More and More, I Talk to the Dead

By Margaret Renkl

After my mother died so suddenly — laughing at a rerun of “JAG” at 10 p.m., dying of a hemorrhagic stroke by dawn — I dreamed about her night after night. In every dream she was willfully, outrageously alive, unaware of the grief her death had caused. In every dream relief poured through me like a flash flood. Oh, thank God!

Then I would wake into keening grief all over again.

Years earlier, when my father learned he had advanced esophageal cancer, his doctor told him he had perhaps six months to live. He lived far longer than that, though I never thought of it as “living” once I learned how little time he really had. For six months my father was dying, and then he kept dying for two years more. I was still working and raising a family, but running beneath the thin soil of my own life was a river of death. My father’s dying governed my days.

After he died, I wept and kept weeping, but I rarely dreamed about my father the way I would dream about my mother nearly a decade later. Even in the midst of calamitous grief, I understood the difference: My father’s long illness had given me time to work death into the daily patterns of my life. My mother’s sudden death had obliterated any illusion that daily patterns are trustworthy.

Years have passed now, and it’s the ordinariness of grief itself that governs my days. The very air around me thrums with absence. I grieve the beloved high-school teacher I lost the summer after graduation and the beloved college professor who was my friend for more than two decades. I grieve the father I lost nearly 20 years ago and the father-in-law I lost during the pandemic. I grieve the great-grandmother who died my junior year of college and the grandmother who lived until I was deep into my 40s.

Some of those I grieve are people I didn’t even know. How can John Prine be gone? I hear his haunting last song, “I Remember Everything,” and I still can’t quite believe that John Prine is gone. Can it properly be called grieving if the person who died is someone I never met? Probably not. But when I remember that John Prine will never write another song, it feels exactly like grief.

In any life, loss piles on loss in all its manifestations, and I find myself thinking often of the last lines of “Elegy for Jane,” Theodore Roethke’s poem about a student killed when she was thrown from a horse: “Over this damp grave I speak the words of my love: / I, with no rights in this matter, / Neither father nor lover.”

Why, when we grieve, can it feel so urgent to make others understand the depth of our loss, even when we have no rights in the matter? I think it must be because people so often fail to honor grief at all. We talk of “processing” loss, of reckoning with it and moving on, as though bright life could not possibly include an unvanquishable darkness. Our culture persists in treating mourning as an unpleasant process we are obliged to endure while waiting for real life to restore itself.

But God help anyone who appears to move on too quickly, or too slowly, for the grief police will be coming for them. They may be accused of giving their late spouse’s clothes away too soon, or of mourning excessively a relationship that seems too far down the grief ladder to justify such a response. People have opinions about how others should manage loss.

Just before my mother died, I heard her say to a stranger, “My husband died nine years ago, and every night I tell God I’m ready to see him again.” Four days later, she got her wish.

I’m in no hurry to join my beloved dead, but like my mother before me, I am spending more and more of my days in their company. As my father was dying, and taking so long to die, I feared that the memories of his brutal last years would overwhelm four decades of happy times. I worried that the father who followed me into my own old age would be the fretful, pain-wracked old man and not the loving optimist who had always been my surest source of strength in an indifferent world.

It didn’t turn out that way. Next month he will have been gone for 20 years, but he is as real to me today as he was on any day of the 41 years we shared on this side of the veil.

I read a newspaper article reporting that NASA will be dismantling the Saturn rocket that rises above the Alabama welcome center on I-65 South, and I remember the model Saturn rocket, taller than my 10-year-old self, that Dad and I built together from chicken wire and papier-mâché. I hear a Cole Porter song on the radio, and I remember my parents dancing in the living room. I see a blue jay perched in the pine tree just outside our family room, and I recall how often I was told that “blue jay” is the first bird I learned to call by name. There were so many blue jays in so many pine trees back in those days when I was still a cherished late-born child, and my parents were still explaining the world to me.

