The 11 qualities of a good death

Opening up about death can make it easier for ourselves and our loved ones.

By Jordan Rosenfeld

Nearly nine years ago, I received a call from my stepmother summoning me to my grandmother’s house. At 92 years old, my Oma had lost most of her sight and hearing, and with it the joy she took in reading and listening to music. She spent most of her time in a wheelchair because small strokes had left her prone to falling, and she was never comfortable in bed. Now she had told her caregiver that she was “ready to die,” and our family believed she meant it.

I made it to my grandmother in time to spend an entire day at her bedside, along with other members of our family. We told her she was free to go, and she quietly slipped away that night. It was, I thought, a good death. But beyond that experience, I haven’t had much insight into what it would look like to make peace with the end of one’s life.

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:

  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous “other” category (cultural specifics, having pets nearby, health care costs, etc.)

In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones—and for our own.

Choosing the way we die

Americans don’t like to talk about death. But having tough conversations about end-of-life care well in advance can help dying people cope later on, according to Emily Meier, lead author of the study and a psychologist who worked in palliative care at the University of California San Diego’s Morres Cancer Center. Her research suggests that people who put their wishes in writing and talk to their loved ones about how they want to die can retain some sense of agency in the face of the inevitable, and even find meaning in the dying process.

Natasha Billawala, a writer in Los Angeles, had many conversations with her mother before she passed away from complications of the neurodegenerative disease ALS (amytropic lateral sclerosis) in December 2015. Both of her parents had put their advanced directives into writing years before their deaths, noting procedures they did and didn’t want and what kinds of decisions their children could make on their behalf. “When the end came it was immensely helpful to know what she wanted,” Billawala says.

When asked if her mother had a “good death,” according to the UCSD study’s criteria, Billawalla says, “Yes and no. It’s complicated because she didn’t want to go. Because she lost the ability to swallow, the opportunity to make the last decision was taken from her.” Her mother might have been able to make more choices about how she died if her loss of functions had not hastened her demise. And yet Billawalla calls witnessing her mother’s death “a gift,” because “there was so much love and a focus on her that was beautiful, that I can carry with me forever.”

Pain-free status

Dying can take a long time—which sometimes means that patients opt for pain medication or removing life-support systems in order to ease suffering. Billawala’s mother spent her final days on morphine to keep her comfortable. My Oma, too, had opiate pain relief for chronic pain.

Her death wasn’t exactly easy. At the end of her life, her lungs were working hard, her limbs twitching, her eyes rolling behind lids like an active dreamer. But I do think it’s safe to say that she was as comfortable as she could possibly be—far more so than if she’d been rushed to the hospital and hooked up to machines. It’s no surprise that many people, at the end, eschew interventions and simply wish to go in peace.

Emotional well-being

Author and physician Atul Gwande summarizes well-being as “the reasons one wishes to be alive” in his recent book Being Mortal. This may involve simple pleasures like going to the symphony, taking vigorous hikes or reading books He adds: “Whenever serious sickness or injury strikes and your body or mind breaks down … What are the trade-offs you are willing to make and not willing to make?”

Kriss Kevorkian, an expert in grief, death and dying, encourages those she educates to write advance directives with the following question in mind: “What do you want your quality of life to be?”

The hospital setting alone can create anxiety or negative feelings in an ill or dying person, so Kevorkian suggests family members try to create a familiar ambience through music, favorite scents, or conversation, among other options, or consider whether it’s better to bring the dying person home instead. Billawalla says that the most important thing to her mother was to have her children with her at the end. For many dying people, having family around can provide a sense of peace.

Opening up about death and dying

People who openly talk about death when they are in good health have a greater chance of facing their own deaths with equanimity. To that end, Meier is a fan of death cafés, which have sprung up around the nation. These informal discussion groups aim to help people get more comfortable talking about dying, normalizing such discussions over tea or cake. It’s a platform where people can chat about everything from the afterlife (or lack thereof) to cremation to mourning rituals.

Doctors and nurses must also confront their own resistance to openly discussing death, according to Dilip Jeste, a coauthor of the study and geriatric psychiatrist with the University of California San Diego Stein Institute for Research on Aging. “As physicians we are taught to think about how to prolong life,” he says. That’s why death becomes [seen as] a failure on our part.” While doctors overwhelmingly believe in the importance of end-of-life conversations, a recent US poll found that nearly half (46%) of doctors and specialists feel unsure about how to broach the subject with their own patients. Perhaps, in coming to a better understanding of what a good death looks like, both doctors and laypeople will be better prepared to help people through this final, natural transition.

Complete Article HERE!

More people are dying at home, but the quality of their deaths matters most

Did they receive care and compassion from loved ones or did they die alone, fearful of getting infected in hospital?

By and

From the start of the pandemic to 24 September 2021, deaths at home in England and Wales have been 37% higher than the 2015-2019 average, according to the Office for National Statistics.

For every three people who used to die at home, four now do. That’s more than 71,000 “excess” deaths, only 8,500 of which involved Covid. Even as mortality elsewhere fell back to past levels, dying in private homes has persistently remained above average. A natural question arises: are these “extra” deaths or a shift from other locations?

