Month: January 2021

Posted on

What to Do When a Loved One Dies

Advice to keep a sad event from becoming even more painful

By Consumer Reports

Responsibility for the various actions can be divided among family members and close friends of the deceased.

Immediately

1. Get a legal pronouncement of death. If no doctor is present, you’ll need to contact someone to do this.

  • If the person dies at home under hospice care, call the hospice nurse, who can declare the death and help facilitate the transport of the body.
  • If the person dies at home unexpectedly without hospice care, call 911. Have in hand a do-not-resuscitate document if it exists. Without one, paramedics will generally start emergency procedures and, except where permitted to pronounce death, take the person to an emergency room for a doctor to make the declaration. Keep in mind that do-not-resuscitate laws vary at the state level and if a person does not want to be resuscitated, “calling 911 is not necessary” according to the National Institute on Aging. “If the death is not unexpected, you might call the individual’s physician first,” says Lori Bishop, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization.

  • 2. Arrange for transportation of the body. If no autopsy is needed, the body can be picked up by a mortuary (by law, a mortuary must provide price info over the phone if you ask for it) or crematorium.

    3. Notify the person’s doctor or the county coroner.

    4. Notify close family and friends. (Ask some to contact others.)

    5. Handle care of dependents and pets.

    6. Call the person’s employer, if he or she was working. Request info about benefits and any pay due. Ask whether there was a life-insurance policy through the company.

    Within a Few Days After Death

    7. Arrange for funeral, memorial service, and burial or cremation. Search the person’s documents to find out whether there was a prepaid burial plan. Ask a friend or family member to go with you to the mortuary. Prepare an obituary.

    8. If the person was in the military or belonged to a fraternal or religious group, contact that organization. It may have burial benefits or conduct funeral services.

    9. Secure the person’s home. Or ask a friend or relative to keep an eye on it, answer the phone, collect mail, throw food out, water plants, and keep minimal heat on to avoid frozen pipes if it’s winter in a colder climate.

    Up to 10 Days After Death

    10. Obtain the death certificate (usually from the funeral home). Get multiple copies; you’ll need them for financial institutions, government agencies, and insurers.

    11. Take the will to the appropriate county or city office to have it accepted for probate. Check your state’s laws, which may require you to file the will within a set period of time.

    12. If necessary, the estate’s executor should open a bank account for the deceased’s estate.

    13. Contact the following:

    • A trust and estate attorney, to learn how to transfer assets and assist with probate issues.
    • Police, to have them periodically check the deceased’s house if vacant.
    • An accountant or a tax preparer, to find out whether an estate-tax return or final income-tax return should be filed.
    • The person’s investment adviser, if applicable, for information on holdings.
    • Banks, to find accounts and safe deposit box.
    • Life insurance agent, to get claim forms.
    • The Social Security Administration (800-772-1213; ssa.gov) and other agencies from which the deceased received benefits, such as Veterans Affairs (800-827-1000; va.gov), to stop payments and ask about applicable survivor benefits. The SSA, like the VA, recommends immediately reporting the person’s death, though in many cases the funeral home will handle this.
    • Agency providing pension services, to stop monthly checks and get claim forms.
    • Utility companies, to change or stop service, and Postal Service, to stop or forward mail. Reach out to other companies to stop recurring bills and subscriptions. If home is vacant, contact the insurer to switch to a vacant policy. If home is under a mortgage, contact the lender.
    • The IRS, credit-reporting agencies, and the DMV to prevent identity theft.
    • Social media companies, such as Facebook or LinkedIn, to memorialize or remove an account.

    Know the Person’s Wishes

    For an elderly friend or relative:

    • Know the location of the will, birth certificate, marriage and divorce certificates, Social Security information, life-insurance policies, financial documents, and keys to safe deposit box or home safe. Ask the person to create an inventory of their digital assets (such as email, social networks, and digital files) and include a plan for these assets in their will.
    • Ask about the person’s wishes concerning funeral arrangements, organ and brain donation, and burial or cremation.
    • Have the person complete an advance directive, including a living will, which specifies wanted and unwanted procedures. The person should also appoint a healthcare proxy to make medical decisions if he or she becomes incapacitated. Some who are more seriously ill might also consider a Physician Orders for Life-Sustaining Treatment in addition to an advance directive.
    • Ask the person about end-of-life care, such as palliative and hospice care (which have key differences), and what their insurance will cover. Medicare, which covers most elderly Americans, will cover hospice care. Palliative care is growing in popularity, but “keep in mind that anyone with six months or less to live should have access to hospice,” Bishop says.
    • Have a do-not-resuscitate order drawn up if the person desires. That tells healthcare professionals not to perform CPR if the person’s heart or breathing stops and restarting would not result in a meaningful life.
    • Make sure the person gives copies of the documents to his or her doctor and a few family members or friends. Take the documents to the hospital if the person is admitted.

