Tag: Death And Dying

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A Dress Rehearsal for Death

We had started down the path of honoring our mother’s wish to have a good death until a hospice nurse figured out that she wasn’t really dying.

Monona Yin, right, with her mother, Fay Hoh Yin, and brother, Duncan Yin.

By Monona A. Yin

Three years ago, my family and I had the experience of going through a full “dress rehearsal” for my mother’s demise. At 83, she had become alarmingly weak from stage IV lymphoma and atrial fibrillation, and asked me and my brother to come home to Delaware for her next oncologist visit.

Mom had already undergone chemotherapy and cardioversion, so we knew there were few treatment options left. Still, we were utterly unprepared when the doctor said, “She probably has less than six months,” and recommended that she begin hospice care.

Widowed at just 37 with two small children, Mom has trained herself to face challenges without flinching. She is that rare Chinese elder who isn’t superstitious about mentioning or planning for her own death.

True to form, when we got home from the oncologist’s office, Mom sat us both down at the kitchen table to discuss her end-of-life wishes. She had witnessed two horrible lingering deaths up close — her mother’s and a longtime friend’s. What she feared most was pointless suffering and the loss of control over her own life. She wanted us to understand that, if she had little hope of recovery, she’d rather go quickly than fall apart slowly and painfully.

My brother, at the other extreme, wanted Mom to pursue every medical option, no matter how long the odds. He believed that doctors were fallible, there was always another treatment out there, and life was worth clinging to. And he couldn’t bear the thought of living without her.

Then there was me, torn between them. I had spent hours listening to Mom’s fears and understood them. A decade earlier, my mother-in-law had died with a feeding tube in her side while her oncologist suggested more surgery — after six months of wasting away from metastatic cancer. It would have been infinitely kinder to allow her to die peacefully in her own bed.

We had given my paternal grandmother just such a “good death.” We sat by her bed and told family stories as she slipped into unconsciousness. We turned away from the outside world and drew close to one another. All was quiet and time seemed to stop. Finally, we held her as she took her last breaths, letting her know how much we loved her but also letting her go. I remember that week as a thing of rare beauty. It taught me that dying well can be a balm and a blessing to all involved.

Recognizing the enormous gulf between those two scenarios, I supported Mom’s right to die on her own terms. Like my brother, I desperately wanted more time with my mother. Despite her failing body, Mom’s mind remained sharp. In recent years, our occasional mother-daughter tensions had subsided, leaving a much warmer and less complicated companionship.

After an emotional week of debate, we all agreed to bring Mom to New York for a second — and final — opinion from the world-class doctors at Memorial Sloan Kettering. If they too determined that nothing more could be done, we would accept the inevitable.

At Sloan Kettering, Mom went through the scans without incident but afterward her blood pressure dropped dangerously low and she was admitted as an inpatient.

By the next night, Mom could hardly breathe at all. It was agonizing to watch her gasping for air. She was terrified of suffocating and on the verge of panic. Finally, she pulled me close to say, “Tell them to stop everything.”

I had promised to honor her wishes, so I found a doctor and activated her D.N.R. In a few minutes, my husband, Steve, and our 14-year-old daughter, Maya, arrived and Mom couldn’t hold back her sobs. “I’m so sorry I won’t see you grow up! I’m sorry I won’t see you graduate or get married!”

We had all been coming to terms with Mom’s mortality for months but the shock and pain were still overwhelming.

Then something that seemed miraculous happened. A hospice nurse, Tracy Kahn, arrived and went in to check on Mom. She came back to tell us that she didn’t think Mom was going to die that night, the next night, or maybe for weeks.

Based on years of observing hospice patients, Tracy did not believe Mom was dying of cancer right then.

Instead, without our realizing it, her heart had been severely weakened by the cardioversion, which required high doses of a toxic drug. Almost two liters of fluid had accumulated in the lining of her right lung.

We immediately reversed the D.N.R. but it would be another 10 days before Mom grew strong enough to have the fluid drained. Over the next month, the hospital’s lymphoma, cardiology and pulmonary teams worked together to bring Mom back from the brink. They administered steroids, gave her blood transfusions, stabilized her immune system, optimized her diuretic and treated her infections.

