Tag: Death Talk

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We Need to Revolutionize End-of-Life Care — Here’s Why

Because it’s time to start thinking about death differently.

By Laura Dorwart

[W]hen Victoria Chang’s mother was diagnosed with pulmonary fibrosis, she didn’t have a single person she felt she could turn to. Six years earlier, her father had a stroke that led to significant neurological changes, and now the young poet realized she alone would have to care for them both. None of her friends had sick or elderly parents, so she felt completely isolated.

What followed was a decade of navigating America’s imperfect end-of-life health care system, without much guidance from the doctors and specialists she so frequently encountered. When asked what she would have done differently over the course of the stressful years, Chang says, frankly, “Everything.”

“Everything was a learning curve, everything new,” she says, noting how she wished there had been more help for people like her. “Emotions were high, and we needed a case manager or a consultant or something. Hospice seemed to help, but in the end, there was only so much they could do.”

Chang’s experience caring for seriously ill loved ones is sadly not unique. Thanks to a combination of denial, a lack of know-how and flawed systems, most Americans don’t have the support they need when it comes to end-of-life care. According to a study by the California HealthCare Foundation:

Furthermore, a majority of those surveyed had not even communicated their end-of-life wishes to the loved one they would want making decisions on their behalf. That’s where Dr. Ira Byock, chief medical officer of the Institute for Human Caring at Providence St. Joseph Health, comes in. A renowned expert in palliative care and the author of The Four Things That Matter Most: A Book About Living and The Best Care Possible, Byock wants to reimagine health care as a more personal, approachable system. He wants to boost the person-to-person communication and eradicate denial — an approach he and his colleagues call Whole Person Care.

Dr. Byock

“[Whole Person Care] attends not just to your medical problems, but to your personal priorities, values and preferences,” explains Byock. “You’re someone with bodily needs but also have emotional, relational, social and spiritual parts of your life, all of which need to be attended to.”

This perspective may not seem all that radical, but it is clearly not the current practice. American medicine is good in that it’s a “problem-based system,” Byock says. “It is organized around your problem list on your chart. Everything we do, by design, responds to a problem on your list.” But life isn’t just a set of problems to be solved; patients have lives that extend well beyond the walls of hospitals and waiting rooms. Health care, in Byock’s opinion, should address this reality at all stages of life.

Perhaps most importantly, Whole Person Care includes patients’ families at every level of care. Byock emphasizes the significance of the familial role in a patient’s comfort, as well as the ripple effects of a single individual’s illness on loved ones and their network of relationships. “Whenever one person gets a serious diagnosis, everyone who loves that person shares in the illness. It’s a family and community issue.”

Chang, for one, can attest to the need for a system like Whole Person Care. “Looking back, I can’t remember the past decade because I was so busy helping everyone around me,” she says.

When asked what advice she would give to those caring for a family member or spouse dealing with a serious illness, Chang emphasizes the importance of self-care and finding community support in whatever form that might take. Remember that “it is OK to think about yourself and to take care of yourself,” she says. “Seek out groups to share with and to get emotional support. I only did this toward the end when I started reading about and writing to people on the pulmonary fibrosis foundation website. Those forums saved my life.” She also encourages folks in similar positions to consider their options, including daycare, homecare and facilities, and weigh the pros and cons of each.

Byock also encourages those faced with these situations to manage their own health: “People can experience wellbeing even in the midst of serious illness.”

Complete Article ↪HERE↩!

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‘This Is Us’ shows Americans it’s OK to grieve

Americans often seek to move on and leave the deaths of loved ones behind — failing to resolve their feelings in the process — which is why “This Is Us” is such useful TV.

By Jennifer Wright

[I] love “This Is Us.”

Not because I think it’s corny, or over the top. I don’t watch it ironically. I love it with a complete and total earnestness. That is what it deserves.

Because NBC’s “This Is Us” is one of the only shows on television that honestly explores the ongoing nature of grief.

Each episode deals with a cast of characters who are still mourning the loss of their father, Jack Pearson, who died 20 years ago. The episode after the Super Bowl finally revealed Jack’s cause of death. Spoiler: It was that he ran back inside his family’s burning house to save his daughter’s dog and suffered a heart attack from smoke inhalation. A stunning 27 million viewers tuned in.

