Category: Death Meditation

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How to Die Peacefully, Part 1 Managing Pain

Managing emotional and physical pain is the most difficult part of end-of-life care. You can learn to face the worst, when it comes, with dignity and grace. Make the necessary arrangements ahead of time and make the most of the time you have left.

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1. Talk to your doctor about your pain management options.

It’s important to make your physical comfort a high priority in end-of-life care. Depending on your condition, you may be taking a variety of medications, or undergoing a variety of different procedures, so it’s important to discuss all treatment options with your doctor and ensure your comfort is provided in addition to these considerations.

  • Morphine is commonly prescribed to terminal patients, sometimes on a constant need-basis. While there’s some debate about whether or not morphine may shorten your life span, it’s efficacy as a powerful pain-reliever is proven. If you’re in serious pain, talk to your doctor about the option.[1]
  • In some cases, it may be appropriate to pursue additional non-traditional methods of pain management, like holistic medicine, medical marijuana, or other non-western treatments. As long as these treatments don’t get in the way of other care you’re receiving, it’s likely they’ll be approved by your doctor, and might be worth a shot.[2]

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2. Be at home as much as possible.

While not everyone has the luxury of paying for home palliative care, you should think about what will bring you the most comfort and peace in your particular situation. There may be more help available in a hospital but you may feel more comforted and peaceful in your own home.

  • If you’re able to leave the hospital, try to get out as much as possible. Even going for short walks can help to get away from the beeping of hospital machines and be a nice change of pace.

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3. Address the symptoms of dyspnea quickly.

Dyspnea, a general term for end-of-life breathing difficulties, can affect your ability to comfortably communicate, leading to frustration and discomfort. It’s something you can address and care for yourself, with some simple techniques.

  • Keep the head of your bed raised and keep the window open, if possible, to keep fresh air circulating as much as possible.
  • Depending on your condition, it may also be recommended to use a vaporizer, or to have additional oxygen supplied directly, through the nose.
  • Sometimes, fluid collection in the throat can result in ragged breathing, which can be aided by turning to one side, or by a quick clearing procedure your doctor can perform.

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4. Address skin problems.

Facial dryness and irritation from spending lots of time in a prone position can be an unnecessary discomfort in end-of-life scenarios. As we get older, skin problems become more significant, making them important to address swiftly.

  • Keep your skin as clean and moisturized as possible. Use lip balm and non-alcoholic moisturizing lotions to keep chapped skin softened. Sometimes damp cloths and ice chips can also be effective at soothing dry skin or cotton mouth.
  • Sometimes called “bed sores,” pressure ulcers can result from prolonged time in a prone position. Watch carefully for discolored spots on the heels, hips, lower back, and neck. Turn from side and back every few hours to help prevent these sores, or try putting a foam pad under sensitive spots to reduce pressure.

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5. Try to manage your energy levels.

The routine of being in the hospital will take a toll on anyone, and the constant blood pressure checks and IV drip can make it difficult to sleep. Be honest about your energy levels, any nausea, or temperature sensitivity you’re experiencing to get as much rest to be as energetic as possible.

  • Occasionally, in end-of-life scenarios, medical staff will discontinue these types of routines, when they become unnecessary. This can make it much easier to relax and get the rest you need to stay energetic and somewhat active.

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6. Ask questions and stay informed.

It can get quickly overwhelming, confusing, and frustrating to be in the hospital and feel like you’re not in control of your own life anymore. It can be very helpful emotionally to stay as informed as possible by using your doctor questions regularly. Try to ask these types of questions to the doctor in charge:

  • What’s the next course of action?
  • Why do you recommend this test or treatment?
  • Will this make me more comfortable, or less?
  • Will this speed up or slow down the process?
  • What does the timetable for this look like?

Tomorrow, Part 2 — Making Arrangements

Complete Article HERE!

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27 heartwarming pics of a man taking his dog on a farewell trip

By Alicia Barrón

Robert is making sure Bella lives out the rest of her days as a happy dog.

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When Robert Kugler found out his beloved chocolate lab, Bella, had cancer — he knew what he had to do.

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Robert adopted Bella as a puppy. She’s now 9 years old, or about 63 if you’re counting in human years.

