The way we die will be considered unthinkable 50 years from now

How we treat dying people needs to change.

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Fifty years ago, a physician was admitted to the hospital with stomach cancer. He wrote down in his own medical chart that he did not want CPR or to be connected to a breathing machine. His wishes were disregarded — he underwent CPR numerous times and was connected to a breathing machine until he died. Back then, not only were people treated in ways they did not want, many patients were also arbitrarily denied potentially lifesaving therapies.

Doctors decided who deserved to live or not: In one New York hospital, doctors put purple stickers on the charts of patients they determined would not receive CPR or other similar measures without the patients’ or their families’ knowledge. Decisions about life and death were subjective and opaque.

End of life care has considerably improved since then. Patient preferences now help direct physicians and nurses about what type of care they would want to receive. But 50 years into the future, we will look back on today and conclude that medicine was sorely lacking when it came to how we handle death.

Many in medicine, as well as patients and caregivers, continue to equate more procedures, more chemotherapy, and more intensive care with better care. Studies in patients with cancer and heart disease, the two greatest killers of mankind, show that patients receiving palliative care, which is an approach that focuses on quality rather than quantity of life, can actually live longer. While the goal of palliative care is to help people with a serious illness live as well as possible — physically, emotionally and spiritually — rather than as long as possible, some people receiving palliative care might also live longer since they avoid the complications associated with procedures, medications, and hospitalization

In addition, while medical advances have moved forward at blinding pace, the ethical discourse surrounding many technologies has not kept up. Take, for example, cardiac devices such as pacemakers and mechanical pumps that can be placed in the heart. Many patients with terminal illnesses who want to deactivate these devices find resistance from the health system, since some continue to equate deactivating them with euthanasia. We need to continue to make sure that even as technological advances blossom, patients remain at the center, and physicians continue to honor their wishes.

And while the palliative care specialty has greatly improved end-of-life care, too often, palliative care has been used as a way to avoid the culture change needed by all medical specialties to better handle death. Despite its many benefits, many patients and physicians are scared of “palliative care” because of its strong association with the end of life. Some have been compelled to change the title of their practices to “supportive care.” To many patients, the very name “palliative” implies that they will be abandoned, making them very reluctant to accept their services. The fact is that palliative care can, and should, be delivered to patients with serious illness alongside conventional care.

But the issues go beyond the name — one recent study showed that palliative care-led meetings with families of patients in intensive care units led to an increase in post-traumatic stress disorder symptoms among family members. Palliative care specialists are often consulted in tense situations when patients are critically ill, and they often have no prior relationship with patients or their families, who might be unprepared to have serious discussions with them. That’s why most of these difficult conversations should be delivered by the doctors and surgeons primarily responsible for treating the patients. One study estimated that by 2030, the ratio between palliative care specialists and eligible patients will be 1 to 26,000. Palliative care specialists cannot be entirely responsible for end-of-life care by themselves.

To emerge on the right side of history, the entire culture of medicine needs to be turned around. End-of-life care is not just palliative care’s business. It is everyone’s business, from emergency room doctors to primary care physicians. Physicians need to abandon outdated ideas that their role as healers is incompatible with helping patients die comfortably and on their own terms. Helping patients die well is as important as helping them live to the fullest.

Complete Article HERE!

The myth of ‘no place like home’ when it comes to end of life

In a new study, MU researchers uncovered several themes that expose the challenges that are often not included in conversations about dying at home.

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She died at home, but it wasn’t the romantic scene found in movies, where the family held her hand and she simply closed her eyes. In reality, there was a night when she had diarrhea 12 times. In reality, every time she had to be moved she was in pain. This was how a caregiver described caring for her mother as she died at home to social scientists studying end-of-life decision-making.

In a new study, Jacquelyn Benson, assistant professor of human development and family science at the University of Missouri, found that home deaths can be physically and emotionally challenging, especially for caregivers.

“The realities of a home death experience present challenges for family members, especially those with limited resources and social support,” Benson said. “It is important that people understand that home death does not automatically equate a good death.”

In recent decades, there has been a groundswell of social movements championing the ideal of dying at home. According to the Centers for Disease Control and Prevention, home deaths in the U.S. increased nearly 30 percent from 2000 to 2014, while deaths in hospitals, nursing homes and long-term care communities dropped.

