the idea of practising my husband’s presence rather than his absence. It seemed to break down some of the enormity of it all. If I had to completely and immediately accept his absence from my life, you might as well have asked me to swim the Atlantic. But if I could practise his presence, which permeated my life, while slowly adjusting to his loss, then it felt more like paddling in the waves at the water’s edge and not getting completely out of my depth.

Practising his presence is simply being mindful of his hand in the life I continue to live. It’s being able to access his way of thinking an issue through. His presence is in the millions of memories. It’s practising his habits of observing and appreciating the beauty around. He is visible in his imprinting on our kids … aspects of him in their personalities. It’s in watching rugby with my daughter and shouting the way he shouted. It’s in the kids’ love of language and awful puns. It’s in the thousands of photos taken over the years.

We remember how he lived and not how he died, but the truth is that suicide grief is a unique grief. People aren’t comfortable around it. I accept now that even if my life should suddenly become deliriously happy, the loss of such a precious partner through suicide will forever be a hugely black awfulness on its timeline.

Actress Dawn French said that when her father committed suicide, it was like a bomb went off in their family. It’s an apt description. My life is forever changed, my confidence diminished and my happy moments are often tinged with poignancy. At the risk of sounding overly dramatic, I feel my heart carries a permanent scarring.

Few understand the complexity and longevity of suicide pain. It isn’t easy, as one friend put it, to “move forward” as a simple act of will. If my husband had died of a heart attack or cancer, I know that grief might have been easier to move on from.

Yet I take joy in our amazing children, their partners and now a grandchild. I am fortunate in having some close friends. I try not to let the manner of his dying take more than it should. Above all, he wouldn’t want that and he would hate the pain that his suicide caused. Despite it all, I will be forever grateful that my life was greatly enriched by a truly lovely man.

Complete Article HERE!

Mother grapples with grief in ‘Where Reasons End’

By Michael Magras

It’s not surprising that someone whose whole life revolves around words would turn to literature in a time of tragedy to make sense of her suffering. The paradox is that the person most likely to seek solace from words is also the most likely to realize their insufficiency.

One such person is the unnamed narrator of “Where Reasons End,” Yiyun Li’s new novel. The 44-year-old narrator is a writer of stories and a grieving mother. For reasons that are never explained, her 16-year-old son, whom she calls Nikolai, “a name he had given himself,” killed himself only a few months earlier — a painful parallel to real life, as Li’s own 16-year-old son committed suicide in 2017

The novel is a series of imagined conversations between mother and son. From the start, we learn that the mother is agonizingly self-aware, both of herself and of the possible futility of these conversations.

That and the parallel to Li’s life are what make the experience of reading this work so powerful: the knowledge that the narrator needs the comfort of words yet senses their limitations. “I was a generic parent grieving a generic child lost to an inexplicable tragedy,” she says in the opening chapter. She seeks specificity, the need to “meet in a world unspecified in time and space … a world made up by words, and words only.”

One of the most arresting aspects of this novel is the way in which Li subverts expectations. One might expect Nikolai to be a sweet boy offering relentless comfort to his grieving mother. He’s a charmer, all right, a precocious son who painted whimsical landscapes, played the oboe and liked classical music and showtunes. And he was a bad speller who labeled a folder of songs “Edith Pilaf.”

But he has a sardonic edge that keeps him from seeming too precious. When his writer mother tells him that so many people miss him, Nikolai says she’s succumbing to the lure of clichés and admonishes her with, “You promised that you would understand.” When he accuses her of wanting him to feel sad for himself, he adds, chillingly, “I’m not as sad as you think. Not anymore.”

The dialogues in “Where Reasons End” cover a wide range of topics. Mother and son discuss love and memory and whether those capacities really do keep people alive forever. They discuss the capriciousness of time. Nikolai chides her for her dislike of adjectives, which she defends by saying that nouns, not adjectives, preserve memories. Besides, “I oppose anything judgmental,” she says, “and adjectives are opinionated words.”