The show’s creator Dan Fogelman tweeted that, “My mom died 10 years ago, unexpectedly. It’s the hinge upon which my life swings. Jack’s death is the Pearson hinge. We look back. We move forward. That’s our collective journey.”

That attitude is quietly revolutionary in a country that doesn’t like to dwell on death, let alone the sadness it provokes. America exists in stark contrast to other cultures like Mexico, where the Day of the Dead is celebrated, or China, whose Qingming Festival is intended to remember ancestors who’ve passed away. In America, we’re expected to move tidily through the stages of grief and then not talk about our loss too much anymore.

Ongoing grief doesn’t fit with American ideals about being strong and resilient.

That doesn’t mean it doesn’t exist. According to Psychology Today, many people are incapacitated by grief. It notes, “approximately 10 to 20 percent of bereaved persons have severe enough, unremitting reactions to loss that result in a complicated grieving process that may require treatment.” When you consider that “8 million people suffered through the death of someone in their immediate family last year,” according to the National Mental Health association, that makes for a lot of powerfully bereaved people out there.

Teens — as the children in “This is Us” were at the time of their dad’s death — can be struck especially hard. An essay in Social Psychiatry on “Suicide following bereavement of parents” found that there is five times greater risk of suicide in teens following the loss of a parent.

For the most part, the Pearsons on “This is Us”s seem to have resumed their lives. But anyone who has lost a loved one can tell you that you don’t just grieve for a limited amount of time and then go back to “normal.” The normal that existed prior to that loss is gone. You can grieve on the days you expect (like Jack’s wife, played by Mandy Moore, who makes his favorite dinner each year on the anniversary of his death), but you can also be hit unexpectedly by it (as happens to Jack’s now-adult daughter Kate when she considers adopting a dog).

In a culture where death is often a taboo topic, “This Is Us” is a show that can get people talking about it.

You can see people on Twitter responding to the episode about Jack’s death by saying, as @littlestgrey did:

“Jack’s conversation w Rebecca about not being in the ground was almost word for word the conversation my Grandma had with me. Have I mentioned how cathartic this show is?”

Or, like @Kab_Fair, who tweeted:

“my mom died when I was young and I carry her with me every day, I think that is the message of This Is Us, she’s never gone, just physically unknown to those who occupy my life today.”

“This Is Us” does something incredibly valuable in showing us that it is OK to be sad. The characters in the show are able to grieve, but they’re also able to partake in life’s many joys.

It’s nice to see that, now that Jack’s death has been revealed, the show will go on to explore how the death of Jack’s brother in Vietnam affected him. And it will probably end up making us cry all over again.

On the show and his own grief Fogelman tweeted, “Sad? Yes. But when you look through a wide enough lens — it’s also outrageously beautiful.”
To grieve is to have known love.

The characters are dealing with a deep sadness that almost all of us will eventually experience. That’s true whether or not we want it to happen, and whether or not we want to talk about it. To experience loss is, as the show’s creator says, our collective journey.

Complete Article ↪HERE↩!

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Sinners, sailors and those who died by suicide: The adults buried in Ireland’s cillíní

Deprived of a Christian burial on the basis that they were unworthy, who are the adults in Ireland’s hidden graves?

Historian William Casey shows the site of a 1920 unofficial graveyard (cillín) a few miles from the village of Ballydehob in west Cork.

By Graham Clifford

[A]cross the water the odd light twinkles on Heir Island. It’s an idyllic evening and the retiring sun shoots a last glance at Jeremy Iron’s castle dressed in its unusual orange.

We’re standing by the shore at Skeaghanore West near Ballydehob. Remote and beautiful spots, just like this, are now coveted by those who seek the beauty and solitude of West Cork – but this was once a place where untold sadness lingered.

In Famine times, people from neighbouring parishes would make the long walk to this spot to gather shellfish in a desperate attempt to stay alive. Exhausted and starved, many died once here and are buried in a cillín overlooking the shore.

With local historian William Casey I attempt to get a closer look at the grave, located on a former ecclesiastical site, pulling back the thick coverage of briars and torn bushes.

“You could have hundreds of Famine victims here,” explains Casey.

“Grown men and women as well as children. This was their last attempt to live but when they lost that battle for life they’d be carried here and laid to rest, one after the other.”

