Month: April 2020

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We are a funeral people who can no longer have funerals

Robbed of obsequies for those we love adds an unconscionable burden

At present only 10 people can attend a funeral Mass or a graveside and are expected to follow the rules about social distancing. File photograph

By Fr Brendan Hoban

The famous spiritual writer Henri Nouwen, as a young man back-packing through Ireland, watched a burial in Donegal, fascinated by a group of men filling in a grave as the grieving family watched in silence.

What struck him was the way, when the task was almost complete, the men used the backs of their shovels to tap down the clay. The ritual, he felt, was saying to the bereaved: “This person is dead, really dead. There is no doubting now this obvious truth.”

In recent years the ritual of filling in the grave is not as common as heretofore but, as with other rituals, we often don’t aver to the purpose behind them, or why they developed. They are part of a pattern, a background against which we measure our way of dealing with death.

When death occurs in Ireland, we move effortlessly into funeral mode. There’s a familiar template for family, community and necessary services

Strangely, for some like Nouwen from other cultures, they are signposts of a comfort zone that in faith and in family we have successfully created around the difficult experience of grieving those we love.

We are a funeral people. Funerals, unlike in some other cultures, are huge events in Ireland. A friend told me once about working in an office in Scandinavia when a colleague broke down at work. It emerged that he had buried his mother that morning and was back at work that evening.

It would be unthinkable, unimaginable, even shocking in Ireland.

When death occurs in Ireland, we move effortlessly into funeral mode. There’s a familiar template for family, community and necessary services. It’s a kaleidoscope of respect, mood, attitude, support systems and rituals that resonate with the need to create a platform for dealing with such an earth-shattering experience.

Community support

A key element is support offered by the community. People gather and individually offer their condolences. It may be no more than a brisk shake of the hand and a cliched formula of words but it’s fundamentally about respectful presence in solidarity with the grieving.

The coronavirus has robbed us of many things but the experience of dealing with the death and funeral obsequies of those we love adds an unconscionable burden at the present time.

Grieving brings with it a variety of responses, some reasonable to the outside observer, others part of the blame game we play to lessen the pain of loss

Stories emerge of family members watching from the distance as a loved one faces into what must be the loneliest experience of all and not be able to hold a hand or give a hug or a kiss seems almost beyond human endurance.

A wife, now a widow, told a newspaper about how she had expected her husband to die at home and how she might have lain beside him to comfort him in his dying but their last moments together were supervised by health authorities as she watched him through a window.

Rites and rituals

The other, added weight to bear for the grieving is to be deprived of the comfort and consolation of the rites and rituals of a funeral. At present only 10 people can attend a funeral Mass or a graveside and are expected to follow the rules about social distancing.

And the community response is limited to neighbours and friends sitting in their cars outside the church or in towns, lining the streets as a mark of respect. Interestingly the Government, knowing the limits to human endurance and the place burying the dead has in our culture, didn’t seek to ban funeral Masses.

Grieving brings with it a variety of responses, some reasonable to the outside observer, others part of the blame game we play to lessen the pain of loss. If a priest, undertaker or doctor gets it wrong at the time of our funeral it becomes an enduring family memory that festers for years.

With death and dying, the ground we stand in is a sacred space.

That said, our obligation to the living has to take precedence. In boring but necessary repetition, the warnings keep coming from the authorities – social distancing, hygiene etiquette, stay at home – and they need to.

The sun may be shining but the journey towards the promised land of something approaching normality is far from over. And if grieving families have to accept the present difficult arrangements around death and funerals, the rest of us should be prepared to accept our more marginal sacrifices.

Complete Article ↪HERE↩!

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Do I want a ventilator?

Coronavirus prompts more people to consider, or revisit, end-of-life care

As the coronavirus pandemic began, internal medicine residents at Massachusetts General Hospital filled out their health care proxy forms and urged the public to follow suit. They are, top row, Dr. Ashley Martinez, left, and Dr. Gabrielle K. Bromberg; bottom row, from left: Dr. Ryan Flanagan, Dr. Samuel D. Slavin, and Dr. Bradley J. Petek.

By Naomi Martin

The coronavirus pandemic has pushed the fact of human mortality to center stage, prompting scores of people, not just doctors, to consider or revisit their end-of-life wishes. Complicating matters, the pandemic has introduced ventilators — a life-support tool seldom discussed outside hospitals before the outbreak — into mainstream Americans’ worries.