    Complete Article ↪HERE↩!

Posted on

Veterans can make an end of life care plan while healthy

By

Veterans have a way to tell their loved ones about their end of life care wishes in advance of any medical crisis.< Life-Sustaining Treatment Orders empower older veterans to communicate their final care wishes at the end of their life. “It is important to have these conversations during non-crisis times when patients have decision-making capacity,” said VA Geriatric Scholar Elkee Baker in a blog post.

Navy veteran Don Begg, 90, completed an order with the participation of.his wife, Beatrice.

“We did it together,” she said. “We talked about it. He was adamant about no resuscitation. He’s lived a good, long life and doesn’t want to be kept alive by artificial means.”

“It’s informative. It puts you in a good mood. You can understand what’s wrong with you,” shared Begg, a Korean War veteran.

Begg’s daughter, Molly Houssian, said knowing her father’s preferences gives her family peace of mind.

“He’s very aware of his situation and feels good about the life he’s led,” Houssian said. “It’s been a good experience for him. He’s been able to make decisions instead of his family scrambling to figure out what he wants as opposed to what he doesn’t want. It gives us peace of mind knowing he’s made that decision for himself.”

Baker said the reactions of both veterans and caregivers to the order have been overwhelmingly positive.

“Many discussions turn into meaningful and loving conversations. I heard statements such as, ‘I’m so glad we discussed this, Dad. I never knew you didn’t want that.’ And ‘I’m so glad you talked about this with my dad before he became so ill, because now I know what he wants me to do., she said

COVID-19 has heightened the need for conversations about end-of-life treatment plans

“It has never been more important to have goals-of-care conversations with our patients during this pandemic,” Baker continued. “We need to talk about potential complications from COVID due to advanced age and underlying health conditions and how this might cut the potential success rate of treatment options like ventilator support, for example.”

To learn more about the orders, visit here.

Complete Article ↪HERE↩!

Posted on

Funeral for Fido

— as pet ownership levels rise, so does the end-of-life care business

By

When Helen Williams’ father died suddenly, her partner left and her first dog died, a Maltese shih tzu puppy called Hudson was exactly the balm required.

“I needed something to love again and Hudson was it,” she says.

When, at 14 years old, Hudson’s declining health meant he had to be euthanised, it was among the most painful experiences of Williams’ life. “It was harder than my divorce,” says Williams, who worked as a personal assistant for 47 years before her retirement.

Williams had buried her previous dog in the back yard of her mother’s place in Melbourne. But that would not work for Hudson, who died three years ago. “I knew that I was going to be moving house shortly after his death … I thought, ‘I don’t want to leave Hudson there’,” she says.

The vet who euthanised the small dog arranged to have him cremated for about $400.

A few days later, Williams received a polished wooden box, containing Hudson’s ashes in a velvet pouch, along with a card and a poem. She brought them with her when she moved to the Brisbane bayside suburb of Redcliffe one year ago.

Williams isn’t alone – either in her grief or her desire to memorialise her pet.

Australians have one of the highest rates of pet ownership (61%) in the world and spend a collective $13bn annually on pet-related products and services, according to Animal Medicines Australia’s 2019 Pets in Australia report.

The social isolation imposed by the Covid-19 pandemic has made companion animals more important than ever, says the University of South Australia’s Dr Janette Young.

Young led a study published in December 2020 in the Journal of Behavioural Economics for Policy, which found more than 90% of the pet owners interviewed identified cuddles, pats and other forms of cross-species touch as integral to their wellbeing during lockdown.

“These relationships [with pets] may be one of our greatest health-promoting resources at this time,” she says.

Our connections with companion animals, and our willingness to spend on them, even after their deaths, is fuelling the booming pet end-of-life business.

Tom Jorgensen, director of Queensland’s only independent pet crematorium, Pet Angel Funerals, says he cremates approximately 9,600 pets a year.

These range from cats, dogs and guinea pigs through to alpacas, water dragons and koi fish.

Packages range in price from $220 to $379 and include the pet’s collection from home or vet clinic, an individual cremation and return of ashes, a lock of fur and paw print if requested, certificate of cremation, engraved plaque and crystal guardian angel memento.

Other memorial products, including urns, lockets for ashes and memory bears, are also available.

The industry is growing at 9% per annum, according to human funeral provider InvoCare. In November 2020 InvoCare spent $49.8m on two pet cremation businesses – Western Australia-based Family Pet Care and Queensland-based Pets in Peace.

In an ASX announcement, InvoCare said the acquisitions represented a strategic expansion of the group’s existing pet cremation business in NSW, Patch and Purr.

