The importance of holding space

By Faryal Michaud, DO

Today I wanted to talk about a concept that is very near and dear to my heart: Holding space.

Have you ever heard of it? Do you know how to describe it?

I will first start with the definition and then give you an example.

Holding space means being physically, mentally, and emotionally present for someone. It means putting your focus on someone to support them as they feel their feelings. An important aspect of holding space is managing judgment while you are present.

Like when you tell a patient that they have stage IV pancreatic cancer and that it is nonsurgical and even with the best treatments, their time is very short. Then you hold space.

You say nothing. You sit there and provide support by sitting there-next to their emotions. You don’t run to offer false hope. You don’t run to talk about 5 percent of the patients that respond to the newest therapy. You don’t try to look at the bright side. Change the subject. Or worse, run out the room.

You hold space. Sometimes, you sit for 2 minutes. Sometimes 10 minutes. While saying nothing. It feels like an impossibly long time, but I wish I could tell you how you are bearing the weight of that news by just sitting there. Holding space.

It is a remarkable skill to learn. As a palliative doctor, it is my skill set to sit there with your suffering. I may not know what you are thinking about, or what you are going through, but I am willing to sit there and be next to you as you figure it out.

Telling a patient that they have a terminal disease is a little like telling someone, “Our plane is about to crash.” Except somehow, you are going to be saved, and they are not. Holding space is you staying with them as they approach this free fall. As bad as it is to bear witness, remember, you are leaving this experience alive.

A very dear chaplain who was from Germany explained to me what a palliative consultation feels like,

It’s like opening the door to the patient’s life, as you start a conversation about the news of their limited time on Earth,

Some run to you (those are the ones who always knew something was wrong, and their doctors kept reassuring them otherwise).

Some stay at the door and don’t even move (shocked, stunned, in denial, and numb).

Some shut the door on your face (anger, frustration, and betrayal).

Holding space means whatever they choose to do at that door, it’s OK. It’s never about you. It is always about them and what they need. You hold space like you open that door. And you just stand there without a word or attempt to change their idea about what they want to do at that door. That is holding space.

Meditation is a little bit like that.

People think that meditation means you breathe in good thoughts and breathe out bad thoughts. No, it’s about the actual awareness of the thoughts.

It’s like holding space for your thoughts. But the simple awareness of the thoughts is huge. Calling them by their names.

Hey, hello anger. I see you, insecurity. I can feel you, loneliness.

When we can name our emotions and hold space for them, something magical happens. They don’t own us; we own them. We can choose how to handle them.

Oh, I see that I am angry because I had this thought …

Obviously, it is a daily practice, to remove yourself away from the feelings and thoughts that cross our minds and watch them go by like clouds in the sky.

The awareness that all will be OK. That there is a blue sky and sun above the clouds. That dying is part of living, not apart from it. This allows us to live in the moment and appreciate all that we have right now.

To hold space for others. To hold space for our emotions and give ourselves grace when we unravel. To take deep breaths in and out to recenter our mind.

Try holding space for a loved one today. Tell me how it felt to do just that.

So much aloha to you all.

Complete Article HERE!

Psychedelics for End-of-Life Patients

— What the Research Says

Psychedelics drugs may help dying patients face death. However, practitioners and researchers advise caution. End-of-life is a unique time with a distinct set of risks requiring specialized care. Using psychedelics for patients facing death has yet to be thoroughly tested.

By

  • Psychedelic drugs may help end-of-life patients by opening floodgates of new brain connections, reducing anxiety and feelings of isolation.
  • Research suggests side effects and risks of psychedelics for therapy are low in medically stable subjects.
  • End of life patients, however, face unique circumstance and are not medically stable.
  • Hope surrounds the promise of psychedelic-assisted therapy, but more research with terminally ill patients is needed.
  • In the meantime, there are other ways end-of-life patients can find connection, peace, and meaning.

Using psychedelic drugs (psilocybin, DMT/Ayahuasca, ketamine, MDMA, and LSD) for mental health treatment is a hot topic in current research.

America’s mental health crisis has not abetted, showing a need for innovative treatment. Evidence and confidence are growing around psychedelic use paired with talk therapy.

Mental anguish is common among people with terminal illnesses. As therapy with psychedelics continues to demonstrate emotional healing, more practitioners are eager to use the tool for end-of-life patients.

