Professor emeritus has last words on death and dying

Professor emeritus Ronald Bayne was one of Canada’s first geriatricians and a lifelong advocate for better care for older adults. Dr. Bayne, shown here receiving his honorary doctorate at McMaster in 2006, died on Friday after deciding to take advantage of the opportunity for medical assistance in dying.

Dr. Ronald Bayne was one of Canada’s first geriatricians and spent much of his long career as a passionate advocate for better care for the elderly, working to solve the problems in long-term care homes.

At 98, and racked with chronic pain, he turned his advocacy to another cause critical to the elderly: planning the end of life.

Bayne, who was a professor emeritus of McMaster University, died on Friday after deciding to take advantage of the opportunity for medical assistance in dying.

Before dying, he shared his story with the media and produced a compelling video urging seniors and their families to take control of the end of their lives.

The 12-minute video is a powerful demonstration of Bayne’s passion for the cause to the very end, part reflection on death and dying, part rallying cry for better health care and autonomy for the elderly.

“I’m 98 so I am near the end of my life. Fortunately, my mind is still clear though my body is exhausted,” he says in the video.

“I want the vast majority of the population, and seniors in particular, to realize that they have far more control at the end than they realize they do. Every Canadian has the right to control their own bodies. There’s no question about it. You are legally entitled, and you must insist that your voice is heard.”

In the video, Bayne is eloquent and passionate, referring to Dr. William Osler and Shakespeare and his long experience in health care.

“I had a long career as a physician and over these many years I’ve been struck by the fact that increasingly people are fearing death and dying. I think it’s become almost universal,” he says. “People themselves have become fearful about what may happen at the end of their lives, and if they’re going to be suffering great pain, if they’ll get relief.

“I want people to get over this fear of the unknown and make it known. Discuss it openly, realizing that death is inevitable.”

He says everyone has the right to end their life if it has become unbearable. “Some people say that’s promoting death. Of course it’s not promoting death. Death is inevitable, you don’t need to promote it. No, this is to reduce suffering and pain. And if you as a person are not likely to pass on soon, you should be able to control your own end of life.”

Trained at McGill University, Bayne was a professor of medicine at McMaster’s Michael G. DeGroote School of Medicine from 1970 until he retired as a professor emeritus in 1989.

He received an honorary degree from McMaster in 2006 for his advocacy and work raising awareness of the need for better care of the elderly and chronically ill people, and his initiation of programs that work to prevent the warehousing of often marginalized populations.

It is clear from the video that his passion for this work continued through the very end of his life.

“We must have our voices heard. That’s what I’m urging people to do in later life,” he says in the video. “Take that responsibility. Let us ensure that the health-care system for long-term care is properly organized and managed and supervised.

“We know, from recent experience with COVID, that these long-term institutions were very poorly managed, and in a way, the general public is justified in their fear of what will happen to seniors in those places,” Bayne says, suggesting the seniors need to realize they have more control than they think they do.

“We as seniors should be working with our families to discuss the end and how we wish it to occur and building up their [family’s] feeling of confidence that it will be peaceful for us and bearable for them. So instead of focusing on the end, build up great memories, happy memories that the family will treasure afterwards.”

Bayne had a close relationship with the university over the years, and 13 of his family members have McMaster degrees, including the honorary degree awarded his son-in-law, Michael Hayes, in 2017.

Bayne and his wife Barbara have made several donations to the university, establishing the Ronald Bayne Gerontology Award for a graduate student conducting aging research; and the Barbara and Ronald Bayne Award to provide support for senior students in the Department of Health, Aging and Society who are engaged in practical learning experience as part of their undergraduate studies.

“Dr. Bayne has been a wonderful teacher for all of us from his days at McMaster helping create geriatrics as its own discipline in Canada, to just before his death,” said Paul O’Byrne, dean and vice-president of the Faculty of Health Sciences. “I am very grateful for all of his lifelong contributions to improving the health of Canadians.”

Parminder Raina, scientific director of the McMaster Institute for Research on Aging, added: “One of Canada’s first geriatricians and a physician at Mac, Dr. Bayne founded the Hamilton-Wentworth Group on Aging, the Gerontology Research Council of Ontario (GRCO) and led the Canadian Association on Gerontology in the ‘80s. His tireless work in the area of geriatrics and gerontology drove the infusion of a lot of provincial funding into research and training in aging at a crucial time.

