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The Vatican may protest, but traditional funerals are dead and buried

A new decree forbids Catholics to scatter ashes, and insists on the sanctity of the cemetery. But in terms of burial options, the Vatican are way behind the times

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‘Burial space in UK graveyards is at a premium, so people are moving towards alternative trends in the disposal of bodies.’
‘Burial space in UK graveyards is at a premium, so people are moving towards alternative trends in the disposal of bodies.’

[J]ust in time for the prayers for the dead on All Souls’ Day next Wednesday, the Vatican has restated its position on what can be done with the ashes of the faithful. In short, no longer can Auntie be kept in a mantelpiece urn or grandad’s ashes scattered on his local team’s football pitch.

Concerned about the adoption of “new ideas contrary to the church’s faith” suggestive of “pantheism, naturalism or nihilism”, the Vatican document conflates ashes-scattering with a dangerously new age spirituality, stipulating instead that remains should be kept tangibly in a sacred place. The Catholic belief in bodily resurrection at the end of days makes this position unsurprising, and the church clearly has a vested interest in discouraging casual rituals outside their control, but it’s a proscription that doesn’t sit well with current trends in the UK. The Vatican may face a harder battle against creeping modernism in the matter of burial and funeral practices than they bargained for.

Burial space in the UK is at a premium. The Labour government’s 2007 plan to allow the reuse of graves was given the green light in London, but the toxicity of the topic has seen it languish “under review” ever since for the rest of England and Wales. A Scottish bill to permit such recycling was passed in March. But such measures won’t make a significant dent in the 75% cremation rate, and the scattering of ashes is still a huge trend – the Mountaineering Council of Scotland warns that the sheer volume of ashes on the most popular summits is such that it is causing dangerous chemical changes in the soil.

The Vatican rejects the idea of death as “the moment of fusion with Mother Nature or the universe, or as a stage in the cycle of regeneration” that scattering in such natural environments represents; it also bans the use of ashes in memorial trinkets. In recent years, ashes have been used to make everything from records to tattoo ink, and such gung-ho going-ons have become associated with rock’n’roll abandon, from Keith Richards snorting his father’s remains, to the metal fan whose ashes were scattered in the mosh pit earlier this year. US experimental act Negativland went so far as to issue their new album this month with a small bag of the ashes of band member Don Joyce. Irreverent stuff, but the modern history of cremation in the UK started in no less paganistic style, with the failed prosecution of druid William Price for burning the body of his baby son on a pyre in 1884, setting a legal precedent that saw the practice legalised in 1902.

But cremation may not be where the individualism and valorisation of the natural world the church so fears is really thriving. Alternative trends in the disposal of bodies are moving towards burial. The Association of Natural Burial Grounds (ANBG) represents more than 270 woodlands and meadows run as natural cemeteries in the UK; 20 years ago there was only one such facility. It is in natural burial that the idea of an unmediated return to the earth that the church has denounced is writ large, with bodies often buried without a coffin and the landscape managed sustainably to preserve its natural beauty.

Rosie Inman-Cook, head of the ANBG and of the Natural Death Centre (NDC), a charity that puts choice, family and respect for the environment at the centre of their funeral advice service, has written inspiringly about the wide range of funeral and burial options available in the UK today. In the words of Leedam Natural Heritage, which operates eight natural burial grounds, these alternatives “offer something gentler”. Indeed, this is all in a context of the rejection of the staid funerals of old, which belonged to a more emotionally buttoned-up past, with British Humanist Association-trained celebrants now conducting more than 7,000 funerals a year.

But more and more people are doing away with formal ceremony and professional celebrant altogether, instead taking the “direct-it-yourself” approach championed by Inman-Cook, or going for direct cremation, which involves no funeral at all. The fact that David Bowie chose this option cemented his image as the ultimate individualist, and the NDC has reported a rise in interest in this possibility.

With adherence to a faith’s doctrines always being on a sliding scale, and the Catholic faithful hardly being immune to changing fashions, the church perceives these new approaches to marking the end of our lives as a threat. But if they are worried about greater freedom and a more individualistic approach to death and burial, scattering of ashes is old news.

