Month: August 2022

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Finding A Reason to Stay Alive Past Age 75

At 90, a grieving widower read an essay from medical ethicist Dr. Ezekiel Emanuel and realized he’s grateful for all his years, even in the face of sadness

I understood my life would have purpose only if I touched others with acts of kindness and brought love to every encounter with my family and close friend

By Robert W. Goldfarb

Dr. Ezekiel Emanuel, an oncologist, medical ethicist and adviser on health care to President Obama, decided he wanted to die when he became 75 years old. He announced his intention in an essay in The Atlantic Monthly when he was 57. Emanuel saw only decline after 75, when the heights to which he had ascended would pitch downward.

As a father, he would have already celebrated the college graduations and career choices of his children, their marriages and the birth and growing independence of his grandchildren. It would be time, he felt, to abdicate the role of patriarch, stepping aside so his children could climb their own mountains.

When Muriel died suddenly and unexpectedly, grief mounted my back and drove me into despair’s black waters.

As a physician, concern that declining dexterity, reading of medical advances but not leading them, being a patient rather than treating patients and taking medication he previously prescribed, only hardened his resolve. He would die up there on the mountain, not laced to a catheter in a nursing home down in the valley. Emanuel is now 65, and nothing he’s written since that I’ve read indicates he’s changed his mind.

Finding A Way to Live

Shortly after my wife died in the early days of the pandemic, a friend sent me Emanuel’s essay. I had already lived 15 years beyond my own 75th birthday and was thankful I hadn’t read the article in the first agonizing months of my loss. For Emanuel, 76 years would have been one too many to live. Would his words have tempted me to think a day without Muriel was one too many to endure?

When Muriel died suddenly and unexpectedly, grief mounted my back and drove me into despair’s black waters. Had I already read Emanuel’s essay, I might have stroked deeper, hoping to drown. But I hadn’t read it and imagined the arms of my children thrashing the dark water, hoping to grasp my hand and pull me to the surface. My death, so soon after their mother’s, would have devastated the family Muriel and I had built. I would have to find a way to live even if I wanted to die.

Since I was 22, just off a troop ship from Korea, I turned to Muriel in moments of uncertainty. I was now 90 and doubted I had the resources and will to go on without her. Emanuel — a physician and medical adviser to a president — saw no point in living beyond age 75. What reason did I have to leave my empty bed to go to other empty places? If there were reasons to live, I would have to reach deep within myself to find them.

The few reasons I did find seemed to have no purpose, certainly nothing important enough to live for. Yes, I speak every day with my children and each weekend with my grandchildren. But the emptiness within me left me with little to give them. I understood that if I found no reason to go on, the despair I felt could kill me. That would take time when every clock seemed stopped at midnight. But, unexpectedly, time’s slow crawl proved to be a blessing: it gave me hours to think of nothing but what made life worth living.

Gradually, in those midnight hours, flickers of light began piercing the darkness. A friend called and said “I don’t like the sound of your voice. I’m coming over. Meet me outside and let’s talk.” It was the first of the acts of kindness that carried with them a hint that I could heal.

A Buddhist friend urged me to talk with Muriel. “She’s not gone,” he said. “She’s in your being. Talk with her!” I was about to shrug off his advice but was in such pain I would try anything.

Understanding Life’s Purpose in My Nineties

Just thinking of Muriel began to fill the empty places within me. I called out to her, hoping she would hear my voice and that I would hear hers. Her first words sounded so like her. She told me it wasn’t what I lost that mattered. What mattered was what we had for all those years. Her words, as they always had, brought with them the gradual return of my courage.

I am certain I have found reason to press deeper into my nineties.

Now, three years since I lost Muriel, I realize what kept me from drowning in those dark waters. I was startled to find how unimportant many of my relationships and activities had been. If I were shaken awake in the middle of the night and asked what kept me alive, I could think of only two reasons. It was being surrounded by the love of my family and by acts of kindness from friends, sometimes from strangers. It was these that gave me the strength to go on, not dinners with people I barely knew.

I understood my life would have purpose only if I touched others with acts of kindness and brought love to every encounter with my family and close friends.

I need no reminder that I’m one of the “old-old.” The slightest graze leaves an angry welt; a scratch I barely feel bleeds through multiple band-aids.

But I am certain I have found reason to press deeper into my nineties. My children and grandchildren will have to climb their own mountains, but I believe they’ve seen that mountains can be climbed even when bearing the heaviest of burdens.

