Let’s talk about dying

The most unavoidable topic that everyone avoids

By Hannah Mirsky

No one talks about death. I didn’t for a long time.

Sometimes the words spilled out when I was with a friend, but I never felt satisfied. Other times it was late at night and I would mope out to the living room past midnight to sit with my mother and briefly discuss how much we missed those in our family who died.

That was it though. Death would be brought up, but the conversation never was discussed for too long.

In the summer going into seventh grade my grandmother died from pancreatic cancer, then my aunt ten months later from bladder cancer. Then my grandfather a few years later.

As I coped with the death of my family members, I began excessively planning out my future. I developed the ideal life from the city I’ll reside in, to the color I would paint my apartment walls. When I committed to college I vowed I would take every opportunity I could possibly get and fill each day with experiences that could help me with this vision.

But I worked so much when I got to college. It got to the point last fall that I lost a part of myself. There were no moments of peace in my day. I took a full course load, managed my school’s broadcast news department, worked an internship, another part-time job and choreographed for Quinnipiac University’s Tap Company. In every way, I was disconnected from the people around me and myself.

Yet during this particular semester, I was enrolled in a course called “Sociology of Death/Dying” where we discussed social interaction between the dying person, professional caregivers and loved ones. The class flowed like an open forum.

I joked that I would start and end my week with death since I only had that course on Mondays and Fridays. My friends didn’t laugh too much.

Three times a week I was forced to consider death in ways I hadn’t considered. For the first time, I was forced to confront the topic of death on a daily basis.

More than anything, this course revealed the significance of starting conversations about the dying process before death itself. While the person is dying, family and friends are often so wrapped up in trying to keep them around for a bit longer. However, the person dying may feel an obligation to fight for their family when it isn’t something they want. We begin making decisions not for ourselves anymore and we become alienated from the people that we should lean on the most.

Conversations need to begin with health workers and doctors, it needs to trickle down to the family.

Death is isolating in our world— a stigma that many don’t talk about directly. It wasn’t until I met a very close friend of mine when I was in Washington D.C. that I mentioned that I joked about death a lot. No one had ever told me that I brought it up that often.

Maybe, had I allowed myself to discuss how I felt about death when I was growing up, I wouldn’t weave it into my conversations so much now. However, death changes you. I don’t think I would be as articulate with how I spend my days or have had such a clear path. In a way, it helped me understand my priorities and know I don’t have forever to meet them. If I want something, I no longer wait.

It shouldn’t have taken so long for me to feel comfortable talking about death, but it is something many people still struggle with. Neglecting conversation on the certainty of something each one of us will go through ends up forcing us to not consider what we want in life.

Complete Article HERE!

And Finally

— Matters of Life and Death review – humility lessons from Henry Marsh

‘Darkly funny and self-lacerating’: Henry Marsh at home in Oxford, June 2022.

The ever candid neurosurgeon reflects on his own mortality, as well as the failings of his profession, in this enthralling third volume of memoirs

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“I am not a scientist,” says Henry Marsh on the first page of And Finally. “Most neurosurgeons are not neuroscientists – to claim that they all are would be like saying that all plumbers are metallurgists.”

Marsh, who worked as a highly regarded neurosurgeon for more than 40 years, has a penchant for truth-telling, unencumbered by faux modesty. It’s what made his previous books – Do No Harm and Admissions – interrogating a life in medicine, haunted by the “reproachful ghosts” of patients he’d failed, so refreshing and inspiring to read.

This latest autumnal instalment follows in the same vein. Philosophical and scientific conundrums about brain surgery permeate the book: to treat or not to treat patients; how honest to be in giving a prognosis; euthanasia v assisted dying. Along the way the 72-year-old author wrestles with the dilemma of becoming a patient himself.

The memoir’s subtitle and celestial cover design allude to the 1946 Powell and Pressburger film, A Matter of Life and Death. It’s befitting as Marsh reflects on his own mortality after a diagnosis of advanced prostate cancer. He is phlegmatic about his prospects. Sometimes, though, he confesses to paralysing anxiety – a result of his approach towards serious problems that his wife, Kate, calls “therapeutic catastrophising”.

Despite its subject this is not a maudlin book; far from it. Divided into parts like a three-act play, it is often darkly funny, especially in the first act, Denial. Here, Marsh is self-lacerating and also self-forgiving when he reminisces about his medical mistakes. On one occasion he steels himself to admit to a patient that he’d operated on the wrong side of his brain. “Well, I quite understand, Mr Marsh,” the patient answers after a long silence. “I put in fitted kitchens for a living. I once put one in back to front. It’s easily done.”

