The Stress of Death: A Guide to Coping with the Uninvited Guest

Death. The ultimate buzzkill. It's like, one minute you're sipping margaritas with your BFF, and the next, you're sobbing uncontrollably because they're no longer with you. Yeah, it's a real party pooper.

Death is a natural part of life, and it's not going anywhere anytime soon. So, instead of trying to avoid it or pretend it's not happening, let's talk about how to deal with the stress that comes with losing someone we love.

The Five Stages of Grief (AKA the Emotional Rollercoaster)

You know the drill: denial, anger, bargaining, depression, and acceptance. Yeah, it's a wild ride, but trust me, it's a necessary one. Here's a breakdown of each stage and how to cope:

Denial: "This can't be happening! You're just joking, right?" Yeah, it's okay to feel like you're in a bad dream. Just remember, denial is a normal response to trauma. Take a deep breath and try to process the reality of the situation.

Anger: "Why did this have to happen? It's so unfair!" You're right, it's unfair. But let's be real, life's not always fair. Take your anger out on a pillow, a punching bag, or a nice, sturdy tree. Just don't take it out on innocent bystanders.

Bargaining: "Please, just give me one more day with them. I'll do anything!" Yeah, we've all been there. It's like, we're trying to make a deal with the universe to get our loved one back. Newsflash: it's not going to happen. But, hey, it's a nice thought, right?

Depression: "I'll never be happy again. Life is pointless." Okay, okay, we get it. You're sad. You're allowed to be sad. Just don't stay there forever. Take small steps towards healing and remember that it's okay to not be okay.

Acceptance: "I'll never forget them, but I'll learn to live with the loss." This is the hardest stage, but it's also the most liberating. You're acknowledging that your loved one is gone, and you're choosing to move forward. It's like, you're saying, "I'll always love you, but I'll also love myself enough to keep living."

Coping Mechanisms: Because You're Not Alone

·    Talk to someone: Whether it's a friend, family member, or therapist, talking to someone about your feelings can be incredibly cathartic. Just remember, you're not alone in this.

·    Write it out: Journaling can be a great way to process your emotions and gain perspective. Just don't worry too much about grammar or spelling – it's all about the feelings.

·    Do something positive: Plant a tree, donate or volunteer your time. Doing something positive can help you feel more connected to your loved one and give you a sense of purpose.

·    Take care of yourself: Eat well, exercise, and get enough sleep. You're not going to heal if you're running on fumes.

·    Seek professional help: If you're feeling overwhelmed or struggling to cope, don't be afraid to seek help from a professional. They can offer you guidance, support, and coping strategies.

In conclusion, death is a part of life, and it's not going anywhere anytime soon. But, with the right coping mechanisms and a willingness to face your emotions, you can learn to live with the loss and find happiness again. So, take a deep breath, put on your big-girl/boy pants, and remember that you're not alone.

Don't take everything seriously

There are a few different approaches you could take to relax and not take everything so seriously:

1. Find healthy ways to cope with stress. Activities like exercising, spending time outdoors, practicing mindfulness or meditation, or talking to a therapist or trusted friend can help.
2. Prioritize tasks. If you are feeling overwhelmed by the number of things you have to do, it's helpful to sit down and prioritize tasks. This can help you feel more in control of your workload and less stressed.
3. Take breaks. Take regular breaks to rest and relax, even if it’s just for a few minutes at a time. This can help you recharge and come back to your tasks with a clearer mind.
4. Reframe your perspective. Sometimes, you can take things too seriously because you feel like there are high stakes or that everything is a crisis. See the bigger picture and put things in perspective. Remind yourself that mistakes are a normal part of life and that it’s okay to make them. 
5. Engage in activities that you enjoy and that help you relax. This could be something as simple as going for a walk or watching a funny movie.

Remember, everyone’s coping strategies are different, so what works for one person may not work for another.

CONSERVING ENERGY

This is flu season, so along with COVID, we have to worry about the flu so one suggestion is that we conserve energy. This can be done easily according to the Oregon Health and Science University Occupational Therapy group. They suggest asking some questions before you start any task and then schedule what you need to do and pace yourself during the day

Before beginning a task, determine:

1.   WHY is it necessary?

2.   WHAT is the purpose?

3.   WHEN should it be done?

4.   WHERE should it be done?

5.   HOW should it be done?

SCHEDULING: Plan ahead to schedule daily tasks, rests, and appointments according to your abilities. Spread things out throughout the day, week, month, etc.

