Dying & Death Talk

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

What happens the moment after you die, according to a hospice doctor

Courtesy of The | By Rachel Hosie | Originally Published 05.01.2017 | Posted 07.20.2018

It’s a “sacred and gorgeous moment,” he says

It’s something we’ve all wondered: what happens to you after you die?

Of course, no one can really know – death is a mystery – but some of us are certainly in a better place to speak about the topic than most.

One such person is Dr B J Miller, who is a hospice and palliative care physician at the University of California in San Francisco.

In his role, Miller spends his time working with terminally ill patients who are reaching the end of their lives.

And in a discussion about life and death with Oprah, Miller, who is also the former executive director of the Zen Hospice Project, has revealed what happens as soon as you die.

“I’ve been around people who are just about to die, bodies that have just died, and there is this lingering sense,” Miller says. “There’s a lingering.”

Unless you’ve been in the situation yourself, it’s hard to understand how this lingering manifests itself, but Miller says it clearly happens.

He himself came close to death in a freak accident that saw him losing three limbs. However he says this has made him less concerned with that happens after the lingering.

Dr B J Miller talks to Oprah

“One thing that my injuries helped me with was to not need to know,” Miller says.

“I didn’t need to have control over everything, I didn’t need to know the answers anymore. I mean, I love not knowing. The answer’s unimportant. It’s just a sacred and gorgeous moment.”

According to Miller, who’s spent years caring for terminally ill people, there’s often no dramatic moment of death, but rather it’s somewhat ordinary.

“I’ve been around folks who, I’ll be sitting there talking with their family and we’re having a conversation, and the person dies in the middle of a conversation. And it’s seamless,” he says.

“It’s almost gorgeously… mundane. It’s just, they were here and now they’re gone. There’s a moment where it’s just so matter-of-fact… That’s its sort of charm. It’s its beauty.”

Miller believes the immediate moment after death should be respected and the moment of transition honoured.

“It’s such a profound, stunning moment to see the body finally as a shell and devoid of that person,” he says.

“In that moment of transition around the body, you’re really in touch with the continuum of life, that life is proceeding. That individual is gone, but life goes on.”


Opinion: Let Dying People End Their Suffering

Courtesy of The New York | By Diane Rehm | Illustration by Hokyoung Kim |  Originally Published 06.08.2018 | Posted 07.18.2018

Ms. Rehm’s husband died four years ago.

It was an emotional moment for my friend and for me. As we sat in the living room of her home in California, she told me that the breast cancer that had been responding to treatment for several years had spread throughout her body. “It’s everywhere now,” she said, adding without a trace of self-pity: “I have less than six months to live. I’m so grateful that I won’t have to spend my last days or weeks in extreme agony.”

She could tell me that because California’s End of Life Options Act — supported by 76 percent of her fellow Californians, passed by the State Legislature and signed into law by Gov. Jerry Brown — had gone into effect on June 9, 2016. The law made it legal for doctors to prescribe drugs to end the lives of terminally ill patients, and my friend found solace in knowing she would have this choice. Her husband and children, who had seen her bear years of chemotherapy and other treatments and supported her as her pain intensified, wouldn’t have to watch cancer torture her mercilessly as it took her life.
California’s law was modeled after the one enacted in 1997 in Oregon, as were similar laws in Washington, Vermont, Colorado and, most recently, the District of Columbia and Hawaii; Montana also permits this end-of-life option as a result of a judicial decision rather than legislation.

But this source of comfort was ripped away from my friend and her family last month when a judge in Riverside County overturned the law on a technicality. His reasoning? The measure was passed during a special legislative session dedicated to health care issues, and complainants argued that it wasn’t about health care.

Try telling that to my friend or the many others whose lives were upended by the decision of the judge, Daniel Ottolia. As opponents of the law cheer, she and her loved ones prepare for the anguish to come.