Marsh is nonetheless fierce on himself throughout the book, as critical as he is of the arrogance of his profession. Now that he’s a patient, he sees clearly how he’s been demoted to an underclass; how some doctors behave as if patients are nothing more than walking pathology; and how they continue to practise medicine under the delusion (once also held by Marsh) that illness only affects patients, not doctors.

Elsewhere, he strikes a sadder personal note, recounting the end of a decades-long friendship with a conscientious Ukrainian neurosurgeon who figured prominently in his earlier memoirs. Working with him in poorly resourced Ukrainian hospitals had left Marsh feeling heroic. But he split from his colleague after discovering he’d been hiding from him a number of cases that had gone terribly wrong, with patients seriously harmed or dying after surgery.

It’s not stated whether Marsh also feels culpable, but certainly he agonises over his professional legacy. That anxiety folds into his nervousness about the future we are bequeathing to our children and grandchildren through inaction over climate change. In one startling passage, he recalls a journey in the Indus delta where he witnessed a catastrophic spectacle: “a flotilla of plastic rubbish … it had neither beginning nor end. It floated past us in complete silence … full of ominous purpose”.

The retired neurologist, who in medical parlance has “hung up his gloves”, has composed a richly discursive book. He charts his ambivalence about undergoing radiotherapy for his cancer, and is especially passionate when advancing the case for assisted dying. He’s scornful of the “dishonest fudge” around the issue that sees doctors accepting the unofficial practice of prescribing large doses of opiate painkillers, as a form of “terminal sedation”.

During Covid, and the cult of death it seemed to spawn, Marsh was animated by the fear his time could run out before he finished making a doll’s house for his granddaughters. Its construction – a mournful metaphor for innocence that a future governed by global warming will deny his grandchildren – is also an act of defiance.

And Finally sounds increasingly ominous about his prostate cancer as the memoir works its way towards a resolution; Marsh is plain-speaking without being dispassionate, almost as if volunteering his own medical history as a case study. Indeed his book reminds me of the mantra – focused on operations – that I first heard at medical school, for doctors embarking on a career in surgery: “see one; do one; teach one”. Henry Marsh may have retired from medicine but let’s hope he keeps producing books as good as this one, which enthral as well as teach.

Complete Article HERE!

3 Stress-Melting Benefits of Box Breathing

(And How to Try It on Your Own)

Try this basic, ancient breathing technique to slow down, reset, and lower stress.

By Lacey Muinos

Focusing on your breath during heightened states of alertness can be a powerful tool for reducing stress, calming anxiety, and cultivating mindfulness. There are many different breathing exercises to keep in your toolbox for when you need them, and one basic breathing technique known as box breathing is gaining mainstream momentum as people discover how straightforward it is and how helpful it can be in everyday life.

While it may seem new to you, the practice of slowing down your breathing with intention has ancient Ayurvedic roots. Box breathing has been used for thousands of years and in practices such as yoga and meditation to calm an anxious mind, engage the rest-and-digest state (the parasympathetic nervous system), and stay grounded in the present moment. It’s even used by Navy SEALs for keeping cool and laser-focused in high-stress, high-pressure situations.

But you don’t need to be a yogi, Zen master, or SEAL to incorporate breathwork like box breathing into your own routine. This uncomplicated, four-step breathing technique is easier than you might think and can be done anywhere and at any time—settle your nerves before a work presentation; slow your breathing while trying to fall asleep; or take a literal breather when you get angry or agitated. We spoke to breathwork pros to find out why this breathing method has resurfaced as an effective and science-backed solution to stress and anxiety.

What is box breathing?

Box breathing goes by many names: four-square breathing, square breathing, four-count breathing, Sama Vritti Pranayama, tactical breathing, and yogic breathing.

“Box breathing is a four-step breathing technique during which you breathe in, hold, breathe out, and then hold for the same number of counts throughout,” says Sophie Belle, a breathwork facilitator and founder of online breathwork studio Mind You Club. So each step of the breath cycle—inhale, hold, exhale, hold—makes up one side of the box. 

Practicing box breathing involves slowing the breath by following a specific pattern:

  1. Inhale for four counts
  2. Hold your breath for four counts
  3. Exhale for four counts
  4. Pause for four counts

(You won’t always have a stopwatch on hand, so “counts” can refer to approximate seconds here.)

Not only does the box breathing physically alter your breath to become slower and deeper, but it also forces your mind to become focused on and conscious of your breath. This can be especially powerful during times of tension or distress, but also beneficial anytime, anywhere as a daily habit. “When we’re consciously breathing, we have the ability to regulate our body and take it from an overstimulated state of stress and nervousness to actual calm,” says breathwork specialist Ali Levine. “Box breathing is a way for you to consciously monitor your breath and pay attention to your rhythm—it’s a reset to your breath.”

