Tag: Death And Dying

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7 Ways to Move from Grief to Gratitude When Death Comes Calling

By Susan Ducharme Hoben, Author of Dying Well: Our Journey of Love and Loss

We may intellectually accept that death is normal and inevitable, but it doesn’t feel that way when it comes knocking on your door. My family was forced to come to grips with mortality when my husband Bruce was diagnosed with an aggressive stage 4 cancer. 

While we may think of bereavement as happening after someone’s death, for us it started when we accepted that Bruce was dying. That acceptance allowed us to focus our energies on achieving the peaceful end-of-life experience that he wanted. On Bruce’s journey I learned many powerful life-affirming lessons about finding gratitude in the face of death. 

Here are 7 lessons that can bring peace and even a sense of joy to what appears to be the most heart wrenching experience we can ever face.

1. Know what a peaceful end-of-life experience means 

At the end of life most of us want to have closure. We want to share our stories and wisdom, say meaningful goodbyes, know that our life had meaning, that we will be remembered, and that our loved ones will be ok. It’s important to describe what that looks like in your personal situation and what matters most to you at the end. Having goals and working towards them will provide an important feeling of purpose and achievement for everyone involved. 

2. Manage the fear of the unknown

If you have not thought about death, fear of the unknown can lead to anxiety and distress. Bruce’s fear of not being able to breathe was calmed when he learned that morphine would control shortness of breath. We didn’t know that the body has an orderly shutdown process that makes it predictable what will happen and when. Knowing what to expect and what can ease the end-of-life journey will help everyone feel more confident and prepared. 

3. Remove barriers to getting the desired care 

Our healthcare system can result in end-of-life care that is aggressive, expensive and not aligned with patient preferences. Avoiding painful and unwanted treatments requires constant championing. Having an advocate working on your behalf to ensure your decisions are honored will provide a much-needed feeling of control.

4. Take a real walk down memory lane 

Bruce and I visited his hometown where he retold the stories of his childhood standing in the places where they actually happened. Reminiscing about these fond memories brought the joy of those past moments into the present. Encouraging loved ones to share stories will also help affirm that their life mattered and will always be present in the hearts of the ones still here. 

5. Gather family and friends to celebrate a life well-lived 

Bruce was the guest of honor at his own “Irish Wake” where family members shared laughter and tears as they told stories of their time together. His colleagues roasted him with funny anecdotes and heartwarming tributes of what he meant to them. Gathering with family, friends and colleagues demonstrated to Bruce that his life had profound meaning, and that he would be remembered. Their outpouring of love and respect stayed with him until the end and will stay with me for the rest of my life.

6. Recreate treasured times together  

We took our children and grandchildren to a beach house for a week, allowing Bruce (and us) to do the things he loved to do. Every afternoon we reflected on joyous moments of the day, recalling memories and emotions from many happy times spent near the ocean. The memories themselves, as well as the sharing of them, brought all of us joy and comfort. 

7. Leave nothing left unsaid

We all want to die without regrets. Ideally we would do that by living without regrets. But if there is a need to make amends or acknowledge what someone has done for you, it’s vital to do that before you run out of time. Our minister told Bruce and I to use these words liberally: I forgive you. Please forgive me for any ways we may have hurt each other. Thank you for your presence in my life. I love you. You can use any words that feel right for you, as long as they impart a sense of love, compassion and resolution. 

Grief is a normal and important part of coping with death. However, there are ways we can soften its sting, and even welcome and embrace joy and celebration. The most powerful antidote to grief is being grateful for a life well-lived and for the people who supported and affirmed us.

With Bruce setting the tone, we helped him live fully to the very end. His last two-and-a-half months were some of the most celebratory, peaceful, and intimate we had shared during our forty-six years together. The feeling of gratitude, years later, has not abated for me, his family or his friends, and has provided a powerful and healing path for future generations to come.

Complete Article ↪HERE↩!

