Death And Dying – Page 348 – The Amateur's Guide To Death & Dying

December 18, 2014

Pain management struggles in the 21st Century

By Tracy Woolrich

According to the American Pain Foundation, there are more than 50 million Americans living with chronic pain. What is unfortunate however is that chronic pain is often improperly treated – or not treated at all. Those with chronic pain will tell you that they feel that there is a war being waged against those who are truly in pain. The answer is to find treatments that work, empower yourself and educate those in the community.

As a nurse with more than 30 years of experience I have witnessed more than my share of pain. During my student nurse days I remember the days of “Brompton’s Cocktail”. It originated in London’s Brompton Hospital and was a concoction made with morphine, cocaine, alcohol and chloroform water. It gained popularity in the 1970s through the Hospice movement with support of Elisabeth Kübler-Ross. However, with advancements during the 21st Century it no longer exists. I personally am glad, as from what I witnessed it did appear to reduce the patient’s pain however at a cost of the ability to have a level of awareness. The patient would be nearly in a coma from sedation. We have come a long way in the ability to control pain effectively. Obtaining and maintaining a proper dose however is another story.

In 2006, the American Pain Foundation surveyed their members and discovered that over 60 percent experienced breakthrough pain while taking routine pain medications. In addition, 75 percent also suffered from insomnia and depression. Activities of daily living were affected with over 25 percent indicating that even driving a car was too difficult to do.

That organization developed the Pain Care Bill of rights and encouraged patients to take an active position in their treatment plan. In my previous position working with chronic pain patients, I would frequently obtain guides and resource items from them to share with their healthcare providers.
In 2011, the Affordable Care Act required the Institute of Medicine to do a study about pain management. In that study it was reported that more than 100 million Americans are suffering from chronic pain. That is staggering and the highest numbers to date.

Despite the growing number of people that are in pain, the war on drugs rages on and in its path there is a tremendous amount of collateral damage. Patients that are truly in pain suffer, and organizations that become advocates and partners cannot sustain themselves. Regrettably in May 2012, the American Pain Foundation dissolved their organization due to lack of funding. They transferred a good deal of their education to other organizations and support groups in hopes of continuing their cause.

Their Pain Care Bill of Rights was a groundbreaking proposition in my opinion. It was an attempt to empower those in pain to take an active role in their care. One of the key concepts was the right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased.

Because of society’s drug addicted behavior, there have been more and more restrictions placed that are making it difficult for those in chronic pain to obtain relief. Misguided state and federal policies are restricting access to appropriate medical care for people in chronic pain. It is deterring even the most compassionate medical providers from treating anyone with pain conditions for fear of governmental scrutiny and penalties.

Better ways to manage pain are continually being developed. With relief as the goal, patients usually try various pain management techniques (often in conjunction) before they determine what works best for them. It is a very individual thing and may change over time.

Medications
There is a myriad of available medications that can be prescribed. From over the counter analgesics like NSAIDS (Motrin and Aleve) to Narcotics (Morphine, Hydrocodone, Codeine). While pain medications will assist in reducing the pain they do little to change the cause other than perhaps NSAIDS that may reduce swelling. As time goes on doses are often increased due to tolerance and often there are side effects such as constipation and stomach upset.

Exercise
Exercise can assist with pain relief in individuals with arthritis. Yoga, tai chi and water aerobics are all very helpful. Some with Fibro and chronic headaches may find the stretching portion helpful.

Massage
Massage can reduce pain, increase tissue circulation, relax tight muscles and reduce swelling. In addition it can reduce anxiety and depression and help promote a better night’s sleep. Patients with headaches, arthritis and traumatic injuries will find this helpful. Those with Fibro may find it too painful. Cranial-Sacral work or Reiki may be more appropriate.

Biofeedback
This uses a combination of combination of visualization, relaxation, visualization, and feedback from a machine that may help you to gain control of pain. Electrodes are attached to you and plugged into a machine that measures your muscle tension, blood pressure and heart rate. In time you are able to control your thoughts and tension and thus reduce pain and anxiety. It is very effective with headaches.

TENS Units
Transcutaneous electrical nerve stimulation uses low voltage electrical stimulation to block pain signals to the brain. This is accomplished through the placement of small electrode patches on the skin that is attached to a portable unit that emits a small electrical charge. It is used for pain in a localized area. Individuals with nerve pain such as diabetic neuropathy or trauma may find this useful.

Meditation / Relaxation
Through the use of guided imagery and meditation techniques, muscles can have reduced tension and general relaxation. Those with all forms of pain will find this helpful especially headaches and nec/back pain.

Deep breathing
Yoga type diaphragmatic deep breathing involved clearing your mind and focusing on slow deep breaths that are rhythmic. This method of breathing involves breathing in and out, slowly, deeply, and rhythmically. It is through its process of inhaling through the nose and exhaling through the mouth you can release tension and induce relaxation. All those in pain will find this helpful.

Water Therapy
Warm water baths or hot tubs can be soothing and relaxing for muscle and joint pain. Water aerobics is often easier on the joints and can increase range of motion. Patients with arthritis and fibromyalgia may find this helpful.

Heat
Hot showers or baths, hot packs, heating pads and paraffin wax baths to hands and feet are especially helpful with arthritic pain.

Cold
Cold therapy is a preferred treatment for some people as opposed to heat therapy. Most chiropractors will advice to use cold to reduce swelling and numb the pain to local injuries. Cold compresses or the simple act of wrapping a plastic bag filled with ice cubes, or frozen gel packs can be applied locally. Those with Reynaud’s should avoid the cold.

Pain Management Clinics
Pain clinics are for those who cannot be helped by medical and surgical treatment options by their primary doctors. It usually involves prescription drug management, physical therapy, nerve blocks and relaxation therapy. Often primary care doctors will refer you to such a clinic for pain management if you suffer from chronic pain. This is twofold. It may help to reduce your pain while allowing the attending doctor to eliminate having to explain his pain prescriptions to state and federal agencies!