The Benefits of Box Breathing

1 Reduces the body’s stress response.

Studies have shown that diaphragmatic breathing (in other words, taking big, deep, gentle breaths that fill your belly) counteracts both the physical and mental elements of stress. Deep breathing has even been shown to reduce the physiological consequences of stress in adults. “Box breathing is a simple, yet powerful way to take yourself from fight-or-flight mode back to a normal rhythm,” Levine says.

When you’re stressed or tense, one of the ways your system reacts is for your breathing to become faster and more shallow (this is all part of a normal, natural stress response). This kind of rapid breathing, known as hyperventilation—essentially where you exhale more than you inhale—lowers carbon dioxide levels in the body and makes you feel lightheaded. Slowing down your breathing helps to control hyperventilation. It restores the rhythm of your breathing, correcting those fast, shallow breaths associated with stress and anxiety.

During states of stress, another thing that happens is that your heart rate increases. This is when your body enters fight-or-flight mode, releasing adrenaline and cortisol, which cause your heart rate to speed up and blood pressure to rise. Slow breathing has been shown to have a profound effect on cardiovascular function. Box breathing activates the parasympathetic nervous system, which is the opposite of fight-or-flight mode, helping the body return to a rested state.

2 Halts unhelpful thought loops.

Box breathing comes with the enormous benefit of calming the mind. Stress and anxiety often come with a cluttered headspace and racing thoughts. “Box breathing focuses your mind, so it’s incredibly good for stress, rebalancing, and [attention],” Belle says. When your thoughts won’t stop swirling, it can feel impossible to quiet them. Using a mindfulness-based breathing exercise like box breathing forces you to bring your attention to something other than upsetting, overwhelming, or just plain obnoxious thoughts. It gives your brain something else to fixate on (what a relief!). And one of the best long-term side effects of doing something like box breathing is that the more you do it, the better your brain will become at redirecting attention away from unhelpful mental chatter. It’s actually a skill that gets sharper with practice.

3 Helps you focus on the present moment.

Anxiety typically involves worrying about the future or harping on the past. Box breathing is heavily associated with meditation and mindfulness, two of the best techniques for anchoring yourself in the current moment.

“The focus on the breath enables you to become very present,” Belle says. “This helps you to practice non-attachment to unhelpful thought patterns, which over time can lead to more positive automatic stress responses.”

How to Try Box Breathing on Your Own

This breathwork practice is rewarding and grounding—and it’s easy to get started. You don’t need any special equipment or even a secluded place, just your mind and your breath. Give it a try when you feel stressed or on a regular basis to encourage relaxation.

How to do it:

  1. Ground yourself (e.g. sit in a chair, sit on the floor, stand in a comfortable position). Sit or stand up straight (but not rigid) and relax your shoulders.
  2. Bring focus to your breath.
  3. Take a slow, deep breath in as you count to four, making the inhale last for all four counts. Feel your belly expand with air.
  4. Hold your breath for four counts. Try to think only about counting to four.
  5. Exhale through your mouth: Breathe out steadily for four counts, making the exhale last for all four counts. 
  6. Hold again for four more counts.
  7. Repeat this cycle as needed.

If you’ve never engaged in breathing techniques before, it will likely feel strange at first—that’s completely normal. “Don’t be disheartened if it feels difficult,” Belle says. “Just reset and reduce the counts or try again at another time when you have a bit more space to focus on the breath.” Instead of attempting to carve out time for box breathing, Belle recommends stacking this habit onto another daily activity that doesn’t require much effort, like waiting for the shower water to get hot or the kettle to boil.

Complete Article HERE!

Why L.G.B.T.Q. Adults Are More Vulnerable to Heart Disease

Experts say that a leading cause of death often goes overlooked.

By Dani Blum

As lots of U.S. residents have been celebrating Pride this month, many in the medical community have highlighted the devastating disparities in health outcomes for L.G.B.T.Q. adults — disproportionate cases of monkeypox in men who have sex with men, high reported rates of alcohol abuse, obstacles to accessing screening and treatments for cancer.

But according to some health experts, one of the most critical health inequities among L.G.B.T.Q. adults often goes overlooked.

A mounting body of research shows that L.G.B.T.Q. adults are more likely to have worse heart health than their heterosexual peers. Lesbian, gay and bisexual adults were 36 percent less likely than heterosexual adults to have ideal cardiovascular health, the American Heart Association concluded in 2018, based on surveys of risk factors like smoking and blood glucose levels. In 2021, the organization released a statement on the high rates of heart disease among transgender and gender diverse individuals, linking these elevated rates in part with the stress that comes from discrimination and transphobia.