Fortunately, National Records of Scotland publishes excess death calculations by location and major causes of death. Its most recent data shows the leading causes of death were cancer, heart disease and stroke. In 2021, the combined total for these causes was only about 1% above the 2015-2019 average, with around 260 extra deaths. However, deaths from these causes at home were 36% higher than recent years, with a corresponding decrease in care homes and hospitals. These additional deaths at home were not “extra”, but resulted from a major, systematic change in where people were dying.

So what’s the reason for this change and, perhaps more importantly, what was the quality of these deaths? How many were free of pain and experienced intimate care and compassion from loved ones and how many have died at home alone, fearful of getting infected in hospital? Existing statistics struggle to answer these important questions.

NHS England has sought to “personalise” end-of-life care in its long-term plan. Reported statistics from surveys and patient records about where people wish to die can exclude “missing” responses, such as when no preference is forthcoming. It is unclear if the shift towards dying at home is, on balance, a positive or negative development.

Every family has to deal with a death and live with its aftermath. In the words of Sam Royston, director of policy and research at Marie Curie: “It is critical that we ensure that those who die at home have all of the support and assistance they need for the best possible death.”

Complete Article HERE!

Death and psychedelics

— How science is reviving this ancient connection

By

In November 1963, the writer and psychedelic explorer Aldous Huxley laid in bed, unable to speak. He was dying of cancer. One of his final acts was to pass a handwritten note to his wife Laura. 

His famous last words: “LSD, 100 µg, intramuscular.”

It was Huxley’s dying wish: a large dose of acid, please. Laura Huxley fulfilled the request twice during her husband’s final hours.

First synthesized 25 years before Huxley’s death, LSD was still legal in 1963. Scientists were studying it as a potential treatment for alcoholism and other ailments, as well as investigating its similarity to other psychedelics. It wasn’t until 1968 that the federal government outlawed these drugs due to their association with the cultural turbulence of the 1960s.

Today, several decades later, terminal cancer patients are once again taking psychedelics. This time around the drugs are being administered by doctors and scientists in controlled settings—and they are not microdoses. The results of this research have been nothing short of remarkable.

Laura Archera Huxley, 40-year-old musician and filmmaker, and husband Aldous Huxley, 61-year-old British novelist, pictured at their Hollywood home in Hollywood in 1956. On his deathbed seven years later, Huxley asked his wife for a massive dose of LSD.

Alleviating anxiety and despair

Terminal patients often suffer from feelings of intense anxiety and despair after receiving their diagnoses. For many, this is just too much to bear. The overall suicide risk for these patients is double or more compared to the general population, with suicide typically occurring in the first year after diagnosis.

Terminal patients have twice the suicide risk of the general public. Psychedelics may help reduce their fear and suffering.

That’s where psychedelic therapy may help. After a single large dose of psilocybin, taken in a curated space and supervised by a pair of doctors, many patients report feeling reborn. It’s not that the underlying physical disease has been cured. Rather, the drug prompts a shift in the theme of their emotional self-narrative—from anxiety and despair to acceptance and gratitude.

It may seem curious to think about psychedelic drugs, often associated with hippies and the Grateful Dead, as clinical-grade tools for overcoming our primordial aversion to death. But maybe it shouldn’t be. Maybe this is only surprising if your window of historical perspective is too narrow. Maybe these “novel findings” are, in a sense, a return to somewhere we’ve been before.

Psychedelics at the dawn of civilization

In late 2020 I spoke to Brian Muraresku, author of The Immortality Key: The Secret History of the Religion With No Name, about the use of psychoactive plant medicine throughout antiquity. Our podcast conversation covers this history in more detail, but it’s clear that humanity’s relationship with psychoactive plants extends back at least to ancient Greece—if not further. It’s hard to look at prehistoric cave paintings like the Tassili mushroom figure and not wonder if psychedelics played a part in their creation.

Western philosophy may have developed with help from psychedelics as well. In Plato’s well-known allegory of the cave, a group of prisoners live chained to a cave wall, seeing nothing but the shadows of objects projected onto it by fire. The shadows are their reality; they know nothing outside of it. Philosophers, Plato states, are like prisoners freed from the cave. They know the shadows are mere reflections, and they aim to understand deeper levels of reality.

Plato’s philosophical ideas might have been influenced by psychedelic experiences.

Was Plato tripping?

If that sounds like someone who’s explored those deeper levels with psychedelic assistance…well, maybe it was. In his book, Brian Muraresku explores the significance of the Eleusinian Mysteries, secret ceremonies that involved death and rebirth. For centuries, philosophers and mystics traveled to the Greek town of Eleusis to partake in a ritual that involved an elixir known as pharmakon athanasias, “the drug of immortality.”

“Within the toolkit of the archaic techniques of ecstasy–plant medicine just being one among many–something you find again and again, in Ancient Greece and other traditional societies, is this sense that to ‘die’ in this lifetime, or achieve a sense of timelessness in the here and now, is the real trick.” -Brian Muraresku

Contemporary archaeologists, digging outside Eleusis, have unearthed ancient chalices containing a residue of beer and Ergotized grain. Ergot is a fungus that grows on grain. It produces alkaloids similar to LSD. It’s possible, then, that influential thinkers like Plato were inspired by genuine psychedelic experiences.