Complete Article HERE!

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Dia de los Muertos (Day Of The Dead) 2016

[M]ore than 500 years ago, when the Spanish Conquistadors landed in what is now Mexico, they encountered natives practicing a ritual that seemed to mock death.

It was a ritual the indigenous people had been practicing at least 3,000 years. A ritual the Spaniards would try unsuccessfully to eradicate.

A ritual known today as Dia de los Muertos, or Day of the Dead.

The ritual is celebrated in Mexico and certain parts of the United States. Although the ritual has since been merged with Catholic theology, it still maintains the basic principles of the Aztec ritual, such as the use of skulls.

Today, people don wooden skull masks called calacas and dance in honor of their deceased relatives. The wooden skulls are also placed on altars that are dedicated to the dead. Sugar skulls, made with the names of the dead person on the forehead, are eaten by a relative or friend, according to Mary J. Adrade, who has written three books on the ritual.

The Aztecs and other Meso-American civilizations kept skulls as trophies and displayed them during the ritual. The skulls were used to symbolize death and rebirth.

The skulls were used to honor the dead, whom the Aztecs and other Meso-American civilizations believed came back to visit during the monthlong ritual.

Unlike the Spaniards, who viewed death as the end of life, the natives viewed it as the continuation of life. Instead of fearing death, they embraced it. To them, life was a dream and only in death did they become truly awake.

“The pre-Hispanic people honored duality as being dynamic,” said Christina Gonzalez, senior lecturer on Hispanic issues at Arizona State University. “They didn’t separate death from pain, wealth from poverty like they did in Western cultures.”

However, the Spaniards considered the ritual to be sacrilegious. They perceived the indigenous people to be barbaric and pagan.

In their attempts to convert them to Catholicism, the Spaniards tried to kill the ritual.

But like the old Aztec spirits, the ritual refused to die.

To make the ritual more Christian, the Spaniards moved it so it coincided with All Saints’ Day and All Souls’ Day (Nov. 1 and 2), which is when it is celebrated today.

Previously it fell on the ninth month of the Aztec Solar Calendar, approximately the beginning of August, and was celebrated for the entire month. Festivities were presided over by the goddess Mictecacihuatl. The goddess, known as “Lady of the Dead,” was believed to have died at birth, Andrade said.

Today, Day of the Dead is celebrated in Mexico and in certain parts of the United States and Central America.

“It’s celebrated different depending on where you go,” Gonzalez said.

In rural Mexico, people visit the cemetery where their loved ones are buried. They decorate gravesites with marigold flowers and candles. They bring toys for dead children and bottles of tequila to adults. They sit on picnic blankets next to gravesites and eat the favorite food of their loved ones.

In Guadalupe, the ritual is celebrated much like it is in rural Mexico.

“Here the people spend the day in the cemetery,” said Esther Cota, the parish secretary at the Our Lady of Guadalupe Church. “The graves are decorated real pretty by the people.”

Complete Article HERE!

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How We Can Learn to Grieve in Public

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francisco-ruela

I was in my dorm lobby when I returned my mom’s call. While the news I received wasn’t incredibly unexpected, I felt tears well up in my eyes before she had even finished her sentence.

“Gramp is dying, honey. They don’t expect him to make it through the night. I’m so sorry, baby.”

It was nearly 8 p.m. on a Tuesday, and home was an hour away. To make my mom leave her father-in-law’s bedside to pick me up didn’t seem like the right thing, even though she was more than willing. I asked if I could say something to Gramp. When my dad got him onto the phone, though he was barely conscious, he managed to utter the words “I love you, Kelsey,” clear as a bell.

When I hung up the phone, puffy-eyed and alone with my sadness, I caught the elevator to get to my room. To my dismay, two other girls entered the lobby and walked toward the elevator. Instinctively, I began to compose myself, wiping running makeup, blotting away tears, and avoiding their gazes once they got onto the elevator. Though I thought little of my actions at the time, my mind having been elsewhere, I now see how the need to hide grief is such a constant and conditioned phenomenon of the culture I live in.

