Category: Philosophy of Living

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Learning how to think about death changed how I live

Viewing death as unrelated to life, or antithetical it, does a disservice to the days we have, because we don’t know how to value them, says John Leland. The journalist and author explains how an elderly friend changed his perspective on the importance of acknowledging our mortality.

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Judy Woodruff:
New York Times reporter John Leland began following a group of men and women in 2015 who ranged in age from 87 to 92.
What he learned shattered his expectations about aging and death, as he explains in his Humble Opinion.

John Leland:

[P]eople are always telling us to live each day as if it’s our last, but we don’t really do it, and for two good reasons.

The first is that, if you really thought today was your last day, you wouldn’t pay the utility bill or save for retirement, and, before you know it, you’re in the dark warming a can of beans over an open flame.

And the second reason is that we don’t like to think about death or dying, except as something that happens to other people.

A few years ago, I met a man named John Sorensen, who taught me how to think about death, and it changed my outlook on life. He was 91, and he missed his partner of 60 years. And every time I visited him, he said he wanted to die. He wasn’t depressed or even sad.

In fact, talking about dying always got him in a good mood. Wanting to die, for John, was the best reason to live.

And what I mean is this. He loved opera and he loved old movie musicals. And wanting to die meant acknowledging that this might be the last time he heard Jonas Kaufmann sing Wagner or watched Gene Kelly singing in the rain. This made each time more worthy of his attention.

And the same went for visits with friends. It’s a textbook economics of scarcity. His days weren’t fleeting. They were saturated with pleasures of his own choosing.

In our culture, we have come to think of death as a kind of failure of medicine or an affront to the self, rather than seeing mortality as built into all of our days, the first as much as the last.

Viewing death this way, as unrelated to life or antithetical to it, does a disservice to the days we have, because we don’t know how to value them. We enjoy a movie more knowing it’s going to end in a couple hours.

That ski run in the Swiss Alps, it’s only fun because you know there’s a bottom. The end of the run gives meaning to each curve on the way down, even when you’re still near the top of the mountain.

I have heard this acceptance of the end from most of the older people I have spent time with.

But you don’t have to wait until we’re 91 to enjoy it. We should rethink what it means to live every day as if it’s your last. The way I learned it from John, it means embracing that part of the end that exists in this moment, and then in the next.

You don’t have to quit your job or stop paying your utility bill. There’s enough to live for in the things you’re already doing. Each brush with a stranger, each moment with friends, each kiss or caress, there’s a little bit of our mortality in all of them. But their ours for now.

And that is reason to be happy.

Complete Article ↪HERE↩!

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Coming to terms with the end of life

by Penny Heneke

[B]eing well ensconced in my senior years, I am faced with the daunting prospect of my mortality. An article I read recently commented that people are afraid to face and to speak of this pending permanent change of address. For me death lurks in the dark like a boogey man under the bed. An elderly, crabby aunt I boarded with as a teenager scanned the death notices each day. She positively cackled with delight when she discovered an acquaintance she had outlived.

Nor is death and dying a scintillating topic to introduce for conversation in an evening entertaining friends. While seniors are renown for recounting “organ recitals” of their many health problems in great detail, death itself is a taboo subject. For some, life is a painful battle against debilitating health issues and for most of us it is trying to find strategies to deal with the everyday evidence of our evaporating capabilities along this final stage of our life journey.

Perhaps a sense of humour is a valuable tool to deal with our aversion to death. A friend on his 90th birthday decided to deal with his advancing age by walking around with a sticky note plastered on his forehead announcing, “expiry date: overdue.”

In the meantime, seniors have to cope with the everyday incomprehensible things we seem to do as we amble along to this dead end. If the solution were only as simple as one friend remarked: “Oh, for some happy pills.”

One morning, my husband, Ken emerged from the unlit walk-in closet attired in my fluffy, light blue, terry housecoat. It fitted him to a tee, as today my hubby is a shell of his former robust five-foot-10. Shrinkage of over 4 inches has occurred due to arthritis. When he realised his faux pas, he looked sheepish and commented: “I’m really losing it.”

