Tag: Death Spirituality

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Diabetics May Often Fare Poorly in Hospice Care

By Serena Gordon

[D]ecisions about diabetes care can become harder as people age, and that may be especially true for those needing hospice care.

A new study has found that, among people getting hospice care in a nursing home, diabetes care may lead to higher rates of dangerous low blood sugar episodes, known as hypoglycemia.

That finding came from the researchers’ analysis of data on nearly 20,000 people with type 2 diabetes, all in nursing homes and receiving hospice care.

In 180 days, the time period covered by the study, about one in nine people experienced low blood sugar episodes. But, among those treated with insulin, about one in three had low blood sugar episodes, according to the study’s lead author, Dr. Laura Petrillo, an instructor in medicine at Harvard Medical School.

Low blood sugar can cause weakness, sweating, confusion, shakiness and dizziness, which can cause suffering and reduced quality of life. The researchers defined low blood sugar episodes as blood sugar levels under 70 milligrams per deciliter (mg/dL).

“Hospice is care focused on maximizing comfort at the end-of-life, and usually includes stopping treatments that are unlikely to have short-term benefits,” Petrillo said. “Patients with type 2 diabetes were experiencing hypoglycemia, which would be an indication that there was room for improvement in their diabetes care.”

The study also looked at high blood sugar episodes, defined as blood sugar levels over 400 mg/dL. High blood sugar — hyperglycemia — can cause excessive thirst and a need to urinate more frequently. During the 180 days, 38 percent of patients treated with insulin had low blood sugar, 18 percent had severe low blood sugar and 35 percent had high blood sugar.

Blood sugar levels were checked an average of 1.7 times a day for people on insulin and 0.6 times a day for those who weren’t given insulin, according to the report.

People in the study were receiving end-of-life care at Veterans Affairs nursing homes between 2006 and 2015. All were 65 or older, and nearly all — 98 percent — were men. About 83 percent died before 100 days.

The study findings bring up an important issue — the need for more specific guidelines for diabetes management in nursing home and hospice patients, according to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

Those institutions often “export guidelines for hospitalized patients, and end up continuing to use a lot of medications that cause hypoglycemia,” he said.

Zonszein noted that insulin isn’t the only medication that can cause low blood sugar levels. Some oral diabetes medications also can cause blood sugar levels to drop too low.

In addition to causing people to feel terrible, low blood sugar levels can also increase the likelihood of falls — a concern in hospice facilities and in nursing homes, he explained.

“If medications are not improving quality of life in hospice, it doesn’t make sense to use them,” Zonszein said. “There are many newer medications that don’t cause lows and control the highs. They cost more, but you don’t have to monitor patients as much,” so ultimately they’re likely cost-saving, he suggested.

Matt Petersen, managing director of medical information for the American Diabetes Association, said that the study adds to the understanding of end-of-life care for people with diabetes.

“Hypoglycemia is to be avoided for safety and quality of life, but severe hyperglycemia is also to be avoided for the same reasons — left to go too high, glucose levels can lead to catastrophic (and very unpleasant) metabolic crisis,” Petersen said. “In patients that may not be eating well, estimating insulin dosing to match food intake can be challenging.”

Petersen said it appears from the information provided that patients in the study were receiving individualized care based on their health condition, which is what the American Diabetes Association recommends for care.

“Care should involve a comprehensive consideration of what will ensure the best circumstances for the patient,” he noted.

The study authors pointed out that about one-quarter of people in the United States die in a nursing home, making this a problem many people might face.

What, then, can people do to ensure they or a loved one receives the right care for them in a nursing home, particularly as they near the end-of-life?

“Advocate for your loved ones,” Petrillo advised. “Ask for a medication review, and make sure that medications are geared toward providing comfort and that they’re not receiving anything that doesn’t have a short-term benefit.”

The study was published as a research letter in the Dec. 26 online edition of JAMA Internal Medicine.

Complete Article ↪HERE↩!

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End-of-life activists ponder how to die in a death-averse culture

“Why, you may ask, take on this unpleasant, frightening subject? Why stare into the sun?”

