Category: Talking about death

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Death doulas explain why everyone should have an end-of-life plan

Death doula Carmen Barnsley thinks people should talk more about death and be more informed about their options.

By Nicole Mills

A new breed of doulas are helping break down the fear around death, which they say shouldn’t be a confronting word.

Carmen Barnsley from Melbourne said just like birth doulas, death doulas were there to provide support, knowledge and assistance during times of upheaval and uncertainty.

“I find it is just a privilege and a humbling experience to be where life enters this world and when life leaves it,” the former nurse said.

“Death is just as amazing an experience as birth is, but we celebrate birth and we deny death.”

Ms Barnsley has had her own experience with death. Her son died when he was five months old.

While she was in the depths of numbing grief, the hospital handed over a Yellow Pages and told her and her husband they needed to pick a funeral parlour.

It was the first of many conversations she had during the grieving process that made her realise that as a society, we need to start doing death better.

“Some cultures do death beautifully. It’s a reflection of the person’s life, whereas I think we do it pretty poorly,” she said.

“The honest thing I can say about the doulas in my network is everyone has been through a personal process of death.

“A lot of the doulas who are coming from personal experiences are coming from terrible personal experiences and were seeking answers to improve it so that doesn’t happen to another person again.”

Emotions run high

Ms Barnsley said her colleagues came from all walks of life, having worked as hospital chaplains, accountants, social workers, celebrants and in the funeral industry.

She wants people to understand that knowledge is power, especially when it comes to death.

“A death doula isn’t about dying, it’s about allowing that individual to live until they die.

“I find when somebody puts a plan in place they will then live until they die, as ironic as that sounds.”

She recommends having conversations about death when you’re young and healthy instead of leaving it until death approaches when emotions run high.

“In the medical profession we have informed consent. I’d love for end-of-life issues to have informed choices.

“I don’t have a terminal disease but I have an advanced life care directive in place.

“My doctor has got a copy; this is probably a little bit touchy at the moment, but mine is actually up on the [My Health Record] healthcare site … so that any hospital in Australia can access my directive.”

The dying space

The main thing Ms Barnsley wants people to know is that death doesn’t have to be impersonal and there is no prescribed process to follow.

“You don’t need a funeral home, and some people don’t even know that,” she said.

“You may need to get one to transport someone, but you can have a loved one at home, you can organise transport straight to burial or cremation or whatever the person’s choice is.

“[In the past] a family did care for loved ones dying; it wasn’t in a hospital, it wasn’t medicalised, it wasn’t institutionalised and that was the norm.

“But there became a fear factor with death; let’s take it behind closed doors, we don’t talk about it, and there’s still people within our community that still have that.”

Melbourne death doula Bonita Ralph says talking about death is important.

Bonita Ralph first came into contact with doulas when she was pregnant with her first child.

Years later she read an article about the work of death doulas and realised it was a similar concept.

“For me it was a very lightbulb moment where I went, ‘Oh my God, of course that’s the same thing’,” she said.

“It’s the same sort of energy, the birthing space and the dying space.”

Ms Ralph comes from a community welfare and social justice background and sees the work of a death doula as an “in-between role” to help bridge the gap between the medical system and the community.

“I think a lot of people think that when you’re a doula, you’re sitting at the bedside of someone who is dying, and that hasn’t been my experience yet,” she said.

“I think that may come, it may not, and that’s OK because I think the doula role, for me, is broader than that.

“A doula is a companion, someone to walk with you, someone to support you in your choices and that absolutely applies to end-of-life care and death.”

Know your choices

Ms Ralph said one of the best things people could do was spend time reflecting on their own experience with death and understand where their knowledge about death comes from.

“I think we’re moving really slowly towards acknowledging that if we don’t have role models and experiences, then we actually don’t know what to do,” she said.

“They need to know that it’s not illegal to take someone who has died home. It’s not illegal to organise your own funeral. You don’t need a funeral director. It’s a lot of work and maybe I wouldn’t suggest it; logistically it’s tricky, but it’s not impossible.

“People do dig their own graves, the graves of family members. That is not impossible. There are options out there.”

Ms Ralph said these options would not be for everyone, and while Australia was blessed to have a good medical system, it was important to know your choices.

“I don’t want people to feel like they’re being forced or that there’s a right or wrong way to do death,” she said.

“Death is so important because if you don’t offer good support, if you don’t offer genuine response to what that family needs, there’s going to be complicated bereavement results because people don’t move through and grow with their grief. They can get stuck.”

