Live As If You Are Dying

I’m delighted to share with you a new review of The Amateur’s Guide To Death And Dying. It appears on the blog of Licensed Mental Health Counselor, Mandy Traut.

Mandy Traut

Just like the famous Tim McGraw song, I good friend of mine recently reminded me to “live like I was dying.” Many of you know that I was a recent guest on Dr. Dick’s Sex Advice: Sex Advice with an Edge (Sex Wisdom Show). Well, my association with “Dr. Dick” (AKA Dr. Richard Wagner) developed into a good friendship. I see him as a role model and mentor. So, I was quite privileged when he asked me to review his new book, “The Amateur’s Guide to Death & Dying: Enhancing the End of Life.”

Richard is, not only a renowned sexologist – Board Certified by the American College of Sexologists, The American Board of Sexology, and The American Association of Sex Educators, Counselors and Therapists, he is the founder and former Executive Director of the nonprofit organization, PARADIGM; “Enhancing Life Near Death — an outreach and resource for terminally ill, chronically ill, elder and dying people.”AGDD_front cover

His book, “The Amateur’s Guide to Death & Dying: Enhancing the End of Life,” is developed to be a workbook for terminally ill patients going through the process of dying. But, the reader realizes early on that one need not be terminally ill to follow the exercises. As Richard reminds us, we all die at some point. Richard introduces the concept of “proactive dying,” referring to an attitude whereby one addresses one’s mortality head-on. Richard illustrates how honest discussions, education and preparation, and support from family and friends, can really benefit all of us. Rather than present a typical workbook with a sequence of exercises, Richard has adapted his own workshop, associated with PARADIGM INC, into written form! You, the reader, become a participant in his workshop as you explore questions of mortality, loss, sickness, and isolation. Eventually, you and your fellow participants come to see death as a part of life.

Whether going through the group process of exploring various issues, listening to presentations on preparing Estates and Advanced Directives, or discussing the stigma of talking about death and dying in the first place, the reader gets to reflect on his/her own thoughts and feelings about death and learns how to be prepared for end-of-life concerns. Richard normalizes death in the most compassionate, authentic, and empathic way. I appreciated that he, as a facilitator, found a balance between professionalism and disclosing his own personal stories, fears, hopes, and dreams to the group. Additionally, reading his book, I, not only reflected on my own fears related to death, but I strangely began to relate and befriend the other participants in the group. I felt as if I were walking the journey with them. It was humbling and moving, as well as educational and informative.

As the group workshop was coming to an end one of the participants read a poem with the theme of “live as if you are dying.” As I read (imagining myself in the room with everyone else), tears welled up in my eyes. By now, I knew the group members pretty well. I empathized with their fears, their anger, and their sense of loss. Then, I thought of my own life and relationships. Inwardly, I thought, “How often do we go through life on automatic?” It is true: Like sleep-walkers, we miss the little moments that make life precious. It takes a terminal illness or a traumatic event to wake most of us up!

In the end, I completed “The Amateur’s Guide to Dying” with several take-aways: To my readers and clients alike, I hope that you can ponder these ideas and see how they fit in your own lives.

1) It is smart to explore your end-of-life wishes while you are healthy and can make these important decisions.

2) Live as if you are dying – do not take one breath – one hug – one smile – for granted. After all, sometimes death comes when we least expect it.

3) Honor and cultivate your relationships – our relationships are at the core of a meaningful, worthwhile life.

One last word: Thank you, Richard for sharing such a fresh, revolutionary perspective with the rest of us. This is not an easy subject for most of us to swallow.

Complete Article HERE!

Unafraid, CLU theologian faces death

Jarvis Streeter is dying.

Jarvis StreeterThe religion professor at California Lutheran University delivers the news of the pancreatic cancer that has spread to his lungs and a prognosis he measures in months without emotion.

