Dying & Death Talk

Looking at dying and death for what it is: a part of life.

When the Hospice Care System Fails

Courtesy of | By Daniela J. Lamas, M.D. | Photo by Ryan McVay | Originally Published 10.17.2018 | Posted 11.17.2018

Let me start with an apology.

When I saw that your 90-year-old father was in our emergency department, after being resuscitated while on home hospice, I assumed that I understood what had happened. As a critical care doctor, I have cared for patients whose families have changed their minds at the last minute, grasping on to impossible hopes rather than face the reality of death.

On the phone with the E.D. physician, I sighed. “Family?” I asked.

“Must have reversed the D.N.R.” — the do-not-resuscitate order that is standard for a patient on hospice care. “They’re on the way,” she said.

I told her I’d head down. I was fairly sure that nothing was going to change. But before we took this patient to the intensive care unit, tethered to machines he had never wanted, I wanted to begin to talk with you.

There your father was. He was so pale. A ventilator breathed for him. His body, wasted by cancer, flopped like a rag doll. I touched his fingers and they were cool, vessels clamped down by the medicines keeping his blood pressure from plummeting. I imagined caring for him in the I.C.U., trying not to hurt him even more. Continue reading “When the Hospice Care System Fails”

The Quiet Blessing of Grief That Never Ends

Courtesy of | By Jill Smolowe | Originally Published 04.27.2016 | Posted 11.14.2018
This writer finds beauty in the pain she feels over the loss of her sister.

In the almost seven years since I laid my husband to rest, followed barely a year later by the loss of my sister and mother, I’ve developed an appreciation for just how unpredictable and, well, amazing grief can be.

I’m not talking about the period of hollowing when the shock and fog of loss clouds every thought and informs every waking (and perhaps sleeping) moment. No, I’m talking about the grief that comes after that. After the deceased loved one’s absence is no longer a constant presence. After the acute ache subsides and then, unthinkably, stills. After life moves forward, opening new melancholy-free vistas that trace no connection to the departed.

The grief I’m referring to lays claim to no stage and holds no hope of being put behind. Even on the happiest days, it lies patiently in wait for some quirk of logic to unleash it. A scent. A song. A glimpse of an almost-familiar face. Suddenly — whap! — you’re puddled in a heap, sobbing and thinking, WhatTheWhatThe. Continue reading “The Quiet Blessing of Grief That Never Ends”

YOUR FUNERAL. LET’S PLAN IT. WHY? So Your Loved Ones Won’t Be Arguing Over What They THINK You Would Want.


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Here is the honest truth: Making final arrangements for a loved one often brings about more pain and bad feelings among the surviving loved ones than healing. Of course, there is the inevitable pain of losing the loved one, but I am referring to the unnecessary pain—the deliberation over which funeral home should perform the service; the discussions about paying for the service; the arguments over whether the loved one even wanted a service in the first place; the debates over what type of service to disagreements over how the deceased should be dressed for the service. The examples are endless, but I believe you get the picture: If the loved one had just written down his or her wishes on what to do when he or she dies, much of the drama around making final arrangements could be avoided.

Death is an important event—and a certainty—in our lives. Unfortunately, however, like most events we deem significant, many of us do not plan or prepare for our death. When we pass on without leaving instructions about what to do when we die, a massive burden is placed on our loved ones. Many decisions must be made within a short period of time, yet clear choices may be difficult to make. By completing this document and distributing it among those you trust to carry out your final wishes, you are sparing your loved ones the emotional and financial burden of making those final arrangements on your behalf.

Leave a legacy of peace and order by documenting and distributing your final wishes.

A Dress Rehearsal for the End of Life

Courtesy of | By Monona Yin | Photo by Loris Guzzetta | Orignally Published 10.23.2018 | Posted 11.11.2018

We had started down the path of honoring our mother’s wish to have a good death until a hospice nurse figured out that she wasn’t really dying.

Three years ago, my family and I had the experience of going through a full “dress rehearsal” for my mother’s demise. At 83, she had become alarmingly weak from stage IV lymphoma and atrial fibrillation, and asked me and my brother to come home to Delaware for her next oncologist visit.

Mom had already undergone chemotherapy and cardioversion, so we knew there were few treatment options left. Still, we were utterly unprepared when the doctor said, “She probably has less than six months,” and recommended that she begin hospice care.

Widowed at just 37 with two small children, Mom has trained herself to face challenges without flinching. She is that rare Chinese elder who isn’t superstitious about mentioning or planning for her own death.

True to form, when we got home from the oncologist’s office, Mom sat us both down at the kitchen table to discuss her end-of-life wishes. She had witnessed two horrible lingering deaths up close — her mother’s and a longtime friend’s. What she feared most was pointless suffering and the loss of control over her own life. She wanted us to understand that, if she had little hope of recovery, she’d rather go quickly than fall apart slowly and painfully.

Continue reading “A Dress Rehearsal for the End of Life”

Anticipatory Grief Symptoms and Purpose

Courtesy of | By Lynne Eldridge, MD | Photo Credits: and Counseling Free Photos/Creative CommonOriginally Published 08.26.2018 | Posted 11.08.2018


Understanding Grief Before Loss and Death

Article Table of Contents

What Is Anticipatory Grief? 
Does It Help Grieving Later On?
Treatment and Counseling 

Anticipatory grief is a common grief reaction among people who are facing the eventual death of a loved one. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), this kind of grief that occurs before a death is not often discussed. Because of this, some people find it socially unacceptable to express the deep grief and pain they are experiencing and receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope with this difficult time?

As a quick note, this article is directed more to someone who is grieving the impending loss of a loved one, but preparatory grief is also experienced by the person who is dying. Hopefully, this article on coping with anticipatory grief, will be helpful to both those who are dying and those who are grieving a loved one’s imminent death.