Amid talk of hospitals rationing ventilators, some people are updating their living wills or proxies to say that they do want a ventilator to extend their lives, if necessary. Others, largely elderly people and those with serious health conditions, are making it clear that if their odds aren’t great, they wouldn’t want the machine to keep them alive.

“In the two-and-a-half years we’ve existed, we’ve never answered questions on ventilators, but now they’re pretty common,” said Renee Fry, cofounder of Gentreo, which offers low-cost estate planning.

It’s urgent that people clarify their wishes to family now, doctors say, because the coronavirus can progress quickly, making patients suddenly so sick that to stay alive, they must be put in a medically induced coma and on a ventilator.

In that moment, they may not have a chance — or be able — to fully consider the potential consequences such as brain and organ damage, or needing to live bed-bound with a feeding tube.

Most people who contract the coronavirus don’t become seriously ill, and only a small portion require intensive care. However, early data suggest that perhaps 50 percent to as many as 80 percent of coronavirus patients who are placed on ventilators don’t survive.

“The reality is even if we have enough ventilators, that’s not going to save most people,” Dr. Breanne Jacobs, an emergency room doctor and professor at George Washington University School of Medicine who wrote about the issue.

Most elderly people would prefer to pass away at home with family rather than alone in a hospital, she said, so “if they understand a ventilator is not going to miraculously get them back to where they were, a lot of people would probably change their mind about allowing doctors to do intubation.”

The crisis has prodded many people to take up the oft-deferred task of discussing end-of-life goals. Thousands have downloaded a new coronavirus-related guide from The Conversation Project, which helps people broach the uncomfortable topic.

Doctors advise against using medical terms, like ventilator, in documents, because that’s not helpful to clinicians aiming to follow someone’s overarching wishes. Instead, they say, people should focus on big-picture values.

“A lot of people say, ‘I don’t want to be intubated,’ but they mean they don’t want to be intubated for the rest of their lives,” said Suelin Chen, cofounder of Cake, which offers free end-of-life planning services. “If it were just to recover for a few days, they’d want that.”

Specialists say everyone over 18 should, at minimum, record their health care proxy, which in Massachusetts requires two witnesses. If that’s impossible during social distancing, people can complete a “trusted decision-maker” form, which is better than nothing.

And they should discuss key questions with their chosen person before an emergency, such as what makes life worth living, how much suffering are they willing to endure, and for what odds of success.

These should be ongoing conversations, as people’s wishes change with age and health status, they said.

“This isn’t just doom and gloom — it’s how do you want to live your life all the way through the end?” said Kate DeBartolo, senior director at The Conversation Project.

The downsides of inaction can be high. Someone may receive procedures they don’t want, as hospitals can be obligated to try to keep someone’s heart beating, regardless of whether their brain is alive. Without clarity, family members may disagree over stopping life support, prompting infighting and guilt. Planning reduces depression in grieving relatives, a 2010 study found.

In some instances, family members may have to go to court to take a loved one off life support.

“With my mom, I always say it was the greatest gift that she gave us,” said Patty Webster, 50, a Conversation Project community engagement leader, whose mother, a hospital chaplain, made her wishes so clear that when she suffered two strokes, her family all agreed when the heart-wrenching time came to stop prolonging her life.

“She had an end-of-life that she wanted,” Webster said. “She had friends and family by her side, laughing and crying, together with her when she took her last breath.”

Amid coronavirus, Webster revisited the topic with her family. She shared an article by a doctor about the damage that ventilation can cause. Afterward, her in-laws, in their 80s, emailed to say they wanted to live to 110, but only if “cognizant, thinking, and communicative,” and likely wouldn’t want ventilators.

Webster and her husband, meanwhile, would be willing to try temporary ventilator treatment for a chance to remain in the lives of their children, 18 and 20, in an active, meaningful way.

People who have started end-of-life planning during the crisis say it offers a measure of control. That doesn’t mean thinking about death gets any easier.

“It’s terrifying to think about when you flat-line, that’s the end,” said Chris Haynes, 48, a South End restaurant publicist who recently crafted his will, but can’t bring himself to envision his end-of-life care. “It just shakes you to your core.”

Pushing past that discomfort can make a huge difference to families and doctors, said Slavin, the MGH resident. In one recent case, he said, a health care proxy for a critically ill coronavirus patient knew that the patient wanted to try a few days on a ventilator. Then, if her condition didn’t improve, she would switch to hospice care.

“It’s hard whenever a patient is dying,” Slavin said, but “it felt like we were doing right by this patient and her family.”