I couldn’t laugh too loud as I find myself in the same category. At my recent optometrist appointment, I was squinting through the phoropter the optometrist was using to test my eyesight, not wishing to admit that the finest print was a blur. I had always had 20/20 vision. In an attempt to improve the images, I closed one eye. As the consultation continued with the instrument going back and forth, I suddenly could not see anything in the one lens — just blackness. My optometrist was puzzled and made some lens adjustments.

“Can you see now?” she asked.

“No, it’s still pitch black,” I replied. “I can’t see a thing.”

She sounded puzzled and moved the machine aside. After a moment’s hesitation, she placed a hand gently on my shoulder and remarked: “My dear, you have your eye closed!”

While my vision might be fading fast, Ken suffered a mini-stroke and lost the use of his right eye. Family and friends responded sympathetically by telling him of someone they knew with the same predicament and yet was still legally able to drive. Neither Ken nor I felt reassured learning how many one-eyed people are out there on the roads driving.

I don’t think it was his eyesight that caused Ken to panic as he was leaving for a doctor’s appointment. He patted his pockets frantically looking for his car keys until I pointed out that he had them in his hand.

Never mind the missing death discussion, aging itself takes a great deal of adjustment. My recurrent nightmare of losing my teeth has been replaced by one of losing clumps of my hair and going bald.

After spending a life time amassing material objects, I have reversed the procedure by decluttering. Now I am fine tuning the unburdening of my “stuff.” I am in the last stage, which I am calling, “closure.” This is as close to the “D” word as I can get.

Preparing for the end, I announced to my children that I was drafting my own obituary notice. I don’t trust them to get the facts right. This resulted from my perusal of the obituary notices each day in the daily newspaper. My first feeling is one of sadness looking at all the smiling faces of people who have passed. However, I am also struck by a few who have had unflattering photographs placed with their notice. In order to avoid this dilemma, I have picked a photo — admittedly a good few years younger — of myself for my obituary. My daughters love to tease me by saying that I will have no control over the whole issue. At least I would have tried.

The lyrics from the English punk rock band, the Clash, “Should I stay, or should I go” underscore that we really have little choice in the timing of our departure so it’s best to make the most of what you still have left of life.

Complete Article ↪HERE↩!

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Dying Young and the Psychology of Leaving a Legacy

by

[O]ften the biggest existential distress that we carry is the idea that no-one will remember us when we are gone—initially we know that our friends and family will hold who we are, but after a generation, these people are likely gone too. At the end of life, the pressure to leave an unquestionably relevant legacy can be crippling for people, particularly for young people. When coupled with the limited energy that people have when they are unwell, the very nature of what people expect to achieve in the world shrinks, and the really important pieces come into focus.

When time is seen to be limited, every moment can take on a weight that has never before been experienced. Some of these expectations come from within and some externally, but regardless of their origin they can be paralyzing for the young person facing their mortality, particularly when unwell. Culturally, there are multiple references as to what ‘dying young’ is meant to mean and most refer to extraordinary and often unobtainable expectations. For instance, members of the ‘27 club’ (celebrities who die on or before their 27th birthday) and notable cancer-related concepts around ‘bucket lists’ and works of fiction (e.g., The Fault in Our Stars). Most young people, particularly those who are dying, do not have the capacity or the options to engage in an extraordinary feat, they can become overwhelmed and paralyzed by what they are ‘meant to be doing’.

Often, as is the case with many things in life, simple and small are the gestures and moments which are the most meaningful, with huge projects and adventures feeling too overwhelming and out of the grasp of someone with limited energy and resources. As such, the fantasy of what something may have looked and felt like, had they have been well, is a much more satisfying space for them to sit with. Similarly, relationships become much more meaningful, as do the simple things that are taken away through the treatment process, like being able to sit in the sun or go to the pub with a friend.

Young patients can be bombarded with well-intentioned suggestions about what they ‘need’ to do, including making future legacy-based activities, such as leaving cards for each of their younger sibling’s birthdays, video journals of their death, or chronicling how they feel about all the people in their world. Although these are good ideas, they are emotionally and physically difficult to manage with limited resources. Patients need to be feeling very resilient and well before attempting any of these things with most being abandoned due to the confronting nature of conceptualizing the world without them present in it. It is a difficult ask for anyone to be able to take the relatively abstract idea of the world continuing following your own death; this does not change for young people and, in some ways, it is even more challenging due to their pervasive sense of self, even in the face of very real threats to their mortality.

