The surprising benefits of contemplating your death

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

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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!

‘Spiritfarer,’ a game about the afterlife, seeks to ease the terror of death

“Spiritfarer”

By Elise Favis

“Goodbye, my friend,” said a deer named Gwen, holding me close in a final embrace as we sailed into the blood red waters of the River Styx. Despite the intense color of the sea, and the intensity of the moment, I felt calm. Flower petals drifted on the surface of the water, and white, lush trees swayed in a tranquil way. Gwen disappeared into thin air.

“Spiritfarer,” a game releasing later this year (on several platforms including Switch, PlayStation 4, Xbox One, PC and Stadia), is about guiding spirits to the afterlife. It hopes to make the subject of death comfortable, even cozy, by focusing on relationships and care in people’s last moments while guiding them to the other side. After playing for an hour, I came away feeling hopeful and uplifted, even after experiencing its somber themes.

You play as Stella (or Daffodil, her accompanying cat, if you’re player-two via local or online co-op), a young girl who becomes a new spirit guide to the dead after Charon, inspired by the ferryman of Hades in Greek mythology, retires from that same position. You sail a fantastical world, gathering spirits and convincing them to board your ship. You help them through their problems and encourage them to accept their fates. For creative director Nicolas Guérin, building a death-positive game was cathartic; a way to cope with his own mortality as well as the passing of loved ones.

“I’m terrified of dying,” Guérin told The Washington Post in a recent interview. “I’m terrified of leaving my daughter behind me. I’m terrified of losing my friends and my family.”

His whole team drew inspiration from their experiences with losing someone. The characters in the game are each inspired by grandparents, uncles and friends who died. They’re not “carbon copies,” Guérin said, but composite characters; a mix of traits, personalities, feelings and anecdotes derived from connections they’ve had with deceased loved ones.

Guérin and his colleagues at indie studio Thunder Lotus Games had “no idea at first” if they could pull off themes of death positivity in a management sim, saying he “lucked out” with how it all came together. He said it was important to combine normal, mundane tasks with the “extraordinarily, terribly gruesome moment we face when we know we’re going to die.”

In “Spiritfarer,” your ship evolves over time as you build different structures on top of one another like eclectic towers. Some of these are temporary homes for the spirits you gather, and others are stations for cooking, harvesting, gardening and more. Each character wrestles with something. A lion couple, for example, struggles to find happiness together when one of them is unfaithful. Others, like Stanley, a talking and walking mushroom with childlike traits, just wants to be cared for, so I made him his favorite meal: french fries. Some just want to be hugged. You spend time on and off the ship, completing quests for these spirits and finding out more about Stella along the way, too.

It isn’t just through mechanics that “Spiritfarer” achieves a sense of serenity. The game has a calming atmosphere, with a striking art style inspired by Japanese painter Hiroshi Yoshida and from whimsical Hayao Miyazaki films like “My Neighbor Totoro.” This world about death is bright and colorful, rather than dark and morbid.

Having spent 15 years in the games industry, much of that time at Ubisoft working on franchises like “Assassin’s Creed,” Guérin wanted to explore death in a way that forces the player to think about it outside the bounds of a game. Instead of a fail state mechanic, death in “Spiritfarer” is the key to progress. Every time a character dies, they leave behind a room filled with beautiful, overgrown flowers. It’s a symbol of heritage, Guérin explained.

“You need to actually gather some of these flowers that are used as a token to pay a shark, to build upgrades on the ship,” Guérin said. “And those upgrades will allow you to go across specific barriers like ice or rocks.”

Guérin’s brother is the chief of staff for a geriatric ward in southern France. During early development for the game, Guérin spent a significant amount of time “documenting and understanding” what people think and feel during their final moments by meeting patients in hospice and end-of-life care facilities. As he visited the terminally ill, he noticed their drive to experience human connection or enjoy a peaceful moment. He wanted to convey this in “Spiritfarer,” rather than have characters give grand speeches or make sweeping life changes as they faced death.

“They just want to still wake up in the morning, brew themselves some coffee and spend time with their family, relatives and friends. And that’s it,” he said.

Complete Article HERE!

Death anxiety

– body bags, catastrophic thinking and facing the inevitable

Psychologist and researcher at the University of Sydney Rachel Menzies, who studies death anxiety.

By

Rachel Menzies has lost count of the number of people she has zipped into body bags.

