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How To Tell The Difference Between Sadness, Grief, And Depression

By Amy Marturana

The emotions are closely connected, but there are key differences between them.

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We all know what it’s like to feel sad. Sadness is a standard human emotion. It looks different for different people and in different situations, but we all experience it regularly, maybe some of us more vividly than others.

Robin Dee Post, Ph.D., a recently retired clinical psychologist with over 30 years of experience in private practice, tells SELF that sadness is actually a desirable and necessary emotion. “It’s an emotion we sometimes think about negatively and it actually is not, it’s a very adaptive feeling.” Being sad allows us to deal with painful experiences and loss. It can be cathartic and relieve tension. “It also aids in empathy for ourselves and what we’re going through, but it’s also an emotion that can help us access other people’s pain and suffering,” Post explains.

Sadness is also one feature of depression—they’re closely tied, but not exactly the same. Being sad is normal and healthy and will pass; depression has a negative impact on your life and needs to be addressed to get you back to a happy, healthy, functional place again.

If your sadness lasts more than two weeks and is accompanied by other warning signs, it may mean it’s more than just that.

“Mood disruption for two weeks or longer,” is one diagnostic criteria for depression, Post says. The key is whether or not that sadness is paired with other factors of depression—loss of energy, trouble concentrating or making decisions, difficulty sleeping, disruption in eating patterns, feelings of hopelessness, worthlessness or thoughts of self harm.

Depression is also marked by a loss of pleasure in life and activities that once made you happy.

Loss of interest in things that normally excited you, or the inability to find pleasure in any way outside of the thing that’s saddening you, is a red flag. “You could be sad but still feel pleasure about something,” Post notes. “Depression is a pervasive lack of pleasure in things you’re doing.” This can also manifest in social withdrawal.

There’s a fine line between grief and depression, but for those predisposed to depression, it can be a slippery slope.

Grief is a normal reaction to a tremendous loss. If you lost something or someone important, it’s expected for you to be stricken with grief for a long time—much longer than the two-week criterion for depression. And chances are, you won’t find too many thing exciting or interesting or pleasurable, depending on how you grieve and what stage you’re in. “We can’t just amuse somebody out of their grief,” Post says. Many people can and should turn to counseling in a time of loss—it’s a way to help you sort out how you’re feeling and learn the best way to cope.

If you think you might be depressed, you should seek counseling—which can be helpful even if you don’t come out with a clinical diagnosis.

If you’re grieving for a long time and it’s disrupting your life, or if you are struggling to cope with another type of sadness or stress and you’re noticing it’s affecting you physically (you’re not eating, losing weight, not sleeping or sleeping all the time), it’s a good idea to seek professional help. Meeting with a therapist can be useful for identifying coping strategies and working through complex emotions, whether you’re depressed or not. For some people, grief and sadness can segue into major depression. “Depression comes with a biological vulnerability, so not everybody who is sad or grief-stricken will morph into depression,” Post notes. For those who do, it tends to be recurrent, “so it will happen more than one time.” If you know you’re prone to depression and have been treated for it in the past, don’t wait until things spiral. Talk to a mental health professional when you are deeply sad or consumed by grief to keep yourself afloat during the most emotionally challenging times.

Complete Article HERE!

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Understanding Muslim funeral practices

By Susan Shelly

Elsayed "Steve" Elmarzouky walks through the area dedicated to Muslims in Laureldale Cemetery.
Elsayed “Steve” Elmarzouky walks through the area dedicated to Muslims in Laureldale Cemetery.

Most people know little about the religious practices of those of other faiths.

Lacking interest, opportunity or sometimes both, we miss out on the significance and beauty of the rituals and ceremonies others use to acknowledge birth, coming of age, marriage, the process of aging and death.Muslims, of which there are about 250 families living in Berks County, have certain beliefs and observe certain practices when a member of their community dies.

