6 Ways to Reduce Stress at the End of Your Life

It’s not easy nearing the end of your life, but that doesn’t mean you need to be stressed.

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Death may be the ultimate stressful moment in our lives. Just thinking about the end is enough to cause your heart to beat faster. And while some levels of depression and anxiety are inevitable, those feelings need not overwhelm the death experience for you or your family. In fact, it’s possible to die well — to experience a sense of wellbeing as you approach the end. You can leave this life with a feeling of closure and a sense of contentment. That’s the difference between completing your life and merely ending it.

But stress disrupts well-being. It distracts you from prioritizing love, family, and dignity. Worry and fear interrupt precious time with family and friends. That’s no one’s idea of a good death. And while it’s easy to think you’ll skip this stressful step and go suddenly from a heart attack or stroke, the reality is the majority of us will need end-of-life care. So, put some thought and preparation into your passing now. Reducing stress will make it easier for you to say goodbye, and for your loved ones to let go. Here are six ways you can make dying the experience you want, rather than the experience you get.

Finalize Your Burial Arrangements

Preparing your burial arrangements lowers stress in several ways. For one, it puts you in control. Eliminate worry by outlining the type of service you want, the manner of internment, and the organ donation process. Burial arrangements also relieve financial stress from your family and friends. Carrying out your last wishes doesn’t have to be a financial burden for your family. So, find the best final expense insurance policy to cover costs. Or get a pre-paid funeral plan that kicks in after you’re gone. You’ll feel less stress knowing everything is taken care of.

Finally, by tending to your funeral arrangements yourself, your loved ones can focus more on spending time with you in your last day. And their grieving will be easier when they’re not weighed down with administrative tasks. Mourners often feel guilty devoting time to such business matters after a loved one dies.

Create a Living Will

If you become incapacitated before death, someone will have to make decisions for you. That’s a heavy responsibility to place on a family member or friend who may only have a rough idea of your wishes. But without a health care power of attorney (or proxy) to speak for you, you may end up being kept on life support longer than you’d prefer, or the opposite. An advanced directive or “living will” is a legal document that lists specific medical treatments you wish to receive and those you don’t. The directive takes the decision-making burden off your family’s shoulder.

To get started, have the end-of-life conversation with one or two people you would want to serve as your proxies. And also talk with your doctor so that everyone is on the same page. Living will forms vary by state. So, download your state’s advanced directive form to get started. If you don’t have the resources to create a living will, other forms of non-legal directives can work as some form of “proof” for your wishes. For example, write a letter to a family member expressing your wishes. Or record audio/video explaining what you want. While these aren’t formally recognized legal documents, they work better than nothing at all.

Make Amends

One thing that makes dying harder is knowing you’re leaving behind unsettled issues, old hurts, and past grudges. When possible, make amends with those you’ve hurt or who’ve hurt you. Now is the time for unburdening yourself and being honest with those you love. While you can leave those hurt feelings behind, your loved ones will carry them after you’re gone. And many will regret they didn’t say something when they had the chance. Knowing this will make leaving this life more stressful for you.

So, don’t put off making amends. Request a private audience with a loved one or wait for the right moment to broach the subject. Be honest and take responsibility for your part in the situation. Refer to the past event/issues that caused the rift, but don’t relive it all over again. And don’t bring up their responsibility; just explain your regrets and apologize. They will reciprocate. Think of this less as a discussion and more as a confession. So, listen more than you talk. The goal of making amends is to replace hurt and anger with forgiveness and love.

Revisit the Past

For those facing imminent death, the bulk of the conversation often focuses on medical needs, medications, or staff visits. While these are immediate needs are necessary, don’t forget the past. Revisiting old memories help us replace the current situation with one of our choosing — at least for a moment. Rather than a form of denial of death, recalling memories is an affirmation of our lives and our effect on others. For friends and family, recounting a past event is a handy way to show how a dying loved one impacted their lives. It’s often difficult for the dying person or loved one to find the right words in these moments. Words of condolence or regret can seem empty. But a pleasant or meaningful story can be a beautiful expression of our gratitude.

Recalling old memories is also a stimulating activity for Alzheimer’s patients. It fosters emotional connections and reduces anxiety. Use family albums, music, videos, or heirlooms to help prompt memories. Encourage family and friends who can’t travel or live too far away to send a short letter or audio recording. And don’t avoid humor. Include funny moments, old jokes, or humorous anecdotes. It may feel awkward at first, but laughter is nature’s way of helping us relieve stress and anxiety while connecting us.

