These Precious Days by Ann Patchett

– a reckoning with loss

‘Having someone who believed in my failure more than my success kept me alert’ … Ann Patchett.


At 57, the novelist Ann Patchett is already preparing for death. She isn’t terminally ill, and her decision isn’t as morbid as it sounds at first. She intends from now on to travel light, to empty her house in Nashville of the residues of adulthood: the boxes of clothes and dishes and jewellery that she has accumulated over five decades of living, things that she now believes prevented her from “thinking about what was coming and the beauty that was here now”.

Call it a pandemic house clearance, if you will, for she first had the idea of sorting out her drawers and closets following the death of a friend’s father last year. It took Patchett’s friend the entire summer to tidy up her father’s house for an estate sale: one man living alone had left behind too much. Patchett thought about the boxes in her own basement, all the gifts and possessions she had forgotten about over the years. “I wonder if we could just pretend to move,” she asked her husband: “I could have said: ‘I wonder if we could just pretend to die?’”

Delve deeper into the essays in These Precious Days and you will find that death is more than a pretense. A typical Patchett piece is a eulogy, suitably warm and affectionate, respectful to those who have died, or are about to die. There is her policeman father, who could do a hundred pull-ups in his 70s, but succumbed to Parkinson’s in under two years. There is her nurse mother, who looked so young that people assumed she was Patchett’s sister (and towards the end, Patchett would insist that she was). There is Tom Hanks’s deceased assistant, Sooki Raphael, protagonist of the title essay that went viral a few months ago when it was published by Harper’s, who had gone to Nashville for her chemotherapy and ended up staying with Patchett during the lockdown.

Each time Patchett begins a new novel, she says she is overcome by the fear of dying before finishing the book. But it is in her nonfiction that she has more visibly reckoned with loss, whether it is Truth and Beauty, her memoir of her friendship with the late poet Lucy Grealy, or the pieces in her 2013 essay collection, This Is the Story of a Happy Marriage, about being a caregiver to her grandmother. Why speak of the dead? For Patchett, it’s a tool for living, a salutary reminder of that “beauty that was here now”. You can seldom intuit conflict or ambivalence in her sentences, regardless of the subject; instead they convey a well-adjusted curiosity, mostly about her friends and family. What Patchett lacks in obsession and poetic depth, she makes up for with her raconteuring energy. In the best of these essays – Flight Plan, about her husband’s passion for flying airplanes, and How to Practice, the one about cleaning out her closets – uncomfortable truths are papered over with disarming wit. About her husband she asserts at one point that he is “honest about everything – which should not be confused with being thoughtful about everything”.

The story of becoming a writer is another recurring theme. Patchett’s father would read early drafts of her novels, give her notes, carefully save her publicity materials and reviews. But well after she had been published, he still believed writing was her hobby and not her job: “Having someone who believed in my failure more than my success kept me alert.” Patchett has good advice for younger writers on attitude (“give up on the idea of approval”), on writing v editing (“if you try to do both things at the same time, nothing will be done”), on publishing a book (“never hesitate to rewrite jacket copy or ask to see ad layouts”), and even on the distribution and sale of the printed book, since she is famously the co-owner of an indie bookstore in Nashville. When she was 30, a male author told her that to become “a real writer” one must have children. “I told him I didn’t have children,” Patchett writes. “What I didn’t tell him was that I would never have children, and that I had known this for a very long time.”In an essay on the American writer Eudora Welty, Patchett says that the usually anthologised favourites “fall short of representing the darkness and depth of her work”. I wondered about the remark as I read Patchett’s own essays. Were the decisions on which ones to keep and which to leave out pondered over enough? There are the inevitable repetitions, as with any corpus of pieces originally written for newspapers and magazines; but sometimes the padding conceals the pearls. A more careful selection, for instance, might have let Flight Plan alone sum up Patchett’s rapport with her husband, and left the two other essays on their relationship out.

There are plenty of cringey moments. By buying a stove for a homeless man, Patchett’s friend is apparently sweeping “down the walls of oppression”. She can’t help but talk up her acquaintances on the page – a “bombshell best friend” here, a “force of nature, force of life” there. And does Patchett honestly expect us to believe that Snoopy, the dog from the Peanuts comic strip, was her only role model as a writer? Yet I found myself ignoring the missteps, the saccharine detours, because they stem from the same impulse that enables the more engaging passages: the wish to let the heart “remain open to everyone, everyone, all the time”.

Complete Article HERE!

Natural Funeral Practices

There are many options for end-of-life practices with low environmental impact.

The natural burial industry is expanding across the United States.

By Carla Tilghman

If you search online for “green death,” the first results might include a “Doctor Who” television episode; a “How to Train your Dragon” wiki fandom for the franchise; a heavy metal band; articles on the perils of 19th-century arsenic-based dyes; and a vodka-based cocktail. From these results, you might conclude that “green death” as a concept hasn’t entered common parlance enough to trump these other cultural touchstones. But thankfully, searching for “green funerals” or “green burials” instead reveals the opposite: there are many alternatives to traditional burial or cremation that are increasingly available. All these death-care practices share a focus on environmentally safe, humane, and loving ways to care for human and animal bodies, so you can choose the one that fits your last wishes.

Composting Funerals

Katrina Spade is the founder and CEO of Recompose, the first full-service human-composting funeral home, which began after almost a decade of planning, researching, fundraising, and working to change Washington state law on human composting.

