Search

Dying & Death Talk

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

Nursing Juliet

Courtesy of TheNewYorkTimes.com | By Danielle Ofri | Illustration by Yvetta Fedorova | Originally Published 10.28.2018 | Posted 11.30.2018

In a world that relentlessly enforces limits, the love of a pet is a refuge for unconstrained emotion, especially for a child.

Here’s the moment when I knew. Juliet — the wiry lab-mutt we’d recently adopted from the pound — raced into our bedroom. In her enthusiasm, her gangly paws entangled a loose rug and she lost her footing. She catapulted through the air, an ebony mass of fur soaring toward the bed where our three-week old infant was lying flat as a Kansas pancake. It happened so quickly that all I could do was watch in fear as she plowed toward our 7-pound baby.

It was over in a split second. Somehow, in all of Juliet’s airborne frenzy, she managed to retain awareness of that speck of life beneath her and landed four paws safely around the baby. That’s when I knew everything would be fine. We parked the baby’s bassinet atop Juliet’s crate — our earliest iteration of bunk beds — and the love affair began.

A dog is both Rorschach and receptacle, a two-way highway for love unbounded and unadulterated. In a world that relentlessly enforces limits, the love of a pet is a refuge for unconstrained emotion, especially for a child.

It became even more apparent as Juliet aged. That infant on the bed is finishing high school, with two other teenagers right behind. While adolescents tend to be blithely self-centered in all manner of human interaction, when it came to Juliet, my three were solicitous, tender and concerned. They treated her as a treasured child whose every fault could be forgiven and whose every personality quirk was lauded like a work of Mozart, retold with the pride of parentage.

Everyone in our Manhattan apartment building knew Juliet, who never once failed to announce her lordship of the lobby with a booming woof upon exiting the elevator. After the fruit-stand vendor on Second Avenue noticed her shoplifting from a low-lying bin of string beans, he thereafter faithfully added a handful of them to my bag for her.

The last few years brought a gradual diminishment of Juliet’s orbit and of Juliet herself. Long afternoons at the dog-run shrank to walks around the block, which became a handful of steps just beyond the doorway.

Her hind legs began to sag when she walked, so we held up her back end with a harness. Then her front legs occasionally buckled, so we added a matching front harness, giving Juliet the improbable look of wearing a fluorescent-green bikini.

The kibble became too hard to chew, so we bought her the fancy canned stuff. Then we added in peanut butter and liver treats to tempt her taste buds. By the time she reached 17, Juliet had shrunk by 20 pounds, her silky jet-black fur sinking into the crevices between her bones. Her lack of body fat made cold weather more difficult, so we found a secondhand dog jacket to wrap around her. And when the snowy sidewalks were strewn with salt, we tugged purple rubber bootees onto her paws before every walk.

As a physician, I’ve always treasured the intimacy of the doctor-patient relationship, the emotional bond that’s created within the harrowing vulnerability of illness. But there is something about the physical intimacy of nursing that is particularly acute. Lifting, feeding or walking frail Juliet became a human-canine tango. It intensified our connection in a manner that felt almost primal. Even with the most mundane tasks, I found myself marveling at the particularity of her breathing, the way her ears creased just so, her luxurious bounty of neck fur, the slender lineation of her paws.

When her back legs failed entirely, we bit the bullet and purchased a doggy wheelchair. But the question always arose: When do you draw the line? We decided that as long as Juliet appeared to be without pain and seemed to take pleasure in giving and receiving love, we’d continue to adjust our lives to accommodate her.

Juliet still perked up at the rattle of a leash, still licked every drop of peanut butter (string beans were now too hard to chew), and still rallied a tail-wag when we walked in the door.

We attempted to prepare our children for the inevitable, but they refused to hear a word of it. They’d been witnessing her slow decline though, calibrating their care and attention accordingly. Crafting one’s own admixture of grief and denial is highly personal, a process best left unimpeded.

And then there was the morning when I, once again, knew.

For the first time ever in her life, this voracious omnivore declined food, even the gourmet canned stuff, even a liver treat garnished with peanut butter. The struggle to ambulate overpowered her implacable ardor for the great outdoors. We wished she could tell us what she was feeling, but we were forced to rely on our anguished observations. This moment seemed like the transition from frailty to suffering, and with a heavy heart I called the vet. She told us to come first thing in the morning.

