Month: April 2023

Posted on

This is how to deal with the heartbreak of losing a pet

— Because it’s often far more painful than any of us let on

By Megan Hotson

From dogs and cats to tortoise and fish – there are few small animals we haven’t brought into our homes and loved as pets over the years.

According to research from the UK Pet Food Manufacturers’ Association (PFMA) 62% of households in the UK were said to have owned some kind of pet in 2022, making us an undeniably animal-loving nation.

Despite this fact (and the reality that there are people losing their animals daily), we tend to shy away from discussing our feelings when it comes to pet grief.

In one 2019 study, researchers found that 25% of owners ‘took between 3 and 12 months to accept the loss of their pet, 50% between 12 and 19 months, and 25% took between 2 and 6 years, to recover’.

Clearly, more of us are struggling than we might care to recognise. So, we spoke to grief and bereavement expert, Lianna Champ, about the best ways to remove the stigma and tackle this strangely taboo issue.

With over 40 years’ experience and a practical guide, How to Grieve like a Champ, under her belt, Lianna is an expert in how to deal with loss of any kind, including your pets. This is what she told us.

Give yourself permission to grieve

One of the most important things we can do, according to Lianna, is to be honest about our feelings and recognise that they are valid. After all, ‘grief is grief,’ she explains, adding that some people can often feel more pain from the loss of a pet, than a relative. ‘It is important to allow yourself to feel devastated by losing a pet and understand the significance of the relationship you had.’

While those without pets might not be as sympathetic, that doesn’t mean these feelings of loss can be any less painful, says Lianna. ‘What determines the level of grief felt is not whether the loss relates to a human or animal, but rather the strength of the relationship between the person grieving and the human or animal that has sadly passed away,’ she says.

Don’t shy away from discussing your feelings

Most of us will drone on for hours about the joy that comes with owning pets. And yet when they die? We’re often silent on the matter, reluctant to discuss or admit the pain which comes with losing an animal.

According to Lianna, human grief is something we are more likely to take time out for to seek help, or work through properly, meaning that we are often better positioned to cope with its effects. But when it comes to animals, the same just can’t be said. Often, she explains, ‘it’s because we feel that we don’t have societal permission to grieve in the same way as we would with humans

One way to feel more comfortable about grieving the loss of a pet, Lianna suggests, is to regularly talk or share stories about your pet with people around you. This, she says helps to set up a support network of people who know just how much that pet meant to you and will already have a level of understanding if you happen to then lose a pet.

Recognise the impact losing a pet can have on wellbeing

The physical and mental health benefits of owning a pet are well known, from a dog’s ability to get you out walking in the fresh air every day, to the soothing, stress-busting capacities stroking a cat can elicit. In fact, research conducted last year found that owning a pet, especially for five years or longer, may be linked to slower cognitive decline in older adults.

Then there’s the unconditional element of the love a pet offers – something which is too often overlooked, says Lianna. Unlike those complicated relationships with our fellow humans, the relationships we have with pets are free from conflict, or compromise.

‘Humans often treasure the unconditional love and comfort they can get from a relationship with an animal because pets don’t get caught up in drama like humans do,’ explains Lianna. The wellbeing impact of that ‘drama’ can be significant too – research from 2020 found that troubled (human) relationships can double our risk of depression and anxiety disorders.

So, when someone says losing their pet was harder for them than losing a relative, believe them. After all, many pet owners might not form the same type of relationship with humans, meaning their grief for their animal could be the strongest emotional reaction they have to death, explains Lianna.

Be honest with your kids about the loss

When it comes to communicating the death of a pet with children, Lianna urges parents to prioritise honesty as much as possible. ‘This is because losing a pet can be a positive way to educate kids on how death is a natural and expected part of life,’ she explains.

A part of this honesty is trying not to conceal your own emotions fully in front of your children in a bid to shield them. ‘Your raw emotions might act to provide comfort and show humility to a child who also feels upset and wants a figure to relate or talk to about their feelings,’ she emphasises.

Alongside this, Lianna outlines the importance of using language that is easy to understand as a way of helping younger children grapple with death. ‘Given the complexity of the concept, honesty and clear vocabulary are key to teaching your children how natural the process is.’

So, avoid confusing euphemisms like “passed away”, “gone to live over the rainbow” and “moved on” etc. Instead, explain to them clearly and precisely what has happened, and be ready to give them the support they need.

Don’t rush to replace your lost pet

Lianna suggests that we tend to replace our pets soon after they die as a quick fix solution to cover up feelings of loss. However, this won’t necessarily help you. ‘Buying a new pet to replace another prevents us from sitting with the grief to accept it and move on in a healthy way,’ she says. ‘It also makes it harder to form a bond with your next pet if you do not leave time to grieve in-between.’

As for your kids? While replacement is a popular course of action, substituting your pet with another could have a damaging effect on your children’s understanding of death. ‘Replacing a pet without explaining to the child what has happened or why it has happened will minimise a child’s relationship or affinity to their pet,’ she explains. ‘Telling your child, “you can go Buy a new one on Monday” will prevent them from working through their loss in an open and healthy way.’

eed something else to help with the heartbreak? Here are three different things you can help your child, or family cope with the emotional heartbreak of losing a pet.

3 WAYS TO COPE WITH PET GRIEF

According to grief expert Lianna Champ

  1. Find an appropriate way to commemorate. You could cremate, bury, or perhaps plant a tree to celebrate the life of your deceased pet. Commemorating and celebrating the end of their life can be a really key and special part of the bereavement process.
  2. Share and celebrate memories. Displaying photos of your pet who has passed away in your house, or sharing them with others, is a nice way to feel their presence after they are gone and remember their legacy. You could even get your children to create memory boxes, or scrap books as a way to work through your loss collectively.
  3. Volunteer at an animal sanctuary. It can be hard for families that have lost a pet to form a bond with another pet straight away. Instead of buying a new pet, try volunteering with other animals – it’ll help you work through your loss whilst being surrounded and comforted by other animals.

