An end-of-life doula’s advice on how to make the most of your time on earth

Life is short. Here’s how to cherish every day of it.

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“I want a party in the woods with an all-night campfire. I’ll be off to the side in a sleeping bag, nice and cozy. There will be s’mores and cocktails. My friends can come and go, saying goodbye however they want, or just sitting quietly with me and holding my hand. Nobody should touch my feet, though. I hate having my feet touched. A playlist of my favorite songs should be on repeat. I’d like to die as the fire burns out at dawn. Lights out and lights out, you know?”

I’m on Zoom and a chaplain from Iowa is describing her ideal final hours of life. We’re training to become end-of-life doulas, and this morning’s assignment is to help each other talk through a final hours ritual. It’s one of many exercises designed to confront us with our own mortality, so we can leave our own feelings about death at the door before we step across someone else’s threshold to help with theirs.

End-of-life (EOL) doulas are at the opposite end of the life cycle spectrum from birth doulas. They provide non-clinical care (emotional, logistical, and physical) and help with planning; engage with life reviews and legacy work; and provide support for family and friends so caretakers can bring their best, rested selves to support their dying loved one.

I knew training to become a doula would change my relationship to death, but I didn’t anticipate how it would transform my day-to-day life. Like others, my smartphone use skyrocketed during the isolation of the pandemic. Even after those panic-inducing first months in NYC, I still found myself using my phone as a constant distraction — lurking on Instagram, clicking every New York Times alert, obsessively refreshing my email like it was a Vegas slot machine.

I didn’t become an end-of-life doula to fix my fragmented focus. I did it because Covid-19 made death suddenly feel very real and very present. But I found that a deep dive into death work profoundly clarified my priorities, and has helped me spend time in ways more aligned with those priorities thanks to the soul-shaking understanding that our time here is truly limited.

Here are three components of EOL doula training that have been useful in my never-ending quest to live a more present and focused life in this Age of Endless Distractions. Think of it as a looking-back-from-your-imagined-deathbed approach to living — which sounds morbid in theory but is empowering and enriching in reality.

Imagine you have three months to live

I’m not going to lie to you: This exercise isn’t going to feel great! Please do it only if you feel equipped to engage with feelings of grief and loss. I recommend having someone you trust read it to you, someone who also has the emotional bandwidth and who is not currently grieving. You’ll need a pen and paper. Choose a time when you’re not going to feel rushed and are in a comfortable space. Take some deep breaths. Settle in. Here we go.

Write down your five most-prized possessions, your five favorite activities, your top five values, and the five people you love the most.

Close your eyes. Imagine you’re at a doctor’s office. You’ve just been given a terminal diagnosis and told you have approximately three months to live. Sit with that news. Breathe. Open your eyes. Cross any four items off your list.

Close your eyes. You’re back home with your spouse or friends or children or pet. You have to find a way to tell those you love: “I’m dying.” Breathe. Open your eyes. Cross another four items off your list.

Close your eyes. You’ve started feeling the effects of your illness. You can’t get around as easily. Your sleep is restless. You’re nauseated from the medications you’re taking. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re mostly confined to your bed now. Your loved ones have gathered because they know they will soon have to say goodbye. They drift in and out of your bedroom, or wherever you have chosen to spend your final days, holding your hand, perhaps playing music you like or reading aloud your favorite book. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re in bed, eyes closed, unable to move much or to speak at all. You sense that you’re going to die soon, and you wonder what will happen when you go. What are you thinking about in these final moments? Breathe. Open your eyes. Cross the remaining four items off your list.

Whew. You did it. Make sure to give yourself as much time as you need to regroup before you reenter the “real world.” Sit still. Focus on your breath. Drink lots of water.

When I did a version of this exercise, I was amazed at how real loss and grief felt as I crossed items off my list. (There is nothing quite like imagining your kid’s life without you to bring on The Sobs.) I don’t want to overstate the impact of imagining loss versus actually experiencing it, nor minimize our individual, multi-faceted responses to real grief, but research has shown that stressful life events can change us, and that includes clarifying our values and priorities. Maybe you, like me, tapped into some of that clarity during this exercise.