Iman Anwar Muhaimin, who travels from Philadelphia to lead prayers at the Islamic Center of Reading each Friday afternoon, along with Elsayad “Steve” Elmarzouky, a Berks County Muslim leader, shared some information about Muslim funeral practices and beliefs regarding death and the afterlife.Understanding that, as with most religions, customs will vary depending on cultural differences, they described what typically occurs after the death of a faithful Muslim.

Preparing a body for burial

When an observant Muslim dies, the body normally is taken to a funeral home to be washed and prepared for burial. Locally, Elmarzouky said, bodies are taken to one of the locations of Bean Funeral Home and Crematory.

Family members or members of the mosque who are trained in the ritual washing of the dead perform that task. Men wash men, and women wash women.Muslims do not cremate the deceased, Muhaimin explained, because they believe that the body should be returned to God in the same state in which it was given.”God gives me the body, so I need to give it back to him,” Muhaimin said. “The idea is that the body is God’s gift to you, so you should give it back to God.”If cremation is necessary due to financial or other circumstances, however, it is permissible.”When we have to do something out of necessity, God understands,” Muhaimin said.

The burial of a Muslim

Once the body is prepared for burial, it is taken in a simple casket to the mosque, where believers can pray over it. A special prayer, called Salatul Janazah, is performed, and the body is taken to the cemetery for burial.

Muslims normally are buried with other Muslims. In Berks County they do not have a cemetery designated exclusively to members of their faith, but use a designated section of Laureldale Cemetery.In cemeteries where caskets are not required for burial, a faithful Muslim would be buried in a simple, white wrapping, Muhaimin explained.”We want to be as close to the way we came into the world as possible,” he said.Believers are called to put the body of a loved one in the ground with their own hands, so shovels often are available at the cemetery.Before the body is placed in the ground there are more prayers, mostly supplications on behalf of the deceased, Elmarzouky explained.”We ask God to forgive sins and grant a happy afterlife,” he said.When the body is placed in the ground, it is positioned so the face is looking to the East, the same direction in which Muslims face while reciting daily prayers.Usually, a Muslim is buried on the same day as the death occurs, or at least within 24 hours of the death.That practice, explained Muhaimin, is so the soul, which has been released from the body, is not looking back.”Once the soul leaves, we no longer have the right to hold it back,” Muhaimin said.

Muslim belief in an afterlife

The span of human life is part of the journey of the soul, Muhaimin said, but not the soul’s home.

“The soul is just passing through when it’s on Earth,” he said. “The purpose of earthly life is to gain enlightenment. It is not the end.”Muslims believe in heaven and hell, and where a person will reside depends on several things, Elmarzouky explained.To arrive in heaven, the deceased must have performed good deeds while alive. His or her relationship with humanity will be examined. And, the fate of the deceased lies largely with the mercy of God.Like many Christians, Muslims believe there will be a day of judgment, during which the righteous are raised up to be with God and the wicked sent to hell.A person who has lived a godly life will be rewarded with heaven, Muhaimin said.”Believers and righteous people who have lived in spiritual covenant with God will be in heaven,” he assured.

Complete Article HERE!

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Push To Take End-Of-Life Forms Digital Reveals Complicated Path Ahead

By Karen Shakerdge

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The top portion of a paper MOLST form. It says, “The patient keeps the original MOLST form during travel to different care settings. The Physician keeps a copy,” on all four pages.

Dennis Rodgers flips over a bright pink piece of paper and rattles off his choices:  “Attempt resuscitation or do not attempt resuscitation… to do limited intervention or to take no medical intervention… and another section, whether to intubate or not to intubate.”

Rodgers, 82, says he and his physician filled out the form together when he moved to a community outside of Rochester, N.Y.

For years physicians in New York state have asked seriously sick patients to fill out this paper document, capturing their wishes in case of emergency.

Most Americans don’t plan ahead for end of life. But for those who do, like Rodgers, there’s a risk that the right people won’t even see the document when it really matters. After all, a piece of paper is easily lost or left behind in an emergency.

Advocates and lawmakers in New York are now pushing to shift the paper system to a mandatory electronic database for better access. But the requirement would call for a technology fix that’s not coming easily.