Lately, Slavin has discussed the coronavirus by phone with his primary care patients who have advanced cancer, dementia, or heart failure. He describes the potential harms and low odds they’d face on a ventilator. He recommends that, if infected, they not pursue intensive care. Most patients agreed, he said.

For Slavin personally, the calculus is different. At 33 and healthy, he faces a good chance of recovery if infected and would want to try every option to survive and build a future with his wife.

“At another point in my life,” he said, “I might say, ‘I want a time-limited trial of intensive care, then shift to making comfort the top priority.’ ”

Complete Article ↪HERE↩!

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Want to help save hospitals from being overwhelmed?

Fill out that medical directive now.

Nurses from Rush Health Systems in Meridian, Miss., set up a triage area on Tuesday.

By Megan L. Ranney, Jeremy Samuel Faust and Chuck Pozner

When there are no ventilators to be had, no intensive-care-unit beds to be occupied, what will hospitals do for elderly patients who have run-of-the-mill respiratory failure? Or for patients with heart attacks or any of the innumerable dire reasons that people need emergency care?

Now more than ever, medical directives about end-of-life care are essential, especially for the elderly, who in the coming weeks and months may find themselves requiring emergency attention, whether for covid-19 or some other illness. With the prospect that ICU beds could soon be in short supply — as they already are in parts of New York City — it is vital for physicians to know, and to honor, every patient’s explicit wishes.

In the absence of that information, many patients may well be assigned ICU beds or placed on ventilators even though they might not ever have wanted any “heroic measures” taken if they had been consulted before falling ill.

We physicians are trained to have these conversations and to have them in ways that reveal patients’ wishes and priorities, while not unduly influencing them. But the conversations are rarely simple.

For one thing, ideas that are second nature to physicians are often foreign concepts for everyone else. Terms such as “mechanical ventilation,” “extracorporeal membrane oxygenation” and “cardiopulmonary resuscitation” seem to fly off our tongues. Yet even when we translate seemingly impenetrable jargon — saying “breathing machines,” “lung bypass” and “chest compressions” instead — we frequently fall short of plainly explaining the patients’ realities. Outcomes are poor much of the time, covid-19 or not. But just because there may be little hope does not mean there is none.

With millions of people now seeing almost nonstop news coverage about the covid-19 onslaught, many may be privately thinking about their own wishes, or considering asking family members about theirs. That may make the conversation with doctors less unexpected and therefore a little less jarring.

Others who thought they had long ago settled on their end-of-life preferences might, in light of the pandemic, have begun to reconsider. For that reason, we urge both health-care workers and families to reopen conversations on the subject with patients and loved ones before they are in the throes of life-threatening illness. We also urge patients and families to record these preferences on paper, with medical orders or living wills, and have them ready for communication with their doctors.

And doctors must respect those wishes. Even under normal circumstances, too often patients’ own explicit choices to forgo heroic measures are ignored. They end up receiving care they never wanted, and great harm is done. That must stop.

With infection concerns limiting access to emergency departments and ICUs, families may not be able to have these talks when patients are in treatment. The conversations might be most relevant for residents of skilled nursing facilities and long-term-care facilities, and other vulnerable individuals for whom life on a ventilator may be crueler than it is compassionate. But everyone needs to think about these questions. No one is immune.

As physicians, our approach matters. We must offer to have these conversations, never impose them. And the invitations must be both welcome and accepted. We hope to never have to make life-or-death decisions based on the availability of a ventilator, and simply by bringing forth the thoughtful wishes of patients, the need to make such heart-rending choices may be postponed indefinitely.

We cannot fully control how many people will be infected in the coming weeks and months. But through discussions with patients and their families, we can respect their wishes, potentially save lives and — most important — make difficult decisions in the light of day, not in the heat of the moment.

Complete Article ↪HERE↩!

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Embracing Life in a Time of Death

By Molly Jong-Fast

Some people have recently described the air in New York City as heavy. I don’t think that’s exactly right. The air has a weird crackliness to it. There’s something about living in a place that has experienced so much death in such a short period of time that changes the physics of a place. There is an electricity to the air, a nervousness that seems to permeate everything, As well it should.

As I write this essay 12,199 people have died of coronavirus in my city. The actual numbers are probably higher. Who knows what the real toll is, what with nursing homes refusing to disclose numbers and many people dying without ever getting a test or getting to a hospital? And people are dying here in surreal ways, the way they die in movies. The husband of a friend is found dead in his car. My friend’s father in law is found dead watching television in his house; he had been like that for three days. I know a handful of people who have died., Mostly parents of friends. They are not young, but in a normal world they would have another decade or two. Instead, they have been taken by coronavirus in what seems like a blink of an eye.