It’s the same with all my lost beloveds. Reminders take every possible form — the feel of pine needles underfoot, the scent of a passing woman’s perfume, the tail end of a song on a coffee shop radio, a letter tumbling out of a long-unopened book, the taste of boiled peanuts, salty and warm. The reminders loop between past and present, between one lost loved one and another, a buzzing sweep of sensations and memories and time. I keep searching for the right metaphor to convey what I mean. Is it like a braid? A web? A shroud?

Finally the word comes to me: It’s a conversation. Every day, all day long, everyone I’ve ever loved is gathered around the same table, talking.

Ten years on, I rarely dream about my mother anymore, but in the dreams where she does appear, it’s the same as before — the ordinariness of life, the rush of relief I feel, her blithe unawareness of my suffering. I walk in the door, and there she is, there they all are, no happier to see me than they would be if I’d only walked in from another room in the same house. In my dreams, as in my waking life, the dead are still here, still talking to me.

Complete Article HERE!

If you could, would you want to know when you will die?

By

Would you want to know when you’re going to die? I’ve thought about this question quite a bit recently.

>Several months ago, I picked up a new novel titled “The Measure” by Nikki Erlick, which opens with quite the plot twist. One morning, everybody on the planet (ages 22 and up) wakes up to a surprise at their front door: a small wooden box, personally engraved, with the words: “The measure of your life lies within.” Each box contains a string whose length determines the length of the recipient’s life.

The characters now face a gut-wrenching decision. Do they open the box and find out how long they will live? If yes, what will they do with that knowledge? If not, which means they’re choosing not to know, will they live any differently?

The question is not entirely a hypothetical one. A few months ago, out of a morbid curiosity, I visited Death Clock, a website that labels itself the “Internet’s friendly reminder that life is slipping away … second by second.”

I entered the month, day and year of my birth, my gender, mood (from pessimistic to optimistic), whether I smoked tobacco, and my height and weight. I hit the submit button, and a second later came my answer: “Your personal day of death is Wednesday, April 23, 2031.”

If true, I had nine years to live; I’d be a few months short of my 74th birthday.

About the same time, my sister, who is 60 and being treated for advanced ovarian cancer, was told by her oncologist that time may be running short. Of course, it was only a doctor’s guess and her current chemo regimen has significantly improved her tumor markers. Regardless, she’d be considered a “short stringer,” one of those who will die before their time, in “The Measure.”

I’ve wanted to be a “long-stringer,” ever since I had cancer in my 20s, but thanks to Erlick’s book and now my sister’s illness, I’ve recognized that focusing on exactly when my time is up is unknowable and probably not particularly good psychically. So I’ve decided instead to focus on how I want to spend those years, not just the number of them.

In any case, longevity doesn’t come with a guarantee of good health, and those “bonus years” may hold less value if confined to home or suffering from debilitating conditions.

As the characters in “The Measure” discover, a long string (meaning many years of life) does not equal happiness. And while the characters who get short strings initially feel as though they’ve come up, well, short. gradually, they find greater meaning and richness in their comparatively fewer days. Their newfound knowledge alters their perspective on what matters.

One of the novel’s characters, Nina, who is married to one of the short stringers, says: “It’s easy to look at our time together and think that we were so unlucky. But isn’t it better to spend ten years really loving someone, rather than forty years growing bored or weary or bitter?”

After her partner, Maura, dies — indeed early — Nina explains that their relationship “felt deep, and it felt whole, despite its length. It was an entire, wonderful tale in and of itself.”

All this brings me back to my little sister, Julie, and the deep angst I feel at what may turn out to be a premature death. I want her to live forever. (Maybe not forever, but, please, longer than me!)

To help me with these stomach-wrenching feelings, I’ve turned to friends, my therapist, a higher-dose antidepressant, meditation, ketamine and Elisabeth Kübler-Ross’s work on the five stages of death and dying. All of which work — some.