The way that young people respond to being presented with a very limited life expectancy can vary tremendously. Some may stick their head firmly in the sand and refuse to discuss or conceptualize anything about what may happen in the lead-up to their death, or following. Others will organize everything about the end of their lives, including where they want to die, how alert they want to be, as well as what will happen following their death—such as where their belongings go and how they want to be remembered. For most people in this situation, in an existential sense, almost everything is out of control, the disease will do what it does, the pain is what it is, and they are an observer to the things happening in their bodies. The things that people can control is what they talk about, how much they talk about it, and who they talk about it too.

Just because death, dying, and legacy are not being talked about, does not mean that it is not in the consciousness and thoughts of the person pondering their own end. Instead, it may be that they have done as much thinking and talking about it as they need to do; it is often these patients that have very well-considered plans about what they want to happen as they deteriorate and the decisions that must be made about their care.

Complete Article ↪HERE↩!

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Rethinking Dying, Part 3

Let’s talk about dying

[W]e can’t control if we’ll die, but we can “occupy death,” in the words of Peter Saul, an emergency doctor. He asks us to think about the end of our lives — and to question the modern model of slow, intubated death in hospital. Two big questions can help you start this tough conversation.

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Rethinking Dying, Part 2

What really matters at the end of life

[A]t the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.

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What Is a “Good Death”?

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[T]hese days, everyone from poets to professors, priests, and everyday folks all opine about what makes a “good death.” In truth, deaths are nearly as unique as the lives that came before them — shaped by the combination of attitudes, physical conditions, medical treatments and people involved.

“A good death can, and should, mean different things to different people,” says Haider Warraich, MD, author of “Modern Death – How Medicine Changed the End of Life.” “To me, it means achieving an end that one would have wanted, and that can really mean anything – from being in the intensive care unit, getting all sorts of life-sustaining therapies, to being at home, surrounded by family, getting hospice care.”

Still, many have pointed to a few common factors that can help a death seem good — and even inspiring — as opposed to frightening, sad, or tortuous. By most standards, a good death is one in which a person dies on his own terms, relatively free from pain, in a supported and dignified setting.

“I think what makes a good death is really different for every individual, but there are some common threads that occur with each person I’ve seen,” says Michelle Wulfestieg, executive director of the Southern California Hospice Foundation (SCHF) and author of “All We Have is Today: A Story of Discovering Purpose.”

Some of patients’ most common end-of-life priorities include being at peace spiritually, knowing that they have the support of loved ones, having their affairs in order and being reassured that they won’t have a painful death, says Wulfestieg, who has worked in hospice care for 14 years.

Having affairs in order

Not everyone has the luxury of planning for death. But those who take the time and make the effort to think about their death in advance and plan for some of the details of their final care and comfort are more apt to retain some control and say-so in their final months, weeks and days.

Legal specifics of such planning can include taking steps to get affairs in order by:

For those considering hospice care at the end of life, another crucial end-of-life planning step is to elect the hospice benefit under Medicare, notes Joseph Shega, MD, national medical director for national hospice care provider VITAS Healthcare. He points out that hospice care is covered by Medicare, along with most health insurance providers.

Richard Averbuch, Executive Director of the Massachusetts Coalition for Serious Illness Care, cautions not to wait until a serious illness or crisis before planning for end-of-life care.

“The best time to name a proxy and talk about your preferences is now – whatever your stage of life. Think of it as part of your overall wellness program – just as important as preventive care, an exercise regime, and a good diet,” he says. “And you need to revisit the conversations periodically, since your feelings may change as you age or as your health status changes.”

Controlling pain and discomfort

Most Americans say they would prefer to die at home, according to recent polls. Yet the reality is that some three-quarters of the population dies in some sort of medical institution, many of them after spending time in an intensive care unit.

Part of that may be due to misunderstandings about the different options for treating a patient’s pain in their final days.

“There are still people who are uncomfortable with the use of pain medications at the end of life, even as their use is essential for the patients who are in pain,” says Warraich.

As life expectancies increase, more people are becoming proactive. A growing number of aging patients are choosing not to have life-prolonging treatments that might ultimately increase pain and suffering — such as invasive surgery or dialysis — and deciding instead to have comfort or palliative care through hospice in their final days.