The data supports what clinicians, and those who research L.G.B.T.Q. health, have observed for decades — that the community faces particular, pervasive obstacles that take a toll on the brain and body.

Cardiovascular disease is the leading cause of death in the United States. The Centers for Disease Control and Prevention estimates that 80 percent of premature heart disease and strokes are preventable. But there are disparities in where this burden falls among the general population. We spoke to doctors and health researchers about why these inequities persist, and what steps L.G.B.T.Q. adults can take to bolster their heart health.

The strain of stress

Experts said L.G.B.T.Q. adults face unique stressors — stigma, discrimination, the fear of violence — which can both indirectly and directly lead to disease.

Stress directly impacts certain hormones that regulate your blood pressure and heart rate, said Billy Caceres, an assistant professor at the School of Nursing and the Center for Sexual and Gender Minority Health Research at Columbia University.

Hypervigilance — the sense of always being on edge, constantly scanning for the next threat — causes cortisol levels to surge, which can lead to long-term cardiovascular issues, said Dr. Carl Streed, an assistant professor at Boston University School of Medicine.

Plus, stress can lead to chronic inflammation, said Dr. Erin Michos, associate director of preventive cardiology at Johns Hopkins University School of Medicine, and it can raise your blood pressure and heart rate.

Researchers sometimes refer to the allostatic load, the cumulative toll that chronic stress takes on the brain and body, said Scott Bertani, the director of advocacy at HealthHIV, a nonprofit focused on advancing prevention and care for people at risk for H.I.V. “It only stands to reason that our bodies respond to these really complex and challenging life events and demands,” he said. For instance, he added, the act of coming out, and in some cases, coming out repeatedly, often comes with severe stress.

To cope with the constant threat of discrimination or harassment, many in the L.G.B.T.Q. community self-medicate with drugs like tobacco and alcohol, said Dr. Streed, who is also a researcher at the Center for Transgender Medicine and Surgery at Boston Medical Center. These industries have targeted the L.G.B.T.Q. community through advertising, he said, especially during Pride month. The Centers for Disease Control and Prevention reports that around 25 percent of lesbian, gay or bisexual adults used a commercial tobacco product in 2020, compared with 18.8 percent of heterosexual adults, a disparity the agency partially attributes to the tobacco industry’s long history of aggressive marketing campaigns.

Research has also identified a link between sleep and heart health, Dr. Caceres said. Mounting evidence shows that L.G.B.T.Q. adults experience more sleep issues and interruptions than the general population, which may also be tied to chronic stress.

Obstacles to seeking care

A 2017 survey of nearly 500 L.G.B.T.Q. adults by researchers at Harvard T.H. Chan School of Public Health and the Robert Wood Johnson Foundation found that more than one in six reported avoiding health care because they worried about discrimination. That hesitancy means that L.G.B.T.Q. adults are less likely to access potentially lifesaving preventive health care, said Dr. Michos. All adults should be screened at least once a year for cardiovascular risk factors, which is typically part of an annual physical, she said.

Finding medical providers that you feel comfortable and safe around can be key in preventing heart disease, experts said. Dr. Streed recommends that L.G.B.T.Q. adults seek out supportive medical practitioners. The Gay and Lesbian Medical Association offers a directory on its website that allows patients to find health professionals. The Human Rights Campaign creates an annual Healthcare Equality Index — a list of health care facilities that say they are inclusive of L.G.B.T.Q. patients.

What L.G.B.T.Q. adults should know about improving heart health

While gender-affirming hormones have been shown to positively impact mental health, Dr. Michos said, there is some evidence that high amounts of testosterone and estrogen can have cardiovascular risks. People who are taking these hormones should consult their doctors about how to maintain their heart health.

The American Heart Association recommends seven steps for optimal heart health: managing blood pressure, keeping cholesterol levels low, reducing blood sugar, exercising daily, eating a nutritious diet, maintaining a healthy body weight and not smoking. Dr. Michos also recommended minimizing consumption of processed foods, sugar-sweetened beverages and highly refined carbs, instead opting for whole grains, lean proteins, and plenty of fruits and vegetables. Adults should also aim for at least 30 minutes of moderate-intensity exercise each day, like brisk walking, jogging or cycling.

These are critical facets of preventing heart disease, she added, “but we can’t just preach ‘You need to live a healthy lifestyle’ if individuals are under significant psychological distress and discrimination.”

