Tag: Education

Posted on

How To Talk To Your Kids About Death And Grief

Loss is a natural, but complex part of life.

By Caroline Bologna

Death and grief are natural parts of the human experience, but mourning a loss is also an incredibly complex process.

When a young child loses a loved one, parents often grapple with the challenge of explaining the concept of death and helping their little one through the grieving process (all while grieving themselves).

To help inform these difficult conversations, HuffPost spoke to a number of child mental health experts. Of course, a family’s cultural and religious background may steer the discussion, but there are certain guiding principles that are helpful for everyone to keep in mind.

Here are some expert suggestions for parents and caregivers when they prepare to talk about death and grief with children.

Be Honest And Straightforward

“Tell them the ‘facts’ about the death,” clinical psychologist John Mayer told HuffPost. “Don’t sugarcoat what death is or use ‘baby talk’ with a child. Do not use phrases like, ‘Grammy is sleeping.’ This is an opportune time to teach them about death. Don’t shy away from it.”

Board certified licensed professional counselor Tammy Lewis Wilborn echoed this sentiment, noting that using “cutesy language” and euphemisms in an attempt to protect kids from the realities of death and loss can actually do more harm than good.

“Children tend to think concretely, not abstractly, so when you use language that’s euphemistic, it can actually be more confusing or frustrating,” she explained. When people say things like “Dad is in the clouds” or “Your dad is taking a really long nap,” a young child may not understand the permanence of the fact that their father died and might even look for him in the clouds or expect him to wake up at some point.

Words like “death,” “died” or “dying” may sound harsh, but this is still developmentally appropriate language, Wilborn noted, and it’s important for children to have the language to understand the permanence of death.

Ask And Answer Questions

The kind of conversation a parent has with a child following the death of a loved one depends on the child’s relationship with the person who died. It should also vary based on the child’s developmental age and their understanding of what happens when someone dies. To that end, it’s useful to ask kids questions or offer to answer any questions they might have.

“Starting with questions can be a way in,” said Wilborn. “And you don’t necessarily need to give the specific details of how the person died, particularly if we’re dealing with traumatic grief. They don’t need all of the information, but they need enough age-appropriate details to understand that a person has died and isn’t coming back.”

Sometimes children may have witnessed something related to the loved one’s death, like being present at the scene of an accident or visiting the person in the hospital. In these cases, they need help understanding what they saw, said Chandra Ghosh Ippen, an expert in early childhood trauma and the associate director of the Child Trauma Research Program at the University of California, San Francisco.

Parents should try to shrink themselves down to the size of their child and walk through what they’ve experienced. Seeing someone in a hospital with tubes coming out of them or watching paramedics perform lifesaving procedures may be frightening for a small child, so it’s necessary for adults to appreciate how scary things might look to them.

“Create space for them to share how it might’ve affected them, and try to help them understand that doctors and paramedics were trying to help their loved one,” Ghosh Ippen explained.

It’s an ongoing conversation. “Young children will often come back to you after your very excellent explanation of death and still ask, ‘Am I going to see so-and-so?’” Ghosh Ippen said. “It’s not that they didn’t understand you, but little kids tend to repeat their questions. It’s sort of their way of mulling it over and making meaning. This can be painful for caregivers, but appreciate that the child did hear you and is just having a difficult time wrapping their head around the concept of death.”

Know That Their Emotions Are Complicated

“Grief is a complex process, so it comes with a range of thoughts, emotions and behaviors,” Wilborn explained. While parents may expect their child to feel sad, angry, confused or even guilty about a loss, there are other behavioral changes that can be harder to understand, like changes in sleeping and eating patterns or school performance issues.

Sometimes parents may feel confused about a perceived lack of sadness in their kids. “Young children have a short sadness span,” said Ghosh Ippen. “A child can suffer a devastating loss and feel really sad, and then they can go play. You may be thinking, ‘Were they really affected by what happened?’”

While adults tend to immobilize and sink into sadness, kids often discharge it by running around or trying to do something else. “They kind of go in and out of sadness, and that can put us at odds with them if we’re thinking, ‘Oh, my God, do they not care?’” she continued. “But recognize that they did care.”

Be Patient

Wilborn noted that grief is a long process, so parents should reject the tendency to want to rush past it and wonder when their kids are going to be over it.