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6 things not to say to a dying friend

There are plenty of ways to make matters worse. Try these responses instead

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It’s never easy to hear that a friend is battling a life-threatening illness. When confronted with the idea of death, especially when it concerns someone one loves, it’s often hard to know what to say or how to react.

It’s normal to experience a whole host of emotions, from denial to anger to grief, and it’s important to be able to talk with both the friend and other professional and personal outlets as needed.

However, in times of confusion and sadness, it’s very, very easy to say the wrong thing. Here are some examples of common verbal faux pas, and what to say instead.

“How are you feeling?”

According to Dr. Sal Raichbach PsyD at Ambrosia Treatment Center, asking someone how they feel is a natural and instinctive way to start a conversation.  “But, for someone with a terminal illness who is likely in pain, asking how they are feeling leads to further discussion about their illness,” Dr. Raichbach told Considerable.

“Many people suffering from diseases are comfortable talking about them, but some aren’t.

What to say instead: “Start the conversation with a positive greeting, such as, ‘It’s great to see you,’ ” Dr. Raichbach advised.

A good way to navigate conversations with an afflicted friend is to let them bring up discussions of their illness. If they want to talk about it, you can be a great friend and offer support by listening. If they just want to talk about last week’s episode of Jeopardy, however, let the conversation be just that.

“Everything happens for a reason.”

Whatever you do, avoid clichés, especially ones that might clash with your friend’s personal beliefs. “Such statements can make the individual feel that the illness is somehow their fault. Even though it might not be your intention to make them feel responsible for their disease, it could lead them to dwell on the uncertainty of their situation,” Dr. Raichbach said.

There’s nothing worse than feeling like karma has somehow contributed to one’s illness, and your friend might not have reached a place of acceptance with their diagnosis yet.

What to say instead: Silence is golden in this case. People facing life-threatening illnesses have plenty of opportunity to consider their own beliefs and consult with spiritual advisors if they choose. Let your loved one express their own views, and be there to lend a nonjudgmental ear.

“I’m sure you’ll get better!”

Kriss A. Kevorkian, PhD, MSW, is a  thanatologist who teaches and offer programs for seniors around related to end-of-life care and planning. She told Considerable that these expressions of false hope usually come from a fear of thinking or talking about death.

What to say instead: “One thing to say as a loved one is dying is, ‘I’m here with you,’ ” Dr. Kevorkian said. “Be with the dying and hold hands if that’s OK, connect, and be present.”

Often, one of the most powerful actions you can take when supporting a terminally ill loved one is simply being there. Offering your time and physical presence tends to go much farther than we give it credit for.

“You don’t look very sick!”

This is another one that Dr. Kevorkian hears a lot, and, quite frankly, it’s not very helpful. Illnesses present in all sorts of ways, and just because someone hasn’t lost all their hair from chemo, it doesn’t mean their disease isn’t grave. Even if these sort of sentiments are meant as a joke, one can’t always be sure that a terminally ill patient will take them that way.

Say this instead: Instead of commenting on their looks, remind them of a time they brightened your life and talk about how great a friend they’ve been.

Sherry Cormier, PhD, recommended affirmations such as, “I’m thinking about you as you go through this process” or, “I’m sending love (or prayers or hugs) your way.” Show your friend that you acknowledge the difficulty of what’s happening and will stick with them regardless of their struggle.

A simple “I love you” has also been known to work wonders.

“You’re going to a better place/ you’ll be with God soon.”

As Dr. Kevorkian pointed out, such sentiments make bold assumptions about a person’s faith and belief systems. Even if you know that your friend believes in heaven, God, or a peaceful afterlife of some sort, don’t assume they’ve acknowledged or accepted their place there quite yet.

What to say instead: The best way to learn where someone might be with their diagnosis and what they need from you is to ask. As Dr. Cormier told Considerable, try “‘How could I (or we) be most helpful at this time?’ or ‘I’m wondering if there are specific needs you or your family have that we could help with?’