This connection between psychedelics and death didn’t end with Eleusis. It survived, often repressed and hidden from view, right through the time of Aldous Huxley.

The connection re-emerges in the 1960s

In the 1960s, Timothy Leary co-wrote a book called The Psychedelic Experience: A manual based on the Tibetan Book of the Dead. Leary, the exiled Harvard professor and psychedelic guru, dedicated the book, “with profound admiration and gratitude,” to Aldous Huxley. It opens with a passage from The Doors of Perception, Huxley’s essay on the psychedelic experience. Huxley is asked if he can fix his attention on what the Tibetan Book of the Dead calls the Clear Light. He answers yes, “but only if there were somebody there to tell me about the Clear Light.”

It couldn’t be done alone. That’s the point of the Tibetan ritual, he says: You need “somebody sitting there all the time telling you what’s what.”

Huxley was describing a trip sitter, someone who guides a person along their psychedelic journey. Sometimes it’s an ayauasquero in the heart of the Amazon. Sometimes it’s a doctor holding your hand in a hospital.

Timothy Leary, shown at home in California in 1979, was deeply influenced by Huxley’s work.

Seeking rebirth within the mind

In his book, Leary grounded Eastern spiritual concepts in the understanding of neurology we had at the time. The states of consciousness achieved by meditation masters and those induced by three hits of Orange Sunshine, he wrote, may actually be the same. Both involve dissolving the ego (“death”) and allowing it to recrystallize as the default mode of consciousness returns (“rebirth”). 

Leary wasn’t talking about magic. Scientists know these as “non-ordinary brain states,” inducible by rigorous attentional practice (meditation), pharmacological intervention (psychedelics), and organic decay (dying).

The ability of psychedelics to induce these remarkable brain states may also be why they’re showing such promise in alleviating the very ordinary fear of death.

Today’s psychedelic treatments: Coping with death

So what, exactly, has recent research on psilocybin as an end-of-life anxiety treatment involved?

A few small studies have seen psilocybin administered to dozens of cancer patients. They’ve been conducted in a randomized, double-blind, placebo-controlled fashion. In general, a large majority of patients showed sustained, clinically significant reductions in measures of psychosocial stress and increased levels of overall well-being.

For example, in one study, 80% of the patients found that a single dose of psilocybin quickly relieved their distress. Remarkably, in some patients that positive effect lasted for more than six months.

Sprouting new physical connections

What’s going on at the neuronal level to produce those changes? We don’t know for sure, but some preclinical research has given us a hint. Both psilocybin and LSD have been shown to induce rapid and lasting antidepressant effects in lab animals.

Early studies hint at how psychedelics may produce positive changes in the brain.

Early indications are that psychedelics may allow brain circuits to rapidly sprout new physical connections. This is exciting, but again: These are non-human studies, and it’s early.

It’s gratifying to see any of these studies happening, frankly. This is research that’s been stalled by the Schedule I status of psychedelics for half a century. Much of this work requires obtaining a special federal waiver to study banned substances, which slows progress.

Potential help for end-of-life patients

Fortunately, the FDA recently designated psilocybin therapy as a “breakthrough therapy” and the DEA has proposed increasing the supply of psilocybin for research. This should speed up the rate at which we understand the clinical efficacy of psilocybin and related psychedelics.

Here’s more good news: In terms of psilocybin’s efficacy as a treatment for end-of-life anxiety, larger human trials are already underway.

Dr. Stephen Ross, one of the field’s leading researchers, has described the significance of this work: “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”

Huxley: Ahead of his time

In one sense, Aldous Huxley was ahead of his time. More than a half-century before today’s renaissance in psychedelic research, his own experiences had evidently brought him to the conclusion that the best way to experience death was in a psychedelic trance.

In another sense, though, Huxley was one in a long line of creators stretching back to ancient Greek philosophers and perhaps even to prehistoric cave artists. They may all have used psychedelics to catalyze their outward creativity and comfort their inner distress.

Huxley titled his famous introspective essay, The Doors of Perception, after a quote from the English poet, William Blake: “If the doors of perception were cleansed everything would appear to [us] as it is, infinite.”

We will never know what he experienced in the final hours before his death, after handing that note to his wife. I like to think that for him, the last breath seemed to last forever.

Complete Article HERE!

A woman on TikTok wasn’t afraid to show her death.

In the process, she helped others live.

By Alia E. Dastagir

In a TikTok video on August 25th, Kassidy Pierson, who had been using the platform to document her life with terminal cancer, told followers she was hopeful it would be a good day. She spent the previous one nauseous, sweating and lethargic. But she was better on this day, and remarked how lovely the weather felt, and how she wished others could feel it, too. She told her followers she wouldn’t be posting every day. That wasn’t realistic anymore, she said.

The video was Pierson’s last. On September 9th, Pierson’s older sister Kasey Metzger posted from her account telling her more than 200,000 followers that the 27-year-old had died.

