Posts

Posted on

Remember that you will die

By Bonnie Kristian

I don’t often think about death.

Well, to be precise, I don’t think about my own death. So rarely, in fact, do such personally existential topics occur to me that my far more reflective husband has suggested we may be of different species.

But I do think about other people’s deaths almost daily — not in, like, a serial killer way, but in that my occupation as a writer covering politics and current events means death constantly invades my work. There’s death in the headlines as soon as I wake up and death in the policy topics, like foreign affairs and criminal justice reform, on which I often offer commentary. Last year I completed a seminary degree, and I wrote my master’s thesis on the theology surrounding the death of Christ.

It is that exposure to death, distant but incessant, which perhaps made a line from late night host Jimmy Kimmel’s mournful monologue on the mass shooting in Las Vegas so striking to me. “I just want to laugh about things every night, but seems to [be] becoming increasingly difficult lately,” he said. “It feels like someone has opened a window into hell.”

What happened in Las Vegas was indeed hellish, but the window is not newly open. This is the way our world has worked throughout the great bulk of history, and it is the way it continues to work around much of the globe today. Think of the persistent evils of conquest and slavery and genocide, plague and flood and fire. Think of the Lisbon earthquake, which in 1755 killed as many as 100,000 people and caused so much anguish it changed the course of European philosophy. Think of the famine and cholera in Yemen right now, where conditions are so dire children are dying of dehydration in the womb. Think of the slaughter in Myanmar, the decimation of Puerto Rico, the refugee crisis in the Middle East.

Yes, we have a window open to hell, but we did not open it last weekend in Las Vegas. It has been open a very long time.

Here in the United States in the start of the 21st century, we are significantly insulated from natural and man-made evils alike. Make no mistake: I do not mean to discount real suffering or to suggest that such insulation is a bad thing. Far to the contrary, it is wonderful to live in a time and place as historically prosperous and safe as ours. For all our debates about health care, for example, we modern Americans are justifiably confident that we will not meet our end in an epidemic of bubonic plague, our bodies consigned to a mass grave stacked — as one medieval Italian put it — “just as one makes lasagna with layers of pasta and cheese.”

But our insulation comes with side effects. It makes us unduly surprised and incapable of appropriate response when grave evils do befall us. We are fixated on asking how such an evil could happen to the detriment of more valuable questions.

As a potential remedy, I propose reviving memento mori, the practice of remembering death. Though there are injunctions to meditate on mortality to be found in pre-Christian and non-Western philosophy, memento mori — Latin for “remember that you will die” — is classically a Christian phenomenon that flourished in the Western world from the Middle Ages through Victorian times.

Memento mori was never a single act or image, but its most identifiable form is the representation of death and the fleeting passage of time in medieval and Renaissance art. Skulls were a favorite theme, as were running hourglasses, wilting flowers, and burning candles. Sometimes full skeletons appeared, inviting people from all walks of life to join the inevitable danse macabre. In poem and fresco alike, the story of “The Three Living and the Three Dead” saw three kings meeting three walking corpses of monarchs past. “Quod fuimus, estis; quod sumus, vos eritis” — what we were, you are; what we are, you will be — the corpses say, cautioning the kings against a frivolous and immoral life.

That warning is central to the message of memento mori, which is neither an effort “to find comfort in the commonality of our mortal lot” nor the indulgence in morbidity and despair it may initially seem. The point of remembering that you will die is to reflect on how you are living now: If life is fleeting, it is all the more important to use it well. For Christians, it is equally a reminder of our hope in the victory of Christ and the coming destruction of death itself. As we remember death, we also remember it will not have the final word. “Where, O death, is your victory? Where, O death, is your sting?”

Still, I am going to die. You are going to die. We are all going to die. That is something we should remember.

Memento mori should not make us cynical about death and other evils, but rather mindful that they are happening to others and better prepared for when they happen to us. This mental habit becomes all the more necessary when you live, like Jimmy Kimmel and me, in circumstances where “laugh[ing] about things every night” is plausible. It is a habit that keeps us from being taken by surprise that our world has a window open to hell, and that keeps us doing what we can to shut it.

Complete Article HERE!