Mom transferred to a rehabilitation center for another month, then came to live with me in Brooklyn. With our newfound sense of “now or never,” Mom and I fulfilled one of her longtime dreams. We edited and self-published her memoirs, which she’d been writing for years, and she’s enjoyed positive reviews from friends and strangers alike.

Today, Mom still wrestles with neuropathy, shortness of breath, and sometimes crushing fatigue — but she is very much alive. Even more amazing, she has been living on her own for the past two years.

We’ve had time to reflect upon our decisions, how we influenced one another, and what we’d do differently. My central insight is that it took all three of us to steer clear of the twin shoals of dying too soon and dying too late. We made better decisions because we listened to one another and weighed all the conflicting information. In hindsight, my mother acknowledges that she wanted to “pull the plug” too soon because she became overwhelmed by fear.

No one thinks clearly in the grip of panic. That’s why it’s so important to start talking long before the end. Not merely about what constitutes a good death but, more important, what makes even a diminished life worth living. As Atul Gawande writes in “Being Mortal,” “Our ultimate goal, after all, is not a good death but a good life to the very end.”

The end-of-life conversation is equally important to both sides — the dying person and the survivors. One of my mother’s greatest comforts is knowing that her children understand her wishes and will honor them. We proved that during the dress rehearsal.

Only recently have Mom and I realized how much it cost me to be her health care proxy, rather than a grieving daughter who wanted to do anything to save her mother. I’m still going to be torn between those two roles “the next time” but simply being aware of that inner conflict helps mitigate it. And Mom’s future decisions will be informed by all the joy she would have missed had she died that night in late 2015.

Complete Article ↪HERE↩!

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Elizabeth Gilbert on Love, Loss, and How to Move Through Grief as Grief Moves Through You

“Grief is a force of energy that cannot be controlled or predicted. It comes and goes on its own schedule. Grief does not obey your plans, or your wishes. Grief will do whatever it wants to you, whenever it wants to. In that regard, Grief has a lot in common with Love.”

By Maria Popova

“All your sorrows have been wasted on you if you have not yet learned how to be wretched,” Seneca told his mother in his extraordinary letter on resilience in the face of loss. One need not be a dry materialist to bow before the recognition that no heart goes through life unplundered by loss — all love presupposes it, be it in death or in heartbreak. Whether what is lost are feelings or atoms, grief comes, unforgiving and unpredictable in its myriad manifestations. Joan Didion observed this disorienting fact in her classic memoir of loss: “Grief, when it comes, is nothing like we expect it to be.” And when it does come, it unweaves the very fabric of our being. When love is lost, we lose the part of ourselves that did the loving — a part that, depending on the magnitude of the love, can come to approximate the whole of who we are. We lose what artist Anne Truitt so poetically termed “the lovely entire confidence that comes only from innumerable mutual confidences entrusted and examined… woven by four hands, now trembling, now intent, over and under into a pattern that can surprise both [partners].”

But we also gain something — out of the burning embers of the loss arises an ashen humility, true to its shared Latin root with the word humus. We are made “of the earth” — we bow down low, we become crust, and each breath seems to draw from the magmatic center of the planet that is our being. It is only when we give ourselves over to it completely that we can begin to take ourselves back, to rise, to live again.

How to move through this barely survivable experience is what author and altogether glorious human being Elizabeth Gilbert examines with uncommon insight and tenderness of heart in her conversation with TED curator Chris Anderson on the inaugural episode of the TED Interviews podcast.

Gilbert reflects on the death of her partner, Rayya Elias — her longtime best friend, whose sudden terminal cancer diagnosis unlatched a trapdoor, as Gilbert put it, into the realization that Rayya was the love of her life:

Grief… happens upon you, it’s bigger than you. There is a humility that you have to step into, where you surrender to being moved through the landscape of grief by grief itself. And it has its own timeframe, it has its own itinerary with you, it has its own power over you, and it will come when it comes. And when it comes, it’s a bow-down. It’s a carve-out. And it comes when it wants to, and it carves you out — it comes in the middle of the night, comes in the middle of the day, comes in the middle of a meeting, comes in the middle of a meal. It arrives — it’s this tremendously forceful arrival and it cannot be resisted without you suffering more… The posture that you take is you hit your knees in absolute humility and you let it rock you until it is done with you. And it will be done with you, eventually. And when it is done, it will leave. But to stiffen, to resist, and to fight it is to hurt yourself.

