What to expect in the last moments before death

— It can be difficult to know exactly when someone is going to die, or has died. This page details some of the most common signs.

The following symptoms are often a sign that the person is about to die:

  • They might close their eyes frequently or they might be half-open
  • Facial muscles may relax and the jaw can drop
  • Skin can become very pale
  • Breathing can alternate between loud rasping breaths and quiet breathing.
  • Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds. This can be upsetting to witness as the person seems to stop breathing only to start again. There might be one or two last gasps a minute or so after what seemed like the last breath, before breathing eventually stops.

When someone dies

The moment of someone’s death is often very profound, even when you have expected it for a long time. You might want to talk to someone or call family and friends to let them know. You might prefer to be alone.

Some people feel overwhelmed with sadness, for others it can take days, weeks or months to process how they feel.

If you have been caring for the person you might feel exhausted, and the relief and finality of the moment of death can take you by surprise.

Every person’s experience of dying and bereavement is unique. However you are feeling, there are organisations and resources to help you. If you think you could benefit from bereavement support visit our page on how to find bereavement services.

Complete Article HERE!

Speaking About the Unspoken

— Sexual Bereavement

All humans experience loss. This loss can include the death of a partner or spouse. Grief inevitably follows during the bereavement period. What is not commonly talked about is the reality of sexual bereavement. When a long-term sexual partner dies, so does one of the most pleasurable features of that connection.

By Delta Waters RN

For many, life brings love and sexual intimacy with a special someone. Illness and death require us to experience the journey of grieving. Responses to grief are as unique as each human fingerprint, but we all share some commonalities. The model of the 5 stages of grief, outlined in 1969 by Dr. Elizabeth Kubler-Ross, is well-known for normalizing what humans encounter over time after a loss.

What is sexual bereavement?

What isn’t so recognized is what is known as sexual bereavement. This is the grief that relates to losing sexual intimacy with your long-term spouse or partner. It may come after the death of the loved one. It can also begin before the loss as their health declines.

Our sex lives are private matters. When we subsequently feel deep sadness when our life companion dies, identifying the loss of the profoundly close sexual attachment once shared can be difficult. In addition, older adults statistically lose their spouses at a higher rate than younger age groups. Sexual bereavement, in turn, is a part of grief seniors may not be talking about.

What we know about sexual bereavement

Research in the area of sexual bereavement is sparse. In 2016, the term was coined in a small study of 104 older women, calling it “disenfranchised grief.” This seems to be the only formal study on what seems to be a common occurrence after loss.

One conclusion noted in this peer-reviewed research is that people aren’t talking about sexual bereavement because, as a society, we don’t recognize that older adults are sexually active beings.

What are the barriers to the discussion?

Baby Boomers are starting to shine a spotlight on the fact that seniors do have sex. The old media image of the asexual elder is giving way to a more accurate one of the sexually active senior. Scientific research is now following suit.

Previous sexual wellness studies typically had an age range that did not include those over the Medicare benefit age. Times are changing for the better as evidenced by the increased numbers of sex studies embracing the older population.

Another reason sexual bereavement isn’t commonly spoken about is that sex is an intimate topic. Older adults tend not to talk to their primary care providers about it, and primary care providers typically don’t ask.

Given that professionals are hush-hush about sexual wellness, how safe do you feel in sharing about the loss of sex in your life with your family or friends?

Until recently, research and discussions have primarily focused on a married, heterosexual experience of sex and the loss of intimacy after a death. If an individual is cohabitating or LGBTQ+, and possibly polyamorous as well, there is virtually no relevant public dialogue with which to relate. Any combination of these barriers can be devastatingly isolating.

You are not alone

Sexual bereavement is a legitimate grief response. Nowadays more people are saying it out loud. With the accessibility of the internet, personal story blogs and virtual support groups specifically addressing sexual bereavement are growing in number. Book publishers are giving voice to older authors telling their stories of love, sex, and loss.

Am I normal?

Because grief and bereavement are complex journeys, responses and behaviors can manifest in ways that may be uncharacteristic of one’s baseline personality. Grief tends to undermine decision-making processes and warp the sense of normality.

For instance, grief can pour water on all sexual fire an individual usually has. Energy typically spent in intimacy is now being rerouted to the hard emotional work during bereavement. So, while sexual bereavement is there as an emotional reality, physical sex drive may be absent.

Another authentic possibility within grief is a noted increase in sexual desire. This can be extremely shocking when a long-term sexual partner is gone, and one is left feeling a strong need to connect sexually.

According to science, it can be normal to feel the need to fill the void left by loss with sex. Orgasms and physical touch typically increase dopamine levels in the brain which elevate optimism and calms the nervous system. Oxytocin, the so-called “love hormone”, is also found in the intoxicating hormone cocktail produced with sexual pleasure. It stands to reason that having a rise in libido is the body’s way to seek pleasure when grief brings little.

Steps for healing

  • Accept your feelings around loss of sexual intimacy as both normal and appropriate.
  • If your sex partner is still alive but is unwell and unable to perform sexually, talk to them and find other ways to support intimacy.
  • Don’t compare your loss and bereavement to others.
  • Allow for time to grieve without outside timetables or agendas.
  • Identify one close person in your life with whom you feel safe and talk about your sexual loss.
  • Seek professional grief counseling or a grief support group, either online or in person.
  • If you experience physical sexual dysfunction during your bereavement, speak to your primary care provider. What may seem a normal part of grief may be a treatable medical issue separate from the grief response.
  • Grief and clinical depression are not the same. Speak to your primary care provider if you suspect mental health changes.

Grief is a complex human experience; so is sex. Sexual bereavement may arrive and complicate the process further. With gentle acknowledgment and conscious processing, this too may be overcome. Remember, you’re not alone in your natural human grief journey.

