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What Happens to Patients After Taking End of Life Drug

Julie McFadden, a hospice nurse in California. McFadden has spoken publicly about end of life care as she tries to educate people about how death with dignity takes place.

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Many people might not like talking about end-of-life care or death until they’re faced with it themselves, but this hospice nurse wants to remove the taboo from the topic and educate people instead.

As an intensive care unit (ICU) nurse for over a decade, Julie McFadden, 40, focused on keeping patients alive, but when she made the switch to hospice care eight years ago, her attention turned towards making people feel comfortable as they neared the end.

McFadden, from California, regularly talks about the realities of hospice care, and what happens when a patient opts for medical aid while dying, on social media. She told Newsweek: “My main point is to make everyone a little less afraid of death. I want to change the way we look at death and dying.”

Medical aid in dying (also referred to as death with dignity, physician-assisted death, and aid in dying) is the prescribing of life-ending medication to terminally ill adults with less than six months to live, who are mentally and physically capable of ingesting the medication independently.

At present, only 10 states and the District of Columbia permit this process, but there is growing support elsewhere. A survey of over 1,000 people in 2023 by Susquehanna Polling and Research concluded that 79 percent of people with a disability agree that medical aid in dying should be legal for terminally ill adults who wish to die peacefully.

States where it’s permitted include Colorado, California, Washington, Hawaii, Maine, Montana, Oregon, and Vermont. Legislation is also being considered in Massachusetts, New York and Pennsylvania.

How the End of Life Drug Is Administered

As a hospice nurse in California, where a bill was passed to permit death with dignity in 2015, and became effective from June 2016, McFadden has assisted many patients who wanted to die on their terms.

She believes that there is real beauty in someone being able to have full autonomy over their death and choosing when they go, but she knows it’s a polarizing issue.

“People have to remember that not everyone has the same beliefs and I think it’s a beautiful thing that someone gets to have control over,” McFadden told Newsweek. “It’s powerful to witness someone be so alert, say goodbye to their loved ones, have their loved ones watch them take this drink and then die, but still be willing to be there to support them.

“I think most people in the U.S. have no idea that this law even exists, and even when I give very descriptive explanations of what the law is, what it means, what the criteria is, there’s still people who think I’m just overdosing patients with morphine.”

In order to acquire the medication, an individual’s request must be approved by two doctors, they have to undergo a psychological evaluation to ensure they aren’t suicidal, and doctors have to confirm that the person is capable of making their own decisions. Patients with certain conditions do not qualify, including those with dementia.

If approved, the person must take the medication themselves, and they can have family, friends, and hospice staff present if they wish.

Since June 2016, in California 3,766 death with dignity prescriptions have been written, and 2,422 deaths registered. To protect the confidentiality of any individual who makes this decision, death certificates usually note an underlying illness as the cause of death.

McFadden continued: “There are a few drugs mixed in, it’s taken all at once and the initial drugs kick in very quickly, within three to seven minutes. This person who ingested this drug will fall asleep or basically go unconscious. I say fall asleep just so people can picture what it looks like, but they’re unconscious.

“Then, the body is digesting and taking in the rest of the drugs that are also in that mixture, which will eventually stop the heart. It’s a general sedative and then they take two different cardiac drugs to stop the heart.

“They have a change in skin color and changes to their breathing, in what we call the actively dying phase, which is the last phase of life.”

Hospice nurse Julie McFadden
Julie McFadden pictured, a hospice nurse in California. McFadden spent several years as an ICU nurse before going into hospice care in 2015.

People Have A Lot of Misconceptions

Regardless of whether you’re in a state that permits physician-assisted death or not, dying isn’t regularly talked about in a positive way.

One of the reasons why McFadden wants to have a more open conversation about it is to remove any prior misconceptions that people might have and educate them on what really happens.

“I have not seen anyone show signs of pain, but people are always concerned about that,” she said. “In general, if you’ve done this for a long time, if you’ve been in the healthcare system and work as a nurse or by someone’s bedside, you know what a body in pain looks like, it’s very obvious.

“A person who is unconscious and can’t verbally say they’re in pain will show you with their body language. Most people that have taken this medication who I have witnessed did not show those signs. I witness it day in, day out, but it’s pretty miraculous to see how our bodies, without even trying, know how to die. They’re built to do it.