While other people stood around watching – sipping tea and nibbling on cake, or snapping photos of their friends’ faces disappearing into the plastic – she always stayed close by, waiting for rustling or a shout from inside the bag.

“They would stay in for however long they felt comfortable – some just for 10 seconds, others for a few minutes,” says Menzies, a Sydney-based psychologist and researcher at the University of Sydney.

After the occupants of the bag – psychologists, psychiatrists, and counsellors – clambered out, they were treated to a video of decomposing human bodies: bloating, maggots swarming over flesh that then ruptures and leaks fluids, and the open grin of a skull wrapped in shrunken skin. It was deliberately shocking, but Menzies says it serves as a reality check.

“It’s important to come to terms with the fact that, at the end of the day, we are all made of flesh and bone which will eventually decay. We need to stare death in the face instead of turning away and pretending it doesn’t happen.”

Psychologist Rachel Menzies says there is growing evidence that death anxiety is a transdiagnostic construct – something that causes or worsens a range of mental health disorders

The idea of death anxiety as central to mental health has been gaining attention in clinical psychology since roughly 2014, says Menzies. So in 2019, she and her clinical psychologist father, Professor Ross Menzies, toured the country running workshops to help mental health professionals address it with patients.

“We wanted to get participants trying out exercises they might recommend as exposure tasks [for clients], with the body bags being one of the more unusual tasks.”

“I would have loved to get a coffin and carry that around Australia, but it’s much less practical than a foldable plastic body bag.”

When fear of death becomes debilitating

Being afraid of dying and having occasional thoughts about it is normal, but if it gets in the way of life – working, travelling, or seeing friends – it’s becoming a problem, Menzies says. And in this particular Covid moment, it’s hard to escape reminders of our mortality, with doom and death tolls constantly in the news.

Canadian-based clinical psychologist Patricia Furer has been working with patients on death anxiety for about 20 years.

“I have found most people who are struggling with fear of death have had difficult experiences with illness and death that have made them particularly attuned to these concerns,” says Furer, an associate professor and director of the anxiety disorders clinic at Saint Boniface Hospital in Winnipeg.

‘People who have thought about what might happen after death … often sit in a more comfortable place when facing their own death,’ says Dr Kerrie Noonan.

“For example, having experienced deaths of four close family members or loved ones in one year or perhaps a series of difficult health issues in themselves and loved ones.”

Death anxiety isn’t recognised as a disorder in the US’s Diagnostic and Statistical Manual of Mental Disorders, but fear of death can be classified as a specific phobia (thanatophobia), and Menzies says there’s growing evidence that death anxiety is a transdiagnostic construct – something that causes or worsens a range of mental health disorders.

Furer agrees, but says a lot of research is needed to understand how it works across categories used for different diagnoses.

“I think it’s probably more of a concept or attribute – like we talk about perfectionism,” Menzies says.

A 2019 study led by Menzies found a strong relationship between death anxiety and worse severity of symptoms in 12 disorders including alcohol use disorder, depression, and social anxiety.

“Death anxiety was also significantly associated with a person’s number of hospitalisations, how many medications they’re on for their mental health, and how many different disorders they’ve had across their life,” Menzies says.

The risk of death anxiety worsening mental health conditions is particularly relevant now, Menzies says.

As an example of the sort of effect this might have, Menzies refers to a study where people with obsessive compulsive disorder were asked to complete personality questionnaires.

Those whose questionnaires included two questions about death spent more than twice as long washing their hands afterwards (more than 20 seconds compared to less than 10) than those who had two questions on dental pain.

Managing catastrophic thinking

If death anxiety is at the root of a mental health disorder, many current treatments may not be as effective as we think, Menzies says.

“If that underlying causal factor of death anxiety isn’t addressed, people might just return to health services with different conditions years later. Say they get effective treatment for OCD, but later develop health anxiety or a specific phobia.”

Menzies cites the case of Anna, 34, who came to Menzies having suffered health anxiety for 15 years and had seen several psychologists.

She often asked her GP for tests for fairly benign symptoms, such as headaches or minor skin irregularities, then worried they had missed something, asking for more tests and second opinions.

“Her worries focused on death-related outcomes, such as dying of cancer, and she made catastrophic interpretations of benign symptoms, for example assuming a headache was a brain tumour,” Menzies says.

“It became apparent that Anna also avoided things: flying, for fear of plane crashes, or driving long distances in case she had an accident. When asked about her general health, Anna mentioned she avoided any exercise as she worried the change in her heartrate may be a sign of a heart attack.”