Complete Article ↪HERE↩!

Posted on

End of life care: medical, emotional and spiritual support

— End of life care can be varied, holistic, and filled with love. We look at two end of life services – hospices and end of life doulas – that show how medical, emotional, and spiritual needs can be looked after in different settings.

By

What is end of life care and what is palliative care?

There’s a lot of confusion around palliative and end of life care. For starters, although related these two terms do not describe the same thing – they are distinct.

Receiving palliative care doesn’t neccesarily mean you’re dying – rather that this kind of care is for people with incurable diseases, many of whom could or will live for many more years or decades. It’s about making life as manageable and as good as it can be.

End of life care is a form of palliative care you are given when you’re approaching end of life – it offers support and is wide-ranging and holistic.

When does end of life care start?

From a healthcare perspective, end of life care may be recommended if you are likely to die within the next 12 months, although this can sometimes be hard for doctors to accurately predict. End of life care may last a few hours, days, weeks, months, or sometimes more than a year – the only rule is that it begins when you need it.

Who provides end of life care?

End of life care doesn’t just take place in a hospital or hospice with doctors and nurses. Depending on your needs and care plan, you could receive various forms of this care at home, over the phone, or at specialist day centres. A whole host of specialists and non-specialists can deliver end of life care.

Specialists include palliative care physicians and nurses – such as Marie Curie and Macmillan nurses – but also counsellors, social workers, bereavement therapists, speech therapists, religious or spiritual carers, and many others.

Non-specialists are made up of people in your community who have different roles to play in your care. These include district and practice nurses, GPs, and pharmacists.

This should give an idea of how varied and personalised end of life care services can be.

What services are available for end of life care?

Here we take a look at two important forms of care that showcase the range of services available.

  • Hospices – hospices are specialised healthcare spaces for palliative and end of life support. Yet, hospice care extends beyond hospice beds and medical treatment.
  • End of life doulas – outside of your medical needs, doulas offer emotional and spiritual care, and they can do this inside or outside of the hospice setting.

Spotlight on: hospice care

In hospices, specialist palliative and end of life care is delivered by a multi-disciplinary team, made up of people who have different roles in a person’s care. This includes doctors, nurses, physiotherapists, occupational therapists, complementary therapists, counsellors and chaplains.

Jodie Morris is deputy director of nursing and care at Myton Hospice. She explains how hospices offer so much more than medical treatment:

“Hospices are happy places full of love and laughter where families can create special memories and spend quality time with their loved ones. This isn’t just about medicine – it’s about whatever is important to the patient and their family and friends. We take a holistic approach and see the person – not their illness.

“At Myton, we provide support right from the moment a person is told that their illness cannot be cured until the very end of life. We provide this free service in our three hospices, in the community via our Myton at home service, and as an outpatient service:

  • Our outpatient services – help people to live well for longer with their terminal illness. This may include advance care planning, counselling, lymphoedema therapy, complementary therapy such as massage for relaxation, physiotherapy, and occupational therapy.
  • Our hospice inpatient services – provide symptom control and end of life care.
  • Our hospice at home services – provide care and support for people in their own homes in the last weeks and days of life.
  • Our bereavement support – looks after the wellbeing of family and friends after their loved one has passed.

Going the extra mile

Jodie goes on to describe how the staff and volunteers at Myton go the extra mile to look after the wellbeing of their patients, welcoming beloved pets and arranging birthday celebrations, weddings and christenings at their hospices, often at very short notice.

Kerry and David’s Myton Wedding

David Black was admitted to Coventry Myton Hospice on Friday 13th May 2022 and less than 24 hours later he and his wife Kerry had their wedding at the hospice. On hearing the couple’s plans to marry, Myton staff and volunteers pulled out all the stops to arrange decorations, food, and refreshments to ensure they had the best possible day making precious memories. They were surrounded by close family members and their two sons, Fergus now aged 10 and Alfie, 7. David sadly died aged just 41, one week after being admitted to Myton.

Kerry said: “Alfie and Fergus were so excited to see us get married and I’m so pleased that they have such happy memories of the hospice. Their faces say it all and for that I will be forever thankful to Myton.”

Kerry and David's wedding
Kerry and David’s wedding

Spotlight on: an end of life doula

An end of life doula, sometimes called a death doula or death midwife, is a non-medical specialist trained to provide emotional and spiritual support to terminally ill people. According to the International End of Life Doula Association, a doula “holds the space for the kind of dying experience that honours who the person is and has been in their life.”1

Alessandra Olanow is a trained end of life doula and author of Hello Grief: I’ll be Right with You. She explains how a doula can be a comforting and positive presence:

“Doulas are there to allow the dying person to be who they are, and to allow them to be more than old or sick. A doula listens deeply to the concerns, fears, hopes, and life stories of the dying person and their loved ones to bring them peace at the end of life.”

There are many things a doula can do, including:

  • Being a companion and source of comfort.
  • Offering emotional support to the care recipient and their loved ones.
  • Have conversations that help death seem less scary and lonely.
  • Providing practical support – for example, walking the dog, providing care, preparing meals, and running errands.
  • Being a point of contact for the other care teams.
  • Enabling family carers to take a break.
  • Advocating for the care recipient’s wishes – for example, making sure the desired religious or cultural rituals are followed during end of life or after death.

Doulas can visit people at home, or in a facility such as a hospice or nursing home. Alessandra volunteers on the palliative care floor of a New York hospital. She adds that training as an end of life doula has helped her appreciate living: “I used to avoid thinking about death and dying; it was just this fearful thing. Now, I choose to live my life with an understanding that every single day is a gift.”

