Month: October 2015

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Doula for the dying: Connecting birth and death

BY AMY WRIGHT GLENN

Amy Doula Dying
Daughters of 97-year-old Utah native William Vance Wright hold vigil.

The last time I saw my grandfather, he was 95 years old. He walked with a bent back. Kindness graced his watery eyes.

During dinner, he asked me how old my son was at least four times.

“Is he 2?” he inquired once again.

“Almost. He’s 21 months, Grandpa,” I answered.

He smiled and returned to eating his tilapia, mashed potatoes and squash.

At the end of our visit, I walked him to the car. As we approached the steps leading down to the garage, he mentioned his bad knee – an injury from the war.

“I can do it,” he said, gently refusing my hand. “Just one step at a time.”

As my uncle opened the car door, my grandpa suddenly stopped. He turned back to look at me. He kissed his hand and lifted it up in the air. I blew a kiss back to him. He “caught it,” then brought it to his cheek with a knowing smile.

The last time I saw my grandfather, he blew me a kiss. That is what I remember most.

Doulas and Dying

I am a doula. I am also a hospital chaplain. In holding space for birthing and dying, I’ve come to see one thing clearly. Standing with an open heart in the presence of birth is very much like standing with an open heart in the presence of death.

The word “doula” translates from Greek to mean “woman servant.” Today, doulas are known best for accompanying laboring and/or postpartum women. Doulas offer emotional, mental, spiritual and physical support during the transition of opening to new life. According to a 2013 nationwide survey conducted by Listening to Mothers, around 6 percent of expectant couples in America hire a birth doula. This number is small, but it’s growing. In 2006, only 3 percent of birthing women had doula support.

The vast majority of American women give birth in a hospital. Given this, the compassionate and consistent presence of a doula offers a healing tonic in an impersonal and medicalized obstetrical setting. Doulas focus solely on providing comfort measures, based on best practices, to ease the pain of labor and steady the heart and mind of a birthing woman. As a doula, I offer support for hours on end. I do my best to mirror back to a woman her courage, beauty and strength. Doulas believe in the power of birth and regard the process of birth as sacred.

What happens when we take the doula model described above and apply it to end-of-life care? What if we doula the dying?

Like with birth, the majority of Americans die in a hospital. While the majority of us wish to die at home, according to the National Center for Health Statistics, only 27 percent of Americans do. Most of us are born and die surrounded by medical professionals and beeping machines. Ideally, the technology associated with important medical advancements doesn’t eclipse the perennial needs of the human heart. Women birth best when they feel safe, are supported, and their bodies are allowed to open with organic wisdom. In the same way, the dying are best comforted with human touch, love, story and song.

In 2003, Henry Fersko-Weiss, a licensed clinical social worker, created the first end-of-life doula program in the U.S. He saw that there was “a gap” that hospice and medical professionals couldn’t fill when it came to supporting the dying and the bereaved. He trained with Debra Pascali-Bonaro, creator and director of Orgasmic Birth and chair of the International MotherBaby Childbirth Organization. Fersko-Weiss transferred knowledge gained about birth doula work to caring for the dying. As president of the International End of Life Doula Association (INELDA), he trains hundreds of individuals, drawing upon his studies of the intersectionality of birth and death work. Today, a small but growing number of organizations wisely build upon the doula model and offer training to support the dying and bereaved.

Fersko-Weiss is unique. Few end-of-life care professionals are trained in birth work. Few birth workers are trained in caring for the dying. Yet, uncanny similarities in best practices exist across these professions. At the October 2014 Midwives Alliance of North America annual conference, I spoke about the overlapping skill set taught in both my training as birth doula and hospital chaplain.There is much to be gained from studying what it means to hold space for both birth and death.

Holding Space

“That sure looks like my brother Darcey,” my grandpa said a few days before he died. His eyes gazed across his room. Then, he added, “Hi Mom. Will you stay close to me today?”

Will you stay close to me today?

When the veil between our visual world and the wonders beyond the physical senses thins, we seek out the hands of loved ones. Whether a mother holds these hands as she bears down to push a beloved child into our world, or whether an elderly woman holds the hands of her children as she breathes her last breath — we reach for each other. We do.