To study how home deaths might impact caregivers, Benson along with fellow MU researchers Benyamin Schwarz, Ruth Brent Tofle and Debra Parker Oliver, captured stories from caregivers to identify common themes surrounding the experiences of home deaths. Through the in-depth interviews, the researchers uncovered several themes that exposed the challenges that are often not included in conversations about dying at home. In some cases, challenges arose because there was uncertainty for the decision maker, and some caregivers were not prepared for making decisions regarding the end of a loved one’s life.

The researchers also found that financial resources and strong relationships can help in differentiating good deaths from bad ones. Researchers found that the “good” death experiences involved high levels of emotional support for the dying individuals and the caregivers, and that the place of death played less of a role.

“A few well-known sayings about home are relevant to our findings,” Benson said. “For instance, many people believe there is ‘no place like home,’ which suggests the physical space we call home is paramount when it comes to our comfort. However, another saying, ‘home is where the heart is’ suggests that the essence of home can be replicated in less familiar spaces. When making end-of-life decisions it is important to remember that death can be quite gruesome and that it might be easier on both the dying individual and the caregiver to make a plan that carries the concept of ‘home’ to wherever they might be.”

“The motivations and consequences of dying at home: family perspectives,” was published in a special issue of the Journal of Housing for the Elderly on Environments of Dying, Death, and Caregiving at End-of-Life. Benson served as guest editor for this special issue.

50 Must-Read Books for Tackling Fear of Death

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Sure, it’s morbid to dwell on the fear of dying. It’s also very human.

For those who’d rather read their way through this fear than ignore it (and I think those are equally valid strategies), here’s a list of suggested reading. This list has been compiled with the help of Jaime Herndon, Heather Bottoms, Dana Staves, and Liberty Hardy. Blurbs are adapted from Goodreads.

Novels About Death

Memento Mori by Muriel Spark

“In late 1950s London, something uncanny besets a group of elderly friends: an insinuating voice on the telephone informs each, “Remember you must die.” Their geriatric feathers are soon thoroughly ruffled by these seemingly supernatural phone calls, and in the resulting flurry many old secrets are dusted off.”

White Noise by Don DeLillo

“Winner of the 1985 National Book Award, White Noise tells the story of Jack Gladney, his fourth wife, Babette, and their four ultramodern offspring, as they navigate the rocky passages of family life to the background babble of brand-name consumerism.”

The Picture of Dorian Gray by Oscar Wilde

“Written in his distinctively dazzling manner, Oscar Wilde’s story of a fashionable young man who sells his soul for eternal youth and beauty is the author’s most popular work.”

A Long Way Down by Nick Hornby

“In four distinct and riveting first-person voices, Nick Hornby tells a story of four individuals confronting the limits of choice, circumstance, and their own mortality. This is a tale of connections made and missed, punishing regrets, and the grace of second chances.”

The Cure for Grief by Nellie Hermann

“This disarmingly intimate and candid novel follows Ruby through a coming-of-age marked by excruciating loss, one in which the thrills, confusion, and longing of adolescence are heightened by the devastating events that accompany them.”

The Caregiver by Samuel Park

A moving and profound story that asks us to investigate who we are—as children and parents, immigrants and citizens, and ultimately, humans looking for vital connectivity.”

If Cats Disappeared from the World by Genki Kawamura

“Our narrator’s days are numbered. Estranged from his family, living alone with only his cat Cabbage for company, he was unprepared for the doctor’s diagnosis that he has only months to live. But before he can set about tackling his bucket list, the Devil appears with a special offer: in exchange for making one thing in the world disappear, he can have one extra day of life. And so begins a very bizarre week…”

One Hundred Years of Solitude by Gabriel García Márquez

“The brilliant, bestselling, landmark novel that tells the story of the Buendia family, and chronicles the irreconcilable conflict between the desire for solitude and the need for love.”

The Heart by Maylis de Kerangal

The Heart takes place over the twenty-four hours surrounding a heart transplant, as life is taken from a young man and given to a woman close to death. In gorgeous, ruminative prose, it examines the deepest feelings of everyone involved as they navigate decisions of life and death.”

My Sister’s Keeper by Jodi Picoult

“A provocative novel that raises some important ethical issues, My Sister’s Keeper is the story of one family’s struggle for survival at all human costs and a stunning parable for all time.”

