Category Archives: Social Factors and Our Approach to Dying

There are social and cultural assumptions/beliefs that contribute to how we view death and dying

deathnotification

“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief.

“I am so very sorry,” I whispered again while leaning in and stroking her hand.

This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered, the worst news that could ever be heard. Continue reading

One Washcloth: a Tool for Change

Wednesday, 16 Sep 2015 14:22

unnamedonewashclot

Over the past century our society has become distant from both death and the tending to our dead. According to Gary Laderman’s book Rest in Peace: a Cultural History of Death and the Funeral Industry in Twentieth-Century America, “The divide was produced by three social factors: changes in demographic patterns, the rise of hospitals as places of dying, and the growth of modern funeral homes” (p 1). Our mental, emotional, spiritual, financial and societal health has been negatively affected directly and indirectly by this disconnect. Because our relationship to death is at the core of what it is to be human, this detachment affects both individual and societal health. Continue reading

“The most significant variable of a relatively uncomplicated bereavement period or a prolonged and
tragic mourning depends to a great deal on the relationship the child and the parent had, on the old unresolved conflicts they carried within, and on the level of communication they had. Last but not least is the mourner’s early experiences with death and loss.”

~Elizabeth Kubler-Ross, MD

~~~~~~

She cried as she held the baby bird. I cried as I held her (my daughter), after all she was my baby
too.

My daughter’s attempt at rescuing and feeding the baby bird who had fallen out of it’s nest had failed. The bird had become weak and then collapsed this morning during feeding. Now it was dying. Continue reading

A “Sign” is defined as an object, quality or event whose presence indicates the probable presence of something else.

One day after having read, “Attending the Dying” by my friend Megory Anderson, I found myself at work in the ER. There was a half-naked psychotic lady screaming in the hall, the sound of a beeping ventilator alarm escaped from the curtained room of a man in respiratory failure, and a large crowd was gathering outside of Bed 2 because a matriarch was dying. Although I am accustomed to such visual and auditory chaos, it struck me that my dying patient and her family were not. Further, as I stood in this hall with the family whom I was attempting to shepherd along in creating a good death for their well-loved matriarch, I became acutely aware that I was not following the wise counsel set out by my friend, Megory.

In her brief and powerful tome, “Attending the Dying- A Handbook of Practical Guidelines”- Megory sagely advises those of us who accompany others on their journey towards last breaths. Standing in the bustle and roar of the ER, I could clearly recall her words regarding creating a sacred space for the dying and their loved ones:

“You have the calling and ability to set the stage for a good and holy death.”

“Creating sacred space is one of the first steps in setting the environment apart from day-to-day issues, which in turn helps everyone present remember the sacredness of the event unfolding.”

“Contain or mark the space.”

“Try to make this an intimate experience for the family, within the boundaries of the medical unit.”

“A sign on the door is always appropriate.”

Hmm…I thought, “What I really need is a sign. But what would it say?”

I mused that my favorite sign would go something like this:

“Shut up! Can’t you see that someone is dying in here?”

Being known for my public decorum, however, I decided against this one. But, what?

I could not imagine the family wanting a sign on the door that overtly stated that someone was dying. This would rob them of some of the privacy that I was hoping to create.

I could not come up with anything decent and reasonable on my own so I turned to the experts. In my ER, we have these fabulous humans called “Patient/Family Representatives” whose job is to socially, emotionally and spiritually help support and gain resources for people who are critically ill or dying. If ever there was a font of wisdom, these people are it! So, I presented the idea to them and of course they had the solution and here it is:

quiet please

Ah, now there we go.

This sign promotes respect and privacy without announcing the condition of the patient.

Brilliant!

So, I shared this on twitter and got this interesting response.

Love it! But this has to be “branded” or a commonly understood symbol for uninformed people to understand the message, or this funny response might be the product:

Ha!