Most states have some version of these documents, typically called a Physician Order for Life Sustaining Treatment, or POLST. In New York state, the form is called MOLST. It stands for Medical Order for Life Sustaining Treatment.

Unlike advance directives, the MOLST form is a detailed legal document, prepared with a physician. MOLST forms are not meant for the general population. They’re meant for patients who physicians suspect may die within a year.

Without a POLST-like form, physicians or paramedics are trained to keep someone alive including aggressive life-sustaining treatment, if need be.

Nearly everyone benefits if patients make their medical wishes clear. Patients make sure they’re not subjected to measures they don’t want. Family members don’t have to wonder. And insurance companies can save money.

End of life care is one of the biggest medical expenses in our health system. About a quarter of traditional Medicare costs are for expenses patients incur in their last year of life, according to a report from the Kaiser Family Foundation.

“The majority of states right now have a POLST process. The question is how effective is that process if I can’t get access to that as a health care provider?” asks Rick Bassett, chair of the national POLST technology committee.

A handful of states have established electronic databases for these forms — eMOLST is New York state’s version. Lawmakers are considering a bill that would require doctors to submit an electronic version when they fill out a hardcopy within 14 days.

In theory, this would ensure access to the form no matter which clinic or hospital a patient may end up in during an emergency, explains Patricia Bomba, vice president and medical director of geriatrics at Excellus BlueCross BlueShield and director of the MOLST program.

“It just is the better way to do it,” she says.

Excellus currently funds the MOLST and eMOLST systems, 100 percent.

But even the electronic solution has its own problems to work out.

“Even if you fill out one of these forms — having it actually pop out in front of the right person at the right time has been a really big challenge,” says Kirsten Ostherr, a Rice University professor focusing on health and medical digital media.

There are major access issues, Ostherr says, in general, when it comes to electronic medical records. For one, different hospital electronic record systems don’t link to each other or to the E-MOLST database, which is separate. And outside providers, like paramedics don’t usually have access to these systems.

The current eMOLST system is just not accessible for busy doctors, explains Daniel Mendelson, director of palliative care and associate chief of medicine at Highland Hospital in Rochester.

“Expecting a medical provider to look in their own record is reasonable. Asking them to look at an outside record and multiple outside records is probably not going to happen,” he says.

Mendelson was on the original team that developed the paper MOLST form in New York. He’s a self-described “power user” and embraces technology. But he doesn’t use eMOLST because it doesn’t directly connect to the system his own hospital uses for patient information.

For his own father, he trusts the paper form more than the eMOLST system.

“It’s not that people are not hardworking and well meaning, but how many tasks can you load somebody with in an emergency?” Mendelson asks.

At least two hospitals in New York state have successfully developed a direct connection between an electronic health records system and eMOLST.

The in-house information technology team at NYU took a few months to work on the connection, start to finish, according to Christine Wilkins, advance care planning program manager at NYU’s Langone Medical Center.  Providers can use one password to sign on and view medical records and a patient’s eMOLST.

Wilkins says they hope the easier to use technology will help doctors start using eMOLST more. And that will ultimately benefit patients.

“It’s about having a more robust conversation, but then, it’s having a much better way to document what their wishes are. And for that documentation to be seen across the board,” Wilkins says.

Another hospital, Orange Regional Medical Center, in Middletown, N.Y. also established single sign on for its providers earlier this month.

Currently, the eMOLST system has roughly 10,000 patient files, according to Katie Orem, eMOLST administrator at Excellus BlueCross BlueShield. That’s about 10 percent of New York state residents who die from chronic disease every year, she says. If the bill passes, New York would have a statewide database.

Complete Article HERE!

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Assisted death was ‘incredibly positive,’ says family of Alberta’s first patient

By Shawn Logan

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[A]t the end, Hugh Wallace still remembered there were 43,560 square feet in an acre.

Surrounded by family on April 19, just before a lethal cocktail was administered to legally end his life, making him the first Albertan to do so in this province, his son asked him the question he feared he may one day not be able to answer.

“Hugh always said if he got to the point where he couldn’t remember how many square feet were in an acre, he didn’t want to go on,” said his widow, Evie.