A powerful therapeutic tool

Psychedelic drugs, also known as magic mushrooms and hallucinogens, affect mood, energy levels, cognition, and perception. For many people, they stimulate profound spiritual experiences, dissolving the feeling of disconnection from self, the world, the universe, and a higher power.

People around the world have used psychedelics for centuries as a cultural and spiritual practice. Today psychedelics in both plant-based and synthetic forms are used recreationally and in scientific studies.

Many therapists, psychologists, and psychiatrists cite dramatic improvements in conditions like anxiety, depression, and post-traumatic stress disorder, lasting for weeks to months.

Science isn’t sure how psychedelics work, but they briefly quiet some parts of the brain and open others, causing a floodgate of new connections. This floodgate releases people from entrenched thought patterns and builds new neurological connections, something known as neuroplasticity.

As a result, many people change their minds and their lives.

These life-changing revelations can arise from disturbing psychedelic trips. Still, many who endure a gut-wrenching hallucinogenic journey say it was one of the top five most important events in their lives – worth the anguish for the rich healing.

Research suggests the best outcomes – long-lasting and life-changing – happen with intense therapy before and after taking a psychedelic drug.

Perhaps the most powerful outcome of using psychedelics for therapy is an increased sense of belonging. Connectedness is a deep, human need regardless of race, ethnicity, and culture. Feeling disconnected causes internal turmoil that can lead to chronic health problems.

Psychedelics for end-of-life care

In the last weeks and months of their lives, people face an intense rollercoaster of emotions, including fear, anxiety, and sadness.

Research has shown that psychedelic therapy can reduce death anxiety and increase a sense of connection and meaning for end-of-life (EOL) patients.

An academic book published in 2022 called Disruptive Psychopharmacology discusses the current science of psychedelic use for therapy and its safety and implementation. Psychiatrists and neuroscientists from John Hopkins and the University of California, San Francisco, collaborated on an end-of-life and palliative care chapter. They reviewed the research on psychedelics for patients facing the last stage of a terminal illness, often cancer.

As the authors noted, research with psychedelics for terminally ill patients started in the 1960s. Since then, research with dying patients continues to be promising – although narrow in scope – for improving depression, fear of death, discouragement, and connectedness.

Relief from fear and isolation are two serious emotional challenges for EOL patients. They seek peace and connection to their loved ones. Psychedelics coupled with therapy could achieve more comfort.

The risks of psychedelics for EOL

However, the psychology community advises caution in using psychedelics for end-of-life patients.

According to Dr. David B. Yaden and his team of researchers who wrote the EOL chapter in Disruptive Psychopharmacology, most researchers have studied psychedelic use with medically stable patients, even if they have a mental illness.

EOL patients are not medically stable and can be highly stressed. Psychedelics may worsen symptoms like insomnia, confusion, delirium, shortness of breath, and diarrhea.

They could also cause patients to question long-held spiritual beliefs, possibly adding more stress to the patient and loved ones.

The authors also said we know too little about whether psychedelics interact safely with medications commonly given to EOL patients.

Furthermore, there are no dosing and treatment protocols, certification processes, or professional organizations to oversee the safe use of psychedelic therapy.

Even worse, there are too many reports of sexual abuse by psychedelic-assisted therapists. Thorough training and vetting of therapists are needed because assisting psychedelic trips is very specialized and challenging for therapists.

In a 2022 Medium article, Dr. Rosalind Watts, a leading researcher on the therapeutic use of psychedelics, wrote that real healing is possible when psychedelics are “interwoven into very intentional therapy…The drug was a catalyst to the therapeutic process, not the therapeutic process itself.” She worries we focus on the drug and not the expertise of therapists.

Palliative care specialists say there are many natural wonders – spiritual and physical – in the dying process. They worry that psychedelics may negatively interrupt a naturally beautiful process that, by itself, can create positive transformation.

Obtaining psychedelics for EOL therapy

Psychedelics are only legally available for research studies, but in the coming years, that will change.

Oregon and Colorado legalized psychedelics for therapeutic use in the United States, while several other states have decriminalized them. Once a drug is legalized or authorized by the FDA, however, implementing their use can still take a few – sometimes several – years.

Other ways to open your mind

Music triggers the brain’s pleasure center and a broad, highly diverse network of brain neurons.