A few days after I tried this exercise, I rewrote my Top 20 list on a notecard. I keep that notecard by my laptop and look at it often. It has been an unexpectedly powerful reminder of what and who I love, of who I am and want to be. Each day I think about how to fit in as much as I can from this list, even if I only have a few free minutes to myself. It has become the framework that informs my daily to-dos and balance of urgent/important tasks.

Practice deep, active listening

A good deal of EOL doula work is listening work. The deep, active listening doulas are trained for involves holding back our own stories, comments, and feelings. Doulas don’t tell a dying person what to do. They don’t try to fix the situation. They ask open-ended questions and understand that how people move through the dying process is up to them. This kind of listening requires empathy and restraint. It insists on being free from distractions, external (cellphone notifications, I’m looking at you) and internal (like that voice inside your head that wants to judge or give advice).

As the person at a party who makes approximately 30 seconds of obligatory small talk before diving into deeply personal conversations with strangers, I assumed I was custom-built for this part of being a doula. But it can be difficult to stick to open-ended questions, to sit comfortably in silence, or to resist giving well-meaning but unsolicited advice.

So, I’ve been practicing. A lot. This kind of listening has altered what I can only think to call the texture of my time. It has made me more present, empathetic, and curious in conversations and relationships.

The next time you’re having a conversation with someone who is sharing important information or struggling in some way, you might try it. Ask open-ended questions. “How are you feeling about X?” “Do you want to talk more about Y?” Give their answers space and silence to settle.

Reflect back what you think you’ve heard. Be open to being wrong about what you think you’ve heard. Be supportive, but don’t try to fix the situation with advice or talk them out of what they are feeling. Avoid platitudes like “give it time” or “it wasn’t meant to be.” Even “I know how you feel,” well-intentioned though it is, often misses the mark because we mostly don’t know exactly how someone else feels or entirely understand their specific situation.

Of course, not all our conversations require this therapist-like level of restraint, but challenge yourself to consider that plenty of them could benefit from a touch more deep listening.

Legacy projects in the here and now

Doulas often help with legacy projects: autobiographies, letters to loved ones, art projects, and more. These projects memorialize a person’s passions and creativity, values and contributions, and — spoiler alert! — you don’t have to wait until you or someone you love is dying to work on one.

Complete Article HERE!

In the I.C.U., Dying Sometimes Feels Like a Choice

By By Daniela J. Lamas

My patient’s wife had just one question: Was her husband dying?

She knew that he was still on the ventilator even after all these weeks, his lungs too sick and his body too weak to breathe on his own. That he still needed a continuous dialysis machine to do the work of his kidneys. That he had yet to wake up in any meaningful way, though his brain scans showed nothing amiss. That it had been more than 50 days since he entered the hospital and we needed to talk about what would come next.

But when she stood there at the bedside, her husband looked much the same to her as he had a week ago, much the same as he might look next week if we continued to push forward. And she had to ask: Why did we need to have this conversation today? Was her husband dying?

You might think this is an easy question to answer. And yet here in the intensive care unit, it is not. Our medicines and machines extend the lives of patients who would otherwise have died. But what happens when it becomes clear that a patient is not actively dying, but not getting better either? How do doctors and family members navigate death when it is not imminent and unavoidable, but is instead a decision?

During my medical training, death happened in one of two ways. It was either a moment of crisis, doctors rushing into a room, all sound and fury and chest compressions for minutes that felt like hours. Or it was something quieter, entirely divorced from machines, family gathered for the last breaths when the lungs were failing, or the cancer had spread too far.

But there’s a third form that dying takes, when it becomes clear that the life that we can offer is not one that would be acceptable to the patient. It is a death that is made imminent only by the withdrawal of medicines and machines — a death that we plan for. It is a strange thing to plan a death, but I have come to understand that this is part of our work in the I.C.U.