So the point is that indeed a sign is often a necessary, simple and powerful tool in defining a sacred space for the dying, particularly in a medical facility. But remember, when creating YOUR OWN signs for this purpose: A “Sign” is defined as an object, quality or event whose presence indicates the probable presence of something else. You have to understand the sign to obey it!

Make sure your sign is recognizable, respectful, and gets the job done.

Thank you, Megory, for teaching us how to better attend the dying and to groom the environment practically and with dignity, even within the chaos of the ER.

*****

To learn more about Megory Anderson’s work visit the Sacred Dying Facebook page

Dr. Megory Anderson was called to a vigil at the bedside of a friend who was dying one night. That experience was so powerful that she began working with others who needed help attending to those who were dying. Today, Anderson is the executive director of the Sacred Dying Foundation in San Francisco, and trains others in the art of “vigiling,” a way of attending to the needs of the dying. She may be reached at: Megory@sacreddying.org

I grew up in just-post-segregation Alabama. In 1976, I was a kindergartener and my best friend was a little black boy named Kendall. We had a lot in common. I would chase him around on the playground and he would eat my crayons. Life was grand or so I thought, until my parents came and had a conference with my kindergarten teacher. The next day we were separated from each other in class. I remember crying to mom in protest saying, “But aren’t we ALL God’s children?”

I still feel the same way today. So, I’m extremely disheartened by the recent increase in racial tensions. But I have something very important to share with you…

Hospice care is the antidote.

IMG_4356

(This photo is of one of my local hospice nurses comforting her patient.)

Hospice is the one social institution in 2015 which contains the seeds of healing for race relations. You may have never had a black, white, yellow or red-skinned person in your home in your entire life. But, if you are a hospice patient, some human with a different skin tone may very well come into your home to love, serve and care for you in ways you didn’t know were possible.

Also, as we travel the end-of-life pathway, we have opportunities to allow old prejudices to fall away in insignificance. Relationship healing and deepening can occur at accelerated rates. Love and even friendship may blossom more easily.

The giving and receiving of hospice care may be one of the most powerful current reminders that “we are ALL God’s children.”

****************

Please share this message.

#healing #racerelations with #hospice

PS. My parents have long since grown out of their prejudices. No one needs to remain trapped by socio-cultural biases. We can choose a better way.

Covered ginger jar, China, c. 1895

gingerjaroriginal

 

Life can only be understood backwards; but it must be lived forwards. — Soren Kierkegaard, 1843

Do thoughts of the past make you unhappy? Are you grieving? “Forget the past. You live now and into the future.” This is still the common-sense, persistent advice from the American public, the voice of the people. Many say the remedy for such unhappiness is simply to forget about it, live for today and – maybe – tomorrow. This remains conventional wisdom, the consensus opinion, the general agreement for an acceptable resolution. The people shall judge. Are the people of The Public right? Does “forget about it” solve the problems of past unhappiness and grief?

Forget the past. Such a curiously vehement, urgent order. Imagine living only in the present and into the future. Gone is childhood. Gone are youthful love and hate, joy and sorrow, laughter and tears. Gone is the spice that makes life rich, exciting, and meaningful. The sage voices of yesterday are silenced, suppressed. The advice to forget is intended as a loving kindness to us when we grieve. Forget about grief and the past. Move on, get over it. The past is past, dead and gone. Forget it.

This is an open expression of the advisor’s worldview, driven by impatience and the ubiquitous fear of death and self-awareness. In this view, death terror must be hidden and insight has no positive value. In fact, insight is seen as harmful, something to avoid and deny. Forget about it! Pursue happiness instead! According to this advisor, happiness excludes insight, the power of grasping the true nature of life and Self. This attitude lacks mature sympathy.