Perhaps that’s reason enough to be grateful I’ve remained alive in the years Dr. Emanuel has chosen to forego.

Complete Article ↪HERE↩!

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An end-of-life doula’s advice on how to make the most of your time on earth

Life is short. Here’s how to cherish every day of it.

By Rachel Friedman

“I want a party in the woods with an all-night campfire. I’ll be off to the side in a sleeping bag, nice and cozy. There will be s’mores and cocktails. My friends can come and go, saying goodbye however they want, or just sitting quietly with me and holding my hand. Nobody should touch my feet, though. I hate having my feet touched. A playlist of my favorite songs should be on repeat. I’d like to die as the fire burns out at dawn. Lights out and lights out, you know?”

I’m on Zoom and a chaplain from Iowa is describing her ideal final hours of life. We’re training to become end-of-life doulas, and this morning’s assignment is to help each other talk through a final hours ritual. It’s one of many exercises designed to confront us with our own mortality, so we can leave our own feelings about death at the door before we step across someone else’s threshold to help with theirs.

End-of-life (EOL) doulas are at the opposite end of the life cycle spectrum from birth doulas. They provide non-clinical care (emotional, logistical, and physical) and help with planning; engage with life reviews and legacy work; and provide support for family and friends so caretakers can bring their best, rested selves to support their dying loved one.

I knew training to become a doula would change my relationship to death, but I didn’t anticipate how it would transform my day-to-day life. Like others, my smartphone use skyrocketed during the isolation of the pandemic. Even after those panic-inducing first months in NYC, I still found myself using my phone as a constant distraction — lurking on Instagram, clicking every New York Times alert, obsessively refreshing my email like it was a Vegas slot machine.

I didn’t become an end-of-life doula to fix my fragmented focus. I did it because Covid-19 made death suddenly feel very real and very present. But I found that a deep dive into death work profoundly clarified my priorities, and has helped me spend time in ways more aligned with those priorities thanks to the soul-shaking understanding that our time here is truly limited.

Here are three components of EOL doula training that have been useful in my never-ending quest to live a more present and focused life in this Age of Endless Distractions. Think of it as a looking-back-from-your-imagined-deathbed approach to living — which sounds morbid in theory but is empowering and enriching in reality.

Imagine you have three months to live

I’m not going to lie to you: This exercise isn’t going to feel great! Please do it only if you feel equipped to engage with feelings of grief and loss. I recommend having someone you trust read it to you, someone who also has the emotional bandwidth and who is not currently grieving. You’ll need a pen and paper. Choose a time when you’re not going to feel rushed and are in a comfortable space. Take some deep breaths. Settle in. Here we go.

Write down your five most-prized possessions, your five favorite activities, your top five values, and the five people you love the most.

Close your eyes. Imagine you’re at a doctor’s office. You’ve just been given a terminal diagnosis and told you have approximately three months to live. Sit with that news. Breathe. Open your eyes. Cross any four items off your list.

Close your eyes. You’re back home with your spouse or friends or children or pet. You have to find a way to tell those you love: “I’m dying.” Breathe. Open your eyes. Cross another four items off your list.

Close your eyes. You’ve started feeling the effects of your illness. You can’t get around as easily. Your sleep is restless. You’re nauseated from the medications you’re taking. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re mostly confined to your bed now. Your loved ones have gathered because they know they will soon have to say goodbye. They drift in and out of your bedroom, or wherever you have chosen to spend your final days, holding your hand, perhaps playing music you like or reading aloud your favorite book. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re in bed, eyes closed, unable to move much or to speak at all. You sense that you’re going to die soon, and you wonder what will happen when you go. What are you thinking about in these final moments? Breathe. Open your eyes. Cross the remaining four items off your list.

Whew. You did it. Make sure to give yourself as much time as you need to regroup before you reenter the “real world.” Sit still. Focus on your breath. Drink lots of water.

When I did a version of this exercise, I was amazed at how real loss and grief felt as I crossed items off my list. (There is nothing quite like imagining your kid’s life without you to bring on The Sobs.) I don’t want to overstate the impact of imagining loss versus actually experiencing it, nor minimize our individual, multi-faceted responses to real grief, but research has shown that stressful life events can change us, and that includes clarifying our values and priorities. Maybe you, like me, tapped into some of that clarity during this exercise.