Two Old Women: An Alaskan Legend of Betrayal, Courage and Survival by Velma Wallis

“In simple but vivid detail, Velma Wallis depicts a landscape and way of life that are at once merciless and starkly beautiful. In her old women, she has created two heroines of steely determination.”

The Buried Giant by Kazuo Ishiguro

The Buried Giant begins as a couple set off across a troubled land of mist and rain in the hope of finding a son they have not seen in years.”

East of Eden by John Steinbeck

“Set in the rich farmland of California’s Salinas Valley, this sprawling and often brutal novel follows the intertwined destinies of two families—the Trasks and the Hamiltons—whose generations helplessly reenact the fall of Adam and Eve and the poisonous rivalry of Cain and Abel.”

Beloved by Toni Morrison

“Staring unflinchingly into the abyss of slavery, this spellbinding novel transforms history into a story as powerful as Exodus and as intimate as a lullaby.”

After Many a Summer Dies the Swan by Aldous Huxley

“A Hollywood millionaire with a terror of death, whose personal physician happens to be working on a theory of longevity-these are the elements of Aldous Huxley’s caustic and entertaining satire on man’s desire to live indefinitely.”

Cat’s Cradle by Kurt Vonnegut

“Told with deadpan humour and bitter irony, Kurt Vonnegut’s cult tale of global destruction preys on our deepest fears of witnessing Armageddon and, worse still, surviving it…”

The Road by Cormac McCarthy

The Road is the profoundly moving story of a journey. It boldly imagines a future in which no hope remains, but in which the father and his son, “each the other’s world entire,” are sustained by love.”

Family Matters by Rohinton Mistry

“At the age of seventy-nine, Nariman Vakeel, already suffering from Parkinson’s disease, breaks an ankle and finds himself wholly dependent on his family. His step-children, Coomy and Jal, have a spacious apartment (in the inaptly named Chateau Felicity), but are too squeamish and resentful to tend to his physical needs. Nariman must now turn to his younger daughter, Roxana, her husband, Yezad, and their two sons, who share a small, crowded home. Their decision will test not only their material resources but, in surprising ways, all their tolerance, compassion, integrity, and faith.” 

Plays About Death

Three Tall Women by Edward Albee

“As an imperious, acerbic old woman lies dying, she is tended by two other women and visited by a young man. Albee’s frank dialogue about everything from incontinence to infidelity portrays aging without sentimentality.”

No Exit by Jean-Paul Sartre

“The play is a depiction of the afterlife in which three deceased characters are punished by being locked into a room together for eternity.”

The Iceman Cometh by Eugene O’Neill

The Iceman Cometh focuses on a group of alcoholics who endlessly discuss but never act on their dreams, and Hickey, the traveling salesman determined to strip them of their pipe dreams.”

The Ferryman by Jez Butterwoth

“Armagh, 1981. The Carney farmhouse is a hive of activity with preparations for the annual harvest. A day of hard work on the land and a traditional night of feasting and celebrations lie ahead. But this year they will be interrupted by a visitor.”

Science and Medicine

Being Mortal: Medicine and What Matters in the End by Atul Gawande

“In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending.

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee

“A magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.”

How to Change Your Mind: What the New Science of Psychedelics Teaches Us about Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan

“Could psychedelic drugs change our worldview? One of America’s most admired writers takes us on a mind-altering journey to the frontiers of human consciousness.”

How We Die: Reflections on Life’s Final Chapter by Sherwin B. Nuland

“A runaway bestseller and National Book Award winner, Sherwin Nuland’s How We Die has become the definitive text on perhaps the single most universal human concern: death.”

Final Exam: A Surgeon’s Reflections on Mortality by Pauline W. Chen

“A brilliant young transplant surgeon brings moral intensity and narrative drama to the most powerful and vexing questions of medicine and the human condition.”

From Here to Eternity: Traveling the World to Find the Good Death by Caitlin Doughty

“Fascinated by our pervasive fear of dead bodies, mortician Caitlin Doughty embarks on a global expedition to discover how other cultures care for the dead.”

The Morbid Anatomy Anthology by Joanna Ebenstein and Colin Dickey

“Since 2008, the Morbid Anatomy Library of Brooklyn, New York, has hosted some of the best scholars, artists and writers working along the intersections of the history of anatomy and medicine, death and the macabre, religion and spectacle. The Morbid Anatomy Anthology collects some of the best of this work in 28 lavishly illustrated essays.”