Posted on

How to help your kids say goodbye to a beloved pet

Tips on how to guide little hearts through their grief to help them deal with their loss and recover from it

By Jennifer Walker

[S]aying goodbye to a pet is an inevitable experience many families will experience.

And telling the truth to children and allowing them to grieve is crucial in helping them deal with their loss, as well as recover from it.

“I think it is important to tell children the truth but depending on their age and developmental level, the information you communicate will differ,” said Kyle Newstadt, individual and family therapist and director of Integrate Health Services. “Regardless, they should know the truth and if you know the pet is sick or death is on the horizon, it is important to communicate that with children.”

According to Ms. Newstadt, books can be helpful to introduce the topic to a child with the family without any other distractions. She said parents could explain to their children that the animal has been to the doctor for medicine and that they’re waiting to see if it helps the situation.

“Don’t hide the truth and say the animal is sleeping or he ran away; it’s abstract and kids wont understand that,” said Ms. Newstadt. “Stick to the truth and avoid unknown language, explain death but leave it up to the child and what they’re asking — children can surprise us.”

A toddler is unlikely to understand death but those words should be used, she added.

“Parents could explain that medicine was given to dog and it will help him close his eyes and he will die peacefully,” said Ms. Newstadt. “Wait for them to ask “what does death mean?’ and, depending on religious beliefs, that would be a good time to talk about that.”

According to the local therapist, it is important to allow your child to express their feelings and deal with grief. A pet memorial would be a crucial part of the process for a child and the entire family, she said.

“Ask the child and give them choices in ways they would want to memorialize their pet and maybe each child can think of something they want to do; a burial outside, pictures in places around the house, creating a scrapbook, or a special ceremony to talk about the memories they had with their pet is important and helps them deal with grief,” she said. “This will open lines of communication which is so important when a child suffers from the death of a pet.”

According to Durham Region registered vet technician Sarah Macdonald, it is required of veterinarian clinics to dispose of a pet’s body once it passes away. A large majority of clinics also offer cremation, she said.

According to Ms. Macdonald and Ontario.ca, homeowners are permitted to bury their pets on their own property. For those living in an apartment, Ms. Macdonald recommends cremation.

The ashes can be kept in a special urn inside the pet owner’s home or be scattered in a special location for a ceremony or as part of a memorial, she said.

For those looking for more ways to memorialize their pets with keepsakes, funerals, cremation ceremonies, and more, Ms. Macdonald recommends Gateway Pet Memorial, specializing in pet aftercare throughout North America.

Parents should be focusing on positive coping strategies by modelling self-expression, letting the child know that it is OK and normal to have these feelings of sadness and that it is important to express, said Ms. Newstadt.

“Children experience grief in different ways from adults; there is no right or wrong way,” she added. “They may appear to be coping well and weeks later experience sadness. Meet the child where they’re at.”

According to Ms. Newstadt, parents shouldn’t approach the conversation until the child is expressing sadness.

“It’s OK if the child isn’t demonstrating that they’re sad, there is no right or wrong way to experience grief,” she said. “It is typical for a child to ask questions or to say they’re feeling sad and then engage in play, it’s a developmentally appropriate way of grieving.”

Complete Article HERE!

Posted on

Religious rituals surround death

Headstones at Catholic Cemetery No. 1 in Victoria.

By Jennifer Lee Preyss

[I]nside Memory Gardens, a well-groomed cemetery off Cuero Highway, marked graves and floral arrangements pay tribute to the lives of thousands of Victorians who have died.

Near the rear of the grounds, 50 plots have been reserved for members of the Victoria Islamic Center.

Even though many Islamic communities throughout the United States bury members in Islamic-only cemeteries, Victoria Islamic Center Imam Osama Hassan said the 50 plots in Memory Gardens fit the needs of the community.

“It has worked out perfect for us. It’s the right size for our needs for the future,” he said, mentioning the small size of its congregation.

Like many other religious sects in South Texas, including Christianity and Judaism, Islam has its own unique rituals for burying the dead.

Often, Islamic communities purchase their own cemeteries, especially if they are part of large communities of Muslims or live in larger cities. But death is an important part of life and how a Muslim is honored in death is especially important for believers.