Support Groups
Sometimes connecting with others that have similar circumstances can not only provide a wealth of information but inspiration to keep going. Only another person experiencing the same level of struggle can understand.

Take home message
Encourage your health-care provider to inform you about the possible causes of your pain, and possible treatments including alternative therapy. Request to have your pain be reassessed regularly and your treatment adjusted if your pain has not improved. Request a pain management referral if your pain does not subside.

Are there other methods you have used to reduce pain? Please leave a comment and explain your experience.
Complete Article HERE!

December 15, 2014

‘Warehouses for dying people’: Are we prolonging life or prolonging death?

By Peter Whoriskey

The doctor floated through the intensive care unit, white lab coat flapping, moving from room to room, scanning one chart and then another, often frowning.

Unlike TV dramas, where the victims of car crashes and gun shots populate the ICU, this one at Sentara Norfolk General, as in others in the United States, is more often filled with the wreckage of chronic disease and old age.

Of 10 patients Paul Marik saw that morning, five had end-stage kidney disease, three had chronic respiratory ailments, some had advanced dementia. Some were breathing by virtue of machines; others had feeding tubes; a couple were in wrist restraints to prevent them from pulling off the equipment.

For a man at a highly rated hospital surrounded by the technology of medical miracles, Marik sounded a note of striking skepticism: Patients too often suffer in vain attempts to prolong life, he said, because of the mandate to “do everything.” The urge to deploy every last aggressive medical technique, in other words, was hurting people.

“I think if someone from Mars came and saw some of these people, they would say, what have they done to deserve this punishment?” said Marik, gesturing to the surrounding rooms. “People might say we are prolonging life, but we end up prolonging death.”

Critics of U.S. health care have long marshaled evidence against the overuse of aggressive end-of-life care, but the idea that many Americans are dying badly — subjected to desperate treatments in ways that are not only expensive but painful and medically futile — has gained currency of late.

This fall, a photogenic 29-year-old with brain cancer made the cover of People magazine with the decision to end her life on her own terms. About the same time, Medicare proposed that doctors be paid for discussing with patients their options for treatment — or not — at the end of life. And on the best-sellers lists is “Being Mortal,” a surgeon’s critique of the way the United States handles decline and death.

In it, author Atul Gawande warns, among other things, that “spending one’s final days in an ICU because of terminal illness is for most people a kind of failure.”

Marik’s long-standing argument, which is notable in part for coming from an ICU doctor, is this: The nation has double or triple as many ICU beds per capita as other Western nations, it spends inordinate amounts of money in the last months of life, and worst of all, this kind of care isn’t what patients want.

His doubts about end-of-life care appear to be widely shared among his ICU colleagues.

A 2013 survey conducted in one academic medical center, for example, found that critical care clinicians believed that 11 percent of their patients received care that was futile; another 9 percent received care that was probably futile, it said.

Marik blames, in part, people’s unwillingness to face up to the inevitable.

“Americans not only don’t want to die, they are unwilling to accept the reality of death,” said Marik, who is also a professor at Eastern Virginia Medical School and chief of critical medicine at the school. “Unfortunately, old people get diseases and die.”

It pays to provide treatment

The remedy lies, in part, with hospices, which are hired to take care of patients after they opt out of aggressive end-of-life care.

Amid rapid growth, that industry has been marked by infrequent government inspections and, in places, lapses in quality. But when the service has been properly provided, families sometimes describe it as a godsend, and experts say hospices serve a critical role in the U.S. health system.

A number of factors, economic and personal, keep many patients from enrolling in hospice care, however.

For starters, it pays to keep dying patients undergoing more treatment, according to experts.

“Financial incentives built into the programs that most often serve people with advanced serious illnesses — Medicare and Medicaid — encourage providers to render more services and more intensive services than are necessary or beneficial,” according to Dying in America, a massive report issued in September by the Institute of Medicine.

But strains at a more personal level also keep patients in treatment.

Doctors are reluctant to disappoint a patient with the grim truth, and knowingly or not, keep false hopes alive. Families meanwhile sometimes overestimate the power of modern medicine.

Take, for example, the use of CPR, the technique that can restart a heart, but which, particularly in the elderly, can result in broken ribs, and even if successful in reviving a patient, may lead to a much-diminished quality of life.

“Have you ever seen it done on television?” Marik asks, rolling down a corridor with a class of students behind him. “They all wake up right away. But in real life, only about 5 to 10 percent of people — if they’re over 70 — leave the hospital alive.”

Indeed, a 1996 New England Journal of Medicine an analysis of popular shows like “ER,” showed that two-thirds treated by CPR survived until discharge.

“When CPR became widespread in the ’60s, it wasn’t considered ethical to perform it on people who are unlikely to recover,” Marik said. “Now it’s done all the time, regardless of the consequences.”

‘A warehouse for the dying’

Marik has been making his argument in published papers at least as far back as 2006, and his criticism echoes others in the field. An ICU doctor in Gawande’s book, for example, complains that she is running “a warehouse for the dying.”

“We’re kind of powerless to change the system — this is what society expects of us and what we are legally required to do,” Marik said. “But many clinicians are frustrated.”

Nurses, who interact with patients more, may be just as adamant about the issue. They see patients grimacing as they clean wounds around tubes into the lungs or stomach; they see confused patients trying to remove breathing equipment; they treat the bed sores of patients immobilized for long periods.

“There are cases where you honestly feel like you are just causing more harm or pain to the patient and you wonder if their family really understands what’s going on,” said Karen Richendollar, a nurse at the intensive care unit at Sentara Leigh Hospital here.

Surveys of intensive care nurses at 14 ICUs in Virginia, published in 2007 in the journal Critical Care Medicine, found that the leading cause of moral distress arises from the pressure to continue aggressive treatment in cases where the nurses do not think such treatment is warranted.

“The distress comes when there is no hope that whatever we are going to do will provide any different outcome,” said Becky Devlin, the supervisor in the ICU here. “The patient is going to die anyway, and we are just prolonging things. That’s where the distress comes in.”