— Irvin D. Yalom, Staring at the Sun: Overcoming the Terror of Death

THE SACRED ART OF DYING: Third Messenger co-founders Said Osio, left, and Greg Lathrop promote community events such as the popular Death Cafe, a community forum that invites participants to engage in conversation about death and dying.

by Monroe Spivey

“Are you willing to pretend something for a minute?” asks Greg Lathrop, a local end-of-life activist. “So, let’s pretend this. March 27 will be your last day here. In this game, we know that you’re going to die March 27th. Now, how’s your life? See, it’s a simple perspective shift. Perspective is just a choice. You shift the perspective just that much, and it opens a door. We’re getting somewhere. Now it’s like, ‘I hate my job,’ or ‘I’m in debt up to my eyeballs.’ What would it look like, in these last three months, to live the best three months of your life? It gives us an opportunity. It’s more than a bucket list. What’s your life’s purpose — why are you even here?”

Lathrop, a registered nurse, holds a certification as a Sacred Passage doula — caring for people who are in the process of dying — and is co-founder of Asheville’s Third Messenger, a community of Asheville death-issues activists who have created a forum for conversations about death at the so-called Death Cafe. Lathrop is also part of a growing  national community that works in “the death trade” — people dedicated, he notes, to broaching the conversation of death and dying within a culture that prefers to speak about virtually any other subject.

Lathrop first began that conversation on the heels of his own significant loss. Synchronistically, the death of Lathrop’s wife and the passing of Third Messenger co-founder Said Osio’s daughter propelled the two men to join forces in end-of-life activism. To Asheville locals and tourists alike, Third Messenger’s work may be most visible in what has become a landmark Biltmore Avenue structure.

Ministered to for years by Earl Lee “Happy” Gray (before his passing in October 2016), the “Before I Die” wall poses passers-by one simple question: What have you left undone? Not surprisingly, responses range from the mundane to the profound, reflecting our culture’s divisive relationship with the end of life. Yet the wall serves as a catalyst, the beginning of what Third Messenger views as a critical and much-needed conversation. “We cultivate the sacred art of being with dying — we use art to engage the conversation,” says Lathrop.

It is precisely this lack of familiarity with death that engenders the paralyzing fear of the unknown and creates what author and end-of-life activist Stephen Jenkinson, who spoke at Asheville’s Masonic Temple Nov. 6, refers to as a “death-phobic culture.”

Dr. Aditi Seth-Brown, hospice and palliative care physician at CarePartners, agrees: “Many years ago, there were so many intergenerational families and communities, so death was something that young children were around and saw — life happened around death.” As a result of an unfortunate marriage of families living farther apart and a highly individualistic culture, Sethi-Brown now frequently encounters many individuals who have virtually no experience with the process she views as an inextricable part of life.

“People come to us, and oftentimes this is their very first experience with death, and there’s so much fear of the unknown,” says Sethi-Brown, who is also is a local musician, whose work includes playing for people transitioning and at Third Messenger events. “Sometimes, family members come to us and say, ‘We don’t want our loved one to know that they’re dying.’ We don’t practice it. There are some traditions around the world that actually have practices around death, meditations around death — just like if you’re birthing, you go to birth classes, read birth books, but [there’s] nothing to prepare you for death.”

CALLING FORTH THE BEYOND: Hospice and palliative care physician and musician Dr. Aditi Sethi-Brown often provides musical accompaniment for those transitioning.

Shining light upon the shadows

“I was 9. That’s the start of it, in my memory.” says Asheville resident Julie Loveless. Beginning in early childhood, Loveless found herself plagued by an inexplicable and inescapable fear of death. One night in particular, Loveless says, “We were at my grandmother’s house. My parents were there, my grandmother, my aunt, and it was time for me to go to bed. I was terrified, because I knew I wasn’t going to wake up the next morning. So I was coming up with all of these tactics to stay up. I had a fever, I had diarrhea, my stomach hurt, I was throwing up, I fell down the stairs — anything I could do to stay up and be the center of attention.” It was as though she needed to be seen in her terror, Loveless says, validated in her very existence. “I needed somebody to know I was alive.”

Loveless’ childhood fear of death is far from uncommon. Recent studies show that children as young as 5 express substantial “death anxiety.” The results of one such study indicated that a mature relationship to dying (understanding death as an inevitable biological event) correlated with a decreased fear of death.

Is it any surprise, when many children are now inoculated from the natural rhythms of life, that they fear, rather than revere, that great unknown? The reality is that “we don’t even have a language for dying,” says Lathrop.