Wisdom and insight are born when we stay close to the birthing and dying. Wounds from the past can be healed. Forgiveness and perspective dawn. Our culture is currently fragmented from much of this wisdom. The training of doulas represents a healing shift. By holding compassionate and nonjudgmental space, doulas support families as they make room for the generations to enter and exit this world. As we attend to birth and death, we touch upon a great mystery and deeply benefit from being starkly reminded of our own mortality.

During my grandfather’s final days, his grandchildren and great-grandchildren came to his bedside. While he received quality and attentive hospice support, it was the consistent and compassionate care of his seven children that mattered most. In particular, my Aunt Colleen’s remarkable devotion to her father made it possible for him to live out his final years and eventually take his final breath in the comfort of his own home. She was his doula.

While the birth/postpartum doula movement makes important inroads in our maternity care system, great commitment and insight are needed to bring doula care to the dying. The elderly are easily disregarded in a culture that worships youthfulness, independence and productivity. Like infants, the dying remind us of our fragility, our dependency and our need for each other. When we sequester either birth or death, we lose touch with the truth of our interdependence, the nesting of generations, and what Buddhist teacher Thich Nhat Hanh calls our “interbeing.”

‘Just one step at a time’

As I work to train death doulas, hold space for the birthing and meditate on the mysteries that connect the threshold points of life, I remember my grandfather’s words: “Just one step at a time.” Yes. Just one birth, one death, one step at a time.

Slowly, steadily, the doula movement brings needed healing to how we perceive and experience both birth and death. Holding compassionate presence in our most fragile moments reminds us of what matters most. Certainly, it’s not what we possess. Even the location of birth or death is secondary. It’s the presence of love and the gentleness we bring to our mortal journey that matter most.

The last time I saw my grandfather, he blew me a kiss. I hold it close to my cheek. It inspires me to do this work.

Complete Article HERE!

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Inmates Help Other Prisoners Face Death in Hospice Program

By Andrew Welsh-huggins

Inmate Scott Abram sings to a fellow inmate who is dying and is spending his last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. (AP Photo/Andrew Welsh-Huggins)
Inmate Scott Abram sings to a fellow inmate who is dying and is spending his last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. (AP Photo/Andrew Welsh-Huggins)

As late-morning sun streams through narrow prison windows, convicted killer Scott Abram stands beside a fellow inmate, speaks quietly to him and starts singing “Amazing Grace.” The prisoner appears to smile, but it’s difficult to gauge his response. He is dying.

He passes away two days later in early September.

Abram is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. Behind bars since the early 1990s for murder, he has gotten used to spending time with male prison friends as they die in rooms 205 or 206 on the second floor of the state’s prison for chronically ill inmates.

“We’re all human, and we make mistakes,” said Abram, sentenced to 15 years to life. “There are some that make bigger mistakes, like me. I make a lot of mistakes each day.”

Abram, 48, is a Stephen Minister, a type of lay counselor common in churches around the country but rarer inside prison walls. He is one of 15 male and female inmates trained in the program at Franklin Medical Center, a small prison just south of downtown Columbus that houses some of the state’s sickest inmates, many of whom die there.

Abram’s hospice work is just part of his Stephen Minister counseling. He and others also work with troubled inmates, perhaps helping them write a letter or make a call.

In Ohio and nationally, the inmate population is graying. Ohio had 8,558 inmates over 50 this year, nearly double the number in 2001. Other states, including Louisiana, Iowa and California, have similar prison programs.

Prisoner Sheila Belknap says her participation also makes her think about her own mistakes. Belknap, 42, plans to continue hospice work after she is released next year from a four-year term for theft charges. She calls her work with the dying a privilege.

