Category: Philosophy of Living

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At the End of Life, What Would Doctors Do?

By IRA BYOCK, M.D.

At the End of Life

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

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

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

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

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

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

Listen to a few.

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

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

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

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

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

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

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

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

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

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

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

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

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

Complete Article HERE!

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‘Samseng’ son pens heartfelt poem as obituary for father

Mr Ong Tiong Yeow
Mr Ong Tiong Yeow with his mother Madam Han Boon Keng and his daughter Andromeda Wang.

SINGAPORE – Four hours – that was the time it took for businessman Ong Tiong Yeow to write his father’s obituary, a frank, heartfelt poem that has since gone viral on social media.

Four hours was also how long he took to pack his things and leave his family home as a 23-year-old, after his father Ong Peck Lye threw him out for standing up to him.

The elder Mr Ong, a wealthy rubber tyre businessman, died of pneumonia last Wednesday aged 82 and was cremated on Sunday (June 12).

He is survived by his wife Han Boon Keng, 82, a housewife, and three sons aged 46 to 54.

Mr Ong, 52, his second son, penned the tribute as a poem in first person, based on conversations he had with his father in his last days.

The verses depicted the complex humanity of his father, describing not just his charitable nature and flamboyance, but also his ego and conflicts with his family.

“I dared to live, and now I dared to die,” concludes the poem. “I am Ong Peck Lye.”

The obituary, which was in The Straits Times on Friday, was shared on Facebook by user Robin Rheaume and had garnered over 4,300 likes and 1,200 shares as of 8pm on Sunday.

Many were moved by the honesty of the poem, which admits that “My last days were dreary and weary” and that “I never got to see my father be/ A husband to my mother so/I made mistakes being both, trying to be as human as I know.”

The late Mr Ong was born in 1935 into poverty, fatherless from a young age. He worked his way from a slum along the Kallang River into prosperity after he co-founded the Stamford Tyres business empire.

He showered his children with privilege, but their relationships were complicated – at some point, he evicted each of them from their bungalow in Upper Serangoon.

Mr Ong said his older brother was thrown out after he converted to Christianity and married into a Eurasian family. His younger brother followed suit after coming out as gay. Both left Singapore, the oldest moving to Australia and the youngest to the United States.

Said Mr Ong: “My father died before he had the chance to ask my brothers to forgive him.”

He himself was ordered to leave when he fought with his father about the treatment of his mother.

He said: “The poem is also a tribute to my mum. My father bullied her, scolded her, kept mistresses – but she tahan (Malay for endure) until the end.”

Madam Han said in Mandarin: “We had good times and bad times. He was a generous man. I loved him and he loved me.”

Together, she and Mr Ong nursed her late husband through seven years of dementia.

Mr Ong said his father had asked him to move back home after a few years. “He got lonely,” he said.

He recalled returning laden with artwork from the beauty pageant franchising company he had set up, determined to show his father how successful he had been. “My father looked at me and said: ‘I don’t care about all this. I missed you.’

“After that, I did not leave his side again for 25 years.”

In the obituary, Mr Ong dubbed himself the “samseng” son, which is Malay for gangster. He said this was because in his youth, he was rebellious and did poorly in school. He was a prolific poet in his youth, having written more than 500 poems, though none were published.

When he was 16, his father bought him a pick-up truck and had him deliver goods after school from the godown to the docks. He would often have to go out to the ships and climb a few storeys up their sides to get the captain to sign the papers.

“He wanted to toughen me up, to show me the same hard life he had led,” said Mr Ong.

Mr Ong, who has a nine-year-old daughter, said he wrote the poem to share the lessons from his father’s life. “We have only one chance in life to be a husband and a father. We learn what we can from our parents, but we only have one chance to get it right ourselves.”

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Complete Article HERE!

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The Challenges of Male Friendships

By JANE E. BRODY

The Challenges of Male Friendships

Christopher Beemer, a 75-year-old Brooklynite, is impressed with how well his wife, Carol, maintains friendships with other women and wonders why this valuable benefit to health and longevity “doesn’t come so easily to men.”