Social support can help buffer against the physical and psychological strain of stress, she said, and seeking out community can be particularly crucial for L.G.B.T.Q. health outcomes. Several organizations can help L.G.B.T.Q. people connect with one another: SAGE, a nonprofit focused on aiding older adults, matches volunteers with L.G.B.T.Q. people over the age of 55 for weekly phone calls. The Trevor Project, which provides crisis intervention and suicide prevention services to L.G.B.T.Q. young people, also offers an online community for those between 13 and 24. The Bisexual Resource Center, a nonprofit focused on bisexual issues, maintains a list of online and in-person support groups for bisexual people.

“L.G.B.T. health isn’t just about H.I.V. prevention,” Dr. Caceres said. “A lot of the time, it ends up being focused on that. Sexual health is not the only dimension of health that we as queer people should be thinking of.”

Complete Article HERE!

Small Differences in the Face of Death

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Every medical student has felt apprehensive about facing death at some point, right? Maybe you have experienced someone dying before, or maybe it is something you have never seen and only rarely contemplated. Regardless, there is a subtle tension lurking during your first two years of pre-clinical studies, during which disease and death are intellectualized and abstract. Then clerkships start. Working throughout the hospital, you feel that death is lurking just around the corner. It is palpable. It is hearing a code blue being called on the overhead speaker. It is entering the room of a comatose patient who is technically “alive” but not truly “living.” Whatever one’s experience has been with death, I am confident I am not alone in having felt apprehension and anxiety towards the idea of watching a patient die for the first time.

I managed to get through half of my third year without even being near a patient who died. As I began my rotation in trauma surgery, my anxiety towards the experience had evolved into dread. I was certain that whenever I did finally see someone die, it would surely result in panic. In a weird way, I wanted to just get it over with. I could hear one of my professors saying, “we all go through it, it is best to just rip the band aid off.” As it happened, on just my second night of trauma surgery, a level 1 rolled into the bay. Five gunshot wounds – one to the arm, one to the leg, three to the abdomen. He was in and out of consciousness by the time he got to us. When he was able to speak, he only sputtered out short phrases about being scared. In almost no time, he was sedated, intubated and on his way to the OR. We scrubbed in as fast as we could.

The operation lasted five hours, but it felt much longer. For the most part, it never really looked good. His bowels were shredded from bullet fragments and every time we closed one bleeding artery, we found another. It seemed no amount of epinephrine or fluids could keep his blood pressure up. About two hours into the operation, he coded. The attending surgeon barked an order at me and I started doing chest compressions. They defibrillated him. He still had no pulse. Back to compressions. I felt the crunch of his ribs fracturing beneath my palms. My face shield fogged up from my own labored breathing and I felt sweat building up in my skin-tight surgical gloves.

“This is it, this is the first patient I will see die.” The thought crept into my head for a split second, but there was no time for those thoughts or feelings — I had to do more compressions and another shock. Suddenly, he had a pulse! A brief wave of relief came over me. We operated for another hour, but despite our efforts, his pulse continued to become slower and weaker with each passing minute. Eventually, we found a hole in his aorta and it became clear to everyone in the room that there was likely no way to prevent this man’s death. Yet, we recognized the importance of striving towards the one-in-a-million chance to save a life; so, we continued to work.

But after another hour, the surgeon received a call. A child had fallen from a tree and required the team’s attention in the operating room across the hall. There was no longer the time or resources to work towards that miniscule chance of survival for the person on the table in front of us. The surgeon called off compressions. We stopped plugging holes, most of which at this point had little blood left to spurt out. Most of the team ripped off their surgical gowns, and hurried off to start the routine over again next door. Suddenly, the only people in the room were me, an intern, a nurse and this man on his literal death bed.

His heart was barely beating, a mere technicality keeping him alive for a few more moments. My job was to keep my hand on his aorta and notify the surgeon when there was no longer a pulse so he could call the time of death. All of the monitors had been turned off and the room was silent. I held the now deflated tube of tissue between my fingers, closely focusing to detect the weak, irregular pulsations coming from a desperately failing heart.

Now, there was much more time and space for that dreaded thought to creep in. Surely, this is when I would recognize the reality of the situation and panic from the experience of witnessing death so intimately. Yet surprisingly, fear and dread were hardly present. Rather, I was simply sad. I was sad for this man I knew nothing about whose life was violently cut short. I was sad for his friends and family. At the same time, however, I was proud. I was proud to be feeling for this dying stranger rather than wrapped up in my own anxieties about death. More importantly, I was proud to have been part of what felt like the best effort possible to save this man’s life. My thoughts were interrupted when I recognized the stillness of the aorta. It was over. The surgeon came back to call the time of death and we sutured his wounds as neatly as we could. Even throughout this routine, I felt the gravity of the task at hand. My sense of pride persisted, knowing that we were still working hard to make the coming experience for his loved ones at least slightly less traumatic. 