How We Live and Why We Die: The Secret Lives of Cells by Lewis Wolpert

“Biologist Lewis Wolpert eloquently narrates the basics of human life through the lens of its smallest component—the cell.”

Body of Work: Meditations on Mortality from the Human Anatomy Lab by Christine Montross

“A hauntingly moving memoir of the relationship between a cadaver named Eve and the first-year medical student who cuts her open.”

Advice for Future Corpses (and Those Who Love Them): A Practical Perspective on Death by Sallie Tisdale

“A lyrical, thought-provoking yet practical perspective on death and dying in this frank, direct and compassionate meditation on the inevitable.

Memoirs About Death

Nothing to Be Frightened of by Julian Barnes

“A memoir on mortality that touches on faith and science and family as well as a rich array of exemplary figures who over the centuries have confronted the same questions he now poses about the most basic fact of life: its inevitable extinction.”

When Breath Becomes Air by Paul Kalanithi

“A profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question: What makes a life worth living?”

The Year of Magical Thinking by Joan Didion

“From one of America’s iconic writers, a stunning book of electric honesty and passion. Joan Didion explores an intensely personal yet universal experience: a portrait of a marriage–and a life, in good times and bad–that will speak to anyone who has ever loved a husband or wife or child.”

The Bright Hour: A Memoir of Living and Dying by Nina Riggs

“An exquisite memoir about how to live–and love–every day with “death in the room,” from poet Nina Riggs, mother of two young sons and the direct descendant of Ralph Waldo Emerson.”

Traveling with Pomegranates: A Mother and Daughter Journey to the Sacred Places of Greece, Turkey, and France by Sue Monk Kidd and Ann Kidd Taylor

“In this dual memoir, Sue Monk Kidd and her daughter, Ann, chronicle their travels together through Greece and France at a time when each was on a quest to redefine herself and rediscover each other.”

The Unwinding of the Miracle: A Memoir of Life, Death, and Everything That Comes After by Julie Yip-Williams

“As a young mother facing a terminal diagnosis, Julie Yip-Williams began to write her story, a story like no other. What began as the chronicle of an imminent and early death became something much more–a powerful exhortation to the living.”

Dying: A Memoir by Cory Taylor

“Written in the space of a few weeks, in a tremendous creative surge, this powerful and beautifully written book is a clear-eyed account of what dying has taught Cory.”

Everything Happens for a Reason: And Other Lies I’ve Loved by Kate Bowler

“A divinity professor and young mother with a Stage IV cancer diagnosis explores the pain and joy of living without certainty.”

The End of Your Life Book Club by Will Schwalbe

“The inspiring story of a son and his dying mother, who form a “book club” that brings them together as her life comes to a close.”

Driven: A White-Knuckled Ride to Heartbreak and Back by Melissa Stephenson

“A searing memoir about one woman’s road to hope following the death of her troubled brother, told through the series of cars that accompanied her.”

Religious

Quran

“The words of Muhammad who claimed to get them from the angel Gabriel.”

The Tibetan Book of the Dead

“It includes one of the most detailed and compelling descriptions of the after-death state in world literature, practices that can transform our experience of daily life, guidance on helping those who are dying, and an inspirational perspective on coping with bereavement.”

The Bhagavad Gita

The Bhagavad Gita is an intensely spiritual work that forms the cornerstone of the Hindu faith, and is also one of the masterpieces of Sanskrit poetry.”

Bible

Old Testament + New Testament

Children’s Books About Death

Ghosts by Raina Telgemeier

“As the time of year when ghosts reunite with their loved ones approaches, Cat must figure out how to put aside her fears for her sister’s sake – and her own.”

The Witches by Roald Dahl

“This is not a fairy-tale. This is about real witches.”

Fear of Missing Out by Kate McGovern

“When Astrid learns that her cancer has returned, she hears about a radical technology called cryopreservation that may allow her to have her body frozen until a future time when–and if–a cure is available.”

Tuck Everlasting by Natalie Babbitt

“Doomed to – or blessed with – eternal life after drinking from a magic spring, the Tuck family wanders about trying to live as inconspicuously and comfortably as they can. When ten-year-old Winnie Foster stumbles on their secret, the Tucks take her home and explain why living forever at one age is less a blessing that it might seem.”

Complete Article ↪HERE↩!