White, honeycomb-like, hexagonal steel cylinders full of wood chips, alfalfa, and straw await human remains, all of which then undergo decomposition, or “natural organic reduction” (NOR). The first bodies were put into their cylinders on Dec. 20, 2020. Each body lays in its vessel for 30 days, with controlled levels of moisture and gases. Microbes and bacteria go to work decomposing all the organic materials. After 30 days, the decomposed material — now turned into soil — is placed in a curing bin to aerate, and is then screened to remove inorganics, such as fillings, pacemakers, and prosthetics. State regulations require the vessel and soil temperature to remain at 131 degrees Fahrenheit for 72 hours to kill any pathogens. Recompose and a third party each test the soil for residual arsenic, lead, and mercury. The client can choose people to keep the soil, as some do with cremated remains, or let their soil be donated to the Bells Mountain conservation forest in Washington.

Spade founded Recompose to offer a feasible, low-impact alternative to other forms of dealing with human remains. Traditional burials use too many toxic chemicals and can be expensive; cremations can produce too much carbon; and green burials are rarely available, especially to urban populations. (See “Death-Care Categories and Comparisons,” below.) Spade partnered with different groups to conduct feasibility studies, worked with a soil scientist, and addressed the legal obstacles for disposing of human remains, as well as fundraised the capital needed to get Recompose going.

Recompose charges $5,500, which covers everything from body pickup to paperwork and the NOR process. Cremation costs ($525 to $4,165) and traditional burial costs ($1,390 to $11,000) vary widely and aren’t always transparent. Recompose isn’t inexpensive, but the costs are fixed. Since opening Recompose, Spade has seen two other NOR competitors plan to open businesses in Washington.

The state of Washington prohibits people with tuberculosis or prion infections, such as Creutzfeldt-Jakob disease, from undergoing NOR.

Infinity Burial Suit

Luke Perry, an actor known for his role in “Beverly Hills, 90210,” was buried in a mushroom suit, first developed by Jae Rhim Lee, founder of Coeio, a California-based green burial company. The suits, called Infinity Burial Suits, are made from organic cotton embedded with a material matrix of cultivated mushrooms that’s designed to accelerate decomposition. Coeio claims the suit “delivers nutrients from body to surrounding plant roots efficiently,” while filtering and decomposing bodily toxins and heavy metals. In Perry’s case, he was encased in the suit and then buried in a decomposing coffin. Coeio charges $1,500 for each human-sized suit — and less for pet-sized suits — and also promises to plant two trees for each suit that’s sold.

Reef Balls

Reef balls can both memorialize a loved one and help build and restore reefs.

Combining cremation with burial at sea, Eternal Reefs’ reef balls are designed not only to memorialize a loved one, but also to promote new growth of reefs and halt degradation of existing reefs. Eternal Reefs is part of the Reef Ball group of companies that’s been operating for more than a decade to create designed reef materials that replicate natural reef substrates. Specialized neutral-pH concrete is combined with cremated remains of an individual, and then placed inside a large, round, hollow form (the reef ball) with multiple openings that attract and support plant life and reef formation. The textured outer surface of each ball creates habitats for microorganisms that provide sustenance for both reef corals and fish.

Eternal Reefs invites family members to participate in as much or as little of the process as they want, including mixing the concrete and attending the reef ball placement. Upward of 2,000 Environmental Protection Agency-approved artificial reefs have been placed off the coasts of Florida, Maryland, New Jersey, North and South Carolina, and Texas.

Pricing depends on the size of the balls, which range from 2 feet high by 3 feet wide (weighing 550 to 700 pounds), to 4 feet high by 5½ feet wide (3,800 to 4,000 pounds). You can spend between $4,000 and $7,500 on a ball and service, which includes the price of choosing the Eternal Reef, family participation, bronze plaque, transportation to the reef site, and GPS survey coordinates of the specific longitude and latitude of your loved one.

Conservation Burials

If you’ve spent much of your time enjoying conserved land, you may decide to choose a natural burial on lands protected by recognized conservation land trusts. Conserved lands have partnered with groups to create sustainably managed cemeteries where human and pet remains are part of the ecosystem. Such management prioritizes restoration of natural resources and protection of the land’s ecological integrity.

Conservation burials are simple interments without a coffin or preservatives. Bodies are wrapped in biodegradable sheets (most often made of cotton), buried in unmarked sites on conservation lands, and allowed to decompose. Family members can visit the site through provided GPS coordinates. Several different types of natural decomposition burials are available nationwide.

What distinguishes conservation burials from other green burials is that the land is protected through a land trust or conservation group, and is actively managed with defined conservation goals. Conservation cemeteries are owned separately from the land trust, but work with them to achieve the trust’s stewardship goals.


Also known as “alkaline hydrolysis,” aquamation uses water flow, electric heat, and 5 percent alkalinity to break down organic matter. The process requires less biofuel than cremation, and it doesn’t produce emissions. Aquamation takes 6 to 8 hours at 300 degrees, or 18 to 20 hours at 200 degrees. In contrast, flame cremation takes 1 to 3 hours at 1,600 to 1,800 degrees.

After the body has been processed, the sterile process water is recycled, and the bioliquidator (the machine that processes the body) rinses the remains, which consist of inorganic materials and bone minerals. The minerals and bones are processed into a fine powder and placed in an urn for the family.

Bio-Response Solutions is one company that offers aquamation services for human remains, and it also sells bioliquidator machines for processing animal remains to livestock and farm operations.

Aquamation is a process that’s widely available in the United States, Canada, Costa Rica, Mexico, and South Africa for humans. For pets, the process is even more broadly available worldwide. In the U.S. and Canada, only a few states and provinces don’t have any human aquamation legislation in the pipeline.

While the pricing of aquamation varies from place to place, it’s generally comparable to cremation, and much less expensive than traditional burial.

Natural burials and funeral practices are designed to offer many different death-care options to individuals, but they all focus on reducing the use of toxic chemicals, reducing dependence on biofuels, and promoting land (and sea) conservation.