Among various studies linking friendships to well-being in one’s later years, the 2005 Australian Longitudinal Study of Aging found that family relationships had little if any impact on longevity, but friendships increased life expectancy by as much as 22 percent.

Mr. Beemer urged me to explore ways to promote male friendships, especially for retired men who often lose regular contact with colleagues who may have similar interests and experiences.

After Marla Paul, a Chicago-area writer, wrote a book, “The Friendship Crisis: Finding, Making, and Keeping Friends When You’re Not a Kid Anymore,” about establishing meaningful friendships with other women, she was inundated with requests from men to give equal treatment to male friendships.

“A lot of men were upset because I didn’t include them,” Ms. Paul told me. “They felt that making and keeping friends was a lot harder for men, that close friendships were not part of their culture. They pointed out that women have all kinds of clubs, that there’s more cultural support for friendships among women than there is for men.”

In a study in the 1980s about the effect on marriage of child care arrangements, two Boston-area psychiatrists, Dr. Jacqueline Olds and Dr. Richard Stanton Schwartz, found that, “almost to a man, the men were so caught up in working, building their careers and being more involved with their children than their own fathers had been, something had to give,” Dr. Schwartz said. “And what gave was connection with male friends. Their lives just didn’t allow time for friendships.”

In their book, “The Lonely American: Drifting Apart in the Twenty-First Century,” the doctors, who are a husband-and-wife team, noted a current tendency for men to foster stronger, more intimate marriages at the expense of nearly all other social connections.

When these men are older and work no longer defines their social contacts, “there’s a lot of rebuilding that has to be done” if they are to have meaningful friendships with other men, Dr. Schwartz said in an interview.

From childhood on, Dr. Olds said, “men’s friendships are more often based on mutual activities like sports and work rather than what’s happening to them psychologically. Women are taught to draw one another out; men are not.”

Consciously or otherwise, many men believe that talking about personal matters with other men is not manly. The result is often less intimate, more casual friendships between men, making the connections more tenuous and harder to sustain.

Dr. Olds said, “I have a number of men in my practice who feel bad about having lost touch with old friends. Yet it turns out men are delighted when an old friend reaches out to revive the relationship. Men might need a stronger signal than women do to reconnect. It may not be enough to send an email to an old friend. It may be better to invite him to visit.”

Some married men consider their wives to be their best friend, and many depend on their wives to establish and maintain the couple’s social connections, which can all but disappear when a couple divorces or the wife dies.

Differences between male and female friendships start at an early age. Observing how his four young granddaughters interact socially, Mr. Beemer said, “They have way more of that kind of activity than boys have. It may explain why as adults they continue to do a much better job of it.”

In defense of his gender, he observed, “Men have a harder time reaching their emotions and are less likely than women to reveal their emotional side. But when you have a real friendship, it’s because you’ve done just that.”

He has found that “it’s important to expose yourself and be honest about what’s going on. If you reveal yourself in the right way to the right person, it will be just fine. There are risks, you can’t force it. Sometimes it doesn’t work — you get a don’t-burden-me-with-that kind of response and you know to back off. But more often men will respond in kind.”

Mr. Beemer has worked hard to establish and maintain valuable relationships with other men of a similar vintage. He joined a men’s book group that meets monthly, and after about two years, he said, “it became a group where the members really mean something to one another.”

He’s also in a men’s walking group that meets three times a week and gathers after each walk to share more conversation and a snack at a local cafe. When one member of the group had a heart attack, they visited him, cheering him up with the latest gossip and a favorite cafe snack.

“What sustains relationships over time is a regular rhythm of seeing each other,” Dr. Schwartz said. “It’s best to build a regular pattern of activities rather than having to make a special effort to see one another.”

He recalls “curing” a 70-year-old patient of his loneliness by encouraging him to join a bunch of guys who regularly dined and joked around at a neighborhood Panera Bread. “There are a lot of cafes in the Boston area where small groups of older men get together for breakfast everyday,” Dr. Schwartz said.