My children and I can empathize. In two weeks, we will mark the fourth anniversary of the death of John Rehm, my husband. He, too, had under six months to live and, he, too, was suffering to such a degree that he begged for medical aid in dying. But that option was not available in Maryland, where he was in an assisted living center. He ultimately chose to end his life by refusing to eat, drink and take medications. It took him 10 long and miserable days to die.

As in my friend’s case, my husband was already going to die. He had Parkinson’s disease, which left him unable to feed himself or do anything else without assistance. He did not choose what some insist upon labeling “suicide.” Those who commit that act do not want to live. Most terminally ill patients like John would choose life if they could.

So today my friend and many other Californians are staring death in the face, without the degree of control over it that the End of Life Options Act briefly granted them. Some people will say they should place their faith in treatments to ease their pain. But despite the compassionate work of hospice and palliative care personnel, those treatments have their limits and cannot offer all patients the end-of-life experience they seek.

Furthermore, as my friend told me, “I am the only one who can define when my suffering has become unbearable.”

John’s death reinforced my belief that medical aid in dying should be a choice available to all Americans. That’s why I have been interviewing patients and doctors for a documentary on the subject, “When My Time Comes.”

What’s happening in California now is an unnecessary tragedy. Judge Ottolia’s decision is being appealed, and a hearing will be held later this month. But it could take many months to play out in the courts — months during which dying patients will be denied the option to mitigate their pain and distress. The Legislature could reintroduce the measure and pass it anew — but that process will also take time.

I believe that this must and will be remedied. My confidence comes from the fact that individual Americans seeking autonomy are driving the national movement for medical aid in dying. Nearly three-quarters of Americans believe that terminally ill patients should have that option.

Let me be clear: I understand that many people believe that only God should determine the time of their death, and I support them 100 percent. Others want every additional minute of life that medical science can give them, and I support those people 100 percent. But the end of life is an extremely personal experience. If, when my time comes, I see only unbearable suffering ahead of me, then I want my preference to have access to medical aid in dying to be supported 100 percent, as well.

As Archbishop Desmond Tutu has written, “Regardless of what you might choose for yourself, why should you deny others the right to make this choice?”

The California law was allowing patients that choice. Its nullification is causing them cruel and unnecessary torment.

Diane Rehm, who hosted “The Diane Rehm Show” on NPR for 37 years, is a producer of the forthcoming documentary “When My Time Comes” and host of the podcast “On My Mind.”

Co-op offers ‘no frills’ cremation service

Courtesy of | By Rebecca Smithers | Originally Published 05.02.2018 | Posted 07.16.2018

The UK’s largest funeral director is to launch a no-frills cremation service in the next few weeks, amid changing attitudes to death and a shift towards celebratory gatherings rather than traditional funerals.

Co-op Funeralcare reports growing interest in direct cremations – a cheaper and more basic option than the normal service, with no mourners present, typically followed by a scattering of ashes or memorial service at a later date.

The plan is revealed as the Co-op prepares to hold a large-scale national study into dying in the UK, in an effort to break taboos around bereavement preparations and ensure the wishes of the deceased are followed.

The survey aims to engage with at least 20,000 adults over the next few weeks, as an initial poll by the Co-op showed 50% of respondents saying that more open conversations about death would have helped them cope with bereavement. The Co-op is working with a number of charities, including British Red Cross, Child Bereavement UK and Dying Matters, to find solutions. Continue reading “Co-op offers ‘no frills’ cremation service”

My Father’s Everyday Heirlooms

Courtesy of | By Isobella Jade | Photo by Ilana Panich-Linsman for The New York Times | Originally Published 06.21.2018 | Posted 07.14.2018

His house was destroyed in a fire, and all I have left are the ordinary items that were in his car. Memories are held within their scuffs and stains.

When my dad died at age 63 in a propane explosion that destroyed his home, there was nothing to claim besides what was in his car.

That was seven years ago, and in my long grieving process, the few everyday items I retrieved — stained, weathered, smelling of smoke, rusted and patched together — have become deeply meaningful. Memories are held within their scuffs and stains.