With an eye to the intimate biological connection between the body and the mind (which is, of course, the seedbed of feeling), Gilbert adds:

There’s this tremendous psychological and spiritual challenge to relax in the awesome power of it until it has gone through you. Grief is a full-body experience. It takes over your entire body — it’s not a disease of the mind. It’s something that impacts you at the physical level… I feel that it has a tremendous relationship to love: First of all, as they say, it’s the price you pay for love. But, secondly, in the moments of my life when I have fallen in love, I have just as little power over it as I do in grief. There are certain things that happen to you as a human being that you cannot control or command, that will come to you at really inconvenient times, and where you have to bow in the human humility to the fact that there’s something running through you that’s bigger than you.

Illustration from Cry, Heart, But Never Break, a Danish meditation on love and loss

Gilbert goes on to read a short, stunning reflection on love and loss she had originally published on Instagram:

People keep asking me how I’m doing, and I’m not always sure how to answer that. It depends on the day. It depends on the minute. Right this moment, I’m OK. Yesterday, not so good. Tomorrow, we’ll see.

Here is what I have learned about Grief, though.

I have learned that Grief is a force of energy that cannot be controlled or predicted. It comes and goes on its own schedule. Grief does not obey your plans, or your wishes. Grief will do whatever it wants to you, whenever it wants to. In that regard, Grief has a lot in common with Love.

The only way that I can “handle” Grief, then, is the same way that I “handle” Love — by not “handling” it. By bowing down before its power, in complete humility.

When Grief comes to visit me, it’s like being visited by a tsunami. I am given just enough warning to say, “Oh my god, this is happening RIGHT NOW,” and then I drop to the floor on my knees and let it rock me. How do you survive the tsunami of Grief? By being willing to experience it, without resistance.

The conversation of Grief, then, is one of prayer-and-response.

Grief says to me: “You will never love anyone the way you loved Rayya.” And I reply: “I am willing for that to be true.” Grief says: “She’s gone, and she’s never coming back.” I reply: “I am willing for that to be true.” Grief says: “You will never hear that laugh again.” I say: “I am willing.” Grief says, “You will never smell her skin again.” I get down on the floor on my fucking knees, and — and through my sheets of tears — I say, “I AM WILLING.” This is the job of the living — to be willing to bow down before EVERYTHING that is bigger than you. And nearly everything in this world is bigger than you.

I don’t know where Rayya is now. It’s not mine to know. I only know that I will love her forever. And that I am willing.

Onward.

Gilbert adds in the interview:

It’s an honor to be in grief. It’s an honor to feel that much, to have loved that much.

Rayya Elias and Elizabeth Gilbert

Complement with life-earned wisdom on how to live with loss from other great artists, writers, and scientists — including Alan Turing, Albert Einstein, Abraham Lincoln, Rachel Carson, Charles Darwin, Johannes Brahms, and Charles Dickens — and the Stoic cure for heartbreak from Epictetus, then revisit Gilbert on creative bravery and the art of living in a state of uninterrupted marvel.

Complete Article ↪HERE↩!

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‘Remember you will die’ – and 11 other tips for a better death

Hundreds of thousands of people have already discussed the last great taboo at one of Michael Hebb’s ‘death dinners’. Here he offers some advice for the rest of us

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Two things preoccupy the US writer Michael Hebb – food and death – and he has managed to combine them in his new book, Let’s Talk About Death Over Dinner. It is the product of an idea he had five years ago when he set up an organisation called Death Over Dinner, whose goal was to bring disparate (and sometimes desperate) people together over an informal meal to talk about what is so often a taboo subject. Since then there have been more than 200,000 “death dinners” all over the world. The new book charts the gentle revolution Hebb initiated, as well as offering prompts for readers who want to organise their own death dinners and guidance on coming to terms with the loss of family and friends, and with our own mortality. No one, after all, is going to get out of this alive.