“At the end, he scored the winning goal in the last second of play.”

Alberta Health Services this week revealed 31 Albertans have so far been granted physician-assisted deaths, two dozen of those coming after the federal government lifted the legal prohibition against the practise in June, following a 2015 Supreme Court ruling.

Wallace, who at 75 had endured a quarter-century of multiple sclerosis before contracting aggressive lung cancer, was an engineer, and at his heart an uncompromising pragmatist, said Evie, who has since become an advocate for assisted death, speaking around the province.

“He wanted to go out with his brain intact,” Evie said.

“He didn’t want to go out in a coma, with a catheter and wearing Depends. That wasn’t him.”

Wallace, like a handful of trailblazers before him, had gone before the courts earlier this year seeking an exemption against the law outlawing assisted death in the Canadian Criminal Code.

In February, Hanne Schafer became the first Alberta woman granted the legal right to take her own life, but, after struggling to find a doctor in her own province, had to go to B.C. for the procedure. A second Alberta woman also went to B.C. to have a doctor assist in her death after a ruling in May.

But Wallace was able to find an Alberta doctor willing to help him die on his own terms, opening the door to others seeking the same release. As of Tuesday, the lead for medical assistance in dying preparedness for AHS, Dr. James Silvius, said two to four patients a week are taking advantage of the service, numbers he admits are somewhat surprising.

Evie said though her husband was suffering in the waning days of his life, he found some comfort in being able to have some control of how he passed on.

“It was an incredibly positive experience,” she said. “He was able to say his goodbyes to everybody and the doctors were fantastic. They were amazing human beings.”

Evie added the doctors involved in his care had meetings with both family and Wallace privately to ensure there were no signs of coercion before he underwent the procedure.

While her family’s experience was positive, the 73-year-old widow noted those who choose assisted death need to make sure everybody’s on the same page, and there are no lingering issues to resolve.

“It’s something for people to really look at their family dynamics before they go through with this,” Evie said.

“If there’s a lot of unfinished business in a family, it’s fertile ground for explosions.”

After 51 years of marriage, Evie said she is left with wonderful memories of the man she deeply loved, and not a shadow of regret about watching Hugh end his own life.

“At the end, we didn’t have any tears left in us. It was a good day.”

Complete Article HERE!

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Will People Of Color In California Use The Aid In Dying Law?

By Ja’Nel Johnson

assisted-dying

Death was a topic that wasn’t discussed in Adrienne Lawson Thompson’s home growing up. The Los Angeles native says it was such a taboo topic, that her own mother didn’t even reveal what illness she was stricken with before she died.

“She didn’t want to disclose things to me because ‘Oh, you’re young. I don’t want to be a burden to you. You have your children, recently married.’ And we don’t look at it that way, as being a burden,” Thompson says.

She believes not talking about death is pretty prevalent in the African American community. And when faced with death, many African Americans lean on their faith.

“Trust in your faith that if God will heal you, he will heal you,” Thompson says.

And it’s that trust that may lead many African Americans not to participate in California’s End of Life Option Act.

“Very few have used the law that are Hispanic, Asian or Black,” says George Eighmey, president of Death with Dignity in Oregon. He says requests are generally made by people who are white and highly educated.

Demographics of Oregon's Death with Dignity Act Recipients.
Demographics of Oregon’s Death with Dignity Act Recipients.

In Oregon, between 1998 and 2015, 97.1 percent of participants were white, according to the Oregon Health Authority.

Last year in Washington, 98 percent of participants were also white, according to the Washington Department of Public Health.

But while Oregon and Washington have largely white populations, California’s demographics are much different. Latinos are 39 percent of the population and Asians and African Americans make up 15 percent and 6 percent of the state’s population, respectively.

“Our demographics are really, very different and we don’t know yet who is going to be asking about this option with the intent of participating,” says Lael Duncan, medical director of consulting services at the Coalition for Compassionate Care of California.

Britta Guerrero, executive director of  Sacramento Native American Health Center, says when members of her community face terminal illness, trust in their culture and their own healers is also important.