“Grief is a process that you cannot go around. You have to go through it. So you need to be OK with the pace of the process,” she said. “It can take some time for a child to return to his or her normal.”

Mayer emphasized the power of this experience and of talking to kids about death as a way to build major developmental coping skills. “This is a positive and helps them cope with loss in their life in the future and even transitions in their life, such as leaving one school to another, advancing to high school or college, and losing relationships.”

Encourage Expression

“Children need to see that their parents are a resource; home is a resource where grief is welcome,” Wilborn said, noting that parents should encourage age-appropriate expressions of grief.

“For example with a school-aged, play is their language, so you want to lean into ways that children play to promote communication ― things like drawing pictures, playing games, dolls, puppet shows at home,” she added. “With older kids, you might encourage them to journal, draw, write songs, create poems.”

Mayer noted that being a resource for your child creates a sense of safety and security that will serve them in later life events. “They know they can depend on you, and it is wonderful modeling for them.”

Create Rituals

Creating rituals around remembering and honoring a loved one who died is another significant form of expression. “Explain that this person may not be here with us, but we can still remember him or her and celebrate their life as a family,” said Wilborn.

“When the death is really traumatic, sometimes caregivers stop talking about the person who died,” Ghosh Ippen explained. “And what’s hard in those cases is that children lose their ‘angel memories’ ― times when they really felt loved and cared for with that person. It’s normal for grown-ups in mourning to find it hard to talk about the person who died, but it’s important to memorialize them.”

The death of a loved one offers an opportunity to talk to your child about your cultural and religious beliefs.

Many cultures and religions promote rituals around saying goodbye and making meaning of death. Mayer noted that losing a loved one presents an opportunity for parents who have religious belief systems to explain these tenets to their children.

“Religious or not, it is also very helpful to teach your children that all the experiences and memories you have had with this loved one do not get erased with their death. People always live in our hearts and our minds forever, and no one or nothing can take that away,” he explained. “Say something like, ‘Where’s Aunt Susie right now? She’s not in this room with us right now, correct? That doesn’t mean she doesn’t exist.’ Aunt Susie is here (point to your head) and here (point to your heart). We have to keep our memories and good times with Aunt Susie alive.”

Make Sure They Know It’s Not Their Fault

“Sometimes children have this really uncanny way of assigning blame to themselves for things that have nothing to do with them,” said Wilborn.

With that in mind, caregivers need to help kids understand that the death is in no way their fault, and it’s not their responsibility to put on a strong face or hide their feelings.

Use Books And Other Resources

There are many great resources for parents navigating this difficult topic with their children. Ghosh Ippen and Wilborn both recommend Sesame Street’s online grief toolkit, which provides talking points, videos, activities, storybooks and more. Ghosh Ippen and Wilborn also pointed to the National Child Traumatic Stress Network as another great source of online resources.

Ghosh Ippen maintains Pinterest boards with book recommendations, including one on loss, grief and traumatic bereavement. Some of her favorite children’s books that tackle these topics include Chester Raccoon and the Acorn Full of Memories, The Dragonfly Door, When Dinosaurs Die: A Guide to Understanding Death, Rosie Remembers Mommy: Forever in Her Heart, Sad Isn’t Bad: A Good-Grief Guidebook for Kids Dealing With Loss and Samantha Jane’s Missing Smile: A Story About Coping With the Loss of a Parent.

As far as books for parents, Mayer recommended the writings of psychiatrist Elisabeth Kübler-Ross, as well as How Do We Tell the Children? Fourth Edition: A Step-by-Step Guide for Helping Children and Teens Cope When Someone Dies and Understanding and Supporting Bereaved Children: A Practical Guide for Professionals.

There are many children’s books that cover the experience of loss.

Beyond books and online resources, Wilborn emphasized the value of community resources, such as school counseling, support groups, play therapy and peer counseling.

Let Them See You Grieve

The way a child’s parents or caregivers respond to a loss is instrumental in helping them cope. “They need to see you grieve,” said Wilborn. “But they also need to see you taking care of yourself and engaging in self-care, which may or may not include professional help. If you don’t, they may feel like they have to take care of you because you’re not managing grief in a way that’s healthy.”

It’s OK to cry in front of your children and show the value of expressing emotions and having shared emotions among family members. It’s OK to say things like “I’m feeling really sad because my dad died” or “Daddy is sad because he misses his mom.”