A few months ago, I took care of a cancer patient in her 70s who had been intubated because of a flare-up of an underlying lung disease. In the moments before the anesthesiologists put her to sleep and placed the breathing tube down her throat, she had given her son instructions: Give her a chance to get better, but if that failed, she did not want a tracheostomy tube for a longer-term connection to the ventilator or months at a rehabilitation hospital. Her cancer was progressing, and that was not the way she wanted to spend the last year of her life.

I told her family that we would continue our intensive interventions for two weeks, a “time-limited trial of critical care,” as we often call it. If my patient was not breathing on her own at that point, then she never would never be — not without a trach and protracted rehab, a best-case scenario that she would find unacceptable. A week passed. She improved a bit and her family let themselves hope, only to be devastated days later when she worsened again.

Then, the day before the time-limited trial was to end, my patient’s son and daughter took me aside. They could not bring themselves to leave that night and return the next morning to hear the words that now seemed inevitable. If their mother was not going to improve, they wanted to take her off the machines that evening. The next day was her grandson’s birthday. She would not have wanted the little boy’s celebration to be forever intertwined with the sadness of her death. Perhaps they could wait until the day after the birthday, but that might only prolong their mother’s suffering.

There is something uncomfortable about these conversations, where it feels as though we are asking family members to plan the end of a life. It begins with a moment in the family meeting, when we have made the decision to “transition to comfort,” and family members ask me what comes next. What they are asking, really, is how their loved one will die.

As gently as I can, I tell them that when they are ready — as anyone really can be for any of this — we will stop the medications and the tubes that are prolonging life. I tell them that the bedside nurse will give other meds, often morphine or a similar drug, to make sure that their loved one is not in pain. Sometimes they ask if this medication will hasten death, and I explain that it can, but that our primary goal is always to relieve discomfort.

We even have a term for this balance, the “principle of double effect” — as doctors, we accept the risk of a negative consequence like hastening death, so long as our intended outcome is to help the patient by alleviating symptoms. The pain-relieving meds that we administer do not themselves cause death; instead they ensure that our patients are as comfortable as they can be while dying from their underlying disease.

Some family members ask us to stop everything all at once. Others ask for a longer process, to stop one medicine and then another. Someone recently asked the nurse to let every medication run out and not to replace the IV bags. Some ask us to remove the breathing tube, others do not. I am often surprised to what extent people have ideas about what feels right to them, about how the unimaginable should play out. Sometimes there is music. Jerry Garcia. Beethoven. For others, this is all one decision too many, and they sit in silence.

A resident doctor in training came to me recently after one such family meeting, worried that by telling a family that their loved one was dying, he had made it true. If we define dying solely by physiology, by a falling blood pressure or oxygen level, then perhaps that concern is valid. But if we broaden our definition, if we think of dying in the intensive care unit as something that begins when an acceptable outcome is no longer possible, then we are acknowledging the inevitable.

Which is what I told my patient’s wife that day outside his room. We had given her husband every chance to rebound, to show us that he could make it through, but the insults his body faced were too great. We could press on, but to what end? He would never make it home, never be able to do the things that made his life worth living.

She was right, the timing of this conversation was, in a way, arbitrary. Had I been dealing with a patient in extremis, I might not have stopped her outside the room that day. But once we recognized the reality of her husband’s medical condition, what choice was there?

That night, my patient’s wife made the decision to take him off the ventilator. The nurses titrated the pain medications that ran through his veins as she held vigil at his bedside. And after weeks of critical care limbo, the answer to her question was finally clear. Her husband was dying.

Complete Article HERE!

How Death Gives Meaning to Our Lives

In her new book, Alive Until You’re Dead, Susan Moon helps us confront our fears around death and shows us why we should be grateful for our own mortality.

Susan Moon’s new book, Alive Until You’re Dead, is out now with Shambhala Publications.

by Alison Spiegel

The subtitle of writer and lay Zen teacher Susan Moon’s latest book may be “Notes on the Home Stretch,” but the wisdom on aging, and more to the point, death, in Alive Until You’re Dead is important for readers of any age. Weaving in personal stories, many about confronting the deaths of close friends, Moon turns her lived experience into tributes and guidance for facing mortality. She also brings a lightness to the subject that so many people fear above all else, but that Moon says actually brings meaning to our lives. Tricycle caught up with Moon to hear more about the intention and writing process of the book, and for further advice on facing death at any stage of life.