Though cillíní are generally recognised as unofficial burial grounds for unbaptised children, records show that adults, such as Famine victims, were often buried in them too.

And it’s shocking to discover why so many Irish adults were deemed unworthy, by the Catholic Church and wider society, of a traditional burial down through the centuries.

Those who died by suicide, sailors, strangers, mothers who died in childbirth, criminals, murder victims, those with mental illnesses or physical deformities, people who died in a duel, excommunicates, were laid to rest in remote cilliní alongside little babies and children.

“Canon law lists ‘Those to Whom Ecclesiastical Funeral Rites Are Denied’,” explains Dr Eileen Murphy, an archaeologist at Queen’s University Belfast, who has studied cillíní closely.

She continues: “While most people buried in cilliní were unbaptised infants we also have examples of older individuals such as a pregnant woman in the cillín at Tonybaun, Co Mayo. Her skull displayed unhealed weapon injuries and I think it is the violent nature of her death that may have necessitated her burial in the cillín. We also have a newspaper account from Co Down of the body of a suicide victim who died 30-years previously and was discovered in 1842.”

Tom Cassidy, Conservation Officer with Limerick County Council, worked on an archaeological survey of Co Galway in the early 1980s.

The foreshore where people searched for shellfish near the site of a 1920 unofficial graveyard (cillín) a few miles from the village of Ballydehob in West Cork.

He says: “Galway has the highest concentration of recorded cillíní in the country. We came across a burial ground near Gort where two adults were said to have been buried. One was a British soldier who met his end during the War of Independence (from 1919 to 1921) and was buried in a cillín so his body wouldn’t be found. The other, we believe, was a man who was killed in a faction fight during a fair in the town. You could see from the stone markers that these weren’t infant’s graves.”

Incredibly some cillíní were still in use up to the early 1980s. Officially there are 1,393 cilliní in the State but most historians believe this figure is a mere fraction of the real number.

Emer Dennehy, an archaeologist now working with Transport Infrastructure Ireland, explains that in some cases mothers and babies who died in childbirth were buried together.

“In some cases it’s recorded that the baby would be buried between the mother’s legs in what were known as ‘tandem burials’. And if the mother died without being ‘churched’ (a blessing given to mothers after recovery from childbirth) then she could be buried in a cillín as well.”

Dennehy carried out one of the most detailed studies into cillíní when she surveyed the hundreds of such burial grounds in Co Kerry. She told me about the logic behind the traditions – especially as they related to suicide victims.

“The thinking which came from the church was ‘if you bury the person who died by suicide in a normal graveyard then they will contaminate it for everyone else buried there’. It was all about fear. They reckoned that only God could decide when you die so these people weren’t welcome. It was considered they, and so many others, ‘died outside the Grace of God’ and the Church completely played on this.”

Understandably, families, so desperately fearful of the stigma associated with suicide, would attempt to cover up the cause of death.

It’s believed this practice continued well into the 20th century so that a conventional burial could be granted.

For many, interment of an adult family member in a cillín was the worst shame to be endured.

Archaeologist Noel Dunne tells of “Mags Kilteel” – discovered by a passing merchant as an abandoned baby in Kildare around the 1890s, she became part of the Broderick family. But when she died, in her mid-20s, she was interred in a cillín rather than with the rest of her adopted family. Forever an outsider.

A range of unsettling practices in cillíní have been recorded. According to folklore some children were buried face down if they were handicapped or illegitimate or when childbirth almost resulted in the mother’s death.

Along the coast, sailors, and other unknown individuals washed up on the shore, were buried in cillíní. Written accounts provided by the National Folklore Collection confirm sailors were buried on the Great Blasket Islands. Similarly, we know sailors were laid to rest at a cillín in Renvyle, Co Galway, as well as in Dooks, Co Kerry, and on Heir Island.

While convicts and criminals would also have been buried in unconsecrated ground Dr Linda Lynch, an Osteoarchaeologist, explains that most would not have been buried in cillín.

“As cillíní are mainly located in rural areas, its less likely convicts would be buried there. It would be more usual for them to be buried near prisons and urban centres – in prison graveyards.”

Like this cillín in West Cork, many such graveyards across the country are left untouched by farmers and landowners who know not to encroach on these places of mass burial.