“His powerful messages around death and dying are inspiring and important.”

Complete Article HERE!

I chased the American dream.

It brought me back to my father’s deathbed in China.

Mangkuk Wong, the author’s father, in 1987.

By Xiaoyan Huang

I thought for sure he was dead: Whenever I cannot reach my father, now 86, I am convinced the day has come and that he has died alone in his apartment. It was nearly midnight in Shenzhen, China. I tried calling him on WeChat, on his cell, on his landline. No answer. I called his friend to check on him. He answered the doorbell that night and seemed okay, she reported. The picture she sent, though he was smiling, did not reassure me. I’m a cardiologist in Portland, Ore. One look at my father’s ashen color told me his end was near. A week later, he was hospitalized and diagnosed with metastatic colon cancer.

This event had a cruel symmetry, echoing what happened in 2003 when my mother suffered a fall and massive brain bleed. Same apartment. Same hospital. Even the pandemics, then and now, involve related viruses: SARS and the novel coronavirus. My mother had gone into a coma by the time I reached her bedside. After months of hospitalization, she was discharged home, comatose. My father kept her alive in a persistent vegetative state for five more years, with hired help and tube feeds, nearly bankrupting himself. Throughout that time and long after, I was overtaken by guilt. Thirty-four years ago, my parents supported their only child to pursue her education in the United States. It pained me to realize that as a physician, I was unable to save my mother’s life, and as a U.S. citizen, I never gave her the good American life she had asked of me.

This time, I was determined to do right by my father. Though I managed to leverage my connections as an established American cardiologist to get him VIP treatment in his local hospital, he adamantly declined further diagnostic testing or care. My father, a retired university professor, is fiercely independent, a loner. He told me he had lived a long, good life and wanted to die on his own terms. When I gently suggested getting a colonoscopy, tissue biopsy and perhaps advanced cancer therapy, he got mad: “I am fine, I can walk to the crematorium myself!”

Palliative and hospice care are not widely supported in China. When loved ones fall ill, spouses and children often show over-the-top devotion, fearing judgment by other family members and by society at large. In cases of terminal illness, the patients themselves almost never participate in discussions about the severity of the condition (a situation depicted in the 2019 film “The Farewell”). Family members are expected to pursue more aggressive treatment, even if medically futile, espousing blind optimism. The higher the price tag, the better the demonstration of filial piety. Dying at home is generally avoided because of superstition. In China, my father faced intimidating cultural stigma against his wish to stop treatment and die peacefully at home.

I wanted to support him, but it would mean figuring out his end-of-life care on my own. After consulting an oncologist friend, I packed my suitcase full of over-the-counter comfort care medicines. I also had to make arrangements to put my life on indefinite hold — applying for family medical leave, rescheduling appointments, asking colleagues to cover my patients and administrative duties, saying goodbye to my husband and children with no set return date.

Decades ago, I was fortunate enough to attend college in America on a full scholarship. Now it would take every inch of my immigrant success — leaning on all my resources and institutional affiliations — to take the return trip on which I would probably lose my remaining parent and sever my last tie with China. Travel during the pandemic is dauntingly difficult: I needed a special family emergency visa, two negative coronavirus tests within 48 hours of my flight and a time-stamped health clearance bar code from the Chinese Consulate. There were only a handful of flights between the countries each day; it was impossible to buy tickets online. With the help of a childhood friend’s wife, who runs a travel agency in China, I got one. The plane was packed. Everyone wore N95 masks, some with double masks, others with goggles, face shields, hazmat suits and gloves. The flight attendants wore disposable surgical gowns. People hardly ate or drank during the 15-hour flight, trying to minimize bathroom trips.

For two weeks, I was quarantined in a hotel room in Xiamen after landing. The first night, on a sleepless high, I made grandiose plans for catching up on emails and work. By day five, I started exercising by putting all 20 hotel-provided bottles of water into a backpack and pacing the room: 14 steps long, six steps wide, over and over. By day seven, each banging of the door by the hotel staff, announcing meals delivered to a chair outside, made me jump — as did the twice-daily temperature check. Finally, after 14 days and 11 negative coronavirus tests, I was released into the world.