Don’t assume you know what the needs are. You might take decide they need food and take it over at a time when they are inundated with food and end up throwing your dish out.”

Ignoring the elephant in the room altogether

“The fact is, often people say nothing to terminally ill or dying people or their loved ones,” Dr. Cormier said. “They are too unsure about what to say, so they act as if nothing is wrong and talk about the weather. Saying nothing is invalidating.

What to say instead: “What is much more helpful is to say something that acknowledges the situation, like: ‘I’ve heard you’ve been diagnosed with an aggressive cancer.’ Then add a comment that expresses empathy and concern such as, ‘I’m really sorry to learn this.’ ”

After this, let them dictate how much of the illness they want to talk about. If they want to dive in and discuss their doctors’ appointments, offer yourself as a compassionate listener. If they don’t want to talk about it at all, so be it. You can let them take the reins from here, but it’s best to at least acknowledge your availability to discuss their pain and hardship.

Interactions after this initial acknowledgement can circle back to Point #1: Express gratitude about seeing your friend, but let them control how much they want to talk about their illness.

Make sure to seek out your own counseling methods as needed for dealing with any kind of loss and grief. Losing a loved one is never easy, and knowing it will happen sometime soon is confusing, upsetting, and difficult. Knowing the right things to say will at least help part of the process for both parties.

Complete Article ↪HERE↩!

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‘Dying is so medicalised. It makes people fearful’

The founder of Soul Midwives on how greater compassion and care can lead to people having a more gentle, tranquil death

Felicity Warner: ‘We need to take the care of dying people back into the community.’

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Felicity Warner wants everyone to die well. She is the woman behind Soul Midwives: non-medical companions who provide one-to-one holistic and spiritual care to people who are dying. The term “midwife” is no accident. It refers to the similarities between drawing our first breath and our last. Just as there are certain stages for a woman in labour prior to giving birth, so are there certain end-of-life stages before someone eventually dies, says Warner. It’s the same idea as end-of-life doulas. “A soul midwife will recognise those stages and will work with them like a midwife would at birth.”

Soul midwives support a dying person to set out their wishes for the final days in a death plan. They listen, keep vigil, allow people to talk openly about their impending death and fears, and provide therapeutic support to help alleviate anxiety and pain. This can be through breathing techniques, massage, sound and music therapy and essential oils. As the “soul” in the title suggests, the role also offers a spiritual dimension linked to healing and detachment. But it’s not just about helping people to die without fear, loneliness or anxiety. It’s also about making people realise they are valued, says Warner. “I’m very keen on that because a lot of people we work with don’t have anyone in their lives. Making them feel that they are special is a very big part of our role and to honour them as the people that they have been, because you can be made to feel very anonymous when you’re dying, whether old or young”.

The daughter of the former Conservative MP David Mudd, Warner cites the “harrowing deaths” of her grandmother – with whom she had lived after her parents divorced when she was six, who died of lung cancer when Warner was 14 – and her stepfather two years later that forced “an enormous amount” of processing and reflection early on and led her to become a health journalist.

In the 1990s, Warner found herself writing a number of features about women dying of breast cancer. Interviewees revealed their loneliness and isolation and the sense of being locked in a room with an elephant in it. “The biggest thing was the feeling that they couldn’t talk to anybody honestly about the fact they knew they were going to die, because everybody kept saying ‘we’ll get you through this; you won’t die’.”

They talked and Warner listened. “I think there was a healing in that they could just talk frankly about how they really felt to somebody who wasn’t judgmental in any way.” But Warner saw her journalistic boundaries begin to slide as she stepped in to fill unmet needs, such as giving a massage after one of the women confided that “nobody touches me any more” because of her cancer. When the last of six women she had interviewed died, her decision to help dying people full-time was realised.

