A good life eases pain of parting

Krissi Goetz

By Krissi Goetz

[T]he day this column hits print marks one year since my first and very beloved dog took his last breath.

He was a remarkable dog for many reasons, the most notable his determination. He not only showed me what marvelous company a dog could be but pointed me down a path in life. Thanks to him, improving the lives of dogs — and their people — is my mission.

So it was everyone’s first guess, including my own, that I would be reduced to shambles after his death. But strangely enough, I was OK.

Don’t get me wrong. It was heartbreaking, and I’m still brought to tears even thinking about him. But his passing was, for me, just about the best I could hope for.

I had a good idea of what a good death looked like, and that’s how it happened. He’d had a long and full life, and I had lots of time to see the end coming and prepare. I did everything I could to help him be comfortable and happy. He showed me when it was time, and luckily it was a beautiful day when it happened. I had weeks to convey to him how much he meant to me, to thank him for all he had done. And I was right next to him when he died, the vet helping him along as he lay in the grass at the farm on a spectacular spring day. It wasn’t perfect, but pretty close.

Of course, what’s an ideal passing depends on who you are asking. Everyone has a different idea of what a good death looks like. But it’s certainly worth thinking about so that when the time does come you have an idea of what would be best for you and your beloved friend.

Indeed, our animals can have clear wishes. While I was fortunate to have another dog pass similarly to my first, my calico cat was a different story. A fierce little creature, she was unlikely be pleased to see the vet — or have anyone suggest she was dying, for that matter. When she stopped eating due to cancer at 15, I arranged my life so I could be by her side at all hours. She seemed to appreciate that. After a week of my carrying her to lay out in the autumn sunshine and back inside to lay in bed, she died in my arms. It was, again, just about perfect.

Nonetheless, after letting my cat choose her own time, I felt similarly to when my dogs had died. It’s hard to put into words. Saddened, of course, yet also perhaps content. With few regrets. Perhaps I wasn’t as devastated as I thought I’d be because I’d had enough time before their death to prepare and adjust, and it went as I’d hoped.

The rituals that surround death also play a part in grieving, and here, too, we all have our own. Many people bury their beloved animals, others choose cremation. A friend of mine shared photos of the pyre she built for her dog, a stunningly beautiful creation. Our individual rituals surrounding a death can help immensely during a difficult time.

Of course, having a dog’s passing go smoothly may not happen. You can’t always be lucky. Sometimes our dogs die unexpectedly. Sometimes you aren’t there. I’ve had that happen, too, and find that harder.

Two months after I began fostering a special young dog he was killed out on a walk with someone else. I was understandably a mess. But a couple of aspects kept coming back to me: He died instantly. He did not die alone and scared in a shelter. And right before he left on that walk I had taken a moment to give him my attention and convey to him that I loved him. Isn’t it funny that nearly 15 years later I can still remember that detail? That was my biggest consolation after his death: that he knew he was loved.

Maybe what really helps make a good death is a good life. Ensuring our dogs have a full and rich daily existence and that they know they are loved may be the best way to finding yourself with few regrets, regardless of how they leave us. I do my best to find time every day to do something with my dogs that we really enjoy, to be aware of and appreciate them and to incorporate little daily rituals to convey to them they are loved. So while what a good death looks like is certainly something to think about sometimes, what a good life looks like is something to think about each and every day.

Complete Article HERE!

How GPs can handle conversations about end-of-life care

Talking to patients about end-of-life care is not easy even for experienced health professionals, says Dr Pete Nightingale, but following simple guidelines can make the process easier.

By Dr Pete Nightingale

[A]s a GP, you are likely to have had many patients in your care with a life-limiting condition, or who are approaching the end of their life. Speaking honestly about death with someone who will soon face it themselves can be daunting, but can also be extremely rewarding.

A new report by Macmillan Cancer Support, No Regrets, explores the taboo around death, and included the worrying revelation that while 76% of people with cancer have thought about their own death, just 8% of these have shared their feelings with a healthcare professional.

This is concerning for a few reasons. I’d hate to think that any of my patients could be suffering in silence, feeling they cannot share their concerns with me.

GPs and their teams have the potential to play a significant role in helping people work through an Advance Care Plan. Macmillan has found that when healthcare professionals have a record of where someone would like to die, they are nearly twice as likely to die in the place of their choosing.