Complete Article HERE!

Why mourning a pet can be harder than grieving for a person

People are often taken aback by the intensity of pet grief.

By

Many pet owners know that our connections with animals can be on an emotional par with those we share with other humans – and scientific research backs this up.

The key ingredients of human attachment are experiencing the other person as a dependable source of comfort, seeking them out when distressed, feeling enjoyment in their presence and missing them when apart. Researchers have identified these as features of our relationships with pets too.

But there are complexities. Some groups of people are more likely to develop intimate bonds with their pets. This includes isolated older people, people who have lost trust in humans, and people who rely on assistance animals.

Researchers have also found our connections with our fluffy, scaled and feathered friends come with a price, in that we grieve the loss of our pets. But some aspects of pet grief are unique.

Euthanasia

For many people, pet death may be the only experience they have of grief connected to euthanasia. Guilt or doubt over a decision to euthanise a cherished companion animal can complicate grief. For example, research has found that disagreements within families about whether it is (or was) right to put a pet to sleep can be particularly challenging.

But euthanasia also gives people a chance to prepare for a beloved animal’s passing. There is a chance to say goodbye and plan final moments to express love and respect such as a favourite meal, a night in together or a last goodbye.

There are stark differences in people’s responses to pet euthanasia. Israeli research found that in the aftermath of euthanised pet death, 83% of people feel certain they made the right decision. They believed they had granted their animal companion a more honourable death that minimised suffering.

Man on bench looking at the ground holding a dog leash
Pet grief can make people turn inwards.

However, a Canadian study found 16% of participants in their study whose pets were euthanised “felt like murderers”. And American research has shown how nuanced the decision can be as 41% of participants in a study felt guilty and 4% experienced suicidal feelings after they consented to their animal being euthanised. Cultural beliefs, the nature and intensity of their relationship, attachment styles and personality influence people’s experience of pet euthanasia.

Disenfranchised grief

This type of loss is still less acceptable socially. This is called disenfranchised grief, which refers to losses that society doesn’t fully appreciate or ignores. This makes it harder to mourn, at least in public.

Older man holding pet dog outside
Older people often more isolated which makes their pets an important source of comfort.

Psychologists Robert Neiymeyer and John Jordan said disenfranchised grief is a result of an empathy failure. People deny their own pet grief because a part of them feels it is shameful. This isn’t just about keeping a stiff upper lip in the office or at the pub. People may feel pet grief is unacceptable to certain members of their family, or to the family more generally.

And at a wider level, there may be a mismatch between the depth of pet grief and social expectations around animal death. For example, some people may react with contempt if someone misses work or takes leave to mourn a pet.

Research suggests that when people are in anguish over the loss of a pet, disenfranchised grief makes it more difficult for them to find solace, post-traumatic growth and healing. Disenfranchised grief seems to restrain emotional expression in a way that makes it harder to process.

Our relationships to our pets can be as meaningful as those we share with each other. Losing our pets is no less painful, and our grief reflects that. There are dimensions of pet grief we need to recognise as unique. If we can accept pet death as a type of bereavement, we can lessen people’s suffering. We’re only human, after all.

Complete Article HERE!

14 Common Dreams About Dying

— And What They All Mean

By Ossiana Tepfenhart

Everyone has had a dream about dying at least once. Regardless of the cause of this dream about death, the whole concept of dreaming of dying is one of the most common nightmares people have.

Oddly enough, it’s also one of the most perplexing scenarios out there. But, believe it or not, dreams about dying don’t always imply death in a literal sense.

What does it mean when you dream about death and dying?

While dreams like this don’t mean you will die in real life, these dreams could mean a bunch of different things, all depending on the circumstances of the dream itself.

And despite feeling pretty ominous, many cultures believe that randomly dreaming of your death could be a sign that your death has died. In other words, it could be a sign that your fate changed for the better and that you’ll live a longer life.

In general, a dream about dying and death symbolizes inner changes, transformation, anxiety, discovery and positive development, and a fresh start. These dreams symbolically also relate to fear of the unknown, built-up resentment, grief, and trying to cope with your own mortality.

Death is a heavy subject, and it’s one that can take a lot of forms. For many people, death shows itself as a major loss. When we say something inside us died, we mean that it’s gone for good, and it’s rarely ever meant in a good way. As a result, a lot of the psychological dream interpretations about dying often will reflect this.

In many cases, having a nightmare about a family member, spouse, friend, or child dying can mean that you are afraid of losing them. It can also suggest that you may be harboring anxiety about the way they are changing, suggesting that you want them to remain the way they were when you first met them.

But there are also rage-related reasons why you might be dreaming about dying, too. Dreams of people dying can also suggest underlying anger or disappointment in some aspect of life. (It’s not unheard of, for example, for people who were victims of abuse to have dreams of their abusers dying pretty gruesome deaths.)

In some cases, dreaming of your own death could also be your brain’s way of giving you a metaphor for the way people abused you. People who are mistreated by others often will have dreams of themselves dying as a result of feeling useless or emotionally destroyed.

Above all, most dream analysts tend to see death dreams as a sign of confronting change.

The only thing that remains constant in life is change — and that might be why common dreams involve dying. This type of dream often represents a very final end and a brand new beginning. If you have recently undergone drastic changes in your life, this is the most likely reason why you’re dreaming of dying.

Adds Greg Mahr, MD, psychiatrist, author of “The Wisdom of Dreams,” and director of Consultation Liaison Psychiatry at Henry Ford Hospital in Detroit, “Dreams about dying are usually not literally about you dying; they are about an aspect of yourself dying, perhaps even an aspect that needs to die.”

The best way to figure out what your dream means is to take a look at your life to get a clue about what it could be. Death dreams often come as a result of having some tumultuous events in your life or are due to anxieties that could be causing you emotional distress.