“The Prophet Mohammed tells us to talk about death because it’s a part of life. But many people are afraid to. Some people feel if they talk about it, it’s like bad luck, like someone they know may die,” he said. mentioning the cultural aspect of international Muslims from various countries around the world who are reluctant to discuss or plan for death. “We should be talking more about it.”

Islamic members are not the only community in Victoria with special requirements for death.

In downtown Victoria, off Vine Street, a Jewish cemetery dating back to the mid-1800s indicates some of the city’s earliest residents were Jewish, including the first Jew to settle in Victoria, Abraham Levi, who established one of the city’s earliest grocery stores on Main Street.

Catholic and early Protestant cemeteries also remain pervasive throughout the region, established in the early 1800s as settlers moved in and established churches and parishes.

The Rev. Max Landman, of Sacred Heart Catholic Church in Hallettsville, said Catholic funerals are distinct, in part because of their reverence for the dead.

“The main thing, with respect to a Catholic funeral, is we’re there to pray for the soul of the dead person. A lot of times, it can be seen as a celebration of the person’s life – and there’s nothing wrong with celebrating the person’s life – but the point of the funeral from the Catholic’s perspective is to commend that soul to God,” Landman said. “We firmly believe that our prayers for that person, especially the Sacrifice of the Mass are helpful in obtaining mercy and speeding that person’s soul into paradise.”

As Halloween approaches, a time of year that gives a not-so-subtle nod to death, cemeteries and afterlife, the season offers a unique opportunity to examine the customs of area religions as they honor the members of their congregations in the religious context they acknowledge.

Here are a few of the many death traditions of Catholics, Muslim and Jewish believers around the world.

In most religions, tombstones and grave markers are permitted and visited by the living.

Islam
When a Muslim dies, the body should be buried as soon as possible. Three to four hours is preferable, up to one day, but no longer than 48 hours. The bodies are not embalmed, and careful consideration is given to treatment of the body because Muslims believe the person can still hear and feel pain.

Autopsies and cremations are not acceptable for this reason; however, organ donation may be permitted in some circumstances because it is seen as a charitable event.

Instead, Muslims are washed with soap and water and wrapped in a white cloth. Men prepare male deceased, while women prepare female deceased.

It is preferable that Muslims not be placed in a casket at all, allowing the dead to return immediately to the dirt.

Overseas, Muslims are buried directly in the ground. In the U.S., caskets are required, so Muslims typically place the coffin upside down to encapsulate the body once it is placed in the ground. Bodies must lie on their side and point toward Mecca in Saudi Arabia.

The typical mourning period is three days, and believers are encouraged to return to normal life. This varies depending on each person, with some wearing black for many years in remembrance of a loved one.

Catholics
Priests are called both right before and after death to pray the appropriate rites over the body.

Vigils are usually held on the evening before Mass, and there is often a praying of the rosary. This is typically the place where eulogies and tributes are delivered.

Caskets can be covered with white linens, or palls, and blessed with holy water as a reminder of baptism.

Bodies are allowed to be embalmed, however organ donation and cremation remain areas of disagreement among Catholics. It is preferred if cremation is being performed that the body not be cremated until after the funeral Mass, so the deceased can be present in the church for the service.

At burial, the Rite of Committal is given at the blessed burial site. The Lord’s Prayer is typically said upon closing.

Judaism
When a Jew dies, the “Dayan HaEmet” prayer is recited, which acknowledges God as the true judge.

Jewish tradition prefers the body be laid to rest as soon as possible, as soon as one day, so funeral planning often begins immediately.

It is also preferable the body not be unattended and is often given a “shomer” or guardian.

If funerals cannot be held right away, exceptions can be made. Sometimes, the body is refrigerated while waiting on the funeral.

Bodies are typically washed and dressed. Men wash men and women wash women. The washing is called the “taharah.” The submerging of the body in water for the ritual bath is the “mikvah.”

The body is fully dried and dressed in a simple white cloth called a “tachrichim.” Men are typically buried in a “kippah” or skull cap, and also a “tallit” or prayer shawl.

Jews tend to avoid holding funerals on holy days or Saturdays.

Organ donation is generally accepted and seen as a good deed. Autopsies and embalming are generally not accepted unless required by law.