“I can’t tell you the amount of times that she would just break down crying because she couldn’t believe how many people just loved her from this platform,” Metzger said. “Thank you so much for all that you’ve done for her.”

Pierson, who was diagnosed with melanoma six years ago, used her popularity to raise awareness about skin cancer, but her earnestness, quirkiness and vulnerability made her account more than advocacy. Pierson, whose username was @ohhkayypee, offered a window into what it looks like to die – the grief and regret, the insistence that life isn’t over until it is.

She posted intimate videos – of the tumors protruding from her small frame, on her decision to enter hospice, on how she talked to her son Hunter, 8, about the inevitability ahead. In the process, she developed a captive community that watched with curiosity and awe as she lived the final days of her life.

“We need to know our life matters and we want our life, our death and our grief witnessed,” said David Kessler, grief expert and author of “Finding Meaning: The Sixth Stage of Grief.” “Our worst fear is dying alone. We always wanted someone at our bedside – to know someone will be there. … What’s new is the Internet.”

People want to be seen – in life and in death. The short-form video app TikTok offers users an unexpectedly intimate space to navigate and narrate experiences with terminal illness, which grief experts say offers myriad benefits to people on both sides of the screen. The hashtag #terminalillness has nearly 40 million views on the app.

The person posting acquires social connection, which science shows may allow them to live longer. And the audience is encouraged to confront existential fears, to develop empathy, and even to reflect on how best to live – in the face of imminent death and especially absent it.

‘We don’t really address death very directly’

People grapple with death’s unknowns in a number of ways, made all the more difficult by Western cultures that sanitize death or hide it, said Pamela Rutledge, an expert on the psychological and social impact of media and technology. The invisibility of death exacerbates fear.

A century ago, Kessler said, death was visible. Grandchildren watched their grandparents die at home. When he was a boy, Kessler remembers being on his way to school and seeing hearses on the street.

“Now the dead move around our cities in white unmarked vans,” he said. “If you want to see death now, you’ve got to see it in a movie or online or on a TV show.”

Like Pierson, many TikTok accounts are offering a raw look at dying, the way its nearness clarifies the preciousness of life. Many encourage followers to take care of their health. Some accounts are intimate, others more humorous.

User @solelenaq& ;shared her perspective on appreciating each day: “If I don’t make it I just want to say, ‘live your life.'” User @kora_the_herbivora shared a video of how overwhelmed she became by something that before her cancer diagnosis may have gone unmarked – the sensation of warm sun on her skin. User @pheovsfabulous posted a video about how she spent her life’s savings when she was given a year to live, only to outlive the prognosis.

Pierson’s mother, TK Dunn, said she’s glad her daughter uncloaked her own experience with death, especially how ambigious it can be. Pierson never really knew how much time she had left.

“There was this roller coaster of, ‘Am I going to die now? What does that mean? Who do I turn to?'” Dunn said. “Our culture doesn’t normalize conversations about death. Death happens. We act like it doesn’t. If we can start demystifying it, maybe these events wouldn’t be so jarring or traumatic.”

‘One of the biggest ways people matter is through personal connection’

The Internet may be making death visible again, but it also offers something to the dying – the ability to connect. To matter widely.

“One of the biggest ways people matter is through personal connection,” Rutledge said.

Research shows people with strong social connections may live longer, healthier lives. Conversely, people who are isolated face a 50% greater risk of early death.

“The ability to connect with people – to have that level of feedback and that level of support can be very positive emotionally,” Rutledge said.

The desire for connection goes both ways. Pierson’s audience was likely captivated because they craved connection, too, Rutledge said. And Pierson gave them that – often telling followers how grateful she was for their support, how much they meant to her.

“If the person who’s going through this, the person who’s dying, is thanking you for your attention and your participation in their journey, then you’re establishing … a parasocial connection in the sense that these people don’t know each other but become emotionally invested, just like you would with any narrative.”

These narratives also offer people fearful of death an alternative to the most terrifying story they tell themselves about how they would cope. Everyone makes up stories, consciously or not, about what they might do when death is close.

“You wonder how you would deal with your erasure,” Rutledge said.

‘It psychologically feels like it prepares us’

Kessler said he believes every fear we have connects back to a fear of death. But that fear isn’t productive. Fear doesn’t stop death, he said. It stops life.

Accounts documenting terminal illness allow people to confront their fears. To go to the edge in a safe, observing way.

“It psychologically feels like it prepares us, or it lets us know when our worst fear happens, we might be OK, too,” he said.

In the final weeks of Pierson’s life, she had family time, wrote in journals to her son, did a ride-along with the police department and sat in a private jet. She reminded her followers not to “be stupid” and to get their skin checked. She cheered on thwho heeded her advice.

“I would like to take you guys as far as I can on this journey with me. I’d like you guys to all see it and experience it and learn,” she said in a video on August 11th. “You’re not alone. … We’re doing this together.”

Complete Article HERE!

This woman guides dying Mainers through the end of their lives

Molly “Bones” Nelson, a certified end-of-life doula, stands at her pumpkin farm in Cornish. Nelson is a death doula credentialed by the International End of Life Doula Association, and the subject of a new documentary screening as part of the Camden International Film Festival.

by Nick Schroeder

There once was a man who lived on a hill in rural Maine. He was 97, and had no living family and few friends. He had neighbors, but most of them were half his age or younger, and the man could sense that they viewed him with reserve. This bothered him, so he hired someone to help him figure out the problem.