“People get really angry and think I’m trying to hurt people. I always want to educate people around this topic, because the main thing people don’t want is for their loved ones to suffer at the end of life.”

As an ICU nurse formerly, McFadden explained to Newsweek that she was trained to keep patients alive, and they “didn’t have conversations about death early enough.” Despite patients being near death, they were kept alive through machinery for weeks or months, before ultimately dying on the ward.

Many of the country’s biggest medical associations are conflicted by death with dignity, with some choosing to endorse it, and others speaking against it. The American Public Health Association, and the American Medical Student Association are among the bodies to endorse it, but it has been publicly opposed by the American Medical Association and the American College of Physicians.

Julie McFadden spoke about end of life
Hospice nurse Julie McFadden, 40, from California, has been discussing death with dignity. Death with dignity is permitted in California, so McFadden has shared her experiences of helping patients go through that process.

Talking Openly About Death

In 2021, McFadden set up her TikTok account (@hospicenursejulie) to speak openly with her followers about death and answer any questions people might have. Many of her videos have gone viral with millions of views, and while she does get a lot of positive feedback, there is also plenty of negativity.

There are people who wholly disagree with her advocacy for death with dignity as they claim she is playing God, or that she’s promoting suicide. But by having an open conversation, the 40-year-old hopes to make people less fearful of dying.

Speaking to Newsweek, she said: “Most of my audience is general public, that’s why I don’t talk like I’m speaking to other nurses or physicians. I talk like I’m speaking to my families who I talk to in everyday life. I think death just isn’t talked about, or it’s not explained well.

“I’m seeing so many times that people who are willing to have difficult conversations about their own death, who are willing to say they’re afraid to die, those patients who were willing to ask me those things and talk to me about death, had a much more peaceful death.”

Complete Article ↪HERE↩!

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Care of the Body After Death

By Glen R. Horst MDiv, DMin, BA

Family members or close friends may choose to be involved in washing and dressing the body after death has occurred. Caring for a body is not easy and can stir up strong emotions. See Moments After a Death. Many people turn to health care providers and funeral directors for help. They find comfort and assurance in entrusting the body to those who provide professional services. The deceased may have left instructions for their after-death care to be handled by the health care team and chosen funeral home. Other people practice religions or belong to communities that view care of the body as a family responsibility. Their faith community, elders or neighbours provide guidance and support for hands-on care of the body. For some, this is a way of honouring the person – a final act of kindness to him or her.

This article outlines the steps involved in the care of the body after death.

In advance of the death

Talk to the health care team in advance about family or friend involvement in after-death care. You may also want to talk to the health care team about the supplies and assistance that will be required.
Washing, dressing and positioning the body

Washing and dressing the body is an act of intimacy and sign of respect. Those who were most involved in the person’s physical care may feel the most comfortable in doing this. Continued respect for the person’s modesty is essential.

Regardless of whether the person died at home or in hospital, hospice or nursing home, washing and positioning the body is best done where death occurs before stiffening of the body (rigor mortis) sets in. Rigor mortis happens within two to seven hours after death. Regardless of the location of care, you may need four to six people to help in gently moving and turning the body.

At home, you can wash the body in a regular bed. However, a hospital bed or narrow table will make the task easier. Since the body may release fluids or waste after death, place absorbent pads or towels under it. It is important to take precautions to protect yourself from contact with the person’s blood and body fluids. While you are moving, repositioning and washing the body, wear disposable gloves and wash your hands thoroughly after care.

Washing the person’s body after death is much like giving the person a bath during his or her illness.

1. Wash the person’s face, gently closing the eyes before beginning, using the soft pad of your fingertip. If you close them and hold them closed for a few minutes following death, they may stay closed on their own. If they do not, close again and place a soft smooth cloth over them. Then place a small soft weight to keep the eyes in position. To make a weight, fill a small plastic bag with dry uncooked rice, lentils, small beans or seeds.

After you have washed the face, close the mouth before the body starts to stiffen. If the mouth will not stay shut, place a rolled-up towel or washcloth under the chin. If this does not provide enough support to keep the mouth closed, use a light-weight, smooth fabric scarf. Place the middle of the scarf at the top of the head, wrapping each end around the side of the face, under the chin and up to the top of the head where it can be gently tied. These supports will become unnecessary in a few hours and can be removed.