Much of this book is devoted to words, which is not surprising given that its narrator lives by them: “Words said to me. Words not meant for me but picked up by me in any case. Words in their written form. Words that make sense and words that make nonsense.” When one is in search of helpful words, poets are a good place to start, as their facility often crystallizes hard-to-express truths. Indeed, the narrator references many poets, including Marianne Moore, Elizabeth Bishop — the novel’s title comes from Bishop’s poem “Argument” — and Wallace Stevens.

Even poets, however, provide limited comfort, and the mother depicted here knows it. This realization compounds her grief as much as it ameliorates. “Words provided to me — loss, grief, sorrow, bereavement, trauma — never seemed to be able to speak precisely of what was plaguing me,” she says. “One can and must live with loss and grief and sorrow and bereavement.”

Later, she adds, “We feel at a loss for words when they can’t do fully what we want them to.” To which Nikolai offers as wise a defense of words as one is likely to find. “They never can,” he says, but, “Why not make do with the percentage they can achieve?”

The book gets repetitive after a while — much is made of the Latin derivations of words, and some of Nikolai’s dialogue is too stilted even for a sophisticated teen — yet its message is nonetheless a sobering one. Nothing can ever fill the hollows formed by tragedy, yet the desire to fill them is every bit as keen as the loss. If even a fraction of the emptiness is replaced, then the quest is worth the effort.

Late in the novel, the narrator quotes Stevens’s poem “This Solitude of Cataracts”: “He wanted the river to go on flowing the same way, To keep on flowing.” Anyone who has ever lost a loved one — that would be all of us — will relate. If only they were still here to keep the river of our lives flowing as it once had.

Complete Article HERE!

‘I was widowed at 23, young people need to talk about death’

Amy Molloy and husband, Eoghan

By Amy Molloy

‘They say you’ve got three months to live.” These were the words I spoke to my then-fiancé when I was 23 years old after learning that his cancer – malignant melanoma that spread to his liver, lungs, pancreas and brain – was likely to be fatal.

At the time, my only experience of “the end” was watching my parents disappear into a room where my grandparents were lying, and of seeing an empty rabbit hut at the end of our garden after the loss of a pet.

When I was 17 years old my father was paralysed from Hodgkins Lymphoma but, after a stem cell transplant, he defeated the odds and made a miraculous recovery. So, I had faith in the power of modern medicine over mortality.

However, not this time.

I was practically still a child when a doctor ushered me into a private room, whilst my soon-to-be husband, Eoghan, was in a chemotherapy session, and revealed his prognosis. I asked if I could be the one to tell him, and they readily agreed.

Perhaps, even doctors will do anything to avoid saying the T-word. Terminal.

In the next three months, I had a crash course in end-of-life conversation: the jargon, the euphemisms and the social awkwardness.

I froze with fear when I walked into the chemo ward and heard another patient ask my partner, “Have you ever thought about euthanasia?” But, in a way, that was better than the wall of silence.

After my husband died three weeks after our wedding day, even my closest friends evaporated or became stiff in my company. In the next few months, as I rebelled against my grief – drinking too much and becoming promiscuous – nobody dared challenge me or raise the topics I ached to discuss.

What on earth are you doing?

Do you really think this is helping you?

How does it feel to marry a man who is dying?

…Do you want to die too?

Do you know what to say when a friend’s loved one dies? Have you thought about the day your own parent, partner or best friend may no longer be visible? How would you discuss it, in a way that would be supportive, constructive, and even light-hearted?

If you don’t know the answer, you’re not alone.

A new study from the Royal College of Physicians in the UK has urged medical professionals to improve their bedside manner when it comes to discussing death, after identifying that “timely, honest conversations” about patients’ futures are not happening. However it’s not only doctors who need to become more comfortable with these conversations.

It’s been suggested that millennials are the generation most fearful of death, unlike our grandparents, raised through world wars, who learnt that life can be short. As medicine advances and life expectancy increases, we prefer to think of death as our “future self’s problem”.

But is postponing the inevitable increasing our terror of it?