A few days after I tried this exercise, I rewrote my Top 20 list on a notecard. I keep that notecard by my laptop and look at it often. It has been an unexpectedly powerful reminder of what and who I love, of who I am and want to be. Each day I think about how to fit in as much as I can from this list, even if I only have a few free minutes to myself. It has become the framework that informs my daily to-dos and balance of urgent/important tasks.

Practice deep, active listening

A good deal of EOL doula work is listening work. The deep, active listening doulas are trained for involves holding back our own stories, comments, and feelings. Doulas don’t tell a dying person what to do. They don’t try to fix the situation. They ask open-ended questions and understand that how people move through the dying process is up to them. This kind of listening requires empathy and restraint. It insists on being free from distractions, external (cellphone notifications, I’m looking at you) and internal (like that voice inside your head that wants to judge or give advice).

As the person at a party who makes approximately 30 seconds of obligatory small talk before diving into deeply personal conversations with strangers, I assumed I was custom-built for this part of being a doula. But it can be difficult to stick to open-ended questions, to sit comfortably in silence, or to resist giving well-meaning but unsolicited advice.

So, I’ve been practicing. A lot. This kind of listening has altered what I can only think to call the texture of my time. It has made me more present, empathetic, and curious in conversations and relationships.

The next time you’re having a conversation with someone who is sharing important information or struggling in some way, you might try it. Ask open-ended questions. “How are you feeling about X?” “Do you want to talk more about Y?” Give their answers space and silence to settle.

Reflect back what you think you’ve heard. Be open to being wrong about what you think you’ve heard. Be supportive, but don’t try to fix the situation with advice or talk them out of what they are feeling. Avoid platitudes like “give it time” or “it wasn’t meant to be.” Even “I know how you feel,” well-intentioned though it is, often misses the mark because we mostly don’t know exactly how someone else feels or entirely understand their specific situation.

Of course, not all our conversations require this therapist-like level of restraint, but challenge yourself to consider that plenty of them could benefit from a touch more deep listening.

Legacy projects in the here and now

Doulas often help with legacy projects: autobiographies, letters to loved ones, art projects, and more. These projects memorialize a person’s passions and creativity, values and contributions, and — spoiler alert! — you don’t have to wait until you or someone you love is dying to work on one.

Complete Article ↪HERE↩!

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One Good Thing

— A food memoir about love, grief, and lockdown

The Year of Miracles by Ella Risbridger.

In The Year of Miracles, Ella Risbridger cooks through the end of the world.

By Constance Grady

British journalist Ella Risbridger’s new food memoir The Year of Miracles was not, she informs us in her first sentence, “meant to be” a book about grief. It was meant to be a cheerful little book about hosting dinner parties, a happy follow-up to Risbridger’s 2019 hit Midnight Chicken, about how she cooked as a way of dealing with her depression. “But what can you do?” Risbridger goes on. Grief “gets into everything.”

Part of the charm of Midnight Chicken was the way Risbridger conjured her lovely life onto the page: a life of quirky, cozy, bookish love with her partner the Tall Man (real name John Underwood) in their Tiny Flat. It was marred only by the tragedy tucked away on the back page in the acknowledgments: In the time between Risbridger handing in her manuscript and Midnight Chicken coming out, Underwood had died of a rare form of lymphoma at age 29. (Risbridger gives Underwood, along with the rest of her friends, a pseudonym in The Year of Miracles. Here, he becomes Jim.)

The Year of Miracles is Risbridger’s account of how she cooked her way through the ensuing grief. And because it is, ominously, set in 2020, she is grieving not just the loss of her partner, but also the loss of a whole way of pre-pandemic life.

“This is supposed to be the year when the world, my world, starts again;” Risbridger writes as she first hears news of the pandemic. “This is not the year the world is supposed to end, because my world has already ended.”

The world does not quite end, and Risbridger keeps cooking through it. She cooks Leftovers Pie for her new housemate, because she loves her; Crisis Cardamom Coffee Banana Bread, because everyone made banana bread at the start of lockdown; Turkish Eggs, because Jim would have hated them and he’s no longer there to object.

It’s this last question, of what to do now that Jim is no longer here to make his objections known, that leads Risbridger to some of her most affecting passages. She spent years of her life as Jim’s caretaker, guiding him through chemotherapy and all its accompanying horrors, rendered “subservient, essentially, in a way no other adult relationship demands.” Now that Jim is no longer there, she has space to think through her own preferences, and to deal with the guilt and the horror surrounding that space.

