There’s No Right Way to Mourn

The ‘grief police’ wield lamentable shaming tactics.

By Sian Beilock

When Kobe Bryant died on Jan. 26, there was an outpouring of grief for the legendary N.B.A. champion. Sports fans placed bouquets of flowers at his high school and held a vigil outside the Staples Center. Shaquille O’Neal, his friend, rival and former Lakers teammate, cried on TV while giving an emotional tribute.

Much of this grieving also took place on social media. His widow, Vanessa Bryant, wrote a powerful tribute on Instagram that was “liked” by more than nine million people. So did Carmelo Anthony and Chris Paul. Grief is no longer private these days, which lets us mourn together. But doing so also allows people to publicly shame how others deal with loss.

“Cancel the games. Cancel the Grammys.,” one person wrote on Twitter. Another criticized those who brought up the rape allegation against Bryant in their commemorations: “Some people have no respect for the dead.” This is part of a broader phenomenon. These “grief police” enforce murky standards of who should be sad, when they’re allowed to be and to what degree. They insist that our grief must be overwhelming and ubiquitous, and for all parts of our lives to be put on hold. This isn’t just problematic in the moment; introducing guilt into the grieving process can negatively impact others’ ability to heal.

Something similar happened at Barnard College where, in December, we were forced to grieve in the media spotlight after one of the newest members of our community, the first-year student Tess Majors, was murdered. I have spent my career researching anxiety and worry, and I was struck by a commonality among people on campus: Amid their feelings of heartbreak, members of our community were worried about how others would perceive their specific form of grieving.

I wasn’t aware of students policing others’ grief, but the perception that this was happening still had an effect, especially given the media attention around the tragedy. One student told me that, in the midst of her deep sorrow, she also felt guilty about feeling eager to write her final papers and was worried she would be judged for not mourning in the “right” way. Another student mentioned that she didn’t know Tess Majors personally and was feeling all right, even looking forward to a long-planned family trip over break, but was going to keep this thought to herself.

I bet some of the N.B.A. players who were eager to play in the wake of Bryant’s death also had mixed feelings — because they are being judged. LeBron James was skewered online for not immediately posting about his friend and mentor: “Why are you not posting Kobe? I never liked LeBron because he is always FULL of himself,” one person wrote on social media.

Public grieving doesn’t happen in a single community where there are shared social norms for how to react, like sitting shiva or walking in a second line. If bereaved players are slow to comment publicly, should we call them out? Must everyone who has ever met Bryant say something in public? When people with vastly different lived experiences come together around a public death, there is no real shared understanding of what is appropriate; this is why the grief police wield such power in calling people out.

Unfortunately, introducing blame into the grieving process causes people to question whether they are dealing with loss the right way and to feel guilty about what they do, say and feel. Recent research has linked guilt in bereavement to a wide range of mental and physical difficulties, including depression. So how, in the age of communal and public mourning, do we grieve and not let the grief police undercut how we feel? How do we continue to perform at our best with heavy hearts?

Everyone responds to death differently, and it’s psychologically healthy to focus on parts of our identity that are not touched by tragedy. It is O.K. for a grieving athlete to play an important game; the same goes for a student who wants to take her finals in the wake of a campus tragedy. Research on resiliency shows quite clearly that people who express (and value) different aspects of who they are tend to be psychologically stronger. For example, their role as an athlete, student or parent provides another outlet to express themselves if they experience a setback or loss in one aspect of their life, or if one of the ways they identify themselves is called into doubt.

Embracing the fullness of our identities in no way represents a lack of respect or a blindness to the gravity of a tragedy. Quite the opposite: It is only through this process that we can effectively take care of one another, including those who have been most affected.

Despite my expertise in this subject, I have had to force myself over the last month to realize that, even in mourning, I have to juggle life as a college president, a researcher, a mother, an athlete and a friend — not only for my own health and mind-set, but also for the well-being of those around me. When the grief police arrive, we need to give ourselves license to express positive emotions and affirm other aspects of ourselves that we value outside of the tragedy. Doing so means we will feel more in control and cope better down the line.

Complete Article HERE!

Anticipatory grief is real.

Here’s how to get help.

By Mary Chaput

I feel like I barely made it through the holidays in one piece. The family was all here; we celebrated with all of our usual traditions and yet I am so incredibly sad. Although my husband is still with us, he has dementia and I could often see confusion and anxiety on his face despite the love and support the family provided. I wish I could just be happy that I still have him next to me instead of feeling sad that things aren’t the way I always imagined they would be.