As psychologists report a rise in young people presenting with anxiety linked to death, it’s time for honest, open, educational conversations about loss of life, and how it can look. Its not enough to be aware of Facebook’s ‘death policy’, warn experts.

“Death is still a certainty even if people are living longer,” says clinical psychologist Renee Mill from Sydney’s Anxiety Solutions CBT.

“When treating anxiety, exposure is what works and avoidance increases the problem. Talking about death or visiting a dying person will decrease your fear of death and make it easier to accept that it is a part of life. Every funeral we attend, no matter how hard, actually helps to reduce anxiety in this way too.”

And, it’s never too early to think about the end. Planning in life is important,” says Mill. “We plan our careers, we save, we want to buy property – end-of-life is another part we need to plan. It means we get our wishes fulfilled and gives guidance to our loved ones who otherwise have to pick up the pieces.”

In a good way, change is happening. Since 2017, the multimedia project We’re All Going to Die has encouraged people to embrace their immortality and use it to empower their lives, through educational films and festivals.

The award-winning podcast, GriefCast, hosted by comedian Cariad Lloyd whose father died when she was a teenager, sees entertainers speak with startling honesty – and surprising humour – about death, from the logistics of palliative care and funeral plans to the long-term effects of bereavement.

When we can talk openly about death, we may also increase our chances of reducing suicides. To help people to help each other, Lifeline offer an online course in QPR – the equivalent of CPR for people experiencing a suicidal crisis.

As part of the training – which only takes an hour and costs $10 – people are urged not to tiptoe around the conversations. Instead, be direct: “Do you feel like you want to die?”

In our social circles, we need to discuss worst-case-scenarios. Do you have a will? Do you have death insurance? Are you an organ donor? As an Australian immigrant living 16,000 kilometres from my parents, I always have enough money in my bank account for an emergency flight home. Because, nobody lives forever.

It’s confronting but it’s necessary

During my book tour, I cried on stage for the first time whilst discussing my journey from a 23-year-old widow to a 34-year-old wife and mother of two. Because, for the first time in a decade, I have reached a place where I can talk about my experience of death – and really be heard.

I shared the reason I light a candle in my bedroom every evening and say a prayer: help me to act from a place of love, not fear.

“If my dad’s cancer comes back, on that day I will light that candle,” I said, “If my husband, who is here with my newborn, dies and I am widowed again then I will light that candle to remind myself to act from a place of love.”

We need to talk about death to be active participants in the full spectrum of life: so we can decide who to be when a doctor pulls us into a private room, when we answer the phone to bad news, when we say goodbye for the last time.

We are so scared of death, we don’t discuss what an honour it is to watch someone die; to be present – really present – when someone takes their last breath, to lean in and breathe them in, to put your head on their chest as their heart stops beating and kiss their skin as it transforms.

I hope you all have that experience one day.

We are not meant to say that, but we should.

Complete Article HERE!

Suicide grief:

Healing after a loved one’s suicide

A loved one’s suicide can be emotionally devastating. Use healthy coping strategies — such as seeking support — to begin the journey to healing and acceptance.

When a loved one dies by suicide, overwhelming emotions can leave you reeling. Your grief might be heart wrenching. At the same time, you might be consumed by guilt — wondering if you could have done something to prevent your loved one’s death.

As you face life after a loved one’s suicide, remember that you don’t have to go through it alone.

Brace for powerful emotions

A loved one’s suicide can trigger intense emotions. For example:

  • Shock. Disbelief and emotional numbness might set in. You might think that your loved one’s suicide couldn’t possibly be real.
  • Anger. You might be angry with your loved one for abandoning you or leaving you with a legacy of grief — or angry with yourself or others for missing clues about suicidal intentions.
  • Guilt. You might replay “what if” and “if only” scenarios in your mind, blaming yourself for your loved one’s death.
  • Despair. You might be gripped by sadness, loneliness or helplessness. You might have a physical collapse or even consider suicide yourself.
  • Confusion. Many people try to make some sense out of the death, or try to understand why their loved one took his or her life. But, you’ll likely always have some unanswered questions.
  • Feelings of rejection. You might wonder why your relationship wasn’t enough to keep your loved one from dying by suicide.