Death-Care Categories and Comparisons

Natural burial, also known as “green burial,” is a form of death care where the deceased’s body is buried in the ground in a way that allows for decomposition and natural recycling. An alternative to conventional Western forms of burial and funerary traditions, natural burial avoids embalming chemicals and nonbiodegradable materials. This market is growing, and with it, the number of natural death-care options a person has. Here’s an overview of several different death-care categories, comparing their general expenses and highlighted environmental impacts.Traditional funeral. Costs, ranging from about $7,000 to $12,000, typically include embalming and other preparation, viewing and burial, transportation, and casket. Embalming fluid can contain formaldehyde, a toxic chemical that can leak into the soil and damage the surrounding environment. Chemicals used in the construction of nonbiodegradable caskets can also leak into and damage soil and waterways.

Conservation burials allow for bodies to decompose and become part of the surrounding ecosystem.

Flame cremation

A less expensive conventional funeral practice, flame cremation costs range from the hundreds to the thousands of dollars, depending on how it’s done and how many additional services are included (such as a memorial or service). Flame cremation can rely on fossil fuels for energy, and harmful air pollutants can be released during the cremation process. However, flame cremation can have a smaller environmental footprint than a traditional burial.

Human composting

A natural alternative to traditional funeral practices, human composting is not a green burial, but a form of funeral care where bodies are “recomposed” into soil amendment and returned to the land. It performs significantly better than traditional burials and cremation in its environmental impact — notably, the carbon sequestration that happens during the entire process. This is a growing field in the United States, and one that relies on states allowing for human composting. The Seattle-based business Recompose has a fixed price for human composting of $5,500.

Green burial

This is perhaps the widest category for natural death-care options, which includes any form of burial that doesn’t introduce harmful chemicals into the environment and allows for natural body decomposition. The environmental impact is less than traditional burials; however, depending on accessibility to green burial spaces, the process of planning and executing a green burial may rack up your carbon footprint. Costs vary depending on the process; generally speaking, it’s the same or less than a traditional burial.

Reef burial

Burials in ocean reefs can be classified as a form of green burial. Eternal Reefs is one example, where cremated remains are mixed into a concrete reef that’s placed into the ocean. Costs vary from around $4,000 to $7,500, which includes most elements of reef ball creation and placement. This process is only available in certain states in the U.S. Eternal Reefs doesn’t include cremation services, which must be organized in advance through another company.

Aquamation (alkaline hydrolysis)

Access to alkaline hydrolysis for human remains is growing, as is its popularity. Aquamation, a company that offers this service, claims that this process has no direct greenhouse gas emissions, involves no burning of fossil fuels, and saves 90 percent more energy when compared with flame cremation. The price is comparable to flame cremation. Not every U.S. state has approved aquamation.


  • Green Burial Council,
  • The Order of the Good Death,
  • Death Café,
  • Conservation Burial Alliance,
  • States with Natural Burial options,
  • Home Funerals,
  • Bioliquidator,
  • The Natural Burial Cemetery Guide: State-by-State Where, How and Why to Choose Green Burial by Ann Hoffner.
  • The Green Burial Guidebook: Everything You Need to Plan an Affordable, Environmentally Friendly Burial by Elizabeth Fournier.

Complete Article HERE!

The many functions of an estate plan

Estate planning to a large extent involves the optimal structuring and managing of your assets while you are still alive.

By Devon Card

A person’s estate is made up of all the assets and liabilities they’ve accumulated during their lifetime and, although estate planning is often perceived as something performed in preparation for death, the reality is estate planning to a large extent involves the optimal structuring and managing of your assets while you are still alive.

As a result, it is important not to perceive estate planning as final stage financial planning designed to secure a financial legacy for your loved ones, but rather as a continuous process of managing one’s assets and liabilities throughout your lifetime to ensure that your estate is optimally designed to achieve both your lifetime goals and your objectives following your death. Being multi-disciplinary by nature, your estate plan can be used to achieve many goals:

Determining estate liquidity

Liquidity in your estate is key to ensuring that your estate costs and liabilities can be provided for without compromising the financial inheritance intended for your loved ones. In preparing liquidity calculations, you will need to take into consideration the potential tax, capital gains and estate duty liabilities in your estate, as well as any debt owing – keeping in mind that when it comes to estate administration, Sars and your creditors will be paid first, following which the remaining balance in your estate, if any, will be distributed amongst your heirs. This means that, if there is not enough liquid cash available in your estate to settle with Sars and your creditors, your executor may need to realise assets – such as your primary residence, vehicles, holiday home, or other valuable assets – in order to pay off the estate’s debts. This, in turn, can severely compromise the financial security of your spouse and/or children, who may well be left destitute as a result of inadequate estate planning.

What to consider: Life cover is an excellent mechanism for creating liquidity in your estate and for avoiding the forced sale of assets intended for your loved ones. It is, however, important to ensure that your life cover is appropriately structured to achieve the goal of creating liquidity. Where you nominate your estate as a beneficiary to your life policy, the proceeds will be paid directly into your deceased estate in the event of death and, as such, can be used to settle debt. Remember, however, that the proceeds of domestic life policies are considered deemed property in your estate and will be taken into account for estate duty purposes, so this should be factored into the calculation.

Ensuring beneficiary nomination

Rather than being a once-off task, beneficiary nomination is something that should be reviewed and updated as your personal and financial circumstances change through your lifetime. Further, understanding how beneficiary nomination works in respect of each type of policy or investment is important to ensure that your objectives are met.

For instance, while your children are minors and legally not capable of inheriting, you may use a testamentary trust structure as the beneficiary for your life cover; whereas as your children reach the age of majority, you may want to name them personally as the beneficiaries to this cover to ensure that the proceeds are paid to them directly.