2. Wash the hair unless it has been washed recently. For a man, you might shave his face if that would be his normal practice. You can find step-by-step instructions in the video Personal Hygiene – Caring for hair.

3. Clean the teeth and mouth. Do not remove dentures because you may have difficulty replacing them as the body stiffens.

4. Clean the body using a facecloth with water and a small amount of soap. Begin with the arms and legs and then move to the front and back of the trunk. You may need someone to help you roll the person to each side to wash the back. If you wish, you can add fragrant oil or flower petals to your rinse water. Dry the part of the body you are working on before moving to another. Some families or cultures may also choose to apply a special lotion, oil or fragrance to the person’s skin.

5. Dress or cover the body according to personal wishes or cultural practices. A shirt or a dress can be cut up the middle of the back from the bottom to just below but not through the neckline or collar. Place the arms into the sleeves first and then slipping the neck opening over the head, tucking the sides under the body on each side.

6. Position the arms alongside his or her body and be sure the legs are straight. If the person is in a hospital bed with the head raised, lower the head of the bed to the flat position.

The Canadian Integrative Network for Death Education and Alternatives (CINDEA) has a video series on post-death care at home that includes videos on “Washing the Head, Face, and Mouth”, “Washing the Body”, “Dressing the Body”.

Next steps

If a funeral home is assisting with the funeral, cremation or burial, call to arrange for transport of the body to their facility. If the death has occurred in a hospital, hospice or long-term care facility, the staff will arrange for the body to be picked up by the funeral home of your choice. In hospital, once the family agrees, the body is moved to the morgue and kept there until transported to the funeral home.

If your family is planning a home funeral or burial, cover the body in light clothing so it will stay as cool as possible. A fan, air conditioning, dry ice or an open window in the room where you place the body will help to preserve it.

See also: Planning a Home Funeral

For more information about providing care when death is near or after a death, see Module 8 and Module 9 of the Caregiver Series.

For additional resources and tools to support you in your caregiving role visit CaregiversCAN.

Complete Article ↪HERE↩!

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Filing Tax Returns for the Deceased

By D.J. Wilson

Responsibilities exist

Losing a spouse or other family member or someone we are close to is never easy. Not only is the emotional aspect weighty, but there are responsibilities that come along with managing the decedent’s affairs. Organization and follow through are key elements when filing tax returns for the deceased. Together, they can help the process go smoothly.

Important to know

For those with taxable income prior to death, a final tax return must be filed. This is typically done by the spouse with whom they’ve previously filed jointly, or by a legally appointed representative of the deceased. In the case of a surviving spouse, they may continue to file jointly for two additional years if there are dependents and they have not remarried.

What the IRS requires

In most cases, the person responsible for filing the return, such as a surviving spouse, is likely named on the will. Whoever is filing the final return must report all income and financial information up to the time of the deceased person’s earthly departure. If there is no spouse, many times a child, trustee, close family member, or business partner is appointed as representative. Click here to learn more about filing tax returns for a deceased parent.

Is official notification of death required by the IRS?

Typically, the IRS generally does not require formal notification of death to accompany the return. However, on the final return, it must be clearly noted DECEASED, indicating that said person has died. The date of death must also be noted. Electronic returns will automatically state this information when properly programmed. In some rare instances, a formal death certificate may be required.

Decisions must be made

A major decision one faces is whether to prepare the final return oneself or use a tax professional. The tax filer is ultimately responsible for the accuracy of the tax return; thus, it is imperative that the final return is properly prepared. For complicated tax situations, or in the case where one is unfamiliar with taxes and/or does not feel comfortable preparing the return, the guidance of a tax professional is wise.

Why hire a CPA?

A Certified Public Accountant, or CPA, is an expert who is licensed to provide accounting services to the public. They are knowledgeable in tax preparation, internal auditing, and perform other valuable tax and financial services. Note that a CPA is an accountant, but not all accountants are CPAs. CPA is a special professional designation earned by qualified accountants. They must adhere to rules of ethics.

What type of information is needed to prepare a return?