You might continue to experience intense reactions during the weeks and months after your loved one’s suicide — including nightmares, flashbacks, difficulty concentrating, social withdrawal and loss of interest in usual activities — especially if you witnessed or discovered the suicide.

Dealing with stigma

Many people have trouble discussing suicide, and might not reach out to you. This could leave you feeling isolated or abandoned if the support you expected to receive just isn’t there.

Additionally, some religions limit the rituals available to people who’ve died by suicide, which could also leave you feeling alone. You might also feel deprived of some of the usual tools you depended on in the past to help you cope.

Adopt healthy coping strategies

 

The aftermath of a loved one’s suicide can be physically and emotionally exhausting. As you work through your grief, be careful to protect your own well-being.

  • Keep in touch. Reach out to loved ones, friends and spiritual leaders for comfort, understanding and healing. Surround yourself with people who are willing to listen when you need to talk, as well as those who’ll simply offer a shoulder to lean on when you’d rather be silent.
  • Grieve in your own way. Do what’s right for you, not necessarily someone else. There is no single “right” way to grieve. If you find it too painful to visit your loved one’s gravesite or share the details of your loved one’s death, wait until you’re ready.
  • Be prepared for painful reminders. Anniversaries, holidays and other special occasions can be painful reminders of your loved one’s suicide. Don’t chide yourself for being sad or mournful. Instead, consider changing or suspending family traditions that are too painful to continue.
  • Don’t rush yourself. Losing someone to suicide is a tremendous blow, and healing must occur at its own pace. Don’t be hurried by anyone else’s expectations that it’s been “long enough.”
  • Expect setbacks. Some days will be better than others, even years after the suicide — and that’s OK. Healing doesn’t often happen in a straight line.
  • Consider a support group for families affected by suicide. Sharing your story with others who are experiencing the same type of grief might help you find a sense of purpose or strength. However, if you find going to these groups keeps you ruminating on your loved one’s death, seek out other methods of support.

Know when to seek professional help

If you experience intense or unrelenting anguish or physical problems, ask your doctor or mental health provider for help. Seeking professional help is especially important if you think you might be depressed or you have recurring thoughts of suicide. Unresolved grief can turn into complicated grief, where painful emotions are so long lasting and severe that you have trouble resuming your own life.

Depending on the circumstances, you might benefit from individual or family therapy — either to get you through the worst of the crisis or to help you adjust to life after suicide. Short-term medication can be helpful in some cases, too.

Face the future with a sense of peace

In the aftermath of a loved one’s suicide, you might feel like you can’t go on or that you’ll never enjoy life again.

In truth, you might always wonder why it happened — and reminders might trigger painful feelings even years later. Eventually, however, the raw intensity of your grief will fade. The tragedy of the suicide won’t dominate your days and nights.

Understanding the complicated legacy of suicide and how to cope with palpable grief can help you find peace and healing, while still honoring the memory of your loved one.

Complete Article HERE!

The Painful But Important Lessons I Learned After My Father’s Suicide

By Christiana Zenner, Ph.D.

Anthony Bourdain; Kate Spade; friends, teenagers, neighbors, veterans; my father. Every suicide is distinct and differently devastating, for those who leave and for those who are left.

Yet there are some commonalities, some moments of recognition both in terms of frequent contributing causes and also in terms of what comes next. Here are the hard and important lessons I’ve learned since my father took his life in 2007—when he was 60, and I was pregnant and in graduate school:

1. Suicide is terrifying.

Suicide is what philosophers and mathematicians refer to as a surd—nonsensical, unexpected, a cavernous impossibility that is nonetheless real.

How often do we presume that other people’s lives are on positive trajectories, if not always totally predictable ones?

Perhaps life looked fine, even good, on the outside (as was the case with Bourdain). Or perhaps friends and family members knew the person was struggling but had sought help, and they seemed to be OK (Spade).

