Herb & Hospice:

How Medical Marijuana Is Helping End-Of-Life Care

While terminal patients are finding that medical cannabis offers relief with fewer side effects, health professionals must navigate legal challenges to offer aid.

While medical and recreational cannabis are currently legal in 33 U.S. states and the nation’s capital, it still remains illegal at the federal level, fostering fears of punishment for professionals within the medical establishment who may want to prescribe cannabis as a medication. Cannabis’ federal illegality not only deters discussions between doctors and patients seeking relief for various ailments, but it also greatly limits scientific research that could help assist medical experts seeking to determine cannabis’ efficacy as a treatment for certain disorders. Hospice patients and those receiving end-of-life care — a group who could arguably greatly benefit from medicinal cannabis use — are often times uninformed about the plant’s therapeutic properties, because their doctors, nurses, and other medical staffers are often hesitant to speak with patients about the advantages and risks of consuming cannabis.

“As an administrator, I can tell you it’s not that we’re not allowed to talk about the use of cannabis, but there’s a fear that the federal funding [Medicare and Social Security] could be pulled, so we just don’t know what we can and can’t talk about. But as a nurse, I feel it’s our duty to advocate for any healing measure for the patient,” says Lance Pool, the main Registered Nurse at Stoneybrook Assisted Living in Corvallis, Oregon. “I’d fear losing my job if I spoke about it… many places I’ve worked would terminate you on the spot if you spoke about cannabis use.”

Lance and Cydney Pool of Treewise Holistic Nursing Services

Armed with a desire to create change in their fields, Lance and his wife Cydney, who is a death doula (someone who assists individuals and their families in the dying process by offering physical, mental, and emotional support, similar to a birth doula), created Treewise Holistic Nursing Services, a company designed to meet the needs of elderly patients and those seeking end-of-life care with the help of cannabis as medicine. “Some of my friends who are administrators in nursing homes and assisted living [facilities] said what they really needed was an outside consultant who they could refer people who have questions about cannabis to… so that’s how Treewise got started,” says Pool. “There are a lot of elderly folks who have questions, and we’re there to answer them as an outside source.”

Treewise offers private consultation to senior citizens who are curious about or need help using cannabis for various ailments. “State regulation requires that the facilities provide for the ‘holistic’ needs of their residents… There are several ways that facilities can [do that with cannabis medications]: they can assign a “caregiver” to visit the dispensary for their residents, [or] the dispensary can “deliver” to the facility. We are licensed as a patient and [a] grower, so we can provide any of these services,” explains Pool. Although they do not sell cannabis to patients, they assist in administering it, advising, and coordinating care and communication between patients and their caregivers. “We are new to Oregon, so we are building a client base and growing our own medicine,” says Pool. “It is nice to be in a legal state where our professional licenses are relatively safe. Federal prohibition has never held us back — we are doing exactly what we want to do and always have, but federal prohibition is holding our elders back from the ‘holistic’ benefits of nature’s medicine.”

Jennifer Rosenthal Iverson, an attorney specializing in medical marijuana in Monterey, California, explains why assisted living facilities may be apprehensive to get on board with medical marijuana despite it being legal at the state level since 1996: “In California, any entity receiving federal funding is concerned because [cannabis] it’s still a Schedule I narcotic. The fear or notion that the federal government will come after an assisted living place is very far off, but if someone is receiving federal subsidies, it would be a concern.” Many hospice companies run into the same dilemmas as nursing facilities — patients who are anxious, in pain, and lacking an appetite who could potentially benefit from cannabis as medicine — and an inability to speak about cannabis for fear of reprimand or loss of federal Medicare and Social Security funding.

T Ngu, the owner of Project Object in Portland, Oregon, has been volunteering for a hospice organization for five years. “One of the families was very involved in the medication process. They really wanted to know what the medication was doing, how it was affecting them, and what the side effects are,” says T. “It was very apparent that many of the medications made [the patient] feel anxious, have hallucinations, or made them feel worse, so they needed other medications to help with those side effects. Then they started giving their loved one cannabis-based products. They tried tinctures and she didn’t like the taste, so they started giving her marijuana chocolates. It was really apparent that when she had the chocolates, she was happier, would laugh, make jokes, was a little more present, and had less pain. When she wasn’t on them, she would scream and be more anxious and uneasy.” T is aware of the benefits of cannabis-based products, but doesn’t speak about the medication with hospice patients and their families because it’s against the hospice company’s policy.