A prison official points out a handmade quilt featuring the names of inmates who have died in prison hospice at the Franklin Medical Center, on Friday, Sept. 11, 2015 in Columbus, Ohio. Inmates trained in a counseling program called Stephen Ministries help fellow prisoners in their last days. (AP Photo/Andrew Welsh-Huggins)
A prison official points out a handmade quilt featuring the names of inmates who have died in prison hospice at the Franklin Medical Center, on Friday, Sept. 11, 2015 in Columbus, Ohio. Inmates trained in a counseling program called Stephen Ministries help fellow prisoners in their last days. (AP Photo/Andrew Welsh-Huggins)

“It’s just the satisfaction I get just from being there at the time of need,” she said. “No one wants to pass alone.”

Nos. 205 and 206 — there is also a room in another unit for female patients — resemble ordinary hospital rooms. Hanging wall quilts made by volunteers soften the institutional feel. Abram and Belknap are often joined by members of a Columbus choir that sings to hospice patients around central Ohio.

The Department of Rehabilitation and Correction hopes to expand the number of Stephen Ministers at other prisons, though hospice care would remain in the Columbus facility.

On average, an Ohio inmate dies of natural causes every three and a half days, not unexpected with a statewide prisoner population of 50,000, the size of a small city.

The national Stephen Ministry office in St. Louis is unaware of other state prisons with inmates trained in their counseling program.

Louisiana began an inmate hospice program in 1997 at the state penitentiary in Angola and developed a 40-hour training program for offenders, who volunteer for four-hour shifts with dying prisoners. California says it established the nation’s first inmate hospice at the California Medical Facility in Vacaville in 1993.

Inmate Scott Abram, holding a training dog, Ziva, talks about his work counseling fellow inmates including some who are dying and spending their last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, also trains puppies that may end up as pilot dogs. (AP Photo/Andrew Welsh-Huggins)
Inmate Scott Abram, holding a training dog, Ziva, talks about his work counseling fellow inmates including some who are dying and spending their last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, also trains puppies that may end up as pilot dogs. (AP Photo/Andrew Welsh-Huggins)

The program at the Iowa State Penitentiary in Fort Madison, Iowa, was the subject of “Prison Terminal: The Last Days of Private Jack Hall,” a documentary by filmmaker Edgar Barens that received a 2014 Academy Award nomination.

“It not only helps the prisoner who’s dying of a terminal illness, but it’s so redemptive for prisoners who go through the process of becoming hospice workers,” said Barens, a visiting media specialist at the University of Illinois at Chicago. “It’s tenfold payback when a prison does this.”

Complete Article HERE!

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The Biggest Mistake Pet Owners Make at the End

City dog
City dog

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If I had a big huge red pen and could permanently strike five words from the Standard Veterinary Dialogue, it would be this: “You’ll know when it’s time.”

Waiting for The Look

Wouldn’t that be great, if pets had a little button that popped up like a Butterball turkey when they were ready to be euthanized? It would eliminate a lot of agonizing on the part of loving pet owners who are struggling with one of the most significant decisions they will have to make in a pet’s life. But that’s rarely how it actually works.

Perhaps you’ve heard people talk about “The Look,” the appearance a pet has when he or she is ready to depart this Earth. “You’ll know it when you see it,” they say, and they are right. It’s hard to describe, that sort of intuitive emotional bond that develops between owner and pet when they are signaling that they are done. I’ve seen it and I agree, it’s hard to miss. It provides a great deal of reassurance to pet owners to know that their pet seems in agreement that it’s time for the next adventure.

The only problem is, this doesn’t always happen.

Pets have other ways of communicating with us beside a meaningful gaze that speaks to our soul; namely, their behavior. Veterinarians experienced in end-of-life care work with very specific quality of life assessments that can give more subjective endpoints than simply “a look,” which can be key when an owner is waiting for a sign that may not come and ignoring all the other cues that a pet is communicating.

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The Quality of Life Assessment

Appetite, mobility, hydration, pain, interest in their surroundings, and hygiene are all very specific categories we can assess to determine a pet’s quality of life. Think of it less as a “yes/no” switch that gets flipped and more like a spectrum as a pet approaches death. There’s a large grey zone towards the end where owners could make a good argument for or against it being “time”, and that is the agony and the burden we face as pet owners.