But talking isn’t always easy, so here are some tips:

Starting the conversation

Some people will make it clear that they are ready to start talking about it, but some may be waiting for a professional to bring it up. You could try a gentle prompt, such as, ‘many people at times like this want to discuss the future’.

Listen to the patient rather than talking yourself

People with an incurable diagnosis may value a sense of control so follow their agenda as much as possible in conversations. Some people, when they are nervous, try to cover this up by talking, but all you need to do is show you are listening. Reflecting what  the patient says back to them can be a reassuring way of letting the patient know you are listening.

Think about including a family member in the conversation

Ask if they want someone close to them to be present. It can provide support for the patient and can also help ease communication within families. Some families shy away from discussing Advance Care Planning, so emphasise the importance of letting the patient talk about the future, if that’s what they want.

Focus on personal preferences

Support the patient in talking about what they would like to happen and what a ‘good’ death means to them. This can include anything from pain relief, location, whether they want their family members present, religious or spiritual needs, or more. Be prepared for the conversation to be more wide-ranging than their clinical needs.

Don’t rush

As GPs, we have an increasingly hectic working life. But remember, there is no time-scale for completing an Advance Care Plan. You can carry the conversation into other appointments, or ask other primary care staff to help.  Help could come from members of  the nursing team or trained care administrators and in some areas trained volunteers are involved.

Ask open questions, listen, then record and share (with permission)

If the patient allows it, let their wishes be known to family, key professionals and out-of-hours services, ideally electronically so they’re accessible.

Be honest

It may be tempting to offer false reassurance to comfort the patient. This can be misleading and prevent the person from coming to terms with what is happening. Phrases like ‘don’t worry’ may seem comforting, but they also imply that you are unwilling to answer difficult questions.

It’s ok not to have the answers

You may feel anxious that you won’t be able to answer all their questions, but you don’t have to have all the answers. Be honest, and say ‘I actually don’t know, but let me find out for you’.

Take opportunities when they arise

If you have the chance to complete an Advance Care Plan with someone, or even just start the conversation, take it! Even if they seem well, remember that there may not be more opportunities to have this chat with them, and people can deteriorate quickly. It’s better to have the conversation sooner rather than later.

Complete Article HERE!

Laid to Rest at Home

How to Plan a Home Memorial Service for Your Departed Loved One

[H]aving a memorial for a loved one after their passing is an important part of the grieving process. It’s a time to honor them, share memories with family and friends, and say goodbye. Some families find that there’s no better place to hold this personal event than at home, but knowing exactly where to start the planning process — especially amid the grief of a loss — can feel overwhelming.

This guide will help you plan a beautiful, meaningful home memorial service for a recently departed loved one. Proceed with patience and plenty of support. With a little time and the right planning, you can hold a service that will allow your family to come together and say goodbye.

Choosing a kind of service: Memorials vs. Funerals

The services and items you’ll need in planning a home memorial will vary depending on the kind of service you’ll have. Your loved one may have left instruction on their final arrangements, but if not there are two main options: memorials and funerals.

Memorials usually involve a group of family and friends coming together to mourn the loss of a loved one. There may be photos of the departed, flowers, and at least one eulogy, often from a surviving spouse, parent, or sibling. Some families also choose to have a religious or spiritual figure speak. The loved one is typically represented by a large photo, collection of photos, wreath, or if they’ve been cremated, their urn.

Food and drink are often incorporated into memorials, and can be organized in just about any format that works for you and your loved ones. Some memorials will offer light refreshments like water, coffee, crackers, cheese, and mini sandwiches. In other cases, the memorial is a potluck where family and friends are invited to bring a dish to share. Alcohol isn’t required, but it’s commonly offered — typically a basic wine selection is sufficient. Leftovers stay with the host or are given to the immediate family of the deceased (if the memorial is held at someone else’s home). For large memorials, it might be worth the expense to hire a caterer to provide finger foods, utensils, and drinks.

The location of the memorial within the house is entirely up to you; one convenience of a home memorial is that you can tailor it to be exactly how you want. Some families even choose to have a backyard service if the weather permits. The living room, den, or formal dining room are all good options, but ultimately it will depend on the space available in the house. You’ll need adequate room for your guests to chat amongst themselves before and after the service, seating for the formal eulogy or service, and places for people to set their food and drinks. Finally, there should be some kind of a dedicated space where the speakers will be clearly seen and heard, usually close to the visual representation of the deceased loved one.