With staffers at assisted living, nursing home, and hospice facilities uneasy about discussing medicinal cannabis use, families with loved ones receiving end of life care are left to their own devices — often times led by a younger member of their family who discovered the benefits of such products on their own.

James Lumis, a Portland resident whose mother recently passed away, was reminded of the possible benefits of giving his mother cannabis during her time in hospice by his nephew. “He had some [edibles, which he’d made himself with recreational marijuana], so I asked my mom if she was open to trying it so she could eat, and she was,” explained Lumis. Not only did the cannabis products help his mother’s appetite, but they seemed to relieve painful constipation caused by her prescription painkillers, while easing her anxiety and diminishing her pain. Due to a lack of research and resources to consult regarding proper dosages and strain types, James tested the products on himself before giving them to his mother. “I didn’t give her anything until I tried it. I was her guinea pig,” he adds.

“If cannabis was federally legal, I feel like I would have had more information when I needed it,” says Lumis. Cannabis’ federal illegality not only deters care providers from prescribing cannabis-based products, but it also results in a lack of reliable research, as many U.S. institutions have been dissuaded by the plant’s controlled legal status. With Canada’s newly adopted cannabis policies, physicians have expressed excitement about the scientific findings expected to come from a country now free of many previous restrictions on marijuana studies.

Dr. Allan Frankel, a physician based in Santa Monica, California, recognizes the lack of resources surrounding cannabis dosing recommendations for hospice patients and those in need of end-of-life care. Dr. Frankel, who says he cured himself of a debilitating viral chest infection by using cannabis, offers in-office and phone consultations for patients who are seeking more information on medicinal marijuana — a service that James Lumis and his mother likely could have benefited from. “I think the odds of the federal government stepping in on an 85-year-old lady, who’s on death’s door getting some relief in a legal state from cannabis, are slim,” says Dr. Frankel.

As far as potential consequences of doctors in California prescribing medical cannabis, attorney Iverson says that if the federal government wanted to get involved, a revocation of medical license would be the worst case scenario; “But that decision is really on a state by state basis… I haven’t heard of any cases in California where there’s been reprimand for this… But then, there aren’t many doctors that will do it.“

Dale Gieringer, the director of California’s branch of NORML (the National Organization for the Reform of Marijuana Laws), has been on the front lines of cannabis legal reform long before the Golden State’s passage of Proposition 215 in 1996 — the nation’s first medical marijuana law. Advocates battling HIV/AIDS (then an often terminal disease), along with senior citizens suffering from cancer, were instrumental in building support for California’s first medical cannabis program. However Gieringer explains to MERRY JANE that originally, “Prop 215 was in no way intended to be limited to terminal illnesses. Our opponents tried to paint it that way so as to limit its application, but we were very definitive about it being for any disorder for which marijuana provides relief.”

He foresees marijuana being legalized on a federal level in the near future: “Most of the [federal] legislation now is all-out legalization of some sort. I think the bill that has the best chance of approval is a bill called the STATES Act, which basically says that anything that’s legal under state marijuana laws will be considered legal under federal law.” Gieringer believes that after the presidential election in 2020, there’s a good chance the U.S. may see federal reform. “I’ve never been one to predict that legalization was just around the corner, but I can see it now… even the head of the [U.S. Food and Drug Administration], Scott Gottlieb, said that federal reform looks inevitable.”

Until then, medical professionals and caregivers for patients approaching the end of their lives will have to continue using their best judgment on how to navigate the remaining legal challenges around medicinal marijuana. Echoing nurse Lance Pool’s belief of doing what’s best for the patient, Dr. Frankel says, “We have to all be a little braver just to do the right thing. You decide what’s best for that patient in that moment, and you do it. If you do anything short of that, you’re not practicing according to [medical] code.”

Complete Article ↪HERE↩!

December 10, 2018December 10, 2018

Why we need end-of-life rituals

By Glenys Caswell

When someone dies, it is common to mark their death with funeral rituals, but the idea of using a ritual to mark someone as they near the end of their life is less common. Yet rituals could provide succour to all involved at this difficult time.

Rituals help people to mark and make sense of the big life changes that we all go through, such as births, marriages and deaths. Rituals work when the people involved understand what is going on. For example, for a non-religious parent, it may make sense to have a secular baby-naming ceremony, rather than a religious christening or baptism to welcome their baby to the community.