Alessandra’s advice for coping with loss

If your loved one is approaching death, an end of life doula needn’t disappear the moment they have passed on. They can also support you through your grief, offering guidance and comfort.

Alessandra shares this advice from her experience helping with grief: “Allow yourself the time and space you need without expectation. There is a misconception that grief has a timeline and that there is a certain way to grieve. But there isn’t. Everyone grieves at their own pace and that is ok.

“It can be helpful to have a creative outlet to express overwhelming feelings of loss. When I first lost my mother, I began to draw my feelings – these drawings became my book, Hello Grief. I hope it helps others to process their own grief.”

Further reading

  1. International End of Life Doula Association: What is an end of life doula?

Complete Article ↪HERE↩!

Posted on

How to talk to your kids about Death

— An age-by-age guide

Talking to your child about death can be daunting, especially when you are also grieving.

By Kelly Fradin

As a pediatrician and a parent myself, I often hear from families in times of need. A child’s beloved grandparent died after a struggle, a child’s father died in an accident, a child’s teacher or friend died unexpectedly, or even a beloved pet dies, and I get a panicked call.

As parents, we want to protect our children, but we also want to raise them to be prepared for life’s realities. While talking to kids about death is hard, it’s important. And we can explain death in a way that’s developmentally appropriate while minimizing the trauma and fear our children experience.

Mom talking to daughter, both somber

Get ready to talk to your kids about death

Before diving into a discussion, consider your own emotional state. Are you feeling ready to discuss the death? Do you have all the details yet? While you will never look forward to sharing upsetting news with your child, it’s important that you feel prepared. 

On the other hand, this isn’t a talk you can put off forever. Even if they can’t explain it, a child knows when there has been a tragedy. Nonverbal communication, like body language, distractedness and tears, cannot be hidden from our observant children.

And kids have big imaginations. It’s better to tell them the truth than to let them imagine the worst.

Get help if you need it

Sometimes a grieving parent is not in a mindset to support a child’s needs. If you are in this difficult space, ask your community to step in and care for your child until you’re better able to do so. Prioritizing your own well-being in these moments is one of the best things a parent can do.

Don’t be afraid to cry

Many parents fear falling apart in front of their children and showing their grief. I think this fear is largely unfounded. We want our children to know that big feelings are okay. Crying in front of your child will not traumatize them.

In fact, allowing them to support you in your sadness can be helpful because it’s an opportunity for connection.

Choose your words thoughtfully

When you are ready to talk to your child, choose your words carefully and do not hesitate to say you’re not sure. We don’t want to use euphemisms for death like “sleeping” or “crossing a bridge” that might confuse a child.

We also want to reinforce a child’s sense of safety and anticipate that they may need reassurance that they are okay and the other people they care about are okay.

Age-appropriate ways to talk about death

As we dive into considering death by age, also remember that children develop at their own pace and children’s cognitive and developmental stage may not match their chronologic age and that’s okay.

Mom talking to daughter, both somber

Children under two or children who are developmentally pre-verbal

Be upfront, even with toddlers

Children in this age bracket may not be able to fully understand death and loss. However, when someone in their orbit dies they still deserve to know about it, particularly if it disrupts their routine. Using short declarative statements “Nana is not coming because she died” and not going into too much detail would be advised.

Consider your spiritual beliefs

When your children are young, it’s a great time to consider your values and beliefs and discuss them with your coparent. If you are religious or were raised with religious beliefs, decide if you’ll be sharing those with your child.

Talk about death in general

Little ones can learn about death through nature. Dead plants, dead bugs, or even roadkill can be relatively benign opportunities to expose children to the concept of death.

Many parents try to avoid talking about death when it’s not an immediate issue, but it’s a lot easier for a child to confront the death of a plant or even an animal than the loss of a loved one or another human being. Talking about these kinds of deaths is a good way to introduce the topic.

Children three to eight

Prepare for lots of questions

Children in this age group can generally understand death and may ask a lot of questions. Developmentally, it’s normal for them to fixate on new information they’ve learned.

This can translate to a child who never used to talk about death talking about death a lot, even up to 10 times a day. This age group will also draw pictures or play games about death as a way to process this new knowledge.

Parents often worry that an ongoing focus on death is a symptom of trauma—and it can be. But thinking about death a lot when it’s a new concept or someone you care about has died—even for weeks—is also a normal adjustment reaction.

Younger children can have magical thoughts about death, that maybe it will be reversible or that perhaps thoughts can cause death. Sometimes hearing their thoughts can help us target what information we share.

Show them that it’s okay to talk about death

Many parents find their children’s questions about and focus on death difficult, especially when grieving themselves. As uncomfortable as it is, we want to teach our children that talking about death (or any hard thing) with their parent or supportive caregiver is welcome.

We may need to discourage talking about it in socially awkward situations such as telling strangers at the grocery store, but we do not want to teach them that death and anxiety about death are totally taboo. If we do, they may continue to have questions and worries about death and feel alone.

Talk about death in general

If a child this age isn’t experiencing an acute loss, it can still be a good idea to introduce the concept of loss, both to prepare a child for the inevitable experience or to build empathy and understanding.

Look at books like The Invisible String for kids under five. For older children, many movies and books have death involved in the storyline. This passive exposure is a safe way to start the conversation. Talking to your children about the deaths in books or movies may feel safer for them because of the distance, but still may trigger a lot of questions.

dad talking to son on a dock overlooking a lake

Children nine and up

Let them seek support from friends

Children in this age group may be nearly adult-size on the outside, but in some ways, their budding maturity can make them more fragile. They are less likely to ask a lot of questions and more likely to internalize a lot of worries.

Parents of children this age who grieve should also understand that their child may not come to them for support. Tweens and teens often want to spare their parent and look to their peers instead.

Make sure they have someone to talk to

If your child withdraws or doesn’t want to talk to you about the loss, the first question should be, “If you’re not talking to me about it are you talking to someone else?” Friends, parents of friends, teachers, coaches and school counselors can all be part of the team supporting your child’s grief.