Oddly enough, “The Measure” has provided me with a greater sense of peace and acceptance than I’ve found anywhere else. Don’t get me wrong, I still hate that Julie is likely to live fewer years than her older brother. But I’ve watched and learned as Julie has lived as big a life as anyone could imagine. This proved true before her diagnosis but even more so in recent years.

Soon after her diagnosis, Julie emailed me to say that she’d already had a full life, even if it’s cut short. Since then, she has focused on what matters to her — seeing her daughters graduate from college, celebrating 35 years with her wife, going away on trips with the whole family, visiting with close friends.

In other words, Julie has fine-tuned those relationships that mean the most to her and not dwelled on those that she may miss out on in the future.

I remember thinking at our recent Christmas dinner about a quote attributed to Ralph Waldo Emerson: “It is not the length of life, but the depth of life” that matters. And then I thought about what Nina, in the novel, tells us: “When we think about the greatest love stories ever written, we aren’t judging them by their length … . [A]nd even though I’ve been given more chapters than Maura, her pages were the ones you couldn’t put down. The ones that I’ll keep rereading, over and over, for the rest of my life. Our decade together, our story, was a gift.”

Amen.

It’s not about how many chapters we’ve lived but how rich and exciting those chapters are. Or, as the late poet Mary Oliver wrote, “Tell me, what is it you plan to do with your one wild and precious life?”

For starters, I’m not going to listen to the Death Clock. I don’t want to know when I’m going to die — but I do want to live each day as though it could be my last.

Complete Article HERE!

I Helped My Mother To Live and Later Die

— After begging her mother to live longer, this author later honors her mother’s wishes for how she wanted to be treated at the end of her life

Kathleen and her mother, less than two years before Mary Elizabeth’s death

By Kathleen M. Rehl

“Please don’t die now, Mom! I can’t handle two funerals back-to-back.”

In a panic, I squeezed my mother’s hand as I sat beside her bed. The hallway’s stark white light streamed through her doorway. Announcements crackled over an intercom as an equipment cart clattered past her room. Mom’s roommate moaned in her sleep before returning to rhythmic snoring.

Then, finally, a sweet-faced nurse’s aide said I could stay beyond regular visiting hours. Staring intently before she spoke, Mom said, “Your father came to me in a dream last night and told me it was time to let go and be with him again.”

Mom Loved Her New Life

Flashback to Dad’s death from colon cancer, a few days after his 80th birthday. After he passed, Mom moved over 1,000 miles from her house on a dusty, isolated road to live near me and my husband, Tom, in Florida.

She blossomed like the red roses she cared for near her apartment.

Leaving sadness and grief behind, she chose a sunny independent living apartment in a continuing care retirement community (CCRC). There she blossomed like the red roses she cared for near her apartment.

Mom made new friends fast, joined afternoon card games, shelved books at the community library, tended a meditation garden, participated in church activities, baked yummy chocolate chip cookies to share, traveled to visit a few relatives across the country, and enjoyed an occasional happy hour glass of sangria with girlfriends.

In addition, Tom and I included Mom in many local activities. “I love my new life here,” she often said. Mom’s newfound happiness lasted almost two years.

Life Changed

A serious fall interrupted Mom’s joyful journey. After spending Thanksgiving with Tom and me, my mother fell in her apartment, shattering her femur. Mom’s next-door neighbor’s frantic phone call brought the ambulance.

At the hospital, we authorized emergency orthopedic surgery. A few days later, she transferred to her CCRC’s skilled nursing care wing, with weeks of physical therapy scheduled. Her spirit was crushed.

I was devastated, of course, but the knockdown punch to the gut hit in early December. That’s when my husband visited his doctor, feeling unusually tired, with jaundiced skin and abdominal pain. He called me at work later, saying he’d been admitted to the hospital for specialized testing.