It’s the first thing he told two dozen students in hooded jackets and T-shirts on a January Tuesday. In the same tone he uses to discuss the interplay of science and theology, Streeter told them he made it to the first day of class at the Thousand Oaks campus. He said he wasn’t sure about the last day.

Wearing a sports coat that enveloped thinning arms, he said he would understand if they didn’t want a class that might ultimately deal with more than its title: faith and reason.

No one left.

“He very matter-of-factly said how it is. Just point blank,” said Lacie Goff, a senior from Chicago. “I think I’ve thought about dying more. We’re confronted with it every Tuesday and Thursday. I think it’s good.”

Streeter is a 63-year-old theologian and ordained Lutheran pastor who does not always act like either. With silver hair and the looks of a California surfer, he plays alternative rock on a blue-violet Fender guitar. He owns a blow-dart gun from Borneo that he sometimes uses for target practice.

He taught school in Kenya, studied at Yale and met his wife of 24 years while leading a graduate class at Southern Methodist University in Dallas. He just finished a draft of a book that dismisses intelligent design as junk theology and attempts to explain how belief in God and the big-bang theory fit in the same jigsaw puzzle.

About 18 months ago, Streeter woke up in his Santa Rosa Valley home feeling as if all the energy had seeped from his body. His doctor thought he might have an ulcer. He did. It was sitting underneath a tumor the size of a golf ball.

Two days later, surgeons removed his gall bladder, his duodenum and parts of his stomach, small intestine and pancreas. They removed all the cancer they could see, but the malignancy had spread to his lymph nodes.

“I just started thinking through it: OK, you’re going to die,” he said, explaining why the news about the cancer didn’t make him bitter. “What I asked was ‘Why not me?’ People get it. Am I so special I shouldn’t?”

He decided to deal with it as another part of life, the final part. He talks about it with anyone who asks: his students, his friends, his wife, his two stepdaughters.

He hides nothing. When the woman with the lap dog in a doctor’s waiting room wants to know why a newspaper photographer would take his picture, he turns to her. “I have cancer,” he said evenly.

To those who want more, he explains how different chemotherapy drugs keep the cancer from progressing, temporarily. Then the malignancy mutates. The cancer grows.

His doctor said the toxic chemicals fed through a port in his chest every 10 days seem to be working for now. He said statistics that show how long most people survive with an incurable cancer can’t be used to predict how long Streeter will live. If they could, he’d already be gone.

“A person is never a statistic,” said Dr. Martin Palmer, a UCLA oncologist.

But because he is on his third regimen of chemo, Streeter thinks his time may be running out.

The ifs could hang in the air like a death sentence. His friends say that hasn’t happened.

“I think with his attitude and the way he has communicated with other people around him, it’s allowed us to focus on enjoying every day with him as opposed to dwelling on the loss,” Hengst said.

Goodbye tour

Susan Streeter took her husband to a Bruce Springsteen concert in December. They went on a cruise to the Caribbean in January. But he doesn’t worry much about making checkmarks on a final litany of to-dos. His bucket list is dominated by relationships.

About 150 friends from school and a Shakespeare company that he supports came to a surprise party planned by his wife. A bagpiper played. So did a rock band. People stood up and told stories. Streeter hugged everyone.

“It’s the greatest gift anyone could give you: taking the time and effort to see me,” he said.

His days are like that, too. His friends see their conversations and dinners as a chance to spend more time talking about religion, science and their love of Shakespeare. But in a sense, it’s as if his memorial service has been bumped ahead of his death.

“Sometimes, he refers to it as the long goodbye tour,” said his friend Michael Arndt. “He’s still fighting the disease and he doesn’t want to die. But he also knows he’s going to die and he’s trying to make the best of his life, every single minute.”

Perhaps the strangest thing about Streeter’s end are the words people use to describe it. Arndt said the way his friend has dealt with it has made the journey a wonderful experience to share. Streeter focuses on the chance to affirm relationships and tell people he loves them.