After years of bouncing around from apartment to apartment and a halfway house, my father had finally seemed settled out in the country near Syracuse, N.Y.

I thought I could worry about him less, until the morning of Feb. 26, 2011, when I heard about the explosion. I initially wanted to rush to the scene but ended up waiting a few days for the autopsy and cremation. I arranged a visit when I could pick up his urn at a local funeral home and take it back to Manhattan, where I lived.

On that visit, I started down my dad’s snowy driveway but stopped when I saw the charred shell of the former pole-barn that was his home. Chunks of debris and cinders covered the front. The rib cage of the barn was the only part intact. There was a rectangular shape that was once the front doorway, an opening where the kitchen window used to be, the grid of wood planks that made up the bathroom closet, and a big opening where my dad’s bedroom was. There was a huge gash on the roof as if the hand of God went in and ripped out the barn’s heart.

When Isobella Jade’s father died in a fire that destroyed his home, his favorite baseball cap and a few other items that happened to be in his car were all she had left.

His car, a pre-owned white Hyundai Elantra, was unlocked and I slipped into the passenger seat for shelter from the cold. I pushed a few coffee cups and newspapers aside and just sat for a minute, among all that was left of my father’s world. I breathed in the smell of Newport cigarettes and old attic that used to cling to him. This car was his portable office. I’d never been in it before.

I scavenged through scraps of paper, half-broken pens, a stack of coffee-stained fliers, folders and envelopes, and many other random bits that looked as if they belonged in the trash. These were the only artifacts of my dad’s life. Anything with his handwriting on it caught my eye, and was put in the pile of remembrance.

In one of the cup holders I saw his thermos.

I imagined him drinking from it, using it every day, his breath on it. The coffee was completely frozen inside. Still I smelled the strong scent of dark coffee when I sniffed the rim. After rehab for his alcoholism there was a lot of coffee. Whenever I saw him he would be holding his thermos or a paper coffee cup, from a recent stop at a gas station for a refill. Greeting me, his breath against my cheek always smelled of stale warm coffee and cigarettes. He’d talk fast, peppy from the caffeine. After our chat at the train station in Syracuse, he would kiss my cheek goodbye, and the aroma of stale coffee breath would stay with me as my train lurched toward New York City.

Credit Ilana Panich-Linsman for The New York Times

In the other cup holder I found a pocketknife, a couple of keys and nail clippers, all held together by a key ring. He gave me a pocketknife like this one when I was 12. My parents had already been separated for a few years.

Credit Ilana Panich-Linsman for The New York Times

I found his old stained Giants hat in the back seat under a food pantry box full of cans of tuna, peas and corn, peanut butter and jelly, apple sauce and a bag of frozen oranges. The smashed hat was damp and smelled of last summer’s sweat and had probably been buried in here since then. My fingers touched the brim where he tried to hand-stitch the frayed edge back together. I could picture him with his jack-o’-lantern smile, wearing this hat to my last high school track meets, carrying a small bag of fruit for me. He wore it sometimes when we met at the train station too, when I was visiting from college. He wore it on the day he met my boyfriend — later to be my husband — and we all went to Onondaga Lake.

Credit Ilana Panich-Linsman for The New York Times

His sports jacket was hanging neatly on a coat hanger over the back door — he was ever the ready salesman. I smiled at his enthusiasm for knocking on doors, handing out fliers, and making calls from gas stations and coffee shops to get a lead for the home improvement contractors he worked with. He liked to dress for the part. He knew the clean, straight lines of the collar and brass buttons on the sports jacket were part of the pitch.

When I pressed my face into the jacket, the well-worn fabric felt slightly scratchy and I got a whiff of cigarettes. Even if it had a few stains on it and was paired with sneakers, it kept him looking sharp. When I went through the outer pockets of the jacket I pulled out some used tissues and eight sugar packets and a pen with his name on it. I put it all back into the pockets for safekeeping.