Trish Rux, hospice and palliative care nurse and Sacred Passage doula, agrees. In contrast to her upbringing, she says, the majority of individuals she meets have rarely contemplated death. “I was raised without a death phobia,” Rux says. “I remember my father bringing me to a friend’s funeral when I was pretty young and my not really understanding about the casket, and his explaining it to me. He was just a very practical person. Just knowing that death is a part of life — it was an accepted thing.”

In stark contrast, Rux now regularly witnesses individuals who, in their final days, have scarcely given a thought to the inevitability of their own mortality. “Curiously, I’ve had people that in are in their late 80s, and they’ve not thought about their death. It’s incredible to me — they haven’t thought about what they want, who they want to see. It’s sad for me, and it’s pretty common.”

MINDFUL LIVING: “All of our time is running out,” says Julie Loveless. “It does make things less scary when you’re faced with what’s considered the scariest thing a human can be faced with.”

Dancing with death

Loveless was 30 when she first received a diagnosis of breast cancer and 37 when it returned with a vengeance. After having been in remission from the cancer for seven years, a persistent lymphedema sent her back to the oncologist for a standard biopsy. “I’ve never seen it happen that fast,” Loveless says. “He walked in, did the core needle biopsy and left. I got my clothes back on and am sitting down, and he immediately walked back in and said, ‘It looks like disease.’ The way he was talking about it, he made it clear it had metastasized. I don’t think he said the word, ever — it was just understood.”

Yet Loveless is no longer afraid to fall asleep. Now faced with the stark reality of her worst childhood fears, she finds herself liberated rather than imprisoned. “When I go back to the last time I remember having that really potent fear of death that was crippling, like pulling over to the side of the road and having to breathe into a paper bag, to now — it’s night and day. Before, when something would go wrong and I’d look into the mirror and see a new mark on my skin, I’d think ‘Oh, that might be skin cancer.’ Or, ‘I have a headache — I might have an aneurysm.’ To have those thoughts in my head all the time, to think that way and then to be like ‘Oh my God, I might have cancer — oh wait, I do have cancer.’ I have the worst thing you can have. Nothing else is scary.”

Freed from the fear of dying, Loveless now finds herself preoccupied with living. “[I] wake up in the morning and [think], ‘This may be my last day — how am I going to spend it?’ [Or], this might be my last minute — do I want to spend it brushing my teeth and sitting on the toilet and looking at Facebook? Or, do I want to go make a really yummy smoothie, or do I want to go outside and look at the leaves? So, if you’re thinking that way all the time, you have no idea that it’s even happening until the end of the day and you realize — ‘I didn’t waste my day today.’”

Lathrop questions whether we cheat ourselves of the chance for a more meaningful life if we spend our days running from the inevitability of death. His answer: “Death is my guru. It becomes a real teacher for how to live.” And Sethi-Brown agrees: “The reality is you don’t know when your time is. Don’t be afraid of having the conversation. The fear of the conversation, the discomfort around it — go there, explore that — and you’ll see, it will change your life.”

Complete Article ↪HERE↩!

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Where Do I Go To Mourn?

By Ariele Mortkowitz

[T]he Jewish tradition is rich with mourning rituals. We’ve done it as a nation for millennia; mourning the loss of Jerusalem, lamenting the Holocaust, remembering the long lost days of the Holy Temple. As individuals, we do it with bagels and covered mirrors and week-long shiva visits. We can say Kaddish (the mourner’s prayer) for a year. There is plenty of space and opportunity to grieve.

And it’s a good thing. A great thing even. It’s supportive. It’s community showing up at times when someone might be at their lowest low. It’s not leaving people to manage their grief alone. It’s a built-in system of shoulders to cry on, arms to lean on, caretakers, yentas – all of them creating a space for you to mourn and pause before gathering strength to move forward.

But while we offer so much to mourn those who have passed, there is nothing available to support those mourning pregnancy loss. There are no rituals. No one brings bagels. No one even talks about it. Some rabbis will tell you that you are not even permitted to say Kaddish after a stillbirth. It’s like it never happened.

And there’s a logical reason for that. In times long ago, pregnancy loss was incredibly common. It was also often very public. It was rare to find a family that had not lost a child or infant in the course of their family-building. In fact, many parents lost more than one in their lifetimes. So if the custom would have been to stop everything to mourn, people would have been in states of mourning constantly. And one could say that therapeutic value of shiva/mourning rituals would be diluted. The rabbis, in their wisdom, thought it better to not make such a big deal of pregnancy loss – precisely because it was so common.