Ritual is often thought of as actions that express shared meanings, such as lighting candles during a funeral ceremony. They could also be words or music, such as reading a poem or playing a favourite song. Rituals can help us deal with change, partly because of the shared understandings we have of the actions involved, but also because those ritual actions tend to be familiar to us. Using familiar words and actions in an unfamiliar situation can help us find our way through it.

We are used to thinking of funerals as being for the living. The funeral can be an opportunity for bereaved people to mourn, to share stories about the person who died and to come together with others who are grieving. Funeral ritual can help people to feel more in control when faced with a terrible loss.

The period of time when someone is dying, however, is viewed differently. The focus is on the dying person and on making sure that they receive the care they need. But ensuring that the person who is coming to the end of their life receives the best care does not mean that those who love them need to ignore their own welfare.

Gathering family and friends around the bed of a dying person is called keeping vigil. It is a common practice in many parts of the world. Traditional Xhosa healers in South Africa, for example, describe death as a collective matter. It is important for the family to be at the bedside to ensure a good death. Family presence allows the dying person to be at peace and to let their relatives know what they want for the family’s future. This doesn’t just benefit the dying person, but also helps family members, offering a chance to mend relationships.

Being with the dying person, whether sitting quietly or chatting, gives people the chance to say goodbye. It is also an opportunity to share the experience with other family members or friends, in much the same way that mourning is shared at a funeral. For some dying people and their families, music is used as a shared experience in the final hours.

Memory box

Memory boxes are another form of ritual that is becoming more common. Women in Uganda recently began the practice of creating a memory book or a memory box in order to share their life story and create a sense of belonging for their children after they had died.

A memory box can also be assembled by the family or friends of the dying person and doesn’t have to be intended for children. Such a box can hold mementos, photos, written notes, a CD, copied poems; anything, in fact, that can act as a reminder of the person.

Thinking about and discussing how to manage the end of life may be useful for both the dying person and their family and friends. The unknown is difficult to deal with so understanding that they are taking part in a ritual of accompaniment and leave-taking can help a family make sense of and mark the change that they are going through.

Death is about the biggest change any person will encounter, whether it is their own death or that of someone close to them. Using rituals that express shared meanings to help them feel more in control at a time of loss can only be a good thing.

Complete Article ↪HERE↩!

December 9, 2018December 9, 2018

The Growing Acceptance of Medical Aid in Dying

More and more voters support options to allow the terminally ill to peacefully end their suffering. Politicians have little to fear from the issue.

By Kim Callinan

While expanding and protecting health care was the number-one issue for voters on Nov. 6, what has gone unreported is that elected officials can now safely run on the issue of expanding and protecting end-of-life care options. For decades, lawmakers feared that sponsoring medical aid-in-dying bills that would allow terminally ill adults to have the option to peacefully end their suffering would harm their chances of getting re-elected. This year’s elections proved those concerns false.

Nearly all of the lead sponsors of bills in 28 states to authorize medical aid in dying in 2017 and 2018 who ran for re-election won (13 out of 14 state senators and 49 out of 53 state representatives). Voters also elected or re-elected at least five governors who publicly supported medical aid in dying: David Ige in Hawaii, Gavin Newsom in California, J.B. Pritzker in Illinois, Gretchen Whitmer in Michigan and Michelle Lujan Grisham in New Mexico. (Grisham’s opponent, Steve Peace, vehemently opposed medical aid in dying.)

In addition, Congressman Keith Rothfus of Pennsylvania, a sponsor of a failed resolution to overturn Washington, D.C.’s Death with Dignity Act and another House resolution condemning medical aid-in-dying laws nationwide that garnered only 13 co-sponsors, was defeated for re-election.

None of this should be particularly surprising. A majority of voters embraced this issue long before many elected officials and political candidates did — since 1996, according to Gallup’s annual polling; its 2017 poll shows that 73 percent of Americans support medical aid in dying, including 81 percent of Democrats and Democratic-leaning independents and 67 percent of Republicans and Republican-leading independents. In short, medical aid in dying is a rare bipartisan/nonpartisan issue. Five GOP legislators are among sponsors or co-sponsors of bills allowing medical aid in dying.

This unusually strong, wide-ranging support explains why 29-year-old Brittany Maynard, who moved from California to Oregon in 2014 to access its medical aid-in-dying law, was able to capture the attention of the American public. Three weeks after her YouTube video went viral, generating international news coverage, a YouGov poll showed that 38 percent of American adults — 93 million people — had heard her story.