Cheryl Strayed writes, “We are allowed to be deeply into basketball, or Buddhism, or Star Trek, or jazz, but we are not allowed to be deeply sad. Grief is a thing that we are encouraged to ‘let go of,’ to ‘move on from,’ and we are told specifically how this should be done.”

We have learned to welcome other sights that would once have been considered socially unusual on a college campus, or anywhere for that matter: belly shirts and low necklines, cursing, clear physical signs of alcohol and drug use, yelling and loud laughter—the list goes on and on. For some reason, though, when it comes to sadness, this must be a private affair, or done only with those with whom we are most comfortable.

Even more interesting is the realization that I had not hidden my tears on that elevator for myself—I wasn’t keeping my emotion hidden for me, but rather I composed myself and held back tears to avoid making these strangers feel uncomfortable.

Whether our reasons for concealing sadness and grief are selflessness or self-preservation, it is odd that this kind of emotion makes us so uncomfortable in public settings. My tears were fine, even expected when my family said a prayer together at the funeral home. It is as if we are expected to allow ourselves to mourn for those two days of rituals, but to leave our tears in the church and emerge back into the world of the living seamlessly.

When kind friends, acquaintances, and even professors did check up on me and acknowledge my loss in person, it always amounted to a “How are you doing?” with a look that lingered a little longer than usual. But actually addressing the loss in public is almost never done. This, we feel, could make a sad person upset in public. Unthinkably, my cover would be blown and lots of people would be made uncomfortable because of me.

All around us, every day, people are grieving something. It is often something much bigger and more heart-wrenching than what I’ve experienced, like the loss of a parent, sibling, or even a child. It may have happened last week or it may have happened five years ago, but pain has no time constraint. There are moments when a loss of years ago can feel as fresh as if it had occurred yesterday. When we avoid emotional expressions of grief, struggling people are left in solitude when what they may actually want is support.

We need to stop being made so uncomfortable by public displays of emotion. Often, even in the presence of close friends, we hide pain and try to appear OK, putting on a composed face to protect our own vulnerability and others’ comfort. But we cannot always be OK, and we need to stop convincing others and ourselves that this is the case. It is OK to not be OK. We need to allow each other sadness, wherever and whenever we need to express it.

Complete Article HERE!

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Why I Decided To Become A “Death Doula” At 33

By Christine Colb

[E]vi Numen, 33, of Philadelphia, could be considered a little death-obsessed. She’s the curator and founder of Thanatography.com, a site that showcases the work of visual artists exploring the themes of death, grief, and loss. Previously, she worked at the Mütter Museum, known for its collection of medical oddities and pathological specimens, such as presidential tumours, murderers’ brains, and books bound in human flesh. She has also recently added a line to her résumé — she’s a “death doula” in training — one of the first in the United States.

Evi Numen
Evi Numen

Numen can be excused for being a little morbid. When she was 20, she survived a car accident that killed her partner on impact. Earlier that night, he had told her he was going to propose. While in the hospital recovering from her injuries and raw with grief, she kept asking if she could see his body in the morgue. “I needed to confront his death to truly believe it,” Numen says. “My doctors thought I couldn’t take the sight of him, dead and broken, but to this day I believe it would have helped. Seeing him in his coffin during the funeral a week later felt staged and artificial.”

Last April, when her late partner’s father was in rapid decline with cancer, Numen rushed to his side. “I held his hand, listened, and talked to him when he could, and also allowed his loved ones to take a break from the bedside. What I couldn’t do for my partner, I tried to do for his father.”

A large part of the assistance Numen provided was for his family. “I had to remind them it was okay to take care of their own needs. I couldn’t “fix” anything, but I could bring food so it was there when people needed it, or stay by the bedside and encourage family members to go for a brief walk to get some fresh air.”