After a suicide, many people will say it “doesn’t make sense.” In many cases, yes, there’s a stunned inability to process that the person is gone. But I think there’s a deeper fear at work here, too: the terror of realizing, “Oh my god, if it could happen to them—could this happen to anyone, even people I love, even me?

It is OK to admit that fear and the cascade of uncertainty it unleashes. Suicide uproots our background assumptions that life makes sense.

2. There are no answers.

There may be generally explicable features in many suicides, but there are no ultimate answers. Hold space for the uncertainty, for the dimensionality of who this person was.

My father was a Navy fighter pilot before he left the military to become a commercial airline pilot. Like many vets, his experiences in Vietnam were traumatizing; he talked about them only rarely, but when he did, the moral and personal agony was palpable. Did he have PTSD? Probably, and society needs to do a better job of destigmatizing veterans and people who have been through trauma. But PTSD isn’t the full story.

The most common response people have when I say that my father killed himself is, “Oh, that’s terrible. Was he depressed?” We don’t know. As a pilot, he resisted seeking psychological diagnoses that would prevent him from flying.

Perhaps he was bipolar, as many family members now think likely. It’s natural to wonder, but we will never know for sure. Posthumous speculation can clarify past patterns. Diagnoses of depression are attractive to people who want explanations. But again: Be careful with the urge to make this “make sense”—because often, that is another way to say, “Oh, this would never happen to me or someone I know.” One of the things that suicide challenges us to do is to recognize that other people’s realities and dimensions far exceed the capacity of our projection.

3. Humility goes a long way.

Check yourself: Avoid explaining what this death means to someone who is grieving a suicide. (This is especially important if you think you have insights or are convinced you are being helpful.) Be present. People in grief need to lean on you, not be lectured by you. And what is true in grief more generally is excruciatingly so when mourning a person who has died by suicide. Frankly, unless we have explicitly said, “What do you think?” it is not at all helpful to hear your speculations or interpretations of what this event means. What we need is the space to grieve and heal in our own complicated realities.

More generally, all of us can work to eliminate unnecessary sayings that are obvious triggers—like “the line at the grocery store was so awful, I just wanted to kill myself!” or making hand gestures that mimic firing a gun into your mouth. It’s been 11 years since my father’s death, and I still cringe at those expressions. Communication evolves with social consciousness, so it’s time to retire those basic expressions.

4. Suicide, I believe, stems from hopelessness—not selfishness.

Some people feel that suicide is a selfish act because it fails to account for the difficulty and devastation wrought on the people who remain. But I agree with the many experts who suggest that suicide is often the result of a total loss of hope and self amid a tsunami of despair.

Suicide may feel selfish to survivors—how could he?—but when someone dies by suicide, they do it not out of selfishness or spite. They do it out of ultimate loneliness and pain so deep that most of us cannot begin to comprehend it because it is on a totally different plane of existence.

5. High-functioning people don’t give many signals. When they do, take those seriously.

My father expressed to a few people that he was thinking of ending his life. Those people, who I know loved him deeply, took him at his word that he would seek help. But I know now that such statements are the high-functioning person’s attempt to seek help—it takes massive effort and will to reach across a divide of loneliness and despair, to entrust someone with such honesty about such heavy burdens. It is another way of saying, “I am alone. I don’t know how to proceed; please help me.”

Take these statements seriously. Accompany the person to get help, right then if possible.

Our society can be very isolating. One antidote that we can give to one another as human beings in moments large and small is in our ability to see one another—to affirm the uniqueness and worth of each individual. We can contribute to bonds and societies that feel secure, safe, trustworthy, and consistent—and perhaps make life a bit less lonely, not just when someone confides in us, but in the caliber and kindness of our everyday interactions.

6. For survivors, some grief is incommunicable.

It is not your job to make your grief legible or to make it conform to other people’s expectations. As a survivor, you will have major triggers that are unrecognizable to most people, and your reactions will vary. I can be totally leveled by the image of my dad’s back in his blue blazer as he strode tiredly away from me at my sister’s graduation, or by how I imagined him leaving the house for the last time, or the first 100-plus times I drove by the fire station outside of which he shot himself. Even the feeling of exhilaration on white water, a delight that he and I shared—these are all particularly potent emotional, geographic, and physical triggers for me, even 11 years later. Most people have no idea.