I received Dad’s rings at the funeral home when I went to pick up his urn. I gave one to my sister and kept this one. I took it to Greenwich St. Jewelers in downtown Manhattan but asked them not to clean the ring too much. I wanted to keep it partially raw to honor the reality that he had it on when he passed away. The original mazelike ring he loved had been stolen during a rough patch, some years back. I had seen a ring similar to the original at a silver jewelry street stand in SoHo so I bought it and gave it to him the next time I visited. He had worn a mazelike ring all of my childhood. The fact that this mazelike engraved ring was there on his finger was all the evidence I needed to know it was him.

Credit Ilana Panich-Linsman for The New York Times

I was surprised to find an orange pocket-size New Testament with Psalms and Proverbs. I opened it and found his name inside. Growing up, the name Jesus was something I heard when the car stalled or when my dad’s leg had to be wrapped in a big white brace because of gout pains. Recently, though, he had begun to go to church and had mentioned that he enjoyed socializing during the coffee hour after the service. He had even asked the pastor how he could be of help in the food pantry or in any other way. I’m sure he liked the free coffee and the opportunity to talk about the bigger picture, the purpose of all things.
In their creases and crevices, these items carried my dad’s scent, his wit, his long stories with a million tangents, his arching eyebrow, the way he looked obstacles in the eye, the tough times he’d been through and how he had just missed the gateway for a quiet, calmer life.
Isobella Jade is working on a memoir.

Isn’t it time we grow up and stop saying we “pass away”? We die, end of story?

Courtesy of The | By Kevin McKenna | Originally Published 06.03.2018 | Posted 07.11.2018

The Co-Op’s new cremation service should making us focus on the truth of dying

I fear that death has lately become something of an inconvenience in a society where the desire for instant gratification exists alongside the need to live life to the max. I’m not saying that death in a previous and less complicated era had been welcomed in and invited to pull up a seat by the fire. Merely, that many of us lived our lives while keeping a beady eye on death; acknowledging its inevitability and perhaps subliminally making plans to deal with it even from an early age when it was your turn to be framed in its silhouette.

Now we seem reluctant to acknowledge its existence at all; as if by uttering its name and admitting to its inevitability will diminish the intensity of this bacchanal we’re all having. People don’t die any longer; they merely “pass away” or “depart”. We now reach for any conjugation that avoids the need to say that Uncle Jimmy has actually died. This in turn has bred a glossary of inauthentic phrases deployed to skirt around the issue.

One of these is that wretched phrase “coming to terms with…” Thus the bereaved are made to think that there will come a time when they will eventually “deal with” the death of their loved one, no matter how tragic and untimely it is. We are unwilling to consider the possibility that the bereaved are capable of getting on with their lives without constantly feeling the pressure to “come to terms with” their loss. Continue reading “Isn’t it time we grow up and stop saying we “pass away”? We die, end of story?”

Being clear about your last wishes can make death easier for you and loved ones

Courtesy of | By Laurie Roscoe | Photo By Jacob Lund/ | Originally Published 05.08.2018 | Posted 07.08.2018

Barbara Bush’s recent death and the way she prepared for it remind us that death can be peaceful and marked by family togetherness rather than conflict.

Mrs. Bush chose palliative, or comfort, care over aggressive medical treatment given her age and overall health status. Her family agreed to support her decisions.
It does not always work this way, but it could.

I recently published a book with Dr. David P. Schenck entitled “Communication and Bioethics at the End of Life: Real Cases, Real Dilemmas.” We include several cases in which such family discussions did not occur. This lack of information led to an unfortunate cascade of events that made the patient’s deaths more difficult, and left lasting scars on both family members and clinicians.

Barbara Bush’s recent death and the way she prepared for it remind us that death can be peaceful and marked by family togetherness rather than conflict.

Mrs. Bush chose palliative, or comfort, care over aggressive medical treatment given her age and overall health status. Her family agreed to support her decisions.

It does not always work this way, but it could.

I recently published a book with Dr. David P. Schenck entitled “Communication and Bioethics at the End of Life: Real Cases, Real Dilemmas.” We include several cases in which such family discussions did not occur. This lack of information led to an unfortunate cascade of events that made the patient’s deaths more difficult, and left lasting scars on both family members and clinicians.