“Within our culture, we often have a sense that we have to be tough, so many parents are trying to help their kids by putting on a brave or overly cheery face,” said Ghosh Ippen. “But that can seem really odd and confusing. The child is feeling sad because it’s devastating that this person is gone, but then the parent is cheery ― which can feel eerie and weird.”

Ultimately, it’s about conveying the idea that “Mom is sad, and Mom is also strong,” she continued. If the feelings of grief become overwhelming, parents should seek help from other sources because it’s not their child’s role to help them.

“It’s important for little kids to believe that grown-ups are bigger, wiser and stronger,” said Ghosh Ippen. “We are not going to fall apart, and if we are going to fall apart, other grown-ups are going to help us.”

Complete Article ↪HERE↩!

Posted on

How death disappeared from Halloween

Americans tend to avoid opportunities to engage with their own mortality

“Trick-or-treating was a way of buying kids off,” says author Lisa Morton.

By Vittoria Elliott and Kevin McDonald

Halloween in America is awfully cute these days — both in the sense that children’s costumes have reached unimaginable heights of adorability and that the holiday has lost its darkness — and that’s rather awful.

Sexy avocado costumes obscure the holiday’s historical roots and the role it once played in allowing people to engage with mortality. What was once a spiritual practice, like so much else, has become largely commercial. While there is nothing better than a baby dressed as a Gryffindor, Halloween is supposed to be about death, a subject Americans aren’t particularly good at addressing. And nowhere is that more evident than in the way we celebrate (or don’t celebrate) Halloween.

Halloween has its origins in the first millennium A.D. in the Celtic Irish holiday Samhain. According to Lisa Morton, author of “Trick or Treat: A History of Halloween,” Samhain was a New Year’s celebration held in the fall, a sort of seasonal acknowledgment of the annual change from a season of life to one of death. The Celts used Samhain celebrations to settle debts, thin their herds of livestock and appease the spirits: the kinds of preparations one might make if they are genuinely unsure whether they will survive the winter.

But in America today, that kind of acknowledgment of imminent mortality rarely occurs, according to Anita Hannig, an anthropologist and professor at Brandeis University. “When we recognize our mortality, we make preparations for it,” she says, mentioning a Romanian acquaintance who had bought their grandmother a coffin for her birthday. “But in the U.S., that kind of engagement is seen as almost frivolous.”

But what could be less frivolous than talking about a wholly universal experience?

“Every other culture has a time set aside during the year where the dead visit,” said Sarah Chavez, executive director of the Order of the Good Death, a group of funeral industry professionals, academics and artists devoted to preparing a “death phobic culture for their inevitable mortality.” Part of the power of these rituals is to make death into a known quantity, something to be accepted, even embraced, rather than feared.

When Roman Christian missionaries began to convert the Celtic peoples, local holidays were not banished, but rather co-opted. All Saints’ Day, formerly celebrated in mid-May, was moved to Nov. 1 as a way to tame the wild Celtic tradition of Samhain. All Saints’ Day is a celebration of all the dead who have attained heaven in the Catholic tradition, a death-centric celebration if there ever was one.

But the rowdiness of Samhain proved difficult to dislodge, according to Morton, so the Catholic Church tacked on All Souls’ day on Nov. 2, to offer prayers for those who were stuck in purgatory. This three-day celebration began on the evening of Oct. 31, eventually becoming All Hallows’ Evening in reference to the holy days to follow.

When the Spanish colonized what is now Mexico, they used the same strategy, taking indigenous rituals and co-opting them into the church, creating what we know today as Día de los Muertos. In both instances, the holidays retained their focus on the ritualistic recognition of mortality and honoring the dead, with the church as arbiter of the afterlife.

Halloween arrived in the United States in the 1840s, brought by Irish and Scottish immigrants fleeing famine. Popular activities included fortunetelling, speaking with the dead and other forms of divination. (To get a sense of how uncomfortable many Americans are with the dead, try this at your next Halloween party and see what kinds of looks you get.)

Catholic-infused Halloween and Samhain shared several similarities with Día de los Muertos. They were both feast days, filled with candles and a reverence for the dead. The traditional sugar skulls, or calaveras, are similar to Halloween’s “soul cakes,” sweet treats people would offer in exchange for prayers for dead relatives languishing in purgatory.