Each dream is different, so it’s worth trying to figure out what the dream’s symbolism means to you.

What It Means If You Dream About Yourself Dying

Some people tend to have recurring dreams or nightmares about their own death. And while it can be a bit scary, this dream is actually a sign of change in your waking life.

This transitional phase will help you redirect your energy source and focus it more on your own mental health and well-being, rather than wasting it on others while neglecting yourself.

What It Means If You Dream About A Parent Dying

Generally, a dream about a parent dying acts as a wake-up call to focus your attention on how you approach life. This dream also indicates that you are experiencing stress and need to find a way to lessen it.

Dreaming about your father dying means you’ve been holding back from expressing your emotions, or that you are entering a new phase of the relationship with your parents, one based on comfort and support.

Dreaming about your mother dying relates to personal transformation, your own indecisiveness, or even missing a motherly figure in your life.

What It Means If You Dream About A Sibling Dying

Any dream about a loved one dying can be horrifying, and that’s especially true if you dream of a brother or sister passing away.

A sister dying in your dream indicates that you may have personal conflict with your close friends or family in real life, and need to take steps to remedy the situation.

If you dream of a brother dying, it is symbolic of the “death” of a brotherly friendship in your life, so it’s important to consider how you may be neglecting your friendships and, as a result, letting them die.

What It Means If You Dream About A Pet Dying

We all wish our furry friends could be with us forever, but part of owning a pet is realizing their mortality.

To dream about a pet dying relates to your desire to be a child again, not having to deal with the constant changes and responsibilities of adulthood. This dream can also indicate your need to step out of your comfort zone and try new things to become a more well-rounded person.

What It Means If You Dream About A Friend Dying

To dream about a friend dying indicates that you’re experiencing a change in a real-life friendship. Or, says Mahr, “If a dream is about a friend or lover dying, think about what aspect of you that person represents and how that aspect of you may be dying. That could be good or bad.”

Depending on how they appear in the dream, this determines the way you see them. In other words, those negative personality traits they have are “dying” in the waking world, as is your friendship with them.

What It Means If You Dream About A Child Dying

In general, the death of a child in your dream is about your own inner child and getting stuck in the struggles of daily life, meaning you aren’t spending time nurturing yourself.

If you dream about your own child dying, this also relates to your inner child, though it focuses more on trauma from the past, and moving on to live a better and brighter future.

Additionally, “Children are often potential, so a dream about a child dying may express a concern that a potential within you is dying,” adds Mahr.

What It Means If You Wake Up Before Dying In A Dream

Many times, people will have dreams about their own deaths; however, sometimes, they wake up right before they are about to die. Dream experts say that waking up before dying in a dream means our minds simply don’t know what lies beyond life, so we are unable to have that experience.

What It Means If You Dream About Dying From Suicide

Though suicide is a very serious subject, to dream about yourself dying from ending your life means there is some aspect of your life that you want to end. It could be a relationship, a career, or something else entirely.

What It Means If You Dream About A Boyfriend Dying

If you dream about your boyfriend dying, it means your relationship in the waking world is changing, both in the positive and negative sense. It could be that you two are simply drifting apart, that his behavior isn’t what it used to be, or that you will soon take the next step in your relationship.

What It Means If You Dream About A Girlfriend Dying

Similar to a boyfriend-involved death, dreaming of a girlfriend dying is your subconscious mind worrying about losing your partner. This dream also indicates that you may not want to be in the relationship anymore and wish to “free” yourself from its constraints.

What It Means If You Dream About A Stranger Dying

While many dreams about death involve people we know, sometimes we may dream of a complete stranger. This dream is a positive sign, however, and means that you will soon come into financial wealth. It can also indicate that you need to slow down and take your time making an important decision.

What It Means If You Dream About Dying In A Car Accident

If you dream about dying in a car crash or accident, this dream symbolizes the need to express your emotions. You may be holding them back for one reason or another, so consider it a sign to let it all out.

This dream can also mean that you must face your daily problems head-on, or that you need to approach life in a different way.

“Cars are usually symbols of the ego, of how we get around in the world. Car accident dreams are often a warning to be less reckless, to live more slowly and thoughtfully,” Mahr comments.

What It Means If You Dream About Dying From Drowning

Because dreams about water relate to emotions, dreaming about drowning means you’re suffering from emotional turmoil and are feeling overwhelmed as a result. This dream means you need to take the steps to overcome what you fear, and focus on renewal.

What It Means If You Dream About A Celebrity Dying

Dreaming about a celebrity dying indicates that they possess certain traits, and depending on what those traits are, it determines what they mean for you personally and how they relate to your life.

So, whether it’s their commitment to philanthropy, their talent, or even their negative attitude, it indicates that these specific qualities will soon come to an end in the real world.

Complete Article HERE!

What Is a DNR (Do Not Resuscitate) Order?

— Sometimes a “natural death” is the best option for everyone

by Angela Morrow, RN

A do-not-resuscitate order (DNR) is a legally binding order signed by a physician at a patient’s request. Its purpose is to let medical professionals know you do not want to be resuscitated if you suddenly go into cardiac arrest or stop breathing.

People who are chronically ill often regard a DNR as a graceful way to leave the world on their terms. The details of a DNR are usually discussed at the time of admission to a hospital, nursing facility, or hospice program.

This article explains what resuscitation means, its side effects, and its survival rates. It also describes the rules that often frame do not resuscitate orders, how to make a DNR order work for you, and some of the ethical issues worth considering.

What DNR Means

You may have seen TV shows set in hospitals in which a patient in cardiac arrest gets cardiopulmonary resuscitation (CPR), comes back to life, and is back to their old self in no time. In fact, being resuscitated is not so simple and can be dangerous in its own right.