In May, a veterinarian told Robert that what he initially thought was a shoulder injury was actually cancer and that it had spread to Bella’s lungs. The doctor had to amputate one of Bella’s legs and told Robert she had three to six months to live.

That was 14 months ago.

Determined to show Bella the same kind of unconditional love she had shown him throughout her life, Robert hit the road to give her the farewell tour of her doggie dreams.

He tells Upworthy it’s not everyday you get to just pack up, get behind the wheel, and go, but after losing two siblings in nine years, he began to look at time as being much more valuable than money.

As for Bella, he says, “She teaches me lessons every day, and I am so blessed to spend my time with her.”

Here are 27 of the most heartwarming photos from Bella’s farewell tour:

You can’t put a price tag on the type of love, loyalty, and companionship a pet provides, and these incredibly moving photographs prove it.

The bond between Robert and his “Bella girl” is truly special. In spite of Bella having cancer and only three legs, Robert says, she begs to be in the car nearly every time she’s awake.

You can follow this dynamic duo’s road trip adventures on Robert’s Instagram, and he says they’ve got no plans of slowing down anytime soon because “right now … sharing the love of this dog with the world has become my new purpose.”

Complete Article HERE!

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What I should have told my dying friend

By Shannon Molloy

Clare Atkinson
Clare Atkinson passed away on June 22 from a rare form of cancer. Her friend, journalist Shannon Molloy, had so much he wanted to tell her.

The last time I saw my friend Clare was two weeks ago in a hospice in Melbourne.

For a place where people come to die, it was an unnecessarily sad old building with no warmth, no comfort. Just beige walls and dull furnishings.

Terms like “palliative care” weren’t hidden away here — but instead, displayed on signs with arrows pointing the way to the sick and dying. There, among the mostly elderly patients, lay my 31-year-old dear mate.

Physically, she was a shell of her former self. Cancer had ravaged her body in 18 short months and left behind a confronting sight where vibrancy and a constantly burning energy once resided. Her stomach and legs were horrifically swollen, overrun with fluid as her organs slowly shut down.

But inside, her old spirit still glimmered.

“How are you?” I clumsily asked as I walked in. The moment the words left my mouth, I regretted them. How did I think she was?

“Well, I’ve been better,” she laughed gently. “Not sure if you can tell.”

I sat and held her hand, gently patting the bony and frail limb that once gripped a pen that wrote stunningly insightful words, and held a microphone that powerfully conveyed compelling pieces, here and abroad, for radio and television. Her remarkable but brief career in journalism seemed a million years ago in that moment, as she slipped in and out of consciousness and struggled to speak.

Like so many of the times I’d spent with her after her diagnosis, words failed me. I said nothing of the consequences at this meeting — the final one I would have with her, as it turned out. Just words to fill the silence, a forced smile painted on my face.

What was there to say anyhow?

Clare Atkinson, with the writer Shannon Molloy, had an inspiring love of life.
Clare Atkinson, with the writer Shannon Molloy, had an inspiring love of life.

I know now. I should’ve said that she’d been a wonderful friend for the past 11 years, from the moment we were introduced at uni and set about reviving our student association together — a task from which a cherished and close friendship was born.

I should’ve said that I’d always admire her and, truth be told, that I envied her; that I was proud of all she’d achieved — more in a third of life than most of us could dream in a whole lifetime.

Perhaps I could’ve told her that she’s one of the kindest people I’ve ever met, with not an ounce of malice in her bones.

I might’ve asked if she was frightened. She didn’t seem it, but I would be. I’d be angry too — furious at how unfair the situation was, that she was just getting started. Why was now the time she had to face this awful, daunting thing?

I should’ve told her that I’d rather selfishly become determined to live a better life than I had before, for her, I suppose. To be more adventurous, to take risks, to love, to be a good person, to be less concerned with the small and trivial things, to stop stuffing around… all of the things she had been, even before her own mortality presented itself at 29.

I should’ve shared all the many fond, happy memories I have of our antics — most of which flooded my mind the moment I stepped away from that small, depressing hospice room.

There was the night of drunken deep and meaningful chat about our futures at an end-of-year uni social.

There was the early morning SOS call after a fight with an ex-boyfriend, when I collected her from a darkened street and took her to McDonald’s for sundaes and a long whinge about stupid boys.