Grief is a universal response to loss; grief is a normal process. Caregivers often also experience ambiguous grief when, like your husband, the care recipient is physically present but psychologically or emotionally absent. The losses experienced in dementia are incremental and are not generally clearly defined making the mourning process rather complex. Handling these continuous losses over time can be emotionally exhausting.

Anticipatory grief when caring for someone with a terminal illness, such as dementia, is also not uncommon; we are may experience sorrow for the losses we anticipate in the future – plans to travel, plans to grow old together – as well as reconciling the fact that there will be a final physical loss. Caregivers may face fears of their own loss of independence and socialization as well as the fear of being alone. Anticipatory grief can be just as intense as the grief we feel when someone dies and, while not discussed as much as the grief felt after a death, it is a normal process for caregivers.

These types of grief are often difficult to acknowledge but they are a normal response to a caregiver’s situation. The grieving process is fluid, varying from person to person. There is no right way or wrong way to feel.

If anticipatory grief is affecting your day-to-day well-being, reach out to your support network or to a support group. Find a way to express your emotions such as through meditation, journaling or exercise. Make the most of the time you have with your husband and, most importantly, take care of your own emotional and physical health.

Complete Article HERE!

Diagnosed With Dementia, She Documented Her Wishes.

They Said No.

Susan Saran was diagnosed with frontotemporal dementia, a progressive, fatal brain disease. After suffering two brain hemorrhages, Saran signed an advance directive for dementia, a controversial new document that instructs caregivers to withhold hand-feeding and fluids at the end of life. She wears a chain bearing instructions that she not be resuscitated.

By JoNel Aleccia

When she worked on the trading floor of the Chicago Board Options Exchange, long before cellphone calculators, Susan Saran could perform complex math problems in her head. Years later, as one of its top regulators, she was in charge of investigating insider trading deals.

Today, she struggles to remember multiplication tables.

Seven years ago, at age 57, Saran was diagnosed with frontotemporal dementia, a progressive, fatal brain disease. She had started forgetting things, losing focus at the job she’d held for three decades. Then tests revealed the grim diagnosis.

“It was absolutely devastating,” said Saran, 64. “It changed everything. My job ended. I was put out on disability. I was told to establish myself in a community before I was unable to care for myself.”

So Saran uprooted herself. She sold her home in 2015 and found what looked like an ideal place: Kendal at Ithaca, a bucolic retirement community in rural New York whose website promised “comprehensive health care for life.”

And now, she’s fighting with that community over her right to determine how she’ll die ― even though she has made her wishes known in writing. Such a fight could ensnare millions of Americans with dementia in coming years.

In 2018, after two brain hemorrhages, Saran conferred with a lawyer and signed an advance directive for dementia, a controversial new document created by the group End of Life Choices New York that instructs caregivers to withhold hand-feeding and fluids at the end of life to avoid the worst ravages of the disease.

“It’s not something that I am willing to endure,” she said. “I don’t want my life prolonged beyond the point where I’m participating in life.”

But when Saran submitted the document to Kendal at Ithaca, the New York continuing care retirement community where she has spent more than $500,000 to secure her future, officials there said they could not honor her wishes.

In a letter, lawyers told Saran that the center is required by state and federal law to offer regular daily meals, with feeding assistance if necessary.

There’s no provision, the letter said, for “decisions to refuse food and water.”

It’s a cruel quandary for Saran and other Americans who have turned to a crop of dementia directives created in recent years. Even when people document their choices ― while they still have the ability to do so ― there’s no guarantee those instructions will be honored, said Dr. Stanley Terman, a California psychiatrist who advises patients on end-of-life decisions.

“It is, in my opinion, a false sense of security,” Terman said.

That may be especially true for the 2.2 million people who live in long-term care settings in the United States. People with dementia are most likely to die in nursing facilities, according to new research from Duke University and the Veterans Affairs Boston Healthcare System.

“If you’ve got the resources, where you’ve got family and paid caregivers at home, you’re all set,” said Dr. Karl Steinberg, a California geriatrician and hospice physician who has written extensively about dementia directives. If you’re living in a facility, he added, “it’s not going to happen.”

One key question is whether patients with dementia ― or those who fear the disease ― can say in advance that they want oral food and fluids stopped at a certain point, a move that would hasten death through dehydration.

It’s a controversial form of what’s known as VSED ― voluntarily stopping eating and drinking ― a practice among some terminally ill patients who want to end their lives. In those cases, people who still have mental capacity can refuse food and water, resulting in death within about two weeks.