Cognitive behaviour therapy (CBT) focused on exposure is the most evidence-based treatment for death anxiety, Menzies says.

But there’s a twist.

“Standard CBT for most disorders generally won’t touch on death at all, and if it does, it’s trying to disprove the person’s estimate of the likelihood of death: for a fear of flying, you’re trying to get them to see that dying in a plane crash is very unlikely,” Menzies says.

But as life comes with a 100% likelihood of death, says Menzies, reducing someone’s fear of dying from a specific cause won’t help. Instead of trying to convince someone that planes don’t crash, Menzies would suggest exposing that person to death-related situations, like writing their own obituary or planning their funeral.

In Anna’s case, therapy included books and TV shows featuring death, and gradually reducing her GP visits each month. Over time, she returned to work, and could see sick loved ones she had avoided visiting before, Menzies says.

Or you could also have your phone remind you five times a day that you’re going to die – which is what Menzies does. She has the app WeCroak and recommends it to clients to help normalise death.

“I often find I’m stewing on something or worrying about a deadline, then the notification comes up and helps put things in perspective.”

Furer also says writing a list of death-related fears can identify exactly what people are afraid of.

“For example, some people fear the process of dying, some people fear missing out on life after they are dead, some fear leaving loved ones behind.”

Finding joyful activities can balance out the more difficult exposure tasks, she adds.

“Fear of death can result in people limiting their lives and spending all of their time focused on their worries. Shifting at least some of their energy to building positive and satisfying activities into their day-to-day lives can be helpful.”

On the positive side, Furer says patients who were already working on death anxiety are feeling “particularly well-equipped” to manage current pandemic fears because they already had coping strategies – such as managing catastrophic thinking – in place.

Are we warming up to death?

Dr Kerrie Noonan, who researches community behaviours around dying, says death-related groups and public activities have bloomed in the last decade.

“There are weddings and community events in cemeteries, Coffin Club in Tasmania where you build your own casket, festivals like We’re All Going To Die,” says Noonan, a clinical psychologist and social researcher at Western Sydney University.

But it’s too soon to know whether this will lead to death anxiety easing in individuals, Noonan says.

“All this interest could speak to the fact we’re really anxious about dying, but we’re often educating ourselves in these events and that could help our fears decrease.

“In my experience [in palliative care] people who have thought about what might happen after death – whether they’re religious, spiritual, or have no religion – often sit in a more comfortable place when facing their own death.”

While first-hand experience around death can be agonising, it does appear to help us and others.

People experiencing loss often find a “mentor” in their family or friends who have experienced bereavement before, Noonan says.

“If we can deal with our fears about death and dying, we will be better at supporting our families, our friends, those who are dying and bereaved. We all need to be better at that – for ourselves, and for each other.”

Complete Article HERE!

Unmasking the fear of death with Tolstoy

During this pandemic when we’re feeling the anxieties of infection and death, The Death of Evan Ilyich (1886), by Leo Tolstoy gives us the message of our capacities to respond to the fear of death in ways we never knew we could. It reminds us that, fear isn’t real. Human, as a species, is not defined by fear.

By Nayan Sayed Jibon

YES, we’re scared. We’re on the edge, unable to think properly. Our focus flutters and floats around flea-like from one update to the next. We follow the news, because we feel we should but soon we wish we hadn’t, because it’s sad.

The thought of dying alone with a respiratory sickness is so horrifying to hide under our masks. We are separated from one another but we can’t keep our distance from the fear of death. This led me to question, how can I accept my own mortality, so that I can live my life to the fullest during this terrifying situation?

Then I found a novella The Death of Evan Ilyich (1886), by Leo Tolstoy which helped me not only to understand the author’s philosophy towards death but also the psychology behind it. As a result, I could gather some emotional courage to embrace my fear of death during this COVID-19 pandemic situation.

Leo Tolstoy (1828-1910), a Russian writer, is regarded as one of the greatest authors of all time. He is best known for his novels like War and Peace (1869) and Anna Karenina (1877). But due to his unusual firsthand experiences of death and dying, he also wrote extensively about the inevitability of death for our understanding of life itself. Some of his most memorable meditations on this theme are found in his novella The Death of Ivan Ilyich. In the novella through the story of a dying Russian judge, Tolstoy successfully narrates the different episodes of ‘dying’ some eighty years before its discovery by Swiss-American psychiatrist Elizabeth Kubler Ross. In her book On Death and Dying (1969) Kubler Ross outlined five stages that a dying individual goes through.