“I’ve had so much love poured out to me, it’s stunning,” he said. “It’s been the most fulfilling time of my entire life.”

He wants to be cremated. He wants a bagpiper to play at the beginning of his memorial service at CLU. He wants the service to end with Springsteen’s “Land of Hope and Dreams.”

But Streeter hasn’t fleshed out many of the details. He hasn’t written his obituary. Those jobs may be left for Susan Streeter, who worries something won’t be exactly the way he wants it.

“It’s important to me,” she said, focusing on the obituary. “I wonder how much detail he wants. … I don’t know.”

They met in a classroom in Dallas 26 years ago. She was the student. He was the teacher. Sometimes, she sits in his class at CLU to see him teach again.

She writes a blog that details his blood counts and the effectiveness of the latest drug. She sits beside his reclining chair in two-hour chemotherapy sessions, watching toxic chemicals drip down a plastic tube into his body.

It’s their journey. She said her part is walking down the path with him.

“It has helped give meaning for my life,” she said. “I feel like if this was the only reason for being put on the Earth, besides having my kids, of course, this is worth it.”

She has two adult daughters who play a central role in their lives. They’ve visited with both since the news of the cancer. Jarvis Streeter’s father is 91 and lives in a Thousand Oaks retirement community. He calls his son every evening just to chat, timing the calls so he can tell how the day went.

When the end comes, they’ll still be here. Streeter won’t. He and his wife say that’s the hardest part.

“I have faith enough that I will get through it,” she said. “Somehow, it will be OK, but that doesn’t mean it’s going to be easy.”

Complete Article HERE!

Deathbed Visions and Escorts

Deathbed visions are apparitions; that is, appearances of ghostly beings to the dying near the time of their death. These beings are usually deceased family members or friends of the one who is dying. However, they can also be appearances of living people or of famous religious figures. Usually these visions are only seen and reported by the dying, but caretakers and those attending the dying have also reported witnessing such apparitions. In the majority of these cases, the apparition came to either announce the imminent death of the individual or to help that person die. In the latter situation they act as escorts to the dying in the process of passing from this life to the next.

Deathbed Visions and EscortsVisions at the time of death and announcements or omens of impending death, as well as escorts for the dead, are part of many cultures and religious traditions stretching back through antiquity. The religious motif of the soul making a journey from this life through death to another form of existence, whether it be reincarnation or to an eternal realm, is commonly found in many religions throughout history.

Shamans from many native cultures were adept at journeying from the land of the living to the land of the dead and were thus able to act as guides for those who were dying. Hermes, the Greek god of travel, was also known as the Psychopompos, the one who guided the soul from this life to Hades, and the realm of dead. Certain religious traditions have elaborate rituals of instruction for the soul at the time of death. The Egyptian Book of the Dead and the coffin texts of ancient Egypt gave detailed instructions for the soul’s journey to the next life. Similarly, by use of the Bardo Thodol, or Tibetan Book of the Dead, Tibetan Buddhist monks have guided the souls of the dying through death to their next incarnation. In the Christian tradition it has been guardian angels that have acted as the soul’s guide to paradise. The ancient hymn, “In Paradisum,” invoking the angels to escort the soul to heaven, is still sung at twenty-first-century Roman Catholic funerals.

Christianity’s belief in resurrection and the concept of a communion of saints, that is, the continued involvement of the dead with the spiritual welfare of the living, is reflected in the historical accounts of deathbed visions in the West. Third-century legends about the life of the Virgin Mary recount Christ’s appearing to her to tell her of the approaching hour of her death and to lead her into glory. In the hagiography of many early Christian martyrs and saints, impending death is revealed by the visitation of Christ, Mary, or another saint who has come to accompany the dying into heaven. This tradition is carried over into early historical records. The eighth-century English historian Bede wrote of a dying nun who is visited by a recently deceased holy man telling her that she would die at dawn, and she did. Medieval texts such as the thirteenth-century Dialogue of Miracles by the German monk Caesarius of Heisterbach recount similar stories, but always within a theological framework.