I bolted from my desk and didn’t return to it for many weeks. Meetings and phone calls with a medical staff filled our coming days. By week’s end, we knew his diagnosis was a callous killer — late-stage inoperable and untreatable liver cancer.

His prognosis was death within a few months. My 72-year-old husband chose home hospice care rather than a war he couldn’t win.

Mom Rallied

“All right! I won’t die now,” Mom said from her nursing home bed when she understood Tom’s death sentence. And that’s just what she did.

Mom mustered her petite body’s life force, willing her health to improve.

She completed prescribed physical therapy, navigated with her fractured leg plus a walker, and moved back into her apartment with daily assistance from an aide and friends.

I boomeranged between caring for my mother and my husband. Then, Tom’s progressive downward spiral gathered speed while Mom’s condition stabilized. He died in my arms on February 12, 2022 with my brother beside us both.

A packed church celebrated my husband’s life. Mom sat near me as I stood in the funeral’s receiving line, both brokenhearted.

Years Before, We Talked About Care Preferences

“I don’t want you kids to have to pull the plug on me someday,” Mom said over a decade before.

Several years before Dad’s death, our family discussed health care preferences if we experienced a severe illness. My mother had once carried the burden of being the one who authorized disconnecting her aunt and mother from life support after each suffered debilitating strokes.

“I didn’t know what they would have wanted because we never talked about topics like that back then.”

“I didn’t know what they would have wanted, because we never talked about topics like that back then,” she said. Mom felt she “killed Aunt Frances and your grandmother.”

Dad, Mom, Tom, and I completed the Five Wishes advance care planning document years before we updated our estate plans. It’s easy to understand, covering one’s personal, spiritual, medical, and legal wishes at the end of life.

In addition, it identifies the person designated to make care decisions when you can’t do it yourself. After my father passed, Mom revised her plans, naming me the primary health care agent.

The Beginning of Mom’s Ending

After my mother told me about her dream of Dad, she didn’t speak of that vision again until Tom died. Then her health plummeted within a month. Complications put her in the hospital again.

Two older adults getting off a bus. Next Avenue, caregiving for mom
Mom and Tom in St. Petersburg

That’s when she repeated that Dad was preparing to welcome her. She wanted to go. Tearfully hugging my mother, I told her it was OK. I understood. I wouldn’t hold her back.

They requested my mother’s advance health care documents when she was admitted to the hospital. I gave them a copy of her Five Wishes form, verifying she didn’t want life support treatment to keep her body alive when she was close to death.

Even though this paperwork was accepted and filed, Mom’s plans were almost upset when she went into immediate cardiac arrest in the middle of the night. Finally, exhausted, I left her hospital room to go home for a shower and a few hours of sleep. But a hospital nurse called after midnight, saying they were taking Mom to the intensive care unit (ICU) for life support.

“No! That’s not what she wants! Read her advance care directives!” I yelled over the phone. “I’ll be there as fast as I can. Please don’t move Mom!”

I pulled on my jeans and raced for the car, driving in the dark over the speed limit. I ran to her room with a copy of Mom’s Five Wishes form. Assistants started rolling her bed into the hall on the way to the elevator and the ICU.

Committed to Her Wishes

The nurse said she needed to get the doctor. He looked over the forms, stepped away for a few minutes, and returned to ask what I wanted. “Plain palliative care, please!” I answered.

I encourage you to avoid heartache and upset as you consider what you want and do not want for your end-of-life care.

Fast forward. That’s precisely what happened, with my mother moved into a private hospice care room. My brother and I were allowed to camp with her in that room for the remaining three days of her life.

We facilitated a few short phone calls with her family, sang to her, read her favorite scriptures, and monitored her morphine. Then, before slipping into her final slumber, she told us of a clear new vision, where she saw relatives waving from across a bridge and preparing for a party.

“They have to wait for me to cross over that bridge before starting the festivities,” she said. Tom and my Dad were in that welcoming crowd, along with her mother and aunt. She finally said, “Awesome!” as she crossed her bright bridge.