“He said, ‘The neighbors don’t understand me,’” said Molly “Bones” Nelson, who offered her services to the man during his final days. “‘I’ve been here for 50 years and they fish on my land but they still think I’m the crazy old guy they can’t talk to.’”

Her solution? Throw a party.

“He kept telling me, ‘I’m not dying; I’m graduating,’” Nelson said.

Nelson is a death doula. She helps people with the emotional and psychological work of confronting the terminal stage of life, whatever that entails. Often, her work looks like talk therapy, working through death’s thorny questions with those facing them. She also works with clients who have lost someone suddenly, such as in a miscarriage or abortion. In this case, it meant helping a man find a kind of happiness at the end of his life.

To prepare for the party, the man and Nelson baked cupcakes that looked like skulls, crafted a tasseled cap for him to wear, and painted a mural of scenes from his life. They had partygoers write questions they had about death — even unanswerable ones — and throw them in a bowl. Then they played a game: pick a stranger at the party and take turns answering questions from the bowl.

“We played that game for three and a half hours,” Nelson said. “People didn’t want to stop.”

Nelson is the subject of a locally screening documentary, “death and her compass” by the California-based filmmaker Annie Munger. The film is part of the Camden International Film Festival, which runs virtually through Sept. 26.

While they aren’t considered medical professionals, death doulas perform a work that has existed around the world for centuries. In present-day America, the kind of end-of-life care work they provide is something of a lost art.

“Our elders get put off to the side,” Nelson said. “Older people have a ton of wisdom and experiences to share about their lives.”

The cost of in-home elder care has skyrocketed in the U.S. even before nursing homes began facing staffing shortages and enhanced risk of infection with the coronavirus. The trend leaves little time and resources for talking through the end of life.

But it’s often no easier at home. The vast majority of older people — 88 percent — prefer to receive government assistance to age at home rather than receive care in a full-time nursing home or senior living facility, according to a study by the Associated Press-NORC Center for Public Affairs Research published in May. That can push the expensive and time-consuming work of caring for elderly people onto families, who struggle to absorb the often-invisible costs of managing a family member’s physical and mental health, memory loss, food and other needs while juggling their personal and professional lives.

“Death is a huge part of life,” she said. “You’ve had all this amazing growth, adventure and experience. If you don’t process it and have those difficult conversations, it’s like skipping dessert.”

Nelson likes to let her clients lead the process. In the initial phase, they hang out, talking through fears and memories, anything of significance. The dying person supplies their own spiritual beliefs, and she works with what they give her. Big religious and existential questions inevitably come up, but Nelson mostly works with relationships on the mortal plane. (Nelson keeps information from clients confidential, but others, like the 97-year-old, allow her to discuss their cases in general terms after their passing.)

Then, Nelson works with them to design a “legacy project,” something they can leave behind to friends and family, or to the world, that doesn’t neatly fit in a legal will. It might be a party or it might be a quilt, a donated plot of land or a long poem she writes with the dying person’s help and reads to them when fear rides high.

Nelson learned the trade with the International End of Life Doula Association, a training organization founded by New York hospice worker Henry Fersko-Weiss in 2003. Fersko-Weiss was a social work manager at the largest hospice in New York City, accepting roughly 500 patients a day. While he saw them receive adequate medical care, the sheer volume of patients needing hospice care meant that some needs were going unattended.

“I kept seeing these gaps,” Fersko-Weiss said. “As dedicated as the clinicians are, unfortunately the structure and logistics of hospice made it difficult for clinicians to spend a great deal of time and do deep work with people who are facing death.”

Something clicked when Fersko-Weiss talked with a friend who was becoming a birth doula. He trained to become one too, eventually modeling an end-of-life doula program from its teachings about helping expecting parents usher babies into the world. He could train volunteers to be present for dying people in a way similar to those learning to be birth doulas.

Nelson is the only one in the state formally credentialed through international association, which offers a rigorous certification process. There are roughly a dozen working death doulas in Maine who have trained through the association or the End of Life Doula Alliance, which was founded in 2017.

Nelson, 57, took a long road to this line of work. The nickname “Bones” is unrelated to her profession — a scrawny child, she’s had it since youth — but many clients find as much humor in it as she does. She moved to rural Maine from New Jersey at age 18 and has been farming ever since. Today, she primarily grows pumpkins.

Death has been a part of Nelson’s life since birth. She was born with a heart condition, a thin-walled aorta that’s “shaped like an hourglass.” Doctors have told her that it “could explode at any moment.” In 2007, she had a stent put in her heart, and it tore through two layers of her aorta. But she survived and continues to farm, hike and ride dirt bikes.

She’s also lost those close to her. Nelson’s mother died by suicide at the age of 82, after multiple attempts during her life, and her father died of cancer in 2013.

“I’ve had a lot of healing to do,” Nelson said.