Why did you want to write Alive Until You’re Dead: Notes on the Home Stretch? I wanted to write about my ongoing concern with what it means to be mortal and the idea that our condition of mortality and impermanence, which we are constantly fighting against, actually gives us life. Death is very hard and painful but it’s also what gives meaning to our lives. I really wanted to talk about how we actually can be grateful for our mortality, and that the fact that we’re going to die gives us the opportunity to make our life meaningful.

You wrote this book during the pandemic. How did that unique time impact your work? I think of it as my pandemic book, in a sense, because the pandemic provided me time and space and simplicity of life to write. I’ve been on writing retreats, I’ve been to writers’ residencies, and weirdly, this horrible tragedy was also kind of a perfect writer’s retreat for me. But at the same time, I think all the tragedy and fear added to the relevance of my subject in a way. I have to add that I’m grateful to my sister and brother-in-law who live with me and who supported and encouraged me as this was going on.

Early in the book, in a story about a friend of yours who died in the hospital after suffering a stroke, you say that “the Grim Reaper metaphor is all wrong.” Can you explain what you mean by that? Death is not one separate thing that’s coming after us. In Buddhism, birth and death are kind of conceived as a hyphenated thing. Life is the realm of birth and death, and there’s a sense that before we were born into this body, and after we leave this body, there’s this other realm of the absolute, which is a mystery to us. People often worry about what will happen to them after they die, but we never think about where we came from before we were born. We don’t even think about that as a parallel thing. 

Though you don’t shy away from the hard parts of aging, you also describe the upsides. Referencing a dharma brother who gave a memorable talk at Berkeley Zen Center, you write, “In his old age, it came naturally to him to put himself aside and not think about what he needed all the time.” How have you experienced this? It’s about letting go of self clinging. I’m not building a life anymore so there’s some freedom there to attend to the needs of others, like my own children and grandchildren. How can I just be present with loved ones? I love the example in that essay when the man said when he was playing with his grandson, and they would build a tower, his grandson would knock it over again and again, and they would just laugh and build it again. You don’t have to worry about building a tower that stays up.

But letting go of self-clinging is appropriate for anyone at any stage of life. If you’re grasping for your own happiness at the expense of others, that’s not going to bring you happiness. I really feel that the path to joy is to let go of self-clinging in whatever way you can, and I think Buddhist practice has been helpful for me in that. But there’s many other routes, like being in community and continually remembering that we’re all in this together, we’re all interconnected, and your happiness isn’t separate from anybody else’s happiness.

“The fact that we’re going to die gives us the opportunity to make our life meaningful.”

Throughout the book you reference beautiful moments with your grandchildren, who you connected with frequently over Zoom during the pandemic. These stories speak for themselves, but you also talk about the term “grandmother mind.” Can you explain what that means? It’s connected to letting go of clinging. Dogen uses the phrase when he tells a young male monk, who is different from a grandmother in every possible respect, that he won’t be able to have a mind of compassion and be a true Buddist practitioner unless he can develop “grandmother mind.” Dogen is speaking, I believe, about what he calls “the mind of great compassion.” So it’s that spirit, but I think as I’m using it, it’s also about a certain kind of love. If you’re not one of the grandparents who are raising your own grandchildren—an amazing thing that a lot of people are doing—and you’re able to just be a grandparent and not be responsible for all the hard parts, the kind of love that you can have for your grandchildren is unencumbered, unconditional. I see “grandmother mind” as an obligation to apply that feeling to all children. All of us need to have “grandmother mind” about children.