Use Music Therapy

Studies suggest that music therapy has emotional and physical benefits for hospice and palliative care patients. Researchers found that patients who listened to music reported “less pain, anxiety … as well as an increase in feelings of well-being afterward.” Music therapy has a profound effect on people with cognitive and mental decline. The rhythmic nature of music requires little mental processing and helps stimulate memories. Choose music that your loved one enjoys, tunes from their childhood era, or a neutral New Age track. But don’t overstimulate; that can create stress. Take note of the other noises in the room. When mixed with many different sounds, even soothing music at a low volume to create a cacophony of stress.

Ask for Pain Medication When You Need It

Palliative care is about making patients feel as comfortable as possible until the end. And pain management and medication are part of this process. Unlike other vital signs, hospitals and staff can’t measure your pain. You have to help them know when you’re feeling discomfort. Still, some patients forego their pain meds because they want to stay awake to see their friends and family. Others see pain medication as “bad” substances or only for the weak or needy. But these are myths. Pain meds are integral to the palliative care process. And there’s no reason to forego pain medications that’s more important their your comfort. You may think you’re being strong for your family, but having to watch you fight intense discomfort will only increase their stress levels. Ask for pain medication when you need it.

These six tips will increase well-being and reduce stress when you’re nearing the end of your life. But once you’re faced with death, it’s important to know when it’s time to let go. Too often, we hold on too long out of a primal urge to keep going or fear of leaving our loved ones. Death is a natural process we all share. Take comfort in that immutable fact. Let your loved ones know you’re ready to go. They, too, will hold on to you, fearing that letting you go is “giving up.” This creates enormous amounts of stress. When it’s time, reassure them that — while you’re not ready to die — you have accepted it.

Complete Article HERE!

How Jewish Rituals Helped Me Mourn My Miscarriage

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I had a miscarriage this summer — and it broke me in more ways than I could have imagined. At my nine-week appointment, I discovered, to my complete surprise, that I was experiencing a “missed abortion” – a pregnancy loss in which I’d had no miscarriage symptoms whatsoever. Not only did I have to make medical decisions while in shock, but I also struggled intensely to make sense of what I was feeling emotionally and spiritually.

With help, I recognized that I was deep in the throes of grief. Jewish tradition provides an incredible structure for mourners to grieve the death of a loved one. Yet nothing is prescribed for my miscarriage grief. When grieving, it can be harder to make any decision, large or small. I craved a prescription for what to do; that might have left me with fewer heart-wrenching decisions.

Nonetheless, I found healing and comfort in adapting Jewish rituals and traditions.

In honor of October being Pregnancy and Infant Loss Awareness Month, here are some of the lessons I learned:

  1. Jewish tradition teaches that we are not obligated to mourn a miscarriage or even the death of a baby who lives less than 30 days. In fact, we are taught that up through 40 days after conception (this would be just under 8 weeks pregnant in today’s terms, since counting begins at the woman’s last period, not at conception), the embryo is considered to be merely water (Yevamot 69b). This does not describe the emotional reality of many pregnant women or couples. Even in those early weeks, the connection to the embryo can be incredibly deep. And yet I recognize that mourning a miscarriage is not the same as mourning the death of a child or an adult. I didn’t lose a baby that I’d held. I didn’t even lose a fetus. I lost an embryo (the transition from embryo to fetus happens in the 11th week), but that embryo was supposed to make me a mother. That embryo was supposed to grow into a fetus. I would have delivered a baby, named and held my child. That embryo had a due date. I had a timeframe sketched out already for when I would start looking at daycare options.
  2. The specific grief of a miscarriage is different but still very real. In order to cope with my grief, I needed to mourn. The ancient rabbis likely believed that having a prescribed set of mourning rituals for a miscarriage may have been a burden, since families could experience multiple miscarriages.
    Today, too, families may experience one or more miscarriages. While miscarriage rates may or may not have changed since rabbinic times, many things have changed: birth control has led to less pregnancies; at-home pregnancy tests help women find out that they are pregnant much earlier than even several decades ago; because of ultrasound technology, pregnancies feel much more “real” when a future parent sees an embryo or a flickering heartbeat at a fairly early stage. All of this leads to pregnant people (and their partners, if applicable) who are more likely to experience grief when losing a pregnancy. The Perinatal Grief Scale was developed in 1988 to help clinicians diagnose and care for their patients’ grief. What if certain rituals of mourning were opportunities to grieve, instead of a potentially weighty obligation placed on the family? Michael I. Norton and Francesca Gino, faculty at Harvard Business School, conducted experiments to measure the impact of mourning rituals. They determined that rituals are incredibly effective in reducing grief because they allow mourners to regain a sense of control, at a time when it feels like they have lost any semblance of control of their world. For me, rituals like burial and mikveh also helped me find a sense of validity in my grief. I needed concrete physical acts that also stemmed from Jewish tradition to help me recognize that my loss was real and mattered, both in my own eyes, and perhaps more importantly, in the eyes of Jewish tradition.
  3. Rituals may be traditionally absent, but Jewish rituals, modified from other contexts, are emerging. Not everyone marks time and life cycle through Jewish liturgy and ritual, but I do. Each person will find what is meaningful for them in coping with a miscarriage. In the first few days, I felt compelled to have a way to externalize my pain. 