She said often people found it easier to talk openly about death with a doula, but she always encouraged people to have those same conversations at home so their next of kin understood their wishes.

“Talking about death is not weird. It’s important.

“Ask anyone who has had to work through a complicated death process such as a tragic death or complicated families or someone has died and left everything undone and the family has to pick up the pieces.

“Have these conversations when you’re young and well and alive and engaged, and have these conversations ongoing because things change. Relationships change. Expectations change. So don’t be afraid and keep having that conversation.”

Events are being held across Australia on August 8 for Dying to Know Day, which aims to start conversations around death, dying and bereavement.

For more information and to find events near you visit the Dying to Know Day website.

Complete Article ↪HERE↩!

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What does it mean to have a ‘good death’?

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What do you see when you picture an ideal death?

Are you surrounded by friends and family members, or is the setting more intimate? Are you at a hospital or at home? Are you pain-free? Were you able to feed yourself up until your death? Is there a spiritual element to your experience?

“We talk about personal medicine, but there should be personalized death too,” said Dr. Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego School of Medicine. “Finding out what kind of death a person would like to have should not be a taboo topic.”

To help open up the conversation in our death-phobic culture, Jeste and his colleagues are working on a broad definition of a “good death” that will help healthcare workers and family members ensure that a dying person’s final moments are as comfortable and meaningful as possible.

“You can make it a positive experience for everybody,” Jeste said. “Yes, it is a sad experience, but knowing it is inevitable, let us see what we can do that will help.”

The group’s first step was to look at previously published studies that examined what constitutes a good death according to people who are dying, their family members and healthcare workers.

The results were published this week in the American Journal of Geriatric Psychiatry.

The researchers searched through two large research databases — PubMed and PsycINFO — but they were able to find only 36 articles in the last 20 years that were relevant to their work.

Jeste said the lack of studies on a good death was not surprising.

“We don’t want to deal with unpleasant things, and there is nothing good that we associate with death, so why do research on it?” he said.

The articles the team did find included studies done in the United States, Japan, the Netherlands, Iran, Israel and Turkey.

From these, they identified 11 different themes that contribute to successful dying including dignity, pain-free status, quality of life, family, emotional well being, and religiosity and spirituality. Also on the list were life completion, treatment preferences, preference for dying process, relationship with healthcare provider, and “other.”

The authors report that the most important elements of a good death differ depending on whom you ask, but there was agreement on some of them.

One hundred percent of patients and family members as well as 94% of healthcare workers said preference for the dying process — defined as getting to choose who is with you when you die, as well as where and when — is an important element of a successful death.

There was also widespread agreement that being pain-free at the time of death is an important component of successful dying. Ninety percent of family members, 85% of patients and 83% of healthcare workers mentioned it across the various studies.

Religiosity and spirituality — meeting with clergy, having faith, and receiving religious or spiritual comfort — appeared to be significantly more important to the definition of a good death by those who were dying than to family members or healthcare workers. The authors report that this theme was brought up by 65% of patients, but just 59% of healthcare workers and 50% of family members.

Family members were more concerned with the idea of dignity –defined here as being respected as an individual and having independence — at the end of life than either healthcare workers or patients were. The idea that dignity was an important element of a good death was brought up by 80% of family members, but just 61% of healthcare workers and 55% of patients.

Similarly, having a good quality of life –meaning living as usual, and believing life is worth living even at the end– was listed as an important part of a good death by 70% of family members, but just 35% of patients and 22% of healthcare workers.

“For a dying person, the concerns seem to be more existential and psychological and less physical,” Jeste said.

And here the authors see a call to action.

“Although it is important that we attend to the patient’s physical symptoms… it is crucial that the healthcare system… more closely address psychological, social and spirituality themes in the end-of-life care for both patients and families,” they write.

They also say this work is just the start of a much longer conversation.

Jeste hopes that one day terminally ill patients might receive a checklist that will help them think about and express what they consider a good death so that family members and healthcare workers can help them achieve it.

“We are not just interested in research,” Jeste said. “We are interested in improving well being.”

Complete Article ↪HERE↩!

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6 Ways to Help Someone Who Lost a Loved One to Suicide

Family members and close friends of someone who dies by suicide are at increased risk of suicide themselves. Here’s how you can help.

By Sarah Klein

There’s a common estimate that every suicide leaves behind six survivors who are the most affected by the death. Not to be confused with suicide attempt survivors, who have taken action toward ending their own lives, suicide survivors or suicide loss survivors are friends or family members of someone who died by suicide.