What made facing death more tolerable that day was the efforts made along the way. Feeling powerless is perhaps the most overwhelming aspect of death. But it is now abundantly clear that small efforts in the world of medicine provide a certain sense of empowerment and peace even in the face of horrific and inescapable outcomes. What I will remember from my first death is that we worked to provide a fighting chance and maybe even some eventual comfort to his loved ones. Efforts like these provide clinicians hope for a better outcome next time, or at least help a family find some peace knowing that everything possible was done. They preserve patients’ dignity in both life and death. Now, I am sure that feelings like fear and anxiety will oscillate throughout my career — after all, medicine is imperfect, things go wrong and people suffer despite our best efforts. I recognize now, however, that the best way to combat our sense of powerlessness when facing outcomes which are out of our control is to appreciate the small differences we are able to make. Ultimately, these seemingly-minimal differences give medicine its meaning, make the hard times more tolerable and more broadly, make this a field I am proud and confident to be joining.

Complete Article HERE!

A ‘death doula’ explains how to transcend your fear of dying so you can truly live in the present

Death doula, Tree Carr, explains what she’s learned as an end-of-life guide and how to overcome fear of death so you can live a life with no regrets

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Death doula Tree Carr’s insight into peoples’ final days means that she’s more in touch with mortality than most. Supporting people on their final journey may sound like a grim task, but for Tree, this calling has taught her lessons on how to truly live. Lessons which she has shared with woman&home…

Death is the great unknown and the idea of having to face up to our own mortality and how we’ll be remembered after death can feel more than daunting. However, by learning to interact with this inevitable experience with a positive and supportive lens—you can stop being scared of it. In doing so, you focus on living a far better life, with no regrets.

The word alone can evoke terror, superstition, grief, feelings of loss of control, and existential dread. The sobering reality of death is often kept swept under the carpet and considered taboo for most conversational circles. 

In our long timeline of humanity, we’ve sought to cheat it; delay it; bargain with it; or transcend it. Its great and elusive mystery has captivated the mystics and has raised the eternal question that science has yet to answer—does consciousness carry on after the body expires? No matter what your ontological or epistemological worldview on death is, it’s safe to say that most people are scared to death of dying.

What is a death doula?

A death doula is an end-of-life guide who holds compassionate space for a person journeying through the psychological, emotional, spiritual, and practical terrains of death and dying. The word doula is from ancient Greek, meaning, ‘a woman who serves’—although the role is far from being gender-specific.

I felt the calling to become a death doula in my early forties after a lifetime of synchronistic events all revolving around death. From a near-death experience of nearly drowning in the Atlantic Ocean at the age of four, through to many serendipitous moments involving being at the right place at the right time when strangers on the street have been close to death.

“You can stop being scared of it. In doing so, you focus on living a far better life, with no regrets.”
— Tree Carr

What I’ve learned as a death doula

In my work as a death doula, the most challenging aspect that I witness a dying person go through is surprisingly not the biological deterioration of the body (there is plenty of palliative care pain control for that). In fact, it is the emotional or psychological loss of the sense of ‘self ‘ that appears to be the most painful.

From what I’ve personally observed, at the end of life many people experience a long, slow, and winding loss of who they knew themselves to be. They are thrown into the existential dark night of the soul asking the big questions: What am I? Who was I? What was this all for?

As a result, this can propel the dying person into depression, grief, isolation, and anxiety. This is where the role of a death doula can be very helpful, traversing alongside a person as they lean into the fears and trepidation of the big D!

Certainly, overcoming the fear of death it’s not a ‘one shot’ remedy most of the time and can be a gradual unfolding that combines a mixture of practices and experiences.

How I help people overcome fear of dying

Person contemplating life

Surprisingly enough, my death doula work isn’t always for people who are actively dying. I have folks getting in touch who aren’t dying at all, but they have anxiety around death. Perhaps they are coping with the loss of a parent or struck with grief from experiencing the death of another person they knew.

I guide my client’s through navigating death phobia, tackling grief illiteracy, bereavement catharsis, and reframing the narrative around the topic and therefore moving into a peaceful acceptance of death.

Part of the journey can involve meditations on death, closure techniques, and emotional integration through a variety of creative processes—letter writing, drawing, conversation, and more.

Here are some simple practices I encourage my clients to engage in each day to help overcome the uncomfortable feelings around death…

Observe the ‘little endings’

One way you can start to journey into your fear around death is to have a daily practice where you bear witness to the ’little deaths’ all around you every single day.