Further, if your intention is for the proceeds of your retirement funds is to provide for your loved one’s financial security, it is important to understand the limitations that Section 37C of the Pension Funds Act brings to the process. Unlike beneficiary nomination on life policies, the distribution of retirement funds benefits (being pension, provident, preservation, and retirement annuity funds) lies ultimately with the fund trustees whose job it is to identify all your financial dependants and to allocate the benefits accordingly – and their determination may not be in line with your wishes.

What to consider: Make a concerted effort to review the beneficiary nomination on your policies and investments on at least an annual basis, and upon any major life event such as the birth of a child, a death in the family, marriage, or divorce.

Drafting your legacy documents

Naturally, an important part of estate planning is to ensure that your legacy documents are appropriately drafted and valid and that they are fully aligned with how you wish your estate to be distributed in the event of death. Along with a well-drafted will, the collation of an estate planning file can be invaluable to your loved ones and to expedite the process of winding up your estate. Essential documents to include your estate planning file include obvious ones such as your birth certificate, marriage certificate, antenuptial contract, divorce certificate, maintenance orders, title deeds, trust deeds and share certificates. Other information that can be kept close at hand includes gun licences, codes for your safe, loan agreements, digital passwords and log on credentials, and alarm codes.

What to consider: A living will can be a valuable document for your loved ones should tragedy strike. In this document, you can provide much-needed guidance to your family and medical doctor regarding end-of-life medical care and treatment – something that can provide great comfort to your loved ones who may be faced with tough medical decisions. Through a living will, you can request that medical treatment that would prolong your life be withheld in circumstances where you are in a permanent, vegetative status, irreversibly unconscious, or where there is no hope of recovery.

Protecting the inheritance of minors

If you have minor children, structuring your estate to ensure that they are adequately provided for in the event of your passing will be imperative. Remember, children under the age of 18 may not inherit lump-sum payouts or other assets directly as they are deemed not to have the legal capacity to manage such assets. Thus, if you intend to nominate a minor child to a life insurance policy or bequeathing immovable property to them, it is important to understand the estate planning mechanisms available to ensure that your objectives are achieved. This could include the formation of a testamentary trust in terms of your will with your minor child as the named beneficiary to the trust. In the event of your death, any assets intended for your minor children can be left to the trust which, in turn, will manage the trust assets until your child reaches the age of majority.

What to consider: If you have a minor child, your will should also make provision for a legal guardian for your child in the event of your death. While your nominated guardian can also be a trustee of the testamentary trust, it is sometimes preferable to keep the roles separate for the sake of maintaining checks and balances.

Ensuring efficient estate administration

Effective estate planning allows one to put mechanisms in place in advance to ensure that in the event of your death the winding-up processes can be expedited and unnecessary delays can be avoided. Simple steps such as ensuring the validity of your will, communicating the location of your original will, appointing a professional executor, and keeping a file of all your estate planning documents, can be hugely beneficial when it comes to streamlining the estate administration process.

For instance, if you no longer have a copy of your marriage certificate, your executor will need to apply for a copy at the Department of Home Affairs which, in turn, will delay the administration process.

What to consider: Executorship is a highly specialised function that requires expertise in finance, deceased estates, trusts and accounting. As a result, think carefully before appointing a family member or close friend as executor. Inexperience and/or lack of understanding with regard to the estate administration process can cause unnecessary delays. Also, remember that family relationships and dynamics change over time, and it may be preferable to appoint a fiduciary expert to this role.

Reducing tax liabilities

While it is not possible to avoid paying tax, proactive estate planning gives you the opportunity to structure your estate so as to reduce the tax obligations of your estate in the event of death. Estate duty, which is essentially tax paid on the transference of wealth from your deceased estate to your beneficiaries is levied at 20% of the dutiable amount of an estate up to R30 million, and at 25% on the dutiable amount exceeding R30 million. Very simplistically, the dutiable value of your deceased estate will be calculated by adding the value of your property, deducting any allowable expenses, and then deducting the Section 4A rebate, keeping in mind that as a South African resident you will be taxed on your worldwide assets.

There are, however, a number of mechanisms that you can use to reduce the estate duty liability in your estate so as to maximise the inheritance of your loved ones. Compulsory retirement funds, including pension, provident, preservation and retirement annuity funds, are not considered property in your deceased estate and these benefits will not be subject to estate duty.

Living annuities are very useful estate planning tools because they also fall outside your estate and are not estate dutiable, while domestic life policies can also be used effectively to provide financially for your loved ones while ensuring that no estate duty is payable on the proceeds. Trusts, which are dealt with in the paragraph below, are also effective in housing growth assets and reducing estate duty liabilities in one’s deceased estate.

What to consider: When using living annuities and domestic life policies to reduce your estate duty liability, it is important to correctly nominate your beneficiaries.

Structuring growth assets appropriately

In terms of the Income Tax Act, death is considered a capital gains event and the deceased person is deemed to have disposed of their assets for an amount equal to the market value of the assets at the date of death. While the Act provides for a once-off exclusion of R300 000 in the year of death, any amount thereafter will have an inclusion rate of 40% subject to tax as per the deceased’s marginal tax rate. To avoid unnecessary CGT being charged in the event of death, an estate plan can help structure growth assets, such as property or shares, to reduce the tax liabilities in your deceased estate.

An effective mechanism for housing growth assets, particularly those intended for future generations, is an inter vivos trust during one’s lifetime. As the trust founder, you would need to either donate or sell the asset to the trust in the form of a loan account following which you would relinquish control of the asset which, going forward, would be managed by the trustees on behalf of the nominated beneficiaries. By transferring a growth asset – such as a holiday home – to a living trust, all growth on the property will remain in the trust and only the loan account to the seller will be repayable on death thereby reducing estate duty.