As coronavirus rages, New York City is quickly eclipsing Wuhan (3,869, based on official numbers, at least) and Lombardy region of Italy, which includes Milan (11,851) and any other city on earth in terms of recorded deaths. We are the epicenter of the epicenter. We are the ground zero of death.

And yet, outside my window are flowers, spring in empty Manhattan continues unabated. The flowers don’t care that no one is there to witness them bloom. The streets continue to be empty except for the occasional ambulance. In my neighborhood, the ambulances do this little beeping thing now, not a full siren anymore, and perhaps they don’t need a full siren since there is no traffic. The stores are all closed except a small gourmet food store and a pharmacy which is selling both pandemic supplies (masks, and pulse oximeters) and fancy Manhattanite supplies (expensive candles and skin creams). Life here is both terrifying and oddly mundane. Most of my day is spent inside; occasionally I’ll go for a walk. I see my one friend from six feet away. I watch a lot of television. I write my pieces. My mother and stepfather continue in their apartment alone, 20 blocks away, but I haven’t seen them in five weeks. My in-laws occasionally call in a panic, desperate for us to leave to the city.

But what they don’t understand, what they can never understand is that New York is not a habit; it’s an addiction. To New Yorkers, New York isn’t something you casually use and then abandon when you realize it could be fatal. I always knew New York was fatal it’s just fatal in a slightly different way now. When I grew up here in the 1980’s, I was only mugged once. Most of my friends were mugged multiple times–it was kind of what happened here. Right now, it’s not the crime that kills you. In fact crime in New York is down 22 percent. Right now it’s this mysterious, dangerous virus that kills. But the idea that New York can be dangerous, and bad for your health, that’s always been part of its sometimes explicable charm.

And life here can still feel oddly normal. Sometimes, if I close my eyes, everything can seem for a minute or two, like it was before March. But then there’s the silence — the lack of traffic, the lack of construction, the lack of life– and I remember it’s mid-April and we have been in lockdown for more than a month now.

The feeling here is that things are getting better, that our curve is flattening, I talked to a doctor friend who confirmed this and said cheerfully that they were “no longer going on bed checks and finding dead bodies.” There’s a cautious optimism in New York City; it’s quiet but you can feel it percolating, just under the surface. Yes, things are getting a bit better here, people are no longer dying in their cars as much. Hospitals no longer have lines around the block outside of them.

On Saturday, Gov. Andrew Cuomo said that 540 people had died the day before due to coronavirus, less than the 630 the day before. A newscaster on NY1 just said, moments ago, that we are “trending in the right direction.” Yes, this is better than previous days but it doesn’t feel better. We’re supposed to be celebrating the fact that fewer people are dying here every day, but a lot of people are still dying every day.

New York is used to tragedy. We New Yorkers have survived AIDS, 9/11 and catastrophic hurricanes. And, yes, we will survive coronavirus. But not without some very profound scars.

Complete Article ↪HERE↩!

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These Are The World’s Oddest Funeral Traditions

(Still In Practice Today)

When it comes to dealing with the dead, some countries have traditions that are a bit stranger than most.

by Vanessa Elle

Unique traditions help to preserve the history and identity of a particular culture. From Halloween practices to funerals, every culture has its own traditions when it comes to dealing with the dead. Keep reading to find out about some of the world’s oddest funeral traditions that are still practiced today.

Indonesia: The Funeral Takes Place Years After Death

In many countries, funerals are held only a short amount of time after someone passes away. But in eastern Indonesia, funerals amongst the Toraja ethnic group are sometimes held years after a person has died. The primary reason for this is that they are often larger-than-life events lasting anywhere from a few days to a few weeks and it sometimes takes a family that long to save up enough money to afford such an affair.

Between the moment a Toraja person dies and the moment they have their funeral, they are still kept in the family home rather than in a morgue. They are referred to as someone who is sick or sleeping rather than someone who has passed away and is even cared for, laid down, and symbolically fed.

Ghana: People Are Buried In Fantasy Coffins

Ghana has made headlines in the past for the fantasy coffins that are so popular in the African nation. The idea behind fantasy coffins is that people get the chance to rest forever after in a casket that represents something they were passionate about or something they achieved. For example, a fisherman might be laid to rest in an oversized fish while a businessman might choose a casket shaped like a Mercedes.

It’s common across many cultures to invest a lot of money into the ideal coffin and this tradition just takes the idea one step further. After all, a coffin serves as someone’s final resting place, so it only makes sense that it represents them properly.