Dr. Olds said of her husband, “Richard has a regular group phone call with friends who live in different parts of the country. We program it into our schedule or it would disappear.”

Among other ways men can make new friends in their later years are participating in classes, activities, trips and meals at senior centers; taking continuing education courses at a local college; joining a gym or Y and taking classes with people you then see every week; volunteering at a local museum, hospital, school or animal shelter; attending worship services at a religious center; forming a group that plays cards or board games together; perhaps even getting a dog to walk in the neighborhood.

After my dentist’s wife died, he made several new friends and enjoyed lovely dinners with other men when he joined a group called Romeo, an acronym for retired old men eating out.
 
Complete Article HERE!

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‘Death doulas’ help dying people and their loved ones say goodbye

By Kevin Fagan

Henry Fersko-Weiss, co-founder and president of the International End of Life Doula Association, conducts a session at the association’s training at the Omni Hotel in San Francisco.
Henry Fersko-Weiss, co-founder and president of the International End of Life Doula Association, conducts a session at the association’s training at the Omni Hotel in San Francisco.

The emotional crumbling started when she was 14 and a friend was killed in a car crash. Three years later, her father died when his helicopter exploded. When she was in her 30s, her brother committed suicide.

By the time a close friend was murdered three years ago, the coping skills Bonnie Ludwig had for dealing with death were shattered — and she found herself one day on her knees on a sidewalk, sobbing obliviously.

Therapy gave healing, which allowed her to help comfort dying dogs at the pet care company she runs — and which soon led to her sitting in a San Francisco hotel room on Friday, learning how to help people die better.

Ludwig, 45, was taking a class in how to become a “death doula,” someone who helps shepherd the dying and their families into loving, peaceful exits. The man who founded the craft in 2003, Henry Fersko-Weiss, is guiding her and 47 other students through a weekend-long course on handling what for many seems like the worst moment possible — but, if handled deftly, can be a beautiful journey to whatever lies just beyond a heartbeat.

‘Learn to let go’

“Humans hold onto life so tightly,” said Ludwig, who flew up from San Diego to take the $600 training at the Omni Hotel. “We need to learn to let go better. We grieve so badly in our culture, and I have found it is sacred and an honor to be with animals when they die. Now I want to be able to do that with people.”

Fersko-Weiss, 68, has trained more than 1,000 people in his discipline, and this was his first session in San Francisco. People come to his trainings for many reasons, he said — some from pain, like Ludwig, some because they’ve already helped others die and feel a calling to do more. But they all have one thing in common.

“I have found that the people who come to these trainings have a great deal of compassion and want to serve people at this incredible period in their lives — death,” said Fersko-Weiss, who lives in the small town of Warwick, N.Y. “They are self-selecting. Like me, they feel this is a way they can really do some good and help. It’s very intense and very important.”

The idea of finding a better way of dealing with the obliteration of life came to Fersko-Weiss when he was a hospice volunteer and saw too many people missing the last breaths, not saying the words they wanted to say before passing, not feeling complete in what they were leaving behind.

International End of Life Doula Association
Laura Statton attends the training session by the International End of Life Doula Association at the Omni Hotel in San Francisco.

He had a friend who was training at the time as a birth doula — a midwife of sorts, who helps birthing moms and their partners stay comfortable and well-centered — and he found the approach so dynamic he took the course himself.

What he learned there led him to co-found the International End of Life Doula Association. Doula, in ancient Greek, means “woman who serves.”

“It’s just our human nature that we want to be reassured as we die,” Fersko-Weiss said. “We’re going into the unknown, and everybody has fear of passing that boundary between life and death.

“I believe the only thing that counts at the end is having people we love, someone at your bedside, talking to you, telling them how much they love them, reassuring them it’s going to be OK. Those things are important.”

Calming techniques

Students learn techniques for calming the dying and their family and friends, and then they help them find the right kind of intimacy to say the things that need to be said. To cut to the chase about what they want to be remembered for, to compile scrapbooks. To face the end with grace.

