Relearning how to die

By Richard Smith

Kevin Toolis, author of the beautiful My Father’s Wake, would agree with the surgeon Atul Gawande that we have forgotten how to die. Toolis’s core argument is that his forebears on an Atlantic-lashed island off the west coast of Ireland had a familiarity with death that meant that they knew how to die. Unfortunately, what he calls the Western Death Machine has destroyed that familiarity, leaving us with an existential dread of our inevitable mortality. But he ends the book with a call for rediscovery of how to die, although recognising that “It’s harder than you think to break away from the blinding of the Western Death Machine. In fact, it’s the work of a lifetime.”

The book is constructed around the death, wake, funeral, and burial of Sonny, Toolis’s father, an ordinary but much loved man who had 300 people at his funeral. (As I read that, I thought of funerals I’ve attended with just one or two people and of David Bowie being whisked off without any funeral.) Sonny, who had spent much of his life away from Dookinella, the village where he was born, returned there to die. The dying and those who care for them are not alone: family, friends, villagers, and children are there.

Toolis describes standing beside his unconscious dying father: “We were becalmed. Waiting for his heart to stop, the wake, his funeral, the church, the grave. Waiting for the death of this very ordinary man. Waiting, I thought, to start again. Resume Life. As it turned out, nothing else I have ever done or will do was more important than those precious days.”

Those days were precious because Sonny retaught Toolis how to die. Toolis had experienced the horrors of the Western Death Machine when his brother died young of leukaemia. He could make no sense of that death and launched into a desperate attempt to make sense of death by, as a journalist and filmmaker, interviewing families in Northern Ireland and Palestine whose family members had been killed by terrorists or the Israeli army or whose children had blown themselves up. These experiences produced powerful reports and films but no equanimity with death.

Sonny’s death and wake merged into each other. Given the last rites he died, and his sister and daughters washed the body and prepared him for his coffin. They washed the body of their father as the mother and wife of Hector washed his body after he was killed by Achilles; throughout the book Toolis draws parallels with the Iliad, emphasising how what is happening in rural Ireland has been happening across the world for thousands of years. There was no question of Sonny being spirited away to a funeral home. 

With Sonny dressed and in his open coffin the wake could get into full swing. It would last until he would be carried to the church and then up the mountainside to his grave, two days and a night. Sometimes wakes would last longer if family had to return from abroad. Everybody is welcome at the wake. Toolis didn’t recognise many of those who came. Children play around the coffin. Everybody touches the corpse, and most kiss him. Food and drink are served. People talk about farming, the price of sheep, the weather, but they also tell stories. Death often features in the stories. Toolis hears one young man tell the story of working in a rich home in Essex and finding the owner having hanged himself.

An elderly woman tells the story of having to bury her stillborn child in the unconsecrated ground reserved for suicides and the stillborn. “Sonny’s corpse, his touchable deadness,” writes Toolis, “had made it harder to deceive ourselves of the shiny lies of daylight. So for a few hours, at least, we were free of the constraints of our daily dissembling….In those close watching hours upon the corpse a portal had opened, too, amongst the living, and we spoke without fear on the nature of what each had seen and felt on the shores of life and death.”

Perhaps the most surprising line in the book is a teenager saying to other teenagers after they have left a dance at 3 in the morning: “Shall we go back to the wake for the craic?” Many people outside Ireland are now familiar with the Gaelic word craic, which Wikipedia defines as “a term for news, gossip, fun, entertainment, and enjoyable conversation.” It’s unthinkable that teenagers in London would go to a room with a corpse for fun. It would be thought indecent. But at the wake the teenagers play “the ring,” one of the wake games (which were also played in the Iliad), which are a mixture of violence, kissing, and “libidinous foreplay.” 

Death, as Toolis observes, can be a great aphrodisiac: “The coldness of a corpse has its own perverse existential aphrodisiac; nothing so encourages the animal within us, the hunger for sexual consummation, the need of the comfort of another warm body, than death’s present denial. We affirm ourselves in heat and flesh.” A central argument in the book is that by learning how to die we also learn how to live and love.

Once the wake is over, Sonny is carried to the church and then up the mountain to the grave that has been dug by local people. Toolis carries the coffin, along with his sisters (a development in the tradition). “The carrying of the dead, into and from the church altar and onto the grave, rests on the shoulders of their kin, hopefully their sons. To be carried by those of your own house to your grave is an ancient tribal blessing—a life and death hope, that you will multiply and prosper, bear children, die amidst your family, your community, and still be loved at the end of days. To carry the weight of your own dead, to link arm to shoulder with your brother pall bearer, whoever that might be, shuffling forward in three sets of pairs, in sight of the congregation, is another communal rite of the wake, another fusion of the individual within the wider community.”

There is nothing romantic or sentimental in Toolis’s account of his father’s death, wake, funeral, and burial, but already these traditional customs are disappearing in Ireland and are unknown in the big cities. Can they ever come again? Toolis ends his powerful book with a chapter on how to defeat the Western Death Machine and this challenge:

“You cannot step twice into the same river, ever newer waters flow around and beneath your feet. And we cannot all go back to the island, listen daily to the cowboy songs and the ‘deaths’ on the radio, and live on and die in the last full gatherings of this ancient Celtic rite. But we can carry much of the Irish Wake with us in our hearts. A rite that survived the fall of Troy and a thousand generations before the rise of the Western Death Machine can easily survive the retransplantation back to our cities of glass and concrete. We need to find our way again with death. To be human is to be mortal, and to be mortal is to love, live and die amidst the lives of everyone around you on the island or in the city. And to embrace rather than deny our mortal fate.”

Complete Article HERE!