When I finally got to my father’s bedside, suitcase in tow, it was almost anticlimactic. For a surreal second, I felt I was rounding on an elderly patient, as I do every day in my hospital. Reunion in Chinese style, even in such weighted circumstances, is restrained. No matter how many times I had cried in private, there would be no embrace, not even a handshake, no tears in front of him. I instinctively checked on key physical exam findings: Was his neck vein elevated, and legs swollen, suggesting congestive heart failure? I stopped myself just short of probing his abdomen. My hand went, instead, to tuck him into his comforter. At this moment and going forward, I wanted to be only his daughter.

A few days later, I brought my father home. Together with a friend of his, I took care of him: shopping for and cooking his favorite meals; helping him shower and dress; dispensing his few remaining pills. Back in his own environment, my father instantly began feeling better, eating more. We still don’t use the word “cancer” or talk openly about his prognosis, but this feels like neither denial nor forced optimism. Instead, we focus on the concrete tasks at hand. When he has energy, I sit by his bed listening to him talk about his life, about history, philosophy and technology. I tell him about his grandsons and their girlfriends, my work and my life.

I began this journey initially stricken by grief, and by fear of reliving the guilt my mother’s death had induced. But I came to appreciate an unexpected symmetry: Years ago, my parents sacrificed to set me free and allow me to pursue a new life in America. In returning to China, I sacrificed to set my father free and help him have a good death. The first choice is relatively common and often celebrated; the latter is unconventional, even frowned upon — seen as almost unnatural in a culture that prioritizes extending life. But the limbo of quarantine, and all the hurdles I had to surmount en route, brought me to a realization: how important it is, for the living and the dying, to share a moment of peace. In that moment, love is no longer measured by the quantity of pills, the number of CT scans or the extent of heroic medical interventions, but by time spent together.

Complete Article HERE!

Between The Rhymes

— Writing Universal Songs

by

One of the biggest challenges any songwriter faces is how to turn their own story into a universal story that an artist and millions of his or her fans will like. Most of us find it relatively easy to write OUR story, but much more challenging to write our truth in that universal way.

Early in my career, I wrote a song that I thought I crafted very well. It was called “She Stopped Livin’ The Day He Died”. It was the sad but true story of my grandmother who was so dependent on my grandfather that, when he passed away at age 51, just spent the next 25 years of her life in a sad place.

I painted beautiful pictures of their life together before he passed away. I described his job at the factory and her life as a homemaker. I even used their real names in the song. When I played it for my family, they cried. I thought I had a masterpiece.

So, I confidently walked in to my publisher’s office and told him I “thought I had one”. That’s what we said when we thought we really nailed a song. He listened carefully to my song all the way to the end. I was ready for the “Way to go!!! Garth will love this!!”

It never came. Instead, his response was “That’s the saddest crap I ever heard.” He wasn’t one for sugar-coating anything. I was so upset. I couldn’t imagine why he didn’t love my song.

I asked him what was wrong with the song and he simply said “Garth doesn’t want to tell his audience YOUR grandmother’s sad story night after night.” He went on to explain that the key to writing a hit song was telling MY story in a way that millions of people relate it to THEIR story.

It took a while to sink in, but I finally realized that there is a difference in a great, well written song and a great, well written hit song.  What’s the difference?  Universal emotion.

My publisher challenged me to take my song about my grandmother and find the universal emotion behind it.  So, I spent weeks playing and studying that song until I finally thought I had it figured out.

The universal idea or emotion behind my song was that losing someone sometimes makes us feel like a part of us died.  So, I started working on song ideas that would express that feeling in a more universal and less personal way.

First, I decided that writing about someone dying might limit my chances.  Not many artists are searching for songs about death.  There’s no better way to bring a crowd down at a concert than to start singing a good death song.  That idea led me to a more universal (and positive) thought.

I realized that losing someone you love doesn’t have to be talking about dying.  In fact, more people would relate if I wrote a song about losing a love interest just because the relationship ended.  Armed with that knowledge, I looked through my title database and found the perfect title! 

It just so happened I was headed to my publisher’s cabin to write with him (Kim Williams) and Danny Wells.  Both Kim and Danny already had hits.  I did not!  So, I came armed with a bunch of strong ideas.  The first one I threw out was “While You Loved Me”.  Here’s the lyric we wrote.