Many states prohibit the withdrawal of assisted feeding, calling it basic “comfort care” that must be offered. Only one state, Nevada, explicitly recognizes an advance directive that calls for stopping eating and drinking. And that’s via a little-known law that took effect in October.

Critics of such documents, however, say they could lead to forced starvation of incapacitated people. The directives may be biased, reflecting a society prejudiced against age, disability and cognitive change, said Dr. James Wright, medical director of three long-term care facilities in Richmond, Va.

He’s the lead author of a recent white paper advising facilities not to honor dementia directives. Based on his years of clinical experience, Wright said many people with dementia become content with their situation, even when they never thought they would be.

“To enforce an advance directive on someone who may have had a complete turnaround on what they think of a life worth living is unethical and immoral,” Wright said.

The dementia directives published in the past few years are aimed at filling what experts say has been a major gap in advance-care planning: the gradual loss of capacity to make decisions about one’s care.

One version, published in 2018 by Dr. Barak Gaster, a professor of medicine at the University of Washington, has been downloaded 130,000 times after it was mentioned in a New York Times story and continues to be retrieved about 500 times per week.

“This is an issue that people have really thought a lot about,” Gaster said. “They worry about it a lot. They’re so eager and excited to have a structured opportunity to make their wishes known.”

Traditional advance directives focus on rare conditions, such as a persistent vegetative state or permanent coma, Gaster said. “And yet the No. 1 reason a person would lose ability is dementia,” he added.

In addition to Gaster’s document, directives drafted in New York and Washington state have drawn hundreds of users. The aid-in-dying advocacy group Compassion & Choices released a dementia directive this month.

As the U.S. population ages, more people ― and their families ― are grappling with dementia. By 2050, nearly 14 million Americans aged 65 and older may be diagnosed with Alzheimer’s disease.

“We are right now experiencing the very first upswing of the giant wave of dementia that’s heading our way,” Gaster said.

Saran is on the crest of that wave. Divorced, with no close family, she turned to Kendal ― with its 236 independent units and 84-bed health center ― as her final home. During her four years there, she has noticed some decline in her mental clarity.

“Even some of the simplest mathematical problems, like even seven times seven, I can’t think of it now,” Saran said.

Still, she is able to manage her affairs. She cooks her own food and cares for her three cats ― Squeaky, Sweetie and Pirate, a one-eyed tabby. A longtime Buddhist, she often drives to a nearby monastery to practice her faith.

In late summer, Saran invited visitors to her small cottage at Kendal, where tapestries hang on the walls and bookshelves are filled with tomes on religion, death and dying.

Frontotemporal dementia affects about 60,000 people in the U.S., and patients often die within seven to 13 years, but Saran’s disease appears to be progressing more slowly than expected.

“I think I have great capacity,” said Saran, who wears her silver hair long and favors jeans, linen shirts and turquoise jewelry.

She chain-smokes, lighting up the Seneca cigarettes she buys for $3 a pack from a nearby Indian reservation. She thought about quitting but decided it wasn’t worth the effort and continues to indulge her habit. “If you had my diagnosis, wouldn’t you?” she said.

When Saran was hospitalized after her strokes, she suddenly understood what losing her abilities might mean.

“I realized, oh, my God, I might get stuck in a situation where I can’t take any independent action,” she recalled. “I better make sure I have all my paperwork in order.”

She was stunned to learn it might not matter, even after her local lawyer, Chuck Guttman, drafted health care proxy documents and a power of attorney.

“I thought this was it,” she said. “I thought I’d move here and everything was taken care of, everything was settled. And now it’s not.”

Laurie Mante, Kendal’s executive director, declined to comment on Saran’s situation, even when Saran authorized her to do so.

“We recognize the great complexity in balancing our residents’ wishes with what is required of us,” Mante wrote in an email. “We have a dedicated team who works to balance those interests, and, when appropriate, work with our residents and their families to seek alternative paths.”

Saran said no one from Kendal has reached out to discuss an “alternative path.”

Not all dementia directives include instructions about assisted feeding. Gaster said he and his colleagues had “heated conversations” before deciding to leave that issue off their popular document.

Instead, he said, his option helps more people by addressing general goals of care for each stage of the disease. The most important thing, he said, is for people to consider their choices and share their desires with their loved ones.

The debate, Gaster said, boils down to whether assisted feeding is “basic support” or “a medical intervention that can be declined in advance.”