Dr Rachel Allavena, a senior pathologist in the University of Queensland’s School of Veterinary Science, says that there are sound reasons to cremate, rather than bury, an animal.

If an animal has been “put to sleep” with powerful anaesthetic drugs, a back yard burial comes with a hidden risk: the poisoning – sometimes fatal – of wildlife or other pets who dig up and eat the remains.

Allavena refers to one case, from a vet in Darwin, who reported a poisoning eight years after an animal was buried: “It shows how long these things stick around.”

The pet funeral industry is unregulated and owners should choose a service carefully, as some have been fined for dumping bodies.

She urged pet owners living close to veterinary schools to consider donating their pets’ bodies to science or education as an alternative.

Pet owners should also choose a cremation service carefully, as the industry remains unregulated.

In 2011, a British woman who ran a pet crematorium was jailed for ditching animals’ remains in a field. Closer to home, Bendigo-based business Pets at Peace was fined $5671 in 2008 by the Environment Protection Authority for dumping 19 pets’ bodies in bushland.

Jorgensen says he would welcome regulation of the industry. Twenty years ago, long before he established Pet Angel Funerals in 2015, Jorgensen paid to have his beloved border collie Sophie cremated, but he “never saw the ashes”. In order to offer a transparent service, Jorgensen has unique numbers imprinted on stainless steel discs, which follow each animal all the way through the cremation process.

For Williams, who has chosen to work as a pet sitter rather than love and lose again, the money she spent on Hudson’s cremation was well worth it. “I’m so glad I did this, as this way, he is always with me,” she says.

Complete Article ↪HERE↩!

Posted on

Film ‘The Elephant in the Room’ Shines a Light on Palliative Care

By Holly Vossel

Public misperception is a barrier between patients and palliative care. Based on the true story of a nurse practitioner’s experiences with patients and families facing serious and terminal illnesses, the film “The Elephant in the Room” depicts the patient-centered interdisciplinary care that so many seriously ill patients need.

The film was written by Bonnie Freeman adapted from her novel, “Resilient Hearts: It’s All About the Journey,” based on true stories of her experience as a supportive care nurse practitioner for the Department of Supportive Care Medicine at City of Hope Medical Center located in Los Angeles. Shot throughout 2017 and directed by husband and photographer Allen Freeman, the book turned film brings an inside look into goal-concordant and patient-centered care through the eyes of those who provide it.

“Bonnie wanted to educate, that was her passion at the root of it all,” said Executive Producer William Dale, chair in Supportive Care Medicine at City of Hope. “She just wanted to make sure that our message got delivered. She had aspirations for us to break out of our little crowd that care about the cause, care about supportive care and palliative care.”

Dale also helped provide funding to support the film’s making.

According to producers, Freeman passed “unexpectedly and suddenly” before the film completed on April 26, 2018. She played an integral and hands-on role during filmmaking, working closely with Niko Vitacco, who played the lead role of nurse practitioner Michael Lafata. 

Films like the “The Elephant in the Room” could help to raise awareness and improve understanding of palliative care. The medical comedy-drama, walks viewers through end-of-life care through a provider’s lens, including goals-of-care conversations. The comical drama is currently available on Amazon Prime.

As many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice, according to A Journal of Palliative Medicine study.

While no standardized definition exists for “palliative care,” the U.S. Centers for Medicare & Medicaid Services (CMS) defines the term as “patient and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social and spiritual needs and to facilitate patient autonomy, access to information and choice.”

Roughly half of community-based palliative care providers in the United States are hospices, according to the Center to Advance Palliative Care (CAPC). While a growing number of hospices are diversifying their service lines to include palliative care, many struggle to sustain and grow programming due to a widespread lack of awareness. These services remain relatively unknown and misunderstood among the general public, as well as within medical communities.

“Bonnie knew that storytelling was a way to help improve end-of-life care,” said Vitacco, actor and co-producer of Absolution Films. Vitacco read the following quote Freeman initially wrote to pitch the film. “‘I realized many health care providers did not know what we provided and the community was even less informed. I felt a film would reach a broader audience and could be a tool to promote discussions about effective ways to communicate the need for compassion and show the difference a dedicated palliative care team can make in the lives of each other, their patients and their families.’”

The film strikes a strong chord as the world comes face-to-face with a deadly pandemic. The COVID-19 outbreak has brought serious illness to the forefront, with the World Health Organization reporting more than 1.6 million lives lost globally since its onset.

“Something within this script resonated so strongly with me. I saw it as an opportunity to help people on a larger scale, to share a story that was meaningful and bigger than me,” said Vitacco. “Even more so now in a world where humanity can sometimes feel lost, this film can show the type of the side of people that we all want to become but sometimes struggle to be.”