For example, Devlin and Richendollar said, a woman then in their care was more than 90 years old, with blood pressure and severe kidney problems as well as severe dementia. She was being fed through a tube and had a urinary catheter.

Most imposingly, the woman was breathing via a ventilator, and to prevent her from removing the tube that had been inserted into her mouth and down her throat, restraints tied her hands to the sides of the bed.

“No one can be comfortable with all of that,” Devlin said. “Some of the family members are against further treatment, but there are others that make the decisions and they want to keep going.”

End-of-life planning key

One key way to avoid unwanted treatment, according to experts, is to solicit a person’s preferences for end-of-life care before a crisis arrives.

Toward that end, Sentara, which was ranked this year atop the “Best Hospitals in Virginia” by U.S. News & World Report, joined a coalition of hospitals and agencies on aging that in November launched a program to promote end-of-life planning in the Norfolk and Virginia Beach area. It has set up a Web site, asyouwishvirginia.org.

The program hopes to inspire people to write down their wishes and appoint a health-care advocate to speak for them if they can no longer do so. Organizers will blanket the region’s religious group and elderly care organizations to encourage people to make end-of-life plans.

“Unfortunately when these situations [in the ICU] come up, families will say, ‘Doc, what should I do?’ But that’s not something that doctors can really answer,” said David Murray, director of the group, known as the Advance Care Planning Coalition of Eastern Virginia. “We need to hear from the patients or their representatives — earlier than we do now.”

Take, for example, one of Marik’s patients, a 72-year-old woman who’d come into the emergency room last month after her family found her confused.

Living at home, she’d long been beset by multiple health woes, mainly congestive heart failure and respiratory problems and bipolar disorder. Given her fragility, it would have been natural to have elicited her end-of-life wishes.

No one did, however, and at the hospital last month the hospital staff and the family spent several anguishing days discussing how best to proceed with her care.

Her labored breathing — her inability to draw in oxygen — was the central problem for the doctors. As she struggled for air, the carbon dioxide levels in her blood rose to dangerous levels. She grew anxious as a result, and this only worsened her breathing.

She was moved to the ICU.

The staff placed an oxygen mask called a biPAP around her head, fitting it snugly around her mouth and nose. The device forces oxygen from a hose into the nose and mouth, but it is often uncomfortable.

As a result, the patient was at risk of removing it. So in addition to being sedated, her hands were restrained — tied by cloth belts to the sides of her bed.

She could be heard that Monday calling out, at times, unintelligibly.

“Take me, Jesus,” she shouted at one point.

She wasn’t the only one bothered by the arrangement.

“The nurses and I were really uncomfortable — this poor little old lady,” Marik said. “She was an elderly demented lady with chronic end-stage lung disease. . . . We were subjecting her to a lot of pain and indignity with very little potential for gain. We shouldn’t be forced into that kind of situation, but we often are.”

By Wednesday, the hospital’s palliative medicine team met with family members, and in the coming days, the patient’s sister and daughter decided to forgo aggressive treatment and opt for measures meant primarily to keep her comfortable.

The uncomfortable mask and the wrist restraints came off. Her vitamins and cholesterol drugs were stopped. She was given medicine for her anxiety, which family members said had been a long-running source of trouble for the patient.

The patient was also prescribed morphine, a drug sometimes avoided until the end of life, but one that relieves pain and calms breathing. Nurses were instructed to give her morphine when her breaths exceeded 20 per minute.

Placed under hospice care, she was sent to a nursing home the next Monday.

There, the patient seemed to rally, regaining the ability to interact with family members. The color returned to her face. She even said she was enjoying music they brought in.

A few days later, after the family had the chance to call in distant relatives, she died.

Marissa C. Galicia-Castillo, a doctor in the hospital’s palliative medicine department, said it is common for patients to die in the ICU hooked up to machines.

“Fortunately . . . [this patient] was able to get out of the hospital into a more home-like environment, enjoy some familiar comforts, visiting and talking with loved ones before the natural end of her life,” she said.

But it wasn’t without the torment before the family decided that the aggressive measures may be introducing more pain than relief. Sometimes frail elderly patients languish weeks or months before family members opt for the comfort measures. Sometimes they die hooked up to multiple machines. In this sense, this patient constituted a success.

“We all knew she was dying, and that was the tragedy,” Marik said. “We knew we were just prolonging her death.”

Complete Article HERE!

December 4, 2014

Chinese Funeral Etiquette

Traditional Chinese funeral is an elaborate ceremony that involves a number of rites and rituals. However, the etiquette that needs to be followed during these ceremonies is worth noting.

By Rave Uno

The funeral or death ceremony is one of the most important rites of passage that virtually every human being has to go through. Funeral rites differ from country to country and from culture to culture, but all of them are unanimously aimed at ensuring that the soul of the deceased enters the afterlife without any hurdle. People have been following various funeral customs and practices from time immemorial, and we indeed have ample archaeological evidence to prove that certain patches of land served as cemeteries and that certain platforms were used particularly to carry out last rites on a person. Even today, there are a plethora of funeral rites and etiquette that cultures across the world follow, and it is indeed interesting to know that some of these are ages old, owing to the antiquity of the culture itself.

China is, without doubt, one of the oldest surviving civilizations of the world. People of today’s China value their age-old customs and traditions as much as they value advancements in technology and modernization. For the Chinese, the funeral rites are an important part, not only of their religious lives, but also social lives.

Chinese Funeral: Protocol to be Followed

Funeral rites occupy a very important place in the traditional Chinese society, and all the set rules and etiquette need to be very strictly followed. It is believed that the one who fails to adhere to the rules and etiquette of the funeral invites bad luck to his/her family. Traditionally, the Chinese people are known to host lavish funeral ceremonies for their deceased near and dear ones because elaborateness of the funeral ceremony determines the status of the family in the society. This Buzzle write-up features some of the important etiquette to be followed during a traditional Chinese funeral.