Sometimes a heads up for these important people in your child’s community can help them to be more empathetic and receptive to supporting your child. It’s best to be clear about what you’re asking, “My child is grieving a loss, so I would appreciate it if you could check in with them.

On the other hand, privacy matters to children too and taking a break from thinking about their loss can be restorative.

For some children, it may be better to say “My child is grieving a loss and has a lot of people speaking with them about it. Please don’t feel like you have to say something or check in, but I wanted to let you know in case they bring it up or if you see something that has you concerned in any way.”

Give them a sense of control

Regardless of your child’s age, after you inform them of a loved one’s death, you want to leave them with feelings of safety and agency. What that means is acknowledging that while they may feel terrible, it’s okay to be sad and things will get better. There will be happy days and things to look forward to despite your tragedy.

To encourage a child’s feelings of control over the situation, sometimes a project like a memory box or a special card or photo for a loved one who may be hurting can be helpful.

For older children, advocacy can be healing in addition to potentially making positive change in the community, connecting with others who have lost loved ones for the same reason can make them feel less alone in their grief.

Every family’s take will be different

Undoubtedly every family is unique in how they consider loss. Our own upbringing, values, religion and culture will determine the words we choose. But death is universal and an inevitable part of life. When connecting with your child to teach them about death remember that there is no one perfect way to do it.

What’s important is to be authentic and connect with your child to talk about it in a way that makes sense to you. As with grieving adults, grieving children can have an unpredictable course, with holidays, songs, places, and memories often causing more sadness weeks or months after a death. Continued check-ins and connection can help a child feel safe and supported in these moments.

Death is an ongoing conversation

If you’re not acutely in a loss and still trying to teach a child about death, just as with other topics it’s often not just one conversation, but rather a series of small conversations where your children will learn and understand more.

Great resources for teaching kids about death

Complete Article ↪HERE↩!

Posted on

Respecting patient autonomy and the importance of hospice care

By Paul B. Hofmann, DrPH, MPH

A KevinMD article about Jimmy Carter’s end-of-life care decision, “The heartbreaking story of Jimmy Carter: a call for Medicare reform in end-of-life care,” indicated that the former president’s decision was heartbreaking. However, I have a different view. In my opinion, the 39th president, at age 98, made an autonomous and well-informed decision.

On February 18, The Carter Center announced in a statement that “after a series of short hospital stays, former U.S. President Jimmy Carter decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention. He has the full support of his family and his medical team.”

In the March 29, 1984 issue of USA Today, I stated that “often there is an obscure point in the continuum of intensive treatment when it is death, not life, that is being prolonged. We must remember that pneumonia, once described as the old man’s friend, has died. Thus it is even more important that patients be allowed to remain the beneficiaries of modern technology, not its victims.”

In the Spring 1994 issue of Stanford Medicine, I wrote that “with distressing frequency, we’re doing too little for patients and too much to them. Real caring often means choosing not to perform invasive diagnostic and therapeutic procedures that extend the dying process instead of improving life.” When a patient in the ICU or on a medical surgical unit is unlikely to survive to be discharged, studies have confirmed that a DNAR order, along with a focus on comfort measures emphasizing pain and symptom management, not only extends a patient’s remaining days but also improves the quality of his or her life during this period.

A column co-authored with internist Lawrence Schneiderman and former chair of the ethics committee at the University of California, San Diego Medical Center, published in the May/June 2007 issue of the Hastings Center Report, was titled “Physicians Should Not Always Pursue a Good ‘Clinical’ Outcome.” Although good clinical and patient outcomes are usually aligned, this is not always the case. Predictably, cardiologists are proud of helping the patient maintain a strong cardiac output, nephrologists want to make sure the patient’s kidney function is adequate, and pulmonologists properly concentrate on lung capacity and viability. However, if the patient has metastatic cancer with no likelihood of survival, timely referral for hospice services should be the priority. Under these circumstances, death should not be viewed as a medical failure. Conversely, causing or allowing a bad death represents an ethical failure.

An article co-authored with Douglas Van Houten, assistant chief nursing officer, Washington Hospital, Fremont, CA, appeared in the January/February 2014 issue of Health Progress. It was titled “When the ICU Is Not the Answer.” We identified ten recurring issues that characterized many cases when we conducted ethics rounds. For example, one such issue was “Staff members are concerned and uncomfortable when asked to provide treatment they feel is not in the patient’s best interest, and they experience moral distress in providing what they consider painful and inappropriate treatment.” Consequently, 12 guidelines were recommended based on preventive ethics to reduce the number and magnitude of issues potentially compromising patients, families, and staff members. The first guideline was “As early as possible after a patient’s ICU admission, assuming the patient is unable to express his or her preference (and has prepared no advance directive regarding such preferences and a designated surrogate), family members or friends should be asked for information about the patient’s values, goals, and any previously stated treatment preferences. Potential treatment goals are identified by the patient’s principal attending physician in light of this information, and expectations are clarified.”

Unfortunately, patients near the end-of-life are often referred for hospice services and palliative care belatedly. Instead of lamenting President Carter’s decision to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention, the author should have endorsed and applauded this decision.

Overall, it is important for health care providers to recognize the limitations of medical interventions and respect patients’ autonomy in making end-of-life decisions. As health care professionals, it is our duty to provide patients with all the information they need to make informed decisions and support them in their choices. Hospice care and palliative care can provide patients with a more comfortable and dignified end-of-life experience, and we should strive to ensure that these options are available to all patients who need them.

Complete Article ↪HERE↩!

Posted on

A guide for the end

— Woman finds support in end-of-life doula program


Jane Schostag (left) sits with her end-of-life doula, Mary Beth Trembley, at Schostag’s Skyline home on March 15. When Schostag learned she had terminal cancer, she sought out Trembley as a doula for support and guidance on her end-of-life journey. This week Schostag entered hospice.

