Be in the moment

My thanks to Tammy for sharing this and to Sarah Kerr, Ritual Healing Practitioner and Death Doula, Death doula for writing these beautiful words

Expected Death

When someone dies, the first thing to do is nothing. Don't run out and call the nurse. Don't pick up the phone. Take a deep breath and be present to the magnitude of the moment.

There's a grace to being at the bedside of someone you love as they make their transition out of this world. At the moment they take their last breath, there's an incredible sacredness in the space. The veil between the worlds opens.

We're so unprepared and untrained in how to deal with death that sometimes a kind of panic response kicks in. "They're dead!"

We knew they were going to die, so their being dead is not a surprise. It's not a problem to be solved. It's very sad, but it's not cause to panic.

If anything, their death is cause to take a deep breath, to stop, and be really present to what's happening. If you're at home, maybe put on the kettle and make a cup of tea.

Sit at the bedside and just be present to the experience in the room. What's happening for you? What might be happening for them? What other presences are here that might be supporting them on their way? Tune into all the beauty and magic.

Pausing gives your soul a chance to adjust, because no matter how prepared we are, a death is still a shock. If we kick right into "do" mode, and call 911, or call the hospice, we never get a chance to absorb the enormity of the event.

Give yourself five minutes or 10 minutes, or 15 minutes just to be. You'll never get that time back again if you don't take it now.

After that, do the smallest thing you can. Call the one person who needs to be called. Engage whatever systems need to be engaged, but engage them at the very most minimal level. Move really, really, really, slowly, because this is a period where it's easy for body and soul to get separated.

Our bodies can gallop forwards, but sometimes our souls haven't caught up. If you have an opportunity to be quiet and be present, take it. Accept and acclimatize and adjust to what's happening. Then, as the train starts rolling, and all the things that happen after a death kick in, you'll be better prepared.

You won't get a chance to catch your breath later on. You need to do it now.

Being present in the moments after death is an incredible gift to yourself, it's a gift to the people you're with, and it's a gift to the person who's just died. They're just a hair's breath away. They're just starting their new journey in the world without a body. If you keep a calm space around their body, and in the room, they're launched in a more beautiful way. It's a service to both sides of the veil.

Fear of the road not taken

A friend of mine said that he had just attended his first online “Celebration of Life” a week after I had attended my first. COVID has taken many of our loved ones from us and we are learning new ways to celebrate them. I was thinking that when that someone special chose between two great and wondrous paths, like studying the arts versus sciences, living in British Columbia or Toronto, or dating Sky instead of Skylar, there was no sudden devastation, heartbreak, and tears for the road not taken? What there was in fact was a celebration, jubilation, and excitement for the infinite possibilities that lied ahead for them, was there not?

So maybe it should be the same when someone special passes beyond the veils of time and space. This is something that all must one day. When we lose someone special, I think we should choose to do celebrate the infinite possibilities that they have given to us that will help us in the path forward. We must remember the big lessons they taught us and the little lessons that still stay with us as we remember them. Life is hard when we lose someone special but we honour them by remembering the infinite possibilities that they helped us see in ourselves and that they through their life helped us and others achieve.

Accepting the inevitable

Ronnie Bennet at Time Goes By has some interesting posts, and she had one a while back that was titled, “Being 97” in which a 97-year-old philosopher looks at his own death in an 18-minute video created by his grandson. In the video clip he says “So, I just go on existing until it is time to say goodbye.” 

This was a dramatic revision of his thinking in the 1990s. In his 1996 book about death, Herbert Fingarette argued that fearing one’s own demise was irrational. When you die, he wrote, “there is nothing.” Why should we fear the absence of being when we won’t be there ourselves to suffer it?

Twenty years later, facing his own mortality, the philosopher realized that he’d been wrong. Death began to frighten him, and he couldn’t think himself out of it. Fingarette, who for 40 years taught philosophy at the University of California at Santa Barbara, had also written extensively on self-deception. Now, at 97, he wondered whether he’d been deceiving himself about the meaning of life and death.

“It haunts me, the idea of dying soon, whether there’s a good reason or not,” he says in his grandson’s short documentary Being 97. “I walk around often and ask myself, ‘What is the point of it all?’ There must be something I’m missing. I wish I knew.”

The day before he died in 2018, Fingarette uttered his final words. After spending many hours in silence with his eyes closed, His grandson said, his grandfather suddenly looked up and said, “Well, that’s clear enough!” A few hours later he said, “Why don’t we see if we can go up and check it out?”

“Of course, these cryptic messages are up to interpretation,” his grandson said, “but I’d like to believe that he might have seen at least a glimpse of something beyond death.”