In the seventeenth century treatises began to be published specifically on the phenomena of apparitions and ghosts. By the nineteenth century specific categories within this type of phenomena were being described. For instance, apparitions began to be distinguished between those seen by healthy people and those seen by the dying. It was noted that when the dead appeared to the living, it was usually to impart some information to them such as the location of a treasure, or the identity of a murderer. However, when an apparition was seen by a dying person, its intent was almost always to announce the impending death of that individual, and often to be an escort for that death.

Early in the twentieth century, the doctor James H. Hyslop of Columbia University, and later Sir William F. Barrett of the University of Dublin, researched the deathbed visions of the dying. They were particularly interested in what became known as the “Peak in Darien” cases. These were instances when dying persons saw an apparition of someone coming to escort them to the next world whom they thought to be still alive and could not have known that they had preceded them in death.

In 1961 the physician Karlis Osis published Deathbed Observations of Physicians and Nurses. In it he analyzed 640 questionnaires returned by physicians and nurses on their experience of observing over 35,000 deaths. Osis refers to the deathbed visions of the dying as hallucinations because they cannot be empirically verified. He categorized two types of hallucinations: visions that were nonhuman (i.e., nature or landscapes), and apparitions that were of people. His work confirmed previous research that the dying who see apparitions predominantly see deceased relatives or friends who are there to aid them in their transition to the next life. With the assistance of another physician, Erlandur Haraldsson, Osis conducted two more surveys of physicians and nurses: one in the United States and one in northern India. The results of these surveys confirmed Osis’s earlier research on deathbed hallucinations with the exception that there were more apparitions of religious figures in the Indian population.

These studies and the extensive literature on this subject confirm that throughout history and across cultures, the dying often experience apparitional hallucinations. What significance these deathbed visions have depends on the worldview with which one holds them. In this data those with religious or spiritual beliefs can find support for their beliefs. Parapsychological explanations such as telepathy or the doctrine of psychometry, whereby environments can hold emotional energy that is received by the subconscious of the dying, have all been advanced to explain apparitions at the time of death. The Jungian psychoanalyst Aniela Jaffe viewed apparitions, including those of the dying, as manifestations of Carl Jung’s transpersonal views of the psyche and, therefore, a validation of Jungian metapsychology. Indeed both the visions as well as the apparitional hallucinations described by Osis can be attributed to a number of medical causes, including lack of oxygen to the brain. Ultimately the research into the phenomenon of deathbed visions, while confirming that such events are common, offers no clear explanations.

Complete Article HERE!

Patients, doctors, and the power of religious faith

By Dr. Suzanne Koven

In the lobby of the hospital where I did my medical training stands a 10½-foot marble statue of Jesus. Patients and visitors often pause before the imposing figure to gather their thoughts, pray, or just touch its smooth white foot. The hospital has always been secular, but the statue has brought comfort to thousands for over a hundred years. It also reminds doctors that, in medical matters, our patients do not necessarily see us as the final authority.

praying_handsSeveral surveys show that over 90 percent of Americans believe in God. It’s not surprising, then, that religion plays an important role in medical care. Just as there are no atheists in foxholes, a nonbeliever might reconsider while being rolled into the operating room or waiting for a biopsy result.

The clinical efficacy of prayer is difficult to measure, though researchers have tried. In one study, strangers were instructed to pray for patients undergoing heart surgery. The prayers did not seem to improve the patients’ outcomes. Interestingly, if the patients were told they were being prayed for, they had more postoperative complications.

Still, there’s no question that prayer benefits many people. Prayer, like meditation, can lower blood pressure and anxiety and put patients in a more positive frame of mind. Even doctors like me who are not religious appreciate the element of mystery in medicine; an unexplainable force that seems, at times, to aid recovery. I was discussing this recently with a patient of mine who is a nun. She pointed out that what I call a coincidence she calls a GOD-incidence — even though we might be talking about the same thing.