Procedures used to resuscitate someone include:

  • Chest compressions: When a person’s heart stops beating, the heart cannot pump blood to the rest of the body, including the brain and lungs. Pushing down on the chest repeatedly can help keep blood flowing throughout the body until heart function is restored.
  • Intubation: When breathing becomes difficult or impossible due to an illness or injury, a patient may be intubated. This involves inserting an endotracheal tube through the mouth and into the airway. The tube is then connected to a ventilator, which pushes air into the lungs.
  • Cardioversion: Cardioversion is used to correct abnormal heart rhythms, including arrhythmias and atrial fibrillation (also known as AFib). This may be done using a set of paddles to deliver an electrical shock to the heart or via medication.
  • IV medications: Medications that are sometimes used in the case of cardiac arrest include epinephrine, amiodarone, vasopressin, and atropine sulfate. These are “crash cart medications,” so named because they can be found on the wheeled cart that medical professionals use during an emergency resuscitation.

For a patient in cardiac or respiratory arrest, a DNR states that none of these tactics will be used.1

Respiratory vs. Cardiac Arrest

The difference between respiratory and cardiac arrest is that respiratory arrest patients still have a beating heart that’s pushing blood around the body. Cardiac arrest patients do not. In both cases, though, a patient is unconscious and not breathing. Respiratory arrest will always lead to cardiac arrest if nothing is done to treat it.2

Resuscitation Side Effects

It’s important to realize that even if you are successfully resuscitated, you may end up with significant physical injuries as a result. For example, because the chest must be compressed hard and deep enough to pump the blood out of the heart, it can lead to broken ribs, punctured lungs, and possibly a damaged heart.3

Those who are resuscitated may also suffer brain damage. This can occur due to lack of blood flow to the brain followed by abnormal cell activity when blood flow to the brain is restored. Generally, the risk increases the longer the duration of CPR.4

Resuscitation Survival Rates

Survival statistics for resuscitation vary widely, partly due to the fact that there are many variables involved, including the age and health status of the patient and whether CPR was performed in a hospital, where emergency support is available.

A 2021 review looked at research published from 2008 onward that focused on the outcome of CPR in patients age 70 and older following in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Survival rates were 28.5% and 11.1%, respectively.5

Meanwhile, a Danish study found that 30-day survival rates among nursing home residents who received CPR after OHCA was only 7.7%6

Fatal Outcomes

It’s a painful irony that most people who suffer cardiac arrest are not in a hospital, nursing facility, or hospice program. About 70% of them are at home, and the vast majority (about 90%) die. CPR can double or triple a person’s chance of survival.7

Types of Orders

A DNR order is sometimes referred to by other names, though the directive not to resuscitate someone is the same. Two other names for these orders are:

  • No code: In a hospital, an order to withhold resuscitation is sometimes called a “no code” to distinguish it from a “full code” or “code blue,” both of which mean every effort should be made to resuscitate a patient.
  • Allow natural death (AND) orders: While a DNR order simply states that no attempts should be made to restart breathing or restart the heart if it stops, an AND order ensures that only comfort measures are taken.8 This would include withholding or discontinuing resuscitation, artificial feedings, fluids, and other measures that would prolong a natural death. These orders are typically used in hospice settings or elsewhere for terminally ill patients.

Discussion Matters

A study on DNRs and ANDs finds “healthcare providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.”8

DNR Order Rules

The application of DNR orders varies from state to state, especially regarding out-of-hospital (meaning ambulance) care. Some states have standardized forms for DNR orders; if the order is not written on that specific form, it cannot be honored. Other states are less regimented and honor any type of clear DNR order.

Many states allow emergency responders to follow DNR orders written to other care providers, even if they aren’t written on standardized forms. For instance, in New York State, paramedics and emergency medical technicians are usually allowed to follow DNR orders written for the staff of a nursing home.

They also may be able to honor orders written for patients getting nursing care at home if the home care nurse has a copy of the DNR order in hand.1 Each state is different, and municipalities may differ within each state.

Regardless of the format or the venue, DNR orders almost always follow some of the same general rules; they have to in order to be valid. DNR orders must:

  • Be written by a doctor rather than verbalized.9 There are exceptions to this rule, such as an emergency medical service physician ordering an ambulance crew to withhold resuscitation via the radio or a registered nurse taking an order from an admitting doctor over the phone.1 Generally, there are safeguards for these exceptions to make sure the order is validated later.
  • Be signed by a doctor. In those cases where orders were taken by a nurse over the phone, states usually set a deadline for the doctor to physically verify and sign the order.
  • Include the patient’s name as well as the date. Depending on the state, orders may expire after a certain amount of time or there may be a deadline for the physician to follow up. Even if a DNR order doesn’t expire, a particularly old order may prompt a caregiver to revisit the decision.
Diligence on DNR Orders

A doctor writes a DNR order only after conferring with the patient (if this is possible), the patient’s appointed representative, or members of the patient’s family.

Making a DNR Order Work for You

If you opt for a DNR order, here’s what you can do to ensure your wishes are respected:

  • Keep the physical order on hand and display it wherever paramedics might find you. Make a point to tell them about the order when they arrive. It’s a good idea to have more than one copy available and displayed, as well as a copy to bring with you to the hospital.
  • If you are traveling, ask your traveling partners to keep a copy of your DNR order on them at all times.
  • Consider wearing a piece of medical jewelry to alert others of your intentions. MedicAlert Foundation provides jewelry designed specifically for patients with DNR orders. The foundation keeps a copy of the order on file and can fax it to anywhere in the world.