“There’s still a very wide perspective of viewpoints on that,” he said.

Backed by statute and practice, facilities say they are bound to offer food to all residents willing to eat, and to assist with hand-feeding and fluids if a person needs help.

The controversy centers on the definition of those terms.

Wright says late-stage dementia patients who show any interest in food ― a flick of the eyes, grunting or gestures, opening the mouth ― should be fed until they refuse it. Steinberg and others contend the default should be “don’t feed unless they ask for it.”

It’s always going to be “somewhat of a guess,” Wright acknowledged, about whether hand-feeding someone is help ― or force.

“I’ve not seen any guidelines that can faithfully give good, unbiased guidance,” he said. “I feel that I personally can determine when food means something to my patients and when it doesn’t.”

The new crop of dementia directives was inspired, in part, by high-profile cases of dementia patients who were spoon-fed against their apparent wishes. In Oregon and  British Columbia, courts ruled that food and water were basic care that could not be withdrawn.

But so far, there’s been no court case that says a clear advance directive for VSED “may or must be honored,” said Thaddeus Mason Pope, a professor at the Mitchell Hamline School of Law who studies end-of-life decisions.

Pope said he has heard of many people who move out ― or their families move them out ― of long-term care facilities to avoid assisted feeding in the last stages of dementia.

Saran has considered that, too.

“I should probably just leave,” she said, although that would mean losing the nonrefundable investment she’s already made. “I think about that every day.”

But then what? Hospice might be a solution, but only if there’s room when she needs it, she said.

Saran said her situation should be viewed as a cautionary tale. She wishes she’d asked more questions, insisted on answers about exactly how she would die once her dementia progressed.

“I didn’t realize I was signing away my right to self-determination,” she said. “I am appalled that my future demented self takes precedence over my competent current self.”

Complete Article HERE!

Death came a knocking- Ruthie Foster

Death came a knockin’
You know that death came a knockin’ on the mama’s door
Singin’ come on mama, ain’t you ready to go
And my mama stooped down, buckled up her shoes
And she moved on down by the Jordan stream
And then she shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

You know that death came a knockin’ on the sister’s door
Singin’ come on sister, ain’t you ready to go
And my sister stooped down, buckled up her shoes
And she moved on down by the Jordan stream
And then she shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

You know that death came a knockin’ on the brother’s door
Singin’ come on brother, ain’t you ready to go
And my brother stooped down, buckled up his shoes
And he moved on down by the Jordan stream
And then he shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

You know that death came a knockin’ on the neighbor’s door
Singin’ come on neighbor, ain’t you ready to go
And my neighbor stooped down, buckled up his shoes
And he moved on down by the Jordan stream
And then she shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

You know that death came a knockin’ on the preacher’s door
Singin’ come on preacher, ain’t you ready to go
And my preacher stooped down, buckled up her shoes
And she moved on down by the Jordan stream
And then she shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

You know that death came a knockin’ on my front door
Singin’ come on sister, ain’t you ready to go
So I stooped down, buckled my shoes
And I move on down by the Jordan stream
And then I shout “Hallelujah, done, done my duty, got on my travelin’ shoes”

Why ceremony matters

By Lois Heckman

Creating ceremonies is what I do, and every once in a while it’s good to stop and remember why. To my way of thinking, there are three really big transitions in life: birth, death and marriage. Every culture and religion, all around the world, has different ways to honor these milestones. Momentous occasions are honored and celebrated in diverse ways, almost always involve ceremony; rites of passage.

Elizabeth Gilbert wrote: “Ceremony is essential to humans: It’s a circle that we draw around important events to separate the momentous from the ordinary. And ritual is a sort of magical safety harness that guides us from one stage of our lives into the next, making sure we don’t stumble or lose ourselves along the way.”

That really nails it. I probably don’t have to even say anymore. But naturally I will!

Besides those three big ones, other life changing transitions include coming of age, sexual identity, and any major disruption in relationships— especially divorce. All are deserving of recognition, in small or big ways. We also have ceremonies for graduation or receiving awards and even retirement.

Each tradition has its own way to express the meaning, with specific rituals, readings or actions. And let’s remember that cultures and traditions evolve, changing with the times, or struggling to do so.

Perhaps you have heard of one of the most unusual coming-of-age ceremonies. It takes place in a remote island in the South Pacific, where boys risk their lives jumping head-first from a 90-foot tall wooden tower with nothing but vines wrapped around their ankles. Yes, ceremony can take many forms.