·    Spread heavy and light physical tasks throughout the day, considering what the best time is for you.

·    Prioritize tasks according to your needs and desires.

o   When do you want or need to do for yourself that is realistic within your present abilities?

·    Delegate responsibilities and determine what you need help with, who can help you and a date and time you will be receiving help.

 PACING: Balance work and rest. Include rest periods during and between activities.

·         Avoid rushing.

·         Allow more time to complete a task.

·         Know your limits.

·         Pain is no gain – listen to your body.

·         Analyze demands of the task:

o   Are they physical, cognitive or emotional?

o   Balance and vary each type of task throughout the day

o   Include rest periods

o   Schedule high demand tasks for your peak performance time of day

 

SIMPLIFYING: Analyze each task and determine the easiest way to do it

·         Avoid unnecessary motions

·         Avoid unnecessary details

·         Sit instead of stand

·         Use two hands instead of one

·         Slide instead of lifting

·         Use modern equipment

 

ORGANIZING: Set up your environment to avoid unnecessary steps.

·         Have things in easy reach

·         Have chairs to sit on

·         Keep things in the same place each time to avoid search time

·         Avoid unnecessary clutter

Once you are into the habit of following the above steps then you can begin to take steps to control your stress. Here are some ideas on how that can be done

STRESS MANAGEMENT: The above-mentioned techniques will help you decrease your stress through increased energy efficiency, knowing your strengths and limitations and sharing this with others, and avoiding over-fatigue which ultimately leads to increased stress.

·         Set realistic goals

·         Live in the present, not the past or future

·         Think about what you can do not what you are unable to do

·         Accept what cannot be changed

·         Practice good posture and breathing techniques

·         Eat nutritionally

·         Learn from your success AND your mistakes

·         Listen to your body

·         Save time and energy for fun

·         As questions.

o   Take control of your illness. Don't let it control you.

If You’re Feeling Stressed, Volunteer

At times, it can seem as if you’re on a constant treadmill at work.  There are deadlines to meet, people to consult, relationships to cultivate.  You may feel as if you’re under consistent stress, but you don’t know how to manage it effectively.  You could always quit your job, but your next position might be just as stressful.

Stress can take a tremendous toll on both body and spirit.  It can leave you feeling fatigued, making it hard for you to concentrate.  You may be more susceptible to illness as a result of your stress, resulting in increased absenteeism from work.  You may be more prone to getting into accidents, and you may feel as if you’re on edge much of the time.

There are a number of strategies you can employ to deal with stress.  But perhaps one of the most rewarding is to engage in volunteer work.  There is something so comforting about donating your time to helping someone else.  The mere act can elevate your spirits, helping you to better cope with the stressors in your life.  You are giving a tremendous gift—the gift of your time and talent.  And you find your reward in the smiles on the faces of the people (or animals) you’ve assisted.

If you’re considering volunteering, you don’t want the search for volunteer opportunities to be stressful.  Therefore, you’ll want to make the process as simple as possible.  A good resource can be your local newspaper.  Often, the Sunday paper lists organizations that are looking for volunteers.  The newspaper usually provides complete contact information so you won’t have to hunt around for a phone number.

Deciding on which organization to volunteer for can be a challenge.  There are so many causes worthy of our attention.  For instance, there are groups that assist people in times of disaster groups that lobby for research to find cures for debilitating diseases…homeless shelters…soup kitchens…and pet shelters.  You might also consider volunteering at a school, where teaching assistants and mentors are always appreciated.

In order to decide where to put your talents to use, you might ask yourself some questions.  For instance, how much time can you realistically devote to volunteer work?  Are you limited to doing your volunteering in the evenings or on weekends?  How much of your own money can you spend in connection with your volunteer work?  What causes are the most important to you?  The answers to these questions could help you to choose the volunteer opportunity that’s right for you.

Next, you’ll want to tour the volunteer facility.  You want to get a sense of whether you will enjoy the work.  If you find that the other volunteers are difficult to work with, it could simply produce more stress in your life.  Usually, an initial tour will help to give you a good idea of what it would be like to actually volunteer at the facility.  Also, be sure to find out if the organization offers training to its volunteers.  This could be quite important, especially if you have only a nodding acquaintance with the work of the organization.