Suicide loss survivors are themselves at an increased risk of mental health conditions and suicide in the future. One study found that people who knew someone who died by suicide in the previous year were 1.6 times more likely to have suicidal thoughts, 2.9 times more likely to make a suicide plan, and 3.7 times more likely to make a suicide attempt than people who did not know someone who died by suicide.

Family members may be genetically predisposed to suicide, while friends and peers may be influenced by the behavior of a person who died by suicide—or distraught by the “emotional destruction suicide leaves in its wake,” says John R. Jordan, PhD, a clinical psychologist in Pawtucket, Rhode Island, and the author of several books and articles on bereavement after suicide.

To address this increased risk, experts in the field of suicide practice something called suicide postvention. “[Clinical psychologist] Edwin Shneidman coined the term to mean what we do after a suicide has happened to help people who are loss survivors and help reduce their risk of suicide,” Jordan says.

Postvention tactics can include professional measures, like therapy sessions or meetings with a support group. But help can also come from family and friends. If you know someone who is a recent survivor of suicide loss, here are expert-recommended ways you can help.

Be present

“Even though this is changing, suicide is still a very stigmatized death,” Jordan says. “Losing someone to suicide can be tremendously isolating. Many people either don’t know anybody or don’t know they know somebody” who was close to someone who died by suicide, he says. Help break down those isolating walls by being there for your friend or family member

Kim Ruocco’s husband died by suicide in 2005. A Marine Corps pilot, he came back from what she describes as a “pretty difficult deployment” in Iraq with PTSD, depression, and anxiety. Their sons were 8 and 10 at the time.

Ruocco, who has a master’s degree in social work and is now the vice president of suicide postvention and prevention at the Tragedy Assistant Program for Survivors, says she took comfort in people simply being by her side. “The people who were most helpful to me could be in my presence and tolerate my pain and didn’t have to say anything,” she says. “There are no right words really, but it was really comforting to have someone who can be with you with that much pain.”

Deflect feelings of blame

Grief is never easy, but grief in the wake of suicide can be particularly complicated, says Mara Pheister, MD, an associate professor in psychiatry and behavioral medicine at the Medical College of Wisconsin, who has researched suicide prevention and postvention. “There’s the sense that it is a little different than the grief involved in losing someone in general. There can be a lot of guilt, a lot of what if,” she says.

Because a suicide loss survivor may already be blaming themselves for not doing something differently, comments like, “How could you not have known?” or “Why didn’t you stop him?” are particularly unhelpful, Dr. Pheister says. “That’s not something that needs to be said.”

Other survivors may be working through feelings of blame surrounding what turned out to be their final interaction or conversation with the person who died, Ruocco adds. “Help them understand that suicide is a multi-factor event that comes together on a kind of ‘perfect storm’ day,” she says, and encourage them to try to let go of that kind of guilt.

Let them dictate how much detail to share

Although it can be uncomfortable and scary to talk about suicide, avoiding the topic altogether might make a suicide survivor feel like you’re pretending nothing happened. Don’t shy away from talking about suicide—but don’t pry for details, either. Listen to how the survivor is talking about it and take cues from them. “Be there for them if they want to talk about it,” Dr. Pheister says. “It depends on what the person feels like bringing up themselves, what they’re okay talking about.”

That includes how you talk about the person’s death, Ruocco says. “Everyone is different in what kinds of words they want to use in connection with their loved one’s death,” she says. “Listen carefully to how the survivors are talking about the death and use those words.”

When in doubt, ask for guidance. Say something like: “I can only try to imagine what this is like for you. Would it be helpful for you to talk to me, or would you rather not talk about it?” Jordan says. However they respond, treat the person with compassion, as you would anyone who is grieving the death of a loved one, he says.

Celebrate the life the person lived

Put aside your curiosity about how the person died and instead share stories of how they lived. Funny stories of her husband or memories she may not have heard before were most comforting, Ruocco says.

“Use their loved one’s name, remember who they were before they struggled with whatever their issues were, acknowledge that the death doesn’t define them,” Ruocco says. “Talking about the life they lived is incredibly helpful.”

Reassure the survivor their feelings are normal

Alongside the guilt that a survivor might be feeling, there could also be sadness, self-doubt, anger, helplessness, and a wide range of other totally normal reactions, Dr. Pheister says. “Depending on how much the person [who died by suicide] was struggling, the survivor might [also] feel relief, which then induces more guilt,” she says. You can help by reinforcing that these and many other emotions are all well within the range of normal reactions to suicide loss. For example, help them “recognize that relief is the natural response to the removal of stress,” Dr. Pheister says.