Cremation may be accepted depending on the degree of orthodoxy of the Jewish family. Orthodox Jews do not permit cremation, while conservative and reformed Jews may allow it.

Jews are placed in a simple pine casket without any metal, and sometimes holes are drilled in the bottom of the box to accelerate decomposition. There is generally no wake or visitation in the Jewish faith. Funerals are held in the synagogue, at the grave or funeral home, and include a eulogy, reading of the psalms, and the memorial prayer, “El Maleh Rachamim.”

It is customary for the tombstone or grave marker to be put up one year after the death. A stone is usually placed on the grave within the first 30 days to indicate someone has visited.

Complete Article HERE!

Posted on

Cleaning the dead: the afterlife rituals of the Torajan people

For the Torajan people of Indonesia, death is part of a spiritual journey: families keep the mummified remains of their deceased relatives in their homes for years – and traditionally invite them to join for lunch on a daily basis – before they are eventually buried. Even then, they are regularly exhumed to be cleaned and cared for

By Claudio Sieber

[I]n contrast to Western norms, Torajans people, who live in the mountains of Sulawesi in Indonesia, treat their beloved relatives as if they are sick not dead. In this picture, a grandchild stands next to her deceased grandparents. Yohanis (right), was 77 years old and passed away two weeks ago; his wife Alfrida Tottong Tikupadang (left), was 65 years old and passed away five years ago. In Toraja, it is customary to feed the deceased every day and to keep the corpses cozily bedded in a separate room of the family house until the family can afford a proper funeral.

After the funeral rites of “Rambu Solo”, the deceased are finally buried in tombs. But still they are regularly visited, cleaned and given new clothes in a ritual known as Ma’nene (‘Care of Ancestors’). Datu died 35 years ago. In this picture relatives are removing the insects that covered her.

 

It’s customary for the Torajans to put gifts in the coffin, such as a bracelet or a watch. Others might even bury a diamond with their loved ones. Grave robbery often occurs and some Torajans keep their gifts a secret. Grandpa Ne Pua passed away when he was 85 years old. He has been buried in his favourite suit together with his favourite belongings.

 

Roughly 50 bodies are being moved from Balle’ graveyard to a new mausoleum. As soon as the traditional coffins are dragged out of the tomb, the relatives put on surgical masks and attend to their loved ones.

 

In this picture, a family presents Djim Sambara, who died two years ago when aged 90. Sambara was honourably buried in his military uniform before the family changed his outfit.

 

Andaris Palulun is given new clothes by his brother Ferri before returning to the family tomb. He died 20 years ago.

 

Todeng died in 2009. A young relative of his, Sam, lights him a cigarette and changes his glasses.

 

Yuanita takes a selfie with her relative Allo Pongsitammu who passed away roughly 20 years ago.

 

This picture shows Ne Duma Tata waiting to return his deceased wife to the mausoleum. Ludia Rante Bua (right) died in 2010. She stands alongside her sister.

 

With the bodies having been dutifully cleaned, they are carefully returned to the mausoleum.

Complete Article HERE!

Posted on

Learn to Cope With Death as a Future Physician

Prospective medical school students can use volunteer experiences to learn how to care compassionately for dying patients.

As a prospective medical student, remember to take the time to grieve.

By Kathleen Franco, M.D.,

[M]ost prospective medical school students set out to become physicians because they want to heal the sick, often forgetting that patients, young and old, sometimes die.

Death is a very real – and natural – part of medicine that you will not only face but also will need to learn how to handle. Before you start medical school, consider how you might care compassionately for a dying patient and how you will cope with the loss.

Some physicians – although very few in my experience – look at death as defeat and cope by emotionally running away from dying patients. For example, in the inpatient setting, they may visit the patient less often or avoid contact altogether.

In the outpatient setting, they might recommend a longer time between visits or, rather than suggest a follow-up appointment, wait for the patient to request one. This coping strategy makes patients feel abandoned.

Other physicians – again, very few – cope by behaving callously or indifferently. Subconsciously, they may be trying to avoid emotional involvement, but their behavior leaves their patients and families feeling hurt and disappointed.