Inspired, in part, by Maynard’s advocacy, since 2015 California, Colorado, the District of Columbia and Hawaii have enacted medical aid-in-dying laws. Today, D.C. and seven states accounting for nearly one out of five Americans have the option of medical aid in dying.

This movement is picking up major momentum, particularly among the millions of baby boomers who have watched their parents die in needless suffering because they did not have the option of medical aid in dying.

In addition, we know that these laws improve care by prompting conversations between doctors and patients about all end-of-life options, including hospice and palliative care. Oregon’s 1994 Death with Dignity Act has helped spur the state to lead the nation in hospice enrollment.

This helps explain why a 2016 Medscape survey of physicians showed doctors supporting medical aid in dying by nearly a 2-to-1 margin, 57 percent to 29 percent, up from 46 percent support in 2010. Just last month, the American Academy of Family Physicians dropped its opposition to medical aid in dying and adopted a position of “engaged neutrality,” noting that “family physicians are well-positioned to … engage in creating change in the best interest of [their] patients.” Medical societies in D.C. and nine states have adopted similar positions, and the New York State Academy of Family Physicians has endorsed allowing medical aid in dying.

Perhaps the most important benefit of medical aid in dying is that it is transforming end-of-life care in the same way childbirth care was transformed decades ago. As more states implement medical aid-in-dying laws, more and more patients have a voice in how they live the final chapter of their lives and how they die. Just as obstetricians and gynecologists now ask women for their input about who they want in the birthing room and whether they want to receive medication, doctors in states where medical aid in dying is authorized now are engaging in similar conversations with terminally ill patients.

In time, we will live in a world where health care providers fully inform their terminally ill patients about the benefits and burdens of all available forms of treatment and where deciding to end suffering and allow for a peaceful death will be a widely accepted medical option. The sooner we get there, the better.

Complete Article ↪HERE↩!

December 8, 2018December 8, 2018

At a Death Cafe, Tea and Couscous Make Mortality Easier to Swallow

Let’s talk about death, baby.

Attendees gather around a table to talk death at Tagine.

by Abbey Perreault

On a brisk November night, Tagine, a Moroccan restaurant tucked away on a quiet side street near Times Square, is alive with conversation. Nearly 20 people pack in around two tables cluttered with heaping, communal plates of steaming couscous, chickpeas, and yellow lentils. People exchange stories, laughs, and soft wedges of bread dipped in bright green chermoula. Multi-colored disco lights dance across the walls, and the swell of conversation rises and falls against a soft pulse of music and noise from the bar. A young, blonde woman walks through the door and surveys the crowd.

“Is this the singles’ event?” she asks, pointing to the tables. I shake my head.

“Nope,” I tell her. “This is the Death Cafe.” She thanks me, brow furrowed, and heads to the back of the restaurant.

While it may seem strange for conversations about death to be conflated with courting, our group could easily be mistaken for speed daters. Relatively young, open, and inquisitive, my dining companions exude a curious energy, solid appetite, and hunger for good conversation. But, unlike the majority of small talk with strangers, dialogue here is all about death—from philosophical musings about post-death life to the physiological components of dying.

“When the body is dying there are lots of … secretions,” says Tanya, a nurse who works in the intensive care unit at a local hospital. “We sometimes give patients medicine to try to dry them out and stop them from gurgling.”

“Is that what they call the death rattle?” someone asks from across the table.

Those noises, we learn, arise once the dying person can no longer swallow or clear fluid from the throat, and often indicates that they’re within a day of passing. But as disturbing as it may sound, the death rattle typically doesn’t cause the individual pain or discomfort. We talk about the sounds of death, and how to attempt to interpret them, sipping mint tea from delicate, warm glasses. “Having to take care of somebody who’s dying, and their family … it can be a lot. I want to talk about it with my husband, but I don’t want to fatigue him with it,” says Tanya. “But I think about it all the time.” It can be months, even years, she says, before she stops thinking about a patient who has passed away under her watch.

But not all Death Cafe diners come from professions that deal with death. According to Nancy Gershman, the facilitator of our cafe, attendees come from all walks of life, from college students with a philosophical curiosity about death to those who have witnessed something supernatural. Some people want to understand death better in order to prepare for their own. “I had this one 80-year-old who kept asking these roundabout questions,” recounts Gershman. “It turned out she wanted to know what dying was like.”