Lori Goldwyn attends the training session by the International End of Life Doula Association at the Omni Hotel.
Lori Goldwyn attends the training session by the International End of Life Doula Association at the Omni Hotel.

Sometimes doulas ease pain by having the dying visualize soothing times in their lives or by giving therapeutic touch. And they help plan what the final moments will be like. Sometimes people want candles burning, certain clothes, favorite poems read out loud. Doulas stay at the bedside, ready to recognize when death is minutes away — mottled skin, fingernails turning blue, other clues — so everyone can be prepared.

Cynthia Imperatore, who lives in New Jersey and is helping Fersko-Weiss at this weekend’s training, found that sometimes the simplest actions are the most important.

Recently she was helping a son sit vigil with his terminally ill mother, and found herself sitting at the woman’s bedside, holding her hand while the son stood stiffly at the foot of the bed with a TV blaring in the background. The final minutes were near. It didn’t feel right.

“I had him turn off the TV, put on some classical music, and I said, ‘Come here and hold your mother’s hand,’” said Imperatore. “So he came, and then I said, ‘Tell her these things’ — in Spanish, because that’s what his mother spoke. I said, ‘Tell her she’s done everything right. Tell her you’re grateful. Tell her you love her. Tell her what she did mattered.’

“And what happened is that these were the last words she heard,” Imperatore said. “He didn’t have to carry a sense of unfulfillment with him. It was good.

“What we do is not morbid,” she said with a gentle smile. “It’s a privilege to be there when people are dying. Death takes us to a place where we seek meaning, makes you question what is life. And sometimes it can make you appreciate life more.”

Complete Article HERE!

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Maori Digital Stories about whanau caregiving

Today’s posting comes to us via Clare O’Leary | Palliative Care Educator | Mary Potter Hospice | Wellington, New Zealand

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Maori digital stories about caring for kaumatua (elders) at the end of life. Teaching resource for nursing students, nurses and other health professionals who want to know more about Maori whanau (family) end of life needs and priorities.

 

More information:  https://www.fmhs.auckland.ac.nz/en/so…

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Powerful Advice From A Dying Man

By Houston Barber

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Life is all a matter of perspective. We may look at someone and think they’ve got the perfect life and everything figured out, but we never know what that person is really going through. At the same time, we spend countless amounts of energy struggling and stressing over the small stuff in life, and unfortunately, it’s not usually until something traumatic happens that we realize this.

Recently, a young man in California was face to face with a life-threatening illness, and his prognosis did not look good. His cancer was diagnosed too late and doctors only gave him months to live. This is the sort of thing that will put your life into a harsh perspective, and the 24-year-old wanted to share his new outlook on life with those he would be leaving behind.

So, the young man began to write a letter and addressed it to anyone who would take the time to read it. In the letter, he wrote the things he wished he would have done, and some pieces of advice to those who would be willing to listen. Read the full letter below and take the dying man’s words to heart as you go about your life.

“I am only 24 years old, yet I have actually already chosen my last tie. It’s the one that I will wear on my funeral a few months from now. It may not match my suit, but I think it’s perfect for the occasion.

The cancer diagnosis came too late to give me at least a tenuous hope for a long life, but I realized that the most important thing about death is to ensure that you leave this world a little better than it was before you existed with your contributions. The way I’ve lived my life so far, my existence or more precisely the loss of it, will not matter because I have lived without doing anything impactful.

dying_man

Before, there were so many things that occupied my mind. When I learned how much time I had left, however, it became clear which things are really important. So, I am writing to you for a selfish reason. I want to give meaning to my life by sharing with you what I have realized:

  • Don’t waste your time on work that you don’t enjoy. It is obvious that you cannot succeed in something that you don’t like. Patience, passion, and dedication come easily only when you love what you do.
  • It’s stupid to be afraid of others’ opinions. Fear weakens and paralyzes you. If you let it, it can grow worse and worse every day until there is nothing left of you, but a shell of yourself. Listen to your inner voice and go with it. Some people may call you crazy, but some may even think you’re a legend.
  • Take control of your life. Take full responsibility for the things that happen to you. Limit bad habits and try to lead a healthier life. Find a sport that makes you happy. Most of all, don’t procrastinate. Let your life be shaped by decisions you made, not by the ones you didn’t.
  • Appreciate the people around you. Your friends and relatives will always be an infinite source of strength and love. That is why you shouldn’t take them for granted.