While I specialize in honoring weddings (what I think of as the No. 3 spot in the all-important life changes challenge) I also officiate funerals, baby welcomings and occasionally other types of events. I recently performed a lovely renewal of vows, and I have also created interesting anniversary celebrations, blessing of animals, and community events. I even create secular confirmation programs and ceremonies.

A funeral or memorial service is another important milestone. Sometimes people choose to do something a few weeks or more after the person has died. It can be somewhat more uplifting, and also allows people time to make plans to travel. These are often called a “celebration of life” rather than a funeral. But some traditions do not allow for this. Devout Jews and Muslims are required to bury almost immediately after the death. However, this still wouldn’t preclude a celebration of the person at a later date, after the burial.

I know there are times when families skip a formal ceremony for the dead. The reasons for this are varied. Sometimes it is a discomfort with religion, especially if the deceased had given up on her or his faith, or the family has a mixture of beliefs and they are unsure how to handle that.

There could be costs that make it prohibitive or seem wasteful to the survivors.

There might be family dysfunction and no one wants to come together, especially if it feels like you are honoring someone who was not a good person. We know how people always say nice things about the dead, even if they don’t deserve it. These are tricky issues, but if you loved the person who has died, even without a formal ceremony, it is worthwhile to take some special time to honor that loss. As we often hear (and rightly so) — a funeral is for the living

Weddings are entirely different. Even elopements deserve to be properly honored. A wedding is a joyful time and the ceremony is meant to move everyone through this transition. The wedding ceremony honors the partner’s separate lives, their past, and the journey that led them to one another, then marks the moment of commitment, and takes them into their future as they walk down the aisle, beginning a new path, side by side.

Even for couples who have been together for years, it is still important. Getting married is meaningful at any time or stage in one’s life. There are so many good reasons to marry, including legal rights and science has shown that a healthy marriage promotes better and longer lives. And let’s remember if the couple getting married has children, it is also an important moment for them.

Big changes have always deserved recognition, and I believe they always will. I hope everyone realizes the importance of taking the time to do just that, in whatever way works for you. And of course, I’m happy to help if you need me.

Complete Article HERE!

Dates With Death

When My Time Comes

Diane Rehm poses for a portrait at her home in January. After more than three decades and thousands of programs, she’s stepping away from the broadcast microphone.

By Amy Kepferle

“My mother begged to die,” Diane Rehm writes in the preface of her new book, When My Time Comes: Conversations about Whether Those Who Are Dying Should Have the Right to Determine When Life Should End.

“There was no hope of recovery,” she continues. “There was nothing more they could do to ease her pain or to keep her comfortable. She died suffering.”

Rehm, a beloved National Public Radio talk show host and bestselling author, wondered why she’d had to watch her mother endure the horrific effects of non-alcohol-related cirrhosis for so long, and why she didn’t have the right to choose when she’d had enough.

The subject again became personal in 2014 when her husband of 55 years, John Rehm, decided to end his life when the side effects of Parkinson’s disease became overwhelming. He couldn’t use his hands, could no longer feed himself or use the bathroom on his own, and slept for most of the day.

“Because John could not receive medical aid in dying, he had to starve himself and go without medication for 10 days, until he died,” she relates during a chapter focusing on an interview with palliative care physician, internist and geriatrician Christina Puchalski. “I as his wife could do nothing but watch him suffer.”

Puchalski’s take on Rehm’s story is an interesting one. Although she has plenty of compassion for those who are facing their final journey, she has concern that in states where assisted suicide is legal—like Washington, Oregon, Maine, Vermont, California, New Jersey, and Colorado—people might be too quick to seek medical aid to quicken their deaths. She believes palliative care and hospice care can help with pain and symptom management, and can also be done with dignity.

“Are we giving a message that when you get to that point, there’s not a lot of opportunity for meaning and purpose and joy?” Puchalski asks.

At 83 years old, Rehm is a clear proponent of the right-to-die movement. But in When My Time Comes, she uses her interviewing prowess to explore the topic in ways that go beyond a simple “yes” or “no.” She questions terminal cancer patients—one of whom moved to Oregon so she’d be able to end her life on her own terms—and widowed spouses, doctors, death educators, reverends and Roman Catholic priests, constitutional law professors, attorneys and politicians for their opinions.

It’s heady reading, especially when hearing from those who know they’re running out of time. But it’s also a reminder that life is fleeting, and that it’s better to let your family and loved ones know what you want before its final chapter.