The calavera tradition remains in the modern form of Día de los Muertos, but in the United States, soul cakes have all but vanished. We now have trick-or-treating, a tradition borne purely out of concerns for the living. In the early part of the 20th century, destructive young pranksters would take full advantage of Halloween, vandalizing and destroying property.

“It was costing cities a lot of money,” says Morton. Instead of banning the holiday altogether, neighborhoods banded together to host parties and give out snacks. “Trick-or-treating was a way of buying kids off.”

Similar to how Halloween has drifted from death ritual to doorbell ringing, modern American engagements with death have changed from up close to a culture of avoidance.

In a lot of ways, Halloween in the United States “mirrors our experience with death directly,” says Chavez.

“We used to take care of our dead in our homes — people used to die at home. We took care of our loved ones, dug their graves. We were there through the entire process. We have no idea what death looks like anymore,” she says. And that ignorance breeds fear, uncertainty and avoidance.

Today, about 80 percent of people die in a hospital or a nursing home. Hannig calls these “institutional deaths,” and they’re just one part of how modern death has been sanitized and sequestered away from the world of the living.

“The responsibilities of death have been outsourced,” she says, adding that hospitals and the mortuary industry allow ordinary people to avoid engagement with the messiness and gruesomeness of death.

“When someone dies in a hospital, oftentimes the body will be whisked away almost immediately and family and friends won’t see it again until after it’s been embalmed.”

And it’s not just dying that modern America is losing touch with; it’s death rituals as well. As the United States becomes increasingly secular, religion’s role in making meaning out of death has shrunk. According to Hannig’s research, memorial services are becoming less and less common, and a collective honoring of the dead — something like All Souls’ Day — is practically nonexistent.

Hannig pointed out that in many other cultures, death is a community affair and something people prepare for together. In certain Buddhist communities in Nepal, for instance, when someone dies they will be surrounded by their loved ones and valued possessions to make sure they don’t have any longed-for attachment tying them to life. It’s a way for both parties — the dying and the living — to accept and let go.

Instead, modern Halloween focuses on the creepy and the capitalistic. “We consume death in a commercialized, entertainment way,” says Chavez. By making death fantastical, we make it feel almost impossible, and therefore less threatening. “We know that a zombie movie isn’t realistic. It’s all a way that we can reassure ourselves that we are safe and it won’t happen to us.”

But haunted attractions, horror films and safety from zombies haven’t made us less afraid of death. If anything, by continuing to keep death at a distance, we transform it into an unknown: possibly the scariest thing of all.

Posted on

5 Reasons to Plan Your Funeral Now

No one likes to think about death, but planning ahead for your funeral is smart

By Candy Arrington

Although I didn’t know it at the time, a week after my father received a terminal cancer diagnosis, he asked my cousin to take him to a local mortuary where he made decisions about his burial and paid for his funeral. Following his death five months later, as a grieving only child, I was thankful my father had the foresight to plan ahead, as he had always done for other life events. His choice to preplan was a gift that prevented me from making emotional and costly decisions based in grief.

Death is a subject none of us want to confront. Talking about death causes us to face mortality and run head-on into the fact that we will not always be here. Yet death is inevitable and planning your funeral is a lot like planning for retirement. It requires honest evaluation and sometimes hard decisions, but it’s something that needs to be done.

Here are five reasons to overcome hesitancy and consider planning your funeral now:

1. Rising Costs

Each year, funeral costs continue to rise. Planning and paying for your funeral now is a way to avoid those increasing costs. According to the National Funeral Directors Association (NFDA), the median cost for an adult funeral with viewing and burial, including vault, was $8,755 in 2017. For a funeral with viewing and cremation, the median cost was $6,260. These amounts do not include cemetery costs, monument or marker, pall flowers, obituary or other related expenses, which could raise the cost to between $10,000 and $12,000. However, consumers have options.

“Charges at all mortuaries are based on operating costs and overhead and are higher in larger metropolitan areas,” said Glenn Miller, manager at J.F. Floyd Mortuary in Spartanburg, S.C. “With a full-service mortuary, there are many options. All of our services are itemized, and families can choose what to include. Our fees are the same for a funeral at a church or at our chapel as long as it involves our standard five staff members.”