Regardless of whether a tax return is done by an executor or by a professional accountant, the tax filer must gather information regarding the decedent’s tax situation to prepare a final return. The following information is generally useful:

  • A death certificate. Some financial institutions may require a copy before releasing information. CPAs may request a copy of the death certificate to confirm that someone is indeed deceased. In some rare instances, it may also be needed for the final return.
  • Proof as court appointed representative of the estate or deceased. This clarifies who is responsible for filing a tax return on behalf of the deceased.
  • Copies of previous tax returns. If the representative of the deceased does not have copies of the most recent tax returns, there are ways to obtain them. One may file a power of attorney to enable their CPA to obtain copies of previous returns. Alternatively, one may submit Form 4506-T to the IRS to request a transcript of the previous tax return. One must likely demonstrate representative or executor status.
  • A tax organizer. This is a document given to clients by their tax preparer to help individuals collect, organize, and submit information needed to prepare an accurate return. This helps to ensure that vital information is not overlooked. It also helps to confirm that all tax deductions and credits are noted. Paperwork that is generally important to collect and provide to your CPA may include 1099s, mortgage information, bank statements, investment statements, and more.
  • A copy of the will. This may outline other important financial information that may be useful for tax return preparation.

An important job

Filing tax returns for the deceased is a task not to be taken lightly. When a taxpayer passes away, a final return is still expected. This responsibility generally falls onto the surviving spouse or appointed representative. If the responsible party fails to file taxes for a deceased person, the IRS may take legal action, for example, by placing a federal lien against the Estate.

Complete Article ↪HERE↩!

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She helps people cope with death.

— The Indiana Attorney General’s Office made her stop.

By Johnny Magdaleno

As one of Lauren Richwine’s clients lay in bed, his stepdaughter wrote a note and slid it into the shirt pocket over his motionless chest. Friends from the local music scene cried at his side as they prepared to carry the former bassist out of his home, permanently.

Cancer killed the young father. Instead of being rushed away to prepare for burial, his family kept him at home for a day. He rested in a sunroom, Richwine said, where the people in his life grieved and his children climbed in and out of bed with his body.

Richwine runs Death Done Differently — a Fort Wayne company specializing in “community-led death care.” She does end-of-life planning and informs people about alternatives to conventional funerals.

“Some people (say), ‘Isn’t it going to be traumatizing to the children, or couldn’t it be traumatic to see or be with someone after they’ve died?’” Richwine told IndyStar. “And I think, in my experience, it’s the opposite. It’s traumatic when we remove them too fast because we haven’t had time for this to really sink in.”

But as of this week, her work is on hold. On Wednesday she launched a new lawsuit against Indiana after the state shut her business down.

Attorney general’s office says she needs funeral director license

Death Done Differently caught the attention of the Indiana Attorney General’s Office in 2021. Someone filed a complaint against Richwine with the office. The complaint didn’t allege she harmed or deceived anyone, according to a copy reviewed by IndyStar, but said she “may require a license from the state to provide funeral services.” It doesn’t say who complained.

After giving Richwine the chance to reply, the office asked the State Board of Funeral and Cemetery Service for a cease-and-desist order.

Death Done Differently “offers several services that constitute the practice of funeral service,” the office said. It points to services like discussing body disposition, helping with legal paperwork and “readings, music, conversation, healing touch, or general companionship with the dying individual.”

State law says the practice of funeral service includes “the counseling of individuals concerning methods and alternatives for the final disposition of human remains.”

The board agreed. It issued a cease-and-desist order against Richwine on Aug. 21.

Richwine says her work is protected by the First Amendment

Her lawsuit claims Indiana is restricting her free speech because her work is speaking with and educating clients. Richwine’s attorneys want a judge in federal Northern District of Indiana court to issue an injunction that would stop the state from denying her “ability to speak with adults regarding death care.”

“There are a lot of people who currently talk about funeral options, funeral care that are not funeral directors,” Richwine said.

She gave the example of pastors. Some have “healthy relationships” with funeral homes and can be a link between congregants and funeral providers.

“Are they going to now be not allowed? Where does this end if they don’t want you talking about any of the laws and any of the funeral code at all?”

IndyStar has asked the attorney general’s office for its response to the lawsuit.

Former client: ‘She was just there to facilitate’

Andrea Schwartz’s family called Richwine hours after her daughter, Nova, was stillborn. It happened five years ago.

She told IndyStar Richwine played a different role than the funeral home her family worked with.

“Our experience was she was just there to facilitate, give us information, show us what our choices were, support us through it,” Schwartz said. “But then as far as the actual funeral, all the procedures and everything were done through a funeral home with their own funeral director.”

Richwine gave “warm support and comfort.” It was like night and day compared with Schwartz’s past experiences with elderly deaths in the family.