Most Don’t Have End-of-Life Conversations

In June 2020, the National Poll on Healthy Aging was conducted for the University of Michigan’s Institute for Healthcare Policy and Innovation. A sample of U.S. adults aged 50–80 was asked about their advanced care planning.

Nearly two in five adults aged 50–80 had not discussed their health care preferences if they experienced a severe illness. More than two in three hadn’t completed an advance directive and durable power of attorney documents.

More than half of the folks who had not talked about their care preferences with others or completed related legal documents said it was because they needed to take the time to do this.

I encourage you to avoid heartache and upset as you consider what you want and do not want for your end-of-life care. I hope my story encourages conversations with you and your loved ones. It’s a precious gift you can give them.

Complete Article HERE!

Preparing Jewish bodies for burial, an artist finds inspiration

‘I could have painted landscapes,’ says Karen Benioff Friedman. Instead, she’s portraying the rituals around death.

Angels of Mercy Embrace the Dead, 2023, oil on canvasboard.© 2023 Karen Benioff Friedman.

By Stewart Ain

When a Berkeley rabbi in 2004 announced that he wanted to form a chevra kadisha, Hebrew for a group that cares for the dead before burial, an artist in his congregation signed herself up.

Karen Benioff Friedman had a mostly secular upbringing, and hadn’t known much about Jewish burial societies, but she knew she wanted to be a part of one.

“What I found compelling is the idea that we never leave the dead alone,” she said.

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Thresholds: Jewish Rituals of Death and Mourning – Placing the Metah into the Casket, 2019, oil on canvas. © 2023 Karen Benioff Friedman.

Ten years later, while Friedman was studying human anatomy and classical realism at an Oakland art school, she learned of 18th century paintings of Prague’s chevra kadisha. They depicted tahara, the rituals of the burial society.

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Thresholds – Jewish Rituals of Death and Mourning – Tying the Avnet, 2023, oil on canvas. © 2023 Karen Benioff Friedman.

As part of these rituals, bodies are placed in a white shroud before they are lowered into a casket. Coincidentally, Friedman had been painting images of shrouded figures. Seeing the Prague paintings made her think that tahara could be her subject too.

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Tahara, 2021, graphite on paper. © 2023 Karen Benioff Friedman.

“I could have painted landscapes or pets, but this is what really moved me,” said Friedman.

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Taharah: Pouring the Second Bucket, 2017, oil on canvas. © 2023 Karen Benioff Friedman.

Since then, Friedman, now 59, has drawn, painted and etched more than 150 images of tahara, each a window into a ritual so private that many Jews have little idea what it looks like. Those who perform tahara wash the body, and sit by it through the night, reciting prayers and psalms.

In her paintings, gauzy figures, some enveloped in light, attend lovingly to the dead, cradling their heads and pouring water over their bodies. The mood is somber, despite the daubs of bright blue she often uses for the aprons of the women of the chevra kadisha.

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Thresholds, Attending Grandmother’s Passing, 2020, charcoal on paper. © 2023 Karen Benioff Friedman.

Tahara calls for men to care for men and women for women, so Friedman’s subjects are mostly female, because, she said, that is what she knows from her own participation.

Respecting tahara, which means “purification,” Friedman would never try to draw or take photographs of the deceased. But she didn’t work solely from memory either. She hired models to impersonate both the living and the dead. One model did a “pretend tahara while another pretended to be a body that was dressed in a shroud,” she said. She worked from the photographs she took of them.

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Angels of Mercy Embrace The Dead, 2019, charcoal on paper. © 2023 Karen Benioff Friedman.

 

Friedman paints in oils and makes monotypes, a form of printmaking. All her drawings are in charcoal.

Many of her works depict angels. “One of the main pieces of liturgy we talk about is the one about the angels of mercy who embrace the metah — the female body,” Friedman said. “Angels come up a lot, including standing outside the gates of heaven. I love the concept of the angels.”