2. The Ability to Make Your Own Decisions

Most people like to feel in control over decisions that affect their lives, and often that extends to end-of-life decisions. While no one can predict the time and circumstances of death, many take comfort in knowing they’ve selected the type of burial, location and funeral they want. While many plan to make these decisions eventually, most never actually follow through.

“Emotions are the greatest deterrent to preplanning,” said Miller. “People often have the attitude that if they don’t talk about death, it won’t happen.”

If you approach funeral planning as you would a financial or business decision, you may be able to get beyond those difficult emotions. Many mortuary websites provide preplanning information. Other websites, such as Funeralwise, help calculate costs. Move beyond any superstitious notions that funeral planning hastens death, and take time to investigate.

Be aware that preplanning does not require prepayment. The NFDA provides a Bill of Rights for Funeral Preplanning. Knowing your rights helps you plan wisely and avoid being overcharged.

3. To Lessen Future Family Conflict

If you’ve ever tried to plan a family reunion or holiday get-together, you know suggestions and opinions abound and conflict. When planning a funeral — factoring in intense emotions, personality conflicts and multiplying by the number of siblings — you potentially have a recipe for a family squabble.

“Many people are still traditional in their faith and type of funeral they want, while their children may not be,” said Miller. “Children think differently than their parents and often have a more contemporary approach to burial, funeral location, music and minister. Planning ahead documents your wishes.”

While you can’t guarantee family members will abide by your choices, preplanning documents your wishes and provides a benchmark.

4. To Reduce the Financial Burden

We all hope to leave assets for our children, yet a prolonged stay in a care facility can deplete savings. Remaining assets are often non-liquid, which doesn’t help with the immediate need to pay mortuary or crematorium costs. Prepaying for your funeral and associated costs eliminates or reduces the financial burden on those left behind. Most mortuaries provide incremental prepayment options over months or years.

5. Preplanning is a Gift to Loved Ones

Planning a funeral is a huge hurdle for grieving family members who may be physically and emotionally exhausted. If even some planning has been done ahead, the burden of making rapid, costly decisions is eased.

Sometimes planning occurs near the end of life, but any information given or selections made are gifts to those who will execute the funeral.

Sherry Cochran’s father made decisions about his funeral while in hospice care, with his wife and six children present.

“My father was a minister, and he openly discussed his funeral,” said Cochran, a retired attorney in Raleigh, N.C. “He chose the hymns, minister, mortuary, cemetery and told us any casket we chose was fine as long as it was plain and didn’t cost much. When your parent is willing to talk about end-of-life issues and make decisions, it teaches you how to approach death and provides closure.”

Complete Article ↪HERE↩!

Posted on

How to Deal With a Bereavement As a Teen

Dealing with a death as a teenager can be extremely hard. Many teens have lost loved ones, so you aren’t alone!


1
Never be afraid to cry. Crying is good for you. It helps you let go of some of the hurt or anger you may have. You shouldn’t feel weak or silly while crying. After all this shows that you loved the person and that they were important to you.

2
Talk to someone you trust. This could be a parent or guardian, your best friend or if you are religious, a pastor or priest. Talking about the one you loved can help you remember all the good memories you have had with them.

3
Help yourself to remember them. Listen to their favorite songs, look at pictures, read their favorite poem, plant their favorite flower in your garden. This is a good thing as it means you still have a small part of them with you.

4
Don’t blame yourself. This is a common reaction to the death of a loved one, but remember they wouldn’t want you to blame yourself.

5
If you are religious, find comfort in the fact they have gone to a better place. Remember that they are more peaceful, and there is no more hurt or pain were they are now.

6
Visit their grave site. This can bring some comfort as you can take care of their grave site. If you do not like visiting a resting place it does not mean you are a bad person, they would understand that maybe you don’t want to remember them that way.

7
Pray. Sometimes it can sound silly but if you are religious or even if you aren’t this can bring a lot of comfort as you feel closer to the person, you can talk to them and ask them to watch over you and keep you safe.

8
Have some alone time. Time on your own can help you get your thoughts together. Sitting in silence for a while can be quite comforting and can help you feel better.

9
Remember the person how you want to. Do not let other people tell you how to remember the one you loved. Remember them however you want. Your love for them could have been different than others.

10
Remember that they loved you. They always will and by feeling pain this shows you also loved the person.

11
Say goodbye. Say it however you want. Scattering the remains in a place they loved can bring some closure, also having a service can help you say goodbye.