When an immediate relative dies, the mourner tears their clothes or wears a kriyah ribbon. I chose to let my nail polish chip away naturally over the coming weeks instead of taking it off my fingernails once it started to chip. I looked unkempt and that felt appropriate. People should know that something was awry. I whispered kaddish once while tears streamed down my face – it felt both rebellious and cathartic. I realized that I needed a burial of sorts, echoing how we address a loved one who has died. 

With the help of Sinai Memorial Chapel, I arranged to bury my embryo, unmarked, near newly planted trees in a cemetery. I chose not to be present for it, but it was comforting to know that it was returned to the earth. I also visited the site a few weeks later with a friend and buried a piece of paper on which I’d written my due date, and some other dates that would no longer be shared with this baby – I had envisioned a baby costume for this Purim, and had imagined that this Passover would be my first as a parent. None of this was halachically prescribed or encouraged but these acts helped me say goodbye.

 

Some new Jewish rituals for mourning a miscarriage suggest planting a sapling. But for me, this didn’t seem fitting. A sapling would grow into a larger plant, but my baby-that-should-have-been was never going to grow. While I yearned to one day be able to grow a different pregnancy, that wasn’t what I wanted out of this ritual. I needed a ritual that was solely about loss before I could begin to think about new life again.
  4. The cultural norm is to keep the pregnancy quiet through the first semester — but that’s not always helpful. Miscarriages are common, but it feels incredibly lonely.* The Jewish community has a superstitious relationship to the evil eye: if you tell others about your blessing (of pregnancy), the evil eye might overhear and change your luck. Soon after the first trimester, you start to show, and the secret is out, so the concern about the evil eye lessens a bit then. When I miscarried, only a small group of people knew about my pregnancy. How could my tight-knit Jewish community support me through this trauma when only a handful of people knew that I was pregnant? We have been trained to not publicly reveal pregnancies until we are past the first trimester, and yet that first trimester is when 75-80% of miscarriages occur. And they happen more than we realize. 20-30% of pregnancies end in a miscarriage, and the statistics only increase as women continue to have children into their late 30s, 40s, and beyond.   One the one hand, the more people you tell about your pregnancy, the more people you feel like you need to ‘un-tell’ should you, God forbid, miscarry. On the other hand, those people are the ones who can hold you – feed you, check in on you, and let you fall apart with them. 

When I did tell people who didn’t know that I had been pregnant, I had to tell them three secrets at once: (a) I decided to try to become a parent (b) I had been elated that I got pregnant (c) I am now crushed because I had a miscarriage and now I need you to be gentle with me. Sharing pregnancy news – whether about a new pregnancy or a pregnancy loss – is an incredibly vulnerable act. Don’t be too afraid of letting people know before you cross the first-trimester finish line, if those people would not only celebrate with you but also support you through your fears or even a loss. Let’s change the stigma around revealing a pregnancy while it is still uncertain. The uncertainty doesn’t go away entirely until you hold a baby in your arms.
  5. A miscarriage is related to, but not identical to, infertility. Trying to get pregnant again may feel intensely different than before. 
For weeks, I couldn’t shake the feeling that I’d done something to cause this, even though I was reassured again and again that running too much or taking a redeye or that sip of coffee would not cause me to miscarry. 
People told me that it was a good sign that I was able to get pregnant. While there might be medical truth to that, as much as I wanted reassurance that I would eventually, God willing, be able to carry a pregnancy to term, I need to mourn this particular loss – this particular baby-to-be that I carried and would never become a baby that I could hold in my arms. I went to the mikveh before I tried again, so that I could acknowledge that my body, which was supposed to create life, had in fact held a sort of death. I needed to immerse and wash that away in order to be ready for new life again.
  6. A miscarriage is not (always) the same as being sick. 
My mental and spiritual health were compromised, but thankfully, in my particular situation, I was never worried about my physical well-being. This may not be true for other women, but I did not want to benschgomel (a call-and-response moment during an aliyah to the Torah, often said when you survive a potentially life-threatening experience) both because of this gratitude for my health throughout and because I was not sure that I wanted to acknowledge my miscarriage quite so publicly. 

I associate gomel with surviving in the face of fear, but I had not been afraid. Instead, I had been devastatingly sad.
  7. When in shock and grief, decisions are exponentially harder. Prescribed rituals or other things to do or not to do can help you move through that. 
When an immediate family member dies, Jewish tradition prescribes very specific and concrete changes in order to grieve the life lost. 