Most of us won’t die at home

While we might hope for a quick death at home, a majority of us will die from a chronic condition like heart disease, cancer, or respiratory disease, and nearly 80 percent will die in an institutional setting, following an explicit decision to suspend life-sustaining treatment.

Advance directives or living wills are made to ensure their preferences guide decisions should the person be unable to communicate them.

Studies have shown that discussions between family members can greatly improve end-of-life planning and decision-making. Patients who have discussed end-of-life care with their families generally have shorter stays in intensive care units and more timely “do not resuscitate” orders. These can prevent attempts to perform cardiopulmonary resuscitation and instead allow a natural death to occur. Patients and family members who are prepared experience lower rates of depression and anxiety when a family member nears death.

On the other hand, neglecting to discuss such issues can result in longer hospital stays, a greater likelihood of continuing life-sustaining treatment against a patient’s preferences, and poorer quality of life for patients and family members. Continue reading “Being clear about your last wishes can make death easier for you and loved ones”

Anderson Cooper: Thirty years after my brother’s death, I still ask why

Courtesy of | By Anderson Cooper |Originally Published 06.24.2018 | Posted 07.05.2018
Anderson Cooper anchors CNN’s “Anderson Cooper 360°,” which airs weeknights at 8 p.m. ET. A version of this article was originally published in the September 2003 issue of Details magazine. Cooper will host the CNN Special Report, “Finding Hope: Battling America’s Suicide Crisis,” Sunday, June 24 at 7 p.m. ET. If you or someone you know needs help, call the national suicide hotline: 1-800-273-TALK.

(CNN) My brother died by suicide nearly 30 years ago, and still not a day goes by when I do not find myself thinking about what happened and asking, “why?”

That is one of the things about the suicide of a loved one: It’s easy to get stuck on how their life ended, instead of remembering how they lived their life.

July 22, 1988. That was the date. It was a warm summer night in New York. When my brother died, I was in Washington, D.C., sitting on one of those silent subways the city is known for.

You always hear tales about brothers who can feel each other’s pain. This isn’t one of them. When my brother died, I didn’t feel a thing.

His name was Carter Cooper, and he was 23 at the time, two years older than I was. I’d always considered us close, though now I’m not so sure, because I didn’t see the pain he was in. And when I did get a glimpse of it, it scared me so much I didn’t know how to help. Continue reading “Anderson Cooper: Thirty years after my brother’s death, I still ask why”

The Positive Death Movement Comes to Life

Courtesy of The New York | By John Leland | Photographs by Devin Yalkin | Originally Published 06.22.2018 | Posted 07.04.2018 

 Death cafes, death doulas, ‘Ask a Mortician,’ DeathLab — once the province of goth subculture, death is having a moment in the sun.

It was the party of a lifetime, and Shatzi Weisberger wouldn’t have missed it for the world. After all, it was her funeral. Or, as she pronounced it, her FUN-eral.

“Come on in,” she said. “There’s lots of food. And a coffin that people are decorating.”

And so it was that a hundred or so people gathered in the common room of an Upper West Side apartment building recently to eat, sing, mingle and hear Ms. Weisberger’s thoughts about death and dying.

“I hope we have fun,” she said.

A former nurse, Ms. Weisberger wore white slacks, white sneakers and a bright floral print blouse. A biodegradable cardboard coffin in one corner bore handwritten messages in colored marker: “Go Shatzi! (but not literally)”; “death is only the beginning”; “Shatzi, many happy returns … as trees, as bumble bees, as many happy memories.”

Ms. Weisberger worked the crowded room. “I have been studying and learning about death and dying, and I want to tell people what I’ve learned,” she said. “Some people are coming because they love me, and some people are coming because they’re curious about what the hell it’s about.” Continue reading “The Positive Death Movement Comes to Life”

Dr. Death and The Humorist – Episode 6: What Are Advanced Directives

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