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Dying & Death Talk

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

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Talking about dying

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”

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”

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”

At the End of Life, Denial Comes at a Price

Courtesy of TheNewYorkTimes.com  | 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

 

What To Say To Someone Grieving The Loss Of A Pet (And Things You Should Never Say)

Courtesy of Everplans.com | By Gene Newman |  Posted 10.29.2018

For most people, it’s not just a dog, cat, or other domesticated animal. They just lost a part of the family.

It’s not easy to know what to say when a friend or family member loses a furry (or smooth) friend. Maybe you’ve experienced this and can empathize. But what if you’re not really an animal person and have no idea how to react?

Though you might not be able to understand or sympathize with the grief associated with this type of loss, there are certain things you can say to offer support while not inadvertently offending the grieving.  Here are some tips to help everyone be a compassionate friend.

The safe initial reaction to the news

Start by offering one of the simple phrases that we suggest saying to all who are grieving, “I’m sorry for your loss” or “my condolences.”

It’s always hard to say the right thing after a death, but of all the benign things to say, these two are the safest. Even if you never met the pet, this fail-proof phrase is a simple acknowledgement of the pain the friend/colleague/sobbing stranger next to you on a park bench is feeling.

Simply listen

If the grieving person wants to talk about it with you, and you have no idea what to say, just listen.

Remember Thumper’s advice in Bambi: “If you can’t say something nice, don’t say nothing at all.” Even if you can’t relate or think the person is overreacting, it’s important that you keep these feelings to yourself. You’re there to lend support and help.

Also, don’t bring up your own experience of pet loss, or how you would feel if your pet passed, because that can belittle their current pain and make it feel like a grief competition. This is about them, so the best thing you can do is lend a sympathetic ear.

Continue reading “What To Say To Someone Grieving The Loss Of A Pet (And Things You Should Never Say)”

Why Do We Avoid Advance Directives?

Courtesy of TheNewYorkTimes.com | By Paula Span | Originally Posted 04.09.2009 |

 

When I visit my father, I make a point of checking: Is that battered leather folder full of legal documents sitting in its usual spot in the den?

At 86, Dad is managing quite nicely in his own apartment. But the day will likely come when he’ll face choices about how much medical treatment to undergo, and he may be too incapacitated to make or express such decisions. It could happen in 10 years or next week; whenever it is, I want to be able to lay hands on one of those documents, called an advance directive for health care. In it, he authorizes me “to make decisions in my best interest, based upon what is known of my wishes.”

We’ve had a number of conversations about those wishes, he and I. Nevertheless, the document goes on to specify what my father doesn’t want (no C.P.R., ventilator or feeding tube) and what he does want (pain relief) in the event that he becomes “permanently unconscious” or is diagnosed with “an incurable and irreversible illness” that two doctors deem terminal. Nothing on paper can make such a moment less than wrenching, but the lack of something in writing can make it much, much worse.

It’s startling how few Americans have advance directives, an umbrella term including living wills that state your wishes and health care proxies that designate someone to carry them out if you can’t. A Pew Research Center survey in 2006 found that only 29 percent of people had a living will; in 2007, a Harris Interactive study (PDF) put the proportion with advance directives at two in five. Even among “severely or terminally ill patients,” the majority had no advance directives in their medical records, researchers for the federal Agency for Healthcare Research and Quality reported a few years ago.

That can put both physicians and families in an awful bind. If a terminally ill parent lands in a hospital and daughter A tells the staff no, no feeding tube, will daughter B accuse her of killing their mother? If daughter B tells the staff to go ahead and turn on a respirator, will son C argue that no, after the Terry Schiavo case in Florida, their mother declared she never wanted to be kept alive by machines? Sometimes, a hospital ethics committee has to get involved. Sometimes, courts and lawyers do.

“It gets so emotional,” said Ronda Hughes, co-author of the A.H.R.Q. report. A onetime cardiac critical care nurse in Boston, she’s seen “people crying, screaming, threatening.”

“When you’re faced with those decisions, you can’t say, ‘Let me get back to you in a week,’” she said.

If only the patient had left clear instructions!

So why don’t we?

One reason is that advance directives may be misperceived, theorized Nathan Kottkamp, a health care attorney in Richmond, Va., and organizer of this month’s National Healthcare Decisions Day. People may equate such documents with limiting care, with “pulling the plug.” In fact, Mr. Kottkamp said, “Your living will can say you want every medical treatment known to science applied to you at the end of life. Or no treatment. Or anywhere on that spectrum.”

Maybe people may think drafting an advance directive is complicated and expensive and requires a lawyer. But forms for every state (state laws regarding advance directives differ) are widely available on the Internet, at the National Hospice and Palliative Care Organization’s Web site or through the National Healthcare Decision Day site, among others. An advance health care directive doesn’t have to cost more than a couple of bucks for a notary.

People can have dreadful accidents or face incurable illness at any age, of course. Ms. Hughes, after she finished the A.H.R.Q. study, promptly drafted a highly specific advance directive for herself. She’s 42. But most Americans die not suddenly, but of chronic diseases associated with aging. So I’m grateful that my father has an advance directive. As I steam towards 60, I have one myself.

The sad fact is that even with an advance directive, your designated decision-maker may still face a fight in trying to follow your instructions. It’s not uncommon for doctors to disagree with a family about what should be done; it’s not uncommon for family members to disagree — sharply and painfully — with one another. But, as Mr. Kottkamp said, “It’s an uglier fight if you don’t have the documents.”

I hope my daughter is up for the battle, should one arise. At least, I tell myself, I’ve given her the ammo.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions,” to be published in June by Grand Central Publishing.

After Death: 8 Burial Alternatives That Are Going Mainstream

Courtesy of LiveScience.org | By Stephanie Pappas, Live Science Contributor | Image by Stephanie Pappas | Originally Posted 09.09.2011 | Posted 10.24. 2018

 

The ancient world is full of examples of burial customs that seem strange now, from Egyptian mummification to bodies dumped in bogs to departed Vikings launched out on ships-turned-crematoriums. But space constraints and environmental concerns are pushing modern man to explore new options for dealing with the dead.

The most recent of these to land on American shores is a process that uses heat, pressure and chemicals to liquefy a body in just a few hours, leaving behind sterile remains that can be poured into the wastewater system.

But unusual customs, from launching cremated remains into space to old-fashioned burials in hand-dug graves, are a growing trend. Here are some of the newest choices (not all eco-friendly) for the end of life. Continue reading “After Death: 8 Burial Alternatives That Are Going Mainstream”

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