Studies suggest spirituality – like psychedelics – hushes the self-focused parts of the brain. This effect happens in the deepest states of prayer and worship, causing “me” to meld seamlessly into connectedness with others, the universe, and a higher power.

Various forms of meditation also open neurological pathways in transforming ways.

Many studies show that healthy relationships and participation in a diverse community reduce stress and improve a sense of belonging.

If you or a loved one face the end of life, it’s essential to talk with a spiritual advisor or a palliative care specialist who can help you find what works for you to feel connected and unafraid.

Complete Article HERE!

End-of-Life Issues and Support for LGBTQ+

LGBTQ+ people can face unique challenges at the end of their lives. The article discusses some of the struggles they face and why they face them. Advance directives are the best way for LGBTQ+ individuals to make their end-of-life wishes known and to counteract discrimination.

By

  • Individuals who identify as LGBTQ+ statistically encounter discrimination and this does not stop when they face death and dying.
  • Biased blood relatives and medical personnel can be sources of end-of-life challenges for LGBTQ+ community members.
  • Having an advance directive may assist in ensuring a more dignified and respected dying process.

The end of life is a profoundly intimate time for the dying person and their loved ones. The dying process can strongly illicit emotions related to fear of the unknown and anticipatory grief. For lesbian, gay, bisexual, transgender, queer, and non-binary (LGBTQ+) individuals, the challenges can multiply.

What are some possible concerns?

When a dying person is not cisgender (identifying with the gender they were assigned at birth) or heterosexual, the end of life may become complex.

For example, family members who previously rejected their now-terminal LGBTQ+ relative may wish to visit to say their goodbyes. They may still hold biases against the sexual orientation or gender identity (SOGI) of the dying relative. Relationships that are already strained can add undue burden on the dying one and their close caregivers.

Family dysfunctions are not the only issue facing terminal LGBTQ+ folks. They can routinely experience discrimination from their palliative and hospice care providers. The results can be devastating.

Culturally insensitive attitudes held by medical professionals can translate into micro-aggressions, withheld care, or abuse. Even people in legal same-sex marriages that have codified protections at the bedside are sometimes met with contempt.

The result could be that the non-conforming person may be denied the care, dignity, and support at the end of life every human wants.

Further difficulties for transgender individuals

Systemic and social prejudices that harm the transgender community persist and can follow them to the end of life. Again, the withdrawn relative who has not yet embraced the SOGI of their dying family member may arrive at the bedside, still deadnaming (using their birth name and not their chosen one), perpetuating an environment of perceived discord.

Medical workers are sometimes responsible for inequitable care provision when faced with patients and their bedside support system who are not cisgender or don’t fit a heteronormative presentation. Studies that contain evidence of this type of discrimination are now surfacing.

A supportive solution – advance directives

Advance directive creation acts as a vital process for formally stating exactly what a person envisions for their end of life. The term ‘advance directive’ is an umbrella term used for a group of formal documents that include a living will, a document naming one or more health care proxies, and organ/tissue donation documents (if so desired). It is not to be confused with a legal, financial will established with an attorney.

The living will

A living will spell out the detailed choices regarding what medical treatments a person would and would not want at the end of life. It communicates pre-planned decisions to all medical practitioners based on personal values. Also, a living will is what the chosen healthcare proxy will use as a guide in advocating for the dying LGBTQ+ person when they can no longer speak for themselves.

Each state has its own version. However, they all ask the same basic questions regarding medical procedures and interventions typical at the end of life. It guides medical providers in knowing whether or not to administer artificial hydration and nutrition as well as life-sustaining interventions such as a breathing machine or CPR.

Also, there is always space provided on the documents for writing personal statements and unique information to establish autonomy further. These addendums can be the key to receiving more personalized and respectful medical care. Appropriate pronouns, who one wants at the bedside, chosen name use, and more can be highlighted here.

What is a health care proxy?

A proxy is a person carefully chosen ahead of time to be the voice at the bedside when an actively dying person cannot express their wishes. This term is also known as a health care agent, patient advocate, medical power of attorney, or medical proxy (state-dependent). The proxy cannot override medical decisions if a person is conscious and competent at the time decisions are required.

It is recommended that more than one healthcare proxy be named in the advance directive. If one proxy is unavailable at a crucial time, having another designee who can step in can provide assurance.