“We would seek maybe to see a medicine person and try to receive doctoring from a cultural perspective, a spiritual perspective,” Guerrero says.

In addition to these cultural and spiritual differences, there’s also the country’s history of using people of color for medical experiments.

Between 1973 and 1976, the US government sterilized 3,406 American Indian women without their permission.

“I think we have a long-term distrust for the medical and health care system,” Guerrero says.

CynthiaPerrilliat, executive director of Alameda County Care Alliance, says trust in the health care system is also a major issue in the African American community due to medical experiments like the Tuskegee Study of Untreated Syphilis in the Negro Male.

“Black men that had syphilis not being treated, the role that the government, quote, unquote, had to play in that, the role of the health system in that,” Perrilliat says.

It’s too early to tell whether this dark history will affect minority participation in the End of Life Option here in California.

The Department of Public Health will release a report on participation in the law, including a racial and ethnic breakdown, next summer.

Complete Article HERE!

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A publicly funded hospital can’t refuse assisted death

By Ottawa Citizen Editorial Board

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[D]uring the bleakest, most vulnerable period of their lives, terminally ill patients should be able to count on top-notch care and generous doses of compassion. But in one key area, Canada’s Catholic hospitals are letting them down.

At St. Paul’s Hospital in Vancouver, a dying 84-year-old patient who had requested a medically assisted death was required to go to another hospital, and his last day was pure agony as an ambulance shuffled him between institutions. St. Paul’s would not even permit him to be assessed for assisted death on its premises.

Catholic health providers across the country have said that while medically assisted dying is now legal, their faith does not allow them to participate. “These organizations neither prolong dying nor hasten death, and that’s a pretty fundamental value for them,” says the president of the Catholic Health Alliance of Canada.

We have argued before that individual choice must be the over-arching principle behind assisted dying decisions. While, in accordance with strict legal rules, a patient should be able to request assisted death, individual medical practitioners should not be forced to provide it against their own ethics.

But individual rights don’t apply to publicly funded institutions. If no individual health care expert in a Catholic hospital will personally support a medically hastened death, the publicly funded institution itself must still find a qualified practitioner who will. Forcing those in pain and mental distress to leave the site in order to obtain even an end-of-life assessment is simply inhumane.

In Ottawa, the situation is particularly complicated for Bruyère Continuing Care, a Catholic facility. Although organizations that support Catholic health care don’t want even a conversation about assisted dying to take place there, the Bruyère is the only publicly funded, complex palliative-care option in this region. To its credit, it appears to recognize that it must be more flexible.

A Bruyère administrator told the Citizen that if a patient requested information, the facility would be bound to acquiesce. If the patient were too ill to be assessed off-site – which is likely in palliative cases – the assessment, at least, could be done without moving the patient.  Still, the person would have to transfer elsewhere to actually obtain a medically hastened death.

Provincial governments must step in – yet in Ontario, at least, regulations aren’t expected until 2017. Why should a publicly funded institution be permitted to refuse a service to the dying that is legal and that could be performed on its premises with considerably less agony than exiling the patient?

Force individual medical practitioners to end a life? No. Tell institutions to follow the law? Yes. A dignified ending shouldn’t be hostage to institutional beliefs.

Complete Article HERE!

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B.C. man faced excruciating transfer after Catholic hospital refused assisted-death request

By Tom Blackwell

Ian Shearer’s daughter, Jan, says she was surprised by his request for doctor-assisted death, but she realized that he was dying “a slow, painful” death.
Ian Shearer’s daughter, Jan, says she was surprised by his request for doctor-assisted death, but she realized that he was dying “a slow, painful” death.

Ian Shearer had had enough of the pain and wanted a quick, peaceful end, his life marred by multiple afflictions.

But the Vancouver man’s family says his last day alive became an excruciating ordeal after the Catholic-run hospital caring for him rebuffed his request for a doctor-assisted death, forcing him to transfer to another hospital.