Talking about how a person is feeling—and that it’s okay to feel that way—might help stave off some self-judgment and self-doubt, Dr. Pheister says.

Help them embrace their grief

Survivors often expect to grieve for a set period of time and then get over it, Ruocco says, which isn’t always the case. “Grief and loss become a part of who you are; people grieve their entire lives,” she says.

With time, grief can certainly become less painful—but it may still linger, she says. She counsels survivors to think of it in a somewhat more positive light. “Grief is love. You grieve because you loved someone. See it as a connection with a loved one.”

If you or someone you know is thinking about suicide, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Complete Article ↪HERE↩!

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Natural Burials Are Rising, and That’s Good for the Planet

Natural burials offer a greener alternative to traditional cemeteries, but Big Funeral is fighting back.

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Even in death, Americans just can’t stop themselves from destroying the planet, according to new research.

Right now there are around 22,500 active cemeteries in the United States. These sanitized spaces, with bunches of flowers lain among neat rows of gravestones on manicured lawns, are so closely associated with the American idea of mourning that it’s difficult to imagine an alternative.

Yet the practice is deeply unsustainable. Every year, in laying their dead to rest, Americans bury approximately 73,000 kilometers of hardwood boards, 58,500 tons of steel, 1.5 million tons of concrete, and 3.1 million liters of formaldehyde. A typical four-hectare cemetery contains enough wood to construct 40 homes and sufficient volumes of embalming fluid to fill a backyard swimming pool. As the Baby Boomers start to die, these environmental impacts are only going to grow.

“People hate to think about it. They think, ‘I’m going to be embalmed, put in a vault, and have a nice, dry, quiet existence for my body,’ but that’s a total farce,” says Chris Coutts, an associate professor in the Department of Urban and Regional Planning at Florida State University. “The bodies quickly start to rot, and those fluids, if they’re in the body, find a way out of the vault and into the soil, and they can create a plume. It’s a concern if it migrates into water tables. The whole point of embalming fluid is that it doesn’t degrade, so it’s going to be around a long time.”

Coutts is the lead author of a new paper examining the benefits of a greener alternative to the traditional rituals of death: natural burial. While higher-density family vaults can reduce your environmental footprint compared to an individual burial, it’s still a high-impact way of shuffling off your mortal coil. Even cremation, which has doubled in popularity since 2000, leaves an environmental smudge on the Earth, thanks to its high energy consumption and the ensuing air pollution.

Increasingly, Coutts et al. have found, people are rejecting the lawn-park cemetery model, and instead choosing to commit their bodies to a wilder resting place. In most cases, this means eschewing traditional American funerary rites altogether and burying the body without chemicals in a biodegradable casket or a simple shroud. At its best, natural burial allows your death to leave almost no physical damage on the natural world, while helping to protect and conserve threatened landscapes for those still living.

One example is the 142-hectare Glendale Memorial Nature Preserve in Florida, a family farm located in an area full of endangered native longleaf pine and wiregrass. The plan for the cemetery called for 80 percent of the land to be restored and conserved as natural habitat, with around 28 hectares set aside for natural burials. Add-on items include coffins constructed from old bookshelves, while the conserved habitat is also available for recreational activities including hiking and camping. Telling ghost stories remains optional.

John and Bill Wilkerson, the brothers who run the business, say that the income they’ve generated from the burials has allowed them to resist the financial pressure to sell the land to developers—a proposition that was adamantly opposed by their late parents.

The lawn-park cemetery in America might feel like an inescapable ritual, but the idea is relatively recent, arising in the 19th century, as urban elites grew increasingly affluent. Rural cemeteries like Mount Auburn in Boston or Laurel Hill in Philadelphia were not only useful for memorializing the supposed importance of the deceased bourgeoisie, but also for providing their surviving relatives a pleasant getaway from increasingly crowded cities.

The practice of embalming grew popular around the time of the American Civil War, Coutts adds. “They needed to preserve and ship the bodies back to wherever they were going to be buried, and embalming became prevalent. It’s the common expected practice, but it’s really just people going through the motions: It’s what we’ve always done, it’s what we continue to do, but that’s changing,” he says.

This resource-intensive method of burial is far from universal across the globe. Muslim communities practice natural burial as a “basic religious obligation,” according to Coutts and his fellow authors, while in countries such as Australia, grave sites can be reused for new inhabitants after a certain amount of time has elapsed. In the Peruvian Amazon, before the arrival of Christian missionaries, bodies were lain among the buttress roots of large trees. Some Tibetans practice sky burials, placing the corpse on a mountain and allowing it to decompose gradually.