The Death of Ivan Ilyich, as its title suggests, depicts the death of an ordinary middle-aged Russian judge, but it is also about a man who overcame it. Like everyone in his social circle, Ivan Ilyich lives a superficial life and dedicates his life to climbing the social ladder and seeking the bliss which he believes is found at the top. Initially he was contented with his life but gradually he becomes unhappy as his marriage deteriorates so he starts ignoring his family life and focuses on becoming a magistrate. 

One day he falls awkwardly upon hanging curtains for his new home and becomes ill. Doctors offer all kinds of diagnoses and medicines but he cannot recover and within some weeks, Ivan Ilyich could see that he is a bedridden dying man. In his death bed Ivan’s main source of comfort becomes his servant Gerasim. He is the only person in the house who does not fear death, and the only one other than his own son who seems to show compassion for him.

As Ivan’s interaction with Gerasim becomes deeper, Ivan begins to question the how can he accept death without being unhappy? Gerasim guides Ivan in his last days, and allowed him to realise the difference between a superficial and an authentic life and how to accept death with ease. He says, ‘We shall all of us die, so why should I grudge a little trouble?’ Apart from the philosophical thought, Tolstoy also shows the psychological stages of a dying person.

According to Ross, denial is the initial emotional response to the knowledge of death. In this stage people often say, ‘No, not me. It can’t be!’ From chapter five we find Ivan Ilych gets the idea that he is going to die but he could not get used to the idea and immediately denies it. In chapter six he says, ‘It can’t be me having to die. That would be too horrible.’ After a while, he entered the stage of anger, blaming god for imposing this kind of misery and pain to him, and expecting an answer, ‘Why hast Thou done all this? Why hast Thou brought me here? Why, why dost Thou torment me so terribly?’

Then he started talking to god asking for the meaning of his life. During this ‘bargaining’ period he started to look back and after much argumentation with himself he realises that he may not have done anything meaningful during his whole life. Consequently he enters into the ‘black hole’ of depression. He learns that it is impossible to turn back and fight against the forces, now he can only wait for the moment.

Finally, the door of acceptance was opening in his scared mind, with his understanding of the inevitability of death. Ivan Ilyich during this stage realises that he has not lived his life in the best way and he was dead long before he was called to die. He was materialistically driven and blinded most of his life by shallow pleasures. He eventually finds solace from the selfless love and kindness from his family and servants and embraces death. ‘Death is finished,’ he said to himself. ‘It is no more!’ 

Therefore, The Death of Ivan Ilych is Tolstoy’s parable representing the mystery that living well is the best way to die well. Tolstoy tells us that we don’t fear death, we fear life because we feel that we don’t live our destined time on earth as we were supposed to. It also echoes with the Stoic philosopher Marcus Aurelius who told us that ‘it is not death that a man should fear, but he should fear never beginning to live’.

During this pandemic when we’re feeling the anxieties of infection and death, this story gives us the message of our capacities to respond to the fear of death in ways we never knew we could. It reminds us that, fear isn’t real. It is like wearing the uncomfortable personal protective suit around our mind and feeling we’re being protected.

In doing so, we have allowed this fear into our house, our head, and our heart. It’s circulating like the ghostly virus — looking for prey in every thought and every action. But we must remember that human is not defined by fear. We are a hope and a faith-driven species that seeks to live life to the fullest and not die.

Complete Article HERE!

Her greatest fear was dying alone

— two days after she caught coronavirus, she did

Britt Patrick, right, said her mother Jennifer Patrick was a joyful person who loved spending time with friends and family. Jennifer Patrick died of COVID-19 in a Calgary nursing home on April 19.

Nursing professor says everyone should have the chance to say a deathbed goodbye

By Sarah Rieger

Jennifer Patrick was terrified of dying alone.

The 65-year-old was diagnosed with pulmonary fibrosis nearly two years ago. She relied on progressively higher and higher concentrations of oxygen and a few months ago was moved to a Calgary nursing home.

Since the diagnosis, Britt Patrick said her mom just kept repeating her fear — “I don’t want to die alone.”

But two days after she contracted COVID-19 that’s exactly what happened.

On April 19, the 65-year-old from Airdrie, Alta., was having a panic attack, gasping for air. She hadn’t seen a friend or family member in days.