Complete Article ↪HERE↩!

Posted on

Doctors and the D Word:

Talking About Death Is an Essential Skill — and One Often Lacking

By

The vast majority of physicians enter medicine because they want to help people, so it’s not necessarily surprising that many are uncomfortable discussing death with their patients. However, when that discomfort reaches so far as to prevent conversations that patients need and want to have, it’s a problem, experts say. 

A physician’s discomfort with talking about death can go as far as avoiding the word itself, says Helen Stanton Chapple, PhD, RN, an associate professor at the Creighton University Center for Health Policy and Ethics and College of Nursing in Omaha, Nebraska. Although she’s been out of clinical practice for about a decade, Dr Chapple recalls the euphemisms many providers used to avoid the subject.

Dr Chapple explained that the closest she’s heard physicians come to acknowledging that a patient is dying is saying that, “the illness is not survivable,” she told Medical Bag. “Part of it is that they don’t get any training, part of it is that they don’t see it modeled when coming up in residency training, and part of it is that they dislike trying to tell the future. That’s a problem.”

Fortunately, things are beginning to change in terms of the training and education physicians receive. The Palliative Care and Hospice Education and Training Act (PCHETA, H.R. 1676), introduced to Congress by Representative Eliot Engel in 2017, for example, proposes amending the Public Health Service Act to beef up support for palliative care, including training for healthcare professionals.

“It’s still widely variable at different medical schools and institutions, but I think it’s becoming much more accepted that this is part of the basic skills a physician needs,” said J. Randall Curtis, MD, MPH, a professor of medicine and director of the Cambia Palliative Care Center of Excellence at University of Washington School of Medicine in Seattle.

“More and more medical students and physician are being trained in giving bad news and how to have these conversations,” Dr Curtis told Medical Bag. “But it doesn’t make these conversations easy. You’re working with a patient, and you have to give them bad news. It’s hard even if you’re trained and good at it.”

And change is slow, says Lori Bishop, RN, MHA, vice president of palliative and advanced care at the National Hospice & Palliative Care Organization in Alexandria, Virginia.

“I think there’s a concern or perception that some of these conversations could reduce hope or take away hope,” Ms Bishop told Medical Bag. Research suggests the opposite, she adds. “People with serious illness are really expecting to have these conversations and want to have them, but they’re waiting for the doctor to initiate that conversation, so sometimes it doesn’t happen.”

Interestingly, clinicians perceive difficulties with patient and family responses as bigger barriers to these discussions than their own skills and limitations, but patient research does not quite jibe with those findings.1

A small, qualitative study published in 2015 found that “many participants were very comfortable talking about their own death.”2 The authors concluded, “Being able to talk about end-of-life wishes and know how to support people who are dying or bereaved are important to many people, and they would welcome interventions to facilitate this at a societal level.”

It’s not just patients waiting for the physician to take the first step. Providers across the medical profession tend to believe that physicians should lead the discussion, both because of their medical training and because of their ability to answer clarifying questions about the patient’s prognosis, suggests a 2016 qualitative study in the American Journal of Hospice and Palliative Care.3

Broaching the topic as early as reasonably possible also gives patients more time, information, and opportunity to make the decisions they want based on their values and their place in life, Ms Bishop added.

“I may choose a different path once I start a conversation if I know what my risks are and where I’m at in the trajectory in a disease,” Ms Bishop said. “You miss an opportunity for some pretty rich discussions when you don’t have these conversations. It’s not just a medical conversation. It’s really in context of that whole individual and where they’re at in their life and what matters to them.”

Why Doctors Delay

The reasons for physicians’ discomfort with conversations about dying are as much cultural, social, and systemic as they are personal, Dr Chapple told Medical Bag. The health care system is set up in such a way that necessary changes in a care plan do not always keep pace with changes in a patient’s condition, particularly if those changes occur overnight or on weekends when the primary medical team is off. It’s attending physicians who make the decisions, not the nurses or residents who may see the patient — and their deterioration — more frequently.

“Part of it is nurses having to witness and inflict the suffering and getting sick of it when they think there’s no good outcome,” Dr Chapple said. “They become like a Greek chorus, commenting to each other and to individual residents, but the attending physicians make the decisions and have their own reasons.”