What to consider: As a trust founder, it is important to fully understand the implications of transferring an asset into a trust structure. Once the asset is transferred, you are no longer the owner of that asset, and your trustees are responsible for taking full control of the asset and administering it in accordance with the trust deed.

Complete Article HERE!

My dad’s final days

By Ken Dychtwald, Ph.D.

I grew up in the 1950s and ’60s in a mostly blue-collar community in Newark, New Jersey. My father, Seymour, was a fiercely hardworking guy who wanted to be successful. For him, work wasn’t about “finding his bliss,” it was about being a responsible husband and father. His dad had skipped out on him, his siblings and mother for almost 10 years during the Depression. In contrast, my dad was a reliable family man and wanted our family to live the American dream.

Ultimately, Dad rose from selling clothing and home furnishings out of the back of his truck to owning and operating a successful chain of women’s clothing stores. In their mid-60s, my folks retired and relocated to Florida.

Throughout my life, Dad and I had a loving but feisty relationship. He was very opinionated (I guess I am, too) and was skeptical of many of my lifestyle and career moves—from moving to California, from studying physics to the field of psychology and then to gerontology. But he had great love for my family and he eventually developed a deep respect for what I made of myself.

In the 1990s, my father started to lose his vision and with it, control over much of his life. Sadly, Alzheimer’s was also chiseling away at my mother’s mind. Dad loved Mom so much that he railed against the dissolution of her memory and her mind. He got depressed and angry.

“If I die before Mom, she’ll struggle terribly, and if she dies before me, I’ll go crazy. Just as we’ve lived together, we want to die together,” he said. That was quite a lot for me to digest.

One night, he asked me, “If I take my own life and Mom’s, would that be brave or cowardly?”

I said, “I don’t know, Dad. If I was in your situation, I can’t imagine what I’d think or do.”

So, for almost a year, every night I’d go to sleep not knowing if my parents would be alive in the morning.

In 2013, my brother Alan called me in a state of distress to report that our dad’s blood sugar was going haywire. And to make things worse, he’d lost his balance and fallen on his face, giving himself a big gash on his forehead. Alan was already on his way to Florida. I packed my bags and headed east.

Dad’s doctor admitted him to intensive care. He had internal bleeding and had suffered a heart attack. When he realized that his boys were there for him, he called out to us: “What’s going on? Get me out of here!”

Dad settled down a bit, and Alan and I went to see our mom. Later that night, the phone rang. It was Dad pleading with us to rescue him. 

We shot back to the hospital and went into our anguished father’s room. His arms, chest, face and hair were covered with blood because he kept pulling out his IV lines. In the morning, after a torturous night for both my dad and brother, and a sad night for me and for my confused mother, I returned to the hospital. Alan and I asked: “Dad, what do you want?”

“I’m scared,” he said, “but I know this: I’ve lived my whole life on my own two feet, and I’m not going out on my hands and knees. Please help me bring this to an end.”

Shortly after, Alan and I met with Dad’s physician. He was a kind and decent man who asked us if we wanted our dad to remain in intensive care or if we preferred to shift him to hospice car
Were we going to battle to keep Dad alive for a few more days, albeit in a ghastly, ghoulish fashion? Or were we prepared to make him comfortable and allow him to die a good death? 

What would he want us to do?

We had Dad transferred to the hospice floor, where the nurses and aides removed all the wires and tubes, lovingly sponged all of the blood off him and even gave him a shave and combed his hair. They asked him what his favorite music was and then put on Frank Sinatra.

Next, they began a low dose of morphine to ease his anxiety. My wife and kids all dropped what they were doing to fly to Florida and be with him.

As I contemplated the end of my father’s life, I reflected that even though we had often butted heads, there was not one instance in my entire life when he wasn’t there for me when I truly needed him.

I wanted to show Dad proper respect and kindness, but not knowing how I should handle the situation with my dad nearing his death, I called one of my closest friends, Stuart Pellman, who had already dealt with the death of both of his parents.

He wisely told me, “Get one-on-one time with your dad. Even if he’s unconscious, tell him you love him, ask him to forgive you for anything you may have ever done to trouble him. Tell him you forgive him for anything he might have ever done to upset you, and then tell him you’ll always remember him.”

And that’s what I did.

Dad and I held each other for a long while, and then I left the room and allowed my brother some privacy to do the same.

Later that night, after the other members of my family had gone home, I joined my dad for a very intense and private conversation.

I said, “Dad, you’ve never asked me what I think happens when a person dies.”

“I’d like to know what you think about that, Kenny,” he responded. “Because I’ve begun to see my brothers and sister and they’re reaching out to me.”

My dad had no religious beliefs, but I had some. So I said, “Dad, I don’t know this for sure, but I believe when a person passes, there is another plane that presents itself. In that place are all the people you have known and loved.”

As I began to describe this, he started to cry. Then he turned toward me and told me he was ready.

I asked him if I could record the rest of our exchange on my phone so I could always have it to watch when I missed him. He said okay, and this is what transpired:

Ken: “Dad, you know that what’s going to be next is going to be beautiful and your vision’s going to be back and you’re going to be a young man again.”

Dad: “I’m ready for that, Kenny.”

Ken: “And you know we all love you, and you’ve always loved us.”

Dad: “I know it, Kenny.”

Ken: “So, what you’ll need to do is let go and not worry about anything because everything is going to be looked after. All we need is for you to be relaxed and calm and just drift off into the white light. Can you do that, Dad?”

Dad: “Absolutely.”

Ken: “I love you, Pops.”

Dad: “I love you, Kenny.”

My father died peacefully that night. With help from all of us, he went out on his own two feet.