Ways to help ensure a “good death” on an emotional level

Along with the practical matters of having one’s affairs in order, it’s equally important to prepare for death emotionally, to spend time with loving people toward the end of life, and to have spiritual sustenance.

Having few regrets

“Patients really want to know that their life had purpose, that they made a difference and that their lives mattered,” says Wulfestieg. “It has to do with family a lot of times, saying those I love yous and goodbyes.” The SCHF often works to reunite dying patients with family members,

including those who have long been estranged.

Often quoted among hospice care providers and in the literature on death and dying are the tenets in “The Four Things That Matter Most“, by Ira Byock, a medical doctor who professes the need for a dying person to express four thoughts at the end of life:

  • I love you.
  • Thank you.
  • I forgive you.
  • Forgive me.

At the time Caring.com spoke with Wulfestieg, her organization was preparing to reunite Marilyn, a woman with ovarian cancer and only a few weeks to live, with her three estranged adult children and grandchildren.

Due to Marilyn’s problems with drugs, alcohol and crime, all three of her children grew up in foster care, and she’d lost contact with them. Her dying wish was to have a family meal with her children and grandchildren, so SCHF have arranged to fly out Marilyn’s family members to make it happen, Wulfestieg says.

“That’s really her dying wish, to be able to say ‘I’m sorry, I love you and goodbye,’” she says. “It’s really a story of grace and forgiveness and hope.”

Receiving mindful care and support

The right company can help aid a “good death.” Although dying may be scary or sad or simply unfamiliar to those who are witnessing it, studies of terminally ill patients underscore one common desire: to be treated as live human beings until the moment they die.

Most also say they don’t want to be alone during their final days and moments. This means that caregivers should find out what kind of medical care the dying person wants administered or withheld and be sure that the medical personnel on duty are fitting in skill and temperament.

“Before health care decisions around end-of-life care can be delineated, clinicians and patients must first recognize when life-limiting conditions such as heart failure, lung disease or cancer are no longer responding to disease-modifying treatment,” Shega says. Next, he says, there should be “a conversation between the patient and clinician about end-of-life care and the role of hospice.” He adds that care teams need to provide ongoing support to the patient and their loved ones throughout their final days, “never abandoning the patient and respecting their choices.”

Favorite activities or objects can be as important as final medical care. Caregivers should ascertain the tangible and intangible things that would be most pleasing and comforting to the patient in the final days: favorite music or readings, a vase of flowers, a back rub or foot massage, being surrounded by loved ones in quiet or conversation.

Spirituality can help many people find strength and meaning during their final moments. Think about the patient’s preferred spiritual or religious teachings and underpinnings, since ensuring access to this can be especially soothing at the end of life.

Complete Article ↪HERE↩!

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What is the best way to explain death to a child?

By Dave McGinn

[T]he popularity of bestselling memoirs such as When Breath Becomes Air and The Bright Hour, both meditations on death by authors who died young, suggest that death is a topic many of us like to think about (while alone, reading silently) – yet, it is still a subject many of us are woefully bad at talking about, particularly when it comes to discussing it with kids.

We all need a better “death education,” says Dr. Kathy Kortes-Miller, an associate professor of social work at Ontario’s Lakehead University and author of the new book Talking About Death Won’t Kill You: The Essential Guide to End-of-Life Conversations. Like a new website launched last November by the Canadian Virtual Hospice, the book takes what remains a taboo subject and shows how to talk about it openly and honestly. The Globe and Mail’s Dave McGinn spoke to Kortes-Miller about having that conversation with children.

Why do we have such difficulty talking to children about death?

As parents we are cultured and conditioned to protect our children. Our generation, we didn’t really learn how to talk about it. Before I was a parent, I was really good at talking to children about dying and death. And then I became a parent myself and found that it was a lot harder than I thought it was.

What’s the risk of ignoring the subject, or not bringing it up unless they do?

It keeps it as an unknown and as a scary and almost a taboo topic. We [need to] recognize that this is a transition event in our life and one that we can prepare for and one that we can learn about, and by doing so, that’s going to help us to live life more fully and prepare ourselves for the end of life.

What is the best way to explain death to a child?