Colors to Wear

► If you are attending a Chinese funeral as a guest, make sure that you dress yourself in sober and dark colors. While you can wear pale and muted shades, black is the safest color to opt for.

► Avoid wearing bright and colorful clothing, as such hues may symbolize moods, contrary to the one of mourning. Do not wear red; in China, it is associated with happiness.

► You can dress up in white clothes, but make sure that they are absolutely plain, with no designs at all. In fact, the deceased is also dressed up in a white robe.

► If the deceased lived up to the age of 80 or above, guests can wear a white attire bearing shades of pink or red. The Chinese believe that if a person dies at 80 or above, he/she lived life to the fullest, and had no desires left to be fulfilled. Therefore, such a death (if it is natural), calls for a celebration, and shades symbolizing happiness are acceptable to a certain extent.

During the Funeral

► The Chinese funeral involves a lot of rites which have to be completed properly. Traditionally, the period called “wake” precedes the actual funeral. Held either in the family home or local temple, this period lasts for several days, wherein family members and close friends are expected to bring flowers for the deceased.

► White Iris is the traditional funeral flower in China, so make sure that you take an elaborate wreath made of these flowers, if you are visiting during the “wake”.

► Though it is not customary, people generally also put banners with couplets about the deceased written on them, within the wreaths. Such a gesture shows that you are equally sad about the person’s death as his/her family.

► On the day of the funeral, all the guests are expected to give money in white envelopes (white is the color of mourning in Chinese culture) to the family members of the deceased. This can be directly handed over to one of the family members (or put into a donation box, if there is one), either on the day of the funeral or one day before.

► You can either write your name on the white envelope while you give the money or you can leave it blank; it is acceptable both ways.

► The amount that you may give varies, depending on the overall income of the family of the deceased, and also that of the guests. The amount of money also depends on the closeness of the grieving family with the guest.

► The minimum expected amount is 101 yuan (about $16), but there is no upper limit for the same. While enclosing money into the white envelope, ensure that you are donating in odd numbers.

► While the funeral is in progress, the members of the grieving family burn joss paper, also known as ghost money, to ensure safe passage of the deceased into the afterlife.

► Apart from joss paper, other miniature items such as houses, cars, televisions, utensils, etc., are also burned. It is believed that all these enter the afterlife with the deceased, so that he/she can lead a luxurious and a comfortable life, even after death.

After the Funeral

► Once all this is done and the guests are about to leave, the family of the deceased distributes red envelopes among them. Each of these envelopes contains a coin.

► Red, in Chinese culture, is the color of happiness. So, the distribution of red envelopes after funeral symbolizes the end of the period of mourning, and the beginning of a new start.

► As a marker of a fresh beginning, the guests are also made to consume a piece of sweet candy before leaving for their respective homes. Sometimes, the guests may also be presented with a handkerchief.

► It should be noted that the three items mentioned above viz., the envelope with a coin, the handkerchief, and the candy, should not be carried home by the guests. If done so, these items are believed to invite bad luck.

► It is also customary for the grieving families to present their guests with a red-colored thread, while they leave for their homes. This thread is believed to ward away evil spirits, and so, it should be taken home by the guests and tied to their doorknobs.

The Funeral Procession

► Once the elaborate funeral ceremony is over, a funeral procession to the final resting place of the deceased, the crematorium or the cemetery, is held.

► For this, a special band is hired and loud music is played until the place is reached. Traditional Chinese culture believes that evil spirits can be kept away by means of loud music.

► The family members of the deceased wear mourning clothes. The children and the sons/daughters-in-law of the deceased wear black and white colors, while the grandchildren wear a blue-colored attire.

► The other mourners are allowed to wear any shades, except the bright and bold ones, and it is also customary for them to wear a cloth band on their arms that signifies that they are mourning the death of their loved one.

► The arm on which the band is worn depends on the gender of the deceased. If the deceased is a woman, the band is worn on the right sleeve, and vice versa.

► More often than not, professional mourners are also hired; however, this is not mandatory, and depends largely on the financial status of the grieving family.

► The coffin, in which the corpse is laid, is kept in a hearse decorated with funerary wreaths and flowers.

► The children of the deceased walk in the front row of the procession, carrying a large portrait of their mother/father. They are followed by other family members and guests.

► Whether the deceased is cremated or buried, depends on the personal preference of the deceased himself/herself and/or his/her family. Both these practices prevail in the traditional Chinese culture, and both are equally acceptable.

It is worth noting that in Chinese culture, the funeral customs and rites vary from person to person, depending on the social status of the deceased and/or also his/her position in the family. They also depend on the age, marital status, and the manner in which the person died. So, while you prepare yourself to attend a traditional Chinese funeral ceremony, ensure that you have considered all these things so that you can follow the appropriate etiquette once you get there.
Complete Article HERE!

November 24, 2014

The Hanging Coffin

First appearing during the Spring and Autumn Period (722-481BC), hanging coffin is a unique funeral and sacrifice custom of the minority groups in southern China. People put the bodies of their ancestors into wooden coffins that were later placed in caves of precipitous cliffsides.

Most coffins were made with one whole piece of wood into various shapes. It was said that the hanging coffins could prevent bodies from being taken by beasts and also bless the soul eternally.

Famous Hanging Coffin Sites :

While hanging coffins can be found in many places in China, the strange thing is all of them only existed for a certain period in history. Those in Wuyi Mountain are the first appear in China, as early as in the Zhou Dynasty (1027-777BC) while those in Gongxian County of Southwest china’s Sichuan province are the most recent, which also marked the end of the hanging coffin custom.

Hanging Coffins of Bo People in Gongxian, Sichuan Provinve
Hanging Coffins of Guyue People in Dragon Tiger Mountain
Hanging Coffins of Guyue People in Wuyi Mountain

The mystery of hanging coffins

Why did the ancient people bury the dead in hanging coffins?