The combination of the cross-town trip and inadequate pain control left Shearer, 87, in agony through most of his final hours, says daughter Jan Lackie.

“To hear him crying out, screaming … was just horrible,” said Lackie, breaking into tears as she recalled the day in late August. “That’s what keeps me from sleeping at night … I don’t want any other person to go through what he did.”

Shearer’s experience at St. Paul’s Hospital highlights one of the thorniest issues concerning assisted death: the decision of most faith-based —  but taxpayer-funded — health-care facilities to play no part in a practice made legal by the Supreme Court of Canada and federal legislation.

Ian Shearer and daughter Jan Lackie.
Ian Shearer and daughter Jan Lackie.

Lackie said the suffering her father endured shows why it is important that church-governed facilities, including dozens of hospitals, nursing homes and hospices across Canada, be required to allow assisted deaths within their walls.

“We have nine judges who said ‘Yes’ to medical assistance in dying,” she said. “I don’t understand how the Vatican has so much power, even here in Canada.”

But the bill that implemented the Supreme Court’s ruling in June does not oblige any institution to permit the practice.

And Catholic health organizations say their objection to assisted death flows from deeply held beliefs, while noting there are numerous other, less contentious procedures available at some facilities but not others.

“Life is sacred and the dignity of the person is important,” said Michael Shea, president of the Catholic Health Alliance of Canada. “These organizations neither prolong dying nor hasten death, and that’s a pretty fundamental value for them.”

Shaf Hussain, a spokesman for Providence Health Care, which operates St. Paul’s, said he could not comment on Shearer’s case specifically. But under a policy finalized this summer, he said, the Catholic organization arranges to transfer patients as comfortably as possible when they express a desire for assisted death.

Even the medical assessment required under the law and the signing of consent forms must take place outside Providence properties.

“All feedback we take very seriously,” said Hussain. “We’ll be working with our partners in the health care system to ensure the patients’ needs do come first … and to minimize the discomfort and pain.”

Shearer, a retired accountant originally from Calgary, suffered from spinal stenosis – a narrowing of the spine that can put pressure on the spinal cord – heart disease, kidney failure and, toward the end, sepsis, said his daughter.

He spent about three weeks at St. Paul’s, the closest hospital to where he lived in Vancouver, said the Calgary woman. The spinal condition was so debilitating, “just to touch him, he would scream.”

Lackie said she was surprised by his request, but supportive, realizing that her father was dying “a slow, painful” death.

It would be days, however, before Shearer was transferred to Vancouver General, and on the designated date – Aug. 29 – the ambulance arrived more than three hours late, said the daughter.

The man’s dose of the pain drug fentanyl had been reduced to ensure he was lucid enough to consent to the assisted death, but as time wore on the pain grew worse, and there was a shortage of the narcotic on his ward, she said.

Already in agony, Shearer cried out desperately with each bump during the four-kilometre ambulance ride, said Lackie.

He eventually received the series of injections ending his life at Vancouver General, a “beautiful,” peaceful death, she said.

Jan Lackie holds father Ian Shearer's hand on his last day, when a Catholic hospital's refusal to consider his request for assisted death forced a painful transfer to another hospital.
Jan Lackie holds father Ian Shearer’s hand on his last day, when a Catholic hospital’s refusal to consider his request for assisted death forced a painful transfer to another hospital.

Dr. Ellen Wiebe, a B.C. physician who has carried out several assisted deaths, provided the service for Shearer, one of three patients from St. Paul’s she has seen for the same reason.

To get around the hospital’s ban on patients even being assessed there, she said she makes “flower visits:” masquerading as a friend bringing a bouquet.

Assisted-death bans can not only lead to suffering during the transfer itself, but effectively deny patients the right in areas where there is no alternative to the faith-based institution, said Shanaaz Gokool, head of the group Dying with Dignity.

“This is going to be a real issue, and it’s going to be a real issue across the country.”

The facilities are causing vulnerable patients suffering because of a decision that benefits only the institution, argued Juliet Guichon, a bioethicist at the University of Calgary.

“How can such harm be justified?”

Complete Article HERE!