There were emails back and forth after she moved to Germany for work. There were excited Facebook chats when she later came home and met the charming man who’d become her husband.

There was a night — now quite funny — when we danced wildly inside a club while our unlucky friend was hit by a taxi outside. She was fine, just a bit bruised. And now, whenever we hear an ambulance siren, we announce that her cab home has arrived. Well, we did.

And of course, there was that day in early December 2014 when she dropped a bomb. She had cancer, it was terminal and it was very rare and very aggressive.

“I’m so sorry,” I said. I couldn’t think of anything else, and so I left it at that and let her speak.

On reflection, I said nothing of real consequence at any stage. I couldn’t. My role was to remain the funny one, I reasoned, to be her brief light of relief from the heavy burden of the rest of her new existence.

I told jokes, brought her old photos, suggested podcasts and books, shared funny stories about diva celebrities I’d encountered through work and generally tried to keep the mood up. In reality, I was scared to confront this thing that was stealing my friend away from me, from her family, from her adoring partner, from the rest of her mates.

I was terrified that if I was to drop my guard that I might cry, and I might never stop. And that would be selfish in light of her struggle. And so I kept the cancer chat light, treating it like a deadly elephant in the corner of the room, and tried to make her smile instead.

There was a day a few months ago though, when I went to see her and she was in a reflective mood. We spoke for several hours about the old days, about the years since, about life, and she said something that still rings in my head.

“If I could go back to the beginning of my life and choose not to have the cancer, but to miss out on everything I’ve done, in exchange for something far duller, I wouldn’t do it,” she told me.

“Because as shit as this is, I’ve had an amazing life. It’ll be over too soon but I’m pretty happy with it.”

In a rare and unfiltered moment, I was as candid as I could be without losing it.

“You did real good,” I said. And she had.

She lived how we all should live — fiercely, bravely, enthusiastically and like her life depended on it — long before it actually did.

And when it’s all said and done, isn’t that a place we all hope to be when our time’s up?

Clare Atkinson died late in the night on Wednesday June 22, peacefully and surrounded by her loved ones.

It was just days after she was able to return home from the hospice to her lovely, bright bedroom, with views out over the city.

Clare Atkinson on her wedding day with husband Lewis Rowland-Coman.
Clare Atkinson on her wedding day with husband Lewis Rowland-Coman.

You can donate to the Clare Atkinson Memorial Fund, supporting the Peter MacCallum Cancer Centre’s research into cancer of the unknown primary (CUP).

Complete Article HERE!

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At the End of Life, What Would Doctors Do?

By IRA BYOCK, M.D.

At the End of Life

Americans have long been chided as the only people on earth who believe death is optional. But the quip is losing its premise. A recent profusion of personal narratives, best-selling books and social entrepreneurs’ projects suggest that, as a culture, we are finally starting to come to terms with our mortality. Nationally, the Conversation Project is engaging people to discuss their wishes for end-of-life care. Death Cafes and Death Over Dinner events are popping up across the country, reflecting an appetite for exploring these matters. So too, the Dinner Party and the Kitchen Widow are using meals as a communal space to explore life after loss.

Admittedly, contemplating mortality is not (yet) a national strong suit. That’s why these cultural stirrings are so significant. At a minimum, our heightened awareness and willingness to talk about illness, dying, caregiving and grieving will lead to much better end-of-life care. However, the impact on American culture needn’t stop there. Like individuals who grow wiser with age, collectively, in turning toward death, we stand to learn a lot about living.

Doctors can be valuable guides in this process. In matters of illness, people are fascinated by the question, what would doctors do? Consider the social phenomenon of Dr. Ken Murray’s online essay, “How Doctors Die.” Dr. Murray wrote that doctors he knew tended to die differently than most people, often eschewing the same late-stage treatments they prescribed for patients. The article went viral, being read by millions, and reprinted in multiple languages in magazines, newspapers and websites across the globe.

Dr. Murray’s observation even engendered studies of doctors’ preferences for care near the end of life. So far, results are mixed. In a Stanford study, 88 percent of responding physicians said they would avoid invasive procedures and life-prolonging machines. But a newly released comparative study of Medicare recipients, as well as a longitudinal study and separate analysis of Medicare datapublished in January, suggest that the actual differences between end-of-life treatments that doctors and nondoctors receive are slight. Perhaps like nearly everyone else, when life is fleeting, physicians find it difficult to follow their previous wishes to avoid aggressive life-prolonging treatments.