Tibet: The Body Is Exposed To Vultures

Sky burials are common amongst the Vajrayana Buddhist communities of Mongolia and Tibet. After a person has died, their body is cut into pieces and left on a mountaintop, where it is exposed to vultures. The underlying belief behind the tradition is that the body becomes an empty vessel following death and must be returned to the earth while the soul moves on.

The practice dates back years and is still the most popular method of burial in Tibet today. Other cultures across the world have also been known to expose a corpse rather than bury or cremate it, including the Zoroastrians, a religious group that today is mostly found in India but can be traced back to pre-Islamic Iran.

Madagascar: Having A Last Dance With The Body

Amongst the Malagasy people of Madagascar, a person’s burial isn’t a singular event. According to the traditional famadihana ritual, the body is exhumed every five to seven years to take part in a celebration. During the ritual, the bodies are sprayed with wine or perfume and family members dance with them while a band plays.

Some take the opportunity to update the deceased person on family news or ask for their blessings. More importantly, during famadihana, people remember the deceased person and tell stories of them to keep their memory alive.

New Orleans: A Jazz Band Funeral Procession

Of course, a jazz funeral could only ever take place in New Orleans! This tradition involves a brass band that accompanies a person’s funeral procession. The idea behind it is that the streets are filled with music and the deceased person’s life can be celebrated in addition to their death being mourned.

The procession typically begins at the church or funeral home and marches all the way to the cemetery. The music steadily becomes more upbeat as the march goes on and people begin to dance, with passersby also encouraged to join in on the dancing.

Complete Article ↪HERE↩!

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Sheltered At Home

Families Broach End-Of-Life Planning

By JoNel Aleccia

Long before she contracted COVID-19 at a Kirkland, Washington, nursing home, Barbara Dreyfuss made sure to document the wishes that would govern how she died.

The medical directive she signed last year at the Life Care Center outside Seattle called for no resuscitation if her heart stopped, no machine to help her breathe. The 75-year-old, who suffered from lung disease and heart problems, had been on a ventilator for two weeks in 2016, a grueling experience she didn’t want to repeat.

“Mom’s form said, ‘Do not resuscitate, allow natural death,’” said son Doug Briggs, 54. “That was her choice.”

So after Dreyfuss fell ill in late February, becoming one of the first U.S. patients sickened by the new coronavirus sweeping the globe, her family reluctantly allowed doctors to halt lifesaving treatment in favor of comfort care.

Dreyfuss, a once-vivacious feminist and activist, died March 1, two days before tests formally confirmed she had COVID-19. But her decision to confirm her wishes in advance could serve as an example for growing numbers of individuals and families feeling new urgency to pin down end-of-life preferences and plans.

In the weeks since the coronavirus has surged, sickening nearly 165,000 people in the U.S. and killing more than 3,000 as of Tuesday morning, interest in advance care planning has surged, too. More than 4,000 requests poured in during the week of March 15 for copies of “Five Wishes,” an advance directive planning tool created by the Tallahassee, Florida, nonprofit agency Aging with Dignity. That’s about a tenfold increase in normal volume, said Paul Malley, the group’s president.

“We started hearing from families that they want to be prepared.” said Malley, noting that more than 35 million copies of the living will were already in circulation.

Stephanie Anderson, executive director of Respecting Choices, a Wisconsin-based group that provides evidence-based tools for advance care planning, said her organization put together a free COVID-19 toolkit after seeing a spike in demand.

“We had hundreds of calls and emails saying, ‘We need help having these conversations now,’” she said.

The tools and documents aim to help adults of all ages plan for their medical, personal, emotional and spiritual care at the end of life with a series of thoughtful questions and guides.

Malley said the COVID-19 crisis has spurred interest from two primary groups. The first: people immediately concerned that they or someone they love will contract COVID-19.

“They’re saying, ‘Will we know what Mom or Dad wants?’” Malley said. “They’re motivated by the urgency of a health crisis around the corner.”

New requests also are coming from families sidelined at home by shelter-in-place orders, he said, as they spend relaxed time with loved ones and have more breathing room for such discussions.

“Their family is playing more board games together and catching up on movies,” he said. “Advance care planning is falling into that bucket of that thing people wanted to do when they had time.”

These conversations can be difficult enough during ordinary times, but the crisis has provided an urgent new reason to start talking, said Anderson. “We’re hearing people are really worried,” she said. “I’ve heard the word ‘terrified’ about what’s happening in the country.