Despite heightened focus, palliative services remain underutilized throughout the globe. The World Health Organization reported in August that only 14% of people who need palliative care currently receive it. Many countries ranked low in an international review of length of palliative care received by people with life-limiting and terminal conditions, including the United States and Australia.

Increasing awareness around the benefits of serious illness care was a stated goal for the filmmakers.

“Palliative care is still considered new within the medical world,” said Vitacco. “Our mission was to make it universally known and share it with not only the professionals, but the public as well to show them what is readily available to them.”

Initially released in Middle Eastern countries, “The Elephant in the Room” came out in Australia, Canada, Germany, India, the United Kingdom and the United States on Amazon on Aug. 21, 2020, representing a broader reach for the film’s universal message.

“The subject is universal and we just wanted to release it wherever we could,” said co-producer Tamir Gedalia of Absolution Films. “For me, the message was that we need to change the way we treat terminally ill patients. It’s universal in every country. There is no country that doesn’t have this kind of love and treatment, there is no relation to a village.”

The film’s use of the term “supportive care” to describe end-of-life care was deliberate. The term is becoming more common in the field as providers seek to avoid stigma associated with the words “palliative” and “hospice.” Numerous organizations rebranded in recent years to remove those words from their company names.

Scenes show providers both engaging with patients and behind closed doors in interdisciplinary team meetings. The film’s team includes the supportive care department chair, oncologist, neurologist, pediatrician, pharmacist, nurse practitioner, social worker, chaplain and a staff psychologist who collaborate from the point of the patient’s admission through his passing. The social worker role of Valerie Howard was played by Rupinder Sidhu, a licensed social work program specialist at City of Hope.

Filming took place onsite for 12 days at City of Hope to minimize disruption to patients and operations, according to Dale, who expressed reluctance at opening the medical center’s doors to filming but ultimately valued an authentic setting.

“My hope is that people elsewhere understand the field and get entertained, but then also imbibe this message that it’s about how you take care of each other and take care of yourself,” said Dale. “We’ve all had those moments as providers when we’re in too deep with patients and families and we’ve gone across that line. The team did an amazing job dramatizing that, and I think that’s what Bonnie wanted and it’s my deepest goal for the field and for the film. This is more than we could have expected and we couldn’t have hoped for a better product that’s actually getting seen.”

Complete Article ↪HERE↩!

Posted on

Near the end of life, my hospice patient had a ghostly visitor who altered his view of the world

By Scott Janssen

For months, as I’ve visited Evan as his hospice social worker, he has been praying to die. In his early 90s, he has been dealing with colorectal cancer for more than four years, and he is flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.

On this visit, though, his depression seems to have lifted. He’s engaged and upbeat — and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?

“You seem to feel differently today than on other visits,” I say casually. “What’s going on?”

He looks at me cryptically.

“Do you believe in ghosts?” he asks.

It’s not the first time a patient has asked me this. People can have unusual experiences when they reach the end of life: near-death or out-of-body experiences, visitations from spiritual beings, messages delivered in dreams, synchronicities or strange behaviors by animals, birds, even insects.

“There are all kinds of ghosts,” I respond seriously. “What kind are you talking about?”

“You remember me telling you about the war?” he asks

How could I forget? He’d traced his long-standing depression to his time as a supply officer for a World War II combat hospital. The war, he’d said, had soured him on the idea that anything good could come from humans and left him feeling unsafe and alone.

“I remember.”

“There’s something I left out,” he says. “Something I can’t explain.” He goes on to describe one horrific, ice-cold autumn day: Casualties were coming in nonstop. He and others scrambled to transport blood-soaked men on stretchers from rail cars to triage, where those with a chance were separated from those who were goners.

“I’d been hustling all day. By the time the last train arrived, my back felt broken, and my hands were numb from the cold.”

He grimaces and swallows hard.

“What happened when the last train got there?” I ask softly.

“We were hauling one guy, and my grip on the stretcher slipped.” Tears roll down his face. “When he hit the ground, his intestines oozed out. Steam rose up from them as he died.”

Evan rubs his hands as though they were still cold.

“Later that night I was on my cot crying. Couldn’t stop crying about that poor guy, and all the others I’d seen die. My cot was creaking, I was shaking so hard. I even started getting scared that I was going insane with the pain.”

I nod, waiting for him to continue.

“Then I looked up,” he says. “Saw a guy sitting on the end of my cot. He was wearing a World War I uniform, with one of those funny helmets. He was covered in light, like he was glowing in the dark.”

“What was he doing?” I ask.

Evan starts crying and laughing at the same time. “He was looking at me with love. I could feel it. I’d never felt that kind of love before.”