While You Loved Me
If I ever write the story of my life,
Don’t be surprised if you’re where it begins
Girl I’d have to dedicate every line on every page
To the memories we made while you loved me

CHORUS:
I was born the day you kissed me
And I died inside the night you left me
But I lived, oh how I lived
While you loved me

I’d start with chapter one, love innocent and young
As the morning sun on a new day
Even though I know the end, I’d do it all again
‘Cause I got a lifetime in while you loved me

CHORUS:
I was born the day you kissed me
And I died inside the night you left me
But I lived, oh how I lived
While you loved me

Copyright 2000 Sony/ATV Music

That song expresses the same universal emotion as my song about my grandmother, but in a MUCH more universal way.  Almost everyone can relate to being broken up with by someone you love.  Only my family can relate to my grandmother’s story.

Rascal Flatts cut an amazing record, “While You Loved Me” went on to sell a million records and it became my first top ten hit, landing at #7 on the Billboard chart.  And, it was inspired by the story of my grandmother. 

All of that to say, the key to writing a hit is finding YOUR truth and then finding the UNIVERSAL truth behind it.  That universal truth is the ticket to success as a songwriter.

All the best,
Marty Dodson

Complete Article HERE!

‘The Bitter Comes With The Sweet’

— Without Death, There Is No Life

By

In the early days of the pandemic, my days were bookended by stories of death. I woke up each day hours before dawn to work on my book manuscript, happy to have a passion project to soothe my anxious energy. My book chronicles how Vermont patients, caregivers and health care providers navigated medical aid-in-dying, in the aftermath of legalization. In the morning, I combed through my notes, writing feverishly about dying, and in the evening, I absorbed the news of bodies accumulating around the world more quickly than they could be buried.

I have never been more acutely aware of my own mortality. I offered my husband detailed instructions about how to tend to my unfinished manuscript, should the need arise. We joked, with gallows humor, about how my death would make an ironic capstone to the book; he, of course, agreed to pen the afterword for the posthumous publication.

Studying medical aid-in-dying, and now living through the greatest pandemic in 100 years, has forced me to reckon with mortality. Over the five years that I’ve collected stories about death and dying, people have often questioned how I could study such a morbid topic. Isn’t it depressing? The answer is, anything but. Humbling and grounding, yes, and at times terribly sad, but never depressing.

An avid reader since childhood, I have always taken great comfort in stories. When the pandemic began, I realized that immersing myself in stories about death had actually helped me. Thinking about my own inevitable death is sad, but it doesn’t terrify me anymore. At 40, I hope I have a great many years left, but I’m also more or less at peace with my finitude.

Yet last spring, when I picked up Natalie Babbitt’s novel “Tuck Everlasting” to read to my 7-year-old son, I realized it was this book that first made me address my mortality, some 30 years ago.

If the concept of mortality was terrifying to me, the idea of immortality was even more so.

Published in 1975, “Tuck Everlasting” takes place in the 19th century, 87 years after the Tuck family unwittingly drinks from a magical spring that renders them immortal. The story is set in motion when a 10-year-old girl, Winnie Foster, accidentally discovers their secret. They bring her to their woodland cottage to persuade her to keep quiet, warning her of the catastrophe that would ensue if news of the spring were to become public.

The novel quickly charmed educators and parents, winning numerous literary awards. While it captivates young readers with its lyrical prose, its matter-of-fact philosophizing on life and death set it apart. In a key scene, Angus, the patriarch of the Tuck family, explains to Winnie that dying is an unavoidable part of the “wheel of life.” The bitter comes with the sweet. It is the difference between having a life and merely being alive. You can’t have living without dying.

The Tucks haunted my childhood. To my 10-year-old self, it seemed clear that the only thing scarier than dying was not dying. How awful it would be to outlive nearly everyone that you love! How bleak it would feel to be resigned to a life of complete social isolation. If the concept of mortality was terrifying to me, the idea of immortality was even more so.

This is precisely what the author had in mind. Babbitt wrote the book to tame the worries of her daughter Lucy, who was then 4-years-old. Babbitt wanted to help Lucy understand that dying was a natural part of the wheel of life, that not dying is much less desirable than it may seem.

Flipping cultural scripts on fears about death: this is the power of stories.

As a non-fiction author, I write for reasons not so different from Babbitt’s. I use real people’s stories to examine cultural fears about death — in my case, about lack of control over dying. Medical aid-in-dying offers what is, for many, a seductive vision of personal control over dying, and the promise of a peaceful, sanitized death. Yet such control often proves illusory, both because access to assisted death is much more complicated than it may seem, and because death, itself, is wily.

People have often questioned how I could study such a morbid topic. Isn’t it depressing? The answer is, anything but.