5 Ways To Live (& Die) With No Regrets

By Remy Blumenfeld

Most of us die with deep regrets about how we spent our lives. It sounds very heavy. But if you’d like to have access to your end-of-life wisdom right now, while there’s still time to do something about it, you can. You don’t need to have faced your own mortality to benefit from my experience, and the end of life experiences of many other people just like you. I feel certain you’ll come away feeling much brighter.

In 1995 I got so sick that doctors at St Thomas’s Hospital in London allowed my partner to bring my dog into the hospital ward. That’s how certain medics were that I would be dead by the morning. Both my then partner, Gavin, and my dog, an Irish Terrier called Sam, slept with me for what everyone thought would be my last night.

I got lucky. 25 years later, I’m still alive, with a new partner and new dogs. What a gift. Despite what you may think, the real gift was being forced to face my own mortality at such a young age, because the experience made it possible for me to understand with life-changing clarity what matters most in life.

Before all this happened, I knew that my partner, family, friends, and dog were more important to me than any achievements or possessions. Of course, I knew this – we all know it, right? Rationally this made sense to me. But I didn’t feel it in my gut. I didn’t live it. Like most of us, I was defined by my job and my home. I thought this was how others defined me too.

In his book A New Earth spiritual teacher Eckhart Tolle writes beautifully about how we are all taught from an early age to identify with “doing” and “having.” “I am this potato print” “I am this doll.” Our parents, who were themselves shown love by our grandparents through “doing” and “having,” take us to the zoo, the movies or the ball game; they buy us toys and treats. What we crave, first as children and later as adults, writes Tolle, is “being” -the intimate closeness we feel in the wordless connection we get from touch and scent and looking into the eyes of someone we love. This is “being.”

When I was first told by Doctors who really knew what they were talking about that it was unlikely I would live more than a year, everything I’d done, all my achievements, and everything I’d accumulated, all my possessions, meant nothing to me. Nothing. None of the other noise – the gossip, the grudges; the rivalry or competition- meant anything to me either.

Suddenly, all that mattered to me was this: Who I love. And who loves me.

This is why I was not at all surprised to learn of the hundreds of profound end of life experiences, witnessed by an extraordinary palliative care worker, Bronnie Ware. The dying people she listened to had experienced exactly what I had experienced.

When questioned about any regrets they had or anything they would do differently, common themes surfaced again and again. Here are the most common five regrets which Bronnie noted:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honored even a half of their dreams and had to die knowing that it was due to choices they had made, or not made.

2. I wish I hadn’t worked so hard.

They felt they’d missed out on some of their children’s youth and their partner’s companionship. A lot of men (and some women) talked about this regret. All of the men Bronnie met deeply regretted spending so much of their lives on the treadmill of a work existence.

3. I wish I’d had the courage to express my feelings.

Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a compromised existence and never became who they felt they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.

4. I wish I had stayed in touch with my friends.

Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. It all comes down to love and relationships in the end, Bronnie concludes. That is all that remains in the final weeks, love and relationships.

5. I wish I had let myself be happier.

This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. Fear of change had them pretending to others, and to themselves, that they were content. When deep within, they longed to laugh properly and have more silliness in their life.

Based on the article she first wrote, Bronnie released a book titled The Top Five Regrets of the Dying – A Life Transformed by the Dearly Departing. It is a memoir of her own life and how it was transformed through the regrets of the dying people she cared for.

The tragedy is that most of us only come to this profound awareness on our deathbed, when it’s too late for us to do anything about it. All we are left with is our regrets.

I can’t tell you how lucky I feel to have been given a diagnosis, mistakenly believed to be terminal, when I was so young. The expected human life span of 83.4 years is 1000 months. Yes, 83.4 x 12 = 1000. Assuming you will live to 100, you can do your own math to figure out how long you have left. However, if you don’t want to die with a lot of regrets:

Live a life that’s true to who you feel you are, not driven by what others expect

Don’t spend so much time ‘at work’

Express your feelings

Keep in touch with your friends

Laugh and be silly

When you too access your end of life wisdom, you will feel that your life is not about your possessions or your achievements. It’s about who you loved and who loved you. So why not get a jump on it and embrace this wisdom and those you love – right now.

Complete Article HERE!

Etiquette and FAQ for choosing flowers for a funeral

A funeral is an important yet highly emotional event that every family has to experience in their lifetime. It is imperative for all members of the family to make sure that just like any other important day of rituals, this day too has a properly defined procedure which most individuals and families choose to follow.