I like the quality of life assessment that uses multiple variables to assess a pet’s condition because all too often, people focus on one specific thing. “Radar hasn’t gotten up for a week,” an owner will say. “He cries all night, soils himself, and pants constantly, but he ate a piece of hot dog yesterday and wagged his tail once, so I don’t think it’s time yet.” In these cases, I counsel owners that we don’t need to wait until every moment of a pet’s waking hours are miserable before making the decision to euthanize.

It’s ok to go out on a bit of a high note. It is one of the blessings of euthanasia, that we can say goodbye in a controlled, peaceful environment and eliminate the pain and stress of a crisis moment at the end.

Death used to be as mysterious for me as it is for most people, but after years working with pets Death and I have become, if not friends, at least very collegial. With that under my belt, the only thing I can tell you with certainty is this: The only way you’ll know that it’s time, truly and without doubt, is when the pet actually stops breathing. Everything else is open to interpretation.

Rarely do people tell me after the fact that they let a pet go too soon. If anything, most feel they waited too long. We have a saying in our field that I repeat on a daily basis to my clients:”It’s better to be a week too early than a minute too late.”

Complete Article HERE!

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California Governor Signs Right-to-Die Bill

By Josh Sanburn

California becomes the fifth state to allow the controversial practice

California Gov. Jerry Brown signed legislation Monday allowing doctors to prescribe life-ending medication to dying patients, making the state the fifth to legalize the practice and the first since the death of Brittany Maynard, whose decision to leave the state to end her life last year lent new urgency to the right-to-die movement.

Brown, a Catholic who at one point considered joining the priesthood, said in a statement that the religious objections to the bill were not enough to convince him to veto it.

“In the end, I was left to reflect on what I would want in the face of my own death,” Brown said in a statement explaining his decision. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”

Right-to-die supporters have been working to legalize the practice in California for almost two decades. The movement gained significant momentum last year when Brittany Maynard, a 29-year-old newlywed, was diagnosed with terminal brain cancer and left California for Oregon to take advantage of the state’s Death With Dignity law, which went into effect in 1997. Since Maynard’s death, half of all U.S. states have introduced aid-in-dying legislation.

“This is the biggest victory for the death-with-dignity movement since Oregon passed the nation’s first law two decades ago,” said Barbara Coombs Lee, president of Compassion & Choices, a right-to-die advocacy group, in a statement.

Polls showed that three-fourths of Californians supported the measure, but legislators routinely ran into opposition from disability rights advocates who say the practice can open the door to abuses of the elderly and disabled, as well as the Catholic Church, which says only God should decide when people should die.

The law allows doctors to prescribe life-ending medication to patients who have been given six months or less to live. It requires two doctors to consent to the prescription as well as written requests from the patient for the medication. California joins Oregon, Washington, Vermont and Montana, which also allow the practice.

Complete Article HERE!

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The Knowing

The loud thud against the window of the cabin startled the group. A bird had flown hard into the glass and dropped to the ground outside the window. Sarah rushed outside to check on the bird and the rest of us waited quietly for news.

BODY-finch

Ten young adults were gathered in the small rustic log cabin built across a fast-flowing creek, surrounded by a grove of aspens. The theme for the group session that morning was how to deal with fear. Cancer had recurred for some people, and others were frightened of their cancer returning. Alicia knew she was nearing the end of her life. I could see the knowing in her eyes.

Sarah pushed open the heavy wooden door and a rush of cool air blew in with her as she entered. She cradled the yellow warbler in the palm of her hand, its glossy black eyes were half-closed and its breast fluttered with tiny rapid breaths.

“I don’t think she’s going to make it,” Sarah said, tears filling the corners of her eyes.

Death had entered the room and the tension was palpable. People shot sideways glances at Alicia. Did she think the bird was a sign that her death was imminent? Would she panic and try to save its life somehow? Was she frightened? Each person’s fear of death was projected on to the person who lived closest to life’s edge.

The room was quiet as we watched the little bird, her chartreuse breast feathers shimmering with each tiny intake of breath. Outside the wind rustled the branches of the trees, and the aspen bark shone white in the mid-afternoon sun. The bird’s last breath went unnoticed. We just knew she was gone.