The first natural burial site in the U.S. was established in 1998 in South Carolina. There are now 162 natural-burial providers in the U.S., of which 99 are hybrid cemeteries, offering both natural and traditional burial. A further 54 offer exclusively natural burial, while nine are active conservation burial sites.

Yet America’s lucrative death-care industry is fighting back, determined to protect a billion-dollar market by perpetuating the idea that a resource-intensive funeral is the only guarantor of lasting peace. Indeed, hybrid burial sites are mostly a way for the sector to cash in on the growing popularity of natural burial, a form of greenwashing that offers little in the way of concrete benefits, says Joe Sehee, who founded the Green Burial Council, which certifies natural burial sites, in 2005.

“There were people who just didn’t like the idea [of natural burial],” Sehee says, “people within the industry, particularly people who liked the merchandise-based model of death care: chemical, casket, and vault companies.”

Perhaps more sinister than this greenwashing are the attempts by the funeral industry to lobby for new regulations that will protect its economic position. There are very few federal laws around the handling of the dead, with states and local governments generally left in control. Around half of U.S. states regulate the amount of time that a body can remain un-embalmed, yet no states require a body to be buried in a coffin. Only a handful of states forbid bodies being buried outside of established cemeteries.

This loose legal framework bodes well for natural burial, and badly for Big Funeral. Correspondingly, the mainstream funeral industry has lobbied state governments to pass legislation protecting its share of the market, such as mandating embalming, only permitting burial in established cemeteries, and requiring the involvement of a licensed funeral director to perform tasks that could ordinarily have been performed by the next-of-kin. Restricting citizens’ freedom to access natural burial is bad for the environment, and could deter those who might have chosen this wilder option because it was cheaper than a traditional plot.

Coutts himself, after years of studying the benefits of a natural burial, sounds almost excited by the contribution he will be able to make to conservation from beyond the grave. “I’ve often just dreamed about walking out into the desert with a bottle of water and just sitting under a tree and waiting for it to come,” he says. “But that would be a luxury and it’s probably not feasible. I have it in my will that I want my body to be buried naturally in a conservation burial ground.”

Complete Article ↪HERE↩!

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This is what happens when you die, according to a bunch of different people who died

Many of their accounts align with a recent scientific study into the subject

Many respondents described have no vital signs, yet being able to ‘see’ what was going on

By Adam Withnall

What happens to us when we die? It’s a question that has exercised humanity’s finest minds since those humans have been around to have them – and has been recently the subject of a number of groundbreaking scientific studies.

Now, a Reddit thread has posed the question specifically to those who have been clinically dead and then revived, and has received hundreds of responses.

Though the veracity of the answers has to be taken with a small pinch of salt, the answers from what essentially amounts to a large survey on the subject can be broken down into three categories.

There are those who felt nothing at all; those who had an experience of light and some interaction with another person/being; and those who felt they could watch what was happening while they were “dead” without being able to do anything.

The first group corresponds closely with the answers of a single Redditor who officially died twice and recently invited questions on the topic from other users.

The latter group, meanwhile, appears to agree with the work of Dr Sam Parnia, who sought out cardiac arrest patients and found that almost 40 per cent described having some form of “awareness” at a time when they were clinically dead.

Here is a taster of some of the Reddit users’ responses – which don’t seem to have produced a consensus on the topic just yet:

“I was getting an angiogram done, wide awake watching the screen and talking to the doctor. Alarms started to go off and everyone became panicked. My world became soft and foggy and everything faded to black. Next thing I remember was opening my eyes and hearing a Dr say “we got him back”. It was really a peaceful feeling more than anything.”

“I collapsed during a class presentation one day. All breathing and blood circulation stopped. I felt as if I was plummeting down an endless hole while my peers cried for help. I was revived and still have no memory of the little bit of time before and after my death.”

“Overdosed on heroin, EMTs said my heart stopped. Didn’t see anything, just like sleeping with no dreams.”

“I collapsed at a work meeting in February 2014 and had no pulse or cardiac rhythm for about five minutes. My last memory was from about an hour prior to the incident, and my next memory was from two days later, when I emerged from a medically-induced coma.”

“I flatlined for around 40 seconds. It was like falling asleep without dreaming, no sense of self.”

“Pure, perfect, uninterrupted sleep, no dreams.”