Saying Goodbye to a loved one can be really tough but that doesn’t mean that this ritual has to be executed in a dull manner. Flowers are the most important part of every funeral proceeding. Not only are they a sweet element to convey your remembrance for the person who has left for their heavenly abode, but they are an omen of hope and affection that you hold for your loved one.

This post will provide you with vital funeral etiquettes that you must keep in mind before executing a funeral with your family.

The Less, the Better

Different cultures from all over the world follow a different set of practices when it comes to funeral rituals. While some religions mandatorily use flowers as an important part of their funeral rituals, other cultures either restraint the use of flowers or take decisions as per their own wishes. The first step towards choosing flowers for a ritual is to make sure that you keep it less cluttered. There is no point in choosing a mix of flowers without knowing their significance.

What does each flower stand for?

When you proceed to get flowers for placing in the casket, you must pay attention to the meaning that each type of flower portrays. Below is a list of the most common flowers that individuals prefer for a funeral and what they stand for:

Camelia

Camelia is a flower which represents Gratitude and Respect when placed over the funeral casket of the person who has passed away. Choosing Camelia is a way of thanking the person for their contributions in their entire lifetime.

Roses

There are different colors of roses that you can choose for the funeral, each one of them representing a different level of Love and Affection. While a light pink rose signifies innocence and love, red roses stand for the remembrance of a dearly loved one.

Daffodils and Daisies

An omen of eternal hope and possibilities, daffodils are known to send across hope and positive vibes to the person who has just departed for their heavenly journey. Daisies, on the other hand, signify the presence of good wishes and innocence.

Forget-me-nots

Just as the name says, Forget-me-nots depict the remembrance that you will hold in your heart forever for the person who has passed on.

Lilies

White Lilies are known to be used as funeral flowers across different religions and cultures as a symbol of perpetual peace and admiration for the one who is long gone.

Cultural Differences

It is important to note here that there are a few cultures of the world which restraint or don’t follow the practice of using flowers for a funeral. Placing funeral flowers is a practice which is not preferred to be followed when it comes to Jewish and Islam Cultures. The Indian culture, on the other hand, places a strong emphasis on the usage of flowers, preferably roses which are laid upon the funeral bed.

Different types of funeral flower Arrangements

Depending upon the length of your casket and the wishes of the family, these are the different kinds of flower arrangements that you must know about, before proceeding for the funeral arrangements.

Wreaths

A wreath is a circular shaped floral arrangement which is covered by a bunch of flowers and leaves woven together and held tightly. A wreath is usually made up of different combinations of flowers along with leaves.

Freshly Cut flowers

If you wish to bid Adieu in the simplest and the most beautiful way possible, then you can choose to pay homage with a bunch of raw flowers which can be combined together and placed near the casket.

Floral Casket Tops

This arrangement permits you to adorn the topmost part of your casket with flowers that you choose to put.

Inside the Casket

Placing flowers inside the casket gives your beloved one a floral bed to lay themselves on for the rest of eternity. This arrangement usually requires the accumulation of flower petals or soft flowers which are laid inside the casket.

Complete Article HERE!

Knowing the Right Time to Say Goodbye to a Pet

End-of-life decisions for animals are difficult. A veterinarian has developed a scale to help clear up the confusion.

By Tara Parker-Pope

Nearly 14 years ago, my daughter and I were grieving the death of my mother, and it seemed nothing could lift our spirits. Then we got Fluffy, a bouncing bundle of gray and white puppy, and everything changed.

Fluffy kept us busy with pee pads and squeaky toys. She made us laugh in spite of our sadness, and the gray clouds of grief began to recede.

Over the years, our 10-pound fluff ball was a constant in our lives. We dressed her up in holiday sweaters, celebrated her birthdays and scolded her for sneaking food from the cat’s dish. But in recent weeks, as our walks slowed down and her naps grew longer, it became clear that our time together was limited. I hoped that in the end, Fluffy would have a natural death, drifting off to sleep for good on her favorite soft pillow.

A natural death is what many of us hope for with our pets. They are members of our family, deeply enmeshed in our lives, and for many of us, thoughts of euthanasia seem unfathomable, so we cling to the notion that a natural death is desirable.

But my veterinarian advised me that my end-of-life scenario for my dog wasn’t realistic. In most cases, a natural death, she told me, means prolonged suffering that we don’t always see, because dogs and cats are far more stoic than humans when it comes to pain.