Additional insights

Advance directives can be downloaded from the internet for free in every state. It may need to be notarized in addition to the necessary witness signatures. An individual’s primary care provider and all proxies must have a copy of the completed and signed documents. Providers can answer any questions to help make these personal medical decisions.

Advance directives are not only for those with a known terminal diagnosis. There is also the scenario of a sudden, catastrophic event that might lead to a critical care unit to consider. This now involves the forethought of younger, healthier individuals as well.

What may happen if no advance directive is available?

When a person is instantly unconscious and possibly dying related to an accident, essential decisions will need to be made immediately. Without a stated proxy, the closest blood relative will be legally elected as “next of kin” to make those choices. If that mother or father, sister or brother, is historically at odds with their dying LGBTQ+ family member, the situation has the potential for further disaster.

With an advance directive in place, wishes are already determined, and the supportive ally in the proxy role can guide the care desired and advocate for respectful treatment at the bedside. Having an advance directive may also prevent the need for guardianship imposed through the state probate court.

Ultimately, if no advance decisions are in writing, the stress of not knowing rests on those that care.

Every person over the age of 18 is encouraged to have advance directives in place, whether legally married, cohabitating, or single. They can provide additional protection of dignity the LGBTQ+ community asks for when it’s needed most. And, until more education is required for medical professionals in providing more culturally sensitive care, advance directives are another ally to add to the circle of support for the dying LGBTQ+ person.’

Complete Article HERE!

‘I will reflect on my own death – and try to conquer my fears’

— The thing I’ll do differently in 2023

‘It is death that makes life meaningful’ … Monica Ali.

I don’t want to be mawkish or indulgent. But I want to consider my mortality in order to live well in the years I have left

By

Have you ever spent time seriously contemplating your own death? I haven’t. I’m 55, in good health, exercise regularly, eat well and – barring the proverbial bus – have no reason to think death is imminent. Thoughts of my own mortality naturally arise from time to time but they’re easy to banish. After all, both my parents are still alive, forming a kind of metaphysical barrier. Not my turn yet! But one thing I will do differently in the coming years is to begin reflecting on my demise. Does that sound mawkish? Self-indulgent? Pointless?

Well, I won’t be picking out a coffin or selecting music for the funeral or tearfully imagining the mourners gathering. All that would be a waste of time and, like everyone else, I’m busy. With work, family, friends, travel, trips to the theatre, galleries, restaurants and so on. What I mean to say is that I have not lost my appetite for life. Why, then, do I wish to begin meditating on death?

For two reasons: in order to live well during whatever years I have left; and to begin to confront and maybe even conquer the fear that, thus far, has stopped me from having more than a fleeting engagement with the knowledge that death is the inevitable outcome of life.

There’s a well-worn trope about living each day as if it’s your last, or if you only had one year to live you wouldn’t choose to spend it at the office. That doesn’t quite chime with me. If I only had a year to live, I’d still choose to work. (I might try to write faster!) Nevertheless, it is death that makes life meaningful. In Howards End, EM Forster puts it like this: “Death destroys man: the idea of Death saves him.” The value of our days floats on the metaphysical stock market of ideas that we hold in our minds.

The idea of ceasing to exist isn’t easy to contemplate. But I don’t believe in reincarnation or an afterlife. I don’t believe that raging against the dying of the light is going to achieve anything. And ignoring the issue isn’t going to make it go away. In fact, it makes the prospect more, rather than less, frightening.

I first read The Complete Essays by Michel de Montaigne when I was at college, but it’s only now that I’m ready to take on this piece of sage advice: “To begin depriving death of its greatest advantage over us, let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death.”

How will I go about it, then, this new contemplative practice? Place a skull or some other memento mori on the shelf above my desk? Fly to Thailand or Sri Lanka and visit the Theravāda Buddhist monasteries where photos of corpses are displayed as aids to the maranasati (mindfulness of death) meditation? Walk around graveyards?

I’ve recently rented an office where I go to write. There’s a huge picture window under which I’ve placed the desk. The window overlooks a Victorian graveyard that’s still in use. When I sit down, all I can see are the trees. But when I stand I have a view of the tombstones and, in the distance, the crematorium.

One day I’ll be gone, my body consigned to the earth or turned to ash. Sooner or later I’ll be forgotten. Truly accepting that revivifies life. It doesn’t make every moment wonderful, but knowing I will die is a source of strength to endure the difficulties, and a spur to be more present for all that is good and precious in life.