“I do remember a little bit of the ambulance ride, but not from my own body. It was seriously the strangest thing I have ever experienced. It could have been a dream, but I saw my own unconscious body, completely flatlined, in the ambulance. I remember the EMT who was in the ambulance with me (whom I did not see before I passed out) had mint green hair and I couldn’t remember his name, but I asked for him when I regained consciousness about three days later.”

“I was standing in front of a giant wall of light. It stretched up, down, left and right as far as I could see. Kind of like putting your eyes 6″ from a fluorescent lightbulb. The next memory I have is waking up in the hospital.”

“I was standing somewhere. There was a fog all around me, and I saw my best friend (who at the time I’d been fighting with and he’d stopped talking to me) come out of the mist. He told me that I couldn’t go yet, that I have to keep trying, and if I promised not to give up, he’d see me back on Earth. I wordlessly agreed, and I was instantly pushed (into?) my body.”

“I see a vivid “flashback” of myself in the ambulance being taken to the hospital and I am stood in the ambulance looking down on myself / others in the ambulance.”

“When I coded, I don’t remember a sensation of floating, but I was able to recall things in detail that happened while I was ‘dead’ on the other side of the room. No white lights, no dead relatives, nobody telling me to go back, but I was definitely able to see things that were in no way visible from where my body was. I remember speaking and being angry because nobody would answer me. My mother told me ‘you didn’t say anything, you were dead’.”

“I saw nothingness. Black, long empty, but I had a feeling like everything was great and nothing was wrong at all. Imagine how preexistence felt, much the same as post existence.”

Complete Article ↪HERE↩!

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Five ways to prepare young children to visit a loved one who is dying

by Jessica F. Hinton

Death and dying can be scary and uncomfortable subjects, so parents understandably may shy away from them and wonder if it’s a good idea to take their children to visit a relative or loved one in the hospital or a hospice facility. I wrestled with this when my grandmother was dying and ultimately chose to take my children to visit her in the hospital in her final days. I don’t regret that choice, because it gave the kids a chance to get to know her and also helped them start to understand that death is a normal part of life.

Kayce Hodos, a licensed professional counselor in North Carolina who specializes in grief and loss, says that while death and dying are difficult, they don’t need to be scary. Hodos likens the lessons a child can learn from a parent’s honest and transparent handling of death and dying to gifts. She says these children are better able to deal with loss and stress, and have a better perspective on the normal cycle of life and death. Visits to see a dying loved one are a great way to introduce these valuable lessons.

Along with teaching them about death, visits give children a chance to say goodbye and provide them with a sense of closure. They also support a familial culture of openness and honesty. Children whose parents include them in these experiences, says Amanda Thompson, a pediatric psychologist at Children’s National Health System, are more likely to feel safe and secure even in the face of a scary and anxiety-provoking event such as an impending death. The message communicated in these families, Thompson says, is: “We face the hard stuff together. We can talk about these things. And we’re here for each other no matter what.”

If you want to visit a sick or dying loved one with children but are unsure of how to prepare them, Thompson and Hodos offer these suggestions.

Consider your goals. Before even asking your children if they want to join you, Hodos says, think about why you want to include them. “Perhaps it is to provide the child and the loved one an opportunity to express love and say goodbye,” Hodos says. Whatever your reasons, being clear on them will help guide how you talk to your child. If, for instance, your goal is to say goodbye, then you’ll focus on why you think saying goodbye matters. It can also help you feel more in command of a situation that you can’t control.

Ask them what they want. Talk to your children about what they are comfortable with, and allow them to say goodbye in a way that they works for them. Having children do in-person visits is a great option for many families, but it’s not the only option, Thompson says. They can also send a card, write a letter, draw a picture or record a video message.

Prepare children thoughtfully. Hospitals can feel like scary and unfamiliar places for adults, let alone children. Talking to your children before the visit, says Thompson, can help them feel a little less afraid. Explain that their loved one may not look the same as they remember. Talk to them about some of things they may see, such as changes in breathing and skin color, weight loss and things in the room, such as tubes and machines, that may seem frightening initially.

It’s also important to go over how long you plan to stay. Hodos recommends shorter visits, especially with younger children, and explaining to them, “We’re only going to stay for ‘x’ amount of time because Grandma needs her rest.” Go over any other hospital rules that you think they’ll need to know (such as leaving the room when hospital staff require it, washing hands and using quiet voices).

Consider hospital supports. Some hospitals have staff members, whether social workers, child life specialists or psychologists, who can talk to your child before, during and after their visit. They can help you with pre-visit preparation, such as explaining some of the things they may experience in the room. And during a visit, they can be a source of support and distraction for a child who is having a hard time coping or needs a break.