Nelson takes death seriously, but doesn’t necessarily see it as a grave subject. It’s easy to imagine her combination of folksy wisdom and well-timed humor softening some thick layers of fear. As shown in “death and her compass,” Nelson’s sessions with clients seem much less like a psychological evaluation or transcendental ritual than two old friends just talking.

Nelson said that she “doesn’t believe in death” after a life spent outrunning its shadow.

“I got a T-shirt that has a picture of a sloth on it. It says: ‘Live Slow, Die Whenever,’” she said with a laugh.

The sentiment captured the way Nelson has come to think about the subject.

“I don’t feel rushed because I don’t feel like there’s an end,” she said. “If I don’t get to ride my dirt bike across Mongolia by the time I’m 60, so what. I’ll just do it next time.”

Complete Article HERE!

Everything Dies

It’s the Buddha’s basic teaching. It’s life’s universal truth. It’s what we most want to deny. Sallie Jiko Tisdale on how this hard but liberating truth can transform your life.

Death and Life” by Gustav Klimt.

by

Most Buddhists put flowers on the altar. We know flowers are beautiful, but that isn’t their purpose here. Flowers begin to die as soon we cut them; we carefully lay death in the place that symbolizes our awakening. We bow and make offering to this crucial truth, built into the bones of the world.

The Buddha spoke volumes of words, an immense canon, but most of what he said comes down to this: Things change. Change cannot be avoided. Change hurts. The fundamental teaching of all Buddhism can be stated as everything dies. The Buddha taught this, it fills the sutras, it is repeated by our teachers. But most of all, we learn this from our own daily lives.

Do we believe that we will dissolve? No. Not deep down in the root of the small self, because the small self plans to live forever.

You have probably learned a traditional formula or two for this insistent teaching about the transitory nature of all things:

Anicca vata sankhara: “Impermanent, alas, are all formations!”

Sabbe saokhara anicca: “All conditioned factors of existence are transitory.”

In the Maha Satipatthana Sutta: “[One] abides observing the phenomenon of arising…abides observing the phenomenon of passing away…”

As a new practitioner, I learned the catechism this way: “All compounded things are subject to dissolution.” The language was strange when I first heard it, and as a young practitioner I found myself parsing the words: Compounded. Dissolution. Notice, I was told, how everything is put together from other things and will be taken apart. I began to notice. A table, a house, a nation—I could see this.

But if all things are compounded and will dissolve, then I am compounded and I will dissolve. And this was not something I could easily accept.

I pretend to accept my own death. Most senior practitioners do; many of them may even believe they accept it. Buddhists have their own peculiar points of pride, outside the usual stream of things we pride ourselves on, like humility and asceticism. Plenty of us are proud of our equanimity in the face of extinction, at least until we see the headlights bearing down.

So how deep does this acceptance really go? It’s not just Buddhists who kid themselves about being prepared for death. It’s people. It’s all of us who don’t want to admit that we are organisms fighting for life, that we can sagely repeat, “Annica, annica, all compounded things are subject to dissolution,” without really confronting what it means.

Do we believe that we will dissolve? No. Not deep down in the root of the small self, because the small self plans to live forever. When we say that “Everything dies,” we mean everything dies but me. And we can get kind of fancy about this point: Everything dies, including my body (but not my awareness—not me). Everything is subject to dissolution, but something passes through to a new form and doesn’t ever go away (that’s me). In a thousand ways, most of them not entirely conscious, we hold on to the hope that something of this self, somehow, will remain, and we hold on to that even as everything we touch slides away like sand in running water.

Why should we pretend to more confidence than we feel? Everyone is a beginner when it comes to death. We can’t practice it. When my mother died, it was the very first time that my mother died, and I didn’t know how to do that, to be a daughter whose mother was dying, to be a daughter whose mother had ceased to exist. When my best friend died—when my teacher died—I didn’t know how to do it. Each death I’ve known has been the very first one of its kind. Even with experience—I know how grieving feels, I know the altered state of a vigil, I know a lot about that—I can’t entirely prepare. And when I die, it will be the first time this particular me dies, and I will be a beginner.

Yes, I know that we are all dying all the time. That’s what it means to be a compounded thing dissolving—this self, this moment, gives way to the next as the girl gives way to the woman who gives way to the crone. I know that the me of today is not the me of yesterday, and I was also taught that if you die once, you never need to die again. But the real teaching of that formula, the falling away of body and mind for a ceaseless moment, is that you are already dead. I know this, but I don’t think my body does.

Slay the demons of hope and fear. My teacher would say this to me at a time when I was knocking up against deepening anxiety. My stubborn refusal to submit to the meaning of that anxiety made me more anxious still. The stronger I resisted, the deeper my anxiety became, until I sank well into true fear. How could I slay that demon when I was afraid to walk out the door?

We need to talk about death bluntly, honestly, and often.

“Vanitas Life, Death, and Resurrection by Ezio Gutzemberg.

The original Pali word for aversion, dosa, is various and shaded. It can be translated as anger or hatred, denial, projection, distortion, aggression, repulsion, even disgust. That is how it can feel to talk about death, about our own death. But I want you to think about it and I want you to talk about it. Even if you have considered your own death deeply, how often do you talk about it? Do you talk about your private conflicts or confusion, your questions, your plans?