Complete Article HERE!

My partner and I are both grieving.

— Sex might help us cope – but he has lost interest

We have had seven happy, loving years together. But I’m feeling the need for physical comfort

By Pamela Stephenson Connolly

My partner and I have been in a loving and happy relationship for seven years. During the past two years three of our parents have either died or been diagnosed with a terminal illness. We remain close but physical contact has become less frequent and meaningful. I find sex a cathartic way to deal with the stresses we have faced, and a way to demonstrate our closeness, but he has understandably become reluctant to be intimate. I feel our need for sex has a different purpose and miss our shared understanding of what closeness means for us.

Grief certainly can negatively affect a person’s sexual response and many people find that recovery can take quite some time. Occasionally, bereavement develops into depression, which in itself can shut down sexual interest or functioning. It is unfortunate that you and your partner are having different sexual reactions as you work through loss and try to heal, but recognise that you are simply experiencing different sexual responses to grief and, if possible, share those feelings with each other to feel more heard. Grief counselling could be very helpful. Your bereavement is relatively new, but if healing does not appear to be progressing it will be essential to seek help. At any point in a relationship it is extremely common for sex to hold different meanings for each partner. Take heart – it is reasonable to maintain hope that there will eventually be healing and a resolution of your current sexual issues.

Complete Article HERE!

Thinking of Becoming a Guardian?

What you should consider before you agree to be responsible for an incapacitated loved one

By Patty Blevins

What you should consider before you agree to be responsible for an incapacitated loved one

If you haven’t had any experience with guardianship for adults with dementia, it’s likely you don’t understand just how complex it is. You are not alone. Many family members of the estimated 6.5 million dementia patients in the U.S. struggle to understand if it is an option for their loved one.

Many more people will face that decision because the number of people with dementia will grow to 14 million by 2060, according to Centers for Disease Control estimates.

An adult son making food for his mother with dementia. Next Avenue
In determining whether to place someone under a guardianship and curb their legal rights, the court may call on a geriatrician or psychiatrist to assess the person’s functional behavior, cognitive function, disabling conditions and ability to meet their essential needs.

The simplest definition of guardianship is the position of being responsible for someone else. State courts appoint a guardian to make decisions for another person if the court finds the person to be incapacitated or unable to make safe, reasonable decisions for themselves, according to National Academy of Elder Law Attorneys (NAELA).

The simplest definition of guardianship is the position of being responsible for someone else.

Guardianship is serious business. People placed under guardianship, who are called wards, may lose their independence in making decisions about their finances, legal issues and health care. According to the U.S. Department of Justice, full guardianship can control whether wards can vote, who they may marry, where they live and if they can make end-of-life decisions for themselves.

An article in the American Journal of Alzheimer’s Disease and Other Dementias explains that the two tasks that are regularly evaluated in determining capacity are an individual’s ability to manage personal finances and take medications as prescribed.

Choosing and Monitoring Guardians

In determining whether to place someone under a guardianship and curb their legal rights, the court may call on a geriatrician or psychiatrist to assess the person’s functional behavior, cognitive function, disabling conditions and ability to meet their essential needs. A geriatrician is a specialty doctor who treats people over 65 with a focus on diseases like dementia that primarily affect this age group.

The National Academy of Elder Law Attorneys says guardianships offer safeguards. Guardians, for example, must periodically update the court on the ward’s finances and health status. Even then, courts have the authority to initiate unscheduled reviews of guardians’ decisions about their wards’ finances, property and health care.

Guardianship, “when properly used,” is a beneficial method to protect an incapacitated person for whom no other means are available to assist with informed decision making, the organization says.

That describes the original intent of guardianship, but it assumes the guardian is honest and accountable. Unfortunately, this is not always the case. Ample examples of abuse are documented by researchers and prosecutors.

An article in the Journal of the American Geriatrics Society first published in April 2022, sought to make a quantitative evaluation of guardianship in the United States but the authors found little consistent standards and data collection regarding the impact on patient care and the quality of life of people subject to guardianship.