I think about a woman in her mid-60s I’ll call Candace, who developed metastatic cancer. Once it was clear that she was not going to get better, Candace decided to die on her own terms, with medical assistance. She procured the lethal prescription, which was no easy feat, because many physicians are reluctant to participate in the process. By the time she was ready to die, however, she was no longer able to ingest the medication.

The pandemic has made me even more sure that, like Candace, we are not in control of our destinies. But the Tucks weren’t in control, either. They waited passively, resigned to let the oppressive unfurling of time wash over them. In this sense, immortality’s promise of control over death is also illusory. It is poignant that the Tucks look forward to the day, every 10 years, when their sons return to the family cottage. During the pandemic’s eternal spring, when days bled into weeks and then months, I identified with this feeling, marking my days with UPS deliveries, as time moved ever so slowly.

During the pandemic, I have been in the fortunate position of being able to forestall illness and death with the appropriate precautions, such as staying at home. These measures should permit me to avoid the wrong sort of death. (There is universal agreement at this point that dying from COVID-19 is the wrong sort of death.) But I cannot avoid death altogether, nor (I think) would I want to

Now, 10 months into this crisis, my book is complete. The wheel spins on. The end of the pandemic no longer feels as far off and impossible as it did last spring. And still, I wonder what kind of story I am in. I marvel at that wonder.

Complete Article HERE!

‘Dear Life’ explores the beauty of end-of-life experiences

By Terri Schlichenmeyer

Before the doctor opened her mouth, you knew this wasn’t going to be good.

And it wasn’t, although you can barely remember what happened a minute after you heard the diagnosis. All you could wrap your head around were monitors and tubes and machines and death, when what you needed was “Dear Life” by Rachel Clarke, and a reminder that it wasn’t time for that yet.

When she was a little girl, Rachel Clarke was in awe of her father, a doctor who loved music and nature and who shared his sense of curiosity with his children. As a teen, Clarke toyed with the idea of following in his footsteps, but she chose a career in television instead. And then one day, after experiencing a couple of close brushes with death, she decided to go back to school to become a doctor, specializing in palliative medicine.

“I learned that dying, up close, is not what you imagine,” she says. “It is the essence of living… that really matters…”

About death, there are two main things: unlike our ancestors, we aren’t used to it; and we can’t know what it’ll be like. These are what Clarke helps her patients and their families deal with, and while she can’t answer the latter question, she promises them that the days and hours before the end are as full of life as possible.

Sometimes, that means meeting fears head-on, and discussing death matter-of-factly. Sometimes, it’s asking questions of a patient because no one else has done so. Caring for someone who’s dying may mean literally opening a window to sunshine or birdsong, holding a hand, letting “a wife curl up in a hospital bed beside her dying husband,” or encouraging a visit from a pet or a beloved grandchild. And sometimes, a doctor just needs to remember that “There is always a spark of beauty or significance…in the life you have left,” even when the person dying is someone the doctor loves.

This year, no doubt, you’ve seen enough death to last several lifetimes, and you’re not sure you can withstand a book about it right now.

But hold on, because “Dear Life” lives up to its title.

Beautiful, thoughtful, and loving, this book is absolutely brimming with life as author Rachel Clarke describes the end-of-life care offered at the hospice where she works and some of the most memorable patients to whom she ministered care.

If that sounds like an anti-life book, well, it’s not. It’s true that people die in this book, and they do it often but Clarke’s accounts of their days prior to death are quiet and serene, with no fear, no pain, and the minimum of loose ends left. Her workplace is not a sterile, clinical home where people go to die; rather, it’s a place where people die but first, happiness sneaks in sometimes.

And for that, curiously, this book on death-and-life may be the balm your COVID-bruised mind needs now. Indeed, calm, truthful, and not too gory, “Dear Life” is good.

Another book to look for is “Grief: The Biography of a Holocaust Photograph” by David Shneer. It’s the story of a photo taken toward the end of World War II, and the emotion inside it. Part meditation, part history, this book is perfect for the historian, too.

Complete Article HERE!

Near the end of life, my hospice patient had a ghostly visitor who altered his view of the world

By Scott Janssen

For months, as I’ve visited Evan as his hospice social worker, he has been praying to die. In his early 90s, he has been dealing with colorectal cancer for more than four years, and he is flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.

On this visit, though, his depression seems to have lifted. He’s engaged and upbeat — and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?

“You seem to feel differently today than on other visits,” I say casually. “What’s going on?”