It’s more than just filling out a document, Anderson emphasized. The conversations about preferences and values can help provide real relief. “They want somebody to talk about these things,” she added.

Eliciting end-of-life preferences in advance also could help ease the strain on the health care system as doctors grapple with how best to divvy up care amid dwindling medical supplies and equipment.

Dr. Matthew Wynia, a University of Colorado bioethicist and infectious disease doctor, is planning how to triage seriously ill patients when the supply of mechanical ventilators runs short at his medical campus. Understanding — and soliciting — patients’ end-of-life preferences are key, he said.

“We’ve always had the requirement that people get asked about an advance care plan, but now we are taking that incredibly seriously,” he said. “Because we need to know if you get much worse, what would you want?”

One new and potentially controversial question his hospital is considering would ask patients whether they’d be willing to forgo a lifesaving ventilator for someone else in a crisis. “Would you want to get in line for those crucial care resources?” Wynia said. “Or are you the kind of person who would say, ‘I’ve had a good life and I’ll let other people get ahead of me in line’?”

The most “ethically defensible” way to make a triage decision is to ask patients in advance, Wynia said. “By the time you’re asking for volunteers, these people can’t talk to you anymore.”

But some experts worry that asking such a question crosses a line, even during an emergency. Malley balked at the thought of asking COVID-19 patients to weigh their lives against others, fearing it could pressure vulnerable people — the elderly, disabled and others — into decisions they don’t really want.

“I think we shouldn’t resort to coercive questions,” he said. “I don’t think anyone should be made to feel they have a duty to die.”

Even if you’ve made advance care plans in the past, Malley and Wynia emphasized the need to reevaluate them in light of the COVID-19 scare. If you’ve documented your wishes to decline CPR or intubation because of a primary disease, such as cancer, consider whether you still want to forgo such treatment for the novel virus. Similarly, if you’ve opted for full treatment — prolonging life by all measures — make sure you’ve considered the potentially devastating aftermath of mechanical ventilation for COVID-19.

“For this condition, people who need to be on a vent for COVID-19 are staying on it for two weeks or three, and they may have very severe lung disease afterward,” Wynia said.

Indeed, Barbara Dreyfuss’ two-week stint on a ventilator shaped her answer to questions on the medical directive that guided her care, her son said. “Because of what had happened to Mom four years ago, we had already sat around as a family and discussed this,” Briggs said.

That doesn’t mean it was easy, said Meri Dreyfuss, 62, Barbara’s sister, who called stopping active treatment “a hellish decision.” But as the infection in her lungs worsened, Barbara Dreyfuss was clearly in pain. “I was like, ‘Oh, my God, I can’t stand the thought of her suffering,’” Meri Dreyfuss recalled.

Late on the evening of March 1, Briggs was with his mother in her isolation room. Nurses asked him to step out because he had exceeded the allowed contact time. But when he looked back, monitors showed that his mother’s vital signs were dropping fast.

Nurses allowed him to rush back into the room. Dressed in a hospital gown, mask and gloves, his cellphone wrapped in a plastic bag, Briggs quickly turned on the ’60s music his mother loved. Nurses had increased doses of drugs to decrease her air hunger and anxiety.

“Somewhere between ‘Stand by Me’ and ‘Here, There and Everywhere,’ my mom passed away,” he said.

At the center of a global crisis, Dreyfuss’ earlier decision allowed her to have control over how she died.

“It felt like she was peacefully sleeping,” Briggs said. “She just stopped.”

Complete Article ↪HERE↩!

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How to Deal with Loneliness If You’re Self-Isolated During the Coronavirus Outbreak

Whether you’re truly alone in this difficult period—or just feel alone—these tips from therapist Rachel Wright will help you feel more at peace with the situation.

By Rachel Wright

Humans have always been pack mammals. Go back in time, and you’ll see we like being part of groups and communities.

But then a thing called the internet came along, and it really halted a lot of that in-person connection. That’s why, before the coronavirus crisis even happened, we were already in a “loneliness epidemic.” Basically, before we were being forced to self-isolate, we were already feeling lonely and isolated.

It’s not that feeling lonely on its own is necessarily a bad thing—just like feeling jealousy or stress on its own is not necessarily a bad thing. They’re natural human emotions that you can’t entirely avoid; plus, they can trigger beneficial responses (like realizing your relationship is unhealthy or spurring you into action to get a big project done). But when you experience it chronically, which is what’s starting to happen with this loneliness feeling, that’s when it can start to have repercussions. When you feel lonely, it affects the activation of serotonin and dopamine—two feel-good neurotransmitters—in your brain. Their activation slows down, which can make you feel low, possibly depressed or anxious. And so it’s really challenging when you’re by yourself, and you’re also navigating anxiety, stress, or depression separately in addition to being alone. (More here: What Are the Psychological Effects of Social Distancing?)