Alicia stood up slowly and pushed her chair back, her swollen belly seemed to lead the way, compassion compelling her forward. Leaning on the backs of chairs she made her way around the circle to where Sarah stood by the door. She looked Sarah in the eye and smiled, and then bringing her palms together against her chest, she bowed to the bird.

“Thank you little bird for showing us what death looks like,” she said, as she ran her forefinger tenderly over the bird’s motionless breast. “Death isn’t so scary, is it?”

Alicia looked around the circle of her new retreat friends, and I heard deep exhalations of breath and fear release together. Death was present and it was okay. Alicia and the bird had made it that way.

By: Janie

Complete Article HERE!

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Longfellow And The Deep Hidden Woods Review

To celebrate the 2nd anniversary of the publication of Longfellow And The Deep Hidden Woods I thought I’d share with you a touching review just published on Amazon.

 
 

myste lynMyste Lyn from Bittersweet Blessing shares her thoughts after reading the Longfellow book

bittersweetblessing

 

5.0 out of 5 stars  Much more than a book on loss…

 

A sweet, simple and soft book… more than a book on loss, it’s a book that reminds us of what is important in life.

I was surprised by the quiet beauty that gently touched my heartstrings singing songs reminiscent of old times on my grampa’s farm…

The illustrations are equally touching and I’ve included a screenshot of one of my favorites.This one’s a keeper.

 

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Thank you, Myste!

For those of you unfamiliar with Longfellow, allow me to introduce you.

Longfellow, the bravest and noblest weiner dog in the world… As our story begins, Longfellow is a puppy learning how to be a good friend to his human companions, Old Henry and Henry’s nurse Miss O’weeza Tuffy. By the end, he has grown old himself, but is still ready for one final adventure. What happens in between is an unforgettable and heartwarming tale that throws a tender light on the difficult truths of loss and longing as well as on our greatest hopes.

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I’m not as brave as my father, who died in misery

tony lopez
When Steve Lopez’s father, Tony, died he was so ill he couldn’t care for himself and death was a release.

By Steve Lopez

 

Dear Gov. Brown:

Three years ago, my father died in a fairly typical manner. His heart and his body had given out, he could barely move, he couldn’t feed himself and he was in diapers.

He was in a bit of pain, but the physical suffering was nothing compared to the emotional and psychological side of things. His life was gone and there was no joy in a day. He had no privacy and he hated having to be cared for as he lay in bed helplessly, a witness to his own lingering death, which finally arrived as a friend might, delivering the gift of mercy.

Maybe I’m not as brave as my father, but I knew then that I do not want to die that way and wouldn’t want my loved ones to experience the misery of watching me slowly dissolve.

In some circumstances, death may be the best remaining friend and it is reasonable and moral to accelerate the dying process.– Dan Maguire, professor, Marquette University

So what will I do? I don’t know. I wouldn’t be one to put a gun to my head, as some do. Maybe I’d stop eating and drinking water, but that can be a pretty miserable way to go too.

Gov. Brown, I don’t know if you read about this in my column, but I died once. Just after a knee operation, I went into cardiac arrest and flat-lined. That wouldn’t be a bad way to go, actually. No long, drawn-out affair. No messy stuff. But I was resuscitated, and I’m alive and well for the time being, and I’m asking you to give dying Californians the right to depart on their own terms.

No one seems to know what you will do with the End of Life Option Act that’s in your hands and would give us the same freedom people have in Oregon, Washington and elsewhere.

I know that our democracy is based on a separation of church and state, and that leaders such as you try not to let the tenets of their faith assert undue influence on secular decisions. I know too, however, that our values are usually set early and that religious beliefs are often core to who we are.

So it seems reasonable to note that the Catholic Church opposes what critics call assisted suicide and supporters call aid in dying, yet polls suggest most Catholics — as well as most Californians — want the option of going through a series of steps to get a life-ending prescription from a physician.

I know, governor, that you got a little farther than I did in the Catholic Church. You were a seminarian and I topped out at altar boy.

I don’t know if you still identify as a Catholic, but to me, any religion is about a search for meaning and we all know you’re a thoughtful — even spiritual — man who reflects, quotes Scripture and works from a set of basic moral principles.