It was her husband’s birthday. They’d spent the last 41 years together but hadn’t seen each other since the Calgary home, Extendicare Hillcrest, was locked down to visitors. Her daughter and grandchildren were two provinces away.

Her nurse, who was sitting by her bedside, left the room to get morphine to ease her panicked gasps for air. When the nurse returned, Jennifer Patrick was gone.

“It was very, very surreal,” Britt Patrick said.

“I feel like maybe my dad should have been allowed in with proper protection just to say goodbye.”

No chance to say goodbye

Patrick said her mom’s COVID-19 diagnosis didn’t come as a shock. The Winnipeg resident knew Calgary was experiencing high numbers of COVID-19 cases, and said she had an ominous feeling, knowing her mom already had a serious respiratory illness.

But the speed of her mom’s death, without a chance to say goodbye, left her reeling.

She doesn’t even remember what they talked about during their last phone call — the oxygen deprivation had increasingly made talking on the phone difficult for her mom.

“That’s frustrating and that’s hard,” she said.

“I know I ended up missing a phone call with her. I had been trying to get a hold of her for quite a while and I finally got a phone call back. I was just getting out the door and I didn’t have time to answer it and I wish I’d taken that two minutes to take that conversation.”

She also doesn’t know what to tell her three children.

“They’re struggling with it, they’re asking, ‘When can we go out there? Are we going to the funeral?’ They’re asking very obvious questions for children that I can’t answer and that’s frustrating, to not be able to let them know when we can visit Grampy, when we can do these things,” she said.

Dying alone all too common during pandemic

While Patrick may feel alone in her grief, tens of thousands of families globally are facing the same harsh reality — forced to say goodbye through a video call or being deprived of even that small connection, due to precautions in place or personal safety decisions made to avoid spreading the infectious disease.

University of Alberta nursing professor Donna Wilson studies end-of-life care, bereavement and what it means to have a good death.

She said while initially many of us were taken by surprise by the pandemic, now that it has been the reality for months, it’s time to find better ways to let people say goodbye.

“There has to be a way around this,” Wilson said.

If a family member thinks it wasn’t a good death … they may have seriously complicated grief.
– Donna Wilson, University of Alberta nursing professor

Wilson said the deathbed goodbye — where loved ones gather around a dying person’s bedside to make amends, and express sentiments that may have previously gone unsaid — is a centuries-old custom for a reason.

“People don’t want to be alone, they want to be surrounded by their family members, the people that really mean something to them… it’s really important because people have the opportunity to say something to the dying person that maybe they never said before.”

She said international research has shown that a good death, which is somewhat expected, largely free from suffering, and in accordance with a patient or their family’s wishes, is vital to the grieving process for those left behind.

“If the family member thinks it wasn’t a good death … they grieve harder and longer and they may never get over the death, they may have seriously complicated grief,” she said.

The families of people who died after getting COVID-19 are sharing the stories of their loved ones to encourage others to do what they can to prevent further spread of the coronavirus. 2:05

That’s the situation Britt Patrick finds herself in.

“You have people who are passing away afraid and alone, why can’t we at least set something up to allow people to say goodbye safely?” she said.

Michael Bittante, the regional director for Extendicare, said while Jennifer Patrick’s family was contacted and informed of her condition, end-of-life visits are not always feasible.

“We continue to provide end-of-life visitation with families when possible, using personal protective equipment and infection control measures. Unfortunately, this is not always possible for a number of reasons, including the progression of a resident’s illness,” he said.

CBC News reached out to Extendicare to clarify the timeline as to when residents are allowed end-of-life visitors, and the company reiterated that it is following provincial directives.

Donna Wilson said it’s important for the government or health officials to step in, as they did to limit visitors to nursing homes, to ensure end-of-life visits happen.

“We’re looking at a lot of people that are going to be really severely damaged if they’re blocked from the deathbed,” she said.

Wilson suggested strategies like bringing in retired nurses to facilitate visits and assist visitors with donning protective equipment, or arranging for visits to be held in private rooms near the entrances of buildings or even in ambulances, that can be cleaned after each visit.

“If you can get a nurse in and out of a hospital safely … you can bring a relative in and out safely.”

Some end-of-life policies were applied too strictly

Dr. Deena Hinshaw, Alberta’s chief medical officer of health, said Wednesday that she knows the protective measures in place at long-term care facilities are causing many residents to feel increasingly isolated and said some end-of-life visitation policies were being applied more strictly than intended.