How to Manage Loneliness During Social Isolation

If you’re living alone or feeling extremely lonely from lack of social interaction, these strategies could drastically help. Even if you’re surrounded by people but this whole situation has you ~in your feelings~, you can take advantage of some of these strategies as well.

1. Decide how often you want to connect through video.

It’s okay if one day is an all-day affair and you’re just going to be on your phone for most of the waking hours. And it’s okay if there’s a day where you want to put your phone down and not look at it at all and just be with yourself. Figure out what the right balance is for you. On average, I would say one to three face-to-face interactions a day is a healthy number. You don’t necessarily need to be interacting with the other person—for example, just watching an Instagram live could count—as long as you feel really connected and fulfilled by it. (If you’re stuck inside with a partner or S.O., these tips fo relationships and dating might help.)

2. Journal.

If you journaled before, great. If you didn’t, now’s the time to start. (Related: 10 Cute Journals You’ll Actually Want to Write In)

It is going to be very interesting to retroactively look back on how you felt throughout this coronavirus pandemic. Take the time to just sit with yourself and ask:

How am I feeling?

What am I thinking?

What am I doing?

If you’re journaling and you’re starting to feel that discomfort of sitting with your own feelings, know that discomfort was probably there before and you’re just now accessing it. Stick with it and process through that—even if you feel your hand getting tired or like you can’t write as fast as your brain is going. You can also use a voice memo on your phone, especially if you’re more of a talker than a writer. There’s no rule that says the journaling has to be a pen and paper in a book with a lock; it can be anything you want. (Related: Journal Apps for “Writing Down” All Your Thoughts)

Another great journaling prompt is to focus on gratitude. It’s so easy for us to get caught up in what we don’t have anymore and what we’re missing—and it’s ok to write that down. But it can also be really helpful to acknowledge the things you’re really grateful for: Do you have food at home? Do you have toilet paper at home? Are you feeling healthy? Is your family healthy? All these things that, honestly most of us probably take for granted.

I like to sit down in the morning and do a brain dump—I write down anything that’s kind of swirling in my head that I just need to get out. Then I wrote down my gratitude and my intention for the day. And you don’t need to journal for a long time—for it to be beneficial you only need to journal for like one minute.

3. Keep a schedule—including time for self-care.

It can help to write out a schedule in the morning because it encourages you to notice the things that you look forward to that bring you joy—including making time to relax, just like you did when you were leaving the house more.

Just because we’re in a new, unprecedented time doesn’t mean that the things that felt relaxing before aren’t going to work now. If you liked to take a bath with a candle, take a bath with a candle. Think about what you did to relax before this pandemic, start there, and then if that’s not working, you can brainstorm some changes. (Related: The Self-Care Items Shape Editors Are Using At Home to Stay Sane During Quarantine)

And for people who are worried about money or looking for a job, you might be thinking ‘what if I don’t have time to relax? I don’t have time to sink into my feelings.’ Still, I’d say if you don’t take the time to relax and focus on yourself, you’re not going to be in a great place to be creative, to figure out finances, or find solutions. You need to take the time for yourself, no matter what socioeconomic or pandemic position you’re in. (Use these self-care ideas as inspiration.)

4. Get rid of “shoulds” and expectations.

Start from scratch because your expectations for yourself are now different. Collectively, we need to lower the bar for ourselves in a compassionate way. Think: ‘Yeah, I showered today, and that is a win.’ Sometimes our anxiety, our loneliness, or whatever emotion it might be, spikes and it’s hard to change out of sweats; it’s hard to exercise. So when we do these things, we should celebrate and honor the fact that we did it and not in a self-deprecating way. Like, truly, ‘we’re in the middle of a global pandemic, and I took a shower. I’m amazing.’ We need to do that for ourselves and for our friends and family as well.

What to Do When You’re Feeling Especially Anxious, Lonely, or Depressed

First of all, just know that you’re not alone; I don’t know anyone who has not felt some level of anxiety and or depression thus far through this. It’s a normal human emotional response to feel that way right now and period.