How Death Doulas Have Adapted End-of-Life Care Amid COVID-19

By

Christy Marek, a certified end-of-life doula, has seen firsthand the added stress that terminally ill individuals have had to endure because of the pandemic. One client had been living at home but decided that her health was putting too much added stress on her family. “She had considered going into a facility just so that she could get the level of support that she needed as she was becoming bed-bound,” says Marek, who is based in Minnesota. But the client found herself at a crossroads: she had to choose between the possibility of dying alone in a facility (upon admission, patients were required to quarantine alone with no visitation for two weeks) or continuing to rely on family care while spending the rest of her time at home.

Marek made several phone calls to facilities to advocate for her client. “I said, ‘What if she doesn’t have two weeks? What are you going to do?’” Marek recalls. Ultimately, her client ended up getting 24-hour home care, but it wasn’t her first choice. “People are then dying at home because the last thing they want is to go into a facility,” says Marek. “They don’t have time to quarantine for the amount of time that [facilities] need.”

For centuries, doulas have been assisting with childbirth, providing emotional, physical, and educational support during pregnancy, labor, and delivery. But there aren’t just doulas for the birthing process: over time, both officially and unofficially, end-of-life doulas have emerged to help individuals with palliative care and support their families through the grief that comes with losing someone. A 2017 study found that women who had continuous support during their labor—whether from a nurse, doula, or partner—reported a more positive birth experience. It seems likely that the same kind of constant emotional support from a death doula would have an equally positive effect on processing the grief around passing.

In a year when death and grief have become a constant, the palliative care process has reached a new level of complexity amid COVID-19. End-of-life doulas have always strived to be a support system for those who are terminally ill, but in 2020 the people who take on that responsibility have been challenged to think outside the box when it comes to caregiving. They’ve had to help their dying clients make unimaginable choices between risking virus exposure and spending their last days alone. They’ve also had their presence questioned at a time when their skills could be most valuable.

Alua Arthur, an end-of-life doula and founder of Going With Grace, has been trying to encourage clients to focus on what they do have control over, even when the world feels full of uncertainty. “Because they’re getting close to the end of life, I remind them that there are some things that are still firmly within our control,” says Alua. “[I have them] look at what it is that we’re trying to control and where the control actually exists. She has her clients work on “cultivating presence and practicing adaptability,” along with “exercises, like finding our feet and consistently planting our feet firmly on the ground [and] becoming present.”

Communication and connection have been the most challenging variables for doulas and their clients. Many in-person meetings with clients and their families have gone digital. For Arthur, FaceTime and Zoom have become essential for helping with clients’ health-related questions when she can’t physically be with them. “Family members [can] scan body parts through a video call, show me and say, ‘Does that look normal?’ Or, ‘She’s breathing like this, does that sound normal?’ And [they] hold the phone up [for me to hear] somebody’s breathing pattern.” That way, even if Arthur is not with the client, she can make an informed decision as to whether they should call the doctor. Arthur has also hosted webinars to help people experience grief and facilitate rituals for transitioning. She has helped coordinate with funeral homes to livestream funerals for clients so that more family members could participate.

For clients who are in assisted-living communities or the hospital, nurses often act as a bridge on behalf of doulas. Janie Rakow, a recently retired end-of-life doula and former president of the International End of Life Doula Association (INELDA), has been raising money for baby monitors for local hospitals so that doulas can keep in touch with their clients, talk to social workers and chaplains, and even play music. “Nurses and medical staff have been integral in helping doulas make sure they connect with families and play music until the end,” she says.

Omisade Burney-Scott, a full-spectrum doula based in North Carolina, has been encouraging her clients to “think about how you show up energetically when you can’t show up physically.”

“Because I’m a Southern Black woman, there’s so much ritual involved with death and dying in the South with Black folk,” says Burney-Scott. “It’s beautiful, it’s complex, but it’s highly ritualized.” Grieving has generally involved a lot of face-to-face interactions and “people coming to your house dropping off casserole after casserole,” so during the pandemic Burney-Scott has tried to help her clients try to find alternate activities that will create a similar feeling of closeness and community. One client with relatives spread throughout the United States and Europe had lost two family members and was looking to honor the deceased. “My question for this person was, ‘Where are they from? What are the things that are meaningful for your family? What are the things that you all love to do together?’ And one of the things that we talked about was food and how much food is a core part of their family culture.” Since their family already did a Zoom session every Sunday, Burney-Scott suggested that they make a dish that everybody in the family loves for their meeting. “Then, when you come to the Zoom call, y’all eat together and honor this person or these people who’ve made their transition,” Burney-Scott says.

End-of-life doulas also help their clients navigate and find support within a racist healthcare system. A 2017 study from Academic Emergency Medicine on implicit bias revealed that White patients were favored, especially by White doctors. Coronavirus has been two times as likely to kill Black and Latino people than White people. In June, Arthur was a panelist for a talk where she and other Black death doulas, along with grief and funeral professionals, discussed the implications of a “good death” in a racist society. More than 2,000 people signed up for the webinar, which touched on the “implicit bias that exists against Black workers, Black deceased and patrons of their families.” “I don’t know how many times I’ve heard people say that racism or race should not be a factor in how we care for people at the end of the day,” says Arthur. “But in order for us to effectively care for people in the afterlife, we have to honor the reality of their lived experience. That includes race, their physical ability, [their] ability to hear, color, sexual orientation, gender identity, and every little part of themselves. We’re honoring a life, so we have to look at the whole life.”