By Brian Arola Mankato

Jane Schostag doesn’t shy away from discussions about death, even her own.

The Skyline woman, a longtime English teacher at Mankato West before her retirement, has terminal cancer.

Rather than avoiding the topic of her own mortality, Schostag has been spending what will likely be her final months reflecting on and preparing for what she calls her “farewell journey.”

An end-of-life doula is helping guide her.

“People have doulas when they have babies because having babies is a lot of work, it’s stressful,” she said. “Well, so is dying, so you got a coach on one end and a coach for the other.”

End-of-life doulas serve as nonmedical companions offering support and guidance on death, sometimes complementing medical services provided by hospice care. A doula’s specific duties vary depending on their background and the person’s needs, but one important quality they share is a willingness to acknowledge and talk about death.

Having doula Mary Beth Trembley with her during this stage in life, Schostag said, is like having a “caring, informed friend” willing to tackle the topic head-on.

By putting death on the table, the hope is people live their final days to the fullest instead of awkwardly avoiding any talk of what will inevitably happen.

“We should treat it as a sacred time and support that process,” Trembley said. “People think it’s morbid to talk about death and dying, but we’re all going to die. It’s part of life.”

Trembley is one of several trained end-of-life doulas in the Mankato area — she received her training through the Conscious Dying Institute in Boulder, Colorado. These doulas meet up monthly to support each other and share resources.

The services can be available on a volunteer basis or paid depending on the recipient’s circumstances.

When they find out about someone in need of a doula, they consider which of them would be the right fit. Sometimes a person will meet with multiple doulas, such as when Trembley introduced colleagues to Schostag because she knew they’d get on well.

Their end-of-life doula network in the Mankato area was just getting up and running when the COVID-19 pandemic started, which made connecting with more people difficult.

Now, as the network looks to work with more people, Trembley and Schostag hope sharing their experiences as doula and recipient leads more people to become doulas and more people to seek out the services.

Diagnosis

Schostag found out she had a malignant lesion on her tongue about two years ago at age 76. In her memoir, the tools for which her daughter, Lindsay, gifted to her a couple of Christmases ago, she described the cancer as making her sound like she’s been “hitting the margaritas.”

An oral surgeon removed the cancer, but she next faced a decision about whether to start radiation treatment. She remembers hearing in detail about how the treatment could have debilitating, painful impacts on her head.

Having already enjoyed a full life, she chose to prioritize the quality, rather than quantity, of the rest of her life. It meant forgoing radiation.

“Even if the cancer returns,” she wrote, “I do not think I will choose to do radiation or chemotherapy. At my age, I fear sickness or debilitation more than death.”

If she were younger and still had children to raise, her decision might’ve been different. She feels gratitude for the good run she’s had — from a fulfilling professional career in education to advocating for children in the court system to being a wife to husband David, a mother to Lindsay and a grandmother.

She notes she isn’t saying others should go the route she went, but thinks people who’ve lived abundant years should examine their options before immediately proceeding with unpleasant, possibly debilitating treatments.

To her, doing so risks “outliving our quality of life.”

In July, Schostag learned she had a swollen lymph node near her surgery site. A biopsy on the node misdiagnosed it as negative for cancer, giving it three months to grow before confirmation of the cancer’s return was revealed by another biopsy in October.

By then, the cancer was rapidly spreading. She again elected to forgo treatment.

Kindred spirit

Schostag was already familiar with the doula program through past presentations and had it in mind to seek out when she needed it. If people need the guidance of counselors before going to college and other important steps in life, she said, why not seek out guidance before death?

“Why not a person who’s an expert at making the best of what you have left, which is really what I see doula work as being,” she said.

She and Trembley knew each other through their church, Unitarian Universalist Fellowship of Mankato. The two met, along with David, in October to review what doula services entail and set a plan for regular meet-ups.

Having family involved and on board makes it easier, Schostag said.

“I think it’s good for families to talk about it,” she said. “We’re gonna deal with the preparations that need to be done. We’re gonna talk about what our thoughts are and what we’re scared of.”

Family and friends otherwise might not know what to say to someone facing death, creating an awkwardness of avoidance. Embracing the subject brings it to the forefront, creating space for people to say what needs to be said before it’s too late.

“It’s interesting what your demise does to other people,” Schostag said.

Doulas can help people work through what to say to their family and friends, Trembley said. They try to bridge gaps, whether the gap is a needed conversation with family or establishing a will and advanced directive.

“When you’re with somebody who likes to talk about death and dying, it’s a different conversation,” she said.

Trembley joined Schostag on her medical appointments, offering another set of ears. Although not all doulas have a medical background, Trembley’s career as a psychiatric nurse proves helpful.

The doula’s work doesn’t necessarily end when their companion’s life ends. They can be a source of comfort to the surviving family afterward.

A grieving person sometimes receives an initial outpouring of support from their social circles before people move on with their lives. Trembley sees potential in doulas continuing to offer support for as long as the surviving family needs it.

Trembley and Schostag think of themselves as kindred spirits when it comes to outlooks on life and death, which furthers their bond. Trembley described Schostag as an “amazing person” whose wealth of life experience will educate people about an important resource.

“By talking openly about death and dying and doula work, she’s helping,” she said.

Schostag’s journey took its latest turn this week when she found out her cancer had spread to her hip area. In one sense, she said after finding out, she felt “very lucky that I went as long as I did without pain.”

Her hospice team has been wonderful, she added. So has her family, friends and doula.

Shortly after starting with Trembley, someone asked Schostag about her doula.

“She’s great,” Schostag recalls responding. “She’s really into death.”

In a society so averse to conversations about death, she said, having a doula on her journey makes the end less lonely.

Complete Article ↪HERE↩!