Be prepared for questions. Children ask lots of questions. Thompson says that while many parents think their children expect them to have all the answers, they really only need you to be honest. “If your child asks a difficult question, you can tell them, ‘That’s a difficult question, and different people have different beliefs about that. What do you think?’ ” she says. At the same time, it can be helpful to think through your answers for some of the more common questions so that, as Thompson says, “you feel less anxious in the moment and can offer your child honest explanations using simple, brief and concrete language that is appropriate for their age.” For me, being able to answer my children’s question about death and confronting my own questions made seeing my grandma in her last weeks all the more worth it.

In our visits with my grandma, we talked about the weather, read books, looked at pictures and did other things that helped us forget why we came. When we said goodbye at the end of our first visit, my daughters gave her a glittery stone with the word “love” on it. At the time, I thought it would be our last gift. But now, with memories of those visits and the journey we’ve taken with our talks on death and dying, I know there were many other gifts, for all of us.

Complete Article ↪HERE↩!

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What to Expect When Witnessing a Loved One’s Death

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Nothing prepares you for being present at the death of a loved one. The emotional enormity of the experience and its relative rarity give survivors little frame of reference to draw from.

“The time of life we call dying is an extremely difficult part of the life cycle, but a normal part,” says palliative-care physician Ira Byock, author of Dying Well. “The nature of it isn’t medical, it’s experiential.”

The death experience unfolds differently in each situation. But those who have witnessed “the passing” observe the following:

The dying person may talk to people not in the room, or may see other places.

“A few hours before she died, my mother suddenly said, ‘No, I’m not Sarah [her mother’s name],’ but she didn’t say it to any of us in the room. Then she was telling Dad she loved him. It was like she was having two conversations at once. One of the last coherent things that she said was, ‘Are you the gentleman who’s come to meet me?'” — Michele, a North Carolina mother of four

Dying people often seem to be in two worlds at once: here and not here. They may talk to or gesture toward people who aren’t visible to others in the room. Or they may describe things or places they see, such as a garden, a favorite location, or lights.

These “deathbed visions,” as British neuropsychiatrist Peter Fenwick, a neuropsychiatrist and specialist in near-death experiences, calls them, almost always take place when the person is clearly conscious — even though witnesses sometimes mistake the visions and speech for signs of delirium. Some dying people switch easily between conversations with those at the bedside and with someone unseen. The people and places are usually connected with feelings of peace and security. In the U.S. and the U.K., nearly three-fourths of visions are of friends and relatives who aren’t living, says Fenwick, author of The Art of Dying. About 13 percent of people seen are religious figures, compared to 50 percent of people in India who see Hindu figures. Seeing strangers is relatively rare.

Dying may seem to involve great physical effort.

“My mom had a dry mouth and scary raspy breath that worsened over a few days. But she didn’t die until the day we gave her morphine. I felt responsible, wondering if we had rushed things.” — Emma, a 45-year-old artist in San Francisco.

“Some go gently — you look up and their chest is no longer moving,” palliative-care physician Byock says. “But for others it’s hard to die. It’s like an animal shedding its skin, a physical struggle to wriggle out of this life.”

Younger people and those who are healthy aside from a single fatal illness often have the most difficult time. But dying can be effortful for anyone. Palliative care — comfort care including pain relief — improves quality of life to life’s end. Unfortunately, say hospice workers, families are often reluctant to use painkillers out of a misguided fear that they curb awareness or hasten the death process.

Morphine dosages given in hospice are only enough to ease pain, Byock says. Even with good comfort care, certain reflexive symptoms of the dying process, such as labored breathing, can still appear as distress. Mental confusion is another common effect of the organs — in this case, the brain — shutting down. (See 10 Signs Death is Near).

The personality of the dying person usually stays consistent to the end.

“My mother never lost her sense of humor. I was complaining about my brother not coming to my daughter’s birthday party. ‘So shoot him!’ she said in her typically droll way. My mother’s last words to me were instructions to kill my brother!” — Dawn Barclay, a New York manager in her 40s, who saw her mom through 18 months of complications of heart surgery and stroke

People tend to die as they lived, says Maggie Callanan, a hospice nurse and the author of Final Gifts, who has witnessed more than 2,000 deaths. “Nice people get even nicer, manipulators manipulate, funny people die funny,” she explains. “We all have ways of navigating through life, and when dying, those tendencies are intensified by 10.”