Furthermore, “forget the past” is an impossible imperative, however kindly it is meant. We cannot live as though the past had not happened. Our grief is one full measure of love given and/or received. To forget is also to deny this love. Forgetting would then become offensive. Why would that be desirable? It wouldn’t. Those who grieve are momentarily hypersensitized by loss and usually understand this. With such understanding, the mourner recognizes a profound absence of empathy on the part of supposed supporters. He feels misunderstood, reduced to silence, and abandoned. The supporter is exposed as emotionally bankrupt and asks the same from the mourner.

“Forget the past” is an authoritative instruction filled with fear, falsehood, and deliberately missed opportunity. (In this context, the directive often means “shut up.”) Such artificially induced forgetting is not genuine forgetting at all – not an inability to recollect. It is more like a conscious, deliberate withholding caused by self-defense and by mistrust or surrender to the supporter. It is ephemeral and provides no healthy returns for the mourner.

Now we see the past from another side. Our unique individual identity as biopsychosocial beings is a product of our whole lives: past, present, and hopes and plans for the future. The past is an undeniable part of this equation. It cannot be denied in the aftermath of a loved one’s death and our overwhelming grief. Health professionals even consider loss of the past to be a sickness: amnesia – a pathology, a defect in memory, a physiological and/or mental disorder.

The past makes us who we become. Who we are now can be explained, at least in large part, by who we were then – by our past. It is our foundation, the basis on which our identity stands. It creates the framework for the present and the future. The history of our lives is precious. We build on it. We treasure it for who was there and what it teaches us, how it informed our growing up. It begins our singular, signature life story.

Remembering can change the way we see others and the world, change it for the better. Remembering changes our Selves. Grief changes us. Active grief also holds close the memory of the loved one lost. That is the nature – and often the beauty – of grief. The past is present in memory. Ultimately, remembering becomes positive energy in the present and for the future. That is strength and growth.

Forget about it? Get over it? Move on? Better counsel may take a different path. We are beings who experience; memories from our experiences of living are all we get to keep. The past is an elegant archive of the mind, a place of intimate historical interest because of its large and ever-expanding collection of stored memories. Hold tight the past, in grief as well, and taste the tears. There is no shame in our tears. How they can refresh, once they are shed! They are filled with the promise of becoming. They are a necessary growth factor, a naturally occurring character stimulant. Memories sometimes bring tears, and that is normal and healthy. Tears are not a defect or disorder. Their absence, not their presence, may be a disorder.

The past is an agent of hope. It is present but not always conscious in our decision-making. It is a force for transformation. Metamorphosis. It is preparation for the future. Life can only be understood backwards. And understanding gradually unfolds into healing. Life is lived forwards and, with healing, into a Self more forgiving, confident, compassionate, peaceful.

The past is never dead. It is not even past.

— William Faulkner, 1936

 

Honor and revere both the present and the past; it is not a matter of either/or.

Both require gentle tending, cultivation.

Remember…

——————-

Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.

Tags: #past, #grief, #eol, #forgetting, #denial, #memory, #PositiveEnergy, #hope

I have a very wise nurse-friend, we call her “Coop.” I have always thought that she double-dipped from the fountain of compassion. This paper, which she wrote for a Nursing 403 class, proves my suspicions true and gives us all a clue on how to become more like her. This lesson is applicable to ALL of us who care for and serve others, not just those called to nursing: Continue reading

It’s Personal… by Michael Fratkin, MD

Friday, 21 Nov 2014 20:13

Picture1

When we hear that we have a terrible illness that will shorten our life, it’s personal.  When we learn about the benefits and trade-offs of the tests and procedures that will decide what treatments and medicines may help us, it’s personal.   As we make our way through side effects, complications, insurance plans, phone calls, waiting rooms, pharmacies, labs, radiology departments, billing departments, emergency rooms, intensive care units, medical jargon, bad news, good news, family conflict, family meetings, caregivers, nursing homes, physical therapy, occupational therapy, speech therapy, psychotherapy, medication lists, medication interactions, medication errors, advance directives, wills, and the many losses, it’s personal. Continue reading