On the subject of death, you say, “When I deliberately consider my own death, I feel more alive,” and you offer some contemplations on death. Could you describe one of them? One that pops into my head—it’s not harder or easier, or more important or anything—is walking in cemeteries. To walk in a cemetery, and to actually look at the gravestones, read the names and think of all these people who have died, to look at the dates and think about the generations, gives me a sense of how there’s a flow of time and generations. For some reason I’m comforted by the thought that I am a leaf in the generations of leaves that keep turning over. I’m part of the turning over. There are many people who were born and died before me and hopefully there will be many who are born and die after me. I’m just one person and I’m not all that important. It’s just amazingly fortunate that I should be walking there, alive and looking at some bird singing in a tree, and life is going on. It’s the same feeling I get from looking at the stars in the sky and thinking of the vastness of the universe, or by reading about physics or cosmology. It’s the idea that there’s this vastness of time and that my life is just a little blink, and I don’t even know what part of the great cosmic consciousness my life is, but it’s a miracle that I have this consciousness in this one little tiny person on the planet. Here I am, and what a great miracle.

Do you think it’s wise or essential to prepare for death? What about preparing for the death of loved ones? When I think about it as a practice myself I resist it because it feels unnecessarily harsh. But should we prepare for the greatest moments of suffering? What I realized when I was writing this book—and I realized it before when thinking about my own loved ones, and particularly my children—is that accepting my own death is a hard job, but accepting that the people I love will die is even harder. Having people leave you is terrible, and then the worst possible fear of all would be to have your children die. I can’t imagine anything worse. I remember when I first became a mother, all of a sudden when I read the newspaper and the war in Vietnam was going on, I would see these pictures of children in the war and the whole thing took on a different meaning. It was much more personal to me, and it became unbearable. It’s the same even now, when I think about the war in Ukraine and the children there.

I think preparing for the death of loved ones is something that one can do. You can prepare for the death of somebody who is old, where the death won’t be such a tragedy. You can just try to appreciate the person and have so much gratitude for this person being in your life. You can try to help them see that their life has been full and rich and help them find some peace. And for children, take as much joy as possible in what’s going on. Don’t let fear rob you of your joy.

I also think that we can trust that sometimes people who are dying find a way to accept what’s happening. Maybe they’re in pain, maybe they want to be released, but it’s important to know that while your pain and your loss is so real and acute, you don’t have to take on their suffering, because you don’t really know what they’re suffering is.

A friend of mine, who I loved very dearly, died of cancer in 2018. I miss her terribly. She was a Buddhist, and she knew she was dying for quite a long time. At first she was still functioning well and then she needed to care, and I was one of the people who took turns to help her at home, making meals for her and things like that. Then she was in some pain and I said, “How do you do this? How do you tolerate this?” She said, “I just say to myself, ‘This is how it is right now.’” This is how it is right now. That became a kind of mantra for me that I bring into a lot of other situations in my life. It’s about being present in the moment, accepting things as they are and then moving from there. It’s not resigning yourself, but being present with things before you go on to the next thing. It’s knowing, thanks to impermanence, that things won’t stay this way, for better or worse. I think that is very helpful.

Complete Article HERE!

Where Do the Dead Go in Our Imaginations?

My friend was gone. I needed to do something to honor the person she was.

By Anakana Schofield

In the west of Ireland, in County Mayo, where my mother lives, there’s a lovely tradition of attributing words or phrases to people. If they are dead, you add an acknowledgment after their name along the lines of “May the Lord have mercy on their soul.”

I love how this reignites the spirit of a deceased person you may or may not have known. You can build an entire sense of someone you never met from hearing their expressions. And for those who knew them, that person can live again in the utterance of those sayings.

From a young age, I’ve had to contemplate death. Early childhood loss of a parent will do that to you. My father died when I was 6. Since then, I’ve been trying to understand the cumulative nature of grief. The resounding question of my life has been, Where do the dead go in our imaginations? Increasingly as I age, I’ve wondered where I will go in people’s imaginations. Will anyone remember me? Will I still matter to anyone once I am dead?