Impediments to Oversight

The inconsistencies included fundamental matters, including the following:

  • The scope of the guardian’s duties.
  • Minimum standards for guardians. As of 2020, there were two states that had yet to require a background check.
  • Determination of incapacity. In the past, this decision often defaulted to a physician based solely on a psychiatric or medical diagnosis.
  • Regular independent reviews of the ongoing necessity of guardianship.
  • Educational requirements for guardians. Guardians are often required to serve in many roles that they may have minimal or no training. The National Guardianship Association (NGF) partnered with the Center for Guardianship Certification (CGC) to standardized educational content and offer certification.
  • Other drawbacks of guardianship included:
    • Once guardianship is assigned, there is greater tendency for the person to become lost to follow up. People who have been labeled as incompetent or incapacitated have limited ability to advocate for themselves, contact an attorney or access funds for court proceedings.
    • There is a greater tendency to assign full guardianship instead of less restrictive alternatives.

    Recent Guardianship Law

    In 2017, the Uniform Law Commission, a non-profit association that provides states with model legislation to clarify and standardize laws across jurisdictions , released The Uniform Guardianship Conservatorship and Other Protective Arrangements Act to encourage the “trend toward greater independence for persons under guardianship.”

    “Over 40% of the American population has never discussed their wishes for end-of-life care with loved ones.”

    The act addresses many of the previous inconsistences and proposes solutions going forward. So far, seven states have enacted the model guardianship statute in full and many more have adopted parts of it, according to the National Center on Elder Abuse.

    Alternatives to Guardianship

    There are multiple alternatives to guardianship but Americans need to start talking to each other. “Over 40% of the American population has never discussed their wishes for end-of-life care with loved ones,” according to the article in the Journal of the American Geriatrics Society. These measures should begin at the first sign of memory loss or preferably when getting ready for retirement to delay or prevent guardianship.

    • Tell your family your wishes and write them down in an advanced directive (living will and health care power of attorney).
    • Create a value history. A value history is based on values and beliefs and it provides a person’s future care choices.
    • Evaluate limited (partial) guardianship as an alternative to full guardianship. In this case, guardianship is granted only over the areas for which the person lacks the capacity for rational decision making (finances).
    • Designate a durable power of attorney and list two or three backup candidates for this important position if the first choice is not available. This agent could be responsible for financial, legal and personal matters.
    • Investigate care management services. Care managers are usually nurses or social workers that are trained to identify and provide for a client’s medical, psychosocial and financial needs.
    • Find a payee. Many organizations offer money management services which serve as a payee for vulnerable clients.
    • Enlist the help of your primary care doctor. You may have to teach them about guardianship and the role you would like them to play, but they could become your greatest asset.

    Guardianship as the Only Answer

    Appointing a family member or friend as your guardian often is the ideal solution. But sometimes a court-appointed guardian is the only answer. My own experience is an example.

    I felt a sense of relief at the appointment of a guardian outside the family. It relieved us of the possibility of having to tell him that he had to stay in a nursing home for his own safety.

    My father was diagnosed with multi-infarct dementia in 2016. The disease transfigured him from an intelligent, robust, fun-loving father into, let’s say, something different. My mother already had passed away, and my three siblings and I agreed that his guardian should be the same sibling who was listed as his Health Care Power of Attorney.

    That legal document lets you state your medical wishes and appoint another person to make sure those wishes are followed if you are incompetent or no longer able to make your own health care decisions.

    Release, Then Relief

    We all arrived at the courthouse and my father surprised all of us by saying he didn’t want my sister, who had his Health Care Power of Attorney, to be his guardian. Another court hearing was scheduled, at which he agreed to have the court appoint a lawyer to be his guardian.

    I felt a sense of relief at the appointment of a guardian outside the family. It relieved us of the possibility of having to tell him that he had to stay in a nursing home for his own safety. We would not be the ones sifting through his financial records to explain his debt and explain that his mortgage was being foreclosed on. We could preserve a few remnants of a familial relationship and focus on being supportive.

    The guardianship duties performed by the appointed attorney were far from flawless. But, overall, they served as the best answer for the situation at the time.

Complete Article HERE!

Have yourself a… 2022

Let your heart be light
From now on,
our troubles will be out of sight

 

Make the Yule-tide gay,
From now on,
our troubles will be miles away.

Here we are as in olden days,
Happy golden days of yore.
Faithful friends who are dear to us
Gather near to us once more.

Through the years
We all will be together,
If the Fates allow
Hang a shining star upon the highest bough.
And have yourself A merry little Christmas now.