“There have been some interpretations where some believed the intention of the order was [to only allow visits] in the last few hours of life … it’s very difficult to arrange for visits in that very narrow window,” she said.

“We expect that individuals who are dying must have the opportunity to have their loved ones at their side.”

She said up to two visitors can be allowed to see those estimated to be two weeks away from death, as long as they maintain two metres of physical distance.

While that update doesn’t change anything for Britt Patrick, she’s learned one thing in her grief she wants to share.

“Just take every chance to connect with your loved ones.”

There were 503 cases of COVID-19 in nursing homes across Alberta as of Wednesday.

In the two weeks since an outbreak was declared at Jennifer Patrick’s nursing home, eight residents have died, and 19 residents and 10 staff members have contracted COVID-19.

Complete Article HERE!

Coronavirus preys on what terrifies us: dying alone

by Daniel Burke

Steve Kaminski was whisked into an ambulance near his home on New York’s Upper East Side last week.

He never saw his family again.

Kaminski died days later of covid-19, the disease caused by the novel coronavirus. Because of fears of contagion, no visitors, including his family, were allowed to see him at Mt. Sinai Hospital before he died.

“It seemed so surreal,” said Diane Siegel, Kaminski’s daughter in law. “How could someone pass so quickly and with no family present?”

Mitzi Moulds, Kaminski’s companion of 30 years, was quarantined herself, having also contracted the coronavirus. She worried Kaminski would wake up and think she’d abandoned him.

 

“Truthfully, I think he died alone,” said Bert Kaminski’s, one of Steve’s sons. “Even if a doctor was there.”

As the coronavirus stalks victims around the world, one of its scariest aspects is how it seems to feed on our deepest fears and prey on our primal instincts, like the impulse to be close to people we love when they are suffering and near death.

In a painful irony, the very thing we need in moments of fear and anxiety could also kill us.

Many hospitals and nursing homes have closed their doors and placed covid-19 patients in isolation wards to prevent the disease from spreading. One doctor called it “the medical version of solitary confinement.”

Priests are administering last rites over the telephone while families sit helplessly at home.

The isolation extends beyond coronavirus patients. Amy Tucci, president of the Hospice Foundation of America, estimates that 40% of hospice patients are in hospitals or nursing homes, many of which have placed strict restrictions on visitors. Their families, too, are worried about loved ones dying without them.

“We crave closure,” said Maryland psychologist Dr. Kristin Bianchi, “so it’s only natural we would want to be there in our loved one’s final moments. We want to bear witness to that process and say our last goodbyes.”

‘Lonely deaths’ can haunt us

Something about dying alone seems to haunt us. To some it may suggest the deceased’s life lacked love and worth, and that in the end they were forgotten.

The Japanese have a word for this: “kodokushi,” meaning “lonely death.” In recent days, as funerals have been cancelled or postponed because of the virus, it can seem as if coronavirus victims simply vanished, like people in “The Leftovers.”

But some medical experts challenge the idea that scores of people are dying unaccompanied in hospitals right now. In many instances, they said, hospital staff are standing vigil by patients’ bedsides during their last moments.

It’s not ideal, they say, but they’re not quite the lonely deaths we may imagine.

As a lung specialist and member of the Optimum Care Committee at Massachusetts General Hospital, Dr. Emily Rubin is on the frontlines of the pandemic.

The hospital, where 41 employees recently tested positive for coronavirus, does not admit visitors except for limited circumstances, like births — and, in some cases, for patients near death.

But Rubin said the situation is evolving rapidly as the virus spreads. In some cases, the hospital may connect families and covid-19 victims electronically instead of in person. Other times, nurses and other hospital staff will step in to stand vigil.

“Even if the disease is too mighty, the ethic of not abandoning people is so strong,” Rubin said. “We feel like being present with people at the end of life is a huge part of what we do.

“People in a hospital are not dying alone.”

Still, shepherding patients through the last stages of life can take an emotional and physical toll on doctors, nurses and other hospital staff, Rubin acknowledged.

Dr. Daniela Lamas, a critical care doctor at Brigham and Women’s Hospital in Boston, wrote about that toll in a recent New York Times op-ed.

“The devastating image of the lonely deaths of coronavirus patients in Italy hangs over us all,” Lamas wrote. “Talking with one of the nurse practitioners in our hospital’s new Covid-19 I.C.U. one recent night, I asked what worried her most. ‘Patients dying alone,’ she replied quickly.”