Dr. Alice Villalobos, a nationally recognized oncology veterinarian based in Hermosa Beach, Calif., said that many pet owners idealize a natural death without thinking about what a “natural” death really means. A frail animal, she noted, doesn’t linger very long in nature.

“When animals were domesticated they gave up that freedom to go under a bush and wait to die,” said Dr. Villalobos. “They become very quickly part of mother nature’s plan due to predators or the elements. And yet in our homes we protect them from everything so they can live a long time — and sometimes too long.”

Dr. Villalobos has dedicated her career to helping pet owners navigate end-of-life issues. She created an animal hospice program she calls “pawspice.” She coined the name because she doesn’t want to confuse end-of-life care for animals with the choices we make for human hospice.

Her program is focused on extending a pet’s quality of life. That might mean treating a cancer “in kind and gentle ways,” she said. It can mean supportive care like giving fluids, oxygen or pain medication. In some cases, it might mean hand-feeding for frail pets or carrying an animal to a water dish or litter box. And finally, she said, it means a “well death.”

Dr. Villalobos has advocated what she calls “bond-centered euthanasia,” which allows the pet owner to be present and play a comforting role during the procedure. She has also championed sedation-first euthanasia, putting the animal into a gentle sleep before administering a lethal drug.

To help pet owners make decisions about end-of-life care, Dr. Villalobos developed a decision tool based on seven indicators. The scale is often called the HHHHHMM scale, based on the first letter of each indicator. On a scale of zero to 10, with zero being very poor and 10 being best, a pet owner is asked to rate the following:

Hurt: Is the pet’s pain successfully managed? Is it breathing with ease or distress?

Hunger: Is the pet eating enough? Does hand-feeding help?

Hydration: Is the patient dehydrated?

Hygiene: Is the pet able to stay clean? Is it suffering from bed sores?

Happiness: Does the pet express joy and interest?

Mobility: Can the patient get up without assistance? Is it stumbling?

More: Does your pet have more good days than bad? Is a healthy human-animal bond still possible?

Dr. Villalobos says pet owners should talk to their vet about the ways they can improve a pet’s life in each category. When pet owners approach end of life this way, they often are surprised at how much they can do to improve a pet’s quality of life, she said.

By revisiting the scale frequently, pet owners can better assess the quality of the pet’s hospice care and gauge an animal’s decline. The goal should be to keep the total at 35 or higher. And as the numbers begin to decline below 35, the scale can be used to help a pet owner make a final decision about euthanasia.

“Natural death, as much as many people wish it would happen, may not be kind and may not be easy and may not be peaceful,” Dr. Villalobos said. “Most people would prefer to assure a peaceful passing. You’re just helping the pet separate from the pack just as he would have done in nature.”

I discovered Dr. Villalobos’s scale as I was searching for answers for Fluffy in her final weeks. When she did get up, she often stumbled and seemed confused. Sometimes at night, I heard her whimper.

I had reached out to two at-home vet services, VettedPetCare.com and Instavet.com, that both offered compassionate guidance and confirmed my fears that no treatments were available to improve her condition. Fluffy was a very old dog, and they suspected her decline was a result of some combination of kidney and liver failure, but discouraged extensive testing since the physical symptoms were obvious. One visiting vet gave Fluffy subcutaneous fluids to help with dehydration and make her more comfortable and advised me to spend a final happy day with my dog before calling her for a final visit to end her suffering.

I trusted her judgment, but my tears and the fact that Fluffy still ate a little and wagged her tail when I stroked her clouded my thinking. I turned to the end-of-life scale and was able to see how poorly she was doing, despite the tail wag. I took my vet’s advice and spent a quiet day with Fluffy, giving her the cat food treats she so loved, without any scolding. I revisited the scale several times, just to remind myself that I was doing the right thing. The scale allowed me to make a more detached assessment of Fluffy, and it was a tremendous source of comfort during a very difficult time.

It wasn’t an easy decision or a pleasant one. But it was the right decision. And in the end Fluffy did drift away on her favorite soft pillow, just as I had hoped.

Complete Article HERE!

The Questions Children Have About Death – And How To Answer Them

‘How did they die, mummy?’

By Mike Rampton

Death is, at once, the simplest and most complicated thing in the world. It’s a tough subject even for adults to fully wrap their heads around, so how are children expected to comprehend it?