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Angel of Death Holding an Infant, 2022, monotype on silk. © 2023 Karen Benioff Friedman.

Ultimately, she said, she wants her works to teach about the mostly hidden work of the chevra kadisha, and its commitment to respect the dead, no matter who has died.

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Shmira (Guarding the Dead), 2019, oil on canvas. © 2023 Karen Benioff Friedman.

“We are all equal in death,” she said. “We all wear the same thing and are buried the same.”

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A Soul, 2023, monotype. © 2023 Karen Benioff Friedman.

An exhibit of Friedman’s work will open on Feb. 5 at  San Francisco’s Sinai Memorial Chapel and run through March 19.

Complete Article HERE!

The toughest conversation

— Talking end of life with patients

By Kristen Fuller, MD

I saw my first code during my third year of medical school. A day later, I called my mom to discuss her last wishes if something tragic were to happen to her.

I did not want her to be that patient on the gurney being violently coded if that was against her wish. It took a few years of coaxing her into having these tough conversations with me, and after enough coercing (and having to deal with a few hair-raising medical issues), she told me exactly what she wanted to do when the time came.

I regularly try to talk about this with patients, even if they give me pushback, as I firmly believe that every person should have the power to make an educated decision on what they want to be done at the end of their life.

Despite our regular proximity to death, many physicians may lack the necessary skills to have direct, detailed conversations about code status, long-term prognosis, quality of life, and end-of-life care.

The last thing we want is for our patients to have to make these very emotional and difficult decisions in the last few months—or even minutes—of their lives. Or for their family members to be forced to guess their loved one’s end-of-life wishes after they’ve become incapacitated. But we can help them prepare for that time—provided we know how to do so.

They don’t teach us about death in medical school

During my medical school and residency, we didn’t spend much time discussing death, having end-of-life conversations with patients and families, how to manage pain or anxiety during the dying process, or the intricate differences between hospice and palliative care.

Nobody taught us how to approach or use advance directives, or when to discuss them with patients. Such terms came up in conversation and during rounds, but there was no teaching method or structured learning objective—or even conversations about them.

We learned how to have end-of-life family meetings while watching senior residents, whose styles and conversational skills were all over the map. Death was not a natural, omnipresent, physiological process but rather the unspoken consequence if we did our jobs wrong—almost like a failure.

Becoming comfortable with death

“Death is a normal part of life. Everyone dies and deserves to die with dignity, with the choice of how they take their last breaths.”
— Kristen Fuller, MD

Luckily, in my final year of residency, I had the privilege (after a lot of kicking and screaming) of taking three important elective rotations: palliative care, hospice, and pain management and rehabilitation.

During these months, I learned how to be comfortable with death and dying, appropriately manage pain in all its different forms, have difficult conversations with patients and families about these topics, and give myself grace and compassion when a patient dies.

These skill sets have tremendously helped me in my professional life—as well as in my personal life, as I am often the one having the difficult conversations on these issues with my family members.

Taking control

A Kaiser Family Foundation study reported that only 56% of adult Americans had a serious conversation about healthcare preferences, 27% wrote down their preferences, and just 11% discussed them with a healthcare professional.[1]

The most powerful thing patients and families can do to take control of their healthcare is to think through what’s most important to them if they become seriously ill. They should also identify a person they trust to represent them if they can’t speak for themselves.

It’s never too early to raise the topic

“I always encourage physicians and family members to ask questions about end-of-life care early on, as it’s never too soon to start talking about it—but there is a point where it may be too late.”
— Kristen Fuller, MD

During office visits, try to discuss code status and advance directives with the patient, and encourage family members to talk about it with each other.

Before asking these questions, you may want to discuss why you’re having this conversation. Perhaps you can offer a professional or personal experience you had with death when a patient or family member didn’t have any decision-making powers.