“What was it like to feel that kind of love?”

“I can’t put it in words.” He pauses. “I guess I just felt like I was worth something, like all the pain and cruelty wasn’t what was real.”

“What was real?”

“Knowing that no matter how screwed-up and cruel the world looks, on some level, somehow, we are all loved. We are all connected.”

This turned out to be the first of several paranormal visits. Each time the specter arrived, he’d wordlessly express love and leave Evan with a sense of peace and calm.

“After the war, the visits stopped,” he says. “Years later, I was cleaning out Mom’s stuff after she died, and I found an old photograph. It was the same guy. I looked on the back, and Mom had written the words ‘Uncle Calvin, killed during World War I, 1918.’ ”

We talk some more, then I ask, “What does this have to do with your being in a better mood?”

“He’s back,” he whispers, staring out the window. “Saw him last night on the foot of my bed. He spoke this time.”

“What’d he say?”

“He told me he was here with me. He’s going to help me over the hill when it’s time to go.”

As I’m formulating more questions, Evan surprises me by asking one of his own.

“You ever have something strange happen? Something that tells you that no matter how bad it looks, you’re connected with something bigger, and it’s going to be okay?”

A memory flashes into my mind. It was 35 years ago. It was after midnight, and I was asleep in a graduate-student apartment at Syracuse University. A siren’s blare woke me, so loud it sounded like it was inside the room. Adrenaline pumping, heart pounding like a hammer, I sat up and wondered what had happened. Was it a dream?

From outside, I distinctly heard what sounded like a two-man stretcher crew talking.

“Bring it here quick,” one guy told the other. I heard a gurney being rolled across asphalt.

I went to the window and pulled back the curtain, certain there was trouble outside.

The night was silent. Nothing was stirring in the parking lot. No one was there.

Just before daybreak, Dad called to tell me that just a few hours earlier, my uncle Eddie had been killed in an automobile collision.

That was a tough day. As night fell once more, questions filled my head: Why did this happen? What was he experiencing when it ended? Was he scared?

On the kitchen table sat a beat-up radio; some kind of malfunction occasionally caused it to turn off or on for no apparent reason. As my questions swirled, the radio turned on, and I heard the opening chords of the Beatles’ song “Let It Be.”

Not being a fan, I’d never listened closely to the song before — but this time, I did. The music and words filled me with an almost otherworldly sense of peace and comfort. The song ended. Shortly after, the radio cut off.

For years, I tried to explain away those events. It must have been a dream, I told myself. Or some kind of fabricated “memory” to fool myself into thinking that uncle Eddie and I were connected in that moment. As for the radio, it was nothing but a random coincidence. Any other conclusion is just wishful thinking.

Inside, though, a part of me knew it was real.

After nearly 30 years as a hospice social worker, I’m certain of it. And I have patients like Evan to thank: dying patients who have convinced me that the world we inhabit is lovingly mysterious and eager to support us, especially during times of disorientation and crisis. It even sends messages of love and reassurance now and then when we’re in pain.

I return to the present. Evan is looking at me, waiting for an answer. I feel grateful that he’s pulled up these memories. Outside, a flock of crows takes off in unison from the branches of an ancient oak.

“Yeah,” I say with a nod. “I guess I have.”

Complete Article ↪HERE↩!

Posted on

Make Space for Grief After a Year of Loss

by Gianpiero Petriglieri

Summary.

This pandemic year, grief is everywhere but we have nowhere to mourn, except online. There have been lives lost, and also jobs and the closeness of relationships in daily life. Those combined losses can put us at risk, and they require managing. First we need to understand the ways that work used to help us with our personal griefs, and why virtual work doesn’t have the same effect. Then managers need to do three things to give employees the space to mourn: Begin by acknowledging that things still aren’t normal. Then offer truth: Take people’s questions and give honest answers — or acknowledge that you don’t have the answers. Finally, provide concrete goals and guidelines for work. All of these actions help to ground your colleagues in reality and orient them to the present, rather than the lost past or an unknown future.

For nearly 20 years, after his first heart attack, I feared losing my dad from a distance, without being able to comfort him or to say to goodbye. And then one day I did.

He died suddenly on a September morning. I flew back to my childhood home that afternoon. He was still there yet gone — his body resting, as they say, or rather, spent. A small crowd of familiar faces hovered as I walked in and hugged him, reaching for what I will always miss most. He was a great hugger. I was too late.

I fell into a pattern in the week that followed. The days were frantic. There were rituals, visits, arrangements to be made, hours of intense sociality and sorrow. The nights were still. When the commotion ceased, I sat at my dad’s desk, opened my laptop, and caught up with work. I found it soothing, as I found getting back to the office soon after. Duties, deadlines, and colleagues simultaneously gave me a break and made me feel my dad’s presence. Work was the place where I had seen him most alive, after all. The place where I could always find him.

I return to those memories often in these days that are so full of loss — of loved ones, of work, of proximity, of a way of life. This year, grief is everywhere, and though it’s been written about and discussed, it’s still going to be felt more acutely at year’s end. Hearing a holiday song, someone told me the other day, brought them to tears. I’m not surprised. “All I want for Christmas is you” takes on a different meaning when you have suffered a loss.

Yes, this year grief is everywhere, but we have nowhere to mourn, except online. With social and working lives going virtual many have lost access to familiar customs, gatherings, and routines that used to comfort the bereft. Those combined losses can put us at risk, and they require managing. A different kind of managing than that we have long been accustomed to.

Complicated Grief

Grief is the personal experience of loss. Mourning is the process through which, with help from others, we learn to face loss, muddle through it, and slowly return to life. Last year, after reading her poignant book Grief Works, I interviewed British psychotherapist Julia Samuel for a piece I wrote with Oxford professor Sally Maitlis about mourning in the office. Samuel had impressed upon me “how physical the experience of loss really is.” Grieving is something we do with our bodies and with each other. It takes stamina and space.

She had also stressed that, for many people, as was true for me, working — and the workplace — can be one of those spaces that help with mourning. Work can offer a sense of stability and predictability, the office some comfort and respite. Routine is soothing. Caring coworkers, at times, can be as valuable and less demanding than family. We hug colleagues who have lost a loved one; our team sits together when facing the loss of one of its own; or we just work quietly next to others and get a reprieve from grieving.

So what happens now that we are besieged by grief while we work and live at a distance for many, many months? “A lot of grief will remain frozen,” Samuel told me recently, “because many people won’t have enough support, enough ritual, to grieve.” Those are circumstances in which the normal and healthy experience of grieving can take a debilitating turn known as “complicated grief.” The term refers to the persistence of acute pain, apathy, and disorientation long after a loss. Reports of exhaustion, angst, and numbness are now beginning to emerge in the workplace. Those experiences are often understood as symptoms of burnout after a burst of panicked productivity earlier in a nine-month-old crisis. But in a year of many losses and much distance, those experiences might well be expressions of a collective bout of complicated grief.

Even those of us who embrace virtual work, I suspect, are struggling with virtual mourning. Recently, for example, I learned that LinkedIn data revealed a change of mores. In 2020, people have been discussing being bereft with their networks in far greater numbers. Those virtual exchanges might be touching, so to speak, but they don’t quite work like actual touch, according to Bill Cornell, an American psychotherapist and author who specializes on the embodied nature of relationships and losses. Cornell advocates using the word remote rather than virtual work to remind ourselves that working this way involves a loss too, that of physical proximity.

Once we acknowledge our remoteness, we can try to understand its impact, Cornell argues. The fatigue that we feel after a video conference, for example, might stem from the fact that each Zoom meeting subtly reminds us that even if our colleagues are very much alive, there are ways that we have lost each other, too. In the same spirit, Samuel reminded me that losing the camaraderie and routines of office life does not end our relationships with work and coworkers. But finding new ways to muster presence, patience, and support requires making room for loss.

How to Make Room For Loss

Many losses cannot be undone, but spaces for mourning those losses can be rebuilt at work. And managers are best positioned to do that. Those who can hold people through loss, whether it involves death or work or proximity, will help them stay healthy, loyal, and productive.

This is how to go about it.

First, acknowledge that people will be anxious, vulnerable, and disoriented — and so are you. Don’t just pretend that things are normal: Share your experience, invite people to share theirs, and make that behavior normal. Even just sharing what you miss most of your old working days at the office, and how you are struggling to learn how to deal with it, might be liberating.

Second, right after sympathy, offer truth. Here is the data. Here is what we are dealing with right now. Take questions. It will soothe people’s anxiety to be heard, even if you don’t have answers to their queries. If it is hard to make long-term predictions, better not make any. Sharing your company monthly revenues and your plans to deal with a steep drop, for example, will be more honest and useful than giving people a pep talk about how bright the next quarter will be.

Third, simplify the work. Make it more manageable. When we are anxious and remote, it helps to focus on clear and concrete goals, to know what is expected and what is enough. Such clarity is ever more important as people return to the office, but not to old normality. Knowing where, when, and how long people are expected to work, for example, is grounding. Grief hijacks the imagination, filling it with catastrophic projections. Just like mourners can find some comfort focusing on their breath, a meal, or regular exercise, there is value in manageable work. Grief erases our sense of agency, and work can help restore it. “Having a task that you can complete when you feel powerless is very helpful,” Samuel advises.

All of these actions help to ground your colleagues in reality and orient them to the present. That is the best work can offer: Reminding us that we are here for now. We often tell those who manage and lead to portray confidence, spark the imagination, and focus on the future. That future orientation is “all well and good,” Cornell cautions, “but it’s difficult when you are sitting with people who have no idea what next week will be like, let alone the future.”

I do not mean to say, with all this, that we need to just get on with an ill-defined “new normal.” That would be like telling those who have lost a loved one that they “will get over it.” We never do. But staying in the present, focusing on the reality of uncertainty and remoteness, can keep us going and connected as we learn to live with loss and maybe, slowly, grow through it.

For managers to make room for loss, however, they must brave a loss of their own: of principles and prescriptions that have long oriented them. By turning from the future to the present, from a sparked imagination to a held heart, from confidence to care, a manager can help us regain our footing and, slowly, some hope. Letting those old prescriptions go, I have written before, might help us humanize management. Likewise, these months in which we have lost each other might end up humanizing work. If it reminds us that we need space to share and soothe our grief, remoteness might even bring us closer. That might be a hopeful ending for a year of loss.

Complete Article ↪HERE↩!

Posted on

Why Canada Could Be Next To Allow Psychedelic Therapy

(And How It’s Already Changing Lives)

Canada’s federal health minister has recently granted patients, therapists and doctors with exemptions to use psilocybin mushrooms for therapeutic purposes

by Amanda Siebert

Canada has an international reputation for progressive health policies, take for example its publicly funded healthcare program and its assisted dying laws. It also led the way in drug reform when it became the first G7 country to legalize cannabis in 2018.

But in the face of a worldwide pandemic, a national overdose crisis, and mounting evidence to show that greater access to both psychedelic and other restricted drugs could have positive public health outcomes, it’s fair to say some of the country’s regulations around restricted substances are outdated.

Now, as a handful of patients and more recently doctors and therapists have been granted exemptions to use psilocybin, the nation’s federal health agency is considering making changes to existing policies that could open the door to much more than magic mushrooms.

In 2020, a handful of firms including non-profit organizations and publicly traded companies have worked with Health Canada to encourage greater access to psilocybin and other psychedelic therapies. While one has gone the route of using existing legislation to help individuals apply for exemptions, another is encouraging policy changes that would allow doctors to seek access to restricted drugs for their patients.

‘The Unknown Of What Can Happen After You Die Doesn’t Feel So Unknown To Me Anymore’

One of the earliest studies to come out of the so-called psychedelic renaissance was conducted at Johns Hopkins University in 2016, and sought to examine how psilocybin would affect depression and anxiety in patients suffering from life-threatening cancers. It found that just a single dose of psilocybin left subjects with longstanding relief, with 78% experiencing lower rates of depression and 83% experiencing lower rates of anxiety six months after receiving the treatment.

When Thomas Hartle, a 52-year-old Saskatoon resident with stage four colon cancer read the results of the study, he says he “felt like they were too good to be true.”

“But when you suffer from anxiety, you really look for whatever sources of relief you can get,” he says. Hartle enlisted the help of TheraPsil, a non-profit organization based in Victoria, B.C., to try and access psilocybin therapy for himself. Using a subsection of the Controlled Drugs and Substances Act that allows the health minister to grant an exemption for medical or scientific purposes, TheraPsil has so far assisted dozens of Canadians, including terminally ill and clinically depressed patients, as well as doctors and therapists, in the application process.

In August 2020, Health Minister Patty Hajdu granted the first exemptions to four Canadians suffering from end-of-life anxiety. One of them was Hartle.

The father, husband, and IT technician says his anxiety is “specialized to the existential kind and doesn’t extend to public speaking,” so he’s more than happy to share his experiences with psilocybin. Before his first treatment, he prepared extensively with a therapist, and has since undergone a subsequent session. Without hesitation, he says the experiences have changed his perspective on death and dying.

“What it’s changed the most for me, is that the unknown of what can happen after you die doesn’t feel so unknown to me anymore. Most of how we define ourselves is our experiences and memories and things like that. In the psilocybin experience, my consciousness existed in ways that had absolutely nothing to do with anything in this life,” he says.

“To exist in another state that has nothing to do with my identity here, and to feel comfortable and serene in that state tells me that it’s possible to have some sort of continuation of consciousness that goes beyond our experience here.”

Hartle adds he feels more empathy towards other people since his initial treatment, and says his family has noticed he uses more emotional words in his speech. As a naturally analytical thinker, he says he’s also welcomed a shift to a more creative mindset.

Beyond the positive mental benefits he’s experienced, Hartle says psilocybin also helps to relieve pain associated with migraines, which he’s suffered from since he was a child. “When I compare it to most of the other treatments that I have gone through over the last few years, psilocybin is like the opposite of side effects,” he says, laughing.