But what about today? 2017. When pregnancy loss is not something that happens as often in each family? And certainly not in the same public way it did in olden times? What do we do with these feelings of loss that can be so devastating – particularly in the midst of communities that value children so highly?

Where should a couple take their grief when they learn that they will not be able to be parents? How should a mother-to-be mourn the loss of a life that she cherished? What prayer should she say? There is no ritual. No one talks about it openly because of the attached shame and disappointment of not being a “fruit bearer.”

It’s rough. It’s lonely. And it is incredibly sad.

It is ironic that a faith community that is normally so very good at supporting individuals laden with grief, can fail so terribly at addressing this common and natural loss.

I know of more than a few synagogue regulars who stopped attending services and recuse themselves from the ebb and flow of Jewish communal life after a miscarriage or when they continue to fail to conceive. With no “official” way to mourn a pregnancy loss or a fertility struggle, it can be incredibly isolating and “othering” for couples — often pushing people away from their communities during the very time they need support most. They feel not understood, invalidated, wrong for being so heartbroken. The absence of ritual or commemoration of pregnancy loss sends a message loud and clear: “Your loss is not a real loss. It is not worthy of the community’s attention or caring.”

Ouch.

So we wanted to do something about that. We wanted these important community members to feel held and supported and we wanted to validate their loss and let them know that they are not alone in their grief.

This month, we participated in Yesh Tikva/The Red Stone’s “Infertility Awareness Shabbat” in an unusual way. Our goal was to create a space for empathy and understanding about infertility in the very tight-knit, family-focused Jewish community. But, rather than ask our clergy to talk about infertility or pregnancy loss in a sermon as has been traditional, we decided to do something new.

On the Sabbath before Passover, the Agam Center at Ohev Sholom invited the entire community to “Light A Candle For Your Loss.” We circulated an anonymous form and asked our community members to indicate the number of memorial candles they would like illuminated on their behalf and gave them the option to have their candles dedicated or labeled in the manner of their choosing.

The response from the community was overwhelming. We lit forty-seven candles, submitted anonymously by thirty individuals – just from our 300 family congregation alone. We displayed these candles publicly, at the entrance to our sanctuary, in our light-filled atrium. Every community member passed by the memorial display on their way into services, and our clergy, Maharat Ruth Balinsky Friedman, invited the community to pay their respects and honor the (often silent) loss felt deeply among our grieving community members.

The responses from the community came pouring in.

“Thank you for doing this. Don’t really have words right now. Just gratitude to have the opportunity to mark my little boy’s birth, especially so close to the actual date.”

“This is absolutely beautiful. Thank you for giving a voice to so many who are on this journey. All my love and support for your amazing, very necessary work.”

“I thought I’d fill out the form because it was a lovely idea – and then found myself in tears, making a small space for something I mostly push aside. Kudos to you for creating the holy opportunity. Really proud to be a part of this community.”

As far as I know, our decision to publicly anonymously recognize pregnancy loss in the synagogue community is a unique endeavor to validate this loss and create a space for a life-experience that can be so isolating and stigmatized and reframe it as an opportunity for communal support.

As we filed into the sanctuary for Saturday morning services, we stopped to read the inscriptions and dedications next to the memorial candles. They took my breath away. Here is but a sample of what was shared:

“I would have loved to love you.”

“Eternally grateful for the journey you were a part of, as painful as it has been. Your loss made way for those we watch grow, shaping me into a mother who strives for daily patience and gratitude.”

“Mothers Day 2011. You were and then you weren’t. Still wonder why I wasn’t supposed to be your mommy.”

“For the family I thought we’d have and the empty seat at our table that I wish we had filled.”

The Agam Center is working hard to make people feel seen and understand that their community is indeed there for them during their time of sorrow or struggle. We want to help people in the midst of a fertility journey see that they are truly not alone, and that there have been so many others – even right in their very synagogue community – who have walked this path with them. We are creating a space to mourn something that is usually so privately painful – particularly in a tradition that is, ironically, so “good” at supporting mourners in other circumstances. I am hopeful that we can begin to highlight ways that communities can create spaces for these losses and families unrealized.

Rather than staying home and feeling isolated, these mourning couples made a point to come to synagogue that week and watched as others learned about and began to appreciate the magnitude of the loss they were feeling. They came inside from standing on the fringe of the community and felt embraced and found solidarity, all without a word. This heartbreakingly beautiful display was our community’s way to show that all loss is real loss and to remind those still struggling that they are not alone in their grief of hopes for the family of their prayers.