“The way we die in western society is broken,” says Hebb. Now 42, he was 13 when his father died, leaving a gap that he felt his mother and immediate family were unable to properly address. “I had a hunch that open conversation about our end-of-life wishes could be the most impactful thing we could do to heal that system and to heal the way we die. We are death-illiterate, and when we don’t discuss death we are not empowered to make decisions.” In a long phone conversation from his home in Seattle, he spells out his philosophy for dealing with dying. You may not be able to conquer death, but you can at least exercise some control over how it happens.

1. Remember you will die

Hebb says we have “ingrained cognitive bias” not to talk about death because we don’t really believe in our own mortality. “We believe we are an exception to basic rules,” he says. “If we haven’t experienced something, it’s hard to know it or to discuss it.” But there are no exceptions, and sooner or later you will have to confront it.

2. Talk now, not later

“Death is a reality for all of us,” Hebb says. “How prepared do we want to be? How comfortable? How much grace do we want to have in the face of it?” He argues that it is better to talk about death when you are well than when you or your parents or other members of your family are terminally ill. “Thinking and talking about death can identify how you want to live,” he says. “If we haven’t made ourselves comfortable with this conversation, we end up being oppressed by it.”

3. It’s not true that you die alone

Before talking to Hebb, I was doubtful that the living could relate meaningfully to the dying. My father died last year and, in the five months that were left to him after he was diagnosed with terminal cancer, I found it hard to find the right words to address what was happening to him or to know how to use what limited time we had together. Everyone, I surmised, had to face death alone, to make their own peace, but Hebb disagrees. “Dying is a realm with no experts, but my sense is that you can reduce the suffering of those who are dying by being as present as possible to them. A lot of people already start dying when they’re diagnosed, but you can live while dying. There is much to be gained from being present until the final chapter. It has the potential for deep connection. I’m not going to gleefully state that dying is a happy time, but I do know that people grieve longer when they don’t know how to honour the person who has died.”

4. Where there’s a will there’s a way

“Statistics show we are very unprepared for death,” says Hebb. “Most people don’t have their end-of-life documents in order.” Sixty per cent of adults in the UK have not made a will; in the US, that figure is 57%. For Hebb, this isn’t just foolish at a practical level; it suggests an unwillingness to talk about death at all. “The documents are important, but more important are the nuanced conversations. If somebody is going to be your health proxy or advocate for you when you are unwell, you want them to have more than just a signed legal document. You want that person to have an entire forest of information about how you feel about end of life.” He says that if you give someone power of attorney to conduct your affairs in the event of you becoming incapacitated, you need to make sure that person really understands you. Spell out exactly what you want in terms of end-of-life care, perhaps through an advance care directive or a living will; do not assume your proxies will make the right calls.

5. Decide what sort of funeral you want

Specifying what you want in terms of your funeral and disposal of your body can be important to the dying. But it may be even more important to the grieving family. “If it makes somebody’s last years more peaceful knowing that their wishes will be fulfilled, then fantastic, but communication is really a gift to the people you leave behind. It’s an important element of the moving through and getting on with their lives.” Making it clear that you do not want a gun carriage pulled by six white horses, or choosing a cardboard coffin rather than a fancy mahogany one with brass handles, can also save a fortune and keep relatives out of the clutches of funeral directors who may be tempted to oversell. How much is spent on a funeral is not a measure of the love felt for the departed.

6. Think about your legacy

Fretting about your legacy seems to me a pointless act of ego, but Hebb disagrees. “Many people do work in this world that they want to extend beyond their death. Some of that can be seen as ego, but some of it is humanitarian in nature, and I think it’s OK to want to have a continuing impact. If that’s what gives your life meaning, I’d say embrace it.” Above all, though, he says, don’t make your legacy suffering and confusion. “You will have a legacy. Everybody has a legacy. So often in families when these things aren’t discussed, there is infighting. For me, it’s not enough to say child A, B and C gets X, Y and Z; if they can have some understanding around your decisions, it’s less likely to haunt them.”