“I often tell patients about my first experience as a medical school student witnessing a code.”
— Kristen Fuller, MD

Here are some possible conversation starters:

  • What is important in your life? How would you like to be remembered?
  • What experiences have you had so far with death? What do you think death means?
  • What will happen when you die? Do you need to make any plans or choices now?

How to discuss end-of-life care

Choose a quiet, comfortable, private space to meet without interruptions (turn off your electronics). Ask your patient what they know about their condition and its prognosis so you can better understand their knowledge and mindset. The goal is for the patient to lead the conversation and tell you what they want to do.

If there are discrepancies between what you and the patient know about their situation, it’s your job to tell them the truth. Use plain language, speak slowly and clearly, and make sure they can hear and understand you. Then give them a few moments to process this information before asking if they have any questions.

Determine what your patient wants in the last years, months, or weeks of their life. How do they wish to take their last breaths? How would they like to spend their time? Do they want to be coded when their heart stops? Do they want to be readmitted to the hospital if their condition worsens? Would they want palliative or hospice care?

“It’s our job to learn and document the patient’s specific wishes. In doing so, we must be honest and educate the patient on the differences between hospice and palliative care.”
— Kristen Fuller, MD

Focus on realistic goals

An author writing in Family Practice Management provided insight on how to guide patients’ expectations about the end of life.[2]

“Redirecting the patient’s focus from ‘cure’ to a more reasonable goal, such as living long enough to complete certain tasks (healing relationships or witnessing certain events such as a wedding or birth of a grandchild) can be helpful,” the author wrote. “Even a pain-free death could be a goal.”

The author added that “it is possible to have both qualities of life and quantity of life,” as research showed that patients who receive hospice care live longer than those who pursue aggressive treatment.

Complete Article HERE!

The importance of holding space

By Faryal Michaud, DO

Today I wanted to talk about a concept that is very near and dear to my heart: Holding space.

Have you ever heard of it? Do you know how to describe it?

I will first start with the definition and then give you an example.

Holding space means being physically, mentally, and emotionally present for someone. It means putting your focus on someone to support them as they feel their feelings. An important aspect of holding space is managing judgment while you are present.

Like when you tell a patient that they have stage IV pancreatic cancer and that it is nonsurgical and even with the best treatments, their time is very short. Then you hold space.

You say nothing. You sit there and provide support by sitting there-next to their emotions. You don’t run to offer false hope. You don’t run to talk about 5 percent of the patients that respond to the newest therapy. You don’t try to look at the bright side. Change the subject. Or worse, run out the room.

You hold space. Sometimes, you sit for 2 minutes. Sometimes 10 minutes. While saying nothing. It feels like an impossibly long time, but I wish I could tell you how you are bearing the weight of that news by just sitting there. Holding space.

It is a remarkable skill to learn. As a palliative doctor, it is my skill set to sit there with your suffering. I may not know what you are thinking about, or what you are going through, but I am willing to sit there and be next to you as you figure it out.

Telling a patient that they have a terminal disease is a little like telling someone, “Our plane is about to crash.” Except somehow, you are going to be saved, and they are not. Holding space is you staying with them as they approach this free fall. As bad as it is to bear witness, remember, you are leaving this experience alive.

A very dear chaplain who was from Germany explained to me what a palliative consultation feels like,

It’s like opening the door to the patient’s life, as you start a conversation about the news of their limited time on Earth,

Some run to you (those are the ones who always knew something was wrong, and their doctors kept reassuring them otherwise).

Some stay at the door and don’t even move (shocked, stunned, in denial, and numb).

Some shut the door on your face (anger, frustration, and betrayal).

Holding space means whatever they choose to do at that door, it’s OK. It’s never about you. It is always about them and what they need. You hold space like you open that door. And you just stand there without a word or attempt to change their idea about what they want to do at that door. That is holding space.

Meditation is a little bit like that.

People think that meditation means you breathe in good thoughts and breathe out bad thoughts. No, it’s about the actual awareness of the thoughts.