When you find yourself spiraling into one of these emotions (and it’s not a chronic issue that you have), imagine that you’re talking to a four-year-old version of yourself. How would you talk to that four-year-old if they said to you, “I’m scared that I’m not going to get to see my friends for two more months.” How would you respond to her? Ideally, you’d meet this little kid with compassion. But when we talk to ourselves, we’re normally like, ‘Ok, you have to push through this. You have shit to get done, you need to do this work.’ And the more that we try to shove it down, the more we try to escape those feelings, they’re just going to come back with even more force and angrier. Sometimes feelings are like that; we just need to acknowledge them with compassion and let ourselves feel them. (Related: Everything You Should Know About Anxiety Disorder)

With what’s going on right now, the fear and anxiety we’re all experiencing makes a lot of sense; there’s so much unknown, and anxiety is based in the unknown. So if you’re thinking, “I don’t like this and I’m feeling anxious,” well, nobody does. Let’s just get that out there—this sucks. It’s the worst feeling.

It can be really helpful to lean into anxiety and use coping tools, even if you’ve never experienced anxiety before. Things like learning about breathwork and practicing grounding breath, limiting your news intake to a certain amount per day (don’t just have CNN on in the background all day; we need to stay informed, but we also can’t take that in all day, every day), and acknowledging the feelings you’re having to someone that you trust and love. So if you’re feeling depressed, if you’re feeling anxious, call a friend, text a friend, and let them know. Say, ‘hey, my anxiety is spiking. I don’t need you to do anything about it. I just, I need to tell somebody.’

Is There Such a Thing as Too Much Internet-Based Socializing?

Everyone will hit a point where they need a break. For me, it was like day two of social distancing. Everyone was reaching out, and, on one hand, it was so wonderful: I would set my phone down for five minutes, and I’d come back to like four missed FaceTime calls and like 82 texts and I thought, “Wow, that’s amazing.”

But then it started creating anxiety: I felt like I had to respond to all of the things coming at me. So there’s a happy medium to find—whether you’re alone or with people. You can still have alone time and find time to socialize just like you would if this wasn’t going on. It’s really easy to think, “Well, I can’t meet up with people in person so I have to be constantly on Zoom or on Instagram with people.” Personally, my screentime shot up from an average of like four hours a day to, yesterday, I was on my phone for nine and a half hours!

That’s not healthy for anybody, even when you’re doing it to connect with other people. It’s really about finding what that “new normal” is for you. I don’t like the term “normal” because we get to times like this and we’re like, ‘I just want to go back to normal,’ and that way of thinking is just going to keep you feeling more frustrated and more stuck.

How to Deal with the Indefinite-ness of It All

Number one is acknowledging it. Say it out loud. If you’re home by yourself, even if you say it to your walls, say it out loud: “I don’t know when this is going to end, and that is scary. I don’t know when this is going to end, and that is horrific.” Whatever word is appropriate for what you’re feeling.

Next, make a list of things you want to do or would like to watch while you’re in quasi-quarantine. Give yourself a bucket list of things—maybe there’s a TV show that you’ve been wanting to watch but haven’t had the time, a project you’ve been meaning to start, or a skill you want to lean. Give yourself things that you can actually accomplish and look forward to within the confines of your home. Maybe Friday you’re working, but Saturday you plan to have a guitar lesson on YouTube—it’s something that you can then still look forward to, even if it’s small.

Lastly, make a post-quarantine bucket list, or a list of things that you want to do once this is all over. This concept is recommended to people when they’re going through things like cancer treatments. It really helps to make a list of what you want to do when you’re feeling healthy and when you can be with your friends again.

How to Deal with a Lack of Physical Touch

This is the hard part. I mean, it’s all hard; let’s just acknowledge that. But this is the one thing that is really hard to replicate and recreate without actually having another human being there with you. The good news is that it’s an opportunity to get into self-love and self-touch. We think of self-touch and most of our minds immediately go to masturbation—but if I’m going to talk about masturbation, I would say masturbation. I’m talking about self-touch as in, literally, take your arm and drag your finger on it. Rub your arm. Then increase the pressure by pressing more deeply. Then go get lotion and rub the lotion into that same part of your arm. Give yourself the physical contact and touch that you are craving from other people. It’s not going to replace it completely—there is no replacement for a human being touching another human being—but it will help in the meantime, and it’s way better than sitting just not touching yourself at all. (Related: The Benefits of Human Touch and How to Get More of It, No Matter Your Relationship Status)

And, yeah, also masturbation. It’s a great time to really take the time to explore your body in all of the ways sexual and non-sexual. Rubbed your feet? See what it feels like to rub your knees. Use this situation as an opportunity to be with yourself with less distraction. (Helloo, mindful masturbation!)

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