Ultimately, even with all his frustration and anger, my dad died a good death. At the end, his pain was minimal. His mind was calm. He found a way to think about leaving his body as not being frightening. And although he had been blind for years, at the very end, he began to describe beautiful waterfalls, flowers, birds and castles.

When my time comes, I hope that my wife Maddy will kiss me goodbye and at least one of my kids—maybe even both—will be there to lovingly guide me out of my body.

Complete Article HERE!

‘We Run Pet Hospice Care For Dying Animals’

Dr. Shea Cox is a vet who helps support pets with hospice and palliative care.

By Dr. Shea Cox

I didn’t grow up with pets but I remember wanting to be a vet since I was 8 years old and working on my stuffed animals as if they were patients. I went into college wanting to be a vet but I failed chemistry three times and ended up going to art school.

In 1991, I moved to LA on a whim. I was broke and looking for a job and ended up working in a nursing home. That led me to nursing school and chemistry started to click. I worked in areas of home hospice and palliative care. That dream never left and I began to think that maybe I could be a vet.

I started taking my prerequisite classes for vet school, and I continued nursing actually to pay my way through vet school. I finally graduated vet school in 2001 and went directly into emergency and critical care.

I spent 13 years working in a veterinary ER​, and during this time, our care evolved and we became a specialty hospital with internal medicine and oncology​. I started to see that during the most critical time in people’s relationship with their pet, when pets were ill or had multiple comorbidities, people would need more time to process complex issues and decisions and they weren’t getting it. We would diagnose their pet with cancer in the ER and people would be left in that state of shock.

I felt like we were failing, and I decided I was going to start offering services strictly focused on hospice and palliative care for pets. But in 2012, when I started offering three hour in-home appointments, people told me that the idea wasn’t financially viable. I said I was going to try. I felt in my heart it was what people and pets needed.

My first hospice patient was a dog named Sunny. Sunny was brought into our veterinary ER with multiple urinary issues by her owner’s fiance, because he was in Colorado at his father’s funeral. I did an exam and discovered it was a tumor that was blocking the urethra so the pet wasn’t able to urinate. It was a situation that is technically one where we would euthanise the animal. But I discovered that Sunny was the pet that had got the owner through his wife’s death. I so clearly remember being in the ER and finding all of this out about the owner and realizing that he could not come back to be with Sunny and say goodbye.

I ended up providing Sunny with an in-dwelling urinary catheter, something which should be in-hospital only. I remember others saying we couldn’t send Sunny home with this catheter, but the alternative was euthanasia, breaking this human/animal bond, not allowing the owner to say goodbye.

Sunny was able to go home and three days later the owner returned and they spent an amazing two weeks together. They managed the catheter and completed their bucket list. Sunny swam in the ocean with her owner and they had a huge party with other dog friends where they ate grilled filet mignon and had these “pupsicle” ice creams. We were able to facilitate a goodbye on the lawn of his house. To be able to create that kind of goodbye for someone, when the alternative would be so different, was life changing for me as a person and a doctor. That is a situation that has lived with me and been my north star since I started this.

For me, hospice and palliative care begins at the time of diagnosis, when there are signs of decline in the pet, because there is so much we can do to improve quality of life and prepare the pet and pet parent. We have had pets in hospice for 18 month to 2 years, so that’s technically palliative care.

Hospice care is done in the pet’s home. We are under the umbrella of the Pearl Pet Hospice but our goal is to be that bridge between the hospital and the home. One of the things I found interesting early on in these 3 hour in-home appointments was that 75 percent of the care people needed help with was non-medical.

Families typically need help planning and goal setting for how they wanted their pet’s end of life to look, help deciding what their bucket list was going to be, whether they wanted a memorial. We discuss what they are struggling with and what their resources are. A lot of the topics are things vets aren’t typically able to address with families because there’s just not the time.

When a family enters their pet into our hospice program, they have an entire team on their side to support them every step of the way. Families work with me, a dedicated nursing team, care coordinators and pet loss support specialists. During our in-home appointment, we educate and empower the family, including in how to recognize signs of decline, how to give medications or injections, and how to monitor progression of their pet’s disease. Following this, the majority of our care continues virtually via telehealth where the family has 7-day a week access to their hospice team for guidance and support until the time of in-home euthanasia. Generally, the pet’s quality of life sky rockets, and the time to euthanasia is generally much farther out than what their pet’s diagnosis would dictate. I’m surprised every day by the difference we can make, and that just makes my heart so full.

Dr. Shea Cox and a Pet Patient
Dr. Shea Cox with Claire, a pet sibling to Sunny, the first animal she helped in hospice care.

The vast majority of my hospice patients are dogs and cats, it is a little more weighted towards dogs, which is surprising since cats don’t generally like to go into hospitals as much. I have had a couple of bird patients. When birds can live for 80 years, people are very bonded to them.

I have helped thousands and thousands of pets in hospice care. I have been doing this close to 10 years and as we have grown as a team, we’ve been able to affect a lot of lives, which is amazing.

Over the past 10 to 15 years I think the human/animal bond has changed dramatically. Millennials are now the largest pet owning population and their pets are their children. When I started this in 2012 in the Bay Area of California, there were four other practices doing something similar. Now I believe there are close to 30. That area may have a unique demographic that supports that but I am seeing this trend across the country.

Pet hospice care is growing pretty rapidly. It has been widely known for around 10 years and in the past five years there has been a large increase of practitioners. The International Association of Animal Hospice and Palliative Care (IAAHPC) is an organization where in the earlier days there were just a couple of hundred of us and now there are close to 2,000 members.