Seating doesn’t necessarily have to be anything formal — though you can rent extra chairs if you have the space and finances to do so — and many people manage by bringing all the chairs in the home to the memorial space. Neighbors and other nearby family and friends will likely be able to bring over extra chairs if needed. Arrange them facing the speakers’ area, and do your best to leave clear pathways for guests.

Flowers are somewhat traditional for memorials, but can be quite expensive. A floral wreath with your loved one’s photo is often more than enough to create a beautiful and personal tribute and won’t cost too much, especially if multiple family members pitch in. If you do choose to buy additional floral displays, don’t be afraid to deviate from the normal white arrangements. A home memorial allows you to really personalize the experience, so consider choosing types and colors of flowers that will bring happy memories of your loved one: the peonies your mother carried on her wedding day, tulips the color of your brother’s prized ’67 Mustang, or the roses your grandmother grew in her garden, for example. Keep in mind that though they make a lovely addition to a home memorial, flowers are completely optional — often those that are sent by loved ones with condolences are enough to create the desired effect.

Another option in lieu of flowers is to collect money and donate to a charity that was near and dear to the deceased one’s heart. This donation can be made in the memory of the person who died to honor a cause that was meaningful to them. People often, most of the time actually, like to have those who would buy flowers donate to a nonprofit organization of their choice. This is often in memory of the person who died or even a cause that was near and dear to the deceased one’s life,

Large memorials may require a more advanced sound system. Some families like to play their loved one’s favorite songs (the volume level really depends on the tone of your memorial, but usually you’ll opt for the quiet side) or other calming music to soothe their guests before the service. Having a microphone and speaker set-up will make it easier for your eulogists to be heard, and even better if you have some kind of podium or raised step for them to stand on.

If finances are tight, you’ll likely be able to find a neighbor, family member, or friend who will have access to equipment you can borrow. Don’t be afraid to ask around; your loved ones will be hoping to lend a hand at this difficult time, so let them.

A funeral will require all the same considerations as a memorial, with the addition of handling the viewing. You’ll need to coordinate with a funeral home (to help prepare the body) and cemetery (for the burial) directly after your loved one’s passing; you don’t have to make any final planning decisions right away, but letting them know your situation and potential needs ahead of time can save you some time and stress later. Additionally, you’ll need to consider how much space you’ll need for the casket within your home memorial space.

Traditionally, families have purchased caskets directly from a funeral home or casket showroom, but options have increased in the last couple decades. Shop wisely, but don’t get too caught up in worrying about finding the “perfect” one. Your loved one wouldn’t want you to fret over it, and no one at the memorial will be focused on anything but their grief.

Though there are some individual facilities that handle body embalming and preparation, many families choose to work with a funeral home for these arrangements. You’ll need to provide an outfit for your loved one to be laid to rest in and any specific grooming details (hair styling, lip color, painted nails, etc). The funeral home will also request photos to use as reference so that the departed appears as natural as possible.

You should contact the funeral home soon after the passing of your loved one so as to keep the remains properly preserved. Determine a clear schedule and discuss plans for transportation. Make sure you’ll have the necessary assistance to physically move your loved one to and from your home, and clear a path through the house to make transport easier. Plan to have your loved one arrive half an hour to an hour early; you’ll want everything else to be set up so that you can direct the funeral home workers and troubleshoot any issues quickly.

You’ll also need to talk to the funeral home about what will happen to the remains after the memorial. If they will be buried within a few days of the funeral, the facility may agree to hold the remains until then and help transport them to the cemetery. Planning a burial service with the cemetery (and coordinating with the funeral home) will be a completely separate process, but you should plan on keeping the cemetery informed of all final arrangements. If your loved one opted for cremation, funeral home employees may pick up the remains after the memorial and take them directly to be cremated.

Seeking Additional Help
One of the most important parts of planning a home memorial is asking for help. Again, those close to you will be eager to help out in any way that they can, but often it’s enlisting their assistance in the smallest tasks that makes the biggest difference. If trusted family and friends are offering to provide child care or meals while you plan the memorial, accept it. If neighbors offer to help pick up family from the airport while you meet with the funeral home director, say yes. You’ll be able to focus on your planning and be more effective, and that accomplished feeling will likely help you relax more in your downtime.