He looks at me cryptically.

“Do you believe in ghosts?” he asks.

It’s not the first time a patient has asked me this. People can have unusual experiences when they reach the end of life: near-death or out-of-body experiences, visitations from spiritual beings, messages delivered in dreams, synchronicities or strange behaviors by animals, birds, even insects.

“There are all kinds of ghosts,” I respond seriously. “What kind are you talking about?”

“You remember me telling you about the war?” he asks

How could I forget? He’d traced his long-standing depression to his time as a supply officer for a World War II combat hospital. The war, he’d said, had soured him on the idea that anything good could come from humans and left him feeling unsafe and alone.

“I remember.”

“There’s something I left out,” he says. “Something I can’t explain.” He goes on to describe one horrific, ice-cold autumn day: Casualties were coming in nonstop. He and others scrambled to transport blood-soaked men on stretchers from rail cars to triage, where those with a chance were separated from those who were goners.

“I’d been hustling all day. By the time the last train arrived, my back felt broken, and my hands were numb from the cold.”

He grimaces and swallows hard.

“What happened when the last train got there?” I ask softly.

“We were hauling one guy, and my grip on the stretcher slipped.” Tears roll down his face. “When he hit the ground, his intestines oozed out. Steam rose up from them as he died.”

Evan rubs his hands as though they were still cold.

“Later that night I was on my cot crying. Couldn’t stop crying about that poor guy, and all the others I’d seen die. My cot was creaking, I was shaking so hard. I even started getting scared that I was going insane with the pain.”

I nod, waiting for him to continue.

“Then I looked up,” he says. “Saw a guy sitting on the end of my cot. He was wearing a World War I uniform, with one of those funny helmets. He was covered in light, like he was glowing in the dark.”

“What was he doing?” I ask.

Evan starts crying and laughing at the same time. “He was looking at me with love. I could feel it. I’d never felt that kind of love before.”

“What was it like to feel that kind of love?”

“I can’t put it in words.” He pauses. “I guess I just felt like I was worth something, like all the pain and cruelty wasn’t what was real.”

“What was real?”

“Knowing that no matter how screwed-up and cruel the world looks, on some level, somehow, we are all loved. We are all connected.”

This turned out to be the first of several paranormal visits. Each time the specter arrived, he’d wordlessly express love and leave Evan with a sense of peace and calm.

“After the war, the visits stopped,” he says. “Years later, I was cleaning out Mom’s stuff after she died, and I found an old photograph. It was the same guy. I looked on the back, and Mom had written the words ‘Uncle Calvin, killed during World War I, 1918.’ ”

We talk some more, then I ask, “What does this have to do with your being in a better mood?”

“He’s back,” he whispers, staring out the window. “Saw him last night on the foot of my bed. He spoke this time.”

“What’d he say?”

“He told me he was here with me. He’s going to help me over the hill when it’s time to go.”

As I’m formulating more questions, Evan surprises me by asking one of his own.

“You ever have something strange happen? Something that tells you that no matter how bad it looks, you’re connected with something bigger, and it’s going to be okay?”

A memory flashes into my mind. It was 35 years ago. It was after midnight, and I was asleep in a graduate-student apartment at Syracuse University. A siren’s blare woke me, so loud it sounded like it was inside the room. Adrenaline pumping, heart pounding like a hammer, I sat up and wondered what had happened. Was it a dream?

From outside, I distinctly heard what sounded like a two-man stretcher crew talking.

“Bring it here quick,” one guy told the other. I heard a gurney being rolled across asphalt.

I went to the window and pulled back the curtain, certain there was trouble outside.

The night was silent. Nothing was stirring in the parking lot. No one was there.

Just before daybreak, Dad called to tell me that just a few hours earlier, my uncle Eddie had been killed in an automobile collision.

That was a tough day. As night fell once more, questions filled my head: Why did this happen? What was he experiencing when it ended? Was he scared?

On the kitchen table sat a beat-up radio; some kind of malfunction occasionally caused it to turn off or on for no apparent reason. As my questions swirled, the radio turned on, and I heard the opening chords of the Beatles’ song “Let It Be.”

Not being a fan, I’d never listened closely to the song before — but this time, I did. The music and words filled me with an almost otherworldly sense of peace and comfort. The song ended. Shortly after, the radio cut off.