I have been working on compiling resources for rabbinic colleagues to help their communities mourn miscarriages, perinatal losses, and neonatal deaths, but there isn’t a definitive set of do’s and don’ts. In the midst of what can be a deeply chaotic and heart-wrenching experience, rabbis can help by developing a concrete set of ways to mourn. Had I been steered toward taking several days to fully grieve in a way that parallels shiva, I believe that I would have healed more easily.

Grieving my pregnancy loss was incredibly challenging. And yet, a foundation in traditional Jewish mourning rituals eventually helped me find ways to adapt them that felt honest and appropriate for miscarriage. As I moved through each day, I also found myself experiencing deep, profound gratitude for the people in my life who showed up for me over and over again.

May we find ways to cushion the pain of pregnancy losses with community, ritual, and tradition.

Complete Article HERE!

To die well, we must talk about death before the end of life

In a research study, 84 per cent of residents and families who received a pamphlet about end-of-life choices felt encouraged to think about their future care.

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I would like to tell you an all-too-familiar story. It begins with a long-term care home resident, Laura, who has multiple chronic conditions and gets an infection that doesn’t get any better.

Her health has been declining for months, but no one has talked to her about her preferences for end-of-life care. In the absence of that knowledge, she is sent to the hospital where she undergoes stressful tests.

The story ends with Laura dying in the hospital, alone and frightened. Her family is traumatized, and so are the staff who have cared for her over the past year.

It’s a simple fact that 100 per cent of us will die. Conversations about our future health care and what’s important to us — called advance care planning — have shown distinct benefits.

In fact, research shows that as many as one third of seriously ill, hospitalized older people are receiving invasive treatments they don’t want at end-of-life, because no one has talked to them about their wishes for future care. This is true even in long-term homes, where the average lifespan is less than two years.

Pamphlets help stimulate conversation

How do we change those statistics and give our older people the care they want — and deserve? My team’s research has focused on answering that question over the past six years.

We recently developed a series of pamphlets and distributed them in long-term care homes to try to get the conversation started.

The pamphlets were disease-specific (for example, focusing on dementia), and included information about life-limiting illnesses, what to expect and tips for talking about wishes for the future.

In our study, 84 per cent of residents and families who received a pamphlet felt encouraged to think about their future care and 70 per cent felt clearer about what to talk about.

Planning death is a great relief

Moving from thinking to discussion, however, was a different matter. Family members worried that bringing up the subject would destroy hope. Residents thought they should protect their families from thinking about their death.

And many long-term care home staff indicated that they did not feel trained to participate in these conversations — in fact, only 21 per cent handed out the pamphlets, preferring instead for families or residents to take them from a display board.

Encouragingly, the 56 per cent of residents and families who did have conversations after receiving a pamphlet expressed great relief. A typical response from families was: “It makes it easier for me right now because now I don’t have to guess.”

Death is taboo, globally

The problem goes beyond long-term care homes. A striking 93 per cent of Canadian participants in a recent poll think it’s important to communicate their wishes for future care should they become seriously ill, but only 36 per cent have actually done so.

That may seem shocking. But according to the World Health Organization, Canada is actually ahead of most European countries.

Clearly, talking about death and the end of life is still taboo around the world.

Informational resources such as our pamphlets can be a great first step in helping all parties gain clarity on what to be thinking and talking about. But because residents and families tend to protect one another, staff need to take more active roles in supporting such conversations.

Care home staff need training

That means we need to clarify roles and provide the necessary training to support long-term care home staff, especially those who develop strong relationships with residents.

We have an aging population, and thanks to technological advances, more of us are living longer with frailty and chronic conditions. We need to find ways to communicate what’s important to us, so that we receive the care that’s right for us.

I would like to be able to tell you a different story. It begins with a care home resident, Sam, who gets an infection and is not getting better, even with antibiotics.

Sam has been living with multiple chronic conditions for some time and his family knew frequent infections could be a sign that the end of life was near. The family also knew that he wanted to die in the long-term care home and not in a hospital — because they had talked about this when he was healthier and could communicate his desires.

Sam dies, but with dignity and in peace and, most importantly, in keeping with his own wishes.

Complete Article HERE!

End-of-life doulas and ‘death cafes’ are changing the conversation around dying

End-of-life doula Nathalie Bonafé leads a death cafe on the last Tuesday of every month at Koffee? in New Haven.

By Cara McDonough

The term “death doula,” which a lot of people use when describing Nathalie Bonafé, makes her job sound edgy. But the proper name for what Bonafé and her company A Gentler Parting do is “end-of-life doula.” And while the job does involve helping individuals and their caregivers face the existential mysteries of the great unknown, end-of-life doulas spend a lot of time facilitating the practical duties that surround the event.

These doulas — who, like birth doulas, are focused on ushering individuals from one phase of life to the next — aren’t as common as the hospice and palliative care workers we associate with end-of-life care. However, they hope their work, approaching death with compassion but also a pragmatic business sensibility, will become more mainstream.