Burney-Scott has been helping members of the Black community process continued grief after the killings of George Floyd, Breonna Taylor, and Ahmaud Arbery and amid continued police brutality and the Black Lives Matter movement. “Grief is not an emotion that is mutually exclusive to physical death,” says Burney-Scott. “So what I have found is that there’s been an unrelenting nature to the grief that we’re all experiencing right now with the pandemic, with COVID-19, but also with racism and white supremacy.” Burney-Scott has been looking to her spiritual background to provide support for others. “My role in that has been to provide instructions and support around how to create your own altar, how to open your space and yourself up to either meditation, prayer, or conversation with your ancestors to ask for support for these families who have experienced the unimaginable,” she says.

More than ever, it’s been necessary for doulas to focus on possibility and opportunity as a way to keep their clients comforted and connected. Still, the challenges of limited physical interactions and restrictions due to COVID-19 have transformed their jobs. In the meantime, end-of-life doulas are doing everything they can to be there for their clients.“We support and empower,” Arthur says. “Why? Because we don’t want people to feel alone in the process. How? We show up.”

Complete Article HERE!

What’s the Best Way to Face Death?

Now There’s A Zoom Class For That.

“If we woke up each morning, knowing we only had a year to live what would change? How would we greet the day, our partner, our job? Until we are directly confronted with our own mortality most of us live life as if it will never end.”

By: Justin Nobel

Back in 2011, Digital Dying interviewed what may well have been at the time America’s only Death Education teacher, New Paltz High School teacher George Campbell. In 2012, we published a lengthy interview with Sheldon Solomon, a Skidmore College psychology professor. He has spent his career trying to understand just how humans respond to the knowledge that they will die. But the heavy words above are for a unique new type of class. They greet visitors to the website for a year-long course offered at the New York Insight Meditation Center, located in downtown Manhattan in New York City. The class is called “Life and Death – Is That All There Is?”

In the class, students write their own eulogy, plan their last day on earth, and connect intimately—or as intimately as our present Age of Zoom will allow—with other like-minded human spirits, young and old, who may be wondering about death, or perhaps trying to live in the face of it. The course is led by instructors Nancy Glimm, Rosemary Blake, Jon Aaron, and Amy Selzer, a former special education teacher who spoke with Digital Dying about the class. Amy also teaches another course at the Insight Meditation Center on aging called “Aging As A Spiritual Practice.” In the time of coronavirus, with Americans anxious, stuck in their homes or communities, and struggling for normalcy, the course is a way to ground people. Below is the conversation Digital Dying had with Amy.

Tell me a bit about what happens in the course?

The course is largely based on Stephen Levine’s book, “A Year To Live,” and Frank Ostaseki’s book “The Five Invitations,” plus other things we have read, exercises, poems. We typically do one full-day class a month. It has been very rich for us teachers, and the feedback that we get has been amazing. The students feel like it is really transforming their relationship to themselves, to their future, to their past.

In one session, we created a bucket list, and also a core values list. The idea is to move toward what is really important, what really matters if you are about to die. Another thing we talk about is regrets, our unfinished business and how to face that. Through different meditations, we talk a lot about forgiveness, forgiveness toward others, and also self-forgiveness. In one recent session, students wrote a set of three eulogies. The first eulogy was with the inner critic in mind—What kind of a eulogy would your inner critic write? The second eulogy was what their dearest friend would write for them. The third eulogy was written by them, keeping in mind that they could forgive themselves. Maybe things are perfect just the way they are. Whatever was unfinished, whatever regrets they had that led them to where they are right now in this moment, we try to teach them to hold that not as an inner critic, but just with love.

Why do you believe there is a need for this course?

There is not a lot of discussion about aging in this culture of ours, and there is not a lot about death or facing death. The students are grateful to have this space where they can talk about these topics because often their friends or family don’t want to hear about it. After a day-long class, one participant came up and said, “That was amazing, but I would have liked a different topic.” That is the attitude of so many people. It is just too scary to talk about. But the point is, we are all going to grow old, and this is part of Buddhism. There is a reflection we spend a lot of time on called, The Five Recollections, and the points they cover go something like this: I am of the nature to grow old; I cannot avoid aging; I am subject to illness; I am subject to death; I will grow different and separate from all that is dear and appealing to me; I am the owner of my actions; I am heir to my actions; I am borne of my actions; I am related through my actions.

Those certainly are powerful lines. Do young people tend to participate in the course too?

Each course is about 60 people, and it is very mixed. Everyone is welcome in this class, and it is a very welcoming group, both age-wise, diversity-wise, gender-wise. I am impressed that younger people wanted to take it. But the feedback we get is that many of them have had difficult issues around death growing up. There is a lot of fear, and they just want to see if they can work with it differently. I used to be a teacher in public education, and I do think it would be useful to bring a course like this to schools, but I think given the way our culture is there would be a lot of resistance. But, this is reality, this is our life. Everything is impermanent, everything and everybody. Anything that arises, that is conditioned, passes away, whether it is a plant, a person, an animal, or an experience. We are all about to die at some point, so what is it you want to focus on? What are the stories you choose to tell yourself?

When you say ‘stories’ are you talking about personal stories, or the stories of our culture and our society?

Both personal stories and society’s stories. A lot of our stories are habits. They are patterns, and from the time we are born, they are being conditioned by our family, our friends, and different experiences we have. Out of these stories we create this persona, and we overly identify with these stories we have about ourselves, even though this is just one thing, one part of us. Then we judge ourselves based on these stories, which makes it even worse, because this leads to a lot of self-judgment, and a lot of wanting and not wanting. One example is with aging, which we discuss quite a bit in our aging class, but it is also pertinent in the life-death class. There is so much anti-aging messaging in our culture. Many of the people who are older feel separate, feel disconnected, feel like they are of no use. And what the Buddhist teachings do is to show them that this is untrue. This is part of a system of old stories we have about ourselves.