With her housemate, she invents “the Self-Esteem Finger: you hold up one finger, to indicate a desire that has no reference or recourse to anyone else, and you say ‘self-esteem!’” She stops making roast dinners, which Jim loved and she hated, and she indulges in meals with very little meat, such as the Turkish eggs in garlic yogurt.

A watercolor illustration shows a black-and-white cat walking below an outdoor metal staircase covered in flowerpots. In the background, a blooming cherry tree and a weeping willow stand against a blue sky while a yellow bird flies overhead. In the bottom right corner is printed the word “April.”
A chapter header from The Year of Miracles.

You can successfully cook from these recipes, more or less. The rice bowl with Vietnamese flavors Risbridger has dubbed Coconut Pow comes out bright and sharp and sweet, although its many parts make it fiddly to put together unless, like Risbridger, you are already in the habit of keeping quick-pickled radishes and salted mango in your fridge. When I followed her recipe for cardamom buns, I found that she’d left out a few details about how to construct them, so that I couldn’t seal them properly and the spiced butter filling leaked out of the buns as they baked. They were still absurdly delicious.

But the recipes here are more indicative of Risbridger’s personality than anything else. They are organized chronologically, with 12 chapters, one for each month of the year, and they are optimized specifically for the way she runs her personal kitchen. As such, she is always specifying the exact color and flakiness of the kind of sea salt you should use, but when a recipe calls for just plain table salt she tells you to pinch your flaky sea salt into dust, because she can never remember to keep plain table salt in stock.

>What you’re really reading for here is Risbridger’s sprightly, evocative prose, which is never more compelling than when she’s describing the sheer joy of her food. Roasted eggplants are “blistered and blackened and chewy and delectable;” fresh dukkah is “a beautiful sunset orange” that makes every salad “a riot;” soy-marinated eggs are “sticky” with “golden, liquid yolks.” Periodically, she peppers her instructions with bossy repetitions (“I do know your life, and you don’t need more flour”) and shameless confessions (“I have a weakness for adding leftover sour cream and chive dip, but I understand this is horrible”).

Bouncing up against Risbridger’s prose are Elisa Cunningham’s whimsical watercolor illustrations, which range in elaborateness from two-page-spread tableaux of the neighbor’s cat in Risbridger’s fire escape garden to half a lemon rolling around the bottom margin of a recipe for parsnip purée. They are sweetly messy sketches, matching the sweetly messy energy of this home cook’s recipe book.

And that, in the end, is what you read The Year of Miracles for: the sweetness and the mess. Cardamom buns that fall apart in the oven but are still buttery and rich with sugar and spices. An account of a life laced with grief that wasn’t supposed to be there, and a world that ends over and over and over again and manages to keep its beauty and its charm regardless.

It’s what makes this cookbook-cum-memoir feel exuberant, unstoppable, and triumphantly on the side of love and life in the face of death and loss and grief.

Complete Article ↪HERE↩!

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A grievers mini library filled with solace

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On Aug. 11, I will stand beside a book box stocked with 50-plus books for bereaved children, teens and adults and cut the ribbon to launch the first ever “Grievers Library.” This mini library, sited on a parking strip in front of a Seattle senior center, is the culmination of a concept that has taken 20 months to fulfill.

With the support of 90-plus volunteers and donors, we are giving away free books, love and compassion. Four more book boxes are planned to open in Seattle later this year.

It is both a small thing — just a wooden box of free books — and a big thing — a biblio-lifeline to grieving folks who want to understand why they can barely breathe, eat or sleep; who seek answers to troubling questions like, “Why has the most important person in my life died?” or, “Where has my person gone?” or, “Will I live through this?”

I know. When my 23-year-old son died by suicide in 2020, I was left with 100 questions and no answers. I was shattered, and I wanted an antidote to my anguish and despair. In those early months, I found books about grief written by grievers and grief experts alike provided a modicum of comfort. They said: I was not crazy; I was not alone; and that, over time, I would somehow survive.

Nonetheless, finding good grief books was just plain confusing. Our local library system listed 1,604 books under the subject of “grief.” The first was a thriller, the second a murder mystery … (Well, I guess it’s not surprising — Dewey gave “grief” short shrift — it’s #158 in his decimal system.)

Cognitively disabled with “grief brain,” I gave up and bought used books online and waited two weeks for them to arrive in my mailbox.