Gershman, who has been facilitating this Death Cafe for the past three years, says there’s no agenda. Meetings often meander thematically, driven by the questions and stories people bring to the table. But she’s quick to remind me that, while the Death Cafe is a safe space to talk about loss, it’s not a support group. “When you lose someone, there’s a particular period right after it happens where you keep repeating, like a groove on a record,” she says. “We’re not here to stay stuck in that groove.”

Instead, Gershman says, it’s a place to speak openly and inquisitively about the end of life. Formally established in 2011, the original Death Cafe arose as the brainchild of the late founder, Jon Underwood, in his East London home. Inspired by Swiss sociologist Bernard Crettaz’s café mortel, he set out to create an intentional space dedicated to talking death in order help people “make the most of their (finite) lives.”

Strangers began gathering in Underwood’s London basement to sip tea, munch on cake, and casually discuss death and dying. Before dying unexpectedly from undiagnosed leukemia in 2017, Underwood and his mother created accessible guidelines and protocols so anyone could create Death Cafes within their own communities. Since then, more than 7,300 cafes have cropped up in over 60 countries—an indication that they address a deep-seated desire to understand death, one that’s been ignored, if not avoided.

After remaining relatively tight-lipped on the topic for centuries, those in the U.S. are more willingly peeking into the abyss—a cultural moment that’s been dubbed the “positive death movement.” From the growing demand for end of life doulas to the creation of apps that send daily reminders that you’re going to die, it’s apparent that more people are interested in confronting death.

“There’s a growing recognition that the way we’ve outsourced death to the medical profession and to funeral directors hasn’t done us any favors,” Underwood told the New York Times in 2013. By avoiding the topic until it happens, we’re left with all sorts of strange feelings about this universal life event. And yet, many of us prefer to keep it at a distance.
Part of this aversion, Gershman suggests, is that talking about it reminds us that it’s real. It shakes the comfortable illusions many of us cling to—that our bodies and brains are ours to control and keep. Sitting around the table, talking about how to financially plan for our funerals (to keep our partners and families from going into debt) can feel alien, even morbid, at first. But, through sips of mint tea, mouthfuls of warm lentils, and a few laughs, I’m reminded that it’s as necessary as making a financial plan before any big life event, such as going to college or getting married.

The strangeness of talking about death, Gershman says, goes beyond the mere fact that it’s been a longtime taboo topic in some cultures. There’s a lot of subject matter that’s taboo, she says, but death is different—largely because it’s inevitable. She compares it to the sex-positive movement in the U.S., where much of the silence surrounding sexuality has been stripped away to increase transparency and dismantle stigma. “People still have a choice when they’re talking about sex. You can either have sex zero times … or many times. But with death, you don’t have a choice. It’s going to happen, and it’s not going to be in your control.”

While making death less taboo will help us understand it and plan for it, it can’t help us prevent it. So planning for it is both frightening and necessary. But by ensuring tea and food are present, hosts of the cafes are able to make discussions of dying a little less scary. “There’s a superstition that if you talk about death, you invite it closer,” said Mr. Underwood. “But the consumption of food is a life-sustaining process. Cake normalizes things.”

My tablemates seem to agree that eating makes engaging with death easier. Tanya mentions that the pediatric unit has a giant bowl filled with candy, and it’s intended for the staff, not the patients. Digesting and processing death might be easier when accompanied by something sweet, something that nourishes us, something we understand to be routine. Like death, eating is something all living bodies simply have to do.

As the night progresses, one attendee whose husband passed away a few years ago tells me that, when she lost him, she lost her appetite, too. But in the past few years, her love for food, particularly dark chocolate, has returned forcefully. “Now, I eat it and I can’t stop,” she chuckles. She reaches into her purse, shuffling around a bit before pulling out three wrapped Hershey’s Dark Chocolate with Almonds nuggets, and hands one to each of us, smiling.

Even after years of facilitating Death Cafes, Gershman finds herself surprised by the feverish interest the cafes continue to garner. Month after month, newbies and returners come to talk death with strangers. A big part of the appeal, she ventures, is that death is great fodder for in-person conversation. “This is a subject that people can stay on, as opposed to babysitters and real estate,” says Gershman. “Death is such a rich topic that you could approach it in a million different ways and never be bored.”

Back at Tagine, conversation shifts from the life and death lessons learned from watching Golden Girls to the weirdness of grieving on social media. In a group of complete strangers, no one looks awkward or distracted, and no one is fiddling with a phone. “I really think that people are starved for interesting conversation at dinner,” laughs Gershman.