For what it’s worth, the terminally ill colleagues I’ve known, including those I’ve been privileged to care for, have usually been willing to use medical treatments aplenty as long as life was worth living, and took great pains to avoid medicalizing their waning days. In any event, the public’s interest in the medical treatments that doctors choose must not be allowed to reinforce our culture’s tendency to see dying solely through medical lenses. More to the point is the question, how do dying doctors live?

What dying doctors do with their time and limited energy, and what they say, are deeply personal, sometimes raw and often tender. Like everyone else, doctors experience pain and suffering – yet many speak of a deepening moment-to-moment sense of life and connection to the people who matter most.

Listen to a few.

Dr. Jane Poulson lost her sight to diabetes while still in medical school. After years of successful internal medicine practice, Dr. Poulson developed inflammatory breast cancer and knew it would claim her life. Writing in the Canadian Medical Journal she said:

In a paradoxical way, I think I can say that I feel more alive now than ever before in my life … When you presume to have infinity before you the value of each person, each relationship, all knowledge you possess is diluted.
I have found my Holy Grail: it is surrounding myself with my dear friends and family and enjoying sharing my fragile and precious time with them as I have never done before. I wonder wistfully why it took a disaster of such proportions before I could see so clearly what was truly important and uniquely mine.

About a year after being given a diagnosis of incurable esophageal cancer, Dr. Bill Bartholome, a pediatrician and ethicist at the University of Kansas, wrote:

I like the person I am now more than I have ever liked myself before. There is a kind of spontaneity and joyfulness in my life that I had rarely known before. I am free of the tyranny of all the things that need to get done. I realize now more than ever before that I exist in a ‘web’ of relationships that support and nourish me, that clinging to each other here ‘against the dark beyond’ is what makes us human … I have come to know more about what it means to receive and give love unconditionally.

Dr. Bartholome referred to this period before his death as “a gift.”

It has given me the opportunity of tying up the ‘loose ends’ that all our lives have. I have been provided the opportunity of reconnecting with those who have taught me, who have shared their lives with me, who have ‘touched’ my life. I have been able … to apologize for past wrongs, to seek forgiveness for past failings.

A healthy defiance is often palpable within the personal decisions of doctors who are living in the growing shadow of death. My friends Herbert Maurer and Letha Mills, long-married oncologists, boldly renewed their vows before a crowd of family and friends during the months Herb was dying of cancer. In “When Breath Becomes Air,” the neurosurgeon Dr. Paul Kalanithi relates the decision he and his wife, the internist Dr. Lucy Kalanithi, made to have a child, while knowing full well that he was unlikely to see their daughter grow up. Such affirmations of couplehood in the face of death are not denial; but rather insubordination, eyes-wide-open commitments to living fully despite the force majeure.

Gratitude also commonly emerges in the experiences of dying clinicians. In one of our last email exchanges, my friend, the clinical psychologist Peter Rodis, wrote:

The shock of knowing I’ll die has passed. And the sorrow of it comes only at moments. Mostly, deep underneath, there is quiet, joyous anticipation and curiosity; gratitude for the days that remain; love all around. I am fortunate.

The neurologist Dr. Oliver Sacks concluded his essay “My Own Life” in exaltation.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

These experiences are like dabs of paint on an Impressionist’s canvas. Taking in this contemporary ars morendi we can appreciate how dying and well-being can coexist. For all the sadness and suffering that dying entails, our human potential for love, gratitude and joy persists.

How fitting would it be for a corrective to the medicalization of dying to come from the medical profession itself? The general public’s interest in what doctors do can teach all of us about living fully for whatever time we each have.

Complete Article HERE!

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Life’s Too Short to Wear Beige

I was a closeted gay woman surrounded by white-hued walls and yearning for my own colorful world. My sister’s death changed everything.

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All my life, my walls have been painted different shades of white, and beige. Ordinary, predictable hues, “normal” and controllable in feel.

My childhood bedroom was a cool shade of white, with Tiger Beat pull-out posters and a 1978 World Champions Yankees poster from Burger King thumbtacked to my bulletin board. My college dorm room walls were made of cinder block with the gum-tacked picture collages I had made of my family, high school and camp friends. My first New York City apartment was a rental — with eggshell painted walls. The Georgia O’Keefe print I had picked up at Bed and Bath, added some warmth, the pastel palette calming. But the walls around me, I always kept those in tones of white, off-white, and beige.

When I got married to my boyfriend of four years, and a year later gave birth to our beautiful son, we moved to the New Jersey suburbs. And yes, we painted our walls different shades of white and beige in our new home.

In 2004, the oldest of my two sisters needed me. She’d been battling stage 4 ovarian cancer for seven years, and we’d learned I was a stem cell donor match, and her best chance to beat her cancer. So, I took time off from my job, and brought my two-year-old-son back and forth for each of my sister’s two-week long treatments at M.D. Anderson in Houston.

A few months before her treatments began, my sister was still living back in Atlanta, at home with her husband and two daughters. “What’s this?” her husband asked after work one night, upon seeing the scattered paintbrushes and Benjamin Moore color wheel. “Life’s too short for beige,” my sister said. It only took a week for every room in their house to get a fresh coat of paint. From rooms of white and off white to bold and bright-colored walls.

As my sister fought her battle, I fought my own. Like the tick of a kaleidoscope, my entire world of control tumbled and rotated; suddenly, my life of white walls felt unstable and discomforting.

Perhaps it was also when I began to realize that my sister’s doctor, the one I had first laid eyes on during round one of the stem cell transplant, was my perfect match. She explained how my blood and stem cells could save my sister, but she also opened my eyes to understanding how my sister’s “you can’t control what life will throw at you, but you can control how you deal with it” philosophy directly related to the safe and normal box I had created for myself all those years, and the reality I had been trying to shove away.

My big sister, who walked the hallways of the MD Anderson Cancer Center in her Fresh Produce clothes and her bald head held high with a Life is Good baseball hat covering it, even during a time of grave uncertainty, with her cross body canvas handbag adorned with different sized John Kerry for President buttons — in Texas, aka Bush country.

The truth is, I was a gay woman trying to convince myself it would be easier to live surrounded by safe, white hued walls rather than within my own colorful world.

My sister knew of my decision to live my truth before she passed away, a year after her transplant. Her doctor, today my wife, and I live together in our suburban New Jersey colonial. We have three children, two of whom are named after my beautiful and brave sister. And our walls? All of them are painted the brightest and boldest colors of the Crayola box. Just how we like it.

Complete Article HERE!

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Death Talk Is Cool At This Festival

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A chalkboard "bucket list" stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.
A chalkboard “bucket list” stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.

In a sunny patch of grass in the middle of Indianapolis’ Crown Hill Cemetery, 45 people recently gathered around a large blackboard. The words “Before I Die, I Want To …” were stenciled on the board in bold white letters.

Sixty-two-year-old Tom Davis led us through the thousands of gravestones scattered across the cemetery. He’d been thinking about his life and death a lot in the previous few weeks, he told us. On March 22, he’d had a heart attack.

Davis said he originally planned to jot, “I want to believe people care about me.” But after his heart attack, he found he had something new to write: “I want to see my grandkids grow up.”

Others at the event grabbed a piece of chalk to write down their dreams, too, including some whimsical ones: Hold a sloth. Visit an active volcano. Finally see Star Wars.

The cemetery tour was part of the city’s Before I Die Festival, held in mid-April — the first festival of its kind in the U.S. The original one was held in Cardiff, Wales, in 2013, and the idea has since spread to the U.K., and now to Indianapolis.

The purpose of each gathering is to get people thinking ahead — about topics like what they want to accomplish in their remaining days, end-of-life care, funeral arrangements, wills, organ donation, good deaths and bad — and to spark conversations.

“This is an opportunity to begin to change the culture, to make it possible for people to think about and talk about death so it’s not a mystery,” said the festival’s organizer Lucia Wocial, a nurse ethicist at the Fairbanks Center for Medical Ethics in Indianapolis.

The festival included films, book discussions and death-related art. One exhibit at the Kurt Vonnegut Memorial Library had on display 61 pairs of boots, representing the fallen soldiers from Indiana who died at age 21 or younger.

These festivals grew out of a larger movement that includes Death Cafes, salon-like discussions of death that are held in dozens of cities around the country, and Before I Die walls — chalked lists of aspirational reflections that have now gone up in more than 1,000 neighborhoods around the world.

“Death has changed,” Wocial said. “Years ago people just died. Now death, in many cases, is an orchestrated event.”

Medicine has brought new ways to extend life, she says, forcing patients and families to make a lot of end-of-life decisions about things people may not have thought of in advance.

“You’re probably not just going to drop dead one day,” she said. “You or a family member will be faced with a decision: ‘I could have that surgery or this treatment.’ Who knew dying was so complicated?”

With that in mind, the festival organizers held a workshop on advance care planning, including how to write an advance directive, the document that tells physicians and hospitals what interventions, if any, you want them to make on your behalf if you’re terminally ill and can’t communicate your wishes. The document might also list a family member or friend you’ve designated to make decisions for you if you become incapacitated.

“If you have thought about it when you’re not in the midst of a crisis, the crisis will be better,” Wocial said. “Guaranteed.”

About a quarter of Medicare spending in the U.S. goes to end-of-life care. Bills that insurance doesn’t cover are usually left to the patients and their families to pay.

Jason Eberl, a medical ethicist from Marian University who spoke at the festival, said advance directives can address these financial issues, too. “People themselves, in their advance directive will say, ‘Look, I don’t want to drain my kids college savings or my wife’s retirement account, to go through one round of chemo when there’s only a 15 percent chance of remission. I’m not going to do that to them.’ ”

The festival also included tour of a cremation facility in downtown Indianapolis. There are a lot of options for disposing of human ashes, it turns out. You can place them in a biodegradable urn, for example, have them blown into glass — even, for a price, turn them into a diamond.

“It’s not inexpensive,” Eddie Beagles, vice president of Flanner and Buchanan, a chain of funeral homes in the Indianapolis area, told our tour group. “The last time I looked into it for a family, “it was about $10,000.”

A crematorium tour was part of the festival, too. Metal balls, pins, sockets and screws survive the fire of cremation.
A crematorium tour was part of the festival, too. Metal balls, pins, sockets and screws survive the fire of cremation.

“Really, when it comes to cremation, there’s always somebody coming up with a million dollar idea,” Beagles added. “If you can think of it, they can do it.”

Beagles showed us a pile of detritus from cremated human remains. He picked up a hip replacement — a hollow metal ball — then dropped it back into the ashes.

I’m a health reporter, so I know a fair amount about the things that could kill me, or are already killing me. But watching this piece of metal that used to be inside a human be tossed back onto the heap gave me pause. I’m thinking about what I might write on a “Before I Die” wall. I still don’t know — there are many things to do before I go. But I’m thinking about it a lot harder now.

Complete Article HERE!

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Ancient Story, Modern Message: The Cracked Pot

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An elderly Chinese woman had two large pots. Each pot hung on the ends of a pole, which she carried across her shoulders. Every day, she used this device to carry water to her home.

One of the pots was perfect and always delivered a full portion of water. The other had a deep crack in it and leaked. At the end of the long walk from the stream to the house, the cracked pot arrived only half full.

For a full two years this situation occurred daily, with the woman bringing home only one and a half pots of water. Of course, the perfect pot was proud of its accomplishments. But the poor cracked pot was ashamed of its own imperfection and miserable that it could only do half of what it had been made to do.

After two years of what it perceived to be bitter failure, the cracked pot spoke to the woman one day by the stream, saying, “I am ashamed of myself because this crack in my side causes water to leak out all the way back to your house.”

The old woman smiled and replied, “Did you notice that there are flowers on your side of the path, but not on the other pot’s side? I have always known about your flaw, so I planted flower seeds on your side of the path, and every day while we walked back home you watered them and made them grow. For two years, I have been able to pick these beautiful flowers to decorate the table and give to my friends and neighbors. Without you being just the way you are, there would not have been this special beauty to grace our homes and lives.”

Sometimes, it’s the “cracks,” or what we perceive as imperfections, in this reality that create something unexpected and beautiful. These “cracks” allow something to change and ultimately make the whole much richer and more interesting. Every thing and every being has its own unique purpose and destiny to fulfill. This is one of the great beauties of the Tao. 

Complete Article HERE!