According to historical records, the Bo people believed “Coffins set high are considered auspicious. The higher they are the more propitious for the dead”. Also, after experiencing years of wars and natural disasters, the Bo people dreamed of going somewhere peaceful and quiet after their death. That is why they chose to rest their bodies on the precipices with the mountains and rivers around, all peaceful, beautiful and quiet. The Guyue people, on the other hand, held a high esteem for high mountains, and believed the higher the hanging coffin was placed; the better they could be protected.

How did the ancient people do it?

So how did the ancient people, including the Bo people and Guyue people, do it? This question once caused heated discussion among experts . Some believe the coffins were lowered down with ropes from the top of the mountain. Some ought the coffins were put in place with wooden stakes inserted into the cliff surface as artificial climbing aids. Others feel that earth ramps were the answer.

Cui Chen, a curator of the Yibin Museum, who examined the three different ways the coffins of the Bo people could have been put in place, has this to say:

“Earth ramps might have been used but experts discount this solution due to the amount of labor required, which would have been difficult in an underpopulated area. A timber scaffold supported on stakes in the cliff might have offered a plausible explanation but years of investigation have failed to find even a single stake hole. On balance the third option of lowering the coffins on ropes from above had always seemed feasible and now cultural specialists have found the telltale marks of the ropes which were used all these years ago. And so this part of the mystery of the hanging coffins has now been resolved.”
During the later years of the Ming Dynasty (1368-1644), the imperial army cruelly oppressed the ethnic minority peoples of Southwestern China Sichuan and Yunnan Provinces. In particular, the Duzhangman and Bo Peoples fell victims of massacre. To escape their oppression, the Bo migrated to new locations. They hid their real names and assimilated with other ethnic groups. Like their culture they have disappeared but their descendents are still here for they are a part of us.
How the Guyue people hung the coffins onto the Fairy-water Rocks of Longhushan (Dragon TigerMountain) remains a mystery, since the hanging coffins are so dangerously located. Over the years, it has taken on a mystic air. Some people say the coffins were hung up with the aid from the immortals in the heaven, while others say there are invaluable treasures within the caves. Longhushan Administration Bureau once offered a 300,000 yuan ($US 36298) reward for solving the mystery, but so far no one has won the reward.

November 6, 2014

Gods and Goddesses of Life and Death

The One God of the Near Eastern monotheisms— Judaism, Christianity, Islam—is both the creator and stern but loving father of humankind. He cares for his creation from birth to death and beyond. This is somewhat exceptional among world mythologies. Many creator gods are unbelievably remote in time and space: Maheo in the myths of the Cheyenne of the U.S. Great Plains existed before existence, and numerous creators are sky gods, such as Olorun, or “Sky,” in the myths of the Edo and Yoruba peoples of Nigeria.

Although most peoples of the world preferred to believe that creation had a purpose, sometimes it was incidental or even accidental. Qamaits, warrior goddess of the Bella Coola people of the Northwest coast of Canada, killed off the primeval giants who ruled the earth, making room for other life forms merely as a by-product. Coniraya, one of the oldest of Inca gods, could not help but create: His mere touch made everything burst into life.

Such creators often take scant interest in their creation. Qamaits seldom concerned herself with the earth once she had killed the giants and perhaps humans as well; her rare visits caused earthquakes, forest fires, and epidemics. Other creator gods withdraw once the act of creation is over, leaving subordinates in charge. In Ugandan myth, the creator, Katonda, left his deputies Kibuka (war) and Walumbe (death), along with others, to rule his new universe.

The War Gods

War and death are an obvious pairing. Almost no one embraces death willingly, unless seduced by the evil songs of Kipu-Tyttö, Finnish goddess of illness, into joining her in the underworld of Tuonela. To express most people’s sense of death as a battle lost, death is pictured in many myths as a warrior: Rudrani, the Hindu “red princess,” who brings plague and death, and gorges on blood shed in battle; and Llamo, Tibetan goddess of disease, riding across the world, clad in her victims’ skins, firing her poison arrows. Because warriors give protection too, the ancient Greeks were ushered out of life by a gentler psychopomp (soul guide) than in most mythologies, the warrior god Thanatos, brother of Sleep, who escorted the dead to the gates of the underworld.

If war and death seem obvious allies, war and life seem contradictions. Yet it is precisely on the patrons of war, and other gods and goddesses envisaged as warriors, that the business of human life often rests. In most mythologies, the divine energy of the gods is seen as the great motive force of the universe. This energy may be analogous to that of a storm or some other powerful natural force, as in Egypt where the desert wind was personified as the lion-headed goddess Sekhmet, who when angry became the Eye of Ra, a terrible war goddess who swept over the land, scorching the earth in her wake.

Just as human warriors are stronger and more active than most other people, war gods and goddesses generally embody pure energy: the Hindu goddess Durga is the anger of Shiva’s consort Parvati, just as Kartikeya (Skanda), Hindu god of armies, is the fierceness of Shiva himself. The divine vigor of these deities is barely contained: Sumerian Ninurta existed as power without form until his mother Ninhursaga confined it in the shape of an eagle-winged warrior. The same idea underlies the curious births of many war gods: Iranian Mithra, born from a rock; Greek Athene, springing from Zeus’s head; Kali, the Hindu death goddess, bursting from the forehead of Durga; and Kartikeya, born from the sparks that fell from Shiva’s eyes. They are eruptions into the universe of divine vitality.

Unsurprisingly, therefore, a number of war gods are themselves creators, like the Mesopotamian Marduk, Mithra in ancient Iran, Min in Egypt, Vahagn in Armenian myth, Unkulunkulu of the Amazulu people of South Africa, and (inadvertently) Qamaits. Many more are deeply involved with the creative and intellectual growth of humankind, their myths saying something universal about the way civilizations develop. Except for the Greek Ares, portrayed as brawn without brain, the war gods are often great benefactors. Tools and weapons are the gifts of Gu, the blacksmith god of the Fon peoples of Dahomey, and of Ogun, venerated by the Yoruba as the power of iron. Craft-skills are bestowed by Greek Athene and Sumerian Ninurta, healing and medical skills by lion-headed Sekhmet and by Unkulunkulu, the Amazulu creator. Magical knowledge is the legacy of Norse Odin, prophecy of Baltic Svandovit. Justice and fair dealing are the province of Norse Tr and Roman Mars, sovereignty and rule of Celtic Medb, Germanic Teutatis, and both Mars and the Roman war goddess Bellona.

