Tag Archives: #eol

Happy-Man-Jumping

By now you’ve surely heard that Medicare is going to pay doctors and other qualified healthcare providers for advance care planning with patients in 2016.

Aren’t you excited?!?

Ok, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and chat about your future.

Here are 8 unorthodox reasons to create your own advanced care plan in 2016:

 1. You don’t want your Aunt Bertha changing your diapers.

Maybe your Aunt Bertha did change your diapers when you were 6 months old, but do you really want her cleaning your feeding tube and wiping up your poop stains when you are 60? I mean heaven forbid that you end up in a chronically dependent or even vegetative state at such a youthful age, but what if…??? Did you even want to be kept alive in such a state at all…??? Certainly something to think about. Maybe you should give Aunt Bertha a call?

2. The loudest person in your family may not have your best interest in mind.

Oftentimes the loudest relative “runs the show” in the hospital- by guilt, intimidation, and a host of other aggressive or passive-aggressive strategies. If you don’t want “you-know-who” making decisions for you or bullying around your other relatives, while you lie helplessly in the hospital bed, then for Pete’s sake, choose and document your own healthcare proxy today! Make sure they know EXACTLY what’s acceptable and not for you.

3. I’ll bet you know who you DON’T want making decisions for you.

Simply put, some people can handle this kind of pressure and some people can’t. The people who would wilt under life and death decisions on your behalf should NOT become decision makers for you, either by intention or default.

4. Hell hath no fury like your family fighting over your fate or your fortune!

I’ve seen feuds break out around a deathbed that would make the Hatfields and the McCoys cringe. I always want to scream, “What the hell are you people doing? Can’t you see that your loved one is dying here?” (Of course that kind of outburst is never good for the physician professionalism scorecard, so I usually manage to translate the sentiment into something a bit more PC.) So, please, please I beg you to have your fate and your fortunes pre-determined before that fateful and inevitable moment arrives!

5. Grudges can come back to bite you.  

One time the closest available relative to my unresponsive patient on full life support was his estranged wife. She had carried a grudge for 20 years. When we finally tracked her down to make a decision for my patient, with glee she whispered evilly, “Pull the plug.” (YIKES!) I’m pretty sure that guy would have had someone else in mind to make this decision, but IT WAS TOO LATE! No advance care plan was in place with his doctor. (I sense that you are getting my drift…)

6. No one knows your secret priorities.  

During one of my traveling lecture series last year I met a gerontologist who shared some of the idiosyncrasies of his advance care plan with me. He had in writing, that should he become demented and placed in a nursing home: 1) Under no circumstances should he ever be physically or chemically restrained, and 2) He should be allowed to have sex with anyone who is willing to engage him :)

7. No one knows you like you… and you deserve a fitting exit. 

I would like to die on a blanket under the oak tree at bottom of my field. My dad would like to be buried in a bright red racecar motif casket. My husband wants a Viking funeral pyre. I’m sure you have some pretty unique idea about your final goodbye as well… do you have the plan in place?

8. Embracing death will allow you to embrace life. 

Is this too much for you? Think it’s too morbid? Let me tell you the great secret… when you embrace death in its inevitability, then each moment of life itself becomes more precious. Now will never come again. Planning for the end-of-life awakens you to the gift of this very moment of life, this very second. What a gift.

“The doctor will see you now…”

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