Most physicians find healthy strategies to support their dying patients. These same strategies help physicians keep themselves emotionally healthy, too.

As a future medical student, it’s vital that you prepare yourself to compassionately face death and dying and the complex emotions that follow. One way to do this is by volunteering in a hospice facility or nursing home and honing these six skills.

1. Be authentic: As a volunteer, introduce yourself and express your hope that someday you wish to become a physician. Let patients know you are there to learn more about their experiences.

Ask patients about how they grew up or what they were thinking about at your age. Ask about their work or career – a generally safe place emotionally – and where they have lived or about their family.

Be sure to make eye contact and watch your body language. You’ll use these skills when you’re a physician to develop trust and open communication with patients.

2. Listen with purpose: Practice your active listening skills so that on future visits you can ask patients more about previous conversations.

By bringing up something from a past visit, you will show that you remembered what they told you and that they matter to you as a person. Active listening is another skill you will use throughout your medical career.

3. Allow patients to talk about death: Everyone faces death differently; some people want to talk about it, while others prefer to reflect on their life and accomplishments.

Whether now as a volunteer or later as a future physician, let patients talk about death as they need to. Don’t shut down the conversation by saying, “Everything will be all right.” Instead, ask them to tell you more. Listen to all they have to say, whether it’s about their health, fears or fond memories.

4. Visit or connect consistently: A good physician builds rapport over time, and you can develop this skill through your volunteer position. During extended time between visits, call or drop the patient a note.

This is a good habit to develop so that when you are a physician, your patients – particularly those who are dying – will feel supported. At the end of each visit, thank the patient. You won’t know at the time if it will be your last opportunity to visit, so treasure each interaction.

5. Seek support: Myriad scholarly articles and books are available to help physicians – and all people – accept that death is an inevitable part of life and that grieving is normal and encouraged. For instance, attending funerals help some people grieve, while others seek solace from support groups or counseling.

Social workers also deal with death and dying regularly and can give you advice about how they cope and prevent burnout. Make the social work team part of your professional network. Their support and advice will help you cope as a physician, especially when you lose a patient who had a particular influence on you.

6. Allow yourself to grieve: Over the course of your relationships with patients who are dying, you will learn a great deal about your capacity to care for others. It will likely hurt when patients die.

Remember that it’s important to grieve, and keep in mind that everyone grieves differently. Give yourself the room to process your emotions and to discover the coping mechanism that’s right for you.

Over time, you will gain some insight about your ability to cope. Physicians often cope by speaking confidentially with colleagues and expressing sadness and other emotions in a journal. After omitting a patient’s protected health information, some physicians publish their writings to help themselves and others who are grieving.

Many medical schools also teach students to reflect about their emotions and write them down. Writing and seeing the words help the healing process.

As a future medical student, embrace the opportunity to get to know someone who is dying. It will allow you to reflect on how you may feel when a future patient dies and learn to create a meaningful bond with the people you touch now and in the future.

Complete Article HERE!

Posted on

Alzheimers Q&A: What is an AIM Program?

[T]he Advance Illness Management (AIM) program/model was developed to provide home-based palliative care and management of transitional care for individuals with advance chronic disease. The AIM program benefits those who are not yet ready for hospice or have refused to elect a hospice program.

For the most part, AIM is essentially a specialized home care program. It is not hospice. Whereas traditional home care services promote recovery and rehabilitation and the individual is admitted and discharged quickly, the AIM program promotes transition between end-of-life care for individuals with late-stage illness. Moreover, AIM focuses on symptom management and comfort.

Traditional home health services are offered to individuals with a brief illness or debilitating circumstances that are not considered terminal. Palliative home health services are provided to those facing terminal illness who wish to continue life-extending or curative treatment or need more time to explore options. The AIM program manages the needs of individuals facing terminal illness. A person can transition into hospice care if and when that decision is made, with no change in the consistent caregiver.

In order to participate in an AIM program, individuals must satisfy at least two of the following criteria:

• Advance cardiac disease, end-stage pulmonary disease, end-stage liver disease, end-stage Alzheimer’s or dementia, other end-stage diagnoses or advanced debility and decline.