After all, as time passes, people can become the subject of their exit. My friend who was hit by a car. My friend who had an asthma attack. My friend who took her life. After the pandemic we will also have to decide how we will talk about the lives of those who were taken by Covid-19: Will the lives they lived be overshadowed by the fact that it was Covid-19 that extinguished them? Will their years of living be reduced to the name of a virus that wiped them out in a matter of days or weeks?

These questions confounded me even before the pandemic. Five years ago this month, one of my oldest friends died by suicide (though it is so tempting to say that she “died suddenly”). A lifetime of loss would not prepare me for the way this buckled me in half. I would see my friend in the T-shirts my son put on, every time I picked up a tea towel or made a cup of tea, because this friend was so incredibly generous, she wallpapered my entire life with that generosity and love. It wasn’t about the objects as much as the thought that at the time she picked out the tea towel or the many tea tins that line my cupboard, she did so because I was on her mind. I was alive for her even though I was absent. In that moment she chose to remember me. How can I return this gesture now, when she is no longer here?

In a way, my friend’s endless generosity has kept her alive for me, but inevitably, whenever I experience small mercies or achievements or special moments, her devastating absence is felt as large as it ever was. I can become overwhelmed by the thought that I failed as a friend, since I never sufficiently demonstrated how important she was to me and now it is too late.

My beloved friend was not just generous; she was an extremely effective and reliable health care professional with boundless empathy and patience who did not take shortcuts. I know this because I watched her work through lunches and weekends to fill out charts, and rarely take sick days. I know she was someone who saw and heard patients in all the ways we need to be heard and seen.

In time, I decided that the only way for me to consistently keep this particular person alive in my imagination was to try to do something that would put me into the precise spirit of who she was. But what that something would be was not yet clear.

As it happened, while researching my novel “Bina,” which explores female friendship and the right to die, I began an email exchange with Dr. Sue Hughson, who was volunteering for Dying With Dignity Canada. She asked if I would be interested in becoming a volunteer witness for the organization. It seemed that this would be something my friend might do and that I might be able to keep her spirit alive by being a compassionate witness to others in their dying. I agreed.

Medical assistance in dying or MAID, which was previously known as voluntary euthanasia, is legal in Canada. All applicants require two witnesses to sign the paperwork to commence the application process to MAID. As volunteer witnesses, we cannot be involved in the care of the dying or be beneficiaries of their wills. We go in pairs. We read aloud (or have patients read) a series of statements confirming that they understand the nature of the request they are making, that they have had all their treatment options explored and explained to them and that they are free to change their minds at any time in the process.

The visit is generally not long — roughly 20 to 40 minutes — yet in those moments we enhance our humanity by helping strangers’ requests for their end-of-life choice be heard and considered. “Choice” is an important word: I have never been in any situation where I was in any doubt that the person had absolute clarity and full understanding of what they wanted, because if I had been, I would not have been able to sign the form. The next step involves assessment by two doctors independent of each other to determine whether the patient qualifies for MAID. Once the form is completed, there’s usually palpable relief from the patient and always enormous gratitude to us for volunteering our time.

In such brief interactions there can be unexpected, profoundly moving exchanges and experiences. There can be laughter and humor. There is nothing I have seen more beautiful than patients supported at this moment by their siblings, children or friends, nothing more loving and compassionate than family members or dependents who are struggling visibly through silent tears, yet stay to support and comfort their loved ones.

Occasionally parents become aware their son or daughter is distressed and spontaneously give a soliloquy to all present; they announce that their child is a good son or a good daughter and plead gently, “Don’t be sad. It is time.” Once a man asked us to turn on Ozzy Osbourne’s “Mama, I’m Coming Home,” and we rocked out to it around his bed.

Every time I have the privilege of witnessing in this way, I feel the presence of my beloved friend in that room with me. Her spirit, her patience and her willingness to hear people live in this act. Every day it’s a struggle for me to imagine she is with us no more, and I find myself pondering, “Where can she be? How can she be gone? How is this possible?” I have concluded she lives now in my ability to imagine her right there with me in the room when I witness, for she was brave and nonjudgmental, kind and honest, warm and supportive, which is the truth of what takes place in these interactions.