DNR Expresses Limits

A DNR order addresses the issue of CPR, but it does not include instructions for other treatments, such as pain medication or nutrition.10

Ethical Complications of DNR Orders

The inconsistent application of DNR orders means some patients may get less than optimal care once providers are aware of the presence of a DNR order.11 It’s important to remember that a DNR order is not an order to withhold all treatment. It’s an order not to resuscitate.

Even the mere mention of “DNR” can spawn a wide range of reactions, many of them emotionally charged. Discuss the options with your doctor and your family when everyone is calm and rational—and hopefully sooner rather than later.

Why a Patient Would Choose to Have a DNR Order

People with a terminal disease, such as advanced cancer or dementia, may not want CPR. A poor prognosis lowers the likelihood of survival, with a higher risk of heart, lung, and brain damage if resuscitation is attempted. Views on CPR within the medical community are ever-evolving too, with some professionals revisiting guidelines on how and why resuscitation should be considered.12

Summary

A do-not-resuscitate order instructs healthcare providers to refrain from cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. It can also pose a dilemma, but one worth considering, especially in the context of your health (or the health of a loved one).

Here’s why: CPR requires the heart to be compressed hard and deep enough to pump the blood out of the heart. As such, it can lead to broken ribs, punctured lungs, and possibly a damaged heart. Those who are resuscitated may also suffer brain damage.

These actions may be too much for someone in frail health. If you wish to explore a DNR order, it’s important to know that the orders vary from state to state. Be sure to investigate the rules in your state before proceeding.

A Word From Verywell

Understandably, loved ones often have difficulty talking about a DNR order and may feel they are “giving up” on their loved one. You can take charge of your end-of-life plans while you’re still able to do so, and investigate the rules governing DNR orders in your state. Keep in mind that even if you get a DNR order, you have the right to change your mind, revoke the order, and request CPR.10

Frequently Asked Questions

  • How do you get a do-not-resuscitate order?

    You can get one from a hospital, nursing home, or hospice program. Most states have standard forms that you can download online.

  • Who can sign a do-not-resuscitate order?

    A doctor must sign a DNR order with the consent of the patient or the patient’s healthcare proxy or designated power of attorney.9

  • Can a DNR be ignored?

    The Patient Self Determination Act (PDSA) requires that the wishes of an individual and any existing advance directives be honored in the United States. However, providers do occasionally disregard a DNR due, for example, to lack of communication.13 It’s also possible that an existing DNR is honored but providers fail to confirm with a patient or their representative.14

  • Complete Article HERE!

Visiting Mariah Carey’s Cat’s Grave

— Reflections on Disenfranchised Grief

E.B. Bartels on the Particular Sorrow of Losing a Pet

The grave I was looking for was in a quiet back corner of the cemetery, surrounded by trees. I was grateful for the shade—it was August in Westchester County, and the place was hot. Asphalt pathways criss-crossed rows of blinding granite headstones; my black dress clung to the sweat on my back. I’d spent the afternoon walking up and down the paths of this four-acre cemetery. Bright spots of metallic pinwheels, Mylar balloons, and neon stuffed animals decorated the headstones. Flowers wilted in the summer sun.

Under the trees, weaving through the graves, I found the marker: pink granite, engraved with hearts. Clarence, it read. My eternal friend and Guardian angel. You’ll always be a part of me forever. And underneath, obscured by flowers: love, M.

I had read about Clarence. I knew he was a loyal friend, kind, affectionate, sweet. Even though he ran with a famous crowd, he didn’t seem to care about money or celebrity or power. He valued the simple things in life. I studied the dates under Clarence’s name: 19791997. Clarence was eighteen when he died— by most cemeteries’ standards, painfully young. But in this cemetery, in Hartsdale, New York, eighteen is a good, long life.

I was looking at the grave of Mariah Carey’s cat.

When we open our hearts to animals, death is the inevitable price.This was not my first celebrity pet memorial. I’ve sat at the grave of Donald Stuart, Royal Nelson, and Laddie Miller—Lizzie Borden’s Boston terriers—their headstone engraved with the phrase sleeping awhile. I visited Pet Memorial Park, in Calabasas, California, where Hopalong Cassidy’s horse, Rudolph Valentino’s and Humphrey Bogart’s dogs, Charlie Chaplin’s cat, and one of the MGM lions are buried.

I traveled to the outskirts of Paris to see Rin Tin Tin’s grave in the Cimetière des Chiens et Autres Animaux Domestiques. I’ve said a prayer standing over the final resting place of America’s hero racehorse Secretariat, in Lexington, Kentucky. But every time, what impressed me more than the celebrity pet graves was all the headstones that surrounded them.

Celebrities are not alone in burying their dead pets. To the left and right of Clarence’s pink granite tombstone were hundreds of graves for other animals belonging to regular people. These memorials were no more or less lavish than the headstone Mariah had engraved for Clarence. If I hadn’t known about the telltale love, M on Clarence’s stone, I wouldn’t have been able to distinguish his grave from any of the others. Celebrities, I thought, studying the two hearts flanking Clarence’s name. They’re just like us.

By the time I visited Hartsdale, I’d already had a long personal history with pet cemeteries; in fact, I went to high school next to one. My school was of the New England prep variety, with facilities better than those at many colleges, on a gorgeous green campus in Dedham, a suburb southwest of Boston. This was the sort of school that carefully curated its image, boasting of athletic alumni competing in the Olympics, generations of legacy students, high SAT scores, and extremely competitive Ivy League acceptance rates. Less present in its marketing materials: that the school is located next to several thousand dead animals, buried in the Animal Rescue League of Boston’s Pine Ridge Pet Cemetery. Pine Ridge was the first official pet cemetery I knew of, but there are more than seven hundred of them scattered throughout the country.