In fact, Bonafé and her colleagues refer to what they do as “a movement.” In addition to their primary responsibilities, they also conduct free workshops, seminars and discussions known as “Death Cafes” to get people talking about death more often, making it a less taboo topic.

Bonafé, previously a molecular biologist, was trained at the New York City-based International Doulagivers Institute. While end-of-life doulas do not provide medical care, she and other doulas offer a wide range of services: Bonafé can help a client do anything from write a living will to downsize his or her home. After a client has passed, she can help create “legacy projects” and facilitates grief management. Rates vary greatly from client to client, she says (most end-of-life doulas seem to average several hundred dollars for typical services).

While the actual client might be the individual facing death, an end-of-life doula can prove invaluable to that person’s family, health care team and legal counsel, too, Bonafé says. The doula serves as an unaffiliated advocate during an “emotionally charged” period, she says, providing crucial support and planning.

Ingrid Harrison of Affordable Personal Services & Pet Care is a former veterinary technician and New Haven County-based end-of-life doula who specializes in keeping clients with their pets.

“I have seen firsthand with my clients, family members and friends that if there is no plan when you become debilitated or pass away, it can have a disastrous outcome,” she says. “Having an end-of-life doula makes for the peaceful passing that everyone deserves.”

As for the Death Cafes? Again, sounds edgy, although the concept is anything but. Bonafé holds them on the last Tuesday of every month at New Haven-based coffee shop Koffee?, describing the gathering in flyers as “a safe, respectful space where we can share our beliefs, curiosity, fears, and stories — and maybe gain a little insight into our mortality.”


End-of-life doula Nathalie Bonafe helps families and individuals deal with the death process, from grief management and emotional support to document organization.

There are usually about 10 participants at each meeting, of different ages and from diverse cultural backgrounds, ethnicities and religious beliefs, she says. One young man joined a recent group after he’d finished a date at the coffee shop because he had recently attended his first funeral and wanted to share thoughts.

People hear about the events through word of mouth, social media or the official Death Cafe website deathcafe.com, which includes events all over the world; there are over 8,800 Death Cafes held in 65 countries, according to the site.

“People leave the meetings with big smiles and a heart full of joy to have been able to share their stories,” Bonafé says. “As the moderator, I ensure that the space is a place of respect and lack of judgment.”

Dawn Whelan operates My Last Gift in Staffordville. Her services, in addition to many like those provided by fellow end-of-life doulas, also include destroying paperwork “not intended for public view” after a client has died.

She says that death is the “one thing we all have in common” and is honored to serve her clients and the community through her work and the free monthly webinar she’s created — DASH — allowing individuals to discuss death openly on a regular basis.

Whether at “cafes” or online, discussing death can help dissuade fearfulness, says Sharon McCullough, an end-of-life doula based in Southington. Her company, Sharon Cares, also offers free discussions on death at a local wellness center.

“People live as if they will recover from all diseases and incidents and are angered by anyone who even starts to talk about the idea that treatment is not curative. This leaves many families stricken with anger when a loved one dies,” she says. “As a doula, I am able to be a witness and support through the struggles of this very natural part of life.”

Dr. Kathleen Leinhardt, a physician who treated one of Bonafé’s clients, saw firsthand how the emotional and logistical support offered — providing food, music and companionship, while also helping organizing home health care and hospice services — changed her patient’s experience. “Nathalie truly took on the role of a surrogate daughter,” she says. “End-of-life doulas can be an invaluable help to those who lack family or whose family lives far away. More than that, though, they can serve as a guide to both patient and family through the emotional and logistical process of dying.”


Nathalie Bonafé shares what she’s learned as an end-of-life doula.

Everyone has a story.
When I spend time with people toward the end of their lives, I am always amazed by the stories they share with me: what/who really mattered to them, where they grew up, their relationships, places they called home, visited, loved, their daily activities, their passions, their beliefs. I find that many express their grace and humanity alongside their vulnerability.

Everyone wants validation.
People want to be seen, heard and understood. No matter what religion, beliefs, education, socio-economic status, mental or physical abilities people have, everyone I encounter is receptive to a smile, compliments or being listened to. People at the end of life want to be witnessed and remembered as the young and strong and able people they used to be. They also want to be remembered as loved, decent, loving human beings, without judgment.

People tend to die the same way they chose to live.
People have a lot more control over the way they die than one can imagine. For instance, a very private person will prefer to spend the very last instants alone or in the arms of a very trusted person; a person who was a natural caregiver will die making sure that the most sensitive/fragile people in their lives are sheltered from shock and pain. Likewise, those who understand the benefits of planning a little, and learn the notion of “letting go” during their lives, tend to find acceptance and inner peace more easily than most.