May our communities know no more suffering. Amen.

Complete Article HERE!

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At the hour of death: Unlocking the mystery of dying

By Glenville Ashby

“Dying has a funny way of making you see people, the living and the dead, a little differently. Maybe that’s just part of grieving, or maybe the dead stand there and open our eyes a bit wider.” (Susan Gress Gilmore)

Glenville Ashby

Most of us have lost loved ones. It is a painful experience that sometimes takes years to heal, if ever. Many depart suddenly without notice and we are left helpless, forlorn and confounded.

Others waste away, a slow process that is painful, difficult to watch. We are called upon to be caregivers, attending to the every need of a dying relative. During that time we learn timeless lessons if we are patient, listen, and learn from this unique experience.

Like birth, death is an integral part of life that should be accorded the right, appropriate response. On a mystical level, the dying person experiences what hospice nurse Maggie Callanan calls the “Nearing Death Awareness”.

It is a process that can take days, weeks and even months; but during that time we are afforded unique information that will help us in our own spiritual travels when we are called home.

Callahan concluded in her cross-cultural research that dying persons speak of travel, maps, trains, and of queuing up to get to another place. She also found that those she studied were not heavily sedated, nor were they speaking in fantastical terms due to any neurological, physical or physiological handicap.

In her book, Final Gifts, she writes, “… we found no common cause for what we were seeing and hearing. Our patients had many different illnesses – varieties of cancer, AIDS. In some cases, their brain oxygen, body fluid and body salt levels had been documented as normal.

“Their medications varied widely, some were taking no drugs at all, others many. In short, there was no apparent physiological explanation for their communication patterns.”

Dismiss the disjointed

Unfortunately, we sometimes dismiss the disjointed, and seemingly incongruous and incomprehensible words of the dying person, attributing it to medication, dementia, or senility.

Confused, we ask the nurse or doctor to take the appropriate medical measures to quiet the patient. Somehow, we miss the mark, missing the opportunity to ease the concerns and burdens of the patient.

When we can decode what the patient is trying to say and ably respond, we have facilitated the process of transition (dying). Patients get agitated or resigned when they are not understood. The dying process becomes longer, even more tortuous as the patient struggles to convey a message or articulate a concern.

Studies have shown that dying persons will opt to leave this earth when they are satisfied that those they are leaving behind will be all right. Others protract their departure because of guilt and the need for reconciliation. They seek forgiveness for past wrongs.

Mountain of experience

A mountain of experience has taught Callanan that many dying persons want to settle personal issues before they leave. They have a thirst for closure. “(There’s) an awareness that they need to be at peace,” Callanan writes in Final Gifts.

“As death nears, people often realise some things feel unfinished or incomplete perhaps issues that once seemed insignificant or that happened long ago. Now the dying person realises their importance and wants to settle them.” We are urged to accommodate their request.

Sadly, many engulfed in the throes of dying do not and cannot speak in literal terms. They use symbolic language.

And the more we dismiss this mode of communication as insignificant, muddled thoughts, the more the patient is likely to withdraw or display bouts of anxiety. In such situations dying is painful to watch.

On the symbolism used by dying persons, we are advised to patiently learn as much as possible and be gently and constructively responsive.

Sometimes our own fears, bewilderment and anger at seeing a loved one die only exacerbate the circumstances. We withdraw, unable to openly and honestly communicate.

Friends, unable to manage their own emotions, and lost for words, do not visit not out of insensitivity, but due to their incapacity to comprehend and deal with this highly charged emotional experience.

Studies have also shown that those at the cusp of death may see and communicate with beings invisible to us.

These visitors are usually relatives and friends who have passed on, or angels, saints and religious personages that are familiar to the patient. These visions have a calming effect and it’s obvious that these exchanges serve to make the dying process peaceful and unthreatening.

Finally, hospice nurses have encountered cases indicating that patients ‘know’ the hour of their death. Others have cited cases where healthy individuals also seem to know of their demise.

In one intriguing scenario with which I am familiar, a physically robust woman, without any prodding, suddenly rushed to prepare her will and last testament. Upon completion, she hastily summoned her son, imparting every bit of religious knowledge.

“This is the most precious gift I can give you,” she told him. She succumbed a day later.