It’s like holding space for your thoughts. But the simple awareness of the thoughts is huge. Calling them by their names.

Hey, hello anger. I see you, insecurity. I can feel you, loneliness.

When we can name our emotions and hold space for them, something magical happens. They don’t own us; we own them. We can choose how to handle them.

Oh, I see that I am angry because I had this thought …

Obviously, it is a daily practice, to remove yourself away from the feelings and thoughts that cross our minds and watch them go by like clouds in the sky.

The awareness that all will be OK. That there is a blue sky and sun above the clouds. That dying is part of living, not apart from it. This allows us to live in the moment and appreciate all that we have right now.

To hold space for others. To hold space for our emotions and give ourselves grace when we unravel. To take deep breaths in and out to recenter our mind.

Try holding space for a loved one today. Tell me how it felt to do just that.

So much aloha to you all.

Complete Article HERE!

‘I will reflect on my own death – and try to conquer my fears’

— The thing I’ll do differently in 2023

‘It is death that makes life meaningful’ … Monica Ali.

I don’t want to be mawkish or indulgent. But I want to consider my mortality in order to live well in the years I have left

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Have you ever spent time seriously contemplating your own death? I haven’t. I’m 55, in good health, exercise regularly, eat well and – barring the proverbial bus – have no reason to think death is imminent. Thoughts of my own mortality naturally arise from time to time but they’re easy to banish. After all, both my parents are still alive, forming a kind of metaphysical barrier. Not my turn yet! But one thing I will do differently in the coming years is to begin reflecting on my demise. Does that sound mawkish? Self-indulgent? Pointless?

Well, I won’t be picking out a coffin or selecting music for the funeral or tearfully imagining the mourners gathering. All that would be a waste of time and, like everyone else, I’m busy. With work, family, friends, travel, trips to the theatre, galleries, restaurants and so on. What I mean to say is that I have not lost my appetite for life. Why, then, do I wish to begin meditating on death?

For two reasons: in order to live well during whatever years I have left; and to begin to confront and maybe even conquer the fear that, thus far, has stopped me from having more than a fleeting engagement with the knowledge that death is the inevitable outcome of life.

There’s a well-worn trope about living each day as if it’s your last, or if you only had one year to live you wouldn’t choose to spend it at the office. That doesn’t quite chime with me. If I only had a year to live, I’d still choose to work. (I might try to write faster!) Nevertheless, it is death that makes life meaningful. In Howards End, EM Forster puts it like this: “Death destroys man: the idea of Death saves him.” The value of our days floats on the metaphysical stock market of ideas that we hold in our minds.

The idea of ceasing to exist isn’t easy to contemplate. But I don’t believe in reincarnation or an afterlife. I don’t believe that raging against the dying of the light is going to achieve anything. And ignoring the issue isn’t going to make it go away. In fact, it makes the prospect more, rather than less, frightening.

I first read The Complete Essays by Michel de Montaigne when I was at college, but it’s only now that I’m ready to take on this piece of sage advice: “To begin depriving death of its greatest advantage over us, let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death.”

How will I go about it, then, this new contemplative practice? Place a skull or some other memento mori on the shelf above my desk? Fly to Thailand or Sri Lanka and visit the Theravāda Buddhist monasteries where photos of corpses are displayed as aids to the maranasati (mindfulness of death) meditation? Walk around graveyards?

I’ve recently rented an office where I go to write. There’s a huge picture window under which I’ve placed the desk. The window overlooks a Victorian graveyard that’s still in use. When I sit down, all I can see are the trees. But when I stand I have a view of the tombstones and, in the distance, the crematorium.

One day I’ll be gone, my body consigned to the earth or turned to ash. Sooner or later I’ll be forgotten. Truly accepting that revivifies life. It doesn’t make every moment wonderful, but knowing I will die is a source of strength to endure the difficulties, and a spur to be more present for all that is good and precious in life.

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