It is very often the war gods, too, who oversee the continuance of the human race, and indeed the ability of all living things to reproduce themselves. The myths say this in different ways. Several war gods and goddesses, notably the Greek Ares and the Celtic Medb, were notorious for their sexual appetites. Just as Ares coupled for preference with Aphrodite, so in Haitian voudun (voodoo), Ogoun enjoys sex with the love goddess Erzulie. The Mesopotamian Ishtar, goddess of sex, was in Assyria also the war goddess, to whom were offered the flayed skins and severed hands of prisoners.

This is less a commentary on the rape and pillage historically associated with invading armies than a reflection of a link between war gods and a broader notion of generation and fertility. Gu, in Dahomey, oversaw both fertility and war; Cihuacóatl, Great Goddess of the Aztecs, had charge of war and women’s fecundity. In particular instances, the link between war and fertility might arise from the war god’s dual role as sky and weather god, by analogy with the life-giving rain, as with Mars and Svandovit. Another line of development is represented by Hachiman, who began as aprotector of crops and children, came to protect the whole of Japan, and then became a war god.

Sex and Fertility

But war gods aside, a connection between sex/fertility and death is made in many mythologies from the most ancient past down to the present time. Nergal in Mesopotamia, embodied as a bull (a widespread symbol of virility), was notorious both for his sexual activity and also for dragging mortals off to the underworld; Sucellus, the “Good Striker,” in Celtic myth had a hammer which he used both to strike plenty from the ground and to hit dying people on the forehead to make death easier; Ghede, originally the Haitian god of love, was in later voudun belief amalgamated with Baron Samedi, the dancing god of death who was often questioned via blood sacrifice on questions of fertility.

This link between sex and/or fertility and death is epitomized by Hathor, originally a fierce blood-drinking Nubian war goddess who wore the same lion-headed form as Sekhmet. When introduced into Egypt, she became the cow of plenty whose milk was the food of the gods and kept them fecund. It was Hathor, too, who entertained the sun god Ra on his nightly voyage through the underworld, and also guided souls to the court of the judge of the dead, Osiris.

Life and death are two sides of the same coin: Innanna, Sumerian goddess of sex and fertility, is the twin sister of Ereshkigal, queen of the underworld. They are not two but one, a dual goddess, light and dark. Consider the Irish myths of the Daghdha. Wise, associated with magic, like the war gods he was master of arts and skills. But he was also the gluttonous god of abundance and of fertility, coupling with Boann, the spirit of the river Boyne, as well as his wife Dana, and with the war goddess the Morrigan (significantly on New Year’s Day). He wielded a huge club—with the knobbed end killing the living, the other restoring the dead to life.

Other Aspects of Gods and Goddesses

Some mythologies have vanished; some have gone on to become world faiths. One of the survivors is Hinduism, which expresses its philosophy of life and death in the myth of Shiva, a warrior of vast strength, the most powerful being in the universe, armed with invincible weapons (including a bow made from the rainbow and a trident of thunderbolts). Like many war gods, he was born oddly,

The connection between fertility and death is made in many mythologies. The orginal Nubian war goddess turned Egyptian fertility goddess, Hathor, is characterized by these labor amulets. CORBIS

The connection between fertility and death is made in many mythologies. The orginal Nubian war goddess turned Egyptian fertility goddess, Hathor, is characterized by these labor amulets.

CORBIS

from a slit in a vast penis that appeared in the universe. (He is still honored in the form of a phallic stone column, the lingam.) At the same time, his titles include Kala (“Death”) and Nataraja (“Lord of the Dance”), because of the terrible dance he dances at the end of each cycle of the universe, when he opens his fearful third eye and unmakes the whole of creation. He is one of the three supreme deities: He destroys, Vishnu preserves, Brahma maintains balance. Together, they order the universe.Though many ancient mythologies explained how death came into the world, comparatively few promised a better life to come. Their underworlds were mostly gloomy places, into which the dead were thrust by hideous demons or fierce warrior-deities, and there either forgotten by their creator or made to stand trial before some dread underworld lord such as Osiris in Egypt or in Chinese Buddhist myth the Four Kings of Hell, who guard the Scrolls of Judgment in which all past lives are recorded. No wonder that many underworlds are filled with unhappy souls, like the spirits led by Gauna, death in the myths of the Bushmen of Botswana, who are so miserable in the world below that they keep trying to escape and take over the world above.

But several societies evolved myths of death and resurrection gods built on the analogy with plant life, which springs up and dies in an annual cycle. The Greeks told the story of Adonis, loved by both Aphrodite and the underworld goddess Persephone. When he was killed by a jealous Ares, scarlet anemones sprang up from drops of his blood. Zeus solved the rivalry between the goddesses by decreeing that Adonis should spend half his year with Aphrodite, half with Persephone in the underworld.

Death and resurrection gods form the background to the emergence in the Near East of mystery religions, so-called because only initiates knew their secrets. These extended the chance of a better hereafter beyond a close circle of special people, such as the pharaohs and nobles in Ancient Egypt afforded a kind of immortality by mummification; Greek heroes taken to the happy Isles of the Blest instead of gloomy Hades; and Norse warriors carried off the battlefield by Odin’s battle-maidens, the valkyries, to the everlasting feast in his mead-hall Vallhalla, whereas those who died in their beds were consigned to the dismal realm of the goddess Hel.