It depends on the age of the child, of course. But one of the ways to do it is by looking around at nature. Kids are inquisitive. They’re interested in how things die and what happens to them. So often they’ll see things in nature and ask questions. Those are really good ways to get the conversation started. As they get a little bit older they start to watch TV and they start to read books. There is a lot of dying and death in media that children are exposed to, and those are also really good conversation starters.

You mention that nature often presents an opportunity to talk about death. I’ve been guilty of telling my kids a dead squirrel they saw was just sleeping.

That’s an easy one to do. We’re almost scared to use the D words – dead, dying and death. But we confuse them if we use euphemisms. Having worked with young kids in a counselling role as a social worker in a hospice unit, when we talk about “oh, grandpa’s just gone for the big sleep,” instead of he’s died, kids get nightmares. Kids don’t want to go to bed at night because grandpa went to sleep and he didn’t wake up.

When a child wonders what death is, is there a good description of the physical process that won’t scare kids?

I would sometimes talk about it from a physiological perspective. The reality is that sometimes we get really, really sick or we get old and our body no longer functions the way we need it to, and as a result, some of the things such as our heart or our brain stop working, and as a result, our body dies. It stops working. And that’s kind of the way I would begin that conversation. I would leave it then on the young person to ask some questions, to see what they want to know more about.

You say in the book that bedtime can be a good time for these conversations. Why?

Bedtime can be great depending on the age of your child. Often, there are rituals and time spent at bed reading books and tucking in and doing all that stuff, which is a great time to have conversations. As children get older and we move in to more of what I call the chauffeuring ages, car-time conversations are really good too, particularly because the kids don’t have to make eye contact.

Is there a euphemism for death that you loathe most?

One that’s probably most common is the idea that people “pass away.” I talk about this story of Sam in the book when he got really confused because he was in school and in school they talk about passing to the next grade, and the only person he knew who had passed was his mom. So that one I think particularly for children is a big one.

Kids usually seem capable of processing much more than we give them credit for.

Yes. For sure.

Helping a child or teenager who is grieving the death of a parent or loved one is always difficult. What do you tell them? How do you help them understand matters? The Canadian Virtual Hospice recently launched a website, KidsGrief.ca, to help answer those questions. It is especially important to talk to young kids about the four C’s, says Andrea Warnick, a Toronto-based registered psychotherapist and co-lead on the project.

“The four C’s are four common concerns that kids have when either somebody’s seriously ill, dying or has died in their life. We’re really trying to encourage families to address these even if kids aren’t bringing them up,” she says.

  • Cause: Am I some way responsible? “A lot of parents are really surprised when they find out that their child has been thinking that they did something to cause the illness or death in their family,” Warnick says. She has worked with children who thought their mom got throat cancer from yelling at them to clean their rooms. “We really want families to let their kids know that this is not their fault, they did not cause this in any way,” she says.
  • Catch: “A lot of families will avoid the word of the actual illness. So as opposed to saying, ‘Daddy has cancer,’ or ‘Dad has ALS,’ they’ll say, ‘Daddy’s sick.’ And for kids whose reference for sickness is that it gets spread across the daycare, or one person gets the flu and then the next person does, that scares them and they often think it’s going to happen to them to or they can catch it,” Warnick says. You can still hug your dad, still kiss him. You can still cuddle.
  • Cure: You have to let your kids know they can’t cure it. “This is not in their control,” Warnick says. “A lot of kids will use the power of their imaginations to come up with pacts, promising a higher power that they will never fight with their mom again if they cure them, and then of course they fight. I’ve had a number of kids feeling very responsible that they did something that could have happened otherwise.”
  • Care: This is one of kids’ biggest fears. “If there’s a parent or a primary caregiver who is ill or dying, who is going to take care of me?” Warnick says. Or if the person has already died, is this going to happen to my other parent or whoever it is who is now taking care of them? “A lot of kids are really worried about that. And that’s where we really walk families through how to talk about that. Some families are tempted to say no, it won’t happen to me. And we can’t promise a child that. So we really encourage families to say: Most likely I’m going to live to be very old, but if anything does happen to me, this is who is going to take care of you. Hopefully, guardians are picked out. Let them know what the plan is.”

Complete Article ↪HERE↩!