Volunteering does require commitment, and you might be wondering if that commitment will add additional stress to your life.  Actually, the opposite will probably be true.  If you find yourself being energized by your volunteer work, you’ll be able to put your problems in better perspective.  Knowing the difficulties that other people face can make your troubles seem quite negligible in comparison.  However, you will want to make sure that you don’t overcommit.  Devote only a limited amount of time to your volunteer work, and resist the urge to do more.  Otherwise, you could find yourself exhausted by the end of the week and unable to perform well on your job. 

Volunteering can be one of the great joys of life.  It is a privilege to serve other people, to make a difference in another person’s life.  Through your volunteer work, you’ll be able to meet people you might otherwise not have the opportunity to encounter.  You can forge friendships which can last a lifetime.  You’ll be contributing greatly to your neighborhood and your society, and your little corner of the world should be brighter because of it.           

Stressed, take control

When the challenges of someone else's life have you tied in knots,  it usually means it's time to start focusing on your own life.

Doesn't that feel better?

Dealing with Stress? Try this

Stress is dangerous if we don't manage it, but how do we start to manage our stress? We all know we need to manage stress. When things get difficult at work, school, or in our personal life, we can use as many tips, tricks, and techniques as we can get to calm our nerves.

Here is one idea, use music. Sound therapies have long been popular as a way of relaxing and restoring one's health. For centuries, indigenous cultures have used music to enhance well-being and improve health conditions.

Now, neuroscientists out of the UK have specified which tunes give you the most bang for your musical buck. Researchers at Mindlab International in the U.K. wanted to know what kind of music induces the greatest state of relaxation. 

The study involved having participants try to solve difficult puzzles — which inherently triggered a certain degree of stress — while connected to sensors. At the same time, participants listened to a range of songs as researchers measured their brain activity, heart rate, blood pressure and rate of breathing.

What they found is that one song — “Weightless” — resulted in a striking 65 percent reduction in participants’ overall anxiety, and a 35 percent reduction in their usual physiological resting rates.

Interestingly, the song was specifically designed to induce this highly relaxed state. Created by the Marconi Union, the musicians teamed up with sound therapists to carefully arranged harmonies, rhythms and bass lines, which in turn slow a listener’s heart rate and blood pressure, while also lowering stress hormones like cortisol.

In fact, the music is so effective, that many of the female participants became drowsy — to the point where lead researcher Dr. David Lewis-Hodgson advises against listening to it while driving.


But don’t take their word for it. Experience it for yourself here:

Dealing with stress as we age

My wife and I have been watching the events in the US as they unfold and we both feel for our American friends as they move along a path that is bringing change. Change is part of life, but when change happens too fast it can cause stress. We all know what excessive stress can do to your energy. 

Dr. Barnet Meltzer, who is perhaps the most renowned doctor of preventative medicine in the United States said, “Stress is the tax you pay for not taking 100% responsibility for your life.”

There are many schools of thought about what stress means, here are two ideas to think about.

The first idea is:

1.   Many of us consider stress to be something that happens to us, the event could be an injury or a promotion, falling in/out of love.

2.   Others think that stress is what happens to our bodies, minds and behaviours in response to an event (e.g. heart pounding, anxiety, or nail biting). 

Interesting ideas however, I believe that while stress does involve events and our response to them, the event is not the most important factor. The most important factor, in my mind, is our thoughts about the situations in which we find ourselves.

A threat is not just a physical threat, the threat could be to our ego, our self esteem, our health or our energy. Stressors that tend to affect seniors are the loss of a loved one; too much unstructured time on your hands; a change in relationships with children; or a loss of physical abilities, such as vision, hearing, balance, or mobility issues.

We all experience a little stress from time to time. It's not so hard to handle when we're young. But as we age, coping with stress isn't as easy anymore.

The classic stress response is fight, or flight.  The body reacts the same for every event we call stressful. The following is from Dr. Wilsons webpage on how the stress response works:

Every event you experience, whether it’s a sleepless night or an argument, may trigger a dual chain reaction that prepares you to physically respond to the stressor. An initial alarm reaction happens before you’re even aware of it in which your brain and sympathetic nervous system directly stimulate your adrenal glands to produce epinephrine (adrenaline) to prepare every part of your body for immediate “fight or flight”.