• Non-palliative treatment of primary disease process is failing or losing effectiveness, such as when cancer chemotherapy is ineffective.

• Individual has poorly controlled pain or other end-of-life symptoms.

• A decline in functional and or nutritional status in the past 30 days.

• The person is eligible for hospice but refuses enrollment.

The AIM palliative home health visits are less frequent than hospice visits, yet the person and his or her family are provided similar services as those received through hospice from the same qualified and compassionate staff, while they continue to see curative treatments. And, with the AIM program, if at some point the individual and family decide to utilize the services of hospice care, they have the comfort of knowing that their team of health care providers will remain the same.

For more information about the services provided by AIM, check with your physician or health care provider.

Complete Article HERE!

Posted on

New study looks at end-of-life decision making for people with intellectual disabilities

by Bert Gambini

 
[A] new study by researchers at the University at Buffalo provides a groundbreaking look at how advance care planning medical orders inform emergency medical service (EMS) providers’ experiences involving people with intellectual disabilities.

Most states in the U.S. have programs that allow to document their end-of-life decisions. In New York, the Medical Orders for Life-Sustaining Treatment form (MOLST) allows individuals to document what measures , including EMS providers, should take near the end of a patient’s life.

Studies suggest that this approach to person-centered advance care planning can alleviate a dying patient’s pain and suffering, according Deborah Waldrop, a professor in the UB School of Social Work and an expert on end-of-life care. Yet little research on end-of-life decision-making has been done on the growing population of older Americans with intellectual disabilities, which the American Association on Intellectual and Developmental Disabilities defines as a disability characterized by significant limitations in learning, reasoning, problem solving, and a collection of conceptual, social and practical skills.

Waldrop and Brian Clemency an associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences, authored one of the first scholarly examinations of how pre-hospital providers assess and manage emergency calls for patients who do not wish to be resuscitated or intubated. Jacqueline McGinley, a doctoral candidate in UB’s School of Social Work, joined their research team and served as first author for their most recent work.

Through a series of interviews with five different agencies in upstate New York, the researchers asked EMS providers specifically how forms like the MOLST shape what they do in the case of someone with an intellectual disability.

“The best available research before our study suggested that as of the late 1990s, fewer than 1 percent of people with intellectual disabilities had ever documented or discussed their end-of-life wishes,” says McGinley. “But with this study, we found that about 62 percent of the EMS providers we surveyed had treated someone with an intellectual or developmental disability who had these forms.”

That disparity points to the need to illuminate this understudied area of how people with intellectual disabilities are engaging in end-of-life discussions, according to McGinley.

She says the EMS providers’ charge is to follow protocol by honoring the documents, their directions and organizational procedures. The MOLST, as its name implies, is a medical order that providers are professionally bound to respect. Their procedures are identical for all emergency calls involving someone who is imminently dying regardless of a pre-existing disability, the study’s results suggested.

But questions remained.

“We heard from providers who wrestled with the unique issues that impact this population, including organizational barriers when working across systems of care and decision-making for individuals who may lack capacity” says McGinley.

There are approximately 650,000 adults age 60 and older in the U.S. with intellectual disabilities, according to Census Bureau figures from 2000. Demographers expect that figure to double by 2030, and triple within the foreseeable future.

Person-centered advance care planning specifically involves the individual in discussions about their health history, possible changes to their current health status and what future options might be available in order to best inform that person’s end-of-life decision-making.

The results, published in the Journal of Applied Research in Intellectual Disabilities, suggest that medical orders largely favor efforts to prolong life. This may be due to a reluctance to discuss advanced care planning in this population. Still, this sociocultural context must be strongly considered as future research explores how people with intellectual engage in end-of-life discussions.

Since January 2016, Medicare pays for patients to have conversations with medical providers. In fact, at least once a year, as part of a service plan through the state, people with have face-to-face discussions with their service providers, according to McGinley, who notes the importance of this built-in opportunity to have conversations about serious illness and the end of life.

“What’s most important in all of the work we do is knowing that people can die badly,” says Waldrop. “We know we can make changes that illuminate some of the uncertainties and improve care for people who are dying. Knowing how forms, like the MOLST, are applied in the field is an incredible step in the right direction.”

Complete Article HERE!