Buried, too, beneath the thorns, the gorse bushes, the long grass and the ferns are stories of unimaginable pain, suffering and tragedy.

In many cases stones mark out the dimensions of the infant’s grave but what of the larger dimensions, the last resting places of so many adults labelled inferior to those buried in graveyards.

Shunned in life and then in death.

Complete Article ↪HERE↩!

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What is the Death Positive Movement?

By TalkDeath 

[S]ome of us think of it often, others none at all. Sometimes we joke about it, other times fear it. No matter your approach or point of view, the fact remains: we will all inevitably die. It is literally the one thing we all have in common. And, on top of that, we will have to bear witness to the deaths of those around us. Yet, in spite of this irrefutable fact, Western culture doesn’t seem to be able to talk about the big “it.” Instead of allowing this commonality to bring us together, it often alienates us from each other. This is where the Death Positive movement comes in.

It is allude to in popular culture, through commercials, music, and other types of media. It is the subject of films and novels, and even television series. But even though we are in many ways surrounded by representations of death and grief, its presence and role in our own lives is something many feel afraid or uncomfortable speaking about. It is this internal and societal conundrum that many of us experience that is the focus of the “Death Positive” Movement.

The Death Positive (or Death Positivity) Movement is represented by the general (and growing) movement toward opening platforms for discussion about the inevitability of death and dying. The movement focuses on the importance of encouraging open discussions on the reality of both our own death, and the death of others. This includes the creation of platforms and spaces where such discussions can transpire in a comfortable, honest, open, and curious environment; where individuals may come together with different perspectives and exchange them with one another.

It also has a very practical goal of teaching us how to speak to others (i.e. our parents and partners) about their end-of-life wishes, as well as our own. The hope is that death will become de-mystified, and that as a result, society (and the individuals that comprise it) will be able to prepare for death and the grief that often follows. More importantly, discussing death and dying actually enables us to think about our own immediate lives. It encourages us to lead the life we want to live, and appreciate the little things.

You may be wondering where it is that these death positive discussions take place? How can you become involved? We’ll give you hint- it doesn’t happen in mortuaries or creepy church basements over skeletons and ouija boards. There are in fact a number of platforms- both online and in physical spaces- where death positive discussions take place on a regular basis.

One of the most widely and regularly practiced organized series of discussions on death and dying are known as Death Cafés, and occur all over the world. First established in 2004 by Swiss social anthropologist, Bernard Cretan, with the intention of breaking the taboo surrounding discussing death, they have since been held in cities all over the world. At a Death Café people will gather over coffee and treats to discuss death, dying, and experiences of grief.

Much of this discussion enables the participants to understand what is most important in their lives, allowing them to focus on these positive elements to live more fully and happily. They are often held in different locations throughout a given city, but always with the intention of creating comfortable spaces to discuss personal experiences and questions about death, dying, grief, and all that’s in between.

We highly recommend taking part in a Death Cafe in your area!

Complete Article ↪HERE↩!

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Writing a ‘Last Letter’ When You’re Healthy

Participants in the Stanford Letter Project working on letters to their family members.

By VJ PERIYAKOIL, M.D.

[O]ver the last 15 years, as a geriatrics and palliative care doctor, I have had candid conversations with countless patients near the end of their lives. The most common emotion they express is regret: regret that they never took the time to mend broken friendships and relationships; regret that they never told their friends and family how much they care; regret that they are going to be remembered by their children as hypercritical mothers or exacting, authoritarian fathers.

And that’s why I came up with a project to encourage people to write a last letter to their loved ones. It can be done when someone is ill, but it’s really worth doing when one is still healthy, before it’s too late.

It’s a lesson I learned years ago from a memorable dying patient. He was a Marine combat veteran who had lived on a staple diet of Semper Fi and studied silence all his life. A proud and stoic man, he was admitted to the hospital for intractable pain from widely spread cancer. Every day, his wife visited him and spent many hours at his bedside watching him watch television. She explained to me that he had never been much of a talker in their 50-plus years of marriage.

But he was far more forthcoming with me, especially when it became clear that his days were numbered. He spoke of his deep regret for not having spent enough time with his wife, whom he loved very much, and of his great pride in his son, who had joined the Marines in his father’s footsteps.