This is quickly followed by a stress response regulated through your hypothalamic-pituitary-adrenal (HPA) axis. It begins with a message from the hypothalamus in your brain and results in the secretion of adrenal stress hormones that prepare every part of your body to sustain “fight or flight” as long as necessary. In order to accomplish this, adrenal hormones are able to affect every cell and system in your body and brain.

When the brain senses danger or a need to fight, it sounds the alarm for action: it tells the muscles to tighten and signals the adrenal glands to release stress hormones—such as adrenaline and cortisol. Those hormones make you breathe faster, getting more oxygen to your muscles, and they trigger the release of sugar and fat into the blood, giving your cells more energy. To accommodate these needs, your heart beats faster and your blood pressure goes up. These physical changes are all part of the stress response, which is helpful if you need to jump out of the way of danger. Once the brain senses safety, body function returns to normal.

This routine isn't harmful if it occurs once in a while. But if you put your body through those paces frequently, or even constantly, you may suffer a cascade of dangerous and sometimes lasting effects such as high blood pressure, a weakened immune system, anxiety, depression, insomnia, heartburn, indigestion, and an increased risk for heart disease.

As we age, our body response differently to stress, and the symptoms may take longer to get over and may cause other problems for us. Symptoms of stress may include tension headaches, indigestion, heart palpitations, poor concentration, sleep difficulties, anxiety, irritability, crying, or overeating.

Stress may be having a physical impact on you that may include any underlying conditions you have, such as high blood pressure. Managing your stress is important at any age, but more important as we age.

A big part of stress management focuses on triggering the opposite of the stress response: the relaxation response, which helps lower blood pressure, heart rate, breathing rate, oxygen consumption, and stress hormones. Techniques to elicit the response include yoga, tai chi, meditation, guided imagery, and deep breathing exercises. Eating a healthy diet and getting plenty of exercise are also important, as is nurturing yourself by pursuing activities that bring you joy, and making time to socialize.

  

Additionally, not all situations that are labelled "stressful" are negative. The birth of a child, being promoted or moving to a new home may not be perceived as threatening. However, we may feel that situations are "stressful" because we don't feel fully prepared to deal with them.

All situations in life can be stress-provoking, but it is our thoughts about situations that determine whether they are a problem to us.  How we perceive a stress-provoking event and how we react to it determines its impact on our health.

We may be motivated and invigorated by the events in our lives, or we may see some as "stressful" and respond in a manner that may have a negative effect on our physical, mental and social well-being. If we always respond in a negative way our health and happiness may suffer. By understanding ourselves and our reactions to stress-provoking situations, we can learn to handle stress more effectively.

Palliative Care Is Not Hospice

The following is from the Fort Worth Daily and it is important for all of us to understand.

Dr. Robert Fine has a story he tells to serve a pair of purposes:  One, it illustrates how the palliative care program he leads at Baylor differs from hospice care. Two, it shows how new the specialty is, so fresh that a real-life incident can modify the specialty itself. 

Palliative care is an end-of-life support program that designs a personalized treatment strategy to help the patient live out their waning months or years how they want to. It also extends to the family members, offering social workers and chaplains as resources to help process losing a loved one.

Which brings Dr. Fine to that story. It began like many other palliative care cases he handles at Baylor Medical Center, even if the details were more tragic than usual. A 35-year-old patient was terminally ill with cancer. His oncologist called Fine to discuss treatment options to make the final days a bit more bearable. The man hadn’t been told the prognosis.

The oncologist, tied up in the clinic, asked Fine to tell the man that his cancer was going to kill him. Fine agreed and sat down with him. This is part of the program after all, making sure the patient understands that palliative care isn’t likely to cure what ails them. It is a way to manage symptoms that accompany disease or treatment to help the individual live the rest of his or her life in comfort, often beyond the confines of the hospital in their own homes.

And so Fine told him: “I said, ‘listen, may I be honest with you?’ And he said, ‘Yes.’ I said, ‘you’re going to die from this and I’m concerned it’s going to be sooner rather than later. I’m so sorry to be the one to tell you that.’”

But the man said thank you. And then he asked for Fine to tell his children, ages 8 and 10.

“You know, I’m an adult doctor. I didn’t train in pediatrics. I’m a nice guy. I have kids. And I’m going OK,” he says, stretching out that vowel sound. “I probably emotionally lost it a little bit and tearfully told them, ‘I’m so sorry, but your daddy is going to die in the next few days.’ I resolved after that, this is nuts. How do we say we support patients and families if we don’t support children?”