7. Be ready to talk to children about death …

You should involve children in your conversations about death, with one proviso – that you go at the pace they set. “My older daughter is interested in the topic,” Hebb says, “but my younger daughter has zero interest and I feel bad for her that her father is the death guy, so I don’t force it on her. But if a child is interested in, curious about, scared of or ruminating on death, it is of great benefit to meet them in their curiosity or concern or fear. It’s also a great way to know your child better.”

8. … And be there for bereaved parents

“We are often afraid to bring up death in the presence of parents who have lost children,” says Hebb. “It’s an unimaginable amount of grief for lots of us. But if we want to stay connected to those people, it’s imperative we engage with them because it is certainly in their thoughts and dreams all the time.” He says many people also lose friends when they lose children because those friends are too frightened to discuss the subject and the relationship breaks down.

9. God makes little difference

You would think belief in an afterlife would make the pain of dying less, but Hebb is sceptical. “Faith plays a role, but it isn’t as central as you would think. Grief will exist regardless of whether or not people have faith. If that’s an excuse not to have the conversation, you’re not doing yourself any favours.”

10. Accept that caring for the dying is hard

People who are dying fret about being a burden on their friends and family, while carers feel they have to be perfect and never show frustration or exhaustion. Hebb says both should be honest about any resentment they feel. “Care-givers should feel they have permission to have all these conflicting emotions,” he says. “If the person thinks they are the only one who feels this way, that’s much more traumatic than realising that it’s OK to resent the person you’re taking care of. ”

11. Death is not a medical act

Like others who have written about death, notably Atul Gawande in his book Being Mortal, Hebb emphasises that death is a human and community event, not a medical event. “Medicine is what keeps you alive and that’s what doctors are focused on,” Hebb says. “We have to reclaim the death part. Don’t leave it in the hands of tacticians.” He praises a project at the Cleveland Clinic called “The Pause” where the medical team gather round the bedside of a person who has just died to have a moment of silence and then share their recollections of the patient. It is not merely a medical failure to be recorded and a body to be disposed of; it is a life and a person to be honoured.

12. There are no rules for grieving

Finally, Hebb says, it is impossible to systematise grief. “Every case, every person, every situation is different. We should give ourselves permission to grieve in precisely the way we need to.” If you beat yourself up for the way you are grieving, you will only lengthen and deepen your grief.

Complete Article ↪HERE↩!

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How death disappeared from Halloween

Americans tend to avoid opportunities to engage with their own mortality

“Trick-or-treating was a way of buying kids off,” says author Lisa Morton.

By Vittoria Elliott and Kevin McDonald

Halloween in America is awfully cute these days — both in the sense that children’s costumes have reached unimaginable heights of adorability and that the holiday has lost its darkness — and that’s rather awful.

Sexy avocado costumes obscure the holiday’s historical roots and the role it once played in allowing people to engage with mortality. What was once a spiritual practice, like so much else, has become largely commercial. While there is nothing better than a baby dressed as a Gryffindor, Halloween is supposed to be about death, a subject Americans aren’t particularly good at addressing. And nowhere is that more evident than in the way we celebrate (or don’t celebrate) Halloween.

Halloween has its origins in the first millennium A.D. in the Celtic Irish holiday Samhain. According to Lisa Morton, author of “Trick or Treat: A History of Halloween,” Samhain was a New Year’s celebration held in the fall, a sort of seasonal acknowledgment of the annual change from a season of life to one of death. The Celts used Samhain celebrations to settle debts, thin their herds of livestock and appease the spirits: the kinds of preparations one might make if they are genuinely unsure whether they will survive the winter.

But in America today, that kind of acknowledgment of imminent mortality rarely occurs, according to Anita Hannig, an anthropologist and professor at Brandeis University. “When we recognize our mortality, we make preparations for it,” she says, mentioning a Romanian acquaintance who had bought their grandmother a coffin for her birthday. “But in the U.S., that kind of engagement is seen as almost frivolous.”