For years, I tried to explain away those events. It must have been a dream, I told myself. Or some kind of fabricated “memory” to fool myself into thinking that uncle Eddie and I were connected in that moment. As for the radio, it was nothing but a random coincidence. Any other conclusion is just wishful thinking.

Inside, though, a part of me knew it was real.

After nearly 30 years as a hospice social worker, I’m certain of it. And I have patients like Evan to thank: dying patients who have convinced me that the world we inhabit is lovingly mysterious and eager to support us, especially during times of disorientation and crisis. It even sends messages of love and reassurance now and then when we’re in pain.

I return to the present. Evan is looking at me, waiting for an answer. I feel grateful that he’s pulled up these memories. Outside, a flock of crows takes off in unison from the branches of an ancient oak.

“Yeah,” I say with a nod. “I guess I have.”

Complete Article HERE!

What Is Death?

How the pandemic is changing our understanding of mortality.

By BJ Miller

This year has awakened us to the fact that we die. We’ve always known it to be true in a technical sense, but a pandemic demands that we internalize this understanding. It’s one thing to acknowledge the deaths of others, and another to accept our own. It’s not just emotionally taxing; it is difficult even to conceive. To do this means to imagine it, reckon with it and, most important, personalize it. Your life. Your death.

Covid-19’s daily death and hospitalization tallies read like ticker tape or the weather report. This week, the death toll passed 300,000 in the United States. Worldwide, it’s more than 1.6 million. The cumulative effect is shock fatigue or numbness, but instead of turning away, we need to fold death into our lives. We really have only two choices: to share life with death or to be robbed by death.

Fight, flight or freeze. This is how we animals are wired to respond to anything that threatens our existence. We haven’t evolved — morally or socially — to deal with a health care system with technological powers that verge on godly. Dying is no longer so intuitive as it once was, nor is death necessarily the great equalizer. Modern medicine can subvert nature’s course in many ways, at least for a while. But you have to have access to health care for health care to work. And eventually, whether because of this virus or something else, whether you’re young or old, rich or poor, death still comes.

What is death? I’ve thought a lot about the question, though it took me many years of practicing medicine even to realize that I needed to ask it. Like almost anyone, I figured death was a simple fact, a singular event. A noun. Obnoxious, but clearer in its borders than just about anything else. The End. In fact, no matter how many times I’ve sidled up to it, or how many words I’ve tried on, I still can’t say what it is.

If we strip away the poetry and appliqué our culture uses to try to make sense of death — all the sanctity and style we impose on the wild, holy trip of a life that begins, rises and falls apart — we are left with a husk of a body. No pulse, no brain waves, no inspiration, no explanation. Death is defined by what it lacks.

According to the Uniform Determination of Death Act of 1981 (model legislation endorsed by both the American Medical Association and the American Bar Association, meant to guide state laws on the question of death), you are dead if you have sustained “either irreversible cessation of circulatory and respiratory functions” or “irreversible cessation of all functions of the entire brain, including the brain stem” — in other words, no heartbeat and no breathing, which is obvious enough, or no brain function, which requires an electroencephalogram.

These are the words we use to describe one of the most profound events in human experience. Most states have adopted them as the legal definition of death. They may be uninspired, and they surely are incomplete. Either way, a doctor or nurse needs to pronounce you dead for it to be official. Until then, you are legally alive.

If we stay focused on the body, the most concrete thing about us, it becomes difficult to say whether death exists at all.

From the time you are born, your body is turning over. Cells are dying and growing all day, every day. The life span of your red blood cells, for example, is about 115 days. At your healthiest, living is a process of dying. A vital tension holds you together until the truce is broken.

But your death is not the end of your body. The chemical bonds that held you together at the molecular level continue to break in the minutes and months after you die. Tissues oxidize and decay, like a banana ripening. The energy that once animated the body doesn’t stop: It transforms. Decay from one angle, growth from another.

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Unfettered, the decay process continues until all that was your body becomes something else, living on in others — in the grass and trees that grow from where you might come to rest, and from the critters who eat there. Your very genes, little packets of stuff, will live indefinitely as long as they found someone new to host them. Even after interment or cremation, your atoms remain intact and scatter to become other things, just as they pre-existed you and became you.

For revelation of the mysteries of an afterlife, or of the forces that kicked off this wondrous circus in the first place, we might look to religion. What is described above is plainly observable science. Yet science doesn’t do the question justice. It won’t tell us why, or what’s behind its laws. The body houses more than we can express; you are more than your body. Becoming a blade of grass is a sweetness that doesn’t compensate for all the heartache death connotes.