If you are a survivor, let the emotions surface, and let them pass (not easy: It’s like getting thrashed by a huge wave of rage, sadness, and ugly crying). Let me repeat: You don’t have to hide your emotions, and you don’t have to apologize for them. You don’t even have to explain them. Grief is a shape-shifting, surprising, and (in the case of suicide) often terrifying entity. Lean into people who are trustworthy, nonjudgmental, and who let you be you. And when you meet people who have also experienced the suicide of a loved one or family member, you might find yourself weeping together on top of a mountain during spring ski season (true story). It’s OK.

Presence, care, laughter, and gentleness are salves. I have personally found therapy to be fantastically helpful, and many people benefit from survivor support groups. If you are trying to support someone who is grieving the loss of a friend or family member through suicide, support them with presence and infrastructure. Just hug. Sit. Bring food. Come over to walk the dog together. Call to say you’re thinking of them.

7. Your presence will sometimes make people uncomfortable. Many will react strangely.

People say weird and even hurtful things out of their own profound discomfort after a suicide. Others will disappear entirely from your life. This sucks, but it’s true. Suicide (along with what I call the 3Ds—other forms of sudden death, divorce, and disability) can make people really nervous, and as a result they may react to your presence in all kinds of intense and often unhelpful ways.

One person with whom I was close didn’t call, text, or write me for nearly a year after. Only when I ran into her at a party by chance later did she laugh awkwardly and say, “Yeah, sorry about that. I mean, what could I even have said?” My answer now: “Just call and say you don’t know what to say, and you love me and are thinking of me.”

I have learned that people’s reactions and statements say much more about what they are grappling with than what is true for you. This doesn’t make it easier in the moment, but it does mean you don’t have to take on their stuff. Find your way with the people who let you be you, without foisting their own anxious interpretations onto you.

8. Memorialize in ways that feel right to you.

Just as everyone grieves differently, everyone memorializes differently. In the aftermath of a suicide, ritual and burial are important, though they can take many forms. For some people, traditional religious funeral services may provide important closure. For others, those same services might feel like emotional handcuffs.

As time goes on, trust your creativity and the legacy of the person’s memory. What are the moments that make you think of them with a grin? Consider memorializing a place or an activity that feels like a positive legacy—a meditation bench in a treasured spot or an annual walk with organizations that raise awareness about suicide or mental illness, for example. I have found it meaningful to memorialize my father by consciously giving him a shout out during water sports that we both loved.

Finally: The days around the anniversary of the suicide will be tough. Be gentle with yourself in these times. You also deserve love and kindness.

9. You will change, and your relationships will too.

Suicide is an extreme event that, for survivors, puts much into excruciating texture. For me, my father’s death began a decade-long journey of self-reflection—about myself, my family, my partnership, me as a parent, and society more generally. It has involved devastating anxiety that, with time and therapy and life changes, has given way to profound, gentle, exhilarating clarities. Many relationships, including my marriage, were sundered as a result of this journey.

It has not been easy. Grief doesn’t end, but it does change, and with time it becomes less debilitating, more gently poignant. I wish beyond words that my daughter could have met her grandfather. I also have found ways that my father’s positive legacy lives on in me—and in her.

One aspect of my journey is a radical honesty, forged in agonies that none of us wished on ourselves. I am the person that I am because of many factors. One of them is my father’s suicide.

10. You can be OK.

There are no neat closures to the surd of suicide. But healing can be real. Small or large changes in your life may emerge over time. Sometimes they will surprise you. But I’m here to tell you: There is healing, and believe me—you are not alone. With the life you have, you can narrate the story that you are always unfurling.

If you’re feeling suicidal or know anyone who is, the National Suicide Prevention Lifeline in the U.S. is at 1-800-273-8255.

Complete Article HERE!