A Dutch research project4 found the biggest reasons for delaying conversations about a patient’s death were “timing (when is the right moment?), reserve (because of the potential emotional despair of the patient), and hope (who am I to rob a patient of their hope?).”4

Nurses may develop a better sense than doctors for some of these answers because they are the ones implementing interventions, Dr Chapple added.

“They’re hanging the IVs, putting the machines on, monitoring the patient and doing all this stuff, so I think they have a sense of when there’s no resilience left,” Chapple told Medical Bag. “So the nurses are looking at the big picture, and the physicians are trying to tweak each complication.”

That tweaking mindset often begins from the first conversation, when a physician tells the patient about a terminal diagnosis but hardly before launching into the treatments they can offer.

“There’s a way of telling that doesn’t let you deal with the existential reality of it and instead moves you immediately into the steps you’re going to take,” Dr Chapple said. She noted that some research has shown that patients are surprised when they learn their treatments were never intended to be curative, even if they were told.

Physicians’ discomfort with discussing death may also arise from differences in patients’ ethnicity or faith. A 2015 study published in PLOS One surveyed more than 1000 physicians and found that 86% rated it “a great deal” or “quite a bit” challenging to discuss death with patients of a different ethnicity.5 In a 2016 study published in the American Journal of Hospice and Palliative Care, providers (albeit mostly nurses) rated conducting a spiritual history with patients as particularly difficult.6

A 2016 systematic review of the research lends credence to all of these reasons: “Recurrent themes within the literature related to a lack of education and training, difficulty in prognostication, cultural differences, and perceived reluctance of the patient or family,” the authors wrote.7

The problem, however, is more complex and far reaching than even those reasons, going deep into the heart of who we are as Americans, the way our healthcare system is set up, and how a big part of the economy’s growth relies on technology, Dr Chapple told Medical Bag.

“In the United States, it’s all tied up together with the idea that if we’re not living and growing and using technology to gain our salvation, there’s something wrong with us, that we have to fight, fight, fight, against death,” Dr Chapple said. “There is something about our culture and what we find acceptable and desirable that’s given us the terrible healthcare we have, that spends most of its money rescuing people from death and stabilizing them and spending so much less money on prevention and universal access to healthcare.”

While that perspective is expansive, reaching toward larger philosophical ideas regarding how our culture thinks about death, it also contains a key to learning to grapple with those conversations, Dr Chapple suggested.

How to Become Better at Talking About Death

“What palliative care people tell me is that the conversation is not difficult,” Dr Chapple said. “Part of what would be helpful is for a physician to think through for themselves what their own thoughts are about dying. What are your own fears, what is the unresolved grief you have about people you’ve lost in your life? Maybe that’s part of the internal work physicians have to do for themselves.”

Physicians who find that difficult may look for triggers they can rely on, such as initiating end-of-life care conversations when a patient reaches a certain age, or when a specific development occurs in a person’s progression of a chronic disease.

An extensive 2001 qualitative study identified 6 areas particularly important for physicians to consider in talking with dying patients8: “talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death,” the researchers wrote.

As with any skill, the secret to improving isn’t really a secret: practice, practice, practice.

“Practicing the conversation is the only way to get better at it and hone that skill,” Ms Bishop noted. “Some physicians have had access to training where they can role play with a mentor or with someone who has that skill set and get feedback on what they may want to do differently.”

Ms Bishop suggests starting these conversations by asking patients what’s important to them at this point in their life and how they feel things are going — and then listening.

“You get a lot of insight into what a person already knows about what their issues are or you may be surprised and find out what matters to them is not at all what you think it is as a clinician,” she added. “It just makes for holistic care when you have the conversations.”

But again, becoming more skilled with these conversations certainly doesn’t make them more pleasant.

“The goal of training is not to make it easy and fun,” Dr Curtis told Medical Bag. “Physicians by and large go into medicine to help people and make people feel better. To be in this position where you have to give bad news is difficult, but it is important, and being trained allows you to do it well and work with that discomfort.”

It’s also an ongoing conversation because people at different stages of life will change their opinions about what they want as circumstances or the disease itself change, she adds.

“We’re all going to die. For anyone who’s in the medical profession, there’s a certain subset of their patients who will die,” Ms Bishop said. “You can ease that burden if you start to have those conversations when someone is well and continue those conversations as the disease progresses.”