Listening is more powerful than speaking.
Compassion, understanding, forgiveness and love can be expressed very simply. Similar to the way a frightened child will find incredible comfort and reassurance in your open arms, people in grief, whether facing their own mortality or that of a loved one, want a safe, intimate space to shroud their pain and fears. Learning to build and offer such a space to others in need of such reassurance has been one of the most sacred, humbling and profound discoveries of my life.

It’s worth living to learn.
Life is hard. Every day, we get disappointed, we either feel hurt, or we hurt, we misunderstand, we get angry, we win sometimes, yet we fail a lot more often than we win. Still, we learn throughout it all. Think about it this way: since it is scientifically proven that novel experiences give us a rush of dopamine, the “feel good” neurotransmitter, we can turn the pain and changes in life into growth and love and more rushes of dopamine. Intense moments of joy and excitement are rare. Pay attention and enjoy them; they are precious.

Complete Article HERE!

We’re looking at death all wrong. Here’s why.

Can a shift in the way we treat death and dying improve our lives while we’re still here?

A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death

  • These days, for the most part, the concept of death is consumed by health care and medicine.
  • However, as humans we need to view death as more than just a medical event. It takes into account our psychology, spirituality, philosophy, social worlds, and personal lives.
  • This reconsideration should also apply to the way we treat people who are dying. Life is in the senses, not just our physical capabilities.

BJ Miller: Health care, medicine in our country is a giant, colossal thing. And it’s got a ton of momentum. And medicine has become– the domain of death is more or less ruled these days by health care. In times past, it’s been the church, or the family was the sort of center of all this.

These days, it’s mostly medicine. But what’s really important in all this is that we people, we humans, we patients, loved ones, we need to kind of take back the subject on some level– that dying is not just a medical event. It’s way bigger than that. It is all-encompassing. It’s where everything comes to account– our psychology, our philosophy, our spirituality, our social world, our intrapersonal lives– all of it. The medical piece is a little itty bitty piece. It just gets too much attention.

So I’ll just think about the emotions for a second. For one thing, to remind ourselves– for me, the difference between emotion and a thought is you can control your thoughts. You can’t really control your emotions. Emotions are much more slippery. They’re going to have their way with you. So you ignore them at your own peril.

That’s one thing to get across. But I also say that to let us off the hook. The way you’re feeling, on some level, isn’t your fault. And one of the things I see that happens a lot around this subject– again, we’ve talked about how one can be made to feel ashamed to be sick, ashamed to be dying, like we’re failing, somehow.

I want to make sure that we all understand, there are certain things that are way beyond our control. And that means– that may be hard to swallow, but it also means we’re off the hook. It’s not my fault, the way I feel. I shouldn’t have to hate myself or be embarrassed about it. So let’s set some ground rules.

And there’s this other layer that is particularly vexing, which is how others start treating you. And it’s very common, under the banner of sanctity or wanting to protect someone, to– I watch people, they stop telling jokes. Maybe they think it’s sort of sacrilegious to try to be funny around someone who’s sick. Or maybe they don’t talk about their own joys that they happen to have in their day while their colleague is meanwhile miserable with a fever or something. They don’t feel like they should talk about their own joys. Or I don’t know, whatever it is– pick anything.

But one of the things that ends up happening is we end up accidentally making life even harder for each other by keeping the truth of the situation at bay. All right? So these are the ways we die before we have to die. We die before we have to die because no one tells jokes to us anymore because they don’t think we’re going to want to laugh, or that sounds perverse.

Or maybe our partner stops the intimacy. Physical intimacy might dry up, or sexuality. The idea that a disabled person can be sexual, that’s still a novel concept. Just look at most exam rooms in a doctor’s office or in a hospital. Most of them are not even wheelchair-accessible.

My mother uses a wheelchair. They used to just assume she wasn’t having sex, so they wouldn’t offer her a pap smear.
And so one of the things you want to avoid if you plan for your death is you want to– ideally, we come to our death without piles and piles of regret. So when I’m working with patients, especially upstream of their death, I’m always encouraging them to feel things, enjoy the body they have while they have it, appreciate their body while they have it, because it’s someday going to go, and you’re going to miss it.

So touch is just profound. It’s elemental. It is, even if you think about, I think, the scourge of dementia, for example– and a lot of us are terrified of this eventuality. We’re going to lose our minds. Yeah. And it’s hard. And that is a very difficult prospect. And I’m also pretty convinced that there’s a life on the far side of our intellect.

And for me, that life is in the senses. As long as I can feel something, I’m interested in being alive. I’m even more interested in that than a thought.

Complete Article HERE!

Need Some Dinner Conversation Topics?

How About Death?

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The dinner table is the most natural place for human connection and difficult conversations.

80% of people want to die at home, yet only 20% of people do.