Breaking the news to our children that Juliet’s moment had come was one of our most painful moments as parents. But the kids formed a tag-team to ensure that Juliet had someone by her side for every remaining minute, that she’d never be without a warm human body nestled up against hers. We slept on the floor with her, snuggling into her rich downy fur, inhaling her ambrosial dogginess.

Juliet’s heartbeats and breaths — suddenly exquisitely finite — continued to pulse faithfully into my embrace. Until they didn’t. Until movement became stillness. I kept holding her, though, because I couldn’t let go.

Death is not a stranger to me. I’ve sat with patients and families as death approaches. I’ve fought to stave off death and have been present to welcome death. I have been there for the aftermath. But I’d never been this close to the precise moment of death. I’d never held anyone so intimately as life handed off the baton.

My sobbing family returned to the room. Each in turn gave Juliet a final longing embrace. I’d maintained my doctorly composure throughout the morning, but watching my children bid Juliet farewell opened the floodgates for me.

They’d never known life before Juliet. Juliet had been waiting for them when they arrived, and they hadn’t counted on the world actually existing without her. There couldn’t be a visiting day at camp without Juliet in tow. There couldn’t be a snowy day without Juliet snuffling though the unplowed drifts. There couldn’t be any of life’s pains without Juliet’s downy neck to cry into. Through her tears, my oldest daughter demanded of me: “Why does it have to be so painful?”

Indeed, why does it have to be so painful? As a parent, your instinct is to protect your children from anguish. But at this moment, there was only the raw pain that is inextricably linked to love. It was an unvarnished introduction to life and the existential risks we take when we choose to love another being.

In the morning we scooped her up in our arms and carried her somberly to the vet.

In the exam room, we gathered around Juliet, forming a protective huddle. Throughout the preparations, she stayed her sweet self, absorbing the love as she always had, radiating back her boundless devotion, rewarding us with a soft wag of her tail.

After my husband took the kids out to the waiting room, I curled myself over Juliet, my cheek resting on hers, arm tucked into the snug of her chest between her front paws. My forearm gave a slight rise with each of her breaths and her heart beat trustingly into my palm. I whispered into her ear that it was O.K., that we were with her, that we loved her desperately, as the vet soundlessly injected the barbiturate.

Juliet’s heartbeats and breaths — suddenly exquisitely finite — continued to pulse faithfully into my embrace. Until they didn’t. Until movement became stillness. I kept holding her, though, because I couldn’t let go.

Death is not a stranger to me. I’ve sat with patients and families as death approaches. I’ve fought to stave off death and have been present to welcome death. I have been there for the aftermath. But I’d never been this close to the precise moment of death. I’d never held anyone so intimately as life handed off the baton.

My sobbing family returned to the room. Each in turn gave Juliet a final longing embrace. I’d maintained my doctorly composure throughout the morning, but watching my children bid Juliet farewell opened the floodgates for me.

They’d never known life before Juliet. Juliet had been waiting for them when they arrived, and they hadn’t counted on the world actually existing without her. There couldn’t be a visiting day at camp without Juliet in tow. There couldn’t be a snowy day without Juliet snuffling though the unplowed drifts. There couldn’t be any of life’s pains without Juliet’s downy neck to cry into. Through her tears, my oldest daughter demanded of me: “Why does it have to be so painful?”

Indeed, why does it have to be so painful? As a parent, your instinct is to protect your children from anguish. But at this moment, there was only the raw pain that is inextricably linked to love. It was an unvarnished introduction to life and the existential risks we take when we choose to love another being.

The mornings are lonelier now. The house is quieter. We all keep glancing expectantly toward Juliet’s spot on the living room rug. Its emptiness echoes from one heart to the next. We wish, of course, that she could have lived forever. But we have to make do with the gifts she left us. The most powerful is what Juliet gave to our children: the opportunity to tender — and to weather — unconditional love, love as an outward, selfless reach. She allowed them to experience what parents experience — love as the magnificent harrowing plunge.

Danielle Ofri, a doctor at Bellevue Hospital and the New York University School of Medicine, is the author of “What Patients Say; What Doctors Hear” and editor of the Bellevue Literary Review.