How do we begin? Begin with the fear. Begin with the resistance. We know the question. It is why we begin to practice in the first place: Why do we suffer? And we know the answer. It is why we keep practicing: We suffer because of change and resistance to change.

But knowing the answer does not stop the question from being asked, and knowing an answer today doesn’t mean we will remember the answer tomorrow. Ignorance is the first link in the twelve-fold chain of causation—ignorance of impermanence, of anicca, of anatta, of no-self. This chain feeds itself endlessly—our ignorance of the ephemeral nature of the self building a self over and over. The chain is broken only by the transformation of that first mistake, being ignorant about the compounded nature of the self, which is not separate or bounded at all.

What do you fear about death? Make a list. Be honest. Autopsy? Being alone? Pain? Loss of privacy? Do you fear soiling your bed? Do you fear needles? For what do you hope? Make a list. Be honest. Do you want to see it coming? Do you want to be asleep? Do you want to be very old?

Ask the question again. Why am I afraid? Because I will die. What does that mean? (Wait a minute. Will I die? Do I have to die?) Ask yourself: Are you ready to die? Don’t answer too quickly, because that last one is a doozy. Even people who have made great strides in accepting the fact of their own inevitable dissolution will be flooded with adrenaline when the headlights bear down. The body has its own hopes.

Talk about death. Talk about everything. Imagine it. Write a description of the scene of your death. Where are you? What do you see? What do you smell, taste, touch? Who is there? Are you inside or outside? Is it warm or cool? Is there music, or words?

Imagine it. Write it down. Then tell everyone who needs to know—your family and friends and teacher and doctor—what you want. Make a record of your wishes and don’t forget to decide how your body should be handled after you’re done with it. Make copies and pass them out.

Then tear it up. Let it go with all your heart. This will be the work of the rest of your life.

We can do all this. We can make a plan, buy a plot, fill out the advance directive, decide what music we want to hear as we go. But we can’t plan not to die. The essence of dying is the loss of control. This is the hardest part for many of us—not that death will happen, but that it will happen without our hand on the controls. It will happen as it happens, when it happens, where it happens, and chances are it won’t go according to plan. The only thing we can control, and only with practice, is how we face whatever happens.

These days it is common to talk about a “good death.” (There are many official, even government-issued, definitions of a good death.) A good death is usually defined as one where a person is comfortable and at peace.

For myself, I want to think about a right death, a death that fits the life I’m trying to live. Most deaths include what anyone might call good moments and bad moments, desired and undesired consequences. So it is with our lives, and so it is with death. Right deaths are all different; you can’t define the details. For me, it means a death unhidden—from me and from those who love me. It means a death met with grace and willingness when the time comes. Achieving this will be the work of the rest of my life.

If we can face it, recognizing the reality of death will transform our lives.
Flowers are beautiful because they are brief. Beauty is a measure of fragility and brevity and transformation, created in part by our awareness of the precious value of this moment—this moment is what we love. Death is utterly natural, shared by all; it is also heartbreaking. That equation isn’t dissonant; it’s the nature of love. With our eyes open to change, each thing we meet is luminous and sparkling. To love means to lose. To lose means to love. The last breath allows us to cherish another without reservation, holding nothing back.

Slay the demons, my teacher told me. That meant accepting my anxiety, my fear. It meant coming to see that hope and fear are one thing: fantasies of the unborn future. Hope pulls and fear pushes and together they keep us stuck in what has not happened, living a half-life of imaginary events. I exhausted myself on that mountain, until I gave up. Giving up was the key. Accepting the demons of hope and fear until they slew me, which was what my teacher had been saying all along.

The parable of the burning house told in the Lotus Sutra is a familiar one. The children do not know the house is on fire, so they won’t leave until their father tempts them with carts full of treasure. So we are with our own suffering, our ignorance. The Buddha offers us treasures, including one so great we couldn’t even imagine it.

Some years ago, I had a brief, vivid dream. I saw a room completely engulfed in flames, and several people were walking calmly through the room, smiling. One turned and looked at me and said, “I can’t tell you how safe I feel in this house.”

When I begin to truly accept myself as this compounded thing—a dewdrop, a bubble, a cloud—when I really believe for a moment that my precious me is a passing sigh in the oceanic cosmos of change, then I begin to find safety inside the burning house. I don’t need to escape if I know how to live inside it. Not needing to escape, I no longer need rewards. I just walk through it, aware of dissolving.

Complete Article HERE!

‘I Run a Death Cafe’

By Megan Mooney

I’ve been interested in death my entire life. I was going to be a mortician, and then I took a grief and loss class in college and switched degrees. I’m now a social worker. But I had always wanted to do something on a macro level to help my community around issues of death and dying.

In 2012, I was completing my social work practicum at a hospice and the team leader there wanted me to do some community involvement work. She told me she’d read an article about a “death cookie” group. I talked to my boss and she explained the correct name for the organization was Death Cafe and told me to get in touch with Lizzy Miles, who had started the cafes in the U.S. that year, after reading about them in the U.K.