More things you may witness at a loved one’s death

The dying person may speak in metaphors.

“On the day she died, my mom kept talking about traveling, like, ‘Let’s go, what are we waiting for . . . oh, there’s a plane ahead of us . . . no, that’s not the right plane.’ She also told my dad that he should take a later flight. She was definitely going someplace.” — Patricia Anderson, 45-year-old Ohio insurance account executive

“The dying often use symbolic language, especially to indicate an imminent change or a need to go forth — to die,” says hospice nurse Callanan. Travel is one of the more common themes, such as talking about modes of transportation or about going somewhere (making a flight, a golfer talking about going golfing).

The person may also allude to “making ready” (packing, making checklists, issuing directions). Some observers think that this talk of journey-making is a subconscious way dying people let family members know they know they’re passing away. It’s a signal for families to offer reassurance — that they, too, understand what’s happening and to convey that although they’re grieving, they’ll look after one another and be all right.

“The family’s reassurances that they’ll be all right often bring the peace a dying person needs,” Callanan says.

The dying person may seem to choose the final moment.

“The hospice people had told me that sometimes people won’t die when their loved ones are in the room, especially if the person has played a protective role in their lives. Or that they hang on if they feel you can’t let them go. So before I stepped out to get something to eat, I told my Dad that if he had to go it was OK, that he had done everything he could to raise us and we could raise ourselves now. Not seven minutes later, a nurse met me in the hall and said he was gone. I guess I felt a bit cheated because I wanted to witness this crossing over.” — Lise Funderburg, Philadelphia writer

Many people report feeling “cheated” or as if they “let down” a loved one by not being there at the moment of death. Others blame themselves as “failures” for inadvertently allowing the person they love to die alone. In many cases the survivor had stayed glued to the bedside for hours, determined to be there, turning away or stepping out for only an instant.

But those who work in hospice think it’s the other way around: Passing away often happens minutes after loved ones leave the bedside, as if the dying person is choosing to spare them the final moment. This is especially true, they say, with individuals toward whom the dying person feels protective.

Also common: The dying person seems to hang on to wait for someone to visit or something to be said. One South Carolina woman’s mother lingered in hospice for months until she received the news that her also-ill, adored younger sister had died. She died herself the next morning. “It was as if she wanted to spare her sister her own news,” her daughter said.

The dying person often seems peaceful at the end.

“She opened her eyes, and the house grew quiet. Her face softened and all the wrinkles and tension went away. Later the hospice nurse recommended that I not watch them take the body out because it had stiffened, and I appreciated that because now I can remember the relaxed mother I saw last.” — Aoife, a designer from Northern California

Especially when the route has been long and marked by physical struggle, many people observe that the moments around death itself are calm. “So many people I talk to about dying tell me they wish they could die in their sleep. I’d estimate 95 percent of people dying naturally from illness go into brief coma — like a profound sleep state — before they die,” hospice nurse Callanan says. “So the good news is that most of us do die in our sleep.”

Jo Reichel, a teacher in Michigan, sat watching the Olympics with her father the morning he died after a summer full of repeat hospitalizations. “I was sitting on the floor next to his chair and kept looking between the TV and him. At 6:30 he was alive, and by 6:32, he’d simply stopped breathing. At first I wasn’t even sure I should wake my sisters to tell them, because he looked so relaxed.”

For Frances, an Ohio accountant, the moments after death were unreal but not frightening. “I’d never been in the room with a dead person before. But I had a strong sense that body wasn’t my father any more. It felt like he had up and left the room; it was terribly sad but also strangely peaceful.”

Witnessing a death is often transformative and brings survivors close.

“Seeing a person you love dying taps into the best parts of your nature.” — Lise Funderburg

Before experiencing the death of a loved one, many people view the prospect with dread. Afterward, they often look back on their death-witnessing experience as having been a horrible, grief-stricken time that nevertheless brought certain gifts. Among these: new insights into their own capacity for selfless love and caring, renewed or intensified bonds with other family members, a new respect for siblings or medical staffers, a healing of old wounds.

“The situation asked for grace, patience, and charity, so something I actually benefited from was to see I had a fairly deep capacity for those things that hadn’t been called on in the same way before,” says Funderberg, who wrote about her father’s long final illness in Pig Candy: Taking My Father South, Taking My Father Home. “Someone dying is a great prioritizer. What does something like the resentment you were holding onto matter now?”

To be sure, the passing away of a loved one can be almost unendurable. That in the end it is endurable seems to be both its blessing and its curse.

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