Last month, Fine traveled to San Diego to accept the American Hospital Association’s Circle of Life Award, which recognized Baylor Healthcare System’s Supportive and Palliative Care program as one of the nation’s three best. And one of the reasons it won that award was what came out of that story.

Fine enlisted therapists from Baylor’s Our Children’s House who began volunteering in the palliative process, helping tell children in a supportive way that their parent or grandparent or sibling is gravely ill. After a year, Our Children’s House higher ups ordered the volunteering stopped: “They said, I’m really sorry, but unless you can pay their salary, you can’t keep stealing them to come over to Baylor.”

Palliative care child life specialists are now stationed at Baylor facilities downtown, in Fort Worth, and in Plano. Fine can’t recall another adult hospital system that offers that service in Texas.

Part of the reason this pivot was necessary is that palliative care is a nascent specialty. The American Board of Medical Specialties started offering a certification exam in 2008, according to the Center to Advance Palliative Care.

Fine says there are only about 3,000 board-certified palliative care specialists. There are around 237 graduates each year. “It’s huge training challenge,” he says. “There really is a whole extra skill set in what we do.”

A palliative care team is made up of a doctor, nurse practitioners, social workers, and chaplains. This setup is inherently difficult for reimbursements. There’s not a code for an hour of intensive discussion, says Dr. Amy Kelley, an assistant professor of Geriatrics and Palliative Medicine at Mount Sinai Hospital in New York.

“We teach them the skills involved in a difficult conversation, we practice those skills and observe them doing it,” Kelley said. “There should also be a procedure code for when they use that higher level of skill and spend an hour with the family teething out what’s most important to them and put together a treatment plan that meets that person’s priorities.”

Palliative care, value speaking, is about the long game. But it has been proven to lessen the costs involved in long-term care. According to a study published earlier this year in the American Cancer Society’s CA journal, palliative care applied quickly after diagnosis was associated “with significantly fewer ED visits, hospital admissions, hospital deaths, and ICU admissions.”

“Patients who were referred to palliative care earlier and as outpatients had better end-of-life care compared with those referred later or as inpatients,” the study read.

Last year, Baylor saw about 4,200 patients. Between 2004 and 2010, the system saw an average of 450 a year. That increase came after changing its name to include the support angle and escape the shadow of hospice care.

“They think, isn’t that just hospice care?” No,” Fine says, “it fills the space between acute aggressive treatment and hospice and can be simultaneous with a treatment.”

Perhaps the largest obstacle facing palliative care is awareness. According to a 2011 study published by the Center to Advance Palliative Care, 70 percent of U.S. adults were unaware of the service. And once they learned about it, roughly the same amount said they thought it was vital for end of life care.

Doctors who practice it, meanwhile, are hopeful that the shift from fee-for-volume to fee-for-value will boost the importance of palliative care. Studies have shown that a 300-bed hospital can save $1.3 million on pharmacy, lab, and intensive care costs with an effective palliative care program. Baylor has cut its Medicare costs by between 20 and 25 percent, which Fine attributes to the program.

“This is about spending a little time together trying to understand the individualized goals for that person,” Kelley said. “We can step back and look at the different medical options and say if the most important thing is to have some time at home and you’re not in pain and you’re with your kids, well, we can’t change that you’re going to die from cancer. But we can change this chemotherapy to another one so you can get out of the hospital.”

Breathing helps in stressful situations

As you move forward, take risks, and follow your calling: you will meet obstacles. Obstacles are part of the path.

The primary obstacles are within. They are the limiting thoughts that you can't see but through which you see the world. The closer you are to and more identified you are with a thought the more it limits what you can think, feel, and do.

How can you free yourself from limiting thoughts?  One simple way is to change your breathing pattern.
Every thought pattern is associated with a signature breath pattern. Fearful thoughts are supported and sustained by a fearful breath pattern. The same with creative thoughts.

So, what breath pattern should you use? A mindful, slow, deep breath pattern dissolves limiting thoughts.
When you are open, aware, and connected to your creative resources, your breath will be slow, deep, and full. By mindfully simulating such a breathing pattern, you bring your neurology into a resourceful and creative state.

So, if you find your mind blocked by limiting thoughts, exercise leadership . . . breathe.