As I gulp down my piece of chocolate, another swell of laughter erupts from the table to my left. In comparison, the singles’ event in the back seems relatively lifeless. Gershman tells me that what I’ve seen and felt tonight is no anomaly.

“One of the waiters told me, ‘Whenever your group comes in, there’s always such great energy.’” she says. When she told him that this was a Death Cafe, a group focused on death and dying, he thought he had misheard her. “I think it’s because there’s a tremendous sense of relief. When you have relief, there’s more laughter.”

Complete Article ↪HERE↩!

December 7, 2018December 7, 2018

Griefcast: life-affirming conversations about death

Podcasts: Cariad Lloyd interviews celebs about losing a loved one. It’s far from a downer

Griefcast features interviews with such celebrities as Aisling Bea, Adam Buxton and Ana Matronic

By Sarah Griffin

A few weeks ago, I covered a podcast called Death in the Afternoon, hosted by funeral directors and experts in the business and cultural history of dying and bereavement. Griefcast, hosted by comic Cariad Lloyd, is a far more intimate examination of grief and loss. Lloyd interviews a person – usually a fellow comedian – about a person close to them who has died. She lost her father when she was 15, which is the central thesis of this podcast: it’s a project about normalising conversations around death. This year, it won in three major categories at the British Podcast Awards and it’s very clear why.

I had been tiptoeing around this podcast for a while, aware of Lloyd as a comedian and gifted improviser, but had been unsettled at the idea of listening to two people dig into a conversation about death in such a personal capacity. Podcasts are already a very intimate medium, and this kind of intimate conversation seemed a long way from the peripheral. However, I am so glad I took the leap – Griefcast has made its way swiftly into my top podcasts of the year. I haven’t been able to stop listening.

Philosophical

This doesn’t come from a voyeurism, necessarily, which may seem hard to believe given the fact that each episode is an hour-ish long interview about loss. Rather, there is something hugely philosophical about each conversation, some wisdom imparted about the horror – and mundanity – of death. Every subject handles it differently, and Lloyd conducts the interviews with huge grace. She is the other person in the conversation, for sure, and acts as a very powerful conduit for conversations that cannot be absolutely easy for the subject, no matter how much levity they conduct themselves with.

Cariad Lloyd: conducts the interviews with huge grace.

The episodes I started with were interviews with Aisling Bea, Adam Buxton and Ana Matronic, all of whom had lost their fathers. Buxton is serene and gentle in his discussions of losing his father – this interview was given only months after his passing. Ana Matronic is a powerful storyteller; her father died of Aids when she was 15, and her episode is a portrait of the late 1980s in America, but also about how stigma operates.

My recommendation as a starting point is Aisling Bea’s episode, which is raw and angry and extremely real. I was floored by the integrity and honesty Bea brought to the interview regarding her father’s death – and her admittance that some days she just didn’t want to talk about it, but she was going to talk about it anyway.

Fascinating

Not only are the stories that the interview subjects dispense important, but the manner in which they dispense them is fascinating too. I cannot stress, either, how none of the episodes I have listened to so far have been downers, or left me feeling distressed. Certainly they are emotional listens at times, but there is an ease to the atmosphere Lloyd creates and facilitates here – which in many regards is a deeply courageous thing to do, as a person who has suffered a loss. She offers hers simply and honestly at the beginning of every episode – her dad died when she was 15 – and sets the tone that this next hour is a place for big, big chats.

I wholly recommend this as a listen, whether or not you have experienced the death of someone close to you. It is one of those rare pieces that, without ego or self-congratulation, examines a vital component of the human condition.

Complete Article ↪HERE↩!

December 6, 2018December 6, 2018

‘I was widowed at 23, young people need to talk about death’

By Amy Molloy

‘They say you’ve got three months to live.” These were the words I spoke to my then-fiancé when I was 23 years old after learning that his cancer – malignant melanoma that spread to his liver, lungs, pancreas and brain – was likely to be fatal.

At the time, my only experience of “the end” was watching my parents disappear into a room where my grandparents were lying, and of seeing an empty rabbit hut at the end of our garden after the loss of a pet.

When I was 17 years old my father was paralysed from Hodgkins Lymphoma but, after a stem cell transplant, he defeated the odds and made a miraculous recovery. So, I had faith in the power of modern medicine over mortality.