On many occasions I have found myself humbled and inspired by my patients’ religious faith, even when I did not share it and even when it did not produce a cure.

One devout woman in her 50s who was dying of uterine cancer made an appointment with me to discuss what she had only identified on the phone as “plans.” I assumed she meant hospice care, DNR orders, and pain management. But what she had in mind was none of these. She told me, matter-of-factly, that she had no fear of death, that she fully expected to be reunited in heaven with her late father, and that she looked forward to this.

She did, however, have some loose ends to tie up before then, including arranging for the care of her mother, an elderly woman who was also my patient. In a very organized and business-like way she told me that she intended to move her mother in with a cousin, and enlisted my help in transferring her medical care to a physician closer to her new home — or, her next-to-last home, the one she’d inhabit before she too arrived in heaven.

I found myself full of admiration for this woman, and envious of her, too. I could not imagine having this kind of equanimity myself, faced with a hereafter about which I did not share her certainty. I had to admit that God offered her more beneficial “end-of-life counseling” than I ever could.

Another time, I found myself in a diagnostic dispute with God. A middle-aged woman developed a series of neurological symptoms. Neither I nor several specialists could determine their cause. The patient, on the other hand, was quite sure that she had chronic Lyme disease. She’d had a divine vision one night, in which the word LYME appeared in large letters. For a few years she took antibiotics continuously, prescribed by a doctor who treats chronic Lyme.

Unfortunately, her symptoms progressed, and she ultimately proved to have ALS, or Lou Gehrig’s Disease. After the woman died, I reflected that while her vision had been misleading, it had brought her hope during the last years of her life — hope that she would not have enjoyed if she’d known from the start that she had ALS.

Occasionally, even I wonder if an event can be purely coincidence.

Years ago, I headed out of town on vacation, neglecting to tell a hospitalized patient of mine that I would not see her for several days. I had arranged for one of my partners to care for her, of course, but worried about whether she would feel I’d abandoned her. This was before the era of cellphones, and the pay phone at the seaside motel where I was staying was broken. I decided that it really wasn’t necessary to call my patient and went for a walk on the beach.

By the water, coming toward me, emerging through the bright sunlight, was a man wearing a T-shirt with a single word imprinted on it: my patient’s last name. I left the beach and found another pay phone. She was doing fine, and was happy to hear from me.

My patient the nun once asked if I might visit her mother, also my patient, at home when the older woman was near the end of her life. She asked if I would draw her mother’s blood during my house call.

I was a crackerjack phlebotomist back when I was an intern, but it had been years since I’d drawn blood and told her I might be rusty. That was OK, she said. She had faith in me.

I dusted off my black doctor’s bag, threw in a needle, some tubes, alcohol wipes and a tourniquet, and headed to my patient’s house. When the time came to draw the woman’s blood, I had trouble finding a vein.

“You can stick her again if you need to,” said the daughter kindly. I confessed that I’d brought only one needle.

“Then, doctor,” said the nun, “I will pray for you.”

I adjusted the needle slightly, and a flash of red appeared. I turned to the patient’s daughter, seeking her approval. But her eyes were not on me.

They were lifted to the sky.

Complete Article HERE!

On The Radio with Chris MacLellan — Tuesday, 01/08/13

I’m delighted to announce that I will be sharing the airwaves with my friend and colleague, Chris MacLellan, from Be A Healthy Caregiver fame.  We’ll be on blogtalkradio Tuesday, 01/08/13 at 1:00pm eastern time and 10:00am west coast time.

Find all the information HERE!

Come and join the conversation; you’ll be so glad you did!

And be sure to visit Chris on his site, The Purple Jacket and follow him on Twitter @TheBowTieGuy.

See Ya Tuesday!

healthy caregiver