Over time, I discovered that public libraries don’t carry the majority of grief books because they are either self-published, too old or have low circulation. Conversely, they don’t buy near enough copies of the latest grief “bestsellers” to meet demand. So why not create mini libraries stocked with free grief books and place them around the city so everyone has 24/7 access?

A University of Washington library student joined our team and led collection development. Unlike Dewey, we parsed “grief” into 50 different categories and created color-coded tags for easy selection by overwhelmed grievers staring at 50 book titles.

Surprisingly, our biggest challenge was not buying, sorting and cataloging hundreds of grief books, nor building and painting five handsome book boxes. It was finding a facility that would let us install a grievers library on the parking strip in front of its building. After we received rejections from churches, libraries, businesses and local nonprofits, we proposed siting our book boxes in front of five Seattle community centers. To our dismay, the progressive, compassionate civic leaders at Seattle Parks, Department of Transportation and City Hall responded in concert, “We don’t think it’s appropriate for them to be installed in parks or in front of community centers.”

This is our cultural allergy to grief at work. A grievers library is not a gruesome gravestone that belongs in a cemetery; it is a medicine cabinet filled with love potions that belongs on our streets — for easy dispensing to those afflicted with heartache and despair.

Thankfully, the Greenwood Senior Center embraced our request to host a book box on the front of its property. Its people know grief and that biblio-therapy is a meaningful, positive resource to offer to our whole community. For this we are grateful. For more information: grieverslibrary.org

Complete Article ↪HERE↩!

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‘My husband’s death left me with so much regret, I don’t want you do make the same mistake’

A simple conversation could have changed so much…

Melissa Reader shares her experience of poor death planning to help others have a better experience.

By Melissa Reader

After losing her husband Mauro tragically young, Melissa Reader is personally motivated to help more Australians talk about the end stages of life. Because accepting that death is a part of life is the first step to ensuring the final stages of living are done with dignity, and surrounded by love.

It wasn’t long ago that these topics were shrouded in stigma. And while we have some way to go in making these areas of life safe topics of discussion for everyone, there’s no doubt that over the last 10 years we’ve come a long way.

So it’s still surprising that we have allowed death to remain a taboo subject. Death is as universal as life – we all die. And just like mental health, sex and identity, talking about it openly normalises the experience and helps to make it the best it can be, for everyone involved.

Avoiding the topic

It’s a known fact that ‘what we resist, persists’, so our fears around death and dying heighten and become more difficult to address as time goes on.

The lack of communication at the end of life leads to a lack of preparation; right now in Australia, only 14% of us have a plan in place for how we want to die. The last stage of life and the end of life is never going to be easy – but it can be better, and learning to talk, plan and care for each other when the time comes is key. Or we end up with a big gap between what we hope for, and what happens, which is what happened in our family.

If we had managed to have the important conversations, like how to make the most of the time ahead, we might have made different decisions.

How my family changed forever

We were a very normal, happy, busy family, with three children. Our youngest child, Orlando, was just nine months old when my husband Mauro’s diagnosis came completely out of the blue.

He was 40-years-old. Through the 15 months of his illness, we did our best to navigate life, family needs and the confronting and ever-changing demands of his cancer disease. But we avoided having honest and open end-of-life conversations as a couple, as a family, and with his medical team. We didn’t understand, or maybe we couldn’t accept, that he was terminally ill – that he was dying.

The regret never fades

I still feel so sad about the way Mauro spent the last stage of his life – in and out of the hospital, away from his family, and his home. We didn’t think about how to really make the most of those precious months together. We never accessed palliative care, which would have been so helpful, and we weren’t in any way prepared for his death.

It all flew by in a painful blur and suddenly, I was standing beside him in the ICU, reeling, and finally realising that he was about to die. Realising that we’d missed so many moments for love, connection, memory, and legacy. Realising that Mauro was going to die in a cold, clinical and unfamiliar setting – something he wouldn’t have wanted.

We were left without a husband, and a father, and I was holding many deep regrets about the way the last stage of his life played out.

How to talk about death, better

Honesty and kindness are not mutually exclusive. By having more open and candid conversations, and planning together where everyone is involved is the key to making the experience the best it can be.

Unfortunately, life doesn’t offer us a chance to re-do this scenario. My advice is this: be gentle, be brave, and try to open more conversations with family and friends about what’s most important in the last stage of our lives.