“It was never a positive experience” working with corporate funeral homes, she said. It was cold and impersonal, “like you’re just a number to them.”

“Kind of feeling like you were at a car sales lot the whole time,” Schwartz said.

Lawsuit says traditional funerals ‘medicalize’ death

Richwine’s lawsuit says she advises people about options other than the “historically recent innovation” of “embalming the body, holding a ceremony in a funeral parlor, and cremation or burying in an expensive casket.”

That process “medicalizes death,” the suit claims. It points to home funerals as one alternative, adding that bodies don’t present health risks to those in their vicinity for at least three days “in ordinary circumstances.”

“There’s a weird dynamic at work, where we have been normalized to relate to someone when they die as … not really belonging to us anymore,” Richwine said. “That’s part of what my work comes out of, this very strong belief that they still belong to those loved ones and the relational ties that were created, those deserve to be honored and respected.”

Complete Article ↪HERE↩!

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Anticipatory Grief Might Be The Process You Don’t Even Realise You’re Going Through

— “We begin to grieve in advance, bracing ourselves for the impending loss.”

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Although you may not have heard of the term ‘anticipatory grief’, there’s a good chance you’ve experienced it at some point.

Anticipatory grief is the grief we feel when we know a significant loss or major life change is on its way. For example, if someone we love has received a diagnosis of a terminal illness or dementia, we begin to grieve in advance, bracing ourselves for the impending loss.

First and foremost – give your feelings your attention as and when emotions arise. Whatever you are feeling is right for you.

Anticipatory creates a great wave of being out of control and that brings fear. Anything we fear we try to avoid. Acknowledge the different emotions, whatever they are. These can include – denial, anger, anxiety, fear, helplessness.

By acknowledging these reactions and allowing them to surface will help your brain and body make the necessary adjustments. All of these feelings are tendrils of our grief and don’t follow a particular pattern. It’s your own unique reaction to the shock – think of it being like a train being derailed.

If you look at each different emotion as a carriage, they need to be checked out and inspected before being put back on the track. A good way to identify how it is making you feel is to sit quietly on your own and try and find words to describe how you are feeling.

Use this time wisely

Once the loss takes place, we can be left with unresolved grief if we feel there are things we should have said or done or not said or done. This is your opportunity to clean the slate. Even in the best relationships, we still need the opportunity to say ‘I love you’ one more time.

Anticipatory grief can also create an inner conflict because we have the guilt of not wanting to lose our loved yet we do not want them to suffer. Our grief in anticipation can also feel completely different to our grief in real time. It’s never predictable or straightforward.

It’s natural to feel a loss of control during this challenging time and it’s good to just step back and identify the things that you can control and also the things you cannot control.

Things you can’t control

The diagnosis.

Timing: We never know exactly when the loss will happen and this can keep us running on adrenalin.

The reactions of others: As with all grief experiences, our feelings and reactions are totally unique to each of us and there is no set pattern. It is our own journey. This is important to grasp as comparisons to others who are experiencing the impending loss alongside us, can be so different from our own feelings. To cope with an impending loss well, we need to have confidence in our instinctive reactions to it, and that means identifying what we feel regardless of what we think we should be feeling or how anyone else is feeling or what others may expect us to feel.

Your emotions: So many things come into play when we grieve – our learnings about loss in childhood, previous ( unresolved ) losses can enmesh in our anticipatory grief and confuse and complicate our emotions. Allow it to just be.

Things you can control

Support network

It is so important that you have someone who can be your sounding board and hold you up when it all gets too much. Someone who will let you talk and give you gentle nudges in the right direction. People can sometimes be very quick to know exactly what you should do, and can often say the wrong thing, but each situation is totally unique and you will know. Learn to trust your initial instincts and trust yourself and don’t be afraid to say what it is that you need. Engage with medical staff or carers so you are informed at each step and can process the stages. When people offer help, take it. You need to care for yourself so you can care for your loved one.

Emotional care

You will rail against the unfairness of it but coming to the realisation that you have no choice will open you spiritually as you find an inner strength. Sometimes it is in the most adverse and challenging times of our lives where we have our greatest learnings and through these experiences we can actually become better people. Our appreciation of love and life deepens ands gains more value.