The mystery religions promised life after death to all believers. In Egypt, Aset (Isis), sister and consort of Osiris, by her magical skills reassembled the corpse of Osiris, after he was dismembered by his brother Set. However, the gods decreed that Osiris (perhaps because he could no longer function as a fertility deity, Aset having been unable to find his penis) should henceforth serve as judge of the dead in the underworld. From this evolved the Mysteries of Isis, a popular cult in Ptolemaic Egypt and Rome, from the first century B.C.E. to the fourth century C.E. At their initiation, devotees were told the secret name of the sun god Ra, which Isis won from him in order to revivify Osiris. They believed that knowing this name empowered them to conquer age and sickness, even death.

From Iran came the cult of the creator and war god Mithra who fought and killed the primeval bull, from whose blood and bone marrow sprang all vegetation. He eternally mediates on humankind’s behalf with his father, Ahura Mazda, the god of light, and combats the dark lord, Ahriman, the evil principle. This battle will end on Judgment Day with Mithra’s triumph. In ancient Rome, where he was known as Mithras, Mithra became the focus of a mystery religion practiced especially by soldiers. Initiation into his cult, as into that of Isis, was believed to ensure immortality. The cult never became widespread, partly because it was secret, partly because it was austere, but chiefly perhaps because it was closed to half the population—the women.

By contrast, Christianity spoke to both sexes. It outlasted both the Mysteries of Isis and those of Mithras, perhaps because the answer it gave to the question “What happens to me after death?” was the same for everyone, king or subject, master or slave, soldier or farmer, man or woman. Moreover, the bodily death and resurrection of Christ himself, prefiguring the triumph over death of all who believed in him, was said to have happened to a historical person within or almost within living memory, rather than to a god in some remote mythical time.

Complete Article HERE!

October 22, 2014

Some Thoughts on The Dying Process: Dying Wisely and Well, Part 2

Look for Part 1 of this series HERE!

One to Two Weeks Prior to Death

Disorientation

Expect that you will be sleeping most of the time now. As you die, consciousness will be harder for you to maintain. Those who attend you will be able to arouse you from your slumber, but upon awakening you may experience a period of disorientation.

Those around you may find you confused at times. They may even report that while you slept you seemed to talk to people who were not there. Your sleep may appear to some as restless and fitful. This will most likely add to the agitation of those who witness it. They may misinterpret these events and imagine that you are in distress.

If you are not in distress, you can reassure them with confidence that this, too, is natural and that they should be at ease.

Breathing exercises like those practiced by expectant mothers, deep and paced, are helpful for all concerned.

Remember you are in charge of your dying environment. The anxiety of those who attend you, if left unchecked, can disturb your sense of well-being and cost you the serenity you seek.

Physical Changes
As you approach your death there will be discernible changes in your body. For example, you will lose weight. Your blood pressure will drop. Your pulse rate will either increase from its usual range to upwards of one hundred fifty beats per minute, or decrease to near zero.

Your body temperature may fluctuate wildly. At times you will feel feverish, at other times you will feel a chill. You will experience an increase in perspiration, and what some describe as clamminess.

Those who attend you should be prepared to deal with all these eventualities. Cold compresses and extra blankets should always be easily available.

Your skin color will change: flushing with fever at one minute, becoming bluish with cold at another. Often a pale yellowish pallor will appear. Your hands and feet will become pale or even bluish as your heart’s ability to move sufficient blood through your body diminishes.

Expect your appendages and abdomen to swell and change color as bodily fluids begin to pool. This can also result in a change in your skin’s texture.

Gentle massage with a light lotion is comforting for both you and the person doing the massage. Don’t be afraid to ask for touch.

Your breathing will also begin to change. At times your respiration rate will increase from its usual range to forty breaths a minute or more. At other times your respiration rate will decrease to nine or even six breaths a minute.

You will want to prepare those who attend you for when you will stop rhythmic breathing altogether. This most often occurs during sleep.

Congestion in your lungs will cause a rattling sound in your lungs and upper throat, and may be accompanied by a dry cough. All of these changes will come and go.

Have those who attend you keep your mouth and lips moist. Ice chips on your tongue and glycerin swabs for your mouth and lips are ideal for this purpose.

One or Two Days to Just Hours Prior to Death

You may have a surge of energy just before death, particularly if you have recently discontinued all your medications, except those you take for pain control. (Many of the medications you consume to treat your illness can have unfortunate side effects. Eliminating them during your dying process often gives your body an opportunity to rebound, resulting in an energy surge.)

You may have periods of heightened alertness and clarity unlike what you have become used to. You may resume eating even though you may not have eaten anything for days.

You may even have a renewed interest in being with people. This is an ideal time for closure with those you love. Giving and receiving farewells and offering blessings, as well as ritualizing this most important passage can be uplifting and life affirming for all involved.

If you are afforded this effervescence, know that it will be short lived. Time is at its most precious now. Use it wisely.

Immediately following this small window of renewed vigor the signs of death’s embrace will become more pronounced.

This can be a time of great distress for those who will survive you. They may have misinterpreted your rally of just days or even hours ago to mean that you are getting better. They should be reassured before this happens that all is on course and that your death is near.

There will be an increase in restlessness now as your body tries to compensate for a decrease in oxygen in the blood. Your breathing will become slower and more labored. It’s not unusual for your breathing to stop for long periods before resuming. Sounds produced by the congestion in your lungs will become more audible.

Those who attend you can ease your labored breathing by changing your position in bed.
Don’t expect to be present during much, if any, of this final stage. Your work is done. All you have to do now is let go. Nature will take care of the rest.

If you are registering any sensory input at all during this time it is most likely through your sense of hearing.

Those who attend you should be aware that they can be an enormous help to you at this time. To die peacefully with soft music playing in the background and with words of goodbye and thank you ringing in your ears will make all the difference in the world for both you and them.

Your eyes may be open or semi-open but you’re not seeing anything. For all intents and purposes, you are no longer here. All that remains is for your body’s mechanical systems to shut down.

Your eyes will have a glassy look to them or they will be tearing. Your hands and feet are now purplish, your extremities, back and buttocks are blotchy. Your dying is complete when you stop breathing.

However, what appears to be your last breath often is not. One or two long-spaced breaths at the last moments of life are not uncommon. When these finally subside, you are dead.