Remember, it’s your compassion, not your vocabulary that matters – there are no perfect words. Rather than getting caught up in trying to find the right things to say, my advice is to instead focus on timing and tone. If you get these things right, the words tend to find their own way. Take your time, use gentle and well-spaced questions and be prepared to revisit conversations over a few sittings.

And if you need support with where to start or how to unravel what comes of these chats, you can always reach out to the Violet Initiative. We’re a national not-for-profit that’s helped thousands of Australian families navigate this life stage.

A personal pledge

I made it my life’s calling to create a safe space where family, friends and colleagues of someone who is in the last stage of life can go for support, so they know that they aren’t alone and that help is available.

So next time you’re catching up with friends and you find yourself discussing your mental health, take a moment to think of some of the end-of-life conversations that might lie ahead, and make a pact to approach these with the same openness and honesty.

Complete Article ↪HERE↩!

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Ashes to Ashes

Turning the dead into soil in Washington State.

By Tricia Romano

Micah Truman, founder of Return Home, uses the word beautiful many times during our conversation about his company’s unique burial process.

Terramation—what Return Home calls human composting—a two-month-long process that turns deceased bodies into soil, is new to the world. So new, in fact, that the service is offered in only a few places on the entire planet, and Washington State happens to be one.

Washington became the first place in the world to legalize human composting, thanks to a small, dedicated group of funeral directors led by Katrina Spade, a founder of the nonprofit Urban Death Project. As an undergrad at the University of Massachusetts Amherst, Spade had received the prestigious Echoing Green Fellowship and worked with scientists and biologists to develop a process that turns human remains into soil. In 2018, Spade pushed for human-composting legislation in Washington, later signed by Governor Jay Inslee in 2019. After it became law, she opened the world’s first human-composting center, Recompose, located in Seattle.

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Currently, there are only three states that provide this service: Washington, Colorado, and Oregon. Other states, including California, are working on similar legislation. In 2021, California Democratic assembly member Cristina Garcia, from Bell Gardens, introduced Assembly Bill 501, which would legalize “natural organic reduction.” It successfully passed out of the California State Assembly, the Senate Health Committee, and the Senate Business and Professions Committee, but it is currently tabled.

Return Home is located in Auburn, a suburb 20 miles south of Seattle. Speaking with me on a sunny spring morning, Truman recalls the story of a California family who recently used Return Home’s service.

The woman’s son had died suddenly, and she’d decided that because he hadn’t liked to fly when he was alive, she would transport him in a car herself. She drove from Northern California to Washington, her son’s body cooled and packed according to Return Home’s instructions. Once she arrived, Truman recalls, “She was able to sit with him and talk with him. We were able to place him in his vessel with his mom there.”

“It was one of the most beautiful things I’ve ever seen,” Truman says.

An entrepreneur and investor, Truman saw the Washington legislation as not just a business opportunity but an environmental one. The funeral industry isn’t particularly innovative: most people opt for either burial or cremation, and neither of those are good for the planet, he explains.

“Cremation has long been considered the environmental alternative. It’s the one that people use. It’s what I would have used, or my family, because we consider it the least environmentally impactful,” he says.

But, he points out, “Cremation uses about 30 gallons of fuel, spews about 540 pounds of CO2 into the air per cremation.”

The burial service Truman offers is different from a green burial, which, at its simplest, involves placing an unembalmed body directly into the ground without a box. Though green burial is also more natural than cremation, it presents the same problem that traditional cemeteries often face: limited space.

The idea of human composting might seem weird at first. Some “conservative religious groups” have reservations, says Truman, but he points out that the Catholic church was also once averse to cremation and is now on board. And if you think of human composting as slow burial, it’s less odd. Return Home uses a custom-made, heavily insulated plastic polycarbonate vessel; the body is placed inside with alfalfa, straw, and sawdust. After 30 days, the body disintegrates, leaving only bones, which are crushed and returned to the vessel to sit for another month. At the end of the cycle, 500 pounds of dense, nutrient-rich soil are created and can be used anywhere.

“We have to tell our families that it is extremely nutritionally dense,” Truman says. “So a lot of people would think, ‘OK, I will take a large pile of this and plant a tree in it,’ but there’s an enormous amount of nitrogen. It’s incredible. It’s the stuff of life.”

Joanna Ebenstein is the founder and creative director of Morbid Anatomy, an organization based out of New York City that has classes and lectures that encourage thinking differently about death and using creativity to explore the end of life. (Sample class: Make Your Own Memento Mori.) “We’re really about bringing death to the forefront,” says Ebenstein. A Bay Area native, she says that many people in the death-positive community are younger women and are more open to embracing natural burials, like human composting.