A survey of 1,000 UK parents by Legal and General found the most common questions three to nine-year-olds ask when confronted with the loss of a loved one are ‘how did they die?’ (55%) and ‘where did they go?’ (38%). 

There’s something starkly direct in those questions, a directness we lose (or learn to contain) as we grow up. Tellingly, among the 10 to 16-year-olds surveyed, just 8% asked where the dead person had gone. But how do you begin to answer younger children’s questions around death?

“Recently my daughter asked me why I didn’t tell her mummy was going to die,” says Elliot Choueka, whose wife Rosie died of secondary breast cancer when his children were four and seven. “I didn’t really have a good answer for that other than that I didn’t want to upset her.”

Choueka says that the last time he told his kids to say goodbye to his wife, he perhaps should have made it clearer they were saying goodbye for the last time. “But it felt too hard on everyone, on the children and on Rosie,” he tells me. “If I were in the same situation again, would I do anything differently? I don’t know.”

We all know death should be talked about in an age-appropriate manner, but how do we answer the questions our kids have – and should we sugarcoat the truth?

Be Honest And Direct

“There’s a question I remember my daughter asking,” says Choueka, who set up the secondary breast cancer charity Secondary1st after his wife’s death. “One of her friends had said to her that people with cancer could die. She asked me if that was true and I said yes.

“She asked me if mummy was going to die and I said I didn’t know, which was the truth at the time. My point of view has always been that an honest, direct answer is better than trying to obfuscate the truth.” 

Experts tend to agree. Avoidance of euphemism and platitudes is widely advised – saying “grandma died” rather than going for something that feels more palatable in the moment, but is potentially confusing. Saying you’ve “lost” someone, or they’re “gone”, or they’ve “slipped away”, all make sense to adult ears but are perplexing to younger ones. You don’t want to inadvertently scare your child into thinking when they go to sleep they might not wake up.

Explain The Eventuality Of Death

Being direct doesn’t mean being unkind or uncaring. The Bereavement Advice Centre says when answering questions such as ‘Why can’t doctors stop people dying?’ and ‘Will I die?’, you shouldn’t hide the truth, but also it’s important to show humanity. One such answer could be: “No one knows what happens when you die. All we know for sure is that it will happen one day – to all of us. Don’t worry or think about it for very long, as there are a lot more interesting and wonderful experiences to look forward to.”

Parenting website Babycentre suggests a similar tone, as well as giving reasons (“Grandpa was very, very old and his body couldn’t work anymore”). There’s a tightrope, they explain, where you want to explain that death happens to everyone, but don’t want your child to think they might just drop dead at any second – and that usually something (age, disease, an accident) is to blame.

Agree That Life Can Be Unfair

The irreversible nature of death can take some digesting. Psychiatrist Bruce Perry, founder of the Child Trauma Academy, remembers a five-year-old asking him “When is my mummy coming home from heaven? I’ve been waiting and waiting.”

There’s no way around it – life is unfair. The Children’s Cancer and Leukaemia Group suggests a blameless but no-nonsense discussion about the topic: “Sometimes life is just not fair. It was nothing you or anyone else did or did not do.”

Use TV And Film

One way of demystifying death is to expose your children to it in entertainment. A 2017 study from the Omega Journal of Death and Dying concluded that Disney and Pixar films which dealt with grief such as Up, Big Hero 6, Inside Out and The Lion King not only act as a useful springboard to discuss death, but also an impetus to do it before it becomes directly relevant.

The authors believe discussing death in the context of child-friendly films leads to a more positive experience when bereavement occurs.

Discuss What People Can Learn From Death

It’s important to consider what children might need in this situation. Budding researcher Paul O’Brien was just 12 when, in 2005, he surveyed 160 children in his school and did in-depth interviews with eight, discussing what their experiences with death had been.

The things that confused them – how a seemingly healthy person could suddenly die – are all things bereaved adults ask themselves all the time. Several of the children involved came to ultimately positive conclusions, reporting that their experiences of death had taught them to live life to the full and appreciate the people around them who wouldn’t always be there. 

Citing his own experience, O’Brien concluded: “It changed me in a way that I wanted to be kinder to the people I love.”

There will always be questions. Some will have satisfying answers, some will have upsetting ones, and some might be unanswerable, but doing our best to have these conversations is, in the face of the only truly inevitable force in life, all we have.

Complete Article HERE!