However, not this time.

I was practically still a child when a doctor ushered me into a private room, whilst my soon-to-be husband, Eoghan, was in a chemotherapy session, and revealed his prognosis. I asked if I could be the one to tell him, and they readily agreed.

Perhaps, even doctors will do anything to avoid saying the T-word. Terminal.

In the next three months, I had a crash course in end-of-life conversation: the jargon, the euphemisms and the social awkwardness.

I froze with fear when I walked into the chemo ward and heard another patient ask my partner, “Have you ever thought about euthanasia?” But, in a way, that was better than the wall of silence.

After my husband died three weeks after our wedding day, even my closest friends evaporated or became stiff in my company. In the next few months, as I rebelled against my grief – drinking too much and becoming promiscuous – nobody dared challenge me or raise the topics I ached to discuss.

What on earth are you doing?

Do you really think this is helping you?

How does it feel to marry a man who is dying?

…Do you want to die too?

Do you know what to say when a friend’s loved one dies? Have you thought about the day your own parent, partner or best friend may no longer be visible? How would you discuss it, in a way that would be supportive, constructive, and even light-hearted?

If you don’t know the answer, you’re not alone.

A new study from the Royal College of Physicians in the UK has urged medical professionals to improve their bedside manner when it comes to discussing death, after identifying that “timely, honest conversations” about patients’ futures are not happening. However it’s not only doctors who need to become more comfortable with these conversations.

It’s been suggested that millennials are the generation most fearful of death, unlike our grandparents, raised through world wars, who learnt that life can be short. As medicine advances and life expectancy increases, we prefer to think of death as our “future self’s problem”.

But is postponing the inevitable increasing our terror of it?

As psychologists report a rise in young people presenting with anxiety linked to death, it’s time for honest, open, educational conversations about loss of life, and how it can look. Its not enough to be aware of Facebook’s ‘death policy’, warn experts.

“Death is still a certainty even if people are living longer,” says clinical psychologist Renee Mill from Sydney’s Anxiety Solutions CBT.

“When treating anxiety, exposure is what works and avoidance increases the problem. Talking about death or visiting a dying person will decrease your fear of death and make it easier to accept that it is a part of life. Every funeral we attend, no matter how hard, actually helps to reduce anxiety in this way too.”

And, it’s never too early to think about the end. “Planning in life is important,” says Mill. “We plan our careers, we save, we want to buy property – end-of-life is another part we need to plan. It means we get our wishes fulfilled and gives guidance to our loved ones who otherwise have to pick up the pieces.”

In a good way, change is happening. Since 2017, the multimedia project We’re All Going to Die has encouraged people to embrace their immortality and use it to empower their lives, through educational films and festivals.

The award-winning podcast, GriefCast, hosted by comedian Cariad Lloyd whose father died when she was a teenager, sees entertainers speak with startling honesty – and surprising humour – about death, from the logistics of palliative care and funeral plans to the long-term effects of bereavement.

When we can talk openly about death, we may also increase our chances of reducing suicides. To help people to help each other, Lifeline offer an online course in QPR – the equivalent of CPR for people experiencing a suicidal crisis.

As part of the training – which only takes an hour and costs $10 – people are urged not to tiptoe around the conversations. Instead, be direct: “Do you feel like you want to die?”

In our social circles, we need to discuss worst-case-scenarios. Do you have a will? Do you have death insurance? Are you an organ donor? As an Australian immigrant living 16,000 kilometres from my parents, I always have enough money in my bank account for an emergency flight home. Because, nobody lives forever.

It’s confronting but it’s necessary

During my book tour, I cried on stage for the first time whilst discussing my journey from a 23-year-old widow to a 34-year-old wife and mother of two. Because, for the first time in a decade, I have reached a place where I can talk about my experience of death – and really be heard.

I shared the reason I light a candle in my bedroom every evening and say a prayer: help me to act from a place of love, not fear.

“If my dad’s cancer comes back, on that day I will light that candle,” I said, “If my husband, who is here with my newborn, dies and I am widowed again then I will light that candle to remind myself to act from a place of love.”

We need to talk about death to be active participants in the full spectrum of life: so we can decide who to be when a doctor pulls us into a private room, when we answer the phone to bad news, when we say goodbye for the last time.

We are so scared of death, we don’t discuss what an honour it is to watch someone die; to be present – really present – when someone takes their last breath, to lean in and breathe them in, to put your head on their chest as their heart stops beating and kiss their skin as it transforms.