“A lot of them are focusing on trying to change attitudes about death so that we can live, so we can have better deaths. And that includes dying with more dignity, being able to choose when you die. And that also includes what you want done with your body and help people get to spend time with your body after you die,” Ebenstein says. “I certainly have seen many, many more people interested in this in the last 10 years than I ever have before.”

Though Return Home’s is the largest facility in the state—11,000 square feet, housing 70 vessels at a time, at full capacity—Truman is composting only 900 bodies a year.

With so few places offering the service in the country, Truman says 20 percent of his customers are from out of state: “Colorado, California, Missouri, Oregon. So we’ve had people come from all over there, and a number of them from California.”

Truman is still moved by the memory of the California family who came to Return Home.

At the end of the two-month process, the woman’s other sons made the drive up to gather the enriched soil made from their brother’s remains and brought him back to California.

“It was one of the most remarkable experiences I’ve ever had in my life,” Truman says.

You might even say it was beautiful.•

Complete Article ↪HERE↩!

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What happens when a patient isn’t actively dying or recovering on their own?

Writing for the New York Times, Daniela Lamas, a pulmonary and critical-care physician at Brigham and Women’s Hospital, explains how doctors and loved ones “navigate death” in cases where “it becomes clear that the life that we can offer is not one that would be acceptable to the patient.”

Making the decision to ‘transition to comfort’

Many people believe that ICU doctors can easily determine whether a patient is going to die, but that’s not always true. “Our medicines and machines extend the lives of patients who would otherwise have died,” Lamas notes.

When a patient is fully relying on these measures—and it has become clear that they are not actively dying but are not improving either—doctors and family members must figure out how to “navigate death when it is not imminent and unavoidable but is instead a decision.”

During Lamas’ medical training, death unfolded in one of two ways: either in a moment of crisis, with doctors rushing into the room, trying to save a patient’s life, or in a quiet room, with loved ones gathered for the patient’s final breaths.

However, Lamas contends that there is a third form of death “when it becomes clear that the life that we can offer is not one that would be acceptable to the patient,” she writes. According to Lamas, this kind of death is planned for, occurring only after the medicines and machines keeping the patient alive are withdrawn.

“It is a strange thing to plan a death, but I have come to understand that this is part of our work in the I.C.U.,” Lamas adds.

For instance, Lamas recently cared for a cancer patient who had been intubated after experiencing a flare-up of underlying lung disease. Before the patient was put to sleep, she instructed her son to “Give her a chance to get better, but if that failed, she did not want a tracheostomy tube for a longer-term connection to the ventilator or months at a rehabilitation hospital,” Lamas recalls. “Her cancer was progressing, and that was not the way she wanted to spend the last year of her life.”

Lamas told the patient’s family that they would continue intensive interventions for two weeks, in “a time-limited trial of critical care.” According to Lamas, if the patient was not breathing on her own after two weeks, she would never be able to breath without a tracheostomy tube and extended rehabilitation—a best-case scenario the patient had already deemed unacceptable.

The day before the time-limited trial was supposed to end, the patient’s son and daughter told Lamas that they wanted to take her off the machines that evening if she was not going to improve.

“There is something uncomfortable about these conversations, where it feels as though we are asking family members to plan the end of a life,” Lamas writes. “It begins with a moment in the family meeting, when we have made the decision to ‘transition to comfort,’ and family members ask me what comes next.” However, “What they are asking, really, is how their loved one will die,” Lamas notes.

The ‘principle of double effect’

After loved ones have made the decision to “transition to comfort,” Lamas explains the next steps. “I tell them that when they are ready — as anyone really can be for any of this — we will stop the medications and the tubes that are prolonging life,” she writes.

In addition, Lamas explains that the bedside nurse will administer other medications to ensure that the patient does not experience pain. “Sometimes they ask if this medication will hasten death, and I explain that it can, but that our primary goal is always to relieve discomfort,” she adds.

Doctors refer to this balance as the “principle of double effect.” According to Lamas, doctors “accept the risk of a negative consequence like hastening death, so long as our intended outcome is to help the patient by alleviating symptoms.”

Ultimately, the pain-relieving drugs doctors administer during this process do not cause a patient’s death. Instead, they ensure that patients are as comfortable as possible while dying from their underlying disease.

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