So I wanted to share some conversations I’ve had with religious people who came to support aid in dying in the context of their experience and training.

“As a Christian I believe God is love,” the Rev. Ignacio Castuera once told me. “…And the God of love would not want any of God’s creatures to suffer undignified situations, especially at the end of life.”

Castuera grew up Catholic and is now a United Methodist Minister in Pomona. He told me about his ministry in West Hollywood during the AIDS epidemic, and he spoke of the honor of being with those who found a way to purchase life-ending medications and face death bravely with loved ones present.

“Death,” Castuera said, “is not the final stage for humans.” It is, in his mind, a deliverance to God.

The Rev. Sergio Camacho, a Methodist minister in Montclair, shares that view.

“Over the years, I’ve seen so many people dying, from brain tumors and other diseases,” he said. “It’s unbelievable how they suffer.… Before they go, they curse their families, they curse themselves, they curse God. It’s horrible, and God doesn’t want that. He wants us to go in peace. We need to think about this with merciful hearts.”

Dr. Robert Olvera, a Catholic physician and former altar boy who grew up in East Los Angeles, has supported aid in dying since watching his daughter die, at 24, from the leukemia she lived with for 17 years. She was blinded by her disease, he said, painkillers offered no relief and she suffered greatly.

“She was basically living in a black hole,” he said. “She had no quality of life.”

She was wasting away, her face was sunken, she did not want to be seen by anyone and she was in that state for the final three months of a life that ended last year.

“She begged me to give her some sleeping pills,” said Olvera, who couldn’t answer that request, knowing he could be criminally charged and lose his license to practice medicine.

Doctors can and do offer palliative sedation, but Olvera believes they should also have the right to grant a terminal patient’s wish to die at the time of their choosing, provided they are of sound mind and have satisfied the safeguards against abuse or coercion that are written into the end-of-life legislation.

I asked Olvera how he would respond to the argument that the timing of death is not something patients and doctors should decide; that should be left in God’s hands.

Doctors, he said, can unplug ventilators and they can answer a patient’s wish to be taken off dialysis. They can recognize that modern medicine has advanced to the point where people can be kept alive almost indefinitely, but all of us must ask whether, in some cases, we are extending life or prolonging death.

As both a physician and a Catholic, Olvera said, he believes no one should have to experience what his daughter did.

I understand that your education was Jesuit, Gov. Brown.

Well, Dan Maguire studied in Rome, became a Jesuit priest and now teaches moral theology at Marquette University, a Jesuit school. Here’s what he told me:

“For almost 50 years a number of Catholic theologians have taught that for the terminally ill, ending life may, at times, be the best that life offers. In some circumstances, death may be the best remaining friend and it is reasonable and moral to accelerate the dying process.”

According to Scripture, Maguire told me, we are made in the image and likeness of God, and it is our God-given right to decide for ourselves on matters such as aid in dying.

“Thomas Aquinas says with great wisdom that human actions are good or bad depending on the circumstances,” Maguire said. “In certain cases, you could say that life is good, and always to be served as best you can, but there are times when the ending of life is the best that life offers, and moral beings can make that decision for themselves…. That’s what human freedom means.”

It’s true, Gov. Brown, that some fear the life-ending option will be abused, and that those who are disabled or in a state of depression will choose inappropriately or be manipulated by relatives who stand to benefit financially.

It’s true, as well, that we need to be mindful of the potentially dangerous intersection of end-of-life options and cost-cutting by health insurance companies that have a financial disincentive in costly end-of-life procedures going on for long.

But I believe the legislation before you offers safeguards against abuses.

I don’t know if my father — who refused a feeding tube before his life came to a close — would have taken advantage of the End of Life Option Act, had it been available at the time.

I’m certain many people — probably most people — would want no part of it. That’s their choice and they should be entitled to the finest palliative care.

But I know that since writing about his death, I have heard from hundreds of Californians who would take a small measure of comfort in knowing that if they so choose, they can avoid physical or emotional suffering as the inevitable end nears. They believe that, as Dan Maguire put it, there comes a time when death is a friend.

I stand with them.

Complete Article HERE!