Caregivers [of the dying] often need to be ‘given permission’ to care for themselves properly.

 
After her partner’s father died, Numen knew she had found her new calling. She did some research and found the International End of Life Doula Association (INELDA). “Immediately, I knew this was the right next step,” says Numen. Cofounded by former hospital social worker Henry Fersko-Weiss in February 2015, INELDA trains people to provide emotional support for the dying — and their family members. Ferko-Weiss was inspired by the concept of doulas who support a mother and her partner during pregnancy and childbirth. “I kept seeing people die in ways that I thought were unfortunate or even tragic. I was trying to figure out how to change that. To me, the principles and spirit and techniques of birth doulas could be interpreted and adapted for the end of life,” says Ferko-Weiss.

A certified death doula can help not only the dying person, but will assist their loved ones throughout the entire death process, from coming to terms with mortality weeks or even months before the death to remembering and memorialising their loved one after passing.

Numen took a 22-hour training with INELDA and has logged more than 20 hours of volunteer training at two different area hospices. She’s been coached to become familiar with the physical changes the body goes through directly preceding death — and in helping comfort and counsel the dying person and their family from the point of a terminal-illness diagnosis all the way through even a year after a death. “I think many of us have the tendency to be problem-solvers and try to offer solutions to someone who is hurting, but there is no solution to dying,” Numen says. “It is easy to develop the habit of offering platitudes to such a situation, such as, ‘This too shall pass.” But that’s not actually comforting to a grief-stricken person. I know this from my own experience. Instead, I serve as an active listener, letting the other person really talk about all their conflicting emotions.”

Numen says that one of the most fascinating parts of her training was learning how to recognise when the person is “actively dying.” “Most of us know what the birthing process is like — foetal development, labor, contractions, water breaking, and such are fairly common knowledge in the Western world. Yet very few of us know anything about what it looks like to die: Your appetite decreases, your skin changes colour, breathing sounds different. There is a huge discrepancy in how we view the two ends of human life. It is easy to see how such ignorance about death can lead to avoidance and fear.”

Numan had asked the nurses at a hospice where she was volunteering to call her if they needed someone to keep vigil for an imminently dying patient, especially if their family couldn’t be there. “My objective was to be with the person who needed me the most,” she says. She was called to the bedside of an elderly man in end-stage pulmonary disease. He had no family present and was unable to communicate. She was his sole companion in his final moments. She knew from her training that he only had a few hours of life remaining.

Over the course of seven hours, Numen played Clint Mansell, Erik Satie, Rachmaninoff, and Chopin on her iPad as she sat by the man’s bedside and watched him breathe. “His breath cycles grew further and further apart, but only by seconds, which to me felt like minutes as I found myself holding my breath with him,” says Numeb. “I knew he was very near. Within an hour, his breath got steady but oddly mechanical, more like a reflex than an action, and then the next inhale never came. I called the nurse and she confirmed the death. It was easier and more peaceful than I thought it would be, and yet it affected me more than I expected. I had, after all, trained for this, read about it, and kept vigil to other dying patients, but his passing was the first I had witnessed.”

Despite all her preparation, Numen was so deeply affected by the experience that she had to skip her next scheduled shift. “Being there for that man, when no one from his family was able to, affected me more than I thought it would,” she says. “I didn’t cry — I felt it wasn’t my place to, like I was just a stand-in for his family. There is a weird sense of intruding, especially when keeping vigil for complete strangers, that I have not been able to reconcile yet.” It also had a personal resonance for her. “Witnessing a death brought up the other losses in my life, and I had to honour these emotions before I could return to keeping vigil for someone else,” Numen explains.

Witnessing a death brought up the other losses in my life, and I had to honor these emotions before I could return to keeping vigil for someone else.

 
Despite her unanticipated reaction, she is even more committed to her calling of caring for the dying than she was before. “It wasn’t gross or scary, but it was certainly difficult. Every death will be different, and maybe it will get easier or less nerve-wracking, but it will not get any less worthwhile. Even if I never get to talk with the patients I attend to, knowing that I brought some small amount of comfort is enough.”