Fresh air and exercise

There is nothing better to soothe and clear your head than a walk in nature. Try to take a daily walk or at least every other day. The rhythm of your footfall and the fresh air can be better than medicine. If you have a dog that’s even better.

Communication

Be honest in your words and actions as this opens the door for truthful and meaningful conversations and enhanced feelings of love. You will dig deep into your reserves for the patience needed in a situation of dementia and it’s ok in those moments when your frustration takes over. You are only human and shouldn’t berate yourself. Mantras and mindfulness can help to find a sense of balance. Don’t underestimate the power of fresh air and exercise.

Making memories

This is huge. Any kind of grief isn’t just emotional, it’s physical too. By physically doing things you are working through something. Really think about what is important and what you will need to feel complete. Make your words a gift to both of you. Say and do the right thing. Have conversations whilst you can, take as many trips as you like down memory lane, visit places and people, before it’s too late. Apologise, forgive, complete. Choose photos together and create rituals. Read to them. Find what works for you.

Memories become a candle in the dark and forge a lifelong bond with those we love. Make good ones.

Knowing that there is an impending loss can make us realise the value and importance of our life and we don’t want to waste time. We want to make every second count.

Try this – think about what will be important to you at the end of your life and then ask yourself why isn’t it important today?

And that will keep you focused on the things you want to accomplish before you die. This is called living.

Complete Article ↪HERE↩!

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Why you should swap your bucket list with a chuck-it list

By Valerie Tiberius

On my father’s 75th birthday, he announced some news: He no longer intended to learn Spanish. He told me that for most of his life he imagined he would one day speak the language fluently, but this year, at this new age and vantage point, he was giving up that goal.

He seemed a little melancholy about it but mostly relieved that he no longer had this piñata of shame hanging over his head.

Best of all, he adopted a mental heuristic for this goal-no-longer that I believe has liberating potential for everyone: Learning Spanish, he told me, was now an item on his “chuck-it list.” (Full disclosure: My dad’s name for the list is a little saltier).

Bucket lists can be a fun, inspirational tool — they encourage us to chase new experiences, such as learning chess or going on an African safari. But let’s face it: They can also be oppressive, irritating reminders that you can’t afford that $3,000 flight to Johannesburg.

As a philosopher of well-being, I can tell you that philosophers tend to divide into three camps on the subject: hedonists, who think well-being is all about good feelings; objectivists, who believe we live well when we achieve things with value transcending the individual; and desire satisfactionists, who think well-being means fulfilling your own goals.

I am in the third camp. I like that this approach respects individual differences and explains why there are so many different good lives. But it also has a serious flaw: Focusing on pursuing our goals often leaves us running on a treadmill of desire and frustration.

The solution to this problem lies in choosing which goals to pursue. The mere pursuit of a goal won’t promote your well-being — you have to be selective. This is where the chuck-it list comes into play.

Are you the kind of person who is going to be on your deathbed regretting that you missed your chance to ride in a hot-air balloon, like Dorothy in “The Wizard of Oz”? Then do it! But when I really thought about that long-held fantasy, I let it go pretty easily, along with parasailing and completing a “century” (a 100-mile bike ride). I felt liberated when I moved these activities to my chuck-it list. It freed me to think about what I actually want to do — which is, turns out, shorter bike rides and flying only in the safety of a commercial airplane.

Of course, building the chuck-it list can be difficult. In his book “Four Thousand Weeks,” Oliver Burkeman reminds us of the old time-management trick of thinking of your goals as rocks that you have to fit into the glass jar of your life. The advice is to put in the big rocks (important goals) first because otherwise you’ll fill your jar with little, unimportant pebbles and won’t be able to fit in the big ones later.

Burkeman dislikes this advice: He points out that the metaphor presupposes that we can squeeze in all the big rocks if we start with them, which might not be true. I agree. Sometimes, it’s a big rock that we have to move to the chuck-it list.

Discarding goals that we really care about is difficult; failing to complete them can elicit sadness or regret. For my father, the relief of letting go of speaking fluent Spanish came tinged with sadness because he saw learning a foreign language as valuable. When you move things to your chuck-it list because you can’t physically do them anymore (e.g., a marathon), there’s also likely to be a layer of disappointment about aging and the reminder of mortality. The same can be said about goals on a bucket list made impossible by financial constraints or time limitations: They force us to come to terms with circumstances beyond our control.

So what should we do about these negative feelings?