Continue reading “Anticipatory Grief Symptoms and Purpose”

Hospice Photography Creates Legacy for Families

Courtesy of | By Kevyn Burger | Photo Credits: Amanda Reseburg |Originally Published 08.15.2017 | Posted 11.06.2018

 Scenes from a loved one’s final days can be moving and meaningful

Wilma Jensen didn’t mind admitting that she was a little vain. The theater director, Red Hat Society chapter founder and one-time Avon Lady always wanted to look her best, a quality she shared with her two girls.

“We know we look better with our eyeliner on,” said her daughter Erika Bender, now 37. “That’s how we roll.”

That was true for Jensen’s last moment in the spotlight.

Last Moments, Memorialized

A longtime breast cancer survivor, Jensen was 70 when her cancer metastasized in 2014. A few days before Christmas, she went into hospice care in a facility in her hometown of Beloit, Wis.

Her family was gathered there when they were asked if they would like a session with a photographer to capture some of their last hours together.

“At first, I wasn’t sure,” Bender confessed. “I wondered if it would be intrusive and too sad.”

But her mother, never camera shy, rallied to be picture perfect for the session.

“She put on her makeup and took her oxygen out to get pretty,” Bender said. Continue reading “Hospice Photography Creates Legacy for Families”

How to Deal With Grief After a Loved One’s Death

Courtesy of | By Amy Florian | Originally Published 07.24.2017 | Posted 11.02.2018

This can be a devastating time, but these tips from a grief expert may help

I’ll never forget that night. I was expecting my husband to arrive home from an out-of-town business meeting, but instead of hearing the garage door go up, I heard a doorbell. My heart pounded as I opened the door, and I felt it would stop when I heard that John died in a car accident and would never come home again.

The death of a beloved person is a scenario we all dread, and rightly so. It is one of the most devastating experiences one can endure. In the initial period of time after it occurs, most people wonder whether they’ll survive.

So if it happens to you, what can you expect and how do you cope? Full discussion would take a book, but hopefully these tips will help. Continue reading “How to Deal With Grief After a Loved One’s Death”

At the End of Life, Denial Comes at a Price

Courtesy of  | By Maggie Jones | Photo By Dana Neely/Getty | Originally Published 04.09.2009 | Posted 11.01.2018


Like the rest of us, doctors struggle to talk about dying. These conversations with patients occur haltingly, awkwardly and often not at all. But a study published recently in the Archives of Internal Medicine suggests just how costly that silence may be, both in health care dollars and in patients’ suffering.

A team of investigators, led by researchers at the Dana-Farber Cancer Institute in Boston, interviewed 603 patients with advanced cancer. They asked the patients, who had about six months left to live, whether their doctors had discussed their wishes for end-of-life care. The majority — 69 percent — said those conversations had not taken place. And in the last week of life, those patients who had talked with their doctors wound up with medical bills that were on average 36 percent lower — $1,876 compared to $2,917 — than those of patients who did not have end-of-life conversations with their doctors.

Why such a big difference? Dr. Holly Prigerson, a professor of psychiatry at Harvard Medical School and an author of the study, explained that the patients who never talked about their end-of-life.

But wouldn’t aggressive, more expensive care at least offer dying patients a bit more time at the end of life? Not according to this study. The patients not only did not live longer overall, but based on reports from family members and other caregivers, they also suffered more physical distress in the end.

These correlations may not prove a cause-and-effect relationship between end-of-life conversations and outcomes. Still, Dr. Prigerson said, “The study suggests that as costs go up, the misery and suffering index also goes up.”

Why should doctors be so reluctant to talk about dying when patients are terminally ill? Dr. Susan Dale Block, chair of the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute, noted that oncologists don’t want to appear to be giving up on patients by discussing plans for dying. At the same time, family members and loved ones worry that such conversations might upset an already vulnerable patient. And patients themselves often feel their role is to be heroic and to soldier on, against the odds, with yet another treatment or intervention.

According to Dr. Anthony Back, an oncologist at the University of Washington who trains doctors in end-of-life conversations, it is wrong to assume that these conversations rob patients of hope. “People can live with hope and do practical planning at the same time,” he said. “As a family member, you can still be protective of the patient while also thinking ahead: `Of course we’re going to keep hoping, and let’s do this little planning, too.’”

Dr. Back and other experts also suggest that family members and patients pace themselves by having ongoing end-of-life discussions, rather than waiting until there’s only time for one big, emotionally loaded conversation when the patient is near death.

For those in need of conversation-starters with their loved ones, here are a couple: Are there things we should talk about if you get sicker? What kinds of things do you want me to advocate for? If the questions feel too emotionally daunting, try rehearsing them first with a friend.

Dr. Block also encourages families to rely not only on oncologists for guidance — many remain poorly trained in this area, experts agree. Look to hospital social workers and palliative care providers, as well.

As this blog has noted, Compassion & Choices offers free consultations to families and patients through its End-of-Life Consultation Program (800-247-7421). The program’s counselors help patients make decisions about continuing treatment and provide advice on asking health care providers some of the tough questions. The counselors also offer tips on how to speak to providers if the patient’s needs and wishes are not being met.

The best advice need not come just from medical experts, of course. What are your experiences with these conversations — or the lack of them? How often do doctors try to have these discussions before families and patients are ready? When the conversations do take place, are doctors willing to follow through on patients’ wishes? And in those final days of life are we, as friends and family members, also willing to follow through?

Why We Should Think About Death 5 Minutes Every Day

Courtesy of Death Hangout | By Roman Krznaric | Originally Posted 09.28.2018 | Posted 10.31.2018


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