By the time I was fourteen and first saw Pine Ridge, I’d already loved and lost many companion animals. I also loved to read, and, frankly, young adult literature is full of dead pets. “I remember that awful dread as the number of pages shrank in each new animal book I read,” writes Helen Macdonald in her memoir H Is for Hawk. “I knew what would happen. And it happened every time.” What happens in Old Yeller? The dog dies. In Where the Red Fern Grows? Two dogs die. The Red Pony? The pony dies. Tales of a Fourth Grade Nothing? The turtle dies.

In this way, grieving pets is a disenfranchised grief, which can make it hard to know how to process and honor it.I could go on.

When we open our hearts to animals, death is the inevitable price. Jake Maynard, in his essay “Rattled: The Recklessness of Loving a Dog,” writes that loving an animal is “mortgaging future heartbreak against a decade or so of camaraderie.” Matthew Gilbert, in his memoir Off the Leash: A Year at the Dog Park, writes, “In the course of an average human lifetime, pots and pans and couches and lamps stay with us for longer stretches of time. Even beloved T-shirts survive the decades, the silk-screened album images and tour dates wrinkled and cracked but still holding on. With a dog, you’re on a fast train to heartache.”

Yet people keep getting pets. As of the writing of this, 67 percent of American households, 84.9 million homes, own “some sort of pet,” according to the American Pet Products Association. And yet, despite those millions of pet owners all over the globe, and despite the inevitable loss that comes with that relationship, the ways people grieve a dead pet aren’t always taken very seriously.

Imagine Mariah canceling a world tour due to “a death in the family.” If her mother died, of course people would understand, without question. She would get cards and flowers; fans would send encouraging, sympathetic messages. But if Mariah put off a tour to mourn for her cat Clarence? Some fans would get it, I’m sure, but she would also certainly become the butt of thousands of jokes on social media.

For every pet that’s died, the one thing they’ve had in common has been my feeling of not knowing what to do with my grief—I could do everything, anything, nothing.Fiona Apple actually did postpone her South American tour in 2012 to spend more time with her dying pit bull, Janet, publishing a handwritten note explaining her reasoning to fans on her Facebook page. (Apple would later play percussion using Janet’s bones in a song on her album Fetch the Bolt Cutters.) Thousands of fans wrote supportive messages—it seems on brand that Fiona Apple fans would get it—but there were also ugly comments the moderators had to delete. Pets don’t live very long. They’re going to die. What were you  expecting? Taking time off from work to grieve for your pet as you would for a human—some say that’s too much.

In this way, grieving pets is a disenfranchised grief, which can make it hard to know how to process and honor it; but there’s freedom in that, too. With social acceptance come social standards and expectations. The human funerals I’ve been to run together in my mind.

I grew up in an Italian Irish Catholic household in Massachusetts, so to me the death of a person meant the same open casket, the same Bible verses, the same laminated prayer cards and stiff black clothes, the same taste of funeral home Life Savers, the overpowering scent of day lilies, the post-funeral deli sandwiches. Different cultures have different traditions, but every culture typically does have its own set of mourning rituals—for humans. The rituals may feel tedious and repetitive at times, but they also offer stability and closure. There is comfort in the expectedness. Even in the “spiritual not religious” memorial services I’ve been to, I see patterns: the same large-format photos of the deceased, the same Dylan Thomas poem, the same covers of “Make You Feel My Love.”

There’s no guidebook for mourning your animal. Some people keep urns with their animals’ ashes on their mantels for decades; others bury their pets (sometimes illegally) in their yards. Some knit scarves out of their cats’ fur; others have their dogs taxidermied. Some immediately go out and get a new puppy or kitten; others vow never to love again.

Taking time off from work to grieve for your pet as you would for a human—some say that’s too much.When your pet dies, it’s possible you’ve never seen anyone else grieve for a pet. There’s a good chance you won’t have a model to follow. My family cremated one of our dogs and spread his ashes by a lighthouse; another I carried home from the vet wrapped in towels, and we buried her in our yard. I made a small cemetery behind my childhood home to entomb my birds and fish; we never acknowledged the inevitable death of the tortoise that went missing.

For every pet that’s died, the one thing they’ve had in common has been my feeling of not knowing what to do with my grief—I could do everything, anything, nothing. I often wished for an encyclopedia of options, a guidebook to help me figure out how best to honor my departed animal friends, to both grieve for and celebrate their lives. I want my book, Good Grief, to be that guide.

That August day in Hartsdale, it struck me that every animal was buried there intentionally. No pet is buried in a cemetery because the law requires it; pets are buried in a cemetery because a human wanted them to be there. It doesn’t matter if it is the Jindaiji Pet Cemetery, in Tokyo, or Pet Heaven Memorial Park, in Miami—worldwide, throughout history, the love is the same, and the people who honor their pets in this way understand one another.

As I sat by Clarence’s memorial, I watched a woman visit her pet’s grave. She borrowed scissors from the cemetery office to trim back the grass around the stone. A few rows over, a man carried a bouquet of flowers. He approached the woman to borrow the scissors; she gave them to him with a nod. No judgment in the exchange, just one pet person to another. When you get it, you get it.

Complete Article HERE!

A Son’s Decision to Help His Father Die

— Ben Griffith’s dad chose a method to end his life that was controversial — but protected by a Supreme Court ruling

John Griffith in 1989 cradling granddaughter Jordan.

By John Rosengren

1990: The right to refuse medical treatment

Ben Griffith rose before the sun the morning of March 18, 2022, packed his car and began the long drive from his house in Frankfort, Ky., to suburban Kansas City, Mo. The time had come to help his father die.

Months earlier, when John Griffith made clear to his three sons that he would end his life by denying himself food and drink rather than go into an assisted-living facility, his two older sons objected. Only Ben, the youngest at 67, agreed to keep vigil with his 99-year-old father. Now that John’s quality of life had deteriorated to the point where he would rather die than have his misery prolonged with unwanted treatment in assisted living, Ben was heading to his father’s house.