How to Cope with Anticipatory Grief and Ambiguous Loss

Courtesy of NextAvenue.org | By Cynthia Orange | Photo Credit: Adobe Stock | Originally Published 09.14.2017 | Posted 11.27.2018

The longer we live and the more we experience, the more we find ourselves in the cracks between joy and contentment on one side of life’s continuum and grief and loss on the other. Children leave our nests, we move from vocations to avocations — from retirement to, as a dear friend puts it, “re-aspirement.” Addresses, relationships, bodies, even spouses, can change. More loved ones get more serious diagnoses. Sometimes we get dreaded medical test results ourselves.

When someone dies, the loss seems clear. But what about those times when grief is anticipatory — when the diagnosis is terminal and we grieve the inevitable? Or times when the loss is ambiguous? Perhaps a parent shows signs of dementia, a son or daughter in the military is missing in action or returns from combat with PTSD (post-traumatic stress disorder) or a dear friend has a serious stroke. Maybe a loved one is in the throes of addiction. What was has changed, replaced by uncertainty. Continue reading “How to Cope with Anticipatory Grief and Ambiguous Loss”

Anxiety Is Another Stage of Grief

Courtesy of NextAvenue.org | By Claire Bidwell Smith | Photo credit: Adobe Stock | Originally Published 10.18.2018 | Posted 11.23.2018

A new book explains why so many grieving people also experience anxiety

(This article is excerpted from Anxiety: The Missing Stage of Grief by Claire Bidwell Smith.)

What is anxiety? Where does it come from, and how can you gain control over it? And why is it so frequently spurred by the loss of a loved one? These are often the first questions I address when meeting with a new client, because understanding anxiety is the first step in learning how to overcome it. But understanding how it is tied to the loss of a loved one is even more important.

I have been a grief counselor for more than a decade. I’ve worked in both hospice and private practice. I’ve held the hands of many people in their final moments of life, including my own father. And I’ve worked with countless people who have struggled to cope in the wake of grief after losing someone they love.

Yet while I’ve written and spoken and worked with death in so many capacities, it is this one issue that I have encountered more than any other: anxiety following a loss.

It is understandable that death makes us anxious. We experience anxiety after a loss because losing someone we love thrusts us into a vulnerable place. Loss changes our day-to-day lives. It forces us to confront our mortality. And facing these fundamental human truths about life’s unpredictability can cause fear and anxiety to surface in profound and unexpected ways. Continue reading “Anxiety Is Another Stage of Grief”

A Handbook for Grieving

Courtesy of TheNewYorkTimes.com | By Caroline M. Grant | Image by Yvetta Fedorova | Originally Published 10.12.2018 | Posted 11.20.2018

Go funeral dress shopping. When the saleswoman asks about the event, say: “Dressier than office, but not as fun as cocktail.”.

Before: Text your friends to tell them that your mother has entered hospice. Tell them that it’s just to get the equipment she needs (a hospital bed, a better wheelchair) and not a sign of her impending death. Pretend you believe it.

Brace yourself for the SWAT team of hospice services and providers that descends on you: the social worker, the nurse, the chaplain, the volunteer bearing a soft blanket, a stuffed bear and lavender-scented hand lotion. Give the bear away.

Answer every phone call from “Unknown Number” because usually it is some kindly person from hospice. Apologize to the Unknown Number who is not hospice when you tell her no, you can’t subscribe to the symphony because your mother is dying. Start to tell her that your mother used to subscribe to the symphony and you would like to someday, when she is … Trail off, hang up and feel guilty about the little bomb you dropped into her day.

A month before your mother’s death, read the draft of her obituary that your father has written, and start to offer edits like it’s any other piece of writing. Don’t cry until you come to the names of your children and nieces. Continue reading “A Handbook for Grieving”

When the Hospice Care System Fails

Courtesy of TheNewYorkTimes.com | 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 NextAvenue.org | 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.

THIS BOOK CONTAINS A LINK FOR YOU TO COPY AND PASTE TO YOUR BROWSER. THE LINK WILL DIRECT YOU TO A DOWNLOADABLE, FILLABLE, REUSABLE PDF AND A FIVE-PART VIDEO TO ASSIST YOU WITH DOCUMENT COMPLETION.

Clicking the image below will take you to Amazon.com
Book is available in Print and Kindle

2018-11-08_21-42-00

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 TheNewYorkTimes.com | 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 VeryWellHealth.com | By Lynne Eldridge, MD | Photo Credits: Flickr.com/Therapy 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?
Purpose 
Symptoms 
Treatment and Counseling 
Coping

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”

A WordPress.com Website.

Up ↑

%d bloggers like this: