01/16/18

Five ways to die with more than just ‘dignity’

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By Pieta Woolley

As Canada’s largest generation ages, more and more of us are dying each year. Ever since 1992, when ALS sufferer Sue Rodriguez brought medically assisted dying to the Supreme Court, most of the conversation about how to have a good death has been about how to actually die.

Now, Medical Assistance In Dying (MAID) is legal and available. So, there’s a new surge of interest in making death not only less painful but good.

In this month’s Observer, I wrote about the recent death of Don Grayston (my former professor), who was an Anglican priest who prepared for his death for 40 years. He and others, including the Vancouver-based death planning agency Willow, have pushed the “good death” conversation way beyond MAID and into the realm of spirituality, relationships, values and ritual.

It’s needed. As a funeral director I spoke to last year said, “People don’t want anything to do with their dead anymore. They treat me like I’m the garbage man, just taking out the trash.”  

No one wants that to be their final story.

So, here are five ways to die — with more than just dignity.

1. Die consciously, with care

Who does it? Death doulas, who are trained to advocate for the dying, increasing their physical comfort and helping them talk about death while acting as spiritual guides. Douglas College in British Columbia offers a straight-forward, college-certified death doula program, but others, such as the Conscious Dying Institute, are less constrained and more spiritually oriented.

Why? “I see the transition out of life as having the potential to be just as celebratory as the transition into this world,” Toronto death doula Susan Dawson told Global TV in June 2016.

2. Die in charge

Who does it? Willow, through its workshop “Departure Directions.” Participants learn how their bodies can be cared for after death and receive help making a plan for rituals and practicalities. It helps to bring peace of mind to the dying, along with their friends and family, especially in the absence of a clear, religious tradition.

Why? “Maybe you’ve experienced the overwhelming frustration of arranging a good-bye ritual for someone who didn’t leave any directions. You’ve struggled with trying to honour what you think are their wishes and meet the needs of those left behind, including you.”

3. Die with fulfilled relationships

Who does it? In 2017, the 20th anniversary of the seminal book Dying Well: The Prospect for Growth at the end of Life was celebrated. Palliative care physician and author Ira Byock advised that the dying — and living — need to hear four things: “Thank you,” “I love you,” “I forgive you” and “Please forgive me.”

Why? “I was death-naive before I read Dr. Ira Byock’s book Dying Well when my father was in his early 80s and in his final, painful decline,” writes Katy Butler, the author of the 2018 book Knocking on Heaven’s Door and A Good End of Life. “It introduced me to the possibility that with appropriate support, dying did not have to be a chaotic, fear-ridden and painful experience. In fact, families could be well-supported and death could even be meaningful.”

4. Die broke

Who does it?
 Some philanthropists and foundations choose to give away their money while they’re still living so that they can celebrate it being used. Some individuals choose to give inheritances to their heirs while they’re still living so that they can offer guidance.

Why? “Benefactors who choose to ‘give while living’ discover that it gives them an opportunity to share their long-term vision with heirs and to witness how their heirs handle the assets,” the Royal Bank of Canada advises. “Beneficiaries, meanwhile, can learn to manage the wealth and become comfortable with an inheritance while consulting with their benefactors, putting everyone in a better position to preserve family wealth for the future.” There are also tax advantages to giving while living, the bank notes.

5. Start dying early

Who does it? Anglican priest Don Grayston started thinking about his own death back while in his 30s. That is, he learned about dying from his aging congregants, figured out that it was going to happen to him and started living in ways that would help him become the old, wise man he wanted to be: in community with friends. In a congregation, this is a no-brainer, as all generations from infants to the elderly sit together each week. But outside of church, tight, multigenerational communities are rare.

Why? Obviously, to prepare yourself for your inevitable death, as Willow’s guides might say. But also, The Guardian tells us that death is cool. Everyone is doing it. Even hipsters. So get with it. 

Complete Article HERE!

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01/15/18

Death: The Greatest Teacher

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The Buddha said the greatest of all teachings is impermanence. Its final expression is death. Buddhist teacher Judy Lief explains why our awareness of death is the secret of life. It’s the ultimate twist.

“Laughing in the Face of Stupidity,” painting by Tasha Mannox from the series “Laughing in the Face of Death: To live and die without regrets.”

by

Whether we fight it, deny it, or accept it, we all have a relationship with death. Some people have few encounters with death as they are growing up, and it becomes personal for them only as they age and funerals begin to outnumber weddings. Others grow up in violent surroundings where sudden death is common, or see a family member die of a fatal illness. Many of us have never seen a person die, while people who work in hospitals and hospices see the realities of death and dying every day. But whether death is something distant for us or we are in the thick of it, it haunts and challenges us.

Death is a strong message, a demanding teacher. In response to death’s message, we could shut down and become more hardened. Or we could open up, and become more free and loving. We could try to avoid its message altogether, but that would take a lot of effort, because death is a persistent teacher.

Teacher death met up with us the minute we were born, and is by our side every moment of our life. What death has to teach us is direct and to the point. It is profound but intimate. Death is a full stop. It interrupts the delusions and habits of thought that entrap us in small-mindedness. It is an affront to ego.

Death is a fact. Our challenge is to figure out how to deal with it, because it is never a good plan to struggle against or deny reality. The more we struggle against death, the more resentment we have and the more we suffer. We take a painful situation and through our struggles add a whole new layer of pain to it.

We cannot avoid death, but we can change how we relate to it. We can take death as a teacher and see what we can learn from it.

“Laughing in the Face of Pride,” painting by Tasha Mannox from the series “Laughing in the Face of Death: To live and die without regrets.”

Facts are facts: everyone is going to die sooner or later. No magic trick or spiritual gimmick will make it go away. Distancing ourselves from death or putting off thinking about it does not work.

I have noticed that the more distant we are from death, the more fear arises. Death becomes alien, other, scary, mysterious. People who work regularly with the dying, who are closer to death, seem to have less fear.

We each have our own unique relationship with death, our own particular history and circumstances, but one way or another we all relate to death. The question is: how do we relate with this reality and how does this color our lives? It is possible to come to terms with the fact of death in a way that enriches our lives, but to learn from death we must be willing to take a dispassionate look at our experiences and preconceptions.

Reflecting on our own mortality and the reality of death is practiced in many contemplative traditions. In the Buddhist tradition, the contemplation of death is said to be the “supreme contemplation.” It encompasses reflecting not only on physical mortality, but on impermanence in all its dimensions.

By means of meditation and by developing an ongoing awareness of death, we can change our relationship with death and thereby change our relationship with life. We can see that death is not just something that pops up at the end of life, but is inseparably linked with our life moment to moment, from the beginning to the end.  We can see that death is not just a final teacher. It is available to teach us here and now.

When we contemplate in this way, our many schemes for getting around the reality of death, such as coming up with interpretations to make it more palatable, are exposed one by one and demolished. Death is the great interrupter, unreasonable and nonnegotiable. No amount of cleverness will make it otherwise.

Contemplating death is not an easy practice. It is not merely conceptual. It stirs things up. It evokes emotions of love, sorrow, fear, and longing. It brings up anger, disappointment, regret, and groundlessness. How tender it is to reflect on the many losses we have experienced and will experience in the future. How poignant it is to reflect on life’s fleeting quality.

How we think about death matters. It affects how we live our life and how we relate to one another.

 
In this practice, we deliberately bring our attention back again and again to our relationship with death. We examine what we mean by death and what it brings up for us. We reflect on our experiences and reactions to it.

It is a bit like going for marriage counseling. “When did you two first meet? Tell me a little about your history. Do you spend much time together? What is it about him or her that has offended you? How do you see your relationship moving forward?” You could say that death is your most intimate partner. It is with you all the time, completely interwoven into your daily activities. Since that is the case, wouldn’t it be worthwhile to make a relationship with it?

But our relationship with death is not that simple. In order to understand it, we need to slow down and systematically examine our ideas about it, what it brings up for us, and what it means to us. Death stirs up all kinds of thoughts. And hidden within those clouds of thoughts is a small, unspoken, deep-rooted, yet persistent notion—that we will come through it intact, as though we could come to our own funeral.

The more closely you look into all these ideas, the more you see how inadequate the conceptual mind is in the face of death. Nonetheless, how we think about death matters. It affects how we live our life and how we relate to one another.

Contemplative practice challenges us to look deeply into our thoughts and beliefs, our fantasies and presumptions, and our hopes and fears. It challenges us to separate what we have been told from what we ourselves think and experience. We have all kinds of thoughts about what happens when we die and how we and others should relate with death, but through meditation we learn to recognize thoughts as thoughts. We learn not to mistake these thoughts and ideas about death for direct knowledge or experience. We learn not to believe everything we think or everything we have been told.

“Laughing in the Face of Attachment,” painting by Tasha Mannox from the series “Laughing in the Face of Death: To live and die without regrets.”

We are in a dance with death at all levels, and each level influences and is influenced by the others. We are influenced by what we have been told about death and dying, by our personal history, by our cultural biases, and by what we have observed. We are also influenced by inner habits of thought and conditioned responses. Our most subtle views and reactions to impermanence may be quite hidden, but they touch on our view of life altogether, and on our personal identity.

If we want to understand our relationship with death, we need to explore its broader as well as its more subtle dimensions. If we are willing to take an honest look at how we personally deal with this reality, we can develop a deeper understanding of impermanence and even befriend it.

One way to begin is by reflecting on your personal history with death. What have you been told about death? What are some of your earliest experiences of it?

In my case, when I was about five, I was told my babysitter had died, and that was it. For me, she just disappeared, and children did not go to funerals. A bit later, when my aunt died, I was told that she would go to heaven, a very beautiful place. But I didn’t think people really believed that, because all I saw were people upset and crying. When pets died, I was told they “went to sleep.” It didn’t look like sleep to me.

As a child, I observed that dead animals did not breathe or move about like live ones. I saw that they shriveled up and began to smell funny, or were squashed beyond recognition. I saw that dogs hit by cars screamed in pain and that animals looked sick before they died. I saw that people became old and frail. I saw that when you killed a bug, you could not make it come back to life, even if you felt sorry. My friends and I thought it was funny to sing ditties, like “The worms crawl in, the worms crawl out…”  Death was not that real to us; we made it into a joke.

I observed many such things on an outer level, but on an inner level, I did not have a clue as to what death was about or what it all meant. I did not know how to make sense of it, or to link it to other experiences in my life.

Death is the texture out of which we grow our identity, the stage on which we enact our story.

 
In our encounter with mortality, it is this inner dimension, the relationship dimension, that we need to explore. It becomes obvious that to get to a more uncluttered relationship with death, we first need to plow through a surprising number of ideas, presumptions, and speculations, some of which are very deep-rooted. Through this process, we can become aware of the many concepts that are floating around in us, and try to figure out where they come from and what effect they have on us.

When we look into where all this comes from, we encounter a paradox. We usually consider death to be the end, but it begins to seem that death is in fact the beginning. It is the texture out of which we grow our identity, the stage on which we enact our story.

We can begin our exploration right where we are. We have already been born, we are alive, and we have not yet died. Now what? We might connect to our life in terms of a story or a history. For instance, we were born in such and such a time and place, we did this and that, and we have a particular label and identity. But that story is always changing and in process; it is not all that reliable. However, when our story is combined with a physical body, we seem to have something more solid, a complete package. We have something to hang onto and defend. We have something that can be taken away.

But what do we have to hang onto, really? Our story is not that solid. It is always being revised and rewritten. Likewise, our body is not one solid continuous thing. It too is always changing. If you look for the one body that is you, you cannot find it.

The closer you look, the less solid this whole thing seems. When we investigate our actual experience, here and now, moment by moment, we see how fleeting and dynamic it is. As soon as we notice a thought, feeling, or sensation, it has already happened. Poof! It is the same with the act of noticing. Poof! Gone! And the noticer, the one who is noticing, is nowhere to be found. Poof! When we contemplate in this way, we begin to suspect that this life is not all that solid—that we are not all that solid.

This may seem like bad news, but in fact this discovery is of supreme importance. As we begin to see through our mythical solidity, we also begin to notice all sorts of little gaps in our conceptual schemes. We notice little tastes of freedom and ease in which our struggle to be someone dissolves, and we just are. In such moments, at least briefly, we are not being propelled by either hope or fear. We see that continually holding onto life and warding off death as a future threat is not our only option. There is an alternative to our tight-jawed habit of holding on and defending.

After each little insight or pause, there is a regrouping, and we find ourselves reconstructing our world. Each time we put it back together, we are also putting together the threat that it cannot be maintained. We do this over and over again. We are repetitively and continuously fueling the pretense of solidity and the fear of death that comes with it.

To undo this harmful habit, we need to see it more clearly. We need to recognize that we ourselves are responsible for perpetuating it, and therefore we have the power to stop.

“Laughing in the Face of Jealousy,” painting by Tasha Mannox from the series “Laughing in the Face of Death: To live and die without regrets.”

In looking at the seeds of our relationship to life  and death at a subtle inner level, we uncover how we set  ourselves up for a struggle with death from the beginning—at the very personal level of identity and self-definition.

The more solidly we construct ourselves, and the more rigidly we identify with this construct, the more we have to defend and the more we have to fear. Looking at death in terms of such subtle underlying patterns may seem inconsequential, but it is not.

When we drop the battlefield approach—that life and death are enemies—we become open to an entirely new way of viewing things. Instead of this vs. that, us vs. them, something much more inspiring can take place. Experiences can arise freshly because they are immediately let go. Because they are dropped as soon as they arise, there is nothing to hold onto and nothing to lose.  There is no battlefield, no winner and loser, no good guy and bad guy.

Simple formless meditation is a very powerful tool for relaxing this pattern of holding and defending. Working with death through our awareness of momentary arisings and dissolvings is a profound practice. It shows us that the life–death boundary is an ongoing and quite ordinary experience, and that this unsettling meeting point colors all that we do. If we can become more grounded at this level, we can become more open to what death has to teach us altogether.

Although death is an ongoing reality, there are times when it hits us particularly hard. It may be when we have a health scare or a near accident. At such times, we really wake up to the presence of death, and its teachings come through loud and clear. The heart pounds, the senses are heightened, and we feel extra alive. There is a stillness, as though time had stopped.

When we become complacent and take things for granted, death steps in.

 
Times like this are so simple and straightforward, so immediate. “This is it,” we think. “It’s actually happening.” In such moments, the heightening of our awareness of death simultaneously heightens our feeling of being alive.

In fact, in the face of death, we feel more fully alive than ever. We are shocked into thinking more seriously about what to do with the time that we have. Usually, though, we don’t maintain that awareness, and the feeling of heightened aliveness fades away. We revert to the default pattern of avoiding death, and, along with that, our dulled down approach to life.

Maintaining an awareness of death makes life more vivid. In the light of death, petty concerns fall away and our usual preoccupations become meaningless. It is as though clouds of dust that have covered over something shiny and vivid have been blown away, and we are left with something raw, immediate, and beautiful. We have insight into what matters and what does not.

Awareness of death—hearing its teaching—cuts through the subtle clinging at the core of our experience. It cuts through our self-clinging and our clinging to others. This may sound harsh, but all that clinging has not really helped us or anyone else. Our clinging to others may have the appearance of real caring, but it is based on fear and an attempt to freeze and control life. It is a way of tuning out death and pulling back from the intensity of life. But if we develop more ease with our own impermanence and struggles with death, we can be more understanding of others and their struggles. We can connect with one another with greater genuineness and warmth.

Death turns out to be the teacher who releases us from fear. It’s the teacher that opens our hearts to a more free-flowing love and appreciation for life and one another. When we get stuck in self-importance and earnestness, death steps in. When we get caught in self-pity, death steps in. When we become complacent and take things for granted, death steps in.

Death spurs us forward with a sense of urgency and puts our preoccupations in perspective. Death lightens our clinging and mocks our pretensions. Death wakes us up. It is our most reliable teacher and most constant companion.

Complete Article HERE!

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01/14/18

Embrace the Reaper: Death and Dying Between the Panels

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Super-heroes are meant to die.

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Stay with me here: all hero stories should end with a coffin. It’s the only logical ending.

Every single super-hero put on their cape, cowl, or spandex because they were no longer able to accept their world for what it was. They couldn’t turn away from the malice, injustice, chaos, or whatever ominous synonym for “badness,” that seeped into the cracks of their society or personal life.

And tragically, they’ll never conquer that badness. The super-hero is never going to fully vanquish their arch-nemesis once and for all. The hero’s mission will never be finished because that which they chose to fight will always remain. Badness, sadly, is a facet of human nature. The only true ending to this futile struggle is a funeral.

Very doom and gloom, right? Not when you realize the beauty in that futility.

Wolverine has the most complete arc in all of superhero comics. Debuting in 1975, the man we eventually came to know as Logan was nothing more than a wandering savage looking for purpose and to atone for his sins. After a tussle with The Hulk, Professor X approached Wolverine to join the X-Men and Wolvie said, “Why not?”

From there, he found a home within the X-Mansion, dignity as an X-Man, love in the eyes of Jean Grey, and finally, atonement by founding his own school for wayward mutants to ensure that they would never suffer the same mistakes that he did. His story is a complete circle — a journey made whole, as the wandering savage found peace in helping others.

And at the end of that circle was death.

In the subtly titled mini-series “Death of Wolverine,” Logan meets his end after he loses his healing factor and ends up encased in a tomb of adamantium en route to finally finding the scientist who laced his bones with the mysterious alloy in the first place. The series felt mundane to me until the last four pages. This scientist, realizing he is about to be all sorts of stabbed, asks a murderous Wolverine — who has a coating of smoldering adamantium hardening on his person — what made him a hero? What had he ever accomplished?

Before Wolverine answers that question, the audience is gifted a stunning, heart-wrenching, two-page splash of Wolverine’s finest moments — right before Logan makes his final kill. Then he kneels down, accepting the adamantium grave, and gruffly answers that question by saying, “Enough.”

“Enough,” meaning that Wolverine finally realized all the pain he suffered, blood that he spilled, and death he brought was worth something.

“Enough,” meaning that the sum of deeds helped make the world around him better.

“Enough,” meaning he had lived his purpose and his journey was at its end.