It’s a form of mindfulness with a central focus on the theme of endings. When you meet a friend for coffee and then you both say goodbye and they walk away and leave. This is a little ending. When you lose your mobile phone. This is a little ending when the sun sets every evening. This is a little ending.

Allow yourself to hold awareness for these little endings and be with any emotions rising up. Begin to surrender to the process of not holding onto the little endings but allowing them to release. 

Engage the art of non-attachment, seeing that the only constant, is change. Regular meditation practice is also a good habit because it will help to stabilize a conscious state of equanimity through experiencing endings.

Watch the cycles of nature

A pathway through a dark foggy wood

Another helpful tip is to sit and be with nature, observe and be mindfully present. Being closer to nature connects a person to the reality of impermanence. Observing the shifting and changing of the seasons. The growth, decay and return to Spring Equinox. This forever cycle of life, death, and rebirth.

Observe yourself falling asleep

Something else that can help out is sleep. The threshold states of sleep are liminal experiences just as death can be. When one becomes comfortable in these altered sleep states it can help ease the fear of death.

Make space in your bedtime routine for observing this. As you fall asleep every night and you hover on the liminal threshold of the hypnagogic state you can practice and surrender to the idea of your own death. Allowing yourself to relax and surrender to sleep from the cusp of fatigue is a surprisingly easy and transformative technique.

Attend a Death Cafe

Death Cafes are safe spaces to gather and meet to talk with other people about all things death and dying over coffee, tea, and cake. Whether you share your own experiences around losing a loved one or a beloved pet. Or maybe you are navigating your own end-of-life journey, Death Cafes are death-positive, compassionate, non-biased, and non-judgemental events.

In the many Death Cafes that I’ve facilitated worldwide, I see the boundaries of culture, gender, age, race, and religion dissolve as we all come together in solidarity over the one thing we all have in common—the fact that we will all one day die.

Living a life in fear of an inevitability that we all share can prompt or worsen difficult emotions, like anxiety, depression, panic attacks, and conditions like sleep anxiety
and insomnia.

However, by embracing the awareness of this inevitable life process, through positive and supportive ways, can not only help us live a more enriching life—but also help us to live one with no regrets.

Complete Article HERE!

How I learned to talk about death and dying

First step: Acknowledge it, together

By Steven Petrow

A serious illness is many things — terrifying, painful, life-altering. The prospect of losing a loved one, or your own life, becomes an unspeakable agony. It’s also isolating in a way I never could have imagined. I’ve been the one in that sickbed, and I’ve also done some time sitting beside it. I wouldn’t wish either experience on anyone.

Lately, however, I’ve been thinking about what memoirist Meghan O’Rourke has called “the long goodbye” and trying to focus on the one gift it does give us: the gift of time. Time to plan, but mostly time to unearth and process our feelings. And then, if we’re fortunate, to be able to share these deep-seated fears with those we love.

This is not easy. When my mother learned she had lung cancer several years ago, we both turned to humor to help absorb the meaning of her diagnosis and to deflect the pain. One afternoon, many months before she died, Mom said with a wry smile, “I think I’m really dying.” To which I replied, “You mean today? Because I’m going to the market, so if you really think so, I won’t shop for you.” “That’s hilarious,” Mom countered, a hungry smile now on her face. “What’s for dinner?” Very adroitly, pretty much reflexively, we had avoided the elephant in the room.

Mom’s health deteriorated over the next several weeks. Again, she raised the question of her death, but now without the smile. “Will dying be painful?” she asked. In that moment, I knew I needed to confront my own feelings about her mortality and not sidestep the conversation with facile banter.

I took Mom’s hand in mine and said, “Don’t worry, it won’t be painful.” I told her hospice had provided a “comfort kit,” which contained medications for restlessness, confusion, anxiety, sleeplessness, constipation and, of course, pain management. I could feel Mom’s hand relax. Finally, she said, with a palpable sense of relief, “Thank you.”

In the weeks after that, we began a new chapter. I hadn’t realized how much effort had gone into my denial. I thought about the many times I had said, “if you die …,” which denied what we both knew was inevitable. After I dropped the subjunctive and began to talk about when she died, a barrier was eliminated. She knew. I knew. Now, we knew together.

I don’t think Mom suffered in her final days. After she became “unresponsive” (considered part of “active dying”) I returned to that comfort kit at the direction of a nurse. I removed the liquid morphine and gently squeezed one drop, then a second into her mouth. When the end came a few hours later, my sister, brother and I sat on her hospital bed, holding hands with each other and our mother as she died. What a gift, I thought, as we helped her to let go honestly, openly, and — most importantly — together.