One afternoon, when I mentioned these comments to his wife and son, they looked incredulously at each other and then disbelievingly at me. They thanked me for being kind but stated that my patient was incapable of expressing such sentiments.

I wanted to prove my credibility and to make sure that his wife could actually hear her husband professing his love. I knew he was unlikely to speak to them directly. So I took my huge family camcorder with me the next morning on medical rounds and – with the patient’s consent — recorded an open letter from him to his family. When I gave them the taped letter as a keepsake, both his wife and son were moved to tears.

The experience inspired an idea that has grown into the Stanford Friends and Family Letter Project. With guidance from seriously ill patients and families from various racial and ethnic groups, we developed a free template for a letter that can help people complete seven life review tasks: acknowledging important people in our lives; remembering treasured moments; apologizing to those we may have hurt; forgiving those who have hurt us; and saying “thank you,” “I love you” and “goodbye.”

A letter by a project participant named Harvey Brown, written with the help of his wife, Wanda Brown.

While these may seem intuitive, many people don’t complete these steps before they die, leaving their family members with unanswered questions and regret.

(A video showing people participating in the project can be seen here.)

The letter template, which is available in eight languages, allows writers to express gratitude, forgiveness and regret. In one letter, a participant wrote to his wife, Lily, “I wish I had loved you more.”

Many writers use the templates to express pride in their children in ways they might not do in person. One wrote to a son, Michael: “You are so courageous to change your major and do what it takes to be successful to reach your dreams.” Another wrote, “Life for us was never easy but you overcame obstacles.”

And some apologize. A man named Tyrone Scott wrote to his daughter, “I’m sorry that I wasn’t there when you were growing up. If I could relive my past, I would not have let your mother take you away from me.”

The letters can be a chance to let go of grudges. Shirley Jones wrote, “To Harold: You have forgotten to repay some of the personal loans you obtained from us. We are wiping your account cleared.”

So we invite you to use the “Dear Friends and Family” template and write your letter now while you still can.

Those with chronic or serious illness may use the illness letter template; there is also a healthy letter template for those in good health. In working with people from diverse cultural backgrounds, I found that some were reluctant to complete the “goodbye” task for fear that it might become a become a self-fulfilling prophecy. I recommend that people write only the parts they feel comfortable with.

Once the letter is written, you can choose to share it with your loved ones right away. You can also store it in a safe place or with a trusted person to be given to your family in the future. Some people prefer to use the letter as a living legacy document and update it over time.

It may take tremendous courage to write a life review letter. For some people, it evokes deep and troubling emotions. Yet it may be the most important letter you will ever write.

Complete Article ↪HERE↩!

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Veteran? Terminally Ill? Want Death With Dignity? That Could Get You Evicted.

By JoNel Aleccia

[C]alifornia voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans’ homes.

Proponents of medical aid-in-dying and residents of the Veterans Home of California-Yountville — the largest in the nation — are protesting a regulation passed last year by the California Department of Veterans Affairs, or CalVet, that requires that anyone living in the facilities must be discharged if they intend to use the law.

That’s a position shared by most — but not all — states where aid-in-dying is allowed. As more U.S. jurisdictions consider whether to legalize the practice, the status of terminally ill veterans living in state-run homes will loom large.

“It would be a terrible hardship, because I have no place to go,” said Bob Sloan, 73, who suffers from congestive heart failure and other serious cardiac problems. He said he intends to seek medical aid-in-dying if doctors certify he has six months or less to live.

“I’m not going to be a vegetable,” said Sloan, a Vietnam War-era veteran who moved into the Yountville center five years ago. “I’m not going to end up living in so much pain it’s unbearable.”

A CalVet official said the agency adopted the rule to avoid violating a federal statute that prohibits using U.S. government resources for physician-assisted death. Otherwise, the agency would jeopardize nearly $68 million in federal funds that helps run the facilities, said June Iljana, CalVet’s deputy secretary of communications.

California is not alone. Three other states where aid-in-dying is legal — Oregon, Colorado and Vermont — all prohibit use of lethal medications in state-run veterans’ homes.

In Montana, where aid-in-dying is allowed under a state Supreme Court ruling, officials didn’t respond to multiple requests about whether veterans would be able to use the law in the residences. However, Dr. Eric Kress, a Missoula physician who prescribes the lethal medication, says he has transferred patients to hospice, to relatives’ homes, even to extended-stay hotels to avoid conflict.