Posted on

The Art of Dying

— Overcoming Our Fear of Death

Enduring, accepting, and embracing the inevitability of one of mankind’s greatest fears.

By Jocelyn Tatum

On my desk at home, I have a true-to-life-sized concrete sculpture of a skull with little porcelain bluebirds resting on its mouth, ears, eyes, and one on its crown. I found it at ArtsGoggle in Fort Worth 13 years ago when the local arts festival was just starting out. I gravitated toward it because it reminded me how fleeting and fragile life can be. The birds, to me, represented the creativity that comes forth in the face of our finitude. The idea was that this mortal reminder would help me get past writer’s block. After all, as a journalist, these stories are not my own. They are your stories. I am merely the vessel who delivers them using my passion and acute sensitivity to humanity. And I borrowed this idea from 14th-century monks who kept skulls on their desks as a reminder of their mortality as they wrote their philosophical dissertations, so this idea wasn’t new. “For dust you are, and to dust you shall return.” Sounds familiar, right? This symbol of death on my desk was a reminder to face my fears head on, and that I am just passing through this world, adding my thread to the massive tapestry that is the story of all us.

I have always thought of myself as a pilgrim. Just passing through. The joys in life like my son, friendships, or romantic partners are merely finite gifts lent to me from the universe, never mine to keep or clutch. I have found that the pain is in the clinging to life or avoidance thereof, whether it is my own or another’s. Peace and serenity lie somewhere in the middle. Everything temporal, everything passing. Life doesn’t have to be so serious, and I think my journey exploring my own non-imminent death has reminded me of this. When achieved, this allows me to live with a free spirit and detachment to the things that weigh me down. And as things have gotten heavier for me lately with my father starting palliative care for his cancer and the loss of a great love in a breakup, I decided it was time to stare death and grief boldly in the face.

Two Fort Worth women just launched their business, The Art of Dying, in January 2023 after completing their death doula training. When I came across their Instagram (@theartofdyingfw), I became curious. Very curious. So, I kept digging. It turns out that a death doula is like a birth doula but assists with the process of dying. They are an end-of-life companion who can guide the dying, whether that is connecting them to a number of resources or inspiring ideas for how to celebrate the life they have left. “The Art of Dying [is a] small collective that offers support, celebration, and companionship to individuals and their loved ones through the end of life.” They offer services for those who have a terminal diagnosis or those who want to plan early in life and are non-imminent.

These end-of-life practices have been steadily growing since the pandemic, according to Alvin Harmon, the head of the National End-of-Life Doula Alliance on an NPR news segment that aired Jan. 17. “How people died, that was what became important, having that safe space, that whole space, people dying in a manner that felt safe to them and was important to them,” Harmon said on air. Any little dignity people had left when dying was stripped of the dying during the isolating loss of COVID-19. This phenomenon led Fort Worth’s Lacy Buynak to get her death doula training. She lost her grandmother during the pandemic.

“As I was grieving her death, I was having this huge collective grief for all of these people who didn’t get that,” she says as tears form in the corners of her eyes. “I started thinking that that has got to be one of the worst ways to go.” She got to say goodbye to her one last time before she died but realized so many others did not have this experience.

Now business partners in all thing’s death, Buynak and Taykor Bell had been friends since attending school together in 2001. Twenty years later, in April 2021, Buynak called Bell to catch up. They had been talking about something else when Buynak said, “I did a crazy thing. I signed up for a training program to be a death doula.” She remembers getting a “holy-shit, so-did-I”-type of response.

The two had been keeping an ear on the heartbeat of death for years as a separate fascination while a parallel nationwide phenomenon of making death more palatable, eco-friendly, meaningful, and even enjoyable was disrupting the $20 billion funeral industry, which celebrity mortician death advocate Caitlin Doughty argues exploits people’s grief and turns it into a profit. After their own experience with death, Buynak and Bell saw a need to provide a comprehensive and holistic service in Fort Worth that also educates the community one death at a time. “We want to hold space for people in those moments. Raising awareness for collectivism, the practice or principle of giving a group priority over an individual, for being there for people,” Bell says.

Bell had her first existential crisis in grade school. She thought about dying and going to heaven and thought, “That is forever.” Her mind kept seeing “road barriers” to this thought of permanence, and anything past that scared her (to death). She couldn’t understand forever. For her, something so big and unknown brought up this debilitating fear. She knew then that death would be her biggest teacher, and her training for this vocation is her life experience. Not only has she read many books over her 40 years alive, but she was able to be there for her mother as she was dying in a way that she would want someone to be there for her. It occurred to her that many people die in the most isolated and sterile way in the U.S. even before the pandemic.

“The vision is to put ourselves out of business to remind our culture to do this for each other. This is a business needed more than ever. There are so many ways people can feel vulnerable and alone, and death is when that is most poignant,” Bell says.

This year marks the 10th year since Bell’s mother died of adrenal cancer. The story gave me chills. When Bell decided to leave her current career, she looked at the amount of money her mother left her, an account she was hesitant to touch because it was the last lifeline to her mom, and it was the exact amount she needed to get her death doula training. Then Buynak called.

DeathShadowFIN.jpg Illustrations by Brandon Hayman[/caption]

My Journey

I met with Bell and Buynak for sparkling tea at Leaves Book and Tea Shop in Fort Worth’s SoMa district. They had a big biodegradable binder waiting for me on the table with their logo on the front. Page 1: “In this binder, you will find a comprehensive list of legal documents to gather, logistics and arrangements to consider, as well as various comfort and care services you may be interested in learning more about.”

Section 1, “Legal: Advance Directive, Durable Power of Attorney, Last Will and Testimony.” This is definitely the least enjoyable part of the process. I went to the websites, which was about what I expected from government sites. Then I had to download a bunch of PDFs to print, fill them out, and then take them to be notarized. Then file them. Bell recommended using RocketLawyer (not a shameless plug) unless you have some massive estate to work through.