This statistic is what helped the founder of Death Over Dinner, Michael Hebb, to recognize the opportunity in creating meaningful conversations around death… over dinner.

“The dinner table is the most natural place for human connection and difficult conversations. The comfort of food and drink goes a long way toward taking the edge off of this topic,” says Hebb.

What is Death Over Dinner?

Death Over Diner was launched in 2013 as an extension of a conversation with friends and colleagues around things that matter. It turned out that amongst topics, death was a central theme –– the fears most harbor about it, both for ourselves and those we love.

The Death Over Dinner website walks individuals through how to host their own dinner, including choosing something for your guests to read, watch, and listen to prior to the dinner.

Since launching, Death Over Dinner has become a global phenomenon, with people holding death dinners every day all over the world. From New York to Seattle, and everywhere in between, more than 200,000 people have used DeathOverDinner.org to talk about:

· Life wishes especially in final days

· End-of-life care desires

· Palliative care desires

· A living will

· Their own mortality

· Fear surrounding death

· and more.

Collaborators including Chase Jarvis, Arianna Huffington, Dr. Oz, The US Surgeon General, and Former Senate Majority Leader Bill Frist have all hosted robust conversations over dinner, as well as have set up an online tool to help others have this important conversation. In 2017, Death Over Dinner joined social wellness venture RoundGlass to expand their mission and reach.

To get a better understanding of how (and why) this started, what is happening now, and where it is going now that the death wellness movement is in full swing, let’s dive in to some questions.

How did Death Over Dinner Begin?

Death Over Dinner actually began as a graduate course Hebb taught at the University of Washington in the Communications Department.

Over a four-year time period, Hebb and a variety of different students and collaborators including Chase Jarvis, Arianna Huffington, Tom Kundig, and Kate Bailey, explored how they could scale meaningful dinner table conversations about critical issues we face as humans.

In the second year, they landed on death and end of life as the primary topic, inspired by the tremendous gap between what people want at the end of their lives and what they get.

The life changing statistic that 80% of people want to die at home yet only 20% of people do was the primary inspiration for the future of Death Over Dinner.

Death literacy was at an all-time low, and open conversation could potentially revolutionize the health care system. The team recognized that a grassroots movement was needed.

Since then, Death Over Dinner has spread across the world, with people holding death dinners every day across the globe.

How Many Death Over Dinner Events Have Been Held?

Since the events are independently organized and people re-use the resources multiple times for multiple dinners, it will always be difficult to know the precise number of dinners held.

The conservative estimate is that 200,000 dinners have taken place, which means that roughly 1 million people have sat down and had the experience of talking about death with others in their family and/or community.

Regional partners have helped launch platforms in Australia, India and Brazil and two years ago the Jewish Edition of Death Over Dinner was launched in partnership with about 30 rabbis.

The Healthcare Edition build in partnership with the Cleveland Clinic is currently in beta and being tested by dozens of the leading health care systems in the US.

For the founder, Hebb, there is nothing more thrilling than to sit down with doctors and nurses and see precisely how meaningful these conversations are to those who are facing death everyday.

How Do The Death Over Dinner Resources Help People Facing Death?

Let’s face it, no one is truly an expert on death. Few people have experience with death and many choose to run far from a conversation about it. End of life conversations are inherently difficult to initiate and can be stressful to navigate for anyone.

That’s why Death Over Dinner strives to make the process crystal clear, and formulated the concept similar to a board game. When you know the rules, it’s easier to relax and just play.

Designed to be held without facilitators, Death Over Dinner gives a little guidance to get started. From there, people intuitively know how to talk about what is most important to them.

Vulnerability is unquestionably the winning move in the Death Over Dinner “board game.” The questions Death Over Dinner prompt allow people to drop their armour and open up about their fears.

Death Over Dinner encourages people to not edit their responses and to say things they are afraid to say. Doing this brings individuals closer to knowing their priorities, and it brings them closer to the people in their life. 

Why Are Death Over Dinner Conversations So Important?

 The impact of grief on our well-being can be detrimental and difficult to calculate.

Roughly 25% of us are actively grieving, which begs the question, how are we grieving? If we don’t know our loved ones wishes, will we grieve longer and more intensely? Will we carry regret and have difficulty letting go?

Not to mention that the end of life expense is the number one cause of personal bankruptcy in the United States.

However, when we face our mortality, there are many beautiful things that happen.

“There is no better medicine than end of life awareness to give you clarity about what is truly important to you, your values, your priorities, how you want to live.  Life becomes more clear and sacred when we thoughtfully and intentionally face our impermanence,” says Hebb.

Studies done by Dr. Jordana Jacobs and other leading psychologists prove that talking about death actually increases our capacity to love. Other studies have shown that we become funnier and laugh more easily after being primed for death.