From their many conversations on the subject over the previous decade, Ben knew his father would have chosen the route of assisted suicide if it were legal in Missouri, as it is in 10 states and the District of Columbia. But it wasn’t. In September 2021, in a power-of-attorney directive, John had given his sons the authority, in the event that he was incapacitated, “to direct a health care provider to withhold or withdraw artificially supplied nutrition and hydration (including tube feeding of food and water).” Now, instead of assisted suicide, John had opted to voluntarily stop eating and drinking, a process known in right-to-die circles by the acronym VSED. The process generally takes between seven and 15 days. Because it can be painful, many who opt for it also seek palliative care through hospice services — which is what John Griffith did.

Seated at the kitchen table of his Frankfort home and surrounded by family photos, Ben recounts his father’s experience with life and death. (Ben participated fully in this article; his eldest brother, Tim, did not comment; his elder brother, Jon, offered this comment: “I just know that Ben did a great job representing the family and our experience of going through VSED with Dad. I don’t need to add anything more.”)

There’s a frost threatening that evening, so Ben and his wife, Patricia, have moved inside a dozen or so plants now safely perched along the kitchen counter. Ben, a piano tuner with short gray hair, is tall and lanky like his father, who was 6-foot-4. His words occasionally give way to emotion. His soft blue eyes, also like his father’s, are warm and kind.

John Griffith — born Dec. 12, 1922, in South Carolina, the son of a Methodist minister — was a man of such strong principles and resolve, he bordered on obstinate. Despite widespread public support for the United States’ involvement in World War II, Griffith at 19 opposed war “for any cause whatever” and refused to register for the draft, which he considered a “contradiction of Christian teachings, democratic liberty and individual freedom.” Instead, as he wrote in an essay for the book “A Few Small Candles: War Resisters of World War II Tell Their Stories,” he served 24 months in federal prison.

The influence of a Quaker attorney willing to defend him pro bono sparked John’s conversion to the Religious Society of Friends. After his release from prison, he attended William Penn College, a Quaker institution in Oskaloosa, Iowa, where he met and married Reva Standing. They raised four sons. Griffith spent his working career managing a farmers cooperative. When their oldest son, Chris, was murdered in 1986, Griffith stuck to his pacifist convictions and opposed the death penalty imposed on his son’s killer.

Reva suffered a stroke in 2003 and showed early signs of dementia in the hospital. Despite his belief that it was wrong to end another’s life in war or by capital punishment, John made the decision to honor her wishes and remove his wife of 56 years from life support in what he considered an act of compassion. “It was clear if she came home, there would be a loss of brain function,” Ben says. “He knew one of her biggest fears was living with dementia.”

Neither father nor son could bear watching a loved one suffer unnecessarily — a point driven home by the experience of Ben’s mother-in-law. In 2016, when Patricia’s 93-year-old mother began losing her sight, she moved into an assisted-living facility and eventually a nursing home after going completely blind. “She fell gradually into a shell,” Ben says. “Her existence was getting not very good.”

 

It was so painful for Ben to watch that he started searching online for ways he could end her life to put her out of her misery and not get arrested. But his father urged him not to do anything that would have negative consequences for his wife and their two adult children. Ben tears up at the telling. “I could have ended her life,” he says. “She suffered — but he said, ‘Don’t do it, Ben.’ ”

Her ordeal seemed to spark something in John. Already into his 90s by then, he began contemplating the end of his own life, which he discussed openly with his sons. Patricia’s mother’s situation “cemented the idea for him: If you go into assisted living, you lose a lot of choices,” Ben says. “If something happens, they call for help. You go to the hospital and they treat you. Same thing if you are in a nursing home. If you’re unresponsive, they are going to treat you.” John made it very clear that he did not want to go into assisted living or a nursing home.

A man as spiritual as he was stubborn, John had meditated daily for years, an hour or so at a time, an essential part of his religious faith and practice. He also swam a mile most every day at the local YMCA. At 90, he set eight state swimming records for nonagenarians on his daily swim, according to Ben. He had decided that once he could no longer swim, life would no longer be worth living and he would begin VSED. “He had identified the red line,” Ben says.

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John “had his last swim at 98,” Ben recalls. His “will to live” did continue, but he was losing physical strength. He was having trouble walking and would soon have to use a wheelchair. And he felt himself slipping cognitively. So that’s how he came to fill out his health-care directive in September 2021. With the help of Compassion & Choices, a nonprofit organization that advocates for access to aid in dying, he also filled out an advance directive addendum indicating his desire throughout various stages of dementia that others “keep me comfortable while stopping all treatments and withholding food and water so that I can die peacefully.”

That fall John discussed his VSED intentions with his primary care physician, who did not approve. The doctor tried to talk John out of the idea over the course of several visits. But John would not be dissuaded.

He informed his sons of his plans in a Zoom call. The two older sons protested. Tim, who had been his father’s primary caregiver, taking him to appointments and helping him at home, tried to persuade his father to move into assisted living instead, according to Ben. But their father refused. He would stay in the two-bedroom townhouse he and his wife had lived in for years and die by his own design. There was no talking him out of it. “If he was going to do something, he was going to do it,” Ben says.

From left: John Griffith celebrating his high school graduation in 1940; with wife Reva in a wedding photo from May 1947.

Though Tim and Jon would visit, they did not want to be accomplices to VSED; Ben alone agreed to be with their father continuously throughout the process. “I felt it was an act of love,” Ben says.

In January 2022, John developed a cough. The prescribed medication he took for it made him confused, even after he stopped taking it. He had trouble focusing during his meditation. He began to notice “a sharp decline, both in memory and in my ability to make decisions,” he wrote in a letter to family, friends, neighbors and his spiritual community. In February, he was diagnosed with dementia.