Of course, we’re sad and afraid of losing ourselves and people we love, but for many of us a fear of death as the Great Unknown has been overtaken by our fears of what we know — or think we know — about dying.

Nowadays, being dead sounds like a lullaby compared with the process of dying. Given a steadily awful diet of stories about breathing machines and already-disenfranchised people dying alone, we’re told to imagine the worst, before cutting to commercial. Our choices seem to be either to picture a kind of hell — that could be mom or me, breathless and alone — or to distance ourselves from the people living those stories, not just in body but in every way, to de-identify with our fellow human beings.

But this is how we make hard things harder. Maybe our fear of death has more to do with our perceptions of reality than with reality itself, and that is good news. Even if we can’t change what we’re looking at, we can change how we look at it.

We do have fuller ways of knowing. Who doubts that imagination and intuition and love hold power and capacity beyond what language can describe? You are a person with consciousness and emotions and ties. You live on in those you’ve touched, in hearts and minds. You affect people. Just remember those who’ve died before you. There’s your immortality. There, in you, they live. Maybe this force wanes over time, but it is never nothing.

And then there’s consciousness — spirit, if you like — and of this, who can say? You may have your own answer to this question, but we do not get to fall back on empiricism. Whatever this mystery is, it blurs all the lines that seem at first glance to separate death from life. And if death isn’t so concrete, or separate, maybe it isn’t so frightening.

The pandemic is a personal and global disaster, but it is also a moment to look at the big picture of life. Earlier this week I had a patient lean into her computer’s camera and whisper to me that she appreciates what the pandemic is doing for her: She has been living through the final stages of cancer for a while, only now her friends are more able to relate to her uncertainties, and that empathy is a balm. I’ve heard many, in hushed tones, say that these times are shaking them into clarity. That clarity may show up as unmitigated sorrow or discomfort, but that is honest and real, and it is itself a powerful sign of life.

So, again, what is death? Talking about and around it may be the best we can do, and doing so out loud is finally welcome. Facts alone won’t get you there. We’re always left with the next biggest question, one that is answerable and more useful anyway: What is death to you? When do you know you’re done? What are you living for in the meantime?

For some of us, death is reached when all other loved ones have perished, or when we can no longer think straight, or go to the bathroom by ourselves, or have some kind of sex; when we can no longer read a book, or eat pizza; when our body can no longer live without the assistance of a machine; when there is absolutely nothing left to try. Maybe the most useful answer I ever came across was the brilliant professor who instructed his daughter that death was what happened when he could no longer take in a Red Sox game.

If I had to answer the question today I would say that, for me, death is when I can no longer engage with the world around me. When I can no longer take anything in and, therefore, can no longer connect. At times, social distancing has me wondering if I’m there already, but that’s just me missing touching the people I care about. There are still ways to connect with others, including the bittersweet act of missing them. And besides, I get to touch the planet all day long.

These are helpful questions to consider as you weigh serious medical treatment options, or any time you have to choose whether to mobilize your finite energy to push, or use it to let go. Our answers may be different, but they are always actionable; they are ends around which we and our inner circles and our doctors can make critical decisions.

They also have a way of illuminating character. They are an expression of self, the self who will one day do the dying and so gets to say. What is it you hold dear? Who are you, or who do you wish to be? You can see how death is better framed by what you care about than by the absence of a pulse or a brain wave.

Beyond fear and isolation, maybe this is what the pandemic holds for us: the understanding that living in the face of death can set off a cascade of realization and appreciation. Death is the force that shows you what you love and urges you to revel in that love while the clock ticks. Reveling in love is one sure way to see through and beyond yourself to the wider world, where immortality lives. A pretty brilliant system, really, showing you who you are (limited) and all that you’re a part of (vast). As a connecting force, love makes a person much more resistant to obliteration.

You might have to loosen your need to know what lies ahead. Rather than spend so much energy keeping pain at bay, you might want to suspend your judgment and let your body do what a body does. If the past, present and future come together, as we sense they must, then death is a process of becoming.

So, once more, what is death? If you’re reading this, you still have time to respond. Since there’s no known right answer, you can’t get it wrong. You can even make your life the answer to the question.

BJ Miller is a hospice and palliative medicine physician, author of “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death,” and founder of Mettle Heath, which provides consultations for patients and caregivers navigating serious illness.

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