She began volunteering in her local hospice, where she noticed “big gaps” in care delivery: the “one-size-fits-all” approach, for example, that saw everyone “wrapped up with crocheted blankets” and “given plastic cups to suck out of”, regardless of their age or their personal needs.

“I sat there thinking it would be so useful if someone could join up the dots in what I was seeing with people who were dying. If there could be some kind of middle ground between the clinical care given and the sort of tender loving care that goes such a long way when you’re really feeling ill, because that seemed to be very lacking or offered very willy-nilly and not always to everybody.”

Warner began road-testing what would become her “gentle dying” approach – the basis of soul midwifery. “It was realising how little things can make such a difference to people at the end of life. Even just sitting and holding their hand is massive to someone who has got no one else sitting with them, and having time to do that is a big thing.”

Warner outlined her philosophy in a book in 2003, then began delivering training in Dorset, where she lives. So far, more than 1,000 individuals have paid to attend her courses, including Macmillan and Marie Curie nurses, doctors, chaplains, social workers and psychotherapists working in the NHS, as well as people from South Africa, Canada, the US and Australia. Around 40% of trainees have gone on to practice.

Warner runs a referral service from the Soul Midwives website. Many practitioners offer sliding scale charges, opt for a donation or charge nothing at all. “Nobody would ever be turned away if they could not pay,” says Warner. “It is not about the money. Nobody would be excluded on financial grounds.”

Soul midwives can now be found in care homes, hospices, hospitals and within the home throughout the UK. They liaise with GPs and district nurses if someone wants to die at home. Warner admits that it’s taken time to build trust with other care professionals, but adds, “this trust has grown as the value of our work is being understood and seen.”

For her, soul midwifery is a movement that can fill the gap once met through closer community networks and she views dying as a process rather than an event – something that she feels has been lost over the generations. Recently Warner has introduced the idea of soul midwife “residencies” so that end-of-life discussions leave the confines of hospitals and hospices. “We need to bring the care of dying people back into the community. It’s been so medicalised and taken out of most people’s normal environment, and that makes it very fearful [for people].”

She cites a recent example of a soul midwife pitching up at a library for a morning so that people could come and discuss various aspects of dying. She now hopes to persuade a coffee shop chain to host residencies.

What is clear is that ensuring a tranquil, gentle death for others is also good for Warner’s own soul. She says: “I feel it’s my reason for being here.”

Complete Article ↪HERE↩!

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Grief is not a thing of beauty but it has helped me discover new parts of myself

It has taken me to the page, to a microphone, and yes, sometimes to bad decisions and booze

‘Bad things will happen, they will keep happening. But there will be little bursts of brilliance where the world feels impossibly wonderful just by sheer contrast.’

By

I’ve had an amazing two years, by anyone’s measure.

First, my mother died a very hard death from cancer. Then I ended my marriage, followed by a gut-wrenching estrangement from my formerly close father. I nearly bled to death in a storage room in a Sydney public hospital, and a few months after that my unborn baby died. It sounds like the plot of a B-grade movie. But here I am, staring myself down in the mirror each day urging myself to carry on, whispering: “Yes, this really is your life now. Yes, you must still shower and dress and go to work.” It is one thing to know figuratively that bad things can happen to you at any moment. It’s quite another to live that realisation over and over again.

When I was grieving my mother, I searched out the stories of people who experienced unfathomable loss. The Year of Magical Thinking became my bible. I followed Joan Didion as she stumbled her way through comprehending the death of her husband and daughter. Back then, my singular loss felt so big that only stories of utter tragedy seemed up to the task of providing me insight into the contours and trajectory of grief. But in time, we can become accustomed to almost anything.

I fear I have become one of those poor souls, like Didion, that people treat as an oracle. How could so much possibly happen to one person? How does she keep going? How did she make it through? Answers I used to search for in Didion’s writing, people now seek in me. Surely, with so much suffering must come wisdom.

Just like Didion, I don’t have any answers. As she puts it: “You sit down to dinner and life as you know it ends.” This is how I feel, but with a kind of repetition that makes it seem almost idiotic I still don’t see it coming.

I am not stronger for my grief. Grieving is not a state of grace and there is no beauty in it. I can say, though, that grief has different flavours. Something I could not have understood until I’d sampled so many types. And grief has brought forth parts of me I didn’t know existed. Grief has taken me to the page, to a microphone, and yes, sometimes to bad decisions and booze.

When my mother died I had felt fury and injustice. My grief spilled over into every area of my life – giving me a certain wildness behind the eyes. From that place of indignation I began to write. I wrote about things, and I wrote in ways I never knew I could. Grief, it seemed, had at least given me a gift.

When my husband, father and I went our separate ways I spat and raged at the world. “I dare you,” I said to no one in particular, “to try and take more from me.” My anger at the destruction of my former life jumped off the page and for the first time I began to perform. I stood in a room of a hundred strangers and read letters I had written to my dead mother. Grief had now taken away my fear.

When I came within a whisper of losing my own life, I was more nonchalant. After a day spent in a hospital emergency room, more than half my blood gushed into my abdomen while I sat waiting for treatment. Afterwards, the doctors told me I nearly died. I fear grief, but I don’t fear death. Not being there to grieve the loss of my own young life, I was rattled but largely unaltered. A friend captured it well: “You are perhaps a little too comfortable with your own death these days.”

By the time my baby died, I longed for the energy of earlier grief. When in my second trimester they couldn’t find a heartbeat, I sobbed tears of defeat. The grief of my dead baby took me to bed. While it is perhaps the most unfair grief of them all, I no longer have the energy to be shocked or enraged by the injustice. Finally, grief has worn me out. There is no realisation, no undiscovered talents, no devil-may-care attitude. There is just exhaustion. A kind of existential exhaustion that no holiday or rest can cure.

I explain to friends: “I am just one of those people.” I just seem to have one of those lives that are marked by great fortune but also great loss. A dream career, an amazing partner, a beautiful home and unintelligible loss.

I have no other explanation. And somehow it brings me to a type of acceptance – bad things will happen, they will keep happening. But there will be little bursts of brilliance where the world feels impossibly wonderful just by sheer contrast.

No, there is nothing you can learn from me. I am not wiser than I was two years ago, and I have nothing to teach you. But come, come and marvel at the relentlessness of life and our ability to endure it. I can show you that with time, you too can become accustomed to almost anything.

Complete Article ↪HERE↩!

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Not all Americans have a fair path to a good death – racial disparities are real

By and

What does it mean to “die well”?

The world got an idea recently from the 92-year-old Buddhist monk and peace activist Thich Nhat Hanh, who popularized mindfulness and meditation in the U.S. The monk returned to his home in Vietnam to pass his remaining years. Many admired his desire to live his remaining time in peace and dignity.

Researchers from the University of California, San Diego recently did a literature search to understand what Americans might consider to be a “good death” or “successful dying.” As can be expected, their findings varied. People’s views were determined by their religious, social and cultural norms and influences. The researchers urged health care providers, caregivers and the lay community to have open dialogues about preferences for the dying process.

As scholars who study social health and human services psychology, we found something missing in these conversations – how race impacts life span.

It’s important to recognize that not everyone has an equal chance at “dying well.”

Black population and ill health

Take the disease burden of the African American population.

African Americans experience an earlier onset and greater risk of what may be referred to as lifestyle-related diseases, including cardiovascular disease, stroke and diabetes. More than 40% of African Americans over the age of 20 are diagnosed with high blood pressure, compared to 32% of all Americans.

In addition, the Centers for Disease Control and Prevention reports that the likelihood of experiencing a first stroke is nearly twice as high for African Americans compared with whites. African Americans are more than two times more likely to experience a stroke before the age of 55. At age 45, the mortality rate from stroke is three times higher for blacks compared to whites.

This disease burden consequently leads to their higher mortality rates and overall shorter life expectancy for blacks compared to whites.

And while the life expectancy gap differs by only a few years, 75.3 for blacks and 78.9 for whites as of 2016, research suggests that African Americans suffer more sickness. This is due in part to the increased prevalence of high blood pressure, obesity and diabetes in this population.

Genetics, biological factors and lifestyle behaviors, such as diet and smoking, help explain a portion of these differences. However, researchers are still learning how race-related social experiences and physical environments affect health, illness and mortality.

Access to health care

factor is that African Americans have historically underutilized preventive medicine and health care services. They also delay seeking routine, necessary health care – or may not follow medical advice.

One study found that during an average month, 35% fewer blacks visited a physician’s office, and 27% fewer visited an outpatient clinic compared with whites.

“The only time I go to the doctor is when something is really hurting. But otherwise, I don’t even know my doctor’s name,” said a young African American male during a research study in Chicago, Illinois.

There are reasons for this mistrust. Researchers who study medical mistrust argue that high-profile cases of medical experiments are still playing a role in how African Americans view health care systems and providers. In the past, physicians have intentionally done harm against people of color. A well-known case is the Tuskegee Study of Untreated Syphilis in African American men, which lasted from 1932 to 1972.

In this clinical study, 399 African American men, who had already contracted syphilis, were told that they were receiving free health care from the government. In fact, doctors, knowing their critical condition, were awaiting their deaths to subsequently conduct autopsies and study the disease’s progression.

Even though penicillin had been proven to treat syphilis by 1947, these men were denied the treatment.

Why discrimination matters for health

Other studies suggest that regardless of their knowledge of past medical abuse, many African Americans have low levels of trust in medical establishments.

“Doctors, like all other people, are subject to prejudice and discrimination,” writes Damon Tweedy, author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.” “While bias can be a problem in any profession, in medicine, the stakes are much higher.”

Unfortunately, these fears are underscored by empirical evidence that African Americans are less likely to receive pain medication management, higher-quality care or survive surgical procedures.

In addition, a growing body of literature has established that experiences of discrimination are extremely harmful for physical and mental health, particularly among African Americans.

This research adds to the body of evidence that experiences of discrimination harm people’s health and may contribute to the increased rates of premature decline and death among blacks.

What does it take to die well?

As African American scholars, we argue the “art of dying well” may be a distant and romantic notion for the African American community.

African Americans are also exposed to earlier and more frequent deaths of close loved ones, immediate family members and friends.

Their increased “vulnerability to untimely deaths,” writes Duke University scholar Karla Holloway, shows African Americans’ lack of access to equitable and fair paths in life.

Before defining “a good death,” American society must first begin to fundamentally address how to promote quality living and longevity across all racial groups.

Complete Article ↪HERE↩!

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When a Parent Dies

Ways to Help Yourself and Your Surviving Parent

A grief-support expert shares a letter she wrote to a grieving friend

By Amy Florian

Not too long ago, a dear friend’s dad suffered a major heart attack and died. At the funeral, there was little time for more than a brief exchange of words.

But, given my background in grieving support and education, I wanted to offer some advice to help her and her mom through the grieving process. So, that evening I wrote her a letter. I’m sharing it here because I believe it can be of help to anyone who has recently lost a parent and wants to help their surviving parent through the grief. Here is what I wrote:

Dear Katie,

The way-too-soon and totally unexpected death of your dad has hit you hard. It was clear at the services that your family is reeling, trying to comprehend what happened to you, to understand the enormity of this loss, and to figure out what to do now.

Leave behind the well-meaning compulsion to cheer each other up or keep looking on the bright side.

I’m glad I was able to attend the services to celebrate his life and mourn his death together, and I also know your grief has only begun.

I remember after my husband’s death, a few of the letters that people wrote were extremely helpful — not the ones telling me the writer’s own story of grief, as if I was supposed to experience the same thing and handle it in the same way, but those that contained hard-won wisdom from grieving people.

In that vein, I offer you some input that may be helpful to you and your mom, gleaned from my many years of providing grief education, facilitating grief support groups and counseling grieving people.

If any of this does not apply in your case or is not helpful, then set it aside. Everyone grieves uniquely and you don’t have to meet my (or anyone else’s) expectations.

Grief hurts. We don’t want to face the pain, the loneliness and the void that will never be filled in the same way again. But if we don’t, we won’t heal.

Grief that is suppressed, denied or ignored does not go away. It stays there, it festers and it will find a way to come back out and bite you in physical, psychological, spiritual and emotional ways.

But it also helps to try to set the grief aside sometimes, as if in a box on the shelf, and let yourself smile or enjoy life for a bit. Those times will sustain you.

Don’t be afraid of bringing up your dad, saying his name and telling the stories. Will it cause tears? Yes, sometimes, but that’s not because you brought it up. The tears are there anyway. It is healing to allow them to spill out, whether you are alone or especially when you share those tears with someone else who also loved him, whether it’s your mom or supportive friends who will let you cry with them.

Did you know that there are physiological chemicals in tears that relieve stress? Tears are our natural stress-relief mechanism when we are sad — that’s why we call it “having a good cry.” So, when you cry, you help yourself heal.

One final thing about tears. People often say they can’t start crying because if they do, they will never be able to stop. Do you know that has not happened in the history of humankind? No one has ever not been able to stop crying. Allow the healing to happen, facilitated by allowing tears when they are there.

As you support your mom, remember your job is not to “fix it” or to make her feel better. Your job is to be her companion, to be there for her whatever she is feeling.

Leave behind the well-meaning compulsion to cheer each other up or keep looking on the bright side. Instead, just keep checking in. Ask what kind of a day it is today — feeling up, down or all over the place?

Talk about when you miss your dad the most. Share your stories about things people say that are helpful, and the well-intentioned things people say that are not! Share what you each wish people knew about what you’re going through. Keep the lines of communication as open as possible, so you can pour your experience out to each other and gain comfort.

Keep in mind that grief takes a very long time. Expect to hit sad periods of time again weeks or months after the death. This is especially true when those “marker days” hit: his birthday (and yours), the wedding anniversary, Father’s Day, the holidays, the monthly and yearly anniversaries of his death.

You will be sad over and over again. You will be happy over and over again, and eventually the happiness will predominate. But expect a roller coaster of emotions — some hours and days will be better, and some will feel like disasters. Hang in there. As long as you continue doing the hard work of grief, you are healing, you will heal and you will get there.

Another word about those “marker days.” Your dad’s absence will be huge, and yet the tendency of most people around you will be to talk about anyone and everything except your dad.

The intention is good — they want to keep you from feeling sad. Yet, these are the times it is most important to say his name, share the memories and keep his legacy alive.

His life and the lessons he taught you are with you forever. His love is with you forever. You are a different person because of him, and no one can ever take that away from you. Keep his name, his stories and your memories alive, even as you let go of all the things that can no longer be.

These are just a few things that I hope can get you on the path to healing. My most fervent hope is that your family may heal, carrying memories and stories of your dad’s life with you even as you move into a future that will be different than you had planned.

I will check in regularly, just to see what’s happening and how you’re doing. I am here for you for the long haul, no matter what.

I hold you and your mom close to my heart. In these crazy, turbulent days, I wish you moments of peace, an occasional smile and continued healing.

Love and hugs,

Amy

Complete Article ↪HERE↩!

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When the future is running out, narrating the past helps to prepare

By Dhruv Khullar

How should you live when you know you’re going to die?

It is perhaps the ultimate, eternal question — one we all have to grapple with, but mercifully, don’t have to, until the end is crystallized by our own illness or that of a loved one. Humans may be the only animal capable of grasping mortality, but it’s usually not something on our minds — until it is.

It’s a question I confront frequently as a physician caring for seriously ill patients. One morning some months ago, I met an older man with an aggressive cancer that had turned an avid runner into a voracious reader. He glanced up from his newspaper as I entered the hospital room.

“It’s [a] strange feeling, you know, reading about a world you’ll never get to see.”

After several rounds of chemotherapy — each more toxic than the last — he decided he had had enough. He could go long stretches without contemplating death, he said, until the sight of a far-off date or curiosity about some newly proposed legislation would bring into sharp focus the unavoidable reality: His days were limited.

“I mostly read biographies now,” he told me. “Reading about other lives helps me make sense of my own.”

I began to wonder whether the secret to a good death wasn’t looking forward, but peering backward — whether retrospective examination might be more therapeutic than prospective preparation. I thought of how often I’d focused solely on helping patients navigate the future: how many weeks or months of life they might expect, which procedures they should or shouldn’t consider. These discussions, while important, fail to address what research has revealed about the deeper wants and needs of seriously ill patients.

Nearly 20 years ago, a seminal study in the Journal of the American Medical Association explored what patients and doctors feel is most important at the end of life. Many responses were predictable and consistent across groups. Both doctors and patients, for example, thought it was important to maintain dignity, control pain and other symptoms, and have one’s financial affairs in order.

But where physicians and patients diverged is telling — and suggests both a missed opportunity and a path to progress.

Patients were far more likely to express that it was important to feel that their life was complete, to be at peace with God and to help others in some way.

In other words, to feel that their lives mattered.

A growing body of work suggests that a powerful but underused method of creating this sense of mattering is storytelling — reflecting on the past and creating a narrative of one’s life, what it has meant, who you’ve become and why.

Humans are natural story­tellers. We have tremendous power to frame a narrative. The same series of events — becoming a parent, getting a divorce, losing a loved one, finding a job — can be a tale of resilience and restoration or misfortune and regret. The process of bringing coherence to one’s life story is what psychologist Dan McAdams calls creating a “narrative identity.” People get better at identifying important life themes as they age, and those who are able to find the positive amid the negative are generally more satisfied with life.

Physicians are also storytellers by profession. But we’ve traditionally focused on narrating the course of disease instead of helping patients make sense of their lives with it. Creating opportunities for patients to reflect on life experiences, however, could offer an important avenue for healing — whether at the end of life or somewhere in the middle.

In a 2018 study, researchers assigned veterans with post-traumatic stress disorder to engage in either five 30-minute writing sessions in which they reflected on traumatic experiences, or a rigorous 12-week program of cognitive processing therapy (CPT), a first-line treatment for PTSD. The study found that the short writing sessions were just as effective at reducing PTSD symptoms as the resource-intensive CPT program.

Other work suggests that the particulars of storytelling matter. Simply looking back and listing life events doesn’t seem to help. It is the constructing of a narrative — exploring linkages, formulating a plotline — that’s critical for arriving at a coherent sense of self.

And even the pronouns seem to matter.

Using the first-, second- or third-person when reflecting on past experiences can each have strategic advantages. Using the third-person, for example, seems to allow us to better appreciate how we’ve changed over time, while the first-person primes us to look for continuity. Reflecting on challenges by using the generic “you” — “you win some, you lose some” or “what can you do?” — can help create psychological distance from a tough situation and universalize the experience. “I” makes the focus your response; “you” tethers it to the human condition.

When the future is running out, can we make more of the past? I often struggle with my role as a caregiver for patients at the end of life. I know the most healing things I can offer aren’t the things I usually do: pain medications, laxatives, intravenous fluids. Rather, they are at once more challenging and more elementary. To sit. To listen. To explore what it’s all meant.

“I tell myself,” my patient said. “Even if I won’t be around to see it, I helped shape the world of the future. At least my little part of it.”

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