My neighbor, a retired pianist and choir director, told me she took learning certain difficult musical compositions off her bucket list. She described the resulting feeling as “sweet loss” — sweet because she can still listen to those beloved pieces, loss because she’s not going to be the one playing them.

Accepting this wisdom requires a shift in perspective. Bucket lists tie the value of our dreams to our value as individuals. Once we cut that tie, we can still appreciate the value of our abandoned goals by finding pleasure in the achievements of others.

Shifting away from a self-centered perspective can help giving up goals feel a bit less bitter. And really, what is the alternative? Keep everything on your bucket list and try to stuff all the rocks into the jar? This inevitably leads to disappointment and frustration. It might also lead to missing out on enjoying what wasn’t on your bucket list — things brought to you by serendipity that you couldn’t plan for, or things you’ve been taking for granted.

This is why I believe your chuck-it list is just as important as your bucket list. As you age, you grow into a different person with new priorities; your goals should evolve, too. Give yourself permission to remove those items you’ll probably never get to. And most important: Don’t feel so bad about it.

Complete Article ↪HERE↩!

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Terminal illness

— Navigating the struggles of acceptance

By Linda Thomas, RN

Reality knocked me for a loop one evening when my father-in-law called from his home in another state and asked for help. This kind of request was very uncharacteristic for him. We responded immediately and drove to his home. After much conversation and many questions from both sides, we eventually came to the hard truth. His cancer had progressed and, to my mind, was most likely terminal. I dug in and started contacting his doctors, trying to sort out his health issues and prognosis. This took most of a day. I came to realize he was seeing nine physicians! He was in a desperate state of denial. The oncologist repeated that he had been very open and clear with my father-in-law about the cancer and its spread.

My father-in-law had been readmitted to the hospital with a very determined but misguided surgeon. My father-in-law thought the surgery proposed by the surgeon would be a cure. It wouldn’t be, and I had the unenviable task of discussing end-of-life matters with the patient, something the surgeon should have been upfront about.

Hospice came to the hospital to discuss the care they could offer him at his home. He elected to enter into hospice, and we took him home. At this point, he was feeling fairly well, and he had a glorious two weeks with friends and family coming for visits from many miles away. Meanwhile, I quickly discovered I was in unfamiliar territory when it came to his care. It was increasingly difficult for me to care for someone I loved and had a close familial bond with. The amounts of medication he was allowed, the hard decisions I had to make… all were uncomfortably entwined with the closeness of being family. He asked for teaching regarding his health and prognosis, and we spent hours discussing end-of-life matters and the decisions to be made. Even though family was in touch, they were in their stages of denial. I became the liaison for the family’s questions, as well.

Uncharacteristically for me, I was struck with uncertainty, processing my grief while maintaining my professional duties. I relied heavily on the hospice nurses as they made their daily visits. The type of care I gave him, the large doses of medications that kept him comfortable… all were different when compared to my decades of working to save lives and titrating medications for patients who would, with the care given, most likely live to go home and resume their lives. I found myself relying on the hospice nurse, asking questions like, “Are you sure it’s ok to give him that large a dose of painkillers?” She worked with me, explaining how different this type of nursing was compared to the care given to save the lives of my usual hospitalized post-surgical, cardiac, neuro, psyche, burn, chronic respiratory, and emergency patients.

There were different, more intense emotions involved in caring for this terminally ill, beloved family member. I second-guessed myself in areas where I normally was quite confident. The advice that most helped guide me through the nights of caring for him was given to me by the hospice nurse. She repeated to me several times, “This is different from the nursing you are used to. You medicate this patient for his comfort… whatever it takes. You cannot overdose him. I repeat, you cannot overdose him.” So I learned a new skill. I learned to titrate medication for his comfort, to give him what he needed, without second-guessing myself. I kept him comfortable but functional.

And one night, he collapsed as he left the bathroom. He had no perceptible heartbeat. He had no perceptible breathing. After 15 minutes, he sat up and started talking! It blew my mind. Once he was settled back in bed, I teased him about him having left us to visit his favorite brother and his much-loved mother, both deceased. He suddenly looked at me with complete seriousness and said, “How did you know where I was?” He was thoughtful for the next few hours, then quietly said, “I’m ready. I’m ready to go, and I’m not afraid. I’ve done everything I needed to.” Three days later, he left us. That time there was no resurrection.

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