Family and friends are extremely helpful when it comes to referrals, so ask around about funeral homes, cremation specialists, caterers, and florists. If you don’t have a necessary item for the memorial — like a podium for the eulogists or an easel for a photo display — ask friends, neighbors, and nearby relatives if they have anything that will suffice. It might be helpful to plan as much as you can, then create a master list of everything you still need and send it to loved ones who may be able to help. Emailing tends to be the preferred method of communication, but for quicker conversations it might be better to opt for a group text with specific loved ones who can pass on the information to others.

Social media is another helpful way to not only reach out to loved ones for help, but also keep everyone informed about the memorial. Creating an event or memorial page on Facebook can be a constant point of reference for friends and family no matter how far away they are. Most families elect a designated loved one to post updates and respond to questions, ideally someone with social media and tech savvy.

It’s important to remember that depending on the situation and the loss, there will be some people you should avoid burdening with favors. The spouse, children, and parents should be asked to do as little as possible outside of voluntary involvement; don’t shut them out of the planning process if they want to contribute, but be willing and prepared to help them make some of the major decisions as needed. If there is some kind of written document (be it a will or other personal document) that details your loved one’s final arrangements and wishes, ask to have access to it while you plan the memorial so you don’t have to constantly ask questions.

The truth is, planning a memorial for someone you love is never easy. Holding the event at home can make the grieving process feel less detached and allow for a much more personal experience. Keep in mind throughout the process that no minor detail, be it the material of the casket or the number of flowers, is worth fretting over. Putting your loved one to rest is about so much more than the physical details, so channel your energy into creating a loving environment for everyone to say goodbye.

Complete Article HERE!

What Judaism Teaches Us About Grief And Loss


By Gila Silverman

[T]he headline on a recent Forward interview with Sheryl Sandberg asks if Sandberg can help Americans learn to grieve. Sandberg has certainly done all of us a great service by opening up a conversation about the way American do –- and don’t –- deal with death, dying and grief. In the essay that follows this headline, both Sandberg and Jane Eisner, who interviewed her, acknowledge that the rituals and structures of Jewish mourning can play an important role in processing our grief. As Jews, we are lucky. We do not need to create new ways of grieving; we need to look no further than our own traditions in order to learn how to grieve.

While the fact that everyone will die is universal, how we understand and respond to death is shaped by historical, cultural, political, economic, and, of course, religious, forces. Shared norms, values, and practices guide our expectations of how the bereaved should behave, of how we relate to the loss, of the responsibilities of the community, and of the social identities of the dead. As American Jews, therefore, the way we think about death is influenced both by our Jewish heritage and by the larger American culture.

In the United States today, death is primarily understood through the language and concepts of medicine, which focus on treatment, recovery and cure. Death is often perceived as a failure of the medical system, and talking about it makes many uncomfortable. Grief too is frequently seen as an individual and medical problem. Bereavement is a crisis to be resolved, and normal grieving behaviors are sometimes interpreted as symptoms of a psychiatric condition. For much of the 20th century, our understanding of grief built primarily on the psychoanalytic theories of Freud, and the work of grief was seen as letting go of the deceased, in order to free emotional energy for new relationships. Mourners were often told to “put the past behind”, “get back to normal”, and “move on”.

In the latter half of the 20th century, and into the 21st, new psychological models of grief emerged, primarily from researchers in North America and Western Europe whose methodologies allowed them to actively listen to the voices of the bereaved. My mother, Phyllis Rolfe Silverman, who died last June, was one of these scholars. In nearly 50 years of research in this field, she helped us to understand that bereavement is a time of change, a normal and expected life-cycle transition. Rather than something to recover from, mourning is a process of accommodation; it is not a linear process through a fixed set of stages, but a helix-like movement of negotiating a series of crises and accommodations. Mourning is an ongoing process of renegotiating a relationship, a “continuing bond”, with someone who is no longer physically present, and of reconstructing a meaningful world, and our place in it, following a loss. This is a process not of relinquishing an attachment or of giving up the past, but of changing our relationship to it. Grief is a life-long process, as the relationship to the deceased, and the meaning of the loss, is continually revisited and renegotiated as life events occur.