In Washington, D.C., where an aid-in-dying law took effect last summer, the Armed Forces Retirement Home won’t assist patients in any way. Those who wish to use the law would be referred to an ethics committee for individual consideration, spokesman Christopher Kelly said in an email.

Only Washington state has a policy that allows veterans to remain in government-run residences if they intend to ingest lethal medications.. At least one veteran has died in a state-run home using that law, said Heidi Audette, a spokeswoman for the state’s Department of Veterans Affairs.

Paul Sherbo, a spokesman for the U.S. Department of Veterans Affairs, said the choice is up to the states.

“VA does not mandate how states comply with federal law,” Sherbo said in an email. “There are a number of ways individual states can choose to handle such situations and still be in compliance.”

To date, none of the 2,400 residents of California’s veterans homes has formally requested medical aid-in-dying, said Iljana. That includes the more than 900 residents of the Yountville center, located about 60 miles north of San Francisco.

“We would respectfully and compassionately assist them in transferring to a hospice, family home or other location,” Iljana said in an email. “We will readmit them immediately if they change their minds.”

But Kathryn Tucker, executive director of the End of Life Liberty Project, an advocacy group that supports aid-in-dying, said that CalVet is interpreting the federal regulations too broadly and denying terminally ill veterans the right to choose a “peaceful death” through medical assistance.

“Nothing exists in the federal statute’s language that would prohibit a resident from receiving aid-in-dying services at state homes, so long as they are not provided using federal funds or employees,” she said.

Ed Warren, head of the Allied Council, a group representing veterans at the Yountville site, co-signed a letter to CalVet officials protesting the ruling.

“My point of view is that it is inhumane to expect people in the last stages of dying to go through the hullabaloo of leaving their homes,” he said.

In Washington state, a 60-year-old man diagnosed with terminal chronic obstructive pulmonary disease, or COPD, died in June 2015 after ingesting lethal drugs at the Washington Soldiers Home in Orting, where he lived.

“It was all done very much in the open,” said Chris Fruitrich, a volunteer with the group End of Life Washington, which assisted the man.

There has been no indication that the policy jeopardizes the nearly $47 million the agency receives each year in federal funds, said Audette, the state VA spokeswoman.

In California, additional protests have centered on allegations that CalVet suppressed information about the aid-in-dying law.

Critics at the Yountville home contend that CalVet passed the discharge rule quietly, with little public input. Then the agency refused to broadcast a public meeting about medical aid-in-dying on KVET, the center’s state-run, closed-circuit television station.

Iljana said the Aug. 21 meeting, led by Tucker and Dr. Robert Brody, also a supporter of aid-in-dying, violated state rules that prohibit using public resources to promote political causes.

“Free speech is great and criticizing the government is great, but not using the government’s own resources and paid staff to advocate for a change in the law,” Iljana wrote in an email to prohibit the broadcast.

That decision, however, prompted Jac Warren, 81, who has been KVET’s station manager for eight years, to resign last month in protest, citing censorship.

“What is at issue is whether a state may completely suppress the dissemination of concededly truthful information about entirely lawful activity,” Warren wrote in an email to CalVet.

The hour-long meeting, attended by about 50 people, was not propaganda, Tucker said, but “an educational event with information provided by an attorney and a physician who both specialize in their respective fields in end-of-life care.”

Bob Sloan, who works as an engineer at KVET for a $400 monthly stipend, disagreed with the decision not to broadcast the meeting on the system that serves residents of the Yountville home.

Sloan said he knows other residents who would like to be able to use California’s aid-in-dying law if their illnesses progress.

“The only other option that people have in this state is committing suicide,” he said. “If I can’t find some way of doing it legally, I’ll do it illegally.”

Complete Article ↪HERE↩!

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Grieving the death of a spouse/partner

[T]he death of a spouse or partner can be one of the most devastating events in a person’s life bringing with it it’s own particular difficulties. As a result of this death you may have lost your life’s partner, lover, confidante, father or mother of your children, breadwinner, home-maker and possibly your best friend. You may be forced to make more changes than from any other event you will ever experience.