People often say they wish they had known about this for their last pet, or
sooner, and that’s something I want to erase from people’s thoughts. I want everyone to know this is available. The other thing I hear a lot is people asking me how I can do this every day, because it must be so sad and make me depressed. Oddly it’s just the opposite. I spent 13 years in the ER doing everything I could to save lives and I have never been so gratified as being able to end them well. People are so grateful that you are taking the time with them and being caring during one of the most intimate times in their relationship with their animals. Of course, it is sad and I still get teary at every euthanisia, but I leave with my heart so full that it’s hard to say this is anything but the most amazing career in the world.

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The Dead Get a Do-Over

In a flurry of streaming television shows, the departed get a second chance. And viewers find an outlet for sorrow and remorse.

As Cal in “Manifest,” Jack Messina returns from oblivion with supernatural gifts.

By Ruth La Ferla

In “Manifest,” a series streaming on Netflix, Michaela, one of the show’s more candidly troubled characters, turns up with her companions after a lengthy, unexplained absence to be reunited with their families.

She ought to be ecstatic. But her reactions more aptly reflect the Kübler-Ross model of grief, some of its stages — denial, depression and anger — mingling on her features, along with a slow-dawning acceptance. As she tells Jared, her former fiancé, “Part of me wishes we hadn’t come back at all.”

Her response seems relatable. Mourning her life as she knew it, Michaela is one of some 200 passengers on the Montego Air Flight 828, who have mysteriously vanished only to return five years later, not a day older and sound of body but freighted with all manner of weighty emotional baggage.

In “Glitch,” Maria (Daniela Farinacci) resurfaces still caked in the soil from her grave.

That tale is but one in a rash of streaming series finding new audiences in the midst of a lingering pandemic, luring viewers with the suggestion that the boundary between life and death may be porous indeed. The departed get a new purchase on life in “Glitch,” an Australian offering in which the long-expired denizens of Yoorana, a fictional community in the Australian outback, stagger back to their homes, bodies still caked with the soil from their graves.

“The 4400,” focused on the undead but with none of the zombie horror effects, shows the newly risen wielding oddly assorted superpowers. In “The OA,” a fable-like iteration of the resurrection theme, the heroine has perished many times over, blind in one incarnation but gifted in another with an extraordinary second sight. Death itself is illusory, she assures a young school friend. “I think you are always somewhere.”

There is “The Returned,” an American adaptation of “Les Revenants,” a decade-old series about the long-gone members of a French Alpine village intent on picking up the shards of their lives, unaware that their near and dear have long since moved on. And “Katla,” an Icelandic production in which the deceased resurface in the shadow of an active volcano, seeking to salve emotional wounds.

At a time when people are grieving not only their dead, but lost jobs, opportunities and daily routines, the appetite for such fare seems especially poignant. Reveries, sci-fi fantasies or meditations on life’s great mysteries, these shows offer viewers little in the way of resolution but hold out a promise of redemption, reunion and, not least, a chance to muse on their mortality.

“Death has been a more omnipresent force in our lives in the last 18 months than it has been in our lifetimes,” said Steve Leder, the senior rabbi of the Wilshire Boulevard Temple in Los Angeles and the author, most recently, of “The Beauty of What Remains,” about the nature of bereavement.

“Death is no longer something we can banish to the basement of our psyches,” Rabbi Leder said. “It is that broomstick pounding on that basement ceiling, demanding: ‘What about me? Pay attention. I must be reckoned with.’”

Dr. Andre (T.L. Thompson) and Claudette (Jaye Ladymore) of “The 4400” beam down with a mission.

Such shows offer, as well, a chance for viewers to confront, or at least contemplate, their most nagging anxieties. “These shows are our version of a roller coaster, a death-defying ride with the things you fear most.” said David Kessler, whose most recent book, “Finding Meaning, The Sixth Stage of Grief,” explores the reverberations of loss.

“When people are grieving, one of their greatest fears is that they’re going to forget about the person they have lost,” Mr. Kessler said. “We don’t want to move on because that feels like abandoning those we love.”

There is scant chance of that in the latest shows, many of them defunct network series revived for streaming at an eerily opportune time. “We live in the world’s first death-free generation, meaning that many people live into their 40s before experiencing the death of a parent, sometimes even a grandparent,” said Alan Wolfelt, a death educator and grief counselor.

“In a mourning-avoidant culture such as ours watching these shows is, in part, a rehearsal,” he said. “They permit audiences to mourn and to acknowledge the reality of their own death.”

Yet they raise more questions than they can or care to answer. What makes us special? Do we, as in the case of “Manifest,” return with a mission or calling? Are there others like us? Are we in danger, or are we among the chosen? Will we get the chance of a do-over?

Matters of faith are underscored in “Manifest,” as when a startled passer-by drops to her knees at the sight of Cal, the youngest and most insightful of the Flight 828 returnees, chanting, “He is risen.” For people eager to regain some semblance of certainty in a disordered time, these stories exert a powerful pull.

“We’re a very mastery-oriented culture, always wanting answers,” said Pauline Boss, an emeritus professor of family social science at the University of Minnesota and the author of “Ambiguous Loss in a Time of Pandemic and Change.”

“With the spread of the virus, those answers are not necessarily forthcoming,” Dr. Boss said. “We don’t know if we can trust the person at the grocery store, whether or not they have been vaccinated. People are dying apart from their families, and those families may be feeling no sense of closure.

“What we have now is this whole host of ambiguous losses: loss of life, loss of jobs and loss of faith that the world is a safe place.”

“Manifest” will return for a fourth and final season, though Netflix has not announced a date. Peter Friedlander, who heads Netflix scripted series in the United States and Canada, said the series resonates with viewers because of their insatiable craving for mystery.

“It scratches that itch, trying in some way to hypothesize about the great unknown, to explore the notion of revisiting unfinished business,” Mr. Friedlander said. Such fare is a balm as well for people dealing with regret, he suggested, those eager to extract a message of hope from apparently meaningless, ungovernable events.