I hope you all have that experience one day.

We are not meant to say that, but we should.

Complete Article ↪HERE↩!

December 5, 2018December 5, 2018

Suicide grief:

Healing after a loved one’s suicide

A loved one’s suicide can be emotionally devastating. Use healthy coping strategies — such as seeking support — to begin the journey to healing and acceptance.

When a loved one dies by suicide, overwhelming emotions can leave you reeling. Your grief might be heart wrenching. At the same time, you might be consumed by guilt — wondering if you could have done something to prevent your loved one’s death.

As you face life after a loved one’s suicide, remember that you don’t have to go through it alone.

Brace for powerful emotions

A loved one’s suicide can trigger intense emotions. For example:

Shock. Disbelief and emotional numbness might set in. You might think that your loved one’s suicide couldn’t possibly be real.
Anger. You might be angry with your loved one for abandoning you or leaving you with a legacy of grief — or angry with yourself or others for missing clues about suicidal intentions.
Guilt. You might replay “what if” and “if only” scenarios in your mind, blaming yourself for your loved one’s death.
Despair. You might be gripped by sadness, loneliness or helplessness. You might have a physical collapse or even consider suicide yourself.
Confusion. Many people try to make some sense out of the death, or try to understand why their loved one took his or her life. But, you’ll likely always have some unanswered questions.
Feelings of rejection. You might wonder why your relationship wasn’t enough to keep your loved one from dying by suicide.

You might continue to experience intense reactions during the weeks and months after your loved one’s suicide — including nightmares, flashbacks, difficulty concentrating, social withdrawal and loss of interest in usual activities — especially if you witnessed or discovered the suicide.

Dealing with stigma

Many people have trouble discussing suicide, and might not reach out to you. This could leave you feeling isolated or abandoned if the support you expected to receive just isn’t there.

Additionally, some religions limit the rituals available to people who’ve died by suicide, which could also leave you feeling alone. You might also feel deprived of some of the usual tools you depended on in the past to help you cope.

Adopt healthy coping strategies

The aftermath of a loved one’s suicide can be physically and emotionally exhausting. As you work through your grief, be careful to protect your own well-being.

Keep in touch. Reach out to loved ones, friends and spiritual leaders for comfort, understanding and healing. Surround yourself with people who are willing to listen when you need to talk, as well as those who’ll simply offer a shoulder to lean on when you’d rather be silent.
Grieve in your own way. Do what’s right for you, not necessarily someone else. There is no single “right” way to grieve. If you find it too painful to visit your loved one’s gravesite or share the details of your loved one’s death, wait until you’re ready.
Be prepared for painful reminders. Anniversaries, holidays and other special occasions can be painful reminders of your loved one’s suicide. Don’t chide yourself for being sad or mournful. Instead, consider changing or suspending family traditions that are too painful to continue.
Don’t rush yourself. Losing someone to suicide is a tremendous blow, and healing must occur at its own pace. Don’t be hurried by anyone else’s expectations that it’s been “long enough.”
Expect setbacks. Some days will be better than others, even years after the suicide — and that’s OK. Healing doesn’t often happen in a straight line.
Consider a support group for families affected by suicide. Sharing your story with others who are experiencing the same type of grief might help you find a sense of purpose or strength. However, if you find going to these groups keeps you ruminating on your loved one’s death, seek out other methods of support.

Know when to seek professional help

If you experience intense or unrelenting anguish or physical problems, ask your doctor or mental health provider for help. Seeking professional help is especially important if you think you might be depressed or you have recurring thoughts of suicide. Unresolved grief can turn into complicated grief, where painful emotions are so long lasting and severe that you have trouble resuming your own life.

Depending on the circumstances, you might benefit from individual or family therapy — either to get you through the worst of the crisis or to help you adjust to life after suicide. Short-term medication can be helpful in some cases, too.

Face the future with a sense of peace

In the aftermath of a loved one’s suicide, you might feel like you can’t go on or that you’ll never enjoy life again.

In truth, you might always wonder why it happened — and reminders might trigger painful feelings even years later. Eventually, however, the raw intensity of your grief will fade. The tragedy of the suicide won’t dominate your days and nights.

Understanding the complicated legacy of suicide and how to cope with palpable grief can help you find peace and healing, while still honoring the memory of your loved one.

Complete Article ↪HERE↩!