But what could be less frivolous than talking about a wholly universal experience?

“Every other culture has a time set aside during the year where the dead visit,” said Sarah Chavez, executive director of the Order of the Good Death, a group of funeral industry professionals, academics and artists devoted to preparing a “death phobic culture for their inevitable mortality.” Part of the power of these rituals is to make death into a known quantity, something to be accepted, even embraced, rather than feared.

When Roman Christian missionaries began to convert the Celtic peoples, local holidays were not banished, but rather co-opted. All Saints’ Day, formerly celebrated in mid-May, was moved to Nov. 1 as a way to tame the wild Celtic tradition of Samhain. All Saints’ Day is a celebration of all the dead who have attained heaven in the Catholic tradition, a death-centric celebration if there ever was one.

But the rowdiness of Samhain proved difficult to dislodge, according to Morton, so the Catholic Church tacked on All Souls’ day on Nov. 2, to offer prayers for those who were stuck in purgatory. This three-day celebration began on the evening of Oct. 31, eventually becoming All Hallows’ Evening in reference to the holy days to follow.

When the Spanish colonized what is now Mexico, they used the same strategy, taking indigenous rituals and co-opting them into the church, creating what we know today as Día de los Muertos. In both instances, the holidays retained their focus on the ritualistic recognition of mortality and honoring the dead, with the church as arbiter of the afterlife.

Halloween arrived in the United States in the 1840s, brought by Irish and Scottish immigrants fleeing famine. Popular activities included fortunetelling, speaking with the dead and other forms of divination. (To get a sense of how uncomfortable many Americans are with the dead, try this at your next Halloween party and see what kinds of looks you get.)

Catholic-infused Halloween and Samhain shared several similarities with Día de los Muertos. They were both feast days, filled with candles and a reverence for the dead. The traditional sugar skulls, or calaveras, are similar to Halloween’s “soul cakes,” sweet treats people would offer in exchange for prayers for dead relatives languishing in purgatory.

The calavera tradition remains in the modern form of Día de los Muertos, but in the United States, soul cakes have all but vanished. We now have trick-or-treating, a tradition borne purely out of concerns for the living. In the early part of the 20th century, destructive young pranksters would take full advantage of Halloween, vandalizing and destroying property.

“It was costing cities a lot of money,” says Morton. Instead of banning the holiday altogether, neighborhoods banded together to host parties and give out snacks. “Trick-or-treating was a way of buying kids off.”

Similar to how Halloween has drifted from death ritual to doorbell ringing, modern American engagements with death have changed from up close to a culture of avoidance.

In a lot of ways, Halloween in the United States “mirrors our experience with death directly,” says Chavez.

“We used to take care of our dead in our homes — people used to die at home. We took care of our loved ones, dug their graves. We were there through the entire process. We have no idea what death looks like anymore,” she says. And that ignorance breeds fear, uncertainty and avoidance.

Today, about 80 percent of people die in a hospital or a nursing home. Hannig calls these “institutional deaths,” and they’re just one part of how modern death has been sanitized and sequestered away from the world of the living.

“The responsibilities of death have been outsourced,” she says, adding that hospitals and the mortuary industry allow ordinary people to avoid engagement with the messiness and gruesomeness of death.

“When someone dies in a hospital, oftentimes the body will be whisked away almost immediately and family and friends won’t see it again until after it’s been embalmed.”

And it’s not just dying that modern America is losing touch with; it’s death rituals as well. As the United States becomes increasingly secular, religion’s role in making meaning out of death has shrunk. According to Hannig’s research, memorial services are becoming less and less common, and a collective honoring of the dead — something like All Souls’ Day — is practically nonexistent.

Hannig pointed out that in many other cultures, death is a community affair and something people prepare for together. In certain Buddhist communities in Nepal, for instance, when someone dies they will be surrounded by their loved ones and valued possessions to make sure they don’t have any longed-for attachment tying them to life. It’s a way for both parties — the dying and the living — to accept and let go.