She’d also like to see more people become comfortable with ageing and the dying process. In a culture where ageism is rampant, Numen has found that learning about the end of life has actually made her less apprehensive of getting older — and the inevitable end. “Most of the patients I’ve seen close to death were peaceful and tranquil. They seemed comfortable and had this beautiful glow about them, this serenity that I didn’t expect to see. I’m still fearful of sudden death and the suffering of prolonged illness, but not of the dying itself.”

Numen also hopes that more family members will recognise that a death doula can be an option that can bring enormous comfort in someone’s final moments. “It’s about regaining control over an uncontrollable process,” she says.

Complete Article HERE!

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Talk about death with your loved ones before you think you have to

Our way of dying is not sustainable.

BY MARINA SCHAUFFLER

“I could see that they were slowly leaving the sphere of TV commercial old age… and moving into the part of old age that was scarier, harder to talk about, and not part of this culture.”

– Roz Chast, “Can’t We Talk about Something More Pleasant?”

A chalkboard "bucket list" stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.
A chalkboard “bucket list” stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.

It’s a topic we avoid at all costs: the inevitable descent each person makes from that American ideal of youthful independence to frailty and death. Fearful of following that path ourselves, we resist discussing it – even as loved ones venture closer to that inescapable end.

In recent decades, American culture has opened to permit candid conversations about many topics once off the table – from gender identity and racism to addictions and disorders. But when it comes to end-of-life discussions, there’s still strong resistance. Those who seek to live sustainably can find that challenge enough, without facing what it might mean to die with integrity.

Many societal undercurrents reinforce our resistance. With urbanization, ties to the natural world have grown tenuous and we witness the life-death cycle less frequently. When we do, it’s often on screen – far removed from our daily reality.

Countries like Mexico and Poland hold collective rituals that help normalize the inevitability of death, but Americans prefer Memorial Day picnics, parades and summer-season sales. Our commercial culture worships youth and novelty, while portraying old age as a protracted talk with your doctor about pharmaceuticals.

Advances in medicine lend hope that we might keep death at bay, an illusion many doctors reinforce. “Our decision making in medicine has failed so spectacularly,” surgeon Atul Gawande writes in Being Mortal, “that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.”

Our cultural resistance to discuss life’s end causes widespread suffering for the dying, depriving them of what Gawande calls the right “to end their stories on their own terms.” Pressured both by medical personnel and by family members, patients can spend their final weeks in Intensive Care Units, swathed in tubes and surrounded by strangers. Even though 80 percent of Americans would prefer to die at home, only about 20 percent today do.

Denying dying people the chance to take what control they can has far-reaching repercussions for family members – who can struggle for years with the death’s emotional, spiritual and financial aftershocks. Many of them experience a sense of lingering regret over lost opportunities for connection in the final days, and some cope with debilitating medical bills. A quarter of households in one study had medical expenses in the five years before a member’s death that exceeded their total household assets.

Costly late-life medical interventions drive up health care costs, straining the budgets of families, businesses and government. Roughly 30 percent of all Medicare expenditures go to the 5 percent of patients in their last year of life.

We cannot afford to continue along this path; it is not sustainable by any measure.

Fortunately, the culture is starting to shift – aided by Gawande’s book and resources like The Conversation Project and Death over Dinner. These efforts address the gap between the 90 percent of Americans who acknowledge they should have end-of-life discussions and the meager third who do.

Columnist and author Ellen Goodman was among those who launched The Conversation Project in 2012 after realizing she’d never had those crucial value discussions with her own mother while there was time. People postpone these talks, Goodman told me, “feeling it’s ‘too soon.’ What we’ve learned is it’s always too soon until it’s too late.” The opportunity is lost once someone lands in the Emergency Room, ICU or Alzheimer’s care facility.

People envision end-of-life talks primarily with elderly parents, but they should occur among all adults. Despite initial reservations, many people find that these dialogues lead to warm exchanges and what Goodman calls the sharing of “deep family stories.”