Recently, I decided to take a full-time job at a nearby lab receiving and processing specimens for coronavirus tests. At the end of the first week, I was exasperated and exhausted and feeling quite useless. I am older than most of the workers, and slower and more easily flustered. The one thing I held on to was the knowledge that my friend would have been proud of me for working in that lab.

So this is where the dead go in our imaginations: They continue to live with us in the moments when we are sad and terrified. They cheer for us. They give us unbelievable strength and the courage we lack to carry on in situations. They coax us through. They lead us where we need to be, to experience the joy and capability that was them. They who have been with us in life manage to teach us how and where in death we can listen for them and find their voices and essence again.

Complete Article HERE!

‘Night is now falling’

— This is what dying looks like

The author and her late husband, Raja, in London circa 2002.

By

Some people have it easy. Like my husband, Raja. We always said we wanted a swift death: a heart attack while when we were young, before the decay and disease set in. That was how he died 11 years ago, at 55, after open heart surgery to change his faulty bicuspid aortic valve. He was waiting to be discharged when he collapsed and died. Lucky guy.

My death, however, is going to be a drawn-out affair.

Fourteen months ago, the breast cancer came back after 23 years, with metastasis (mets) to my hip bone and aortic lymph node. For almost a year, my life was crushed by the side effects of the targeted hormonal therapy — drugs directed at proteins on breast cancer cells to stop their growth. They were too toxic for me, spiking enzymes and tanking blood counts to dangerous levels. I had severe anemia, extreme fatigue and was unable to eat or drink.

As the toxicity in my body increased, I took to my bed. For the first three months of this year, that’s where you’d find me: nauseous, exhausted and lifeless. I only got up to use the bathroom or to have a piece of buttered toast that tasted like sawdust. I love to eat and grieved my inability to do so. My weight dropped several pounds every time I stepped on the scale in the doctor’s office; my clothes hung loosely. I could only manage sips of fluid and became severely dehydrated, exacerbating the vicious cycle of fatigue.

Routine activities that I had taken for granted, like dressing and undressing, taking a shower, putting on my shoes, became punishing activities — and took forever to get right – because my muscles had become deconditioned and lost their strength. I had to carry one leg at a time into the car or onto the bed. The decline was so swift my mind and body couldn’t keep up.

The decline was so swift my mind and body couldn’t keep up.

When the body is not well, the mind and spirit aren’t either. They all go into a state of minimal activity and depression. Even my favorite playlist of Yo-Yo Ma playing Ennio Morricone didn’t stir my spirit. Over time, I stopped listening to music, reading, watching movies, attending Zoom bible class and Sunday services, reaching out to people, writing, and dreaming of travel destinations. I had lost purpose and interest in life.

I was alive clinically, but I was not living.

In March, when I was at the hospital for an urgent intravenous hydration, the nurse practitioner came by (the doctor had a full schedule). She asked me: “Would you consider transitioning to hospice care?”

I was stumped. Where was this coming from? I’d expect that sort of question from my doctor during a consultation, but not when I was being hydrated in the infusion room.

“The treatment isn’t working,” she continued. “Your body is responding violently to the drugs, and the symptoms are likely due to disease progression as well. Moreover, there’s not a whole lot of treatment options for your particular situation.”

I felt blindsided. By definition, hospice care is for people with a life expectancy of six months or less, if the illness runs its normal course. But my medical team hadn’t spoken to me about reaching the end-of-life stage any time soon. I had been soldiering on, until the drugs I’d been taking stopped working, and we moved on to the next line of drugs. Or when my doctor thought it was time to stop treatment. I guess this is that time — and she’s telling me now.

Stopping treatment and moving to hospice care wasn’t a difficult decision to embrace. I made it on the spot. “I’m sick of being sick all the time. So yes, take me off all the cancer meds and I agree to have my medical team take care of me at home,” I told the nurse practitioner. “God-willing, the toxicity of the drugs will wear off and I can get back to the business of living. For a limited time at least. Until the cancer takes over.”