It is difficult for me to fully express my feelings about the importance of these simple realizations, but I hope that you will listen to someone who has experienced how valuable time is.

I’m not upset because I understand that the last days of my life have become meaningful. I only regret that I will not be able to see a lot of cool stuff that should happen soon like the creation of AI, or Elon Musk’s next awesome project. I also hope that the war in Syria and Ukraine will end soon.

We care so much about the health and integrity of our body that until death, we don’t notice that the body is nothing more than a box – a parcel for delivering our personality, thoughts, beliefs and intentions to this world. If there is nothing in this box that can change the world, then it doesn’t matter if it disappears. I believe that we all have potential, but it also takes a lot of courage to realize it.

You can float through a life created by circumstances, missing day after day, hour after hour. Or, you can fight for what you believe in and write the great story of your life. I hope you will make the right choice.

Leave a mark in this world. Have a meaningful life, whatever definition it has for you. Go towards it. The place we are leaving is a beautiful playground, where everything is possible. Yet, we are not here forever. Our life is a short spark in this beautiful little planet that flies with incredible speed to the endless darkness of the unknown universe. So, enjoy your time here with passion. Make it interesting. Make it count!

Thank you!”

Complete Article HERE!

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5 Tips for Choosing a Hospice Provider

Proximity is key

By Angela Morrow, RN

Choosing a Hospice Provider

When a patient is initially referred to hospice care, usually by their physician or a case worker within the hospital, they are usually given a list of hospice agencies in their area to choose from. Sometimes these referral sources have a particular agency that they prefer and their recommendations shouldn’t be taken lightly; they are in position to see how well a particular agency cares for their patients.

However, as with any health care decision, you should be as informed as possible in order to know that you are making the best decision for you and your loved ones.

Why Choosing the Right Provider Matters

All hospice agencies work within the guidelines set forth by Medicare. The basic services they provide are the same across the board. This may leave you wondering why it would even matter which hospice agency you choose. There are differences, however, and they’re often tucked away in the small details.

It’s important to do a little research from the start to find where those differences lie.

To find out what services hospice agencies provide, see What is Hospice Care?

Your first interaction with a hospice agency may happen over the phone after they receive your referral information and call you to set up an appointment. It may happen in the hospital setting when a representative from the agency comes to evaluate your loved one and offer information.

It may be initiated by you. Regardless of how your initial interaction takes place, there are some important facts to gather from the start.

The 5 Things to Consider When Choosing a Hospice Provider

  • First, the location of the staff is important. More on that below.

Location, Location, Location

Hospice care can take place in the home, in a nursing home or in a hospital. Very few hospices have inpatient facilities, which means that most people receive hospice care via an independent agency. So, probably the most important question you can ask a hospice facility is related to the location of their nurses.

Just to clarify, it really makes no difference where the agency’s office is located, but it makes a huge difference where the nurses are located. I used to work on-call for a large hospice agency that covered three counties, over 200 square miles. On weekends, I covered the entire area with only the help of one LVN (licensed vocational nurse). Consequently, I would sometimes be with a patient in one county and get a call from another patient who had a crisis in another county who then had to wait two hours or more until I was able to get there.

Knowing how far away the on-call nurses live from you and how large of an area the nurses cover is essential to knowing how responsive they will be to your urgent needs. Keep in mind that some hospice agencies have multiple branch offices that could be 50 miles or more apart from each other. Make sure that if the agency your looking at has multiple branch offices that they also have a separate on-call nurse covering each one, and that the on-call nurse covering your area also lives in your area. If you have a crisis in the middle of the night or on the weekend, the last thing you want to do is wait two or more hours for help.

Complete Article HERE!