And “Enough,” meaning that he finally atoned for the man he was and was at peace with the man he became.

It’s a perfect death. We were given the opportunity to go on one final adventure with a character we love. The character is given literal and existential threats along the way, suggesting that the audience ponder the meaning of his life. And ultimately, the character and the audience are meant to find closure and meaning from the character’s journey, just as the grim reaper comes for his due.

But Wolverine is a comic book character.

And just like every major comic book character since 1992 (thanks in some part to the wild critical and financial success of “The Death of Superman”), he died and is now being resurrected via plot-chicanery. And so this begets the age-old question: What is the point of death in super-hero comics?

That’s simple. Death in super-hero books is no longer an ending. It’s a plot device. It’s just another story.

A super-hero’s battle will never end. Batman will never rid Gotham of random violence and chaos. The Flash will never be fast enough to stop all the tragedies in Central City from happening. Daredevil will never bring justice to Hell’s Kitchen.

But they’re not meant to. Their battles and stories are meant to be anecdotes and parables that inspire us to make ourselves and our world better.

That message though invariably gets muddled amidst all the plot contrivances, retcons, and reboots of any given hero’s character history. We as an audience often spend more time trying to keep all the details in check. We care more about what the Speed Force can do or what color Kryptonite is getting tossed around. And we stop paying attention to what the super-hero’s story is trying to say.

This is why we need the reaper.

The reaper can tear away all the plot contrivances around a super-hero’s story to distill the very essence of that character’s message. When the Flash famously ran himself to death to stop the Anti-Monitor in Crisis on Infinite Earths, did you care about the specifics of how it happened? Were you concerned about every detail of Doomsday’s origin did as you watched Superman have his ill-fated boxing match with him to protect Metropolis? Did it bother you that Wolverine had bone claws under his adamantium skeleton as the cocoon was hardening around him?

No, you felt that Barry would knowingly die to help as many people as he could. You remembered that Clark is a farm-boy, who taught you to stand up to monsters. And that Logan was just a man who didn’t want people to suffer the way he did.

Super-hero deaths are often telegraphed and advertised to readers for the sake of marketing. No matter how final it appears or how long it takes, they will always be reversed. They may be clichéd, melodramatic, and whatever that guy from your comic-shop said — but: when they’re used effectively, they can definitively epitomize and enshrine a hero’s message.

There is no better way to celebrate the life of a super-hero, than by watching their death.

Complete Article HERE!

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12/27/17

In the 16th Century, the Best Office Decor was a Tiny Rotting Corpse

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Miniature memento moris were all the rage for around 300 years.

A 16th-century memento mori attributed to Hans Leinberger.

by Ella Morton

There are many additions you can make to your office desk in order to remind yourself to stay motivated, seize the day, and make every minute count. A mini zen garden or framed motivational quote, for instance; maybe a page-a-day calendar with a kitten hanging from a branch.

Or a 16th-century statuette of a rotting corpse.

The wooden carving above, sculpted by German artist Hans Leinberger in the 1520s, is a memento mori—a reminder of human mortality designed to keep its owner humble, focused, and untethered to worldly possessions. In 16th-century Europe, these stark odes to humanity’s transience appeared in the form of tomb effigies, full-sized statues, and smaller sculptures perfect for a tabletop.

The predominant image of these artworks was that of the upright corpse, depicted with a torn flesh suit and exposed ribs. The figure sometimes held an object; the corpse in Leinberger’s sculpture clutches a scroll with a Latin inscription that translates to “I am what you will be. I was what you are. For every man is this so.” 

One of the more striking full-sized memento moris of the era is the statue of René de Chalon, a French prince who died at 25 in the 1544 siege of Saint-Dizier. Known as a transi—for its depiction of human transience—the sculpture shows the prince’s desiccated corpse holding his own heart aloft.

The transi of René de Chalon.

Post-Renaissance, portable memento moris continued to be sculpted, with half-human, half-skeleton figures offering a slightly less gruesome way to remember one’s mortality. The half-half statuettes below were created in the early 19th century to encourage “spiritual contemplation.”

Memento mori figures from the early 19th century.

The wooden carving below, which was created in 19th-century Italy, shows a woman’s head with half her skull exposed. Note the baby snake wrapped around her mandible. Note also that despite the facial decay, her ruffled collar and lace cap are perfectly intact.

A 19th-century Italian memento mori.

Those preferring a more subtle, easily concealable reminder of death—one that can be whipped out for contemplation during a train ride, then stashed in a pocket on disembarking—could opt for a pendant-style memento mori like the one below. It dates to either the 18th or 19th century.

Skeleton in coffin pendant, Europe, 1701-1900.

Regardless of their size and level of grisliness, portable memento moris all offered the same message: life is short, you will die, and earthly possessions don’t matter. The fact that this message was contained in an earthly possession is just part of the thrilling paradox that is human existence.

Complete Article HERE!

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12/18/17

Death Without Duality: Three Both/Ands at the End of Life

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Dying, like living, is not an either/or affair. It’s a both/and. Which is part of what makes it all so maddening for the floundering human who craves the comfort of dualities, of right and wrong, of fail-proof instructions.

I was reminded of this by some of the masters this month when I had the honor of hosting the End Well symposium in San Francisco. Twenty-eight speakers took the stage and talked about their experiences of almost dying, or treating the dying, or mourning someone who has died, or caring for the caregivers, or trying to shape policy or redesign systems or teach people about dying and/or do some of these simultaneously. There was some anger, and no small amount of sadness of course, but also a surprising amount of laughter. It turns out that we are funny right to the end.

Here are three both/and axioms that I heard echoed most often from people with a hugely wide range of professional backgrounds:

1) Reckoning with one’s life at the time of death is both the simplest thing in the world and the most complex.

Buddhist teacher and co-founder of the Zen Hospice Project, Frank Ostaseski, put it beautifully:

“At the end of life, it gets really simple: Am I loved? Did I love well?”

He’s right. Those questions are incredibly simple. As are the “four things” one can say — “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” — at the time of death, popularized by Ira Byock. One of the huge, unique gifts of facing the end of life — whether your own or someone you love — is that the urgency for healing is undeniable.

But the dynamics that spark and rot and flow and flutter underneath those questions are anything but simple. They are as complex as human relationships as a whole, which is to say very fucking complex. The answer to the question of whether I am loved may seem obvious to an outsider, but if I’ve never felt loved in the right way by the one person I needed it most from, I may not be capable of a “yes.” Even at the time of death, especially at the time of death, we are not logical creatures.

And to answer whether we have loved well is perhaps an even more charged and challenged task. We carry our regrets and sense of relational inadequacy around for decades and then, in the end, are asked to lay them down and surrender to our own imperfection. A tall order. The tallest perhaps. Dr. B.J. Miller, former executive director of the Zen Hospice Project and a clinician, teaches:

“If there is any enemy at the end of life it is shame.”

If we can’t shed our shame, it makes it hard to go. The power in the dying process, from what I gather from these wise souls, is acknowledging the complexity underneath or behind the simplicity and still managing to grace one another with the forgiveness and recognition that we all so desperately crave. It is the kind of emotional courage that transcends death.

2) Our job, when caring for the dying, is to ease suffering, but also recognize that it is a source of meaning for many people.

B.J. also said, “I wouldn’t wish a lack of suffering on my worst enemy. There’s no way to learn.”

He knows a bit about it, having had three limbs amputated and survived near-lethal burns on much of his body after an accident in college. His own time in hell was incredible preparation for a lifetime of treating patients and talking with people about facing death.

Some of us have an inclination to romanticize death. It’s the peak of drama, no doubt — the final scene. But of course it is not all buzzer beater catharsis and mystical visitations. It is sometimes choking and seizing and terrible, ugly, unbearable pain. In a word, suffering.

Now the role of palliative care, but all health care really, is to ease suffering. This is true and important and so often lost in our current system, which too often feeds the wrong motivations in otherwise decent and smart humans. We have to redesign the system so that easing suffering is the heart of everything we do, or as designer Ivor Williams puts it, “Death involves everyone. Design accordingly.”

And yet, B.J. Miller would not be B.J. Miller without his suffering. None of would be any of us without our suffering. It is what erodes our delusions and softens our hubris and strengthens our capacity to resist duality and blame. It is the fires in which we are all forged.

So that, too, we must remember. Which doesn’t mean easing off on pain meds, but it does mean witnessing suffering as a sacred and necessary part of being human, even as we try to work with its ferocity and sit with the one being visited at this particular moment. Or as Dr. Lucy Kalanithi, a clinician, beautiful speaker, and widow to Paul Kalanithi, author of When Breath Becomes Air, put it:

“A gift we get to have in medicine is to be witnesses. It’s a front row seat to the human condition.”

3) When you die, you are the most alone you will ever be, and yet you cannot do it well without the gift of others.

Think about it: There is no journey more solitary, by definition, than that of dying — unless you Thelma-and-Louise it. Just as you have lived in your body alone all your life — experienced its holy and wholly specific alchemy of aches and pains and pleasures — you and only you leave that body at some unpredictable moment. (As I write this, I’m reminded how otherworldly pregnancy is, a moment when women actually do, in a sense, share their solitary experience for 10 strange months.)

In any case, accepting the solitude of it is probably key to surrendering to it. You have to go it alone, at least from a purely physical sense.

And yet, to die well is to die together. Or at least surrounded by people who care for you in your time of exquisite vulnerability. Hopefully these are people who have known you at your most robust, people that you have cared for, people you have eaten and drunk too much with and laughed beside and tickled and fought with and repaired again. Hopefully these are people who know your wishes and will fight like momma bears to see them through.

In one study, 66 percent of people said that the thing they feared most at the moment of death was pain. Understandable. And not particularly surprising. Do you know what topped that fear? The fear that they would be a burden to their family members — logistically, psychologically, financially.

Dr. Aditi Mallick says, “The things that scare us the most about death are at the core of what it means to be human.” Indeed, we fear being dependent on others, being inconvenient and messy and powerless, our whole lives long. And when we die, this fear becomes epic. Our power lies in making peace with it. If we live like we will one day die, then we can’t help but create relationships that are loving and strong and imperfect and they can weather even this, the final test of the human condition.

As B.J. puts it, “The end of life is a call to learn how to be loved. The hardest thing of all.”

Complete Article HERE!

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12/15/17

The Drift Called the Infinite: Emily Dickinson on Making Sense of Loss

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Reflections on silence and eternity from the poet laureate of death.

“The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created,” poet Meghan O’Rourke wrote in her stirring memoir of losing her mother. More than a century earlier, another poet with a rare gift for philosophical prose reflected on mortality in the wake of her own mother’s death.

Emily Dickinson (December 10, 1830–May 15, 1886) was about to turn fifty-two when her mother, after whom she was named, died. A stroke had left her paralyzed and almost entirely disabled eight years earlier. Despite her lifelong infirm health, her disinterest in the life of the mind, and the surges of unhappiness in the Dickinson home, Emily Norcross Dickinson had been attentive and affectionate to her daughter, igniting the poet’s little-known but ardent passion for botany and prompting her to write that “home is a holy thing.”

Although a contemplation of mortality haunts nearly all of Dickinson’s 1775 surviving poems in varying degrees of directness, her mother’s death forced a confrontation with mortality of a wholly different order — loss as an acute immediacy rather than a symbolic and speculative abstraction.

In a letter to her cousins penned shortly after her mother’s death in November of 1882 and found in The Letters of Emily Dickinson (public library), the poet writes:

Mother’s dying almost stunned my spirit… She slipped from our fingers like a flake gathered by the wind, and is now part of the drift called “the infinite.”

We don’t know where she is, though so many tell us.

Emily Dickinson, daguerreotype, circa 1847.

Even as a child, Emily had come to doubt the immortality so resolutely promised by the Calvinist dogma of her elders. “Sermons on unbelief ever did attract me,” she wrote in her twenties to Susan Gilbert — her first great love and lifelong closest friend. Dickinson went on to reject the prescriptive traditional religion of her era, never joined a church, and adopted a view of spirituality kindred to astronomer Maria Mitchell’s. It is with this mindset that she adds in the letter to her cousins:

I believe we shall in some manner be cherished by our Maker — that the One who gave us this remarkable earth has the power still farther to surprise that which He has caused. Beyond that all is silence…

Writing less than four years before her own untimely death, she ends the letter with these words:

I cannot tell how Eternity seems. It sweeps around me like a sea… Thank you for remembering me. Remembrance — mighty word.

In another letter from the following spring, penned after receiving news of a friend’s death, Dickinson stills her swirling sorrow the best way she knew how — in a poem:

Each that we lose takes part of us;
A crescent still abides,
Which like the moon, some turbid night,
Is summoned by the tides.

She adds a sobering reflection on the shock each of us experiences the first time we lose a loved one:

Till the first friend dies, we think ecstasy impersonal, but then discover that he was the cup from which we drank it, itself as yet unknown.

Complement with a collection of moving consolation letters by great artists, writers, and scientists ranging from Lincoln to Einstein to Turing, psychoanalyst Adam Phillips on how Darwin and Freud shaped our relationship to mortality, Seneca on the key to resilience in the face of loss, and this unusual Danish picture-book about death, then revisit Cynthia Nixon’s beautiful reading of Dickinson’s “While I was fearing it, it came” and Dickinson’s forgotten herbarium — an elegy for time and mortality at the intersection of poetry and science.

Complete Article HERE!

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12/8/17

Can a dying patient be a healthy person?

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By and

The news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news.

Mimi’s case was far from unique. Each year in the U.S., over 1.6 million patients receive hospice care, a number that has been increasing rapidly over the past few years. What made Mimi’s case remarkable was not the grimness of her prognosis but her reaction to it.

When the members of the team walked into Mimi’s hospital room, she was lying in bed holding hands with her husband, who was perched beside her on his motorized wheelchair. The attending oncologist gulped, took a deep breath, and began to break the news as gently as he could. Expecting to meet a flood of tears, he finished by expressing how sorry he was.

To the team’s surprise, however, no tears flowed. Instead Mimi looked over at her husband with a broad smile and said, “Do you know what day this is?” Somewhat perplexed, the oncologist had to admit that he did not. “Today is very is special,” said Mimi, “because it was 60 years ago this very day that my Jim and I were married.”

The team members reacted to Mimi with astonishment. How could an elderly woman with an ailing husband who had just been told that she had a second, lethal cancer respond with a smile? Compounding the team’s amazement, she then went on to share how grateful she felt for the life she and her husband had shared.

Mimi thanked the attending oncologist and the members of the team for their care, remarking how difficult it must be to deliver bad news to very sick patients. Instead of feeling sorry for herself, Mimi was expressing sympathy for the people caring for her, exhibiting a remarkable generosity of spirit in the face of a grim disease.

The members of the team walked out of Mimi’s room shaking their heads in amazement. Once they reached the hallway, the attending physician turned and addressed the group: “Mimi isn’t the only person in that room with cancer, but she is surely the sickest. And yet,” he continued, to nods all around, “she is also the healthiest of any of us.”

“Be thine own palace, or the world’s thy jail.” – John Donne

Disease need not define us

Mimi’s reaction highlights a distinction between disease and illness, the importance of which is becoming increasingly apparent. Simply put, a body has a disease, but only a person can have an illness. Different people can respond very differently to the same diagnosis, and those differences sometimes correspond to demographic categories, such as male or female. Mimi is a beautiful example of the ability to respond with joy and gratitude in the face of even life’s seemingly darkest moments.

Consider another very different patient the cancer team met with shortly after Mimi. Ron, a man in his 40s who had been cured of lymphoma, arrived in the oncology clinic expecting the attending oncologist to sign a form stating that he could not work and therefore qualified for disability payments. So far as the attending knew, there was no reason Ron couldn’t hold a job.

Ron’s experience of disease was very different from Mimi’s, a phenomenon familiar to cancer physicians. Despite a dire prognosis, Mimi was full of gratitude. Ron, by contrast, though cured of his disease and apparently completely healthy, looked at his life with resentment, even anger. He felt deeply wronged by his bout with cancer and operated with a sense that others should do what they could to help make it up to him.

Mimi was dying but content with her life. Ron was healthy but filled with bitterness. Both patients had the same diagnosis – cancer – but the two human beings differed dramatically, and so too did their illness experiences. Mimi felt blessed by 60 years of a good marriage, while Ron saw in his cancer just one more example of how unfair life had been to him.

“Death be not proud, though some have called thee Mighty and dreadful, for thou art not so…” – John Donne

The real meaning of health

When the members of the cancer team agreed that Mimi was the healthiest person in the room, they were thinking of health in terms of wholeness or integrity. In fact, the word health shares the same source as the word whole, implying completeness or fullness. Ron felt repeatedly slighted, but Mimi looked at life from a perspective of abundance.

A full life is not necessarily marked by material wealth, power over others, or fame. Many people who live richly do so modestly and quietly, never amassing fortunes, commanding legions, or seeing their picture in the newspaper. What enriches their lives is not success in the conventional sense but the knowledge that they have done their best to remain focused on what really matters.

Mimi easily called to mind many moments when she and those she cared about shared their company and their love. Any sense of regret or sorrow over what might have been quickly gave way to a sense of gratitude for what really was, still is, and will be. Her outlook on life was shaped by a deep conviction that it had a meaning that would transcend her own death.

When someone has built up a life ledger full of meaningful experiences, the prospect of serious illness and death often do not seem so threatening. For Mimi, who had lived most of her days with a keen awareness that they would not go on forever, death’s meaning had been transformed from “Life is pointless” to “Make every day count.”

Mimi regarded the prospect of dying as a lens through which to view the meaning of life. She saw her illness as another adventure through which she and Jim would pass. Death would separate them, but it would also draw them closer together, enabling them to see more clearly than ever how much their love meant to them.

From Mimi’s point of view, death is not a contaminant, fatally introduced to life at its final stage. Instead death is a fire that burns away all that is not essential, purifying a person’s vision of what is most real and most worth caring about. Though not happy to be ill, Mimi was in a profound sense grateful for death. Her sentiments echo those of the poet John Donne:

“One short sleep past and we wake eternally: And death shall be no more; death, thou shalt die.”

Complete Article HERE!

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