For physicians who are interested in brushing up on their communication skills in the face of bad news, there are a number of available resources, including VITALtalk and the Association for Death Education and Counseling. A list of organizations who provide assistance and information on multiple topics related to trauma, grief, dying, and death can be found here.

Complete Article ↪HERE↩!

Posted on

Gone but never forgotten:

How to comfort a child whose sibling has died

Children not only lose their sibling, their parents can also disappear into profound grief.

By

In 1971, when I was four years old, my brother died of a congenital heart condition. Writing about this experience has prompted more responses than anything else I’ve ever written or spoken about. Untold and unheard stories appear in comments sections, strangers tell me cross-culturally consistent tales in the soft corners of conference rooms and speak about the siblings they’ve lost and how present the memories of them still are in their minds and hearts.

These stories all have one thing in common: a sense of being forgotten, left out of conversations about the dead, of rituals of mourning, and excluded from the respectful circle that is drawn around the bereaved.

One of the reasons stories of sibling loss spark so much interest is that the research literature in the area is so sparse. We still know so little about what children who’ve lived through this kind of death need as they mourn.

While the quantitative literature has explored the profound negative lifelong physical and psychological health impacts of this kind of bereavement, so many social and familial factors contribute to these impairments that it’s hard to imagine how the figures would look if families and communities were better equipped to respond to grieving children.

Children don’t forget about their lost siblings.

Part of the picture of sibling loss is that it is compounded. Children not only lose their sibling, but also the parents they knew disappear at least for a time into profound grief. This can lead to the loss of the child’s position as they try to cope with the higher expectations on their shoulders.

Adding to this complexity, the small body of qualitative research into children’s experience of losing a sibling highlights a raft of social failures. Silence about the mechanics of death, family isolation and the persistent myth across many cultures that children bounce back from grief more easily than adults are some of the most salient.

In this literature, grieving children tell us about what they wanted and didn’t get, and reading it provides some guidance on how to support bereaved siblings for anyone willing to listen. The following short list of suggestions is drawn directly from this qualitative literature.

Make genuine room for children in discussions

The evidence is very strong that grieving children of all ages need to be involved at every level in discussions about death and in the planning and performing of death rituals.

But, if we’re going to make room for them, we have to get across our own death material and be prepared to answer painful, graphic and profound existential questions about death and dying, such as:

Can you show me what a decomposing body looks like? Why are we going to burn my sister in her coffin? When will you die? And how? When will I die? Why do some people die while others keep on living? Why my brother and not someone else?

To tell the truths about death to children and to really include them in family and community meaning-making is to expose our culture’s myths of death and dying, whatever they are, to profound criticism and scrutiny. That is what we are being asked to do.

Accept that children’s grief is no different to ours

Sibling bereavement researcher Betty Davies’s participants spoke to her again and again about their need for the lifelong persistence of their grief to be understood.

You never stop grieving the loss of a sibling.

They spoke of wanting the adults in their lives to accept that their grief is no different to ours, that they are never too young to feel loss and that just because they are children doesn’t make them any more resilient than grown-ups.

They are asking us to challenge the almost universal myth that children forget, and instead to stand with them in their bereavement rather than setting them apart to take solace in their imagined innocence.

Honour continuing bonds with the dead

Our siblings play a significant role in our development, and this helps to explain some of the reasons why we are so deeply impacted when a sibling dies.

We develop our self in relationship to others, and our siblings are a kind of mirror. When they die, we lose a relationship that provided an essential reflection of who we are and who we might become. Children whose sibling has died need to have a place for their ongoing thoughts, feelings and connection to the dead throughout their lives.

For children who never knew their dead sibling, this affirmation of their connection to the lost one has a different quality but is no less important. While for these children the links are not made up of memories of a relationship, they are important symbolic representations of the self through the lens of the grief that came before.

For both groups of children, those who knew their dead sibling and those who did not, stories about the lost child help to make sense of who they are and of their place in the world.

We can all play a part in making space for children whose sibling has died to bear the unbearable – by offering solace in the form of genuine inclusion and by breaking the silence that can turn pain into suffering.

Complete Article ↪HERE↩!

Posted on

A Single Life

In this Oscar-nominated animated short, a young woman receives a mysterious package that contains a vinyl record. She soon realizes that she can go forward or backward in time by simply adjusting the position of the needle as the record plays on her stereo.