My mother always told us that Jews do grief well, that our Jewish traditions map perfectly onto the psychological experience of mourning. As I near the first anniversary of her death, and the end of my Jewish year of mourning, I understand now how right she was. Traditional Jewish laws prescribe a fixed set of mourning rituals and prohibitions, which are collectively referred to as Avelut (Hebrew for “mourning”) These rituals are designed to balance two core commandments: k’vod hamet –- honoring the deceased, and nichum avelim -– comforting the mourners. They make clear what is permitted and forbidden to the mourner during each phase of their grief, and outline for the community its responsibilities in caring for the dying, the dead, and the mourners. They recognize that what we need during the early days of intense pain and sadness is different than what comes later, as we accommodate to the empty space the death has left in our lives. Jewish rituals recognize that the individual is intertwined with the community, that, as the famous 1952 ethnography by Zborowski and Herzog declared, “life is with people”.

Our guidelines for mourning delineate who is considered a mourner (the parents, children, siblings, and spouse of the deceased), and the exact obligations and prohibitions guiding the behavior of each over time. These guidelines follow a clear progression, beginning at the moment of death, and continuing through the completion of the Avelut period, which is 30 days for a spouse, sibling or child, and one year for a parent. This is a highly structured process; as the mourners move from Aninut (entry into mourning) to Shiva (the first week), and then to Shloshim (the first thirty days) and eventually reach the end of Shanah (a year), they separate from, and then slowly return to, the social life of the community. Even after this year ends, those who have experienced a loss continue to participate in additional memorial rituals (yahrzeit, and, in the Ashkenazi tradition, yizkor) for the entirety of their lifetimes. At the heart of Jewish mourning rituals is recitation of the Mourner’s Kaddish. The kaddish, a prayer sanctifying God, is to be recited daily for the Avelut period, and must be said in the presence of a quorum of ten Jews.

Within a larger social context that still expects people to move on from their grieving fairly quickly, the year of Jewish mourning rituals, and the ongoing opportunities to remember the deceased, send the bereaved a strikingly different message. Our rituals recognize that ongoing mourning is accepted, expected and supported by communal norms, rather than being a reason to seek professional help. Jewish mourning rituals encourage the bereaved to temporarily withdraw from normal functioning, gradually accept the reality of the loss, mobilize social support, and find new meaning within the existing frameworks that guide their lives. In particular, the daily recitation of kaddish, and the annual marking of the yahrzeit, serve as a recognition that the memories of the dead will always be with us. These rituals acknowledge that death ends a life, but not a relationship.

By so publicly speaking of, and writing about, her grief, Sheryl Sandberg has powerfully reminded us that we need to acknowledge, make room for, and talk openly about grief. But it is not her job to teach us how to grieve. We have the wisdom of our Jewish traditions to do that.

Complete Article HERE!

Is it Possible to Die of a Broken Heart?

After 55 years of being by his side every day, being apart was more than she could handle when he became ill.


[S]omehow she knew it would be the last time she saw him. They had lived together in their house for 37 years until it became necessary to move to an Assisted Living Facility. Not their choice at all, but they could no longer maintain their home, their finances, their nutritional needs and more.

They met in their mid-twenties on a blind date at the beach. They sat on a blanket smoking cigarettes; she, shy and unsure of herself, was immediately intrigued and attracted to the young man a year and a half her junior. She must have had an open heart; he had just had all his teeth pulled. She didn’t care; she saw a kind and gentle soul. Two months later, he had a new set of teeth and a bride, marrying in his parent’s backyard.Within five years they had two children, a boy, and a girl, just like she wanted. She loved being a mom and a wife. They moved as a family across the country twice, settling in Central Florida and buying a home after many years of renting.


My parents rarely fought. They bickered and disagreed, but I don’t remember any ugly scenes. I just remember love. Whenever they did get on each other’s nerves, it didn’t last long. Especially if  I put their favorite song, The Nearness of You, on the record player. It was impossible for them not to stop fussing and begin to laugh and hug and kiss each other when they heard it.

They loved each other’s company. It was rare they were apart if they weren’t working. They just loved to be together. A lot of husbands don’t enjoy going to the grocery store with their wives. Dad always did. Probably to keep her from spending too much, but regardless, they did it together. I have many memories of them walking through grocery stores and malls holding hands. My parents didn’t have any issues with public displays of affection.

I have fond memories of them bowling and square dancing together too. They got up together every morning, and went to bed together at the same time every night, after the evening news. When they both retired, they drove around the country, stopping to visit friends and family. Just the two of them. Inseparable.