That she consciously knew that she was going to die is debatable, and I disagree with Callahan and others who argue that “dying people often seem to know when their death will occur, sometimes right down to the day or hour (and) their attempts to share information about the time of death may be clear and direct”.

However, I am of the opinion that in most cases this knowledge is a subtle, subconscious impulse unknown to the conscious mind.

Nearing Death Awareness can be taxing, taking a toll on patient and loved ones. Openness, dialogue, honesty, patience and caring by all parties will no doubt ease the burden.

Dying and death are natural, a necessary part of life. And in the same way that we learn from the living, so we must embrace the wisdom brought forth by dying people.

Complete Article HERE!

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How to die well

Lack of faith is no impediment to a decent death – or to helping another through theirs

Stand by me: Shailene Woodley and Ansel Elgort as cancer patients who fall in love, in The Fault In Our Stars.

By Johannes Klabbers

In the secular age you don’t need special authorisation to console a dying person. Just learning what it means to be there for someone is enough.

“Death literacy” is officially a thing. People go to death cafés; books about death are in demand… and around 55 million people worldwide do it every year. But how do you actually do dying well? And who can dying people turn to for support?

Although I know exceptional doctors and nurses who can and do talk with patients about their looming demise, it is something that many don’t feel qualified to do.

Traditionally, expertise in dying was thought to be the remit of religion. The Catholic church recently revived their medieval handbook for dying people, Ars Moriendi, now illustrated with drawings of happy families rather than demons, like the original, and handily available in the form of a website: artofdyingwell.org.

But what are the options for atheists or agnostics today? When it comes to thinking about what it means to be mortal, many people find themselves in a kind of secular vacuum. But living a life without religion doesn’t mean that you have to be alone at the end.

As a secular pastoral carer, I learned that consoling a seriously ill and dying person is something that almost anyone can do, whatever their faith – or lack thereof. You don’t need a special qualification, or a badge, or permission from an authority figure, supernatural or otherwise, just your humanity and determination – and for the suffering person to want someone to be there with them.

The first crucial step is turning up. Too often, our anxiety about saying or doing the “wrong thing” leads us to decide not to visit someone. Offering to be there for someone, even if they decline – and they might – is never wrong. Being there for someone means giving your attention to the person not to their illness, and concentrating on listening, not on worrying about what to say.

You will need to accept that the dying person may not want to discuss their sadness and fears – at least at first. They may want to talk about the football or the latest episode of Bake Off. Or they may just need someone to sit with them in silence.

Remember that it is not unreasonable to feel awkward. You might feel uneasy in the setting, or be distressed by their appearance. But your job is to accept your discomfort and think beyond it. You can show sadness, but do not burden them with your grief. You may need to be supported and comforted yourself afterwards.

While there might not be any formal qualifications in death literacy with which you can arm yourself, there are a number of wonderful, entirely secular, books by brilliant writers who are in the process of dying or supporting dying people, from Jenny Diski’s In Gratitude (to Tom Lubbock) and Marion Coutt’s memoirs, which together form an awe-inspiring document of courage, humility and humanity.

There is a moment which perfectly illustrates how to console a dying person in the Dutch author Connie Palmen’s moving memoir Logbook, when her husband, a leading Dutch politician, lies dying. In a moment of lucidity he sits upright and exclaims, “I am sorry for my sins!”

“I absolve you,” Connie tells him.

Ultimately, our humanity is all the authority we need to offer consolation to dying people.

Complete Article HERE!

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What to say to a dying person

A hospice chaplain offers some insight

By Rona Tyndall

[P]erhaps like I, you like to eat pizza and watch movies on Friday nights.

One night, I watched, “Cleaner.” Samuel L. Jackson plays a former police detective who owns a company that cleans up death scenes.
The opening scene takes place at his 30th high school reunion.  His former classmates are all standing around awkwardly with drinks, making small talk about what they’ve been doing for the past 30 years.  Someone asks The Cleaner what he does.   He responds with the utmost respect and compassion necessary for speaking an ugly truth,

“I handle the remnants of heartache and disappointment so that people can go about the business of healing. Most people don’t know this, but someone dies in your home, you are left to clean it up.”  