Your death, like most things in life, needs formal recognition. An official such as a doctor, hospice nurse or coroner must make that pronouncement.

Conclusion

Some final thoughts.
Throughout your dying process, those who survive and attend you will be looking to you for direction. They will expect and want you to express your needs and desires for as long as you are able. But even when you are no longer able to communicate in any form, crucial decisions continually need to be made. For example, when would you like life support systems such as oxygen removed, and by whom?

The wise person will have clearly and unambiguously addressed all such concerns both verbally and in writing. Durable Power documents and/or a Living Will are specifically designed for this purpose.

Remember there is no one particular way of dying well. In the final analysis, you will probably die the way you lived. However, if you wish to achieve an awareness, appreciation and acceptance of your own dying while participating in it, you can, but it will take work and commitment.

This kind of conscious dying won’t eliminate the pain and poignancy of separation, but hopefully you will learn how to face these and live through them to the end.

Good luck.

September 22, 2014

How to help ensure you die on your own terms

By LISA ZAMOSKY

Earlier this year, Gary Spivack and his sister Betsy Goodkin lost their mother to cancer. Between her first diagnosis and her death in April, her children say, their mother was determined to overcome her illness.

“She was a very stubborn and proud person who fought this and had a lot of support from immediate family and a lot of friends,” says Spivack, 49, a music industry executive who lives in Pacific Palisades.

“She was going to live out her final minutes as healthy and fighting it as much as she could,” adds Goodkin, 51, who describes herself as a “full-time mom” in the Cheviot Hills neighborhood of Los Angeles.

But even as their mother fought to stay alive and healthy, her children say, she made her end-of-life wishes known: If death was imminent, she wanted no heroic measures taken to save her life. And she insisted on dying at home.

They said their mother passed away April 13 in just the manner she had hoped: She was in her own bedroom with the lights low and the mood peaceful. She held hands with loved ones as she passed.

Dr. Neil Wenger, director of the UCLA Health Ethics Center, said most patients would prefer to die that way, but few actually do. That’s because they fail to put their final request in writing, he says.

Without advanced planning, he says, most people die in hospital intensive care units, “in not the most dignified circumstances, in a way most say they don’t want to die.”

Why the gap between what people say they want at the end of their lives and what actually happens? There are many reasons.

A recent study published in the American Journal of Preventive Medicine found that lack of awareness is the most common reason people cite for not having written instructions prepared in advance.

“People go into a mode of thinking — and are encouraged to — that ‘if I just apply enough technology I will survive it,'” says Barbara Coombs Lee, president of Denver group Compassion & Choices. They even continue “in that mode of thinking when it’s perfectly obvious they are actively dying.”

Doctors also avoid such talks. Some physicians incorrectly believe patients don’t want to discuss death. Others pass the buck, believing it’s some other doctor’s responsibility to have the discussion.

These talks take time and can be emotional. “Doctors are human and they bring to the table a lot of their own emotions about death and dying, and these can be very difficult conversations to have,” said Dr. Glenn Braunstein, vice president of clinical innovation at Cedars-Sinai Medical Center.

A report out last week by the Institute of Medicine stated that medical and nursing education fails to orient healthcare providers toward less aggressive forms of end-of-life care, and many providers simply lack the communication skills needed to have these conversations.

Also, the report noted, providers are still largely paid to deliver more services, rather than fewer — even when treatment is futile.

Experts offer recommendations for putting end-of-life plans in place and what needs to be considered.

Open up the lines of communication. Frequent conversations about end-of-life goals between doctors and patients are essential if unwanted treatment is to be avoided, experts say.

“When people fail to plan for the worst, often they find themselves in a struggle to avoid an imminent and inevitable death that ends up causing an enormous amount of suffering for them and for their family members,” Coombs Lee says.

“Anyone with a life-threatening disease should know their options and the efficacy rate of any treatment they are offered,” she says.

Insist on shared decision-making. End-of-life conversations should be part of shared decision-making between a patient and his or her doctor, Braunstein says.

“You take into account the patient’s preferences, their spirituality and a variety of things. At the same time the physician should be giving honest information about what the prognosis is, what we can do and what we can’t do,” he says.

Talk about comfort care: Conversations should include discussions about your various treatment options, including palliative care, which emphasizes a patient’s physical and emotional comfort. Braunstein said palliative care should start well before a patient is terminally ill.

Also important is to talk about hospice care — treatment when you are no longer attempting to prolong your life but rather focusing on staying comfortable and managing pain in your final days.

“We think of hospice care delivered in the home as the gold standard,” Coombs Lee says.

Research suggests that people who receive palliative and hospice care may live longer than ill patients who don’t.

Select an agent. It’s a good idea to name someone such as a family member or close friend to serve as your healthcare agent.

This should be the person you most trust to represent your best interests and who will make sure your wishes are respected and carried out. Your agent can’t be your doctor or other healthcare providers treating you.

Establish an advance care directive. These directives for your last days are legal documents. They allow patients to state their treatment wishes and appoint someone to make medical decisions on their behalf.

They should spell out what you want to have happen and what you don’t. They must be signed by two witnesses — not your doctor or the person you name as your healthcare agent. Alternatively, you can have the document notarized.

A copy should be given to your healthcare agent, other family members or friends, and to your doctor. Ask that it be included as part of your medical record.

Get your doctor’s orders in writing. A Physician Orders for Life-Sustaining Treatment is a frequently used document to be signed by both the physician and the patient.

It generally is filled out when a person’s anticipated life span is six months or less and is put in a prominent place where caregivers and paramedics can see it. “The document is pink so it stands out, and we tell people to put it on their refrigerator or where they’re sitting downstairs,” Braunstein says.

Goodkin of Cheviot Hills says she learned a lot from her mother’s passing in April, namely about how to die on your own terms.

“Everybody wants to die with dignity, bottom line,” she says. “Whatever that means to somebody, you just have to honor that.”

Complete Article HERE!