Physically, he was also failing fast. He could no longer stand on his own. He needed the help of home health-care attendants using a lift device to get from his bed to his wheelchair and back again. He was outfitted with a catheter. By late February, his quality of life had sunk to the point of no return. “It’s exhausting to get through every day,” he explained in his letter. “I’ve had a good life. I think the time for VSED is now.” In another Zoom call with his sons, he told them the same. He eventually set March 19 as the date to begin his life-ending fast.

Ben and his brothers hired a hospice service to provide palliative care. But the assigned chaplain, a Catholic priest, said he could not in good conscience minister to someone committed to dying by their own doing. Another chaplain, who was not Catholic, took his place.

“While I agree with the Court’s analysis today, and therefore join in its opinion, I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field. … This Court need not, and has no authority to, inject itself into every field of human activity where irrationality and oppression may theoretically occur, and if it tries to do so it will destroy itself.”— Justice Antonin Scalia, concurring, Cruzan v. Director, Missouri Department of Health

Others objected, too. Some covertly, some overtly. His next-door neighbor did not disagree with his decision explicitly, though she did come over to read the Bible with John. “She wanted to make sure he was right with Jesus,” Ben says. Once John began the VSED process, Ben says, she stopped visiting.

A key word in the 14th Amendment’s due process clause is “liberty,” a concept that runs deep in the American psyche. “We think of it in terms of: Each individual person controls their own body, especially if you’re an adult and competent,” explains Rob Gatter, a professor at Saint Louis University’s law school and director of its Center for Health Law Studies. “It’s the same reason motorcyclists get mad when states say you have to wear a helmet: … I’m a competent adult and I don’t need the state to be my parent. I make choices for myself understanding if I’m wrong I suffer the consequences. My body does not belong to the state. My body belongs to me.”

Ben arrived at his father’s townhouse in Gladstone, Mo., about 3 o’clock the afternoon of March 18, having driven the better part of 11 hours. He had braced himself for the ordeal, knowing it could become more difficult if his father wavered and requested food or water. Ben could not deny him that. “It’s voluntary,” Ben says. “If a person wants food or water, you give it to him. I had done my homework with Compassion & Choices and read their list of guidance. It says remind the person, ‘Dad, you know you’re doing VSED. If you take ice chips or water, it’s going to delay the process.’ I prepared before I left for that.”

Ben found his father in good spirits. “I am convinced that there is something more: that human consciousness is independent of the body and that the death of the body is not an ending of consciousness — it is rather a passing,” John had written a couple of weeks earlier. “Into what? I confess that I do not know, but I have a deep, abiding trust in the Divine Ground of all existence that the major world religions have variously called God, Mind, Allah, Tao, etc. My parting wish for my friends is that they nurture compassion and walk humbly in the presence of Unfathomable Mystery.”

In addition to the hospice staff coming and going and a home-health caretaker on duty 24/7 beginning March 19, there was a stream of visitors to John’s house the first several days. Neighbors, fellow Quakers and other friends stopped by to spend time with him. John made small jokes at times and laughed with them. Tim and his family also visited. Tuesday, March 22, John was happy to see his son Jon, who arrived from Vermont. He had energy to send some emails. He spent half an hour being interviewed over the phone by someone from Compassion & Choices, which tired him out. The hospice team gave him a bath. Several times a day, Ben gave him the medications prescribed by the hospice nurse — Haldol to ease anxiety and hydromorphone to soothe pain — by squirting them into his mouth with a syringe.

By Wednesday, the fifth day of his fast, John was weakening. It was more difficult for him to get in and out of his wheelchair, even with the power lift. The hospice nurse added lorazepam to John’s list of medications to help him relax. The next day, Thursday, he was talking less, and when he did speak, he didn’t make much sense. He insisted on getting out of bed at one point, then drove his wheelchair into the kitchen but did not seem to know what to do once he got there.

John Griffith on his 90th birthday in 2012, with sons, from left, Jon, Ben and Tim, holding Sammie the dog.

By Friday, March 25, John’s face had lost its color, and his eyes had dulled. One of the nurses tended to his feet and lower legs, which had swollen with fluid. Ben began to sense his father’s life would soon be over.

The process was difficult to watch. Some couldn’t. Matt, married to Tim’s daughter, found it too upsetting to interact with John when he visited. But Ben stayed the course. “I was trying to keep in the role of making sure it happened,” Ben says. “I was the protector of the process.”

At one point during the week, someone informed Ben that a caregiver was swabbing his father’s mouth with a sponge soaked in juice — despite being given clear instructions that they were not to give him any food or liquid. Ben had to go into his father’s bedroom and stop her. “It’s really hard for some people to hear that someone isn’t going to eat or drink anything until they die,” he says.

So hard that others want to intervene. But the law is clear. “A physician who treats a patient against their will — even to save their lives — would be guilty of battery,” Gatter says.

Ben worries the Supreme Court’s recent ruling overturning the right to abortion could cloud the right to refuse treatment. “How can you tell a person you cannot make your own decision?” he says. “It’s their legal right. Who’s going to take that away?”

By Saturday, March 26, eight days into his fast, it was clear John had neared the end. He lay on his side in the fetal position, clutching the rails of his hospital bed and moaning. Ben had been sleeping at his brother Tim’s house, a 15-minute drive away, but he decided to spend that night at his father’s townhouse.

A little after 1 a.m. on the 27th, the nighttime caregiver woke Ben and told him death was at hand. Ben found his father still in the fetal position, breathing very slowly. He laid his hand on his father’s shoulder and leaned over him so that his lips nearly brushed his father’s ear. “It’s okay,” he said. “Let your body go. We love you.” And within a few minutes, John Griffith was gone.

Complete Article HERE!