The classmates look confused.  The Cleaner shares in vivid detail, right down to the special mixture he invented from Listerine to un-coagulate blood.  Everyone is horrified; mouths agape, shifting from one foot to another, coughing nervously.  Noticing their discomfort, he tries to avert attention, asking one of the guys how things have been going for him for the last 30 years;

“Oh, married to the same woman since college, the kids are great, playing a little golf, just got a bigger house so my mother-in-law could move it.  It’s fine; she almost never leaves her room.  Some day she won’t come out.”
Then, a funny look of realization flits across his face and he says to the cleaner, “Um, can I have one of your cards?”  “Sure,” comes the response, “sooner or later, everyone needs us.”  One at a time, each person in the crowd steps forward for a card.

The opening scene touched me; it felt familiar.  People who deal with death know what it feels like to be a skunk at a lawn party.  

That’s pretty much how people react when I tell them I am a hospice chaplain; initial discomfort that such service is necessary, followed by the realization that almost everyone needs hospice care for themselves or a loved one eventually, and finally the realization that the person standing in front of them, who tends to the very deepest of sorrows, does so from a place of deep compassion and love. Then, they ask for my card.

Love, loss and longing…those are the themes that I work with every day in my ministry. 

I love my job, but the most frequent question I get asked is, “Isn’t it depressing?”  It isn’t.  It is sad, often, but not depressing.  Depression is isolating, lonely, hopeless.  Sadness (sorrow) is a point of deep connection, because as human beings, we all experience it at various points throughout our lives.  Joining in that emotion, and the emotions of love, loss and longing that drive sorrow (sadness) begets a deep heart-connection, one to another; the very antithesis of the isolation, loneliness and hopelessness of depression; the very essence of what it means to be in communion, in community, in common, with one another.

Do you know what people talk about when they are dying?  We talk about love; pretty much exclusively.  When we come to the end of our lives and the conversation has narrowed down to, “What was the point of me?” people reflect on love.  It is true that dying people never talk about the unfinished business at work.  We talk about the unfinished business in our intimate relationships.  We talk about the loves that made us whole; the loves that gave us joy and meaning and pride…and the loves that broke our hearts.  We talk about the ones that we loved well and the ones we forsook.  We talk about the intimate love of family and dear friends, and the love for humanity that compels us to reach out to strangers in our professional and private lives.

People are made for love.  We are made to love.  The measure of a life well-lived is always and only a person’s courage in loving.

But though our lives are meant to be a love story, we learn along the way that all love stories end in tragedy.  Whether through choice or through death, someone always is left to grieve. 

Leaving friends and family and home for school or work or marriage is a kind of a death.  Broken relationships are a death.  Divorce is a death.  The end of a life is a death.  The grief that goes with any death is heartbreaking.

Heartbreak hurts!  The feeling of ripping and then aching in our chest, the initial agony of waking up crying, being utterly consumed by the sense of loss, feeling hopeless. 

My eldest daughter loaned me a novel recently.  It was a light read.  Nevertheless, just as even the most simple people contain great wisdom, so does simple reading. 

“When you drop a glass of wine or a plate to the ground, it makes a loud crashing sound. When a window shatters, a table leg breaks, or a picture falls off the wall, it makes a noise.

“But as for your heart, when it breaks, it’s completely silent. You would think, as it’s so important, it would make the loudest noise in the whole word or even have some sort of ceremonious sound like the gong of a cymbal or the ringing of a bell. But it is silent and you almost wish there was a noise to distract you from the pain.” If You Could See Me Now by Celia Ahern

Isn’t that the truth?

When a heart breaks, it is completely silent. But loss is the price we pray for living into our purpose, which is to love.  Love, loss, longing; they are all of one piece.  Life.

In the months following my nephew, Mark’s sudden death at aged 7, none of us could have ever imagined that his parents would smile again.  But then, unexpectedly, like a rainbow arching over the deep, wild, mysterious ocean, something struck my sister-in-law funny one night at dinner, and she laughed.  We never stopped missing Mark, of course. His life and his love and his death shaped our lives and expanded our souls.  But his mother’s laughter was testimony that there is yet hope and joy and life to be had after loss.  Something good is always waiting to be had, eventually.  The resiliency of the human spirit is extraordinary.  The human capacity to hope beyond hope is truly amazing.

Every day, I keep company with men and women and children who are dying and with their families.  It can be a time of profound grace, even in the midst of deep sorrow. Time to look back, pay honor to, and close out a life is precious time. 