Instead, modern Halloween focuses on the creepy and the capitalistic. “We consume death in a commercialized, entertainment way,” says Chavez. By making death fantastical, we make it feel almost impossible, and therefore less threatening. “We know that a zombie movie isn’t realistic. It’s all a way that we can reassure ourselves that we are safe and it won’t happen to us.”

But haunted attractions, horror films and safety from zombies haven’t made us less afraid of death. If anything, by continuing to keep death at a distance, we transform it into an unknown: possibly the scariest thing of all.

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Dia de los Muertos (Day Of The Dead) 2018

More 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.”

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Talking about death with those who are ill is sometimes the kindest thing we can do

If it is true that death and taxes are the only two certainties in life, it is astonishing how much we readily discuss the latter, but often shy away from the former

There are also many patients who simply want to know what will happen to them as their final days approach

By Jonathan Romain

It is the ultimate question that many of us will have to face one day: do we want to be told that we are dying, or would we prefer to be kept in ignorance?

If it is true that death and taxes are the only two certainties in life, it is astonishing how much we readily discuss the latter, but often shy away from the former.

Perhaps even more surprising is that those professionally qualified to deal with death are equally tongue-tied. This has just been revealed in a Royal College of Physicians’s report, which says that doctors are reluctant to talk about death with patients.

This is a dereliction of duty. As a congregational minister who regularly has to visit those who are seriously ill, it is very clear that some patients would benefit from knowing they are nearing the end of their life

It might be that they wish to sort out their affairs – like Derek, who had never written a will but was prompted to do so by the thought of his demise; or Sandra, who had written one, but it was over 30 years old and needed radical changes.

Alternatively, thoughts of imminent departure can lead to important conversations, whether telling loved ones how much they mean to the person, or, as with Beatrice, contacting the sister with whom she had not spoken for 12 years, and effecting a reconciliation.

There are also many patients who simply want to know what will happen to them as their final days approach. They may be fearful, but it is often not so much of death itself, but of dying and the process that they will experience. Talking about it, and the pain relief on offer, can be very reassuring. It can also allow them time to contact organisations such as Compassion in Dying, which provides support for both them and their families.

Of course, doctors also need to know when not to discuss death, for there are patients who prefer not to be informed. If they wish to take the attitude that “ignorance is bliss” and clearly mean it, then why disturb that bliss?

One of my own relatives had a phobia about death. Whilst a long period of therapy might have uncovered his reasons and allayed his fears, telling him he was going to die a few days before the event, was not appropriate.

How do you know if a person really does or does not want to know the truth about their condition? It can be hard, as long-held views can change when confronted with the reality of death. Asking the patient directly but obliquely is one option, such as: “Is there anything you’d like to discuss or talk about?”, and letting them give a signal either way.

The new report begs the question of why many doctors have been so unwilling to tackle the issue until now. It could be lack of training – which should be rectified as a matter of urgency. It might be their own personal anxieties about death, which should also be addressed before qualifying.

Perhaps it is a worry that, if they do open up the subject with patients, then, unlike mentioning a prescription, it is a conversation that could take half an hour – time they do not have, yet which should be considered an important part of patient care.

There may also be the feeling that death is a failure on their part, seeing their job as to keep patients alive, and a reluctance to admit they cannot help any further. Although admirable, this is misguided, for death can be a natural outcome of a life long lived, or the inevitable consequence of the way it was lived.

It is good that doctors do not want to let patients down, but they may be inadvertently doing so by not talking about death.

Complete Article ↪HERE↩!

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Death doula says opioid epidemic means more end-of-life services needed in the Downtown Eastside

Amanda Page Brown completed her training to become an end-of-life doula last November and now is trying to secure funding to work full time as a death doula in the area of Vancouver hit hardest by Canada’s overdose crisis

The stretch of East Hastings Street that runs through Vancouver’s Downtown Eastside sees emergency authorities respond to thousands of overdose calls every year.

by Travis Lupick

Last fall, Amanda Page Brown visited a friend in the hospital.