Tell me more about yourself personally, how did you get here?

I was a public-school teacher for many years. I was in a self-contained classroom with kids who were emotionally disturbed. When I first started classes were small, special ed had become very popular and there was a lot of money for it. That was wonderful. But education goes through cycles, and as money runs out for programs, it becomes difficult to keep them going. I can say that from my own experience a lot of my life, I avoided taking risks. I thought it was too scary for me. I just couldn’t do it. As I became more involved with Buddhism and meditation, I realized that there were wonderful tools. There is no dogma attached, it is just like, ‘This is a teaching, why don’t you try it out and see if it has any value to you?’ If it does, great take it on; if not, then don’t. I still feel fear. It is not that you are not going to have pain. No, that doesn’t happen. But you can learn to respond to it differently when it arises. If you had asked me years ago if I had been in this position taking this class on, especially in my old age, I would say no way.

Do you think the coronavirus has changed the way we view the process of aging?

I know many people from the different classes I teach living in multigenerational families now. Like the grandparents, the parents, the kids, all in one place because they feel safe. I don’t know if that will continue, but there is so much unknown, there is so much uncertainty around the virus. This is something we talk of in the aging class and the facing death class. We live with uncertainty all the time, even before the virus. But we don’t like to focus on that, we don’t know from one moment to the next what is going to happen. Sometimes it is joyful, sometimes it is horrific. There is always uncertainty, but it is too scary to face. That is one of the reasons we distract ourselves so much, so we don’t have to face it.

Give us a sneak preview, what is something you plan to do with the students in an upcoming class?

December is the last class, and one of the things we are hoping to do is visit a cemetery and have a contemplation there. It just puts us in that environment we are all familiar with, because we have all lost loved ones. Some of the people in the group, even the younger ones, have gone through illnesses. To be in that environment moves us closer to actually facing death. How do you feel when you are in that space? What comes up for you, in your mind, and in your body? Do you want to be buried? Do you want to be cremated? Do you want to die at home? All of these different questions and possibilities arise. And they are all important to think about. Throughout the year we are exploring what matters most to us, and facing our own death. We are all about to die at some point, so what is it you want to focus on?

Complete Article HERE!

Are you prepared for death?

Seattle man launches new website to make of end of life planning easier

By Rachel Belle

Seven years ago, Seattle’s Michael Hebb launched Death Over Dinner through the University of Washington.

“With the very simple, but kind of ambitious idea to get people to talk about this taboo topic of end of life, of death, of our mortality,” Hebb said. “It scaled quite significantly; there have been more than one million death dinners since we launched seven years ago. That has been all word of mouth. People having powerful experiences, hosting their own dinners, and then sharing it with others. It’s become a bit of an international phenomenon.”

Based on that success, Hebb just launched a website called EOL.community in partnership with wellness brand RoundGlass.

“Its longer name is the End of Life Collective,” he said. “What we learned with Death Over Dinner is that people want to have this conversation, they don’t want to be in an insurance office or talking to an attorney or an oncologist. They want to be among family and friends. Once they’ve talked about their wishes, and their fears, and their goals, they want to do something. The resources for getting prepared to create an end of life plan were very thin and very scattered. So EOL was designed to be that one central place where you can get prepared and find providers and community and meet experts, et cetera.”

The website is free and offers everything from guidance on making a will and an advanced care directive to any other resource you would need to plan for your own death or to deal with a loved one’s passing.

“Whether that is a legal provider or insurance provider, or a palliative care provider if you’re at that point, we’ve made it very simple for the user,” Hebb said. “So you can find a grief therapist, an end of life doula, you can decide what you want to have happen to your body. Do you want to turn into a tree? Do you want to turn into a diamond? All of these things are now in one place, which has never happened before.”

There’s a “Death FAQ” page on the website, and each question has a tag, labeling it as “religion,” “philosophical,” “grief,” “legal,” or “terminal illness.” There are answers to hundreds of questions like, “What is an end of life doula?,” “How can I be less afraid of dying?,” and “What happens if I don’t have a will when I die?”

I have always assumed that end-of-life planning was for older people, or people with children, but Hebb says all adults should get prepared.

“I think we live in really interesting times. Before COVID, it was primarily people getting prepared as they were closer to their last chapter, or those of us on the fringe who are like, ‘Everybody should get prepared!,’” he said. “There’s a lot of terrible things that have come out of COVID, but one thing that I think is very positive is it now just seems sensible and rational for every average person to just have an end of life plan. It’s very clear that we don’t know. A death can happen in our family or our close circle of friends.”

Hebb started Death Over Dinner to remove the stigma of talking about death and to get families talking about this tough, uncomfortable topic. He says having the conversation and doing the actual planning is not as dark as you may think it is.

“It does make people feel more calm to have a simple plan. It does make people feel more anchored and centered,” he said. “It really is a great way to clarify what your priorities are, what matters most.”

Complete Article HERE!

Tips for Talking with Someone Who is Dying

By: Glen R. Horst MDiv, DMin, BA

Knowing what to say to someone who is dying and when to say it can be difficult. The following tips may be useful at any point during a serious illness, but especially when the person is not expected to live more than a few weeks or days.

Tip # 1: Follow the dying person’s lead

It is normal to feel anxious when talking about dying with someone who is nearing end of life, especially if the person is someone you love. Some people handle this anxiety by being clear and blunt. Others say little or nothing about the situation for fear they may appear to be giving up hope. One way or another, we tend to try to protect each other at this difficult time.

If you feel it is urgent to talk about end of life with the person who is dying, you may be impatient with conversation about ordinary things. Humour and laughter may be distracting. On the other hand, if you find talking about dying embarrassing or awkward, you may be relieved that the topic doesn’t come up. In either case, what is most important is what the dying person needs. Ultimately, he or she will choose if, when and with whom to discuss dying. Listen for cues that the person is ready to talk about dying – for example, a passing comment about new symptoms, not being around for an upcoming event, being tired of being sick, or wanting to go home. When you think you hear such a cue, you might ask, “Do you want to say more about that?” or, “I’m not sure I know what you mean.” Then listen and ask more questions to make sure you understand.

Tip #2: If possible, be clear that you know the end is nearing

Some people who know they are dying avoid talking about it right up until the moment of death. It’s important to recognize that this is a valid choice and to respect it. More often, however, people who are dying feel respected and supported by openness and honesty in conversations. They may talk about symptoms such as pain, shortness of breath, or nausea. They may wonder what to expect when death is near. Rather than avoiding these concerns, acknowledge that they must be worrisome. You might say, “Tell me more about what you are experiencing,” or ask, “What do you think is happening?” You could add, “This would be important to discuss with your doctor. Can I help you make a list of questions for the doctor?”

Inviting the person to share information from the health care team can lead to open conversations about the progress of the illness and an opportunity to ask, “What do you now need most from me (from other friends and family members, from the health care team)?” If the person has difficulty answering this question, offer examples of the support you could provide – perhaps being present and listening, running errands for the family, or helping with housework.

When death is near, close friends and family members may want to be present. This is a tender time requiring balance between the needs of the family and the wishes of the person. Ask who the person would like to have visit and how many guests would be appropriate at one time. Keeping his or her wishes front and centre can provide a dying person with a sense of control at a very vulnerable time.

The gathering of family and close friends becomes a quiet signal to all that death may be near. If the person wonders why you or others are present, explain that you want to be with him or her during this time. Follow the person’s lead in talking about what is happening as death approaches. Direct questions deserve simple, direct responses. Use your own words to say something like, “It seems that your journey on this earth is coming to an end.”

Ask the person if there is anyone he or she would like to talk to by phone, internet, or in person. This may include a visit from a religious leader in the person’s faith community, or the spiritual care provider in the hospital or hospice.

If you feel that you still have important things to say, consider the advice of Dr. Ira Byock, a palliative care physician and author of “Four Things That Matter Most.” According to Dr. Byock, the next four tips are things that dying people want to hear from their loved ones.

Tip #3: Deal with regrets by saying, “Please forgive me.”

There is no need to fuss over small injuries or insults. However, when you are preparing to say a final goodbye, you may be bothered by regrets about hurtful words or actions, or ways you may have disappointed the dying person. Deal with your regrets by saying something like, “I’ve been feeling sorry about something that happened between us. I know I had a part in it and I’d like to apologize for it.” After describing the issue or incident in simple terms, say, “Please forgive me.”

Whatever the response, you will know that you have done what you could to address a painful part of your relationship.

Tip #4: Free yourself of hard feelings by saying, “I forgive you.”

If you ask the person for forgiveness, you may be surprised that she or he wants your forgiveness too. Saying, “I forgive you” can clear the way for a deeper sharing of the remaining time. It can also give you a sense of peace following the person’s death.

Due to defensiveness, a lack of understanding, or some other reason, the person may not be ready to acknowledge the deep hurt in your relationship. You can still, however, forgive the person in your mind and heart. This involves letting go of your anger and any wish to punish the person for the hurt you experienced. One woman did this with an older male family member who had abused her as a child by whispering “I forgive you” in his ear shortly before his death. Since he was no longer able to respond, it was not possible to know the effect it had on him. However, for the woman it was an important step in freeing herself from her burden of pain and anger.

Tip #5: Appreciate the person’s legacy by saying, “Thank you.”

Expressing thanks for the positive ways the person has touched your life is a way of letting someone know of his or her lasting significance for you. It contributes to the person’s sense of dignity at the end of life.

Rabbi Harold Kushner writes: “I am convinced that it is not the fear of death, of our lives ending that haunts our sleep so much as the fear… that as far as the world is concerned, we might as well never have lived.” Dr. Harvey Chochinov’s research into dignity in the people who are dying supports this. You can support your loved one’s dignity with a sincere and specific “thank you.” It will let your loved one know that her or his living mattered.

Tip #6: “I love you” – Say it freely; say it often.

It is never too late to say, “I love you” in a relationship. If you are not in the habit of declaring your love for a person you call a “loved one,” take a risk and surprise her or him. It could take your relationship to another level.

Tip #7: Don’t wait until the last minute to say, “Goodbye”

When your loved one is nearing death, it is important to end each conversation in a way that will be okay if it is the last time you speak. Casual goodbyes like “See you around,” or “I’ve got to run, so bye for now,” may leave you wishing you had said something different. Your goodbyes don’t need to be mushy. Just say goodbye in a way that lets the person know that he or she will always be important to you.

If you are leaving for a longer time and unlikely to see the person again, your goodbye may be more emotional. You might acknowledge openly that you don’t know whether you’ll be with each other again. Say what needs to be said. Remind the person again of what he or she means to you. Saying goodbye in a satisfying way can prevent regrets after the person is gone.

Tip #8: Touch talks too.

When you talk with a person who is dying, you touch each other with your words. When words are no longer necessary or possible, you can still connect through touch. Placing your hand gently on the person’s hand, shoulder or head can be a tender way of saying, “I am here. You are not alone.”
Continue to talk to the person even when she or he is no longer able to respond to you. The dying person will sense your presence and hear your voice.

Complete Article HERE!

When Is Someone Really, Truly Dead?

The World Brain Death Project Seeks a New Answer

By MIKE MCRAE

After your heart beats one last time, but before your body begins to decay, your life will come to an end. Strange as it seems, physicians around the world can’t agree on the exact moment death finally occurs.

A project aiming to find consensus on human mortality has now published its recommendations on what should constitute minimum clinical standards qualifying an individual as officially deceased.

Given the sheer diversity of legal, religious, and moral values different cultures use to frame perspectives on death, it’s unlikely that any single report will unite conflicting opinions.

It’s not the first time researchers have sought a universal definition of death founded in medical science, either.

But the World Brain Death Project’s senior author, University of Southern California medical director Gene Sung, argues the contents of his team’s report are a good place to start.

“This is an important, complex subject. Reaching this kind of consensus across so many organisations is a first,” says Sung.

“With this paper and its 17 supplements – virtually a textbook – it’s a foundation that we hope will minimise diagnostic errors and build trust.”

The recommendations aren’t so much a single column of boxes to step through, or a concise definition, but rather a way for medical communities from diverse backgrounds to find clear lines of agreement.

Through a mix of flow charts, check lists, and decision trees, the report categorises the observations necessary in weighing up whether a patient’s condition is potentially reversible.

Many of these are recognisable to most medical professionals, and include looking for an absence of facial reactions to uncomfortable stimulations, fixed pupils, no gag reflexes, and no spontaneous breaths when blood acidity drops far enough.

There are also some sensible suggestions, such as checking for existing conditions that could mask or mimic brain death – say, the neurological disease Guillain-Barré syndrome, or drugs or treatments that might confuse a diagnosis. 

Children, the paper advises, should receive a second neurological exam, given their young brains can recover from some conditions differently to adults.

The paper also takes resource availability into account, as well as the legal and cultural differences various medical communities will be subjected to.

As an expert on brain death and a physician intimately familiar with the impact traumatic brain injuries can have on his patients and their loved ones, Sung understands too well the importance of having clear guidelines on when to call it final.

“That’s why I started this project – we still have some difficulty in dealing with and understanding these problems,” says Sung.

In days long gone, death was the long, eerie silence of a still chest. Unable to feel a pulse or witness a breath, a doctor could gamble that an unconscious body was ready for the grave.

Of course, mistakes happened. And still do happen. A lot. More often than we might want to admit. So the search has continued for criteria that could prevent the nightmarish error of sending a living person to the morgue.

What’s more, with the advent of ventilators and improved methods for resuscitation helping us bring ‘the recently dead’ back to life, the medical world was desperate for a better way to distinguish a point of no return.

By the 1960s French neurophysiologists expanded on definitions of comas to include what would come to be seen as brain death. The first official criteria for diagnosing a relative lack of neurological function were published in 1968, commonly known as the Harvard Brain Death Criteria.

Medical communities around the world have since prioritised their own subtle differences in involuntary movements, blood flow, brain wave patterns and locations of residual electrical activity, leading to a number of very different sets of brain death criteria.

Religious sensitivities on how long to wait for mortuary preparations weigh in on decisions around the world. Legal precedents also make a difference in the rights of the dead and dying.

Trust in the medical system is paramount, with complex views on the timing and prioritisation of organ donation affecting how we see a doctor’s decisions around diagnosing an end to a life.

With so many variables to take into consideration, Sung and his team saw they needed to rely on more than medical literature and clinical experiments for finding a consensus.

Taking into account the advice of medical experts across disciplines and from different cultures around the world, their report has been endorsed by dozens of eminent medical societies.

Not without a hint of irony, a universal definition on death needs to be embedded in a living document, one that evolves not just with advances in scientific knowledge, but with an awareness of the communities who need to put their trust in it.

Complete Article HERE!

The surprising benefits of contemplating your death

Now is the perfect time to face your fear of mortality. Here’s how.

By

Nikki Mirghafori has a fantastically unusual career. After getting a PhD in computer science, she’s spent three decades as an artificial intelligence researcher and scientific advisor to tech startups in Silicon Valley. She’s also spent a bunch of time in Myanmar, training with a Buddhist meditation master in the Theravada tradition. Now she teaches Buddhist meditation internationally, alongside her work as a scientist.

One of Mirghafori’s specialties is maranasati, which means mindfulness of death. Mortality might seem like a scary thing to contemplate — in fact, maybe you’re tempted to stop reading this right now — but that’s exactly why I’d say you should keep reading. Death is something we really don’t like to think or talk about, especially in the West. Yet our fear of mortality is what’s driving so much of our anxiety, especially during this pandemic.

Maybe it’s the prospect of your own mortality that scares you. Or maybe you’re like me, and thinking about the mortality of the people you love is really what’s hard to wrestle with.

Either way, I think now is actually a great time to face that fear, to get on intimate terms with it, so that we can learn how to reduce the suffering it brings into our lives.

I recently spoke with Mirghafori for Future Perfect’s limited-series podcast The Way Through, which is all about mining the world’s rich philosophical and spiritual traditions for guidance that can help us through these challenging times.

In our conversation, Mirghafori outlined the benefits of contemplating our mortality. She then walked me through some specific practices for developing mindfulness of death and working through the fear that can come up around that. Some of them are simple, like reciting a few key sentences each morning, and some of them are more … shall we say… intense.

I think they’re all fascinating ways that Buddhists have generated over the centuries to come to terms with the prospect of death rather than trying to escape it.

You can hear our full conversation in the podcast here. A partial transcript, edited for length and clarity, follows.

Sigal Samuel

You’ve worked in Silicon Valley and you still live near there, so I’m sure you’ve encountered the desire in certain tech circles to live forever. There are biohackers who are taking dozens of supplements every day. Some are getting young blood transfusions, trying to put young people’s blood in their veins to live longer. Some are having their bodies or brains preserved in liquid nitrogen, doing cryopreservation so they can be brought back to life one day. What is your feeling about all these efforts?

Nikki Mirghafori

It’s the quest for immortality and the denial of death. Part of it is natural. Human beings have done this for as long as we have been conscious of the fact that we are mortal.

A person who really put this well was Ernest Becker, the author of the seminal book The Denial of Death. I’d like to offer this quote from him:

This is the paradox. A human is out of nature and hopelessly in it. We are dual. Up in the stars and yet housed in a heart-pumping, breath-gasping body that once belonged to a fish and still carries the gill marks to prove it. A human is literally split in two. We have an awareness of our own splendid uniqueness in that we stick out of nature with a towering majesty, and yet we go back into the ground a few feet in order to blindly and dumbly rot and disappear forever. It is a terrifying dilemma to be in and to have to live with.

There is a whole field of research in psychology called terror management theory, which started from the work of Ernest Becker. This theory says that there’s a basic psychological conflict that arises from having, on the one hand, a self-preservation instinct, and on the other hand, that realization that death is inevitable.

This psychological conflict produces terror. And how human beings manage this terror is either by embracing cultural beliefs or symbolic systems as ways to counter this biological reality, or doing these various things — cryogenics, trying to find elixirs of life, taking lots of supplements or whatnot.

It’s nothing new. The ancient Egyptians almost 4,000 years ago, and ancient Chinese almost 2,000 years ago, both believed that death-defying technology was right around the corner. The zeitgeist is not so different. We think we are more advanced, but it comes from the same fear, same denial of death.

Sigal Samuel

It seems like in the West, we really have a bad case of that denial. I think we rarely talk about death or are willing to face up to the reality that we’re going to die. We seem to be wanting to always distract ourselves from it.

You are a Buddhist practitioner and you have a practice that is very much the opposite of that, which is mindfulness of death, or maranasati. You’ve done trainings and led retreats around this subject. But some people might say this is too morbid and depressing to think about. So before we actually delve into the mindfulness of death practices, could you entice us by telling us a few of the benefits of doing them?

Nikki Mirghafori

First and foremost, what I found for many people, myself included, is that facing the fact that I am not going to live forever really aligns my life with my values.

Most people suffer what’s called the misalignment problem, which is that we don’t quite live according to our values. There was a study that really highlighted this, by a team of scientists, including Nobel Prize winner Daniel Kahneman. They surveyed a group of women and compared how much satisfaction they derived from their daily activities. Among voluntary activities, you’d probably expect that people’s choices would roughly correlate to their satisfaction. You’re choosing to do it, so you’d think that you actually enjoy it.

Guess what? That wasn’t the case. The women reported deriving more satisfaction from prayer, worship, and meditation than from watching television. But the average respondent spent more than five times as long watching television than engaging in spiritual activities that they actually said they enjoyed more.

This is a misalignment problem. There’s a way we want to spend our time, but we don’t do that because we don’t have the sense that time is short, time is precious. And the way to systematically raise the sense of urgency — Buddhism calls it samvega, spiritual urgency — is to bring the scarcity of time front and center in one’s consciousness: I am going to die. This show is not going to go on forever. This is a party on death row.

Sigal Samuel

So the approach here is to bring to the forefront of our consciousness how precious our time is, by impressing upon our minds how scarce it is. And that helps align our life with our values.

Are there other benefits to practicing mindfulness of death?

Nikki Mirghafori

The second benefit is to live without fear of death for our own sake. That way, we don’t engage in typical escape activities. And it frees up a lot of psychic energy. We have more peace, more ease in our lives.

The third benefit is to live without fear of death for the sake of our loved ones. We can support others in their dying process. Usually the challenge of supporting a loved one is that we have a sense of grief for losing them, but a lot of that grief is actually that it’s bringing up fear of our own mortality. So if we have made peace with our own mortality, we can be fully present and support them in their process, which can be a huge gift.

My mom passed away two years ago. And for me, having done all of these practices, I could be with her by her deathbed, holding her hand and supporting her so that she could have a peaceful transition. She didn’t have to take care of me so much and console me. She could be at peace and take delight in this mysterious process that we just don’t know what it’s like. It might be beautiful, might be graceful. We don’t know — there might be nothing; there might be something.

Sigal Samuel

Now I feel sufficiently enticed to learn about the actual practices of mindfulness of death. Let’s start with one that seems simple: the Five Daily Reflections, sometimes called the Five Remembrances, that are often recited in Buddhist circles. Would you mind reciting those?

Nikki Mirghafori

Happy to. These are the Five Daily Reflections that the Buddha suggested people recite every day.

Just like everyone, I am of the nature to age. I have not gone beyond aging.

Just like everyone, I am of the nature to sicken. I have not gone beyond sickness.

Just like everyone, I am subjected to the results of my own actions. I am not free from these karmic effects.

Just like everyone, I am of the nature to die. I have not gone beyond dying.

Just like everyone, all that is mine, beloved and pleasing, will change, will become otherwise, will become separated from me.

Allow whatever arises to come up. It’s okay. These contemplations can bring a lot up. So just be with them as much as possible.

Sigal Samuel

I’ve done these reflections before, but every time I do them, I notice that some are much harder for me to absorb than others. The fourth one — I’m of the nature to die — does not terrify me. Maybe that’s weird, but that’s not the one that really scares me. The one that I find impossibly hard is the fifth one. Everyone that I love and everything that I love is of the nature to change and be separated from me.

It’s really the death or the separation from the people I love that I find much harder to face than the death of myself. Because if I’m going to die, you know, then I’ll be gone. There won’t be any me to miss things.

Nikki Mirghafori

Yes. So appreciate and make space for the one that really touches you.

Also I would say that with the fourth one, making peace with our own death, I’ve done the practice and sometimes I’m like yeah, sure, whatever. And then I’ve really stayed with it, and thought, “This could be my last breath.” When the practice really takes hold and becomes alight with fire, it’s like, “Oh, my God, I am going to die!” It really hits home.

Sigal Samuel

Just to clarify, this is a separate mindfulness of death practice, where you contemplate with every breath, “This could be my last inhale. This could be my last exhale.”

Nikki Mirghafori

Yes. And to bring the historical context into it: This particular teaching is what’s called maranasati. Marana is death in Pali, the language of the Buddha. Sati is mindfulness. The mindfulness of death sutra, that’s where the Buddha taught it, and it’s actually quite a lovely teaching.

The Buddha comes and asks the monks, “How are you practicing mindfulness of death?” And one of them says, “Well, I think I could die in a fortnight, in a couple weeks.” Another one of them says, “Well, I think I could die in 24 hours.” Or “Well, I could die at the end of this meal.” Or “Well, I could die at the end of this bite of food I’m eating.” And another one says, “Well, I could die at the end of this very breath.”

And the Buddha says, “Those of you who said, two weeks, 24 hours, whatever — you are practicing heedlessly. Those who said right at this breath, you are practicing heedfully, correctly. That is the practice.”

There are ways to really bring the sense of immediacy and urgency to all this. It’s not out of the question that there could be an aneurysm or that a meteor could just hit the Earth in this moment. Use visualizations; be creative.

Sigal Samuel

Another thing I find really helpful is remembering the idea of impermanence. Which, of course, is the theme of our whole conversation — that our whole life is impermanent — and that’s a very central Buddhist teaching. But also any emotion that I’m feeling is impermanent. So if I’m feeling an intense surge of fear as I do a practice, that’s impermanent, too.

Nikki Mirghafori

Yeah, I love that. When I teach impermanence, there are little impermanences that come and go, and then there is the big impermanence, which is your life! I’m chuckling because this is a case where impermanence is on your side. Impermanence is just a rule of how things run in this world. It’s impersonal. It’s just the way things are. But in our perspective, it’s either working for us or against us.

Sigal Samuel

Can you tell me about another kind of contemplation — the “corpse contemplation” or “charnel ground contemplation”? Charnel grounds are these places where, after people have died, their bodies are left to decay above ground, to rot in the open air. And Buddhist monks would go and observe them up close, right?

Nikki Mirghafori

Many monks do that, especially in Asia. In order to become more intimate with a sense of mortality, the practice is to go to the charnel ground and to actually see a corpse. And the contemplation is: My body, this alive body, is just like this body that is decaying. It’s in different stages of being a body, of decomposing.

A specific practice in the Buddhist canon is to contemplate a corpse in different stages of decay. This particular practice requires a sense of stability of mind. Do the other ones first. I only teach it on a retreat when there’s a container of safety, holding people and supporting them through it.

Sigal Samuel

I definitely have not yet worked myself up to doing corpse contemplation by looking at images of actual human corpses. But when I go for a walk, whenever I see a dead bird or squirrel or mouse that’s been run over in the road, I actually pause and take a minute to look at it. I’m trying to ease my way into this practice.

Nikki Mirghafori

Brilliant. Similarly, another informal practice I wanted to share is having a memento mori. Like a little skull, or those bracelets that are all skulls. I just drew on a little Post-It a skull and bones, and posted it on my computer monitor, so I would remember: Life is short. I’m going to die.

I’ve had various memento moris on my desk throughout the years, and I invite people to have them. They don’t have to be sophisticated. On a piece of paper, just write out, “Life is short” or “You are going to die” or “Traveler, tread lightly.” Whatever works for you to keep death in your perspective. And I think it’s good to switch memento moris around so that your mind doesn’t get used to seeing the same thing all the time.

Sigal Samuel

I’m glad you brought this up because I was going to say the corpse contemplation reminds me a lot of that memento mori tradition, which is a centuries-long tradition in Christianity. So many different religious traditions have emphasized the importance of meditating on our death and have devised ways like the memento mori to try to keep forcing the ego to recognize its looming demise.

Nikki Mirghafori

Yes. And I know that for me, I feel most alive and I feel happiest and I feel most connected with myself, when I’m aware of my death. If it happens for a day or two that it’s not in the forefront for whatever reason, I’m not as bright, as sharp, as alive. So I just love bringing it back. It enlivens me. It supports me to live more fully and hopefully die with more delight and joy and curiosity.

Sigal Samuel

I’m wondering if you can help me with something else. I mentioned earlier that I’m not really scared of my own death so much, but I am scared of the death of the people I love. And especially during the pandemic, I think that’s causing a lot of anxiety for me and probably a lot of others. We’re scared about the potential death of our grandparents, our parents, our friends. Is there a way to free ourselves of the overwhelming fear of their death?

Grief is a natural part of the process. However, it is complicated by our own seen and unseen fear of death. So I invite you to actually work with the practice of making peace with your own death. That’s what’s underlying it. Even if you think you’re not afraid of your own death, you probably are.

When people are really at peace with their own passing, there is a different perspective. There’s a different way of being with the fear or sadness of losing others. There is still a pain of loss, but it shifts.

Complete Article HERE!