Even if you maintained a great deal of personal independence within your relationship you can be surprised and frightened to discover just how ‘dependent’ you have been on your partner. Over the years you may have related closely to one another’s fears and joys so that when one dies you feel incomplete. Your life has lost its structure and its purpose. You may be left with many unfulfilled needs – emotional, physical, practical, intellectual and social. It is hard to imagine all the areas of life your spouse once filled until you experience the gaps.

Grieving, in itself, is emotionally and physically exhausting. When you have the additional burden of taking on the roles that were previously performed by your partner, going on living may appear to be just too much. New tasks should be embarked on slowly with as much help as is available. Major decisions should not be taken when vision is clouded by anxiety and panic.

Friends may avoid social contact with you because of embarrassment. You are now a single person. Some may see you as a threat to their relationships. You may feel isolated, no longer part of a group, not invited out, or you may exclude yourself as you feel uncomfortable without your partner. Many surviving partners experience the unwanted sexual advances from those whom they counted among their or their partner’s friends.

The feeling of loneliness can be overwhelming and will probably come to you at your most vulnerable times – at night, weekends and holidays. Plan for this – at night keep the radio on, change your routine. Plan a project or outing for a weekend or holiday. Make contact with another lonely person.

Financial difficulties may arise – especially if your spouse or partner died without making a will. You may not be aware of your financial state and even if matters are in order there is often a delay in getting things sorted out. If there is a reduction in income the effect on your standard of living may cause family problems especially when children’s expectations also have to be adjusted. This can add to feelings of fear, anxiety and anger. Your local Citizens Information Centre may be of help with practical matters.

Sexual loss. The loss of love making which included touch, warmth and sharing a bed with your partner can be very painful. It can be tempting to succumb to sexual advances from another. However, such action based on acute need and deep grief is potentially hazardous. Until you have let go of the past, it is better not to make a commitment to someone new.

If your partner dies in the early years of the marriage / relationship not only do you grieve the loss of a beloved person but also the loss of a new, exciting romantic relationship with the prospect of years of mutual love and companionship. You may also grieve the hope of parenting a child or more children together. You may feel that you are the only one of your generation who has been cheated out of hopes for the future. Young widows and widowers may also be expected to comfort the parents of the dead partner.

If the death occurs in your mid-life years you may have the additional stress of feeling trapped by the total responsibility for all the many needs of teenage children which can also prevent you from expressing your own grief. The agency ‘Parentline’ can be helpful in assisting with parenting problems. At this time you may also feel a loss of identity especially if you have no interests or work outside the home.

For the elderly bereaved – the loss of a life’s partner can cause increased trauma, create health problems and may affect your will to live. Sometimes, with the best of intentions, adult children may smother the surviving parent with care and attention. They do not allow you space to grieve or to make your own decisions. If your family are far away you can feel all alone and may even feel abandoned.

For those in same sex relationships there may be added difficulties. The relationship may have been ignored or denied by the family of one or both partners. This can create added stress for you in the grieving process. As the surviving partner, you may find yourself excluded from decision-making concerning the funeral and burial. You may even be precluded from attending.

Perhaps work colleagues and the wider community may just think that a ‘friend’ has died, but you have lost your life partner and companion and you have to keep your grief hidden. This intensifies all aspects of the grieving process, leading to strong feelings of loneliness, isolation, anger and, at times, frustration. If the death has been from Aids, this can lead to further social isolation. It is important that you can find someone to whom you can unburden your feelings.

Whatever your age when you are bereaved, your feeling and reactions will be influenced by the nature and duration of the relationship. If the relationship had been ambivalent, feelings of relief, regret and guilt can be confusing. It is important, when dealing with these feelings, to be totally honest with yourself. Put words on your feelings, voice them aloud or write them down. It is always helpful to talk about your feelings with someone who will listen in a caring and confidential way. This will help you to discover what you are feeling, why you are feeling like this and what you can do about it. Joining a support group for bereaved people may be helpful.

The Bereavement Counselling Service is there to listen and provide support as you struggle with your grief. In our modern world just surviving can be hard work. It is doubly hard to pull yourself out of an emotional trough but it is not impossible. Each time you cope with a crisis and make a major decision you will feel good about yourself. When you reach a goal you will gain satisfaction and self-assurance through your own competence. With time and effort you will recover to lead a full and rewarding life once again.

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