At the end of the book, Rehm even talks to her grandson, asking him to record their conversation on his iPhone for posterity. She then tells him that if she’s terminally ill and there is no reasonable expectation of her recovery from mental or physical disability, to let her die and not be kept alive by artificial means and heroic measures.

During “A Conversation with Diane Rehm” Tues., Feb. 11 at Sehome High School, the retired radio personality will be in conversation with local author Phyllis Shacter, who—like Rehm—watched her spouse choose to die via Voluntary Stopping Eating and Drinking (VSED) rather than live into the late stages of Alzheimer’s. The discussion is sure to be a fascinating one, and may help give attendees a clearer look at the bigger picture.

Complete Article HERE!

The Pitfalls Of Extending Life And Prolonging Death

Humans have had to face death and mortality since since the beginning of time, but our experience of the dying process has changed dramatically in recent history.

Haider Warraich, a fellow in cardiology at Duke University Medical Center, tells Fresh Air‘s Terry Gross that death used to be sudden, unexpected and relatively swift — the result of a violent cause, or perhaps an infection. But, he says, modern medicines and medical technologies have lead to a “dramatic extension” of life — and a more prolonged dying processes.

“We’ve now … introduced a phase of our life, which can be considered as ‘dying,’ in which patients have terminal diseases in which they are in and out of the hospital, they are dependent in nursing homes,” Warraich says. “That is something that is a very, very recent development in our history as a species.”

Prolonging life might sound like a good thing, but Warraich notes that medical technologies often force patients, their loved ones and their doctors to make difficult, painful decisions. In his new book, Modern Death, he writes about a patient with end-stage dementia who screamed “kill me” as a feeding tube was inserted into his nose.

“This is probably one of the encounters that I had in residency that I have been unable to shake from my memory,” Warraich says. “I think if you ask any physician, any nurse, any paramedic, they’ll have many such stories to tell you.”

Interview Highlights

On the importance of having a healthcare proxy, living will and advanced directive

One of the biggest problems that we face in not only modern society, but in societies of olden times as well, is that people have always been very afraid to talk about death. In many cultures it is considered bad luck to talk about death and it is thought to be a bad omen. I think to some extent that extends to this very day. But … I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you’re not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.

On giving CPR and knowing when to stop giving CPR

One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. …

I was actually working in the hospital last night and it was about 3 in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, “Haider, I need your help. I have a patient that we are doing CPR on,” and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. … There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. …

At the same time while this CPR was ongoing, the patient’s family member, her daughter, was outside the room, and she was crying. … Even though we could give her all the information … that wasn’t perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, “Do you want us to stop CPR?” And that’s the type of thing that I don’t think any of us can ever prepare for, especially when it’s our parent that’s involved.

On why he wrote a book about dying

I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient’s religion but a physician’s religion when it comes to dealing with the end of life? How is social media affecting how people experience the end of life? …

So many times I’ve found myself in the room where there are people who were so much more experienced in life than I was, yet knew so little about death and dying. And so I wanted to write a book so that people could go into those really, really difficult places and feel like they’re armed with information, that this isn’t a completely foreign territory for them and that in some way could help them navigate and deal with the sort of difficult situations that lay ahead for them.

On the possible repeal of the Affordable Care Act

It is very unfortunate that health is so politicized in this country, because it doesn’t have to be. Health and wellness aren’t red or blue, and they shouldn’t be, but unfortunately that is where we are. I hope that when policies are being enacted in DC, patient’s voices, those who have benefited from the ACA, those who have gained insurance, those voices are not lost in the midst of all of this political activity.

On immigrating to the U.S. from Pakistan

Dr. Haider Warraich has written medical and opinion pieces for The New York Times, The Wall Street Journal and The Atlantic.

I came to the United States in 2010 and [until now] have only lived in an America in which Barack Obama was the president. I think in some ways Trump’s victory has really shaken me, because of how invested I was in the idea that America is a special place, it’s a truly multicultural society. And I’m still trying to understand, I think like so many others, just exactly what happened. Especially as a writer and as a physician I’ve tried to separate myself from my identity as a Muslim. I’d rather be known as a physician/scientist/writer who happens to be Pakistani, rather than a young Pakistani Muslim immigrant who happens to be a doctor and a writer, but I don’t know. Given how things are changing, I’m not even sure if I’ll be able to set that narrative for myself. That’s a scary thought — to live an identity that is so politicized even when you wish for it to not be.