There are four phrases that chaplains often offer to people who are dying and to those they love the most, to facilitate sacred conversations:

  • “I love you.”
  • “I am sorry for what has gone wrong between us.”
  • “I ask your forgiveness for the part I had in any hurt between us.
  • “I thank you for your role in my life.”

There is no need to wait for such sacred conversations.  We can have them at any time, and be blessed by the sharing.    

I leave you with a reflection on love, from Dr. Peter Kreeft, from “The Turn of the Clock”

“What to say to a dying person: the profoundest thing you can ever say to a dying person is: I love you.  Not even God ever said anything more profound than that.”

Complete Article HERE!

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The Role Of Mindfulness In End Of Life Care

by vimhsadmin

Mindfulness assists people with their end of life process by giving them and their caregivers a tool they can use in order to be fully aware of the present moment and their own physical and mental states

[T]he Venerable Yin Kit (pictured above) has spent decades in hospitals, hospices, and homes, assisting people through their death. Through these experiences, her understanding of how to compassionately and wisely care for those dying and their families has changed as a result of constantly reflecting on what she experiences and what she learns as a Buddhist nun living in the West in the 21st century.

The end of life is a transformation from one physical existence to another existence. Similarly, mindfulness is a transformation of one mental existence into another mental existence.

Emphasis on mindfulness

Buddhist teachings have always emphasized the contemplation of death; a subject that engenders so much fear and worry for many. Mindfulness can take on a role  that  compliments advanced medical technology in end of life (EOL) care.

Mindfulness assists people with their end of life process by giving them and their caregivers a tool they can use in order to be fully aware of the present moment and their own physical and mental states. This allows them to settle into each moment and open up to a wider vision of the future.

With mindfulness, a dying person not only sees their physical changes, but also how their mind influences the perception and experience of their waning body. With an aware and balanced mind, a person is more able to cope with the vicissitudes and challenges that come with this stage of life and be at peace with these experiences. This in turns greatly helps to console the family, friends and care-givers.

Mindfulness also assists in opening pathways for healing relationships and positive life reviews. One can be more receptive and capable of planning for, dealing with and understanding the constantly changing physical and mental experiences and in the end, one’s own death.

The role of mindfulness in end of life care

Venerable Yin Kit speaks at The End of Life: Dying, Suicide, Death conference in Vancouver, November 2016

Venerable Yin Kit spoke about the role of mindfulness in end-of-life care at Simon Fraser University’s Vancouver campus on November 3, 2016. She was also a participant in a “praxis panel” that included Rabbi Laura D. Kaplan, veterinarian Dr. Jeff Berkshire, and counselor Hilda Fernandez.

Venerable Yin Kit, also known as “Sister Jessie”, has been a Buddhist nun since 1992 and is the spiritual leader of Po Lam Buddhist Association in Chilliwack, B.C. She is involved in leading numerous workshops teaching hospice care and hospital spiritual care in Hong Kong and in Canada. The Venerable is also the advisor to the Hong Kong SPGA Hospice program.

In 2005, Venerable Yin Kit established the Compassionate Centre for Health, a service for the Chinese-speaking community in the Greater-Vancouver area. This group has grown to over fifty active volunteers who visit senior homes and palliative care units at several sites. The Venerable has spent decades in hospitals, hospices, and homes, assisting people through their death. Through these experiences, her understanding of how to compassionately and wisely care for those dying and their families has changed as a result of constantly reflecting on what she experiences and what she learns as a Buddhist nun living in the West in the 21st century.

Dr. Jeff Birkshire, Rabbi Laura Kaplan, Venerable Yin Kit Sik, and moderator Hilda Fernandez
on the Praxis Panel at The End of Life: Dying, Suicide, Death (November 2016)

The End of Life: Dying, Suicide, Death

Simon Fraser University’s Institute for the Humanities hosted a conference in November 2016 called The End of Life: Dying, Suicide, Death. The conference was intended to provide space for pondering the complex and agonizing decisions regarding the end of life. Space for such conversations is especially needed given the 2015 decision of the Supreme Court of Canada declaring that the prohibition on physician-assisted dying infringes upon Section 7 of the Canadian Charter of Rights and Freedoms, and the introduction of Bill C-14 which has resulted in debate about who, when and in what circumstances an individual may make such a decision.

Speakers included academics, graduate students and practitioners who spoke from their own particular perspectives: legal, ethical, medical, and spiritual or religious. The presentations also drew upon insights from literature and art, some of humanity’s most treasured resources.

Complete Article HERE!