As with many people, aging was not kind to my mom and dad. He went through a bout of Leukemia and shingles. She – a heart attack, congestive heart failure, kidney issues and breathing trouble. Her heart surgery went fine, but she contracted MRSA in the hospital and required more intensive surgery that she nearly didn’t survive.

But she pulled through. She was a fighter and she needed my father. And he needed her too. He sat by her side every day in ICU, then at the long-term hospitals and rehab facilities where she was moved for recovery.

Finally, she came home and they enjoyed a few quieter years together with me checking on them daily.

But there soon came a time when they needed more. Much more.

Dad was showing signs of Dementia. Medicine and meals were missed. Food was rotting in their fridge. Bills weren’t getting paid. Little by little, their well-being was eroding and I was struggling to help them maintain.

It took a crisis of their phones being shut off and nearly their electricity too, to really understand their situation, and while it was one of the toughest decisions I ever made, I moved them to an ALF and sold their home.

For a while, Dad did well. Even though he had early dementia, he still was able to drive and he became involved in activities. Mom was less happy, but she was safe, her medications were managed for her and I was finally able to sleep.

And for a couple years, life was status quo. Until it wasn’t.

Little by little, Dad’s mind began to slip and then continued to slip away. It started with him sleeping more than usual which I attributed to depression; sleeping is a great escape when you feel you are “having your life taken away from you.”

And the slide continued. His confusion increased as his cognitive mind decreased. One of the hardest days was having to take his car away. His self-care began to erode. There were days he didn’t get dressed or shave. He wasn’t eating very much. He slept much more of each day than he was awake.

Mom was frightened. She felt isolated and alone. I could tell she was grieving as she watched the man she loved so deeply slowly disappear. I felt the grief as well. The meds the neurologist prescribed we had hoped would slow down what was happening to his mind. didn’t seem to be slowing down anything at all.

Then the phone calls from the ALF staff began.

“We are having a problem with your father. He is wandering into other resident’s rooms.”

We all knew it wasn’t intentional. He just had no idea where his apartment was, after five years of living there. And with each passing day, it became obvious he needed more help with activities of daily living as he could no longer care for himself and Mom was unable to care for him.

This was where the heartbreak began. Dad had always provided for the family and Mom and always been, well, Mom, the nurturing rock as many mothers are. When she became sick, he took over, administering her medications including insulin four times a day. Now neither of them could help each other and he was becoming a shell of the man he used to be.

A painful decision was made to move him to the Alzheimer’s unit. My parents had never been separated before. Mom moved to a smaller apartment a short time after. She became increasingly depressed as his mind continued to drift.

I spent hours trying to reach him. Singing to him. I have read many studies that music is the last thread some Alzheimer’s patients hang onto and there were times he would nod and hum along.

Mom hated going to see him in the Alzheimer’s unit. It bothered her immensely. My stress increased as well trying to help both of them. She called me often, leaving voice mails if I wasn’t available, always asking about my dad. How was he? She was so worried about him. Her grief was palpable.

About six weeks after his move to the unit, Mom asked to go see him. Her color was not good. We entered the unit and found Dad sitting outside his room in his chair – the one I brought down so he would have something familiar. He seemed lost in his own world.

I paused as I heard the music on the sound system. The Nearness of  You was playing. What were the odds that their song was filling the room. Divine intervention perhaps?

“Dad,” I whispered in his ear. “Listen. Do you hear the music? It’s your song. And look, it’s your bride.”

He nodded slightly and looked at Mom. I began to sing in his ear the words and he continued to nod. I glanced at Mom; tears were running down her cheeks. Somehow I helped him stand up, and she did too and they gave each other a hug. I asked him if there was anything he wanted to say to her and he croaked out “I love you,” in a raspy voice, then sat down and closed his eyes.

Mom was shaking by now and asked me to take her back to the main area, out of the Alzheimer’s unit. It was just too painful for her.

The next day, the call from the ALF was not about him, but her. She was being rushed to the hospital: her broken heart had stopped beating.


Complete Article HERE!

The dying process: What to expect when someone is close to death

There’s evidence that even unconscious people can hear conversations and words spoken to them

By Bianca Nogrady

Hollywood has a lot to answer for when it comes to our ideas of what death looks like.

The majority of deaths on screen are violent, bloody, traumatic affairs, with few realistic portrayals of what a death from illness or so-called “natural causes” actually looks like.

Little wonder we have such a fear of death, and especially of being in the presence of it.