“There are two basic motivating forces: fear and love. When we are afraid, we pull back from life. When we are in love, we open to all that life has to offer with passion, excitement, and acceptance.” John Lennon

What’s Next For Death Over Dinner?

When Death Over Dinner was created, Hebb’s moonshot was that they could find a way into the center of the American medical establishment and inspire clinicians to talk about death in an open hearted and vulnerable way.

Knowing that oncologists, nurses, survivors and cancer patients are breaking bread every month at Memorial Sloan Kettering takes Hebb’s breath away when he gets present and lets it sink in.

“To think that we are really just at the beginning seven years after we launched, just starting to crack open the potential of this conversation, that is awe inspiring,” says Hebb.

Since the launch of Death Over Dinner in 2013, death literacy in the US has increased, and people are beginning to make more empowered decisions. The global death wellness movement and conversations around end of life are now front page news.

People are getting more creative, using their imagination for planning their last chapter and planning memorials.

There’s a shift from a reactive to a proactive approach to end of life well-being, and the movement is just getting started.

Learn more about Death Over Dinner and plan your own dinner today.

Complete Article HERE!

End-of-life hospital care in California could soon include cannabis

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Updated 10/24: On October 12th, Governor Newsome unexpectedly vetoed SB 305, citing conflicts between state and federal laws as well as potential loss of federal funding. He did so “begrudgingly,” calling the federal government’s position on cannabis “ludicrous.” 


 

 

 

The awkward legal-ish status of cannabis is something that affects many. And out of those, perhaps terminal patients are the most in need. When someone is painfully dying in a hospital, they are generally pumped full of drugs that often leave them barely conscious, or fully asleep.

Ryan had stage 4 pancreatic cancer that had reached the point where he needed professional care, but his only option to treat the intense pain was morphine, and even fentanyl—which is up to 100 times stronger than already-potent morphine⁠—leaving him barely conscious, or asleep. The last days of his life were being stolen, and he wanted all the coherent time he could gather to spend with his 9-year-old son

So Ryan asked his father, Jim Bartell, to get him off the pharmaceuticals so he could function in some capacity during his last days. Jim located a hospital that would allow cannabis, and Ryan was promptly transferred to it. On the first day that Ryan was allowed cannabis, they had to spray a tincture under his tongue because he couldn’t even swallow.

But by the next morning, he was reportedly alert, talkative, and pain-free. Ryan was able to spend his last two and a half weeks of life chatting on the phone and taking visitors—connecting, laughing, and taking the precious time to say goodbye.

But Jim Bartell’s mission had just begun

Ryan Bartell passed away on April 21, 2018, but Jim wasn’t done with this issue. He drafted a bill that would allow terminally ill patients to use medical cannabis in hospitals.

In an interview with Leafly, he shared that as President of a San Diego firm that handles things like government PR, he’d been prepared for this mission—he’d already reviewed hundreds of government bills over the years.

After three long months of research and another three weeks of drafting, he took SB305 to Senator Ben Hueso at the end of 2018. Sen. Hueso agreed to sponsor it, and Jim and his staff continued to work together near daily until SB305 was submitted in February. Much of the pushback came from the California Hospital Association, who feared that they would lose federal funding as cannabis is still federally classified as a Schedule I drug.

But they worked through the opposition, drafting the bill so if the government were to change position and enforce federal prohibition against cannabis—then that hospital would be suspended from compliance.

And on September 11th, 2019, the California State Legislature unanimously approved their Senate Bill No. 305, which was aptly, and powerfully, titled “Ryan’s Law.” It’s now on its way to California’s pro-cannabis Governor Newsom, who is expected to sign it in the coming weeks. If all goes as predicted, it will come into effect on January 1st, 2020.

This means that starting next year, terminal medical cannabis patients with a prescription will be able to use cannabis in forms other than smoking/vaporization in hospital care. Cannabis will be procured by the patients, not the hospital. Hospitals will not be allowed to interfere with its administration, but will be allowed to help if needed.

Next steps for Ryan’s Law

Jim doesn’t plan to stop there. He says that this issue is affecting people like Ryan, and the people who love them, all over the country—so he’s doing something about it. First steps are to take on the geographically (and politically) close states of Oregon and Washington. And now they’ll only have to amend the bill with state-specific health codes instead of starting from scratch. Hopefully these states align quickly, and others as well.

Medical cannabis may be legal in many places, but patients in need of this medicine still face obstacles in terms of using it when and where they need it. While the chronically ill and those still in the fighting stages of diseases aren’t yet protected, this is an encouraging step in the right direction.

While some other states have on the books that they allow cannabis in hospitals, this will be the very first law that requires allowing it. Finally.

Even with such strict laws in place, a massive library of studies supporting the power of medical cannabis have amassed over the decades. It’s beyond time that medical cannabis became more accessible.

Complete Article HERE!