Doctors Can Access Psilocybin, Too

Dr. Emma Hapke is TheraPsil’s co-chair of research and one of 16 doctors, nurses, therapists and social workers recently granted exemptions to take psilocybin in preparation for work with patients. She is part of a committee at TheraPsil developing a training program for psychedelic assisted psychotherapy, which she hopes to kick off in 2021.

“We feel that it’s essential that therapists themselves have their own experiences in a non-ordinary state of consciousness, to be on the receiving end of that type of therapy so they can then guide others to do the same,” she says.

She emphasizes that while psychedelic substances have been shown to provide benefit for people suffering from an array of mental health conditions, it’s imperative that any psychedelic experience be paired with therapy for maximum and longstanding relief.

“The molecule in and of itself isn’t what’s healing—it’s the whole package of being in a healing relationship with a therapist and going into the non-ordinary state with psilocybin to access different parts of the psyche,” she says. “If the experience is not integrated, it’s hard for it to lead to lasting change, and so it’s really important that we’re not just talking about a psychedelic. We’re talking about psychedelic-assisted therapy.”

Spencer Hawkswell, TheraPsil’s CEO, says before August 4, seeking exemptions for terminally ill patients felt like an uphill battle. Today the mood has changed, and there is a greater sense of optimism among his team.

“I never thought I’d say that it was easy, or that Health Canada has been incredibly cooperative,” he says. “These [patients] are empowered Canadians, and we do have rights and systems that work for them. Just to have that affirmation is pretty amazing.”

Recognizing the utilitarian nature of Canada’s approach to mental healthcare and drug policy, Hawkswell says that while the current system tries to meet the needs of most, it falls short. “What TheraPsil is doing is showing that there are options beyond the current policy regulations and the norm of healthcare in Canada.”

Numinus Advocates For Special Access Program Reform

Health Canada’s Special Access Program (SAP) allows healthcare professionals to request restricted or otherwise unavailable drugs for patients who have tried existing treatments and found them to be unsuccessful. In theory, the SAP should allow doctors to request access to drugs like psilocybin, MDMA, and LSD. That changed in 2013, when under Conservative Prime Minister Stephen Harper, accessing restricted drugs through the SAP was prohibited. Since then, the only way for patients to access such substances is through clinical trials.

On December 12, Health Canada announced its intention to reverse the regulatory changes made in 2013, and initiated a 60-day comment period seeking public feedback. Dr. Evan Wood, chief medical officer at Numinus, has been advocating for changes to the program since early 2019.

Wood says by amending the SAP provision on restricted drugs, Health Canada will better align itself with the Helsinki Declaration, a set of international ethical guidelines that suggest (among other things) if a patient accesses a restricted drug through a clinical trial and finds it to be beneficial, they should be entitled to receive ongoing therapy. Currently, if a Canadian were to access a psychedelic substance or another restricted drug though a clinical trial, even with the support of a physician, they would not be able to continue to access it.

“In my view, it’s really just about stigma and the cultural baggage associated with these molecules,” Wood says. “This is bringing Canada in compliance with those international ethical guidelines, and kicking the door open a crack for Canada to be a real world leader in this area.”

While Wood acknowledges that the Covid-19 pandemic has rightfully taken the majority of Health Canada’s attention in 2020, he’s glad to see that psychedelic-assisted psychotherapy has risen to an area of needed focus, and gives full credit to the agency for proposing the regulatory reversal.

If the change to the SAP is made, Wood says access to novel psychedelic treatment has the potential to increase significantly, as interested patients would simply need to find a doctor willing to apply for access to the drug on their behalf. Applications would then be judged on an individual basis, but would be less arduous than applying for an individual Section 56 exemption, and perhaps even eliminate the need for that process entirely.

For companies like Numinus, Wood says the changes would enable them to better establish the physical infrastructure of their businesses, to train staff, and “to do all of the things that are necessary to do this kind of work safely.”

“When you put the known risks alongside the known safety of these substances, it’s a bit of a no brainer,” he says. “It’s not going to be a cure for everybody, but even to be talking about a ‘cure’ in the context of mental health challenges is a total paradigm shift.”

Some might argue that decriminalization is the obvious next step, however Health Canada isn’t alluding to that just yet. In an email, a spokesperson for Minister Hajdu said the agency “thoroughly reviews all requests for exemption and makes decisions after taking into account the risks and benefits.”

“We still have much to learn about the risks, which is why the sale and possession of psilocybin is still illegal. Until there is a sufficient evidence base, Health Canada will review each request for an exemption on a case-by-case basis.”

Complete Article ↪HERE↩!