But some hospice chaplains question notions of “lonely deaths,” saying that in their experience, some people want to approach the end by themselves.

“I don’t think dying alone has to always be a bad thing,” said the Rev. C. Brandon Brewer, a hospice chaplain in Maryland. “What we’ve done is make it into something that it doesn’t have to be.”

It takes away our end-of-life rituals

When we think about dying alone, we’re really talking about two separate things, psychologists say: The fear that people we love will die alone, and the fear that we ourselves will stare down death solo.

“It creates in almost everyone a sense of terror,” said Bianchi, of the Center for Anxiety & Behavioral Change in Rockville, Maryland. “We want to be be able to cushion the experience from what we believe will be a painful and difficult experience. We also want to be there because we imagine ourselves in that scenario.”

Often, it’s the people left behind who suffer more than the deceased, said Kerry Egan, a former hospice chaplain who has turned to writing essays and books. We want to be there to comfort and help the dying, she said, as if we could somehow alleviate their suffering.

“People feel a sense of guilt. What could I have done better? How could I have stopped this?” she said. “Part of that is just part of the normal grief process.”

This relentless pandemic, which brings deaths shockingly quickly, heightens the anxiety. Many people can’t get to their loved one’s bedsides to whisper last goodbyes or reconcile old grudges.

Secular and religious end-of-life rituals, too, have been stripped away. Hospice care, for example.

“Hospice is all about being able to provide an environment where people can review their life and say their goodbyes and their sorries and hold hands and kiss one another and then — poof! — all of that is just gone overnight,” said Tucci, of the Hospice Foundation. “It’s a nightmare.”

At the same time, many funeral homes have cut way back on memorials, burials and other rituals used to commemorate departed friends and family.

“Even when there are people around to support us during times of mourning, it can be an extremely isolating experience,” said Bianchi. “Take that, and then put someone into forced isolation, like we are now, and it can be absolutely agonizing.”

Dying alone is different from dying lonely

It happens too often to be a coincidence, hospice chaplains say.

Family members will maintain a constant vigil, spending hours, even days, by their loved one’s deathbed. And then, when they leave for a few moments to make a sandwich or take a shower, their beloved dies.

“There’s no coincidence in my mind,” said Brewer, the hospice chaplain in Maryland. “This is an intentional process.”

Egan agreed. “Ask anyone who has worked in hospice and they will have dozens of stories like this. “I think a lot of people want to die alone.”

In other words, there’s a difference between dying alone and dying lonely.

“Dying alone is not necessarily dying without love. It is simply in some cases the absence of another person in the room,” said Brewer. “And if that’s what someone wants, that’s OK. It doesn’t mean they were forsaken.”

In a certain sense, Egan added, we all die alone, even if we are surrounded by people we love. Often, as we die, our bodies are breaking down and our minds are elsewhere. The conscious experience of death is, by nature, solitary.

And the movie image of someone imparting profound last words upon his deathbed, encircled by his faithful family? That’s a comforting fiction, hospice chaplains said.

“That is not how it happens,” Egan said. “Many people are not responsive at the end. Their bodies are busy doing something else.”

This family said their final goodbyes by phone

Before Steve Kaminski died, a nurse practioner at Mt. Sinai set up a group call so he could hear his family’s voices one last time.

His face brightened, the nurse told family members, as each offered their tearful goodbyes or said, hoping against hope, that they’d see him when he left the hospital.

On a ventilator, Kaminski himself could say nothing.

When he died days later, it was a sudden and stunning ending to 86 years of vibrant life, said Bert Kaminski, Steve’s son.

But Bert Kaminski said he took some solace from a dinner he shared recently with his father and his father’s longtime partner. They went to a Vietnamese restaurant, drained a bottle of Merlot and then feasted on ice cream. His father was his usual bon vivant self, Bert remembers.

“People shouldn’t take it for granted that there is time to connect with them later, particularly older family members,” Kaminski said.

“This thing can come very suddenly. No visitors. No final words.”

Complete Article HERE!

The death doula: helping you prepare for the day you die

By , , , and

What does it mean to have a good death? Leah Green meets with Aly Dickinson, an end-of-life doula. Aly helps clients to plan what they want to happen at the end of their lives, and she accompanies them as they transition from life to death. She helps Leah draw up a death plan, and takes her to a death cafe, where strangers discuss dying over tea and cake