Not going to lie, this part made me feel uncomfortable. Itchy. It asks a lot of questions that I really don’t feel like I know the answers to yet. And when it got to the body disposition authorization that included some subtext about whether your body remains are acceptable if you want to donate it to science, I had to step away and get some fresh air. “So you’re saying my body could be rejected even after I die?” I thought.

“We want people 40 and younger to get their [act] together. It can be sad, confusing, and beautiful,” Bell told me regarding the Art of Preplanning, a service they offer to those who get their affairs in order even if death isn’t imminent.

Well, I do not have my act together. And I am not going to lie, this has brought up some feelings. So, I decide once more to procrastinate on the legal paperwork, which Bell and Buynak have both said I need to knock out first because something can happen to us at any moment. Digging into the resistance, I redirected my efforts into research about how to overcome this fear. What I found brought me peace beyond what I could have ever expected.

Overcoming Fears

“The cave you fear to enter holds the treasure you seek,” said 20th century author Joseph Campbell.The New York Times reported a phenomenon in an article titled “South Koreans, Seeking a New Zest for Life, Experience Their Own Funerals” where people choose to face their mortality. “After an instructional lecture and video, participants are led into a dimly lit hall decorated with chrysanthemums, where they sit, often tearfully, beside caskets and write their last testaments. Then they put on burial shrouds and lie down in the coffins,” the article reports. What surprised me is many participants photographed were young and healthy with no end in sight, but some had a terminal illness and wanted to prepare while others struggled with suicidal thoughts and wanted to put those to rest. They reported emerging from their mock funerals and meditations around death with a new and hopeful perspective on life.

Buddhist monks contemplate images of decaying bodies to unlock the door living in the present and letting go of fears. “It makes disciples aware of the transitory nature of their own physical lives and stimulates a realignment between momentary desires and existential goals. In other words, it makes one ask, ‘Am I making the right use of my scarce and precious life?’” Arthur C. Brooks wrote in an op-ed piece for the NYT.

Guided meditations on mortality such as this can be one of many life-affirming activities that can give us a new take on life, according to the resourceful website orderofthegooddeath.com. The website is an endless resource for all things death with everything from how to have conversations about it to how to have an affordable and intimate funeral at home. It was created by YouTube star, mortician, former cremator, and best-selling author of the memoir Smoke Gets in Your Eyes: And Other Lessons from the Crematory, Caitlin Doughty. In an interview on a segment on “CBS Sunday Morning,” Doughty says, “Americans need to think more about end-of-life rituals, instead of keeping death at a distance.” Her advocacy around changing the way we die and think about death has started a movement across the country. “They are just of the belief that the more we talk about it openly and honestly, the less terrifying it needs to be,” the “CBS Sunday Morning” reporter narrates. Doughty’s more recent book, From Here to Eternity, illustrates how death is handled in a more meaningful and intimate way in cultures across the world. What does it mean to have a good death? Is it not to be so separated and detached from the process, to stop looking away?

Doughty even offers a course, complete with videos, lessons, and guided meditations for the price of $195, called Mortal that gives patrons the tools for facing death. Lessons with titles like, “I create my own meaning,” “I meet my true self on my deathbed,” and “There are parts of my death I can control,” help people better cope.

It made me think, why do we wait until the end to start celebrating life? Why do we wait until we are at our rock bottom, when life strips us of everything that we think validates us as humans, to start living in the way we were always meant to?

Ironically, facing death and working with death doulas like Matus and Buynak helped me release the inhibiting fear of loss and to rethink the way I live. And I have been able to show up differently around my father’s terminal cancer. I don’t need to look away, nor do I need to fix it. I can just be with him in it. It puts me at ease to know there is a slew of tools and support out there.

When I was little, I had a fear of being eaten by a monster and dying. I would lie in bed each night staring at the closed closet door waiting for it to open at any time to claim my life. One night, I had the thought, “What is actually in there?” I got up and looked. Nothing was in there, and I started sleeping through the night again. Peace ensued, and a nascent lesson was learned — the pain was in the resistance, the looking away.

American Poet Andrea Gibson’s YouTube video went viral after she famously shared her story about how her cancer diagnosis transformed her lifelong debilitating fear of death into “boundless bliss.” Once she learned that her whole torso was filled with masses, she said she felt her heart immediately begin to open up. She now walked through the world realizing that she may not be here tomorrow, which pushed her deep into the present moment. The paradox is that facing death cured her fear of death. “Why would I waste my time not in search of the celebration [of life] and not in search of awe? There has been so much love this year that I believe legitimately everything is on my side, and I believe death too, is on my side. And the second I realize that death itself is on my side, I felt like nothing could kill me,” Gibson says in an interview.

DeathPartyFIN.jpg Illustrations by Brandon Hayman[/caption]

The Dying

“It is the most supremely interesting moment in life, the only one in fact when living seems life,” wrote Alice James — William and Henry James’ sister — as she faced death.

Whenever I experience some tragedy in life that brings me to my knees, there is also a death to my “self” that happens, which then strips away my ego. All spiritual transformations and religious conversions speak of this. Nature does too after a roaring forest fire burns thousands of years of story to only be reborn in new growth that is stronger. I have to ask myself, is the key to a more meaningful and deeper life usually comes after facing death, figuratively or literally? “All life is lived in the shadow of its own finitude, of which we are always aware — an awareness we systematically blunt through the daily distraction of living. But when this finitude is made acutely imminent, one suddenly collides with awareness so acute that it leaves no choice but to fill the shadow with as much light as a human being can generate — the sort of inner illumination we call meaning: the meaning of life,” Maria Popova of The Marginalian n wrote in an essay.