Even in close-knit families, the responses of loved ones may come as a surprise. People often express desires “besides simply prolonging their lives,” Gawande writes, prioritizing concerns like avoiding suffering, bonding with family and friends, and remaining mentally alert. Contemplating the end of life can help us clarify what matters most – not just when time becomes short, but every day.

Ideally, these heartfelt exchanges lead to completing paperwork that can help guide family members and medical practitioners. The Conversation Project recommends that individuals authorize a medical decision-maker; complete an Advanced Health Care Directive (templates can be found online), and discuss end-of-life wishes with their health care provider. Medicare recently began compensating doctors for time spent having these discussions. Those who are at a late-life stage may also wish to complete and post a Do Not Resuscitate (DNR) form.

One of the many benefits to initiating these dialogues early, Goodman notes, is that it can help family members agree to back the patient’s wishes. Absent that consensus, relatives can unwittingly make the process harder for a dying person through their own resistance to letting go. Roz Chast captures this poignant dynamic in her graphic memoir, portraying how her mother – facing her husband’s impending death – challenged the “defeatist attitude” of hospice and asserted “I told Daddy he was coming with me to 100 if I had to drag him kicking and screaming!”

The prospect of death – whether our own or that of a loved one – is inescapably fraught with fears and uncertainties. It’s easy to see how we’ve drifted into a kind of denial, and slipped into medically managing the end of life despite crippling personal and societal costs.

We owe it to ourselves and each other, though, to discuss what matters most in our waning days. Having that dialogue with loved ones could help us remain authors of our lives through the closing chapters.

Complete Article HERE!

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The transition from curative to palliative care

from-curative-to-palliative-care

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[K]athryn Martin, registered nurse and Faculty Lecturer in the Faculty of Nursing, doesn’t attend the funerals of her deceased patients. But she knows nurses who do.

“You become quite close with the families,” Martin says. “It’s okay to have feelings about the situation. I respect other nurses attending funerals, but I personally don’t (attend). It’s important to set your own boundaries.”

Martin says decades of working in the intensive care unit have made an impression on her. The ICU is a hospital unit dedicated to treating patients with severe and life-threatening conditions. She remembers cases from years ago with vivid detail, and feels she has made a difference in the lives of her patients.

Nursing is a complex and dynamic profession. RNs work with patients and families around the clock, and are often advocates for patients and their families. Nurses advocate for time, information, increased pain medication, spiritual services, and any other needs families may have.

One of nursing’s significant challenges is transitioning patients with life-limiting illnesses — illnesses in which death is the expected outcome such as cancer, heart disease and dementia — from curative to palliative care. The goal of curative care is to modify a disease, either through management or working towards a cure. It can involve intense medication regimens, 24/7 nursing care, repeated hospital stays with limited visiting hours, and it isn’t often provided at home. Palliative care, alternatively, focuses on comfort as opposed to modifying or curing a life-limiting condition. It is provided both at home and in health facilities such as long term care centres or hospitals. Common aspects of palliative care are reduced invasive procedures and increased
pain medications.

When the transition between curative to palliative care goes well, the grief impact on families is minimized and the work experience can be satisfying for health care professionals. When it doesn’t, many walk away with feelings of hurt, failure, and of letting loved ones or patients down — people close to patients often interpret the transition as medical professionals letting patients die. An article in the Journal of Palliative Medicine reports that during the five years previous to 2012, at least half of the physicians surveyed had experienced a patient’s family members, another physician or another health care professional describing their palliative methods as “euthanasia, murder or killing.”

“Transitioning from curative to palliative care is anything but a static process,” says Kristin Jennings, an RN experienced in palliative care. “Unfortunately, (to some) it feels as though our medical system gives up hope.”

In spite of treatment that can be harsh, palliative care is not diagnosis-centred, but person-centred care. It focuses on the needs of all key players: patients, families, caregivers, and loved ones with hopes of creating the most possible value in a person’s last days, weeks, or months. It is a broad category, encompassing anything from the removal of life support to increased pain medications.