Three decades earlier, when I was newly in remission from my own cancer, I had so many worries — about recurrence, additional treatments, more surgery. But at its core the fear was always about dying, which I never acknowledged, which meant no opening for others to broach the topic. I tried hard to keep those anxieties buried away, mostly by taking anti-anxiety medications. I’d pop a Klonopin and for four hours I’d be “fine,” as I often repeated. Still, I felt detached from others, even myself, but in my mind, that was better than feeling. Or worse: talking about feelings with others.

I chose to be alone.

Every time when I returned to the hospital for follow-up labs and scans, I’d medicate. But drugs, it turns out, can do only so much. I’d still taste the fear in my throat, or notice the shallowness of my breathing. A few times I vomited — spontaneously — the associations too strong. No matter how hard I tried, I could not effectively lock away that demon, that fear.

Then I decided to volunteer at the cancer hospital that had given me so much, sharing my cancer “experience” with patients, which invariably included discussions of fear. I realized how helpful these conversations — about hair and weight loss, recurrence and remission, life and death — were to the patients I met in the hospital, either newly diagnosed or undergoing treatment. But these talks changed me, too.

For far too long, my fears had been caged inside me, dense and dark. Laura Wallace, a licensed clinical social worker whose practice focuses on transitions and loss, explained that acknowledging feelings of “loss and longing,” while deeply painful, is a much better alternative than anger, addiction and anxiety. Or denial.

Releasing these fears — into the rooms where I had these conversations, into the air outside the hospital when I would walk away — was liberating. Imagine a vial filled with dark blue worry. Release a drop into a small cup of water and it colors the water. Release another drop, this one into a gallon bucket, and it becomes nearly impossible to detect. By acknowledging and sharing my fears openly, I let them go and they began to dissolve. Eventually, I stopped taking those anti-anxiety medications.

In her recent memoir, “Going There,” journalist Katie Couric, whose husband died of colon cancer in 1998 at age 42, tells of feeling trapped between a rock and a hard place. “I was so worried about letting go of hope because I didn’t want Jay to spend whatever time he had left just waiting to die,” she wrote. “I think it takes extraordinary courage to be able to face death, and I think I was too scared, honestly.”

Couric’s words reverberated with me, especially as I’ve tried to take the lessons learned from my mother’s death, and my own illness: How to be present. How to balance today with tomorrow. How to find the courage to embrace what’s so often unspeakable.

A longtime friend, Barry Owen, succeeded in all three ways.

At 66, he revealed his pancreatic cancer diagnosis in a blog post. He knew, as did his husband, Dan, the unforgiving prognosis. (Stage IV pancreatic cancer has a five-year survival rate of 1 percent, according to Johns Hopkins Medicine.) “I have no illusions about this disease,” Barry wrote on his Caring Bridge blog, which was read by about 30 of his closest friends, including his two brothers.

Three months after his diagnosis, Barry pushed open the door to a conversation about dying. “Dan and I are starting to talk about planning, planning for my death,” he wrote. “This is not easy to write about.”

It was not easy to read about, either. But we joined the conversation with Barry and Dan, I hope, supporting them if not sharing their pain.

Barry did well enough for a while — long enough to celebrate his 67th birthday, to make a farewell tour to friends, and to enjoy the winter holidays. By spring, all that had changed. Eleven months after diagnosis, one of his caregivers posted the sentence everyone expected, yet dreaded. “So, yes, he is dying.” We understood. Barry’s followers made that final journey together with him.

During those final days I thought of “The Mary Tyler Moore Show,” one of Barry’s favorites, specifically the final scene where Mary, Rhoda, Lou, Ted and all the rest huddle, and walk offstage together, as one. It’s a tear-jerker, for sure.

We leaned in, through the Caring Bridge site. One friend acknowledged the heartbreak of losing Barry. His brother, Jamie, posted: “We all know the inevitable result, but it doesn’t keep me from becoming emotional every day.” I wrote that I’d burst into tears upon reading the news, but that I felt so deeply connected to his friends. Amid all this, a friend reminded us that Barry’s mantra had always been “Only connect,” which to him spoke to the importance of our relationships to help defeat “the isolation” — as novelist E.M. Forster put it — that keeps us apart.

I felt privileged to be among all these beautiful souls, so in touch with their feelings and able to express them. I thought then — as I do now — how rare this gift is. When Barry died, we held onto one another, tightly albeit it virtually. One friend posted, “Although I only know a few of all the friends around Barry, I feel part of you and share your grief.” Another wrote, “How terrible our loss.”

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