It happened to be around the same time my uncle had died of cancer; he’d had a horrible death. So I really wanted to create a group where people could come and talk about death and educate each other. After I emailed Lizzy, she called me and we talked for hours.

She helped me get my first death cafe started in February 2013 at a coffee shop in town. The cafes were starting in LA, Atlanta and New York, but I’m in a small town called St. Joseph in Midwest Missouri, so there were none around my area at the time. At my first death cafe and for the five after, I had two women who would drive 7 hours each way to attend. That showed me how much people needed this safe place to talk about death and dying.

We have coffee and cake at each session and my first cake said “Missouri’s First Death Cafe” on it. I laugh about it now because I got so much cr*p for that cake. I went to a big grocery store and told the lady there that I wanted little headstones on the cake. She got mad and told me it was a family business. I had to explain to her what I actually needed the cake for.

But people still thought we were going there to “drink the Kool-Aid” and die. Before my first death cafe a local hairdresser said that an older woman had read a news article about it and was talking about how it was a morbid group getting together to do God knows what. A lot of people still think it’s a morbid group.

Every death cafe is different in terms of who attends and what the attendees talk about, but we all follow the same rules: It’s not a grief or counselling service, we are non-profit, the cafes are held in an accessible, respectful and confidential space and they have no intention of leading people to any conclusion, product or course of action. We also always offer drinks and nourishing cakes! Having food is very important. It is life sustaining and we believe it helps people to feel more open to talking about death.

There were about 20 people at my first death cafe and their ages ranged from 25 to 70. It’s for adults, so 18 and older but I’ll have people of all ages; the oldest attendee I’ve had was 85. But I’ve only ever had one person come who was terminally ill.

When I host, I have four or five people at each table and at the beginning I ask everyone to start with what brought them here to talk about death and dying. That seems to be the only thing I need to ask.

My dad and aunt came to my first death cafe. My father never talked about death and my aunt hadn’t been able to talk about my uncle’s recent death without crying, so I didn’t know how it would be. But as I was looking around, my dad was laughing with his group and my aunt was laughing with hers. I sat down and heard my aunt talking about my uncle’s death without crying for the first time.

The following week my dad called me and was talking about how you’re not supposed to make any big decisions within the first year of a loss. He then told me he’d learned that from the ladies at his table at the death cafe.

My dad came to every single death cafe I held after that, except one, and he planned his funeral and all his funeral songs. He died three years ago, but his death was easier for me because we’d had all these conversations about it. He talked all the time about how much the death cafe helped him face his own death.

Death cafes run all over the world
Megan Mooney has been running death cafes in St. Joseph, Missouri since 2013.

A theme that often comes up is relationships and death. People will talk about losses they have had and how it impacted them. Everybody has experienced a death in their life and most of them have never really talked about it. I had a lady who came in, she was probably in her late 50s and she was really shaky at the beginning. At the end she came and thanked me and said that she had never been able to talk about death with anybody before because in her family it was a “taboo”.

People also talk about what they want at the end of their life. There can be a superstition that talking about death brings it closer, so people avoid talking about it at all costs. But when you don’t plan for the end of your life it can be harmful to your loved ones, or add to their grief. My dad making plans helped me tremendously and it was cathartic for him too.

While there are sometimes tears, most death cafes are full of people laughing and having a good time. I believe that thinking and talking about death helps us to be our authentic selves. It helps us to take our mask off and not take things for granted. We’re often in such denial about death that we hurry through life and don’t appreciate the people in it. At these cafes, you get together with strangers and you’re talking about an intimate topic that most people can’t even talk about with their family. It brings you closer and helps improve your relationships with people.

At the end of each death cafe I ask attendees what their “Aha!” moment has been and I hand out surveys. One of the questions is: “Did your views on death change as a result of the death cafe?” It’s crazy because almost every time people answer something like: “My views on death didn’t change but my views on life have changed.”

When COVID first hit we decided the death cafes had to be online. But it ended up being a blessing in some ways because it meant we could meet with people in different countries all over the world at the same time. Now we’re back meeting in person, but we do have cafes online too.

Death cafes began in the U.K.
Megan Mooney first started running death cafes in 2013. She has now run 45 death cafes with hundreds of attendees.

I’ve run about 45 death cafes since 2013 and the smallest group I’ve ever had was still 10 people. I’ve also had companies ask me to host death cafes for their staff. I had one life insurance company with 1,500 staff and there was a woman there whose son had died by suicide. When I asked if anyone had any “aha!” moments, she stood up and shared how she felt about her colleagues’ reaction to her since she had returned to work.

Being involved with Death Café has taught me to love with my whole heart and that nothing in life is permanent. I’ve learned how to accept change, which can be hard. And, I’ve realized that relationships matter the most in life: my relationship with my daughter and spending time with her. That used to include my dad too, he was my best friend.

As a leader for Death Café, I have learned tremendous lessons from attendees and our followers on social media. I’ve learned that so many things in life are trivial. I don’t really get upset any more. Our views on death usually inform the way we live. When you start to come to terms with your own mortality, it can push you to really live your life and to be the best version of yourself. If you look at life from the vantage point of death you can see how beautiful it is.

Complete Article HERE!