The increasing prominence of palliative care in the past decade is a marker of change in medical thinking towards a more holistic model of care. Palliative methods are now initiated much earlier in treatment than they have been in previous years and are starting to be provided concurrently with curative methods. Comfort matters, and it matters throughout the entire experience of illness.

“In an ideal world, palliative care would be initiated when an individual is diagnosed with a life-limiting illness,” Jennings says.

The value of a “good death” is frequently discussed in health care literature and public media. Value lies not only in how we live, the arguments go, but also in how we die. A good death can mean a week on the beach with loved ones — it can also mean minimizing time spent breathing with a ventilator. The scope of end-of-life care is broad, but value can be created in both situations and all in between.

“There are only two things we can guarantee in life: birth and death,” Jennings says. “The processes of being born and dying are dynamic and unique experiences that deserve equivalent amounts of respect, care, compassion and love.”

“Death has the potential to be a beautiful experience.”

Jennings chooses to attend patient funerals — she says they keep her humble.

“I get to share grief, see an individual’s beginning, middle and end, and see how many people were impacted by their life.”

The most crucial factors in a smooth transition between levels of care are time, information, and communication. Martin says she’s seen physicians give families three to seven days to process information in the smoother transitions she has participated in.

“Lack of time is the worst thing that can happen,” Martin says. “Resistant family members need to be able to ask questions. You need to take any and all questions. You need lots of people to interact with resistant family members and provide consistent information over those days.”

When a transition is abrupt, key players feel they are letting their loved ones down. Family meetings, multiple conversations with care providers, and openness to questions are all necessary.

“(Relatives) feel they are letting their loved one die … They need lots of information about the pathophysiology of what is going on,” Martin says.

Second-year nursing student Olivia Roth says she most likely will attend the funerals of her patients.

“Attending funerals will allow me to grieve, and make the process feel full circle,” says Roth.

Roth had an “eye-opening” experience caring for a palliative patient in her first year.

“It really transformed the way I thought about nursing … It was hard for me to understand that switching from curative to comfort measures would allow her to die with dignity,”Roth says.

Palliative care can also be provided in final moments when an individual is dying suddenly, or after a short period of illness.

When a patient dies suddenly, or without a period of anticipation by the family, there are greater feelings of loss than when a death is foreseen. Family members and other loved ones experience increased stress and higher rates of morbidity in the two years following a sudden death.

Loved ones sometimes turn to requests for potentially inappropriate treatment. Potentially inappropriate treatments are those that may have a small chance of treating the patients, but ethical considerations justify not providing the treatment. Some examples of potentially inappropriate treatment could be extended intubation, or life support beyond a reasonable timeframe.

Responding to requests for potentially inappropriate treatment can create moral, ethical, and legal dilemmas for health care professionals. Potentially inappropriate treatment can include ICU stays when prognosis is poor. Intensive care unit stays are costly in terms of dollars as well as discomfort, and can cause potentially traumatic experiences. Forced intubation, intravenous and arterial lines, time spent breathing on a ventilator, and decreased ability to communicate all add to the dramatically uncomfortable experience of an ICU stay.

Finances are also considered. Health care professionals never hope to have a conversation regarding the ethical and financial benefit of keeping somebody’s loved one on life support, but public dollars are sometimes a factor to be considered in medical decision making.

“It’s important to consider resources,” Martin says of one of the hardest conversations professionals and families face. “Access to intensive care beds, nursing care, ventilators, medications … It’s all very expensive.”

Many health authorities have developed policies and timelines to facilitate transitions from curative to palliative care, and the denial of requests for potentially inappropriate care. One significant aspect of the grief experience can be anger towards professionals, but evidenced-based, health authority-wide timelines can lessen feelings of anger towards and abandonment by the health care team.

Along with the families of patients, health care professionals can also  walk away from end-of-life experiences with pain and grief.