“As I was leaving, I saw their roommate laying in bed, skin and bones, and very little life in him,” she told the Straight. In a telephone interview, Brown explained that she recognized the man through her job as a support worker in Vancouver’s Downtown Eastside.

“He was completely alone and no one knew he was there, dying,” she continued. “I asked him if it would be okay if I visited again. He said yes.”

Brown sat with the man once more before he passed away a few days later. “I realized I was the only person who knew,” she said. “I was it.”

The experience affected Brown deeply. “He taught me much over those three final days,” she said. “He taught me the path I’m meant to walk.”

Brown learned that she wanted to help people in the Downtown Eastside make the transition from life to death. Especially those residents who might not have anyone else to be with them during that time. She began researching how she might be able to do that, and found a certificate course at Douglas College.

“End-of-Life Doulas are advocates for their clients and complement the work of the medical community and hospice-palliative care workers and volunteers,” the program’s website reads. “End-of-Life Doulas assist clients in creating and carrying out their health-care treatment decisions, as well as providing support to clients and their family and friends.”

Brown completed her training to become an end-of-life doula (also known as a death doula) last November. Now she’s trying to secure funding to work full time as a death doula in Vancouver’s Downtown Eastside.

Brown said that her plan is to collect support via her Facebook page and an accompanying fundraiser, but hopefully not for more than one year. Then, with a little experience under her belt (plus the previous seven years she’s spent employed in the Downtown Eastside), she’s hoping she can secure a staff position or reliable and sustainable funding from one or several of the many government agencies, private organizations, and nonprofits that operate in the neighbourhood.

“As a doula, you can walk in as a trusted friend. That’s what is needed here,” Brown said. “I want to be able to offer things like bedside vigils. If somebody is going to be taken off of life…and if that person doesn’t want to die alone, then somebody should be sitting with them.”

There are typical scenarios where it’s easy to understand why a death doula might be needed. For example, an elderly Downtown Eastside hotel tenant with an alcohol problem who doesn’t have any family. But Brown described other situations where it might be less obvious how someone could benefit from the presence of a death doula.

“I’ve asked drug users who have had quite a few overdoses, ‘Has anybody ever asked you if you are trying to kill yourself?'” she recounted. Brown said that with folks in that type of situation, she could befriend them and, once a bond is established, offer to help them draft an advance-care plan.

“Hey, I hear that your overdosing a lot,” Brown explained she could say to them. “Does anybody know your wishes in case something does happen to you?…Because we can do this on a legal piece of paper. Why don’t we do this?”

Brown added that these types of conversations can have unintended benefits.

“That might actually open up another conversation about maybe treatment or detox,” she said. “Maybe, maybe not. But it might be another way to open another very important conversation down here.”

There were 367 illicit-drug overdose deaths in Vancouver last year, up from 235 in 2016 and 138 the year before that. For every fatal overdose that occurs in the city, there are many more that are reversed.

Coco Culbertson is a senior programs manager with PHS Community Services Society (PHS), a nonprofit that manages more than a dozen supportive-housing buildings in Vancouver. She also happens to have the same end-of-life doula certificate that Brown has.

Amanda Page Brown is employed as a support worker and wants to become a full-time death doula in Vancouver’s Downtown Eastside.

“There are volunteer networks that provide this service for free, but maybe not necessarily for the population that we support,” Culbertson told the Straight. “There are so many people in the Downtown Eastside who are living with a chronic illness and comorbidity and who become palliative or require some level of hospice. And there are very limited resources for those folks.

“Having someone who has the expertise and the empathy—professionalized empathy—to sit with them as they live out the last few days, weeks, or months of their life, would be an incredibly meaningful thing,” she said.

Culbertson noted that PHS staff often spend time with tenants who have been transferred to a hospital and are nearing the end of their life. But everyone is spread thin, especially since the dangerous synthetic-opioid fentanyl arrived and overdoses skyrocketed, she added.

“Someone who is able to provide more support for people who don’t have a family…that would be an incredibly important thing,” Culbertson said. ” I think it is just as important to offer dignity and humanity in death as it is in life.”

Complete Article ↪HERE↩!