That day, after the nurse practitioner gave me her honest assessment, I found my way home in a daze. Confused at the suddenness of the change in treatment and the reality of my situation.

My body is shutting down and I’m slipping away. This is what dying looks like.

It slowly dawned on me that the physical symptoms I’d been experiencing were manifestations of metabolic decline. My body is shutting down and I’m slipping away. This is what dying looks like.

There is some sense of relief that the suffering will soon be over, and comfort that I’ll be home with the Lord. But there’s also a real sense of wistfulness of leaving my people and doing the things that I love.

Raja was always a big fan of J.R.R. Tolkien’s work,reading it often since he was a teen. My daughter, Elizabeth, and I became great fans when the movies came out. The closing song of “The Hobbit” resonated with my journey:

Night is now falling/So ends this day/The road is now calling/And I must away/Over hill and under tree/Through lands where never light has shone/I turn at last to paths that lead home

My cancer, without treatment, is now in free fall. I cannot tell where hospice will take me. No one’s ever explained what it’s like to die. But this I can say: Raja ol’ chap, I’m not too far behind. Keep the light on for me.

Complete Article HERE!

How ‘I’m Dead’ Became a Good Thing

Dying of laughter is an exaggeration, but something about it has rung true over the centuries.

By Caleb Madison

On a literal level, it should be impossible to make sense of someone saying “I’m dead” unless you’re attending a successful séance. Yet here we are in 2022, not only proclaiming our own expiration but reveling in it. Far from speech beyond the grave, “I’m dead” has come to communicate one of the highest pleasures of life: the giddy throes of uncontrollable laughter. When someone says “I’m dead” or even just “dead” in 2022, they’re telling you that they couldn’t be more tickled by what just happened. So how did being dead become a good thing?

Death and laughter have been strange bedfellows since ancient Greece, where, legend has it, the fifth-century-B.C. painter Zeuxis died from laughing at the portrait he was painting of a supposedly ugly old woman—a hilarious anecdote later immortalized in an equally hilarious painting by the Dutch master Arent De Gelder. And Zeuxis’s isn’t the only classically depicted death by laughter. The Stoic philosopher Chrysippus, by several accounts, kicked the bucket because he couldn’t stop laughing after witnessing a donkey eating his figs. Bizarrely, King Martin I of Aragon is said to have died laughing at a joke also concerning an animal eating figs. Legends of giggly demises litter history; as recently as 1989, a Danish audiologist is said to have passed away guffawing during a screening of A Fish Called Wanda. Apparently, the best medicine is also sometimes the sweetest poison. Although I admit it would be a great way to go, I myself will be avoiding all zoo-adjacent fig farms in the near future out of an abundance of caution.

The connection between death and laughter was consummated in English by—who else?—Shakespeare. In his comedy The Taming of the Shrew, after the exit of the vivacious and eccentric couple Petruchio and Katharine, Petruchio’s servant, Grumio, says, “Went they not quickly, I should die with laughing.” From then on, the phrase to die laughing was part of the language as a hyperbolic idiom—we all know it’s an exaggeration, but something within the fiction rings true to our relationship with laughter and death. The fatal violence of hilarity proliferated in English over the following centuries. From the 1930s slang to bust a gut to the idea of being “in stitches” to the ironic Catcher in the Rye Holden Caulfield–ism “That killed me,” there’s something about the experience of uncontrollable laughing that seems to put us into close contact with our inevitable nonexistence.

And it makes sense. Intense laughter expresses itself in violent convulsions and temporary loss of bodily control. Who among us hasn’t been part of a tickle-fest that verged on sadomasochistic brutality? Times when I laugh so hard that I cry can feel like an out-of-body experience—a sublime mania that temporarily relieves me of the burden of consciousness. Perhaps we say “I’m dead” because we’ve intuited that deep and frenzied laughter gives us a taste of the eternal unknown toward which we’re all always hurdling. This sense of comatose comicality yielded our Friday-level clue “That’s so funny I can’t even function.”

Complete Article HERE!