“It’s exhausting, both emotionally and physically,” Martin says. “But when (the transition) goes well, it’s one of the most satisfying experiences you can have. You feel like you’ve made a difference.”

Complete Article HERE!

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Why Millennial Women Need To Start Talking About Death

By Sara Coughlin

casket

[M]y mother once told me a very sweet story about how I, as a toddler, handled my grandmother’s death. After the funeral, my mom asked me if I knew where Grandma had gone. I told her, as matter-of-factly as a 2-year-old could, that she was in a garden, surrounded by daisies (her favorite flower).

Even at such a young age, I’d developed a sense for the appropriate kinds of euphemisms for death — and I knew that sharing them would bring comfort to my mom. But that didn’t change the fact that my grandmother was dead — like, she was dead and buried and there weren’t any daisies in there with her, though I didn’t quite comprehend that yet.

It was actually much later, when I was 17 and attending another relative’s funeral, that the reality of death truly hit me. My uncle had died after being diagnosed with cancer way too late, and his passing was a real shock to the family. The memorial service was at his house in Virginia and the choir from his church sang some upbeat hymn about going where you were always meant to go. Listening to that, and knowing how he died, I thought, This must be a joke.

I bristled at the idea that dead people were anything other than dead. On one hand, I found it naive to think about death in such rosy terms, inwardly rolling my eyes at those who did. On the other, I believed that death was supposed to be frightening, and by rejecting the idea of an afterlife or deliverance I all but cemented that fear in my mind.

In other words, I gave myself two options: I could scoff at death or fear it wholeheartedly. Multitasker that I am, I decided I could do both.fear-of-dying

I found myself viewing death as two very different (and equally problematic) beasts — a hulking, dark thing that we only discuss in whispers and a lurking shadow that simply absorbs the rueful jokes we hurl at it.

Neither of these images get death quite right, but there I remained, with death constantly on the brain. For fear of seeming morbid or like a total downer, I kept most of my thoughts about death and dying to myself. Yet, a question nagged at me — Was I alone in feeling this way?

The urgency of that question has only increased over the course of this year. That’s why, this fall, R29 conducted an informal survey about death, to which more than 300 people, mostly millennial women, responded.

Nearly half of all respondents said they learned about death by the time they were 5 years old, citing such sources as dead pets, 9/11, Mufasa, and, like myself, the death of a loved one. They grew up believing that the deceased ended up in God’s arms, went to heaven, took on another earthly form, or were left to fade into nothingness.

Regardless of their foundational experiences with death, most people still think about it — and in a small, strange way, I found that comforting. “Ever since turning 30, I think about death every couple hours,” one person wrote. “It’s almost the only thing I think about,” wrote another.

The thing is, most people don’t simply fear death or laugh at it. Instead, people describe how they use death to interrogate their religious beliefs, take stock of their health, and motivate themselves to spend time with distant, elderly loved ones.

Many said they hope they’ll die quickly and at an advanced age. Some alluded to suicide attempts (If you’re experiencing suicidal thoughts, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Suicide Crisis Line at 1-800-784-2433.) or an unshakable conviction that they’ll die young. One person qualified their acceptance of death like this: “I deeply fear dying, but don’t fear death.”
the-more-i-learnIn total, 71% admitted to having imagined their own death.

I’ve been turning that number, 71%, over and over in mind my since first seeing it. For one thing, it answers my question: I’m anything but not alone in constantly thinking about death. It also makes me regret that we didn’t ask how many of them ever told anyone about imagining their own death. I wonder how much higher or lower that number would be.

Here’s what I want to tell everyone who thinks about death on the daily: You’re not morbid. You’re human. And you don’t have to keep those thoughts to yourself. After all, chances are, most other people are thinking them, too — and death is neither a beast nor a shadow.

It’s something that informs and gives meaning to how we live. As one person put it: “The more I learn about death, the less I fear it.”

Welcome to Death Week, in which we’ll attempt to unpack our feelings, fears, and hang-ups about death, dying, and mourning. We’ll do our best to leave no gravestone unturned.

Complete Article HERE!