It’s still a terrifying notion, because most of us have no idea what we will see.

My own curiosity about death led me to write a book on the topic.

In bringing together medical research and personal stories from those who’ve undergone near-death experiences, I learned a lot.

Dying can be calm and peaceful; it can be awful, shocking, traumatic. Most of the time, it’s a little bit of both.


The expected

There are some fairly common things that happen when someone is approaching death.

They will often eat less and less, and — as things get closer — even stop drinking fluids.

They will also sleep more and more, and in many cases start to slip in and out of consciousness.

The final stages of dying also tend to involve some distinctive, and sometimes distressing, changes in breathing.

Breathing rhythms

One of the breathing rhythm changes is called Cheyne-Stokes breathing; a cycle of anywhere from 30 seconds to two minutes where the dying person’s breathing deepens and speeds up, then gets shallower and shallower until it stops.

Then there is a pause, which can sometimes stretch on so long that you think the person has stopped breathing altogether … before the cycle resumes.

Another is the awfully-named ‘death rattle’, caused by a build-up of saliva or secretions at the back of the throat.

This happens because the dying person is not clearing their throat or swallowing.

It can also sound like there is congestion in the dying person’s lungs.

Unfortunately, not much can be done about either of these signs, but perhaps some comfort can be taken from the fact that there is little evidence either of them is a sign of distress or discomfort.

Can you hear me?

As people near death, their limbs, hands and feet may get cold, and the colour of their skin may change from a healthy pink to a sallow, grey or mauve tinge. Sometimes their skin can be clammy and their hair plastered down with sweat.

While the dying person may be unresponsive, there is growing evidence that even in this unconscious state, people are aware of what is going on around them and can hear conversations and words spoken to them, although it may feel to them like they are in a dream state.

There is also evidence that people in this state are hypersensitive to touch, so soft, gentle physical contact is best.

The unexpected

What should you expect in the final stages of dying?

Sometimes death can deliver one last gift to loved ones who have been long denied meaningful interactions because of disease such as Alzheimer’s disease, dementia or brain tumours.

Terminal lucidity, or ‘lightening up’ was first described in the medical literature as early as 1833.

It refers to a period of awareness or consciousness, sometimes a complete return to form and personality in someone who may have been gone — to all intents and purposes — for many years.

They may recognise close family members for the first time in a very long period. They may also crack a joke, smile and interact as if they had never left.

It can be a silver lining, but a brief one.

It heralds that death is imminent, but can offer people a last precious glimpse of the person they love.

Final conversations

Many people and studies have also reported the dying apparently being visited by and having animated conversations with unseen people in the room.

Sometimes they appear to be talking to a loved one who has long since died — a parent, partner, or sibling. Sometimes it’s a religious figure.

But studies of this suggest that it is almost always a positive experience for the person who is dying; they begin to talk of journeying and being welcomed.

Restless death

Perhaps less welcome — and equally as uncommon, occurring in around 1 to 2 per cent of deaths — is pre-terminal agitation.

This could be as minor as someone plucking at the bed sheets, restlessness and fidgeting, but it can be as dramatic as someone who might be hours away from death running down a hospital corridor yelling and screaming.

These are generally expected signs that death is near.

Death, when it comes, can sometimes be as simple as one last long exhalation with nothing following. The pulse stops, the skin may suddenly take on a waxy hue, and in the majority of situations, this is the moment when we begin to grieve.

But sometimes the unexpected can happen.

The shocking

Death can be shocking enough. But imagine if you had said your final goodbye, the last breath has come and gone, then the person who you thought was dead suddenly draws a gasp and twitches.

Agonal breathing or agonal gasps are the last reflexes of the dying brain.

They are generally viewed as a sign of death, and can happen after the heart has stopped beating.

Another strange and disturbing reflex that has been observed after death is called the Lazarus reflex.

People who have been declared brain dead and have had artificial ventilation turned off have been seen to raise their arms and lower them slowly, sometimes crossed across the chest, sometimes by their side.

Brain death may also be accompanied by other reflexes that are no more a sign of life than the jerk of your knee when it is tapped with a hammer.

These include repetitive facial twitches, slow toe twitches and even the entire leg twitching.

Thankfully these more disturbing aspects of death tend to be rare.

Being with someone when they die may be a confronting and even terrifying prospect to many.

But of those people who have sat with a loved one — or even a stranger — when that person died, very few regret it.

For most people who are present at this event, it is a gift; a chance for stillness and communion and honesty and reflection that we are rarely granted at any other time in life.

Complete Article HERE!

How clergy can help believers die a ‘good death’

U.S. clergy may be increasing the sting of death for many members of their flocks.

By David Briggs

[T]wo new studies find that many clergy are both ill-prepared and reluctant to fully engage in end-of-life conversations with terminally ill congregation members and their families.

The result, both studies suggest, is that more believers may be spending their final days enduring painful treatments with little chance of success in intensive care units rather than receiving comfort care at home.

One of the studies was a national survey of more than 1,000 clergy. The other involved in-depth interviews with 35 ministers from five states. The research raises three critical areas of concern:

· Too much faith in miracles: More than three in 10 clergy in the national survey said they would strongly agree with a congregant who said, “I believe God will cure me of this cancer.” Eighteen percent affirmed the belief that every medical treatment should be accepted “because my faith says to do everything I can to stay alive.”

· Lack of knowledge: In the in-depth study, spiritual leaders showed little knowledge of end-of-life care, including the benefits of palliative care and potential harms associated with invasive interventions. “Many grossly overestimated the benefits of aggressive medical procedures at the end of life,” researchers reported in the Journal of Palliative Medicine. Three-quarters said they would like more training in end-of-life issues.

· Fear of overstepping boundaries: The default position of many clergy, even those who personally believed it was against God’s will to suffer unnecessarily, was to merely support the decisions of dying congregants and their family members.

But even such passivity has consequences, researchers said, in that it can enable congregants to seek potentially nonbeneficial treatments that are associated with increased suffering.

The larger problem was summarized by one study participant: “We have not done a good job…on preparing people to die–that they don’t need to live the last days of their lives under terrible and excruciating pain.”

Competing principles

The new studies are part of The National Clergy Project on End-of-Life Care,

What is clear in both studies is the complexity in end-of-life decision making.

Spiritual principles such as the sacredness of life and the capacity for divine healing may come into conflict with other religious principles to comfort the suffering and place faith that God will care for individuals after this life.

For example, clergy were asked in the national study what they would talk about when visiting a patient with cancer and no hope for a cure.

Fifty-six percent said it is important to encourage acceptance of dying as part of God’s plan. Two-thirds would place a priority on suggesting hospice as a good idea. Eighty percent said it is important to talk about heaven and life after death.

Yet, 60 percent also would strongly encourage prayer for physical healing, holding out hope for a miracle.

At one extreme, 18 percent of clergy endorsed the idea of accepting every medical treatment to prolong life, and 16 percent said doctors and nurses should do everything possible to extend the life of a patient.

The clergy most likely to place their faith in divine healing were from the black church, Pentecostal and evangelical traditions and those serving low-income congregations, researchers noted in the Journal of Pain and Symptom Management.

The attitudes mattered to their flocks.

Clergy that endorsed life-prolonging religious values were approximately half as likely as other clergy to have a discussion concerning entering hospice, stopping treatment or forgoing treatment. The absence of a clergy-congregant hospice discussion was associated with less hospice and more ICU care.

In the in-depth interviews, no clergyperson said aggressive care was an “absolute good.” Several said it hampered a good death, and one said it was an “absolute bad,” researchers reported.

Yet despite their own strong views, many clergy refrained from influencing decisions about end-of-life care.

The ministers said they did not offer guidance out of respect for the “free will” of congregants, but researchers indicated a lack of knowledge of the medical consequences also played a role.

Humble approach

What can be done to assist clergy in helping religious individuals make better informed decisions about end-of-life care?

Clergy education is critical, researchers from both studies said.

The studies concluded that clergy training focused on the intersection of religious values and medical issues at the end of life offer several opportunities for improving care, including:

· Closing the gap between the clergy’s beliefs and actions.

· Empowering clergy to counsel congregants about the moral and spiritual implications of end-of-life medical decisions.

· Supporting religiously informed decision making by patients that minimizes unnecessary physical and spiritual suffering.

· Creating partnerships of ministers and disease-based and palliative care clinicians.

What clergy say – and what they do not say – can make a major difference in whether believers experience a “good death,” the studies find.

“There are times,” one black minister from Chicago told researchers, “Death itself is a cure to what ails you. It’s the healing.’’

Complete Article HERE!