I watched the movie “Marcel the Shell” the other day, and at the end, the main character, Marcel, reflects on a great loss, the loss of his beloved grandmother, Connie, also a shell played by Isabella Rossellini. Before Connie dies, she led Marcel to a quiet place to perch in the basement where the window was always cracked. There the wind blew through Marcel’s shell creating a new sound, a new experience. In the face of loss, Marcel experiences the meaning of life. “It connected me, I felt, to everything. Because if I wasn’t there, the sound wouldn’t exist, and I felt like everything was in pieces, and I stood there and suddenly we were one large instrument. I like to go there a lot because it reminds me that I am not just one separate piece rattling around in this place, but that I am a part of a whole. And I truly enjoy the sound of myself connected to everything,” Marcel says.

Just before she dies, Connie reads the poem “The Trees” by Philip Larkin.
The trees are coming into leaf
Like something almost being said;
The recent buds relax and spread,
Their greenness is a kind of grief.
Is it that they are born again
And we grow old? No, they die too,
Their yearly trick of looking new
Is written down in rings of grain.
Yet still the unresting castles thresh
In full-grown thickness every May.
Last year is dead, they seem to say,
Begin afresh, afresh, afresh.

We tend to look at death as a failing of our bodies (or minds) when it is a natural part of living, of returning, of renewing. Experiencing death is one of the few things all humans have in common, which makes it a thing that connects us in our humanity like the wind in Marcel’s shell. I learned many lessons planning my death with The Art of Dying’s Buynak and Bell. Lesson 1: When that wave of grief hits, whether it is losing my father to cancer, my boyfriend to a breakup, or facing the end of my own life, I can’t swim against the current. I shall surrender to the fear and pain and fall back into the healing water until that final wave washes me ashore.

Lesson 2: To start living as if it could all end tomorrow and work with the doulas to plan a dinner party with my favorite people complete with toasts and convivial conversations about dying, loss, bucket lists, and to celebrate life.

Complete Article ↪HERE↩!

Posted on

The death question

— How to talk to clients about their life expectancy

It may be a grim topic, but death is a key factor in retirement planning.

By Nathan Place

How long do you expect to live? It’s a touchy question, but research shows asking it can significantly help investors prepare for retirement.

Death is rarely a pleasant topic of conversation, but it’s a key factor in retirement planning since the longer you live, the more savings you’ll need to finance your life. But because it’s uncomfortable, many savers avoid realistically estimating their own lifespans — which can lead to poor planning.

“People tend to underestimate how long they will live in retirement, which means they tend to save too little, spend too much and run out of money in later life,” said Olivia Mitchell, executive director of the Pension Research Council at the University of Pennsylvania.

The good news is that, according to new research, even the most cursory conversation on the subject can make a big difference. Mitchell recently co-authored a study by the Leibniz Institute for Financial Research at Goethe University Frankfurt, which surveyed people’s estimates of their own life expectancies. In some cases, the test subjects also read a paragraph about a hypothetical retirement saver (“Mr. Smith”) and answered a multiple-choice question about what he should do.

But the study wasn’t interested in how well the respondents guided Mr. Smith. Instead, it focused on how accurately they estimated their own life expectancies after answering the questions. The researchers measured the gap between people’s subjective and actual life expectancies — in other words, how long they thought they would live versus how long they would probably live in reality, based on their gender, age and other demographics. In general, the average gap was 17.1%. But after reading the Mr. Smith paragraph, that gap shrank by 5.2 percentage points.

“In other words, simply prompting people to think about a financial decision related to longevity risk affected peoples’ estimates of their own anticipated lifespans,” the study said.

For financial advisors, what this means is that even just broaching the subject of a client’s lifespan can substantially help them think more clearly about the future. In some cases, that can mean better preparing for longevity risk — the danger that a person will outlive their retirement savings.

“When financial advisors are doing their jobs well, they will help people understand not only the too-simple concept of life expectancy, but also the notion that half the people live longer than this mean,” Mitchell said. “Therefore, plans are needed to cover the eventuality of living to 100 or beyond, which is what longevity risk refers to.”

Of course, this is easier said than done. How does one remind a client of their own mortality and then have a calm, unemotional conversation about finances? Advisors have a wide range of methods. When possible, some said, it helps to make it funny.

“I find it’s best to be compassionate, direct, and (for the right clients) inject a little humor,” said Louis Leyes, a financial planner and partner at Stages Planning Group in Pennsylvania. For some investors, he puts the question this way: “So, when would you like to take your leave of this mortal coil?”

Lora Hoff, a CFP at IPI Wealth Management in Illinois, said she likes to “keep it light.”

“I say something like, ‘My plan will need to include some assumptions about how long you will live,'” Hoff said. “‘I can use the actuarial default, or I typically use age 100, unless you have some specific preference of what you want to see — I don’t like to kill anybody off in my planning!’ Then I just laugh about it.”

Others use technology, including software like eMoney or MoneyGuidePro, to estimate the client’s lifespan. That way the question stays mathematical instead of emotional.

“We use MoneyGuidePro’s questions about whether they smoke, how healthy they are and the longevity in their family and let the program decide on their lifespan,” said Lisa Kirchenbauer, a CFP and founder of Omega Wealth Management in Virginia. “Then we discuss and change it to fit what the client is comfortable with, explaining the pros and cons of the choice.”

Some advisors say that by treating death as a purely practical matter, they can keep the conversation from getting uncomfortable.

“I actually don’t find it difficult to talk to clients about mortality,” said Anna Sergunina, a CFP and president of Main Street Financial Planning in California. “I explain to them that we need to have an ending point to their financial plan, to make sure we’ve estimated properly how long their money will last.”

Leibel Sternbach, a financial advisor and the chief technology officer of Fusion Capital Management in Texas, said most clients aren’t shocked by the death discussion.

“Our job is to ask the hard questions,” he said. “They know and expect it of us.”

Complete Article ↪HERE↩!