Sean Cohen, 27, a digital artist in Chicago who posts “Manifest”-inspired illustrations on Instagram, finds solace in the series. “It creates this whole story of how everything that happens is connected,” he said in a direct message on Instagram. There is also the emotional uplift, he said, “of seeing the passengers come together to help one another as the mystery unfolds.”

The show also captivates Princess Louden, 25, a dancer and graduate student in social work in Los Angeles. “‘Manifest’ technically is about something that could never happen,” Ms. Louden said. “It’s not like aliens are invading the planet. But it leaves a little room for all kinds of possibility. That’s what draws me in.”

The show is pure escapism, said Audra Jones Dosunmu, 52, a talent manager in the fashion and entertainment industries. “But there is also the idea that ‘There but for the grace of God go I.’”

“In a way I think of these shows as crisis pornography,’” Ms. Dosunmu added. “People like to see others going through things that they could never manage. But if that makes them feel thankful and better about their own lives, it’s a good thing.”

Many of the shows offer the tantalizing possibility of rescue and redemption, reassuring fans that, as is repeated like a mantra on “Manifest,” “all things work together for good. …”

In “Katla,” the dead, rise naked and covered in ash, a volcano erupts.

On “Manifest,” the risen heed inner voices urging them to acts of heroism. Michaela responds to a “calling” to free two teenagers trapped in a killer’s lair. In “Glitch,” a young woman sets out to confront her rapist and murderer. In “Katla,” estranged sisters, one of them dead, work at mending their frayed relationship; and in “The Returned,” a serial killer in a former life learns to rue and curb his lethal impulses.

These shows explore the prospect of a second chance, of tackling unfinished business, revisiting relationships, and dealing with regret, Mr. Friedlander said. “They let you look at the choices you’ve made and reflect on your priorities and values.

“It’s that sliding-door scenario that asks, ‘What if I could say one more thing to that person I’ve lost?’”

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Understanding End-of-Life Options

— New Book Details Voluntarily Stopping Eating and Drinking

When supported by knowledgeable providers, the process can be peaceful and meaningful.

By Kelly Webster

Quality of life can diminish considerably for people living with incurable or terminal diseases. They have thoughts and questions about what the end of their life will look like. They may wonder about their condition deteriorating, losing their dignity and autonomy, and being a burden on their family members. They also worry about suffering. Sometimes, discussion turns to potentially hastening the end of their lives.

In a new book titled “Voluntarily Stopping Eating and Drinking: A Compassionate, Widely Available Option for Hastening Death,” University of Rochester Medical Center professor emeritus Tim Quill, M.D. provides realistic descriptions of what happens to a person when they consider and potentially choose VSED (voluntarily stopping eating and drinking). He addresses misconceptions of this poorly understood practice, which can cause people to inaccurately picture uncomfortable starvation and unrelieved suffering. The truth is that when undergoing VSED supported by knowledgeable and caring physicians, the process can be peaceful and meaningful.

“I have been engaged in research and discussions around medically assisted dying for many years. In New York State, physician-assisted death is not legal, but many terminally ill patients want and need help figuring out what their end-of-life options are,” said Quill. “VSED has been a legally available option in the background for some time now, but most people don’t know about it or fully understand it. We wrote this book to help physicians, patients, and families learn about the process from a clinical, legal, and ethical perspective.”

A Sense of Grief and Relief

Chapters from the book include several real patient stories including a contribution from Robert Horowitz, M.D., URMC division chief of Palliative Care. As a physician, Horowitz has extensive knowledge of end-of-life situations, including patients who have chosen VSED. However, he gained a unique perspective when his own mother who was facing a progressive illness wanted to discuss her future options.

At that point, she was in the early stages and had the capacity to make decisions, but she feared what would happen to her as the disease progressed. The last thing she wanted was to spend the rest of her days dependent, frail and lost in a nursing home. Now facing the situation as her son rather than her physician, Horowitz and his family held many powerful conversations with his mom and her physician. They ultimately agreed that when his mom decided the time was right—that living with additional losses incurred by disease progression was untenable to her—they would support her choice to die by VSED.

The term “grief and relief” appears many times throughout the chapters, because end-of-life can be distressing for both patients and families, but the assurance that a loved one will not suffer a worse fate is a blessing. Horowitz’s contribution to the book details his, his mother’s, and their family’s experience in a way that humanizes this medically and emotionally complicated situation.

Empathy is Key for Discussion

Both physicians and patients are often hesitant to bring up end-of-life planning because it is difficult to talk about, and because of legal and ethical concerns.

This book approaches the topic with a deep sense of empathy for all involved. When a patient and family begin to consider the road ahead, it’s important that they understand all options available, and receive comprehensive information to help them make fully informed decisions.

For a patient worried about their condition dragging on for months or even years, the desire to bring their lives to a meaningful end can bring closure for themselves and their families. The process of VSED usually takes approximately ten days to two weeks from initiation to death, provided the patient strictly adheres to the process. This gives the patient and family a very meaningful but finite period of time to come together, make final plans, and say farewell. For families and loved ones, the patient finally finding a peaceful escape can be a blessing.

The key for any end-of-life situation is open communication. This book can be a tool for opening up the conversation between family members, and/or for a patient to start a discussion with his or her physician. Without doubt, these conversations can be difficult. However, they can be made easier with the knowledge and compassion offered in this book.

Quill is world renowned for his progressive discussions around palliative care and end-of-life situations. In addition to his clinical role at URMC, he is also a board member of the Death with Dignity National Center in Portland, Oregon. In 2013, Quill was included on a list of “Hospice and Palliative Medicine Visionaries” by the American Academy of Hospice and Palliative Medicine.

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