In the film, Fingarette admits that there “isn’t any good answer” to the “foolish question” of understanding mortality. “The answer might be … the silent answer.”

Being 97 is a moving film that explores the reflection that happens as we age, and the struggle of accepting the inevitable. His grandson quietly observes the things that have come to define his grandfather’s existence: the stillness of time, the loss of ability, and the need to come to terms with asking for help. “It’s very difficult for people who have not reached a state of old age to understand the psychology of it, what is going on in a person,” Fingarette says.

Medical Assistance in Dying

I had a cousin who chose to seek medical assistance when she was dying. A friend of mine had his wife seek medical assistance when she was very sick and another friend whose husband wanted to die at home. The idea of seeking medical assistance is a very sensitive and controversial topic. Right now, the Government of Canada has launched an online public consultation aimed at obtaining Canadian's views on amending the federal medical assistance in dying legislation. Canadians and interested stakeholders are invited to share their views online until January 27, 2020. So if you want more information and would like to make your views known go to the link and let the government know your views. The following is from the public consultation page, that gives very good information along with more links to other sites and agencies that can help. 
Who can provide medical assistance in dying and who can help. Those who can provide medical assistance in dying services are:

• physicians
• nurse practitioners (in provinces where this is allowed)

Those who can help provide medical assistance in dying include:

• pharmacists
• family members or other people that you ask to help
• health care providers who help physicians or nurse practitioners

These people can assist in the process without being charged under criminal law. However, physicians, nurse practitioners and other people who are directly involved must follow:

• the rules set out in the Criminal Code
• applicable provincial and territorial health-related laws, rules and policies

Protecting the right of providers to act according to their beliefs and values

Not all health care providers will be comfortable with medical assistance in dying. The federal practice may not be consistent with a provider's beliefs and values. The federal legislation does not force any person to provide or help to provide medical assistance in dying.

Provincial and territorial governments have the responsibility for determining how and where health care services are provided. They may also make policies around where medical assistance in dying can take place as long as they do not conflict with the Criminal Code.

Supporting access for patients seeking medical assistance in dying

We understand that these provider rights could create problems for patients who want to access medical assistance in dying. Most provinces and territories have developed care coordination systems to help patients learn more about this service.

Available Options

There are 2 types of medical assistance in dying available to Canadians. They each must include a physician or nurse practitioner who:

• directly administers a substance that causes death, such as an injection of a drug
  • this is becoming known as clinician-administered medical assistance in dying
  • it was previously known as voluntary euthanasia

or

• provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death
  • this is becoming known as self-administered medical assistance in dying
  • it was previously known as medically assisted suicide or assisted suicide

When the End is near

Providing care for your adult parents during their retirement years can be a demanding job.  And the job continues to become more demanding as your parent gets older and his or her health declines.  You will have to make more and more difficult decisions as the end grows closer and many of them you will make without the consultation your elderly parent if his mental abilities have slipped away due to the effects of ageing.

If the senior citizen you are caring for is dealing with a terminal illness that lingers, those demands will become virtually overwhelming.  When the end is near like this, your need for assistance will become acute.  This is no time to try to be stoic.  Dealing with a dying senior citizen is something that is usually outside of the abilities of caregiver children.  

If you see that time coming, now is the time to make arrangements for additional help.  If funds are in his estate, you can arrange for in-home nursing care.  These outstanding organizations can be with the senior citizen for as many hours as day as you need them to be and provide skilled medical care to minister to the demands of your parent’s terminal disease.

But once your doctor confirms that your parent is terminally ill, waste no time in getting hospice involved.  Hospice has been a lifesaver for many a weary caregiver who is worn out from months or years of caregiving and is incapable of dealing with the extra demands of the patient’s final months of life.

But there is an adjustment you as a caregiver will have to make as the nursing care personnel and hospice begin to surround your parent more and more in preparation for his or her final days.  You have been so intensely involved with every aspect of your parent’s needs.  And you have done a good job of getting them this far.  But now you have to step away and let these skilled professional caregivers provide the comfort and medical care that only they can give.

This may be difficult because your parent will still call for you to be nearby especially during these weeks.  This is a time to bring in the clergy, and to alert your siblings who may have to travel to be beside your mom’s bedside in her final days.  While there will be tears, if they can be with her a little bit before the final moment comes, that is a closure for the family that is tremendously valuable.  And it helps your ageing parent to have her children close to her as she approaches her final transition to another life.

Hospice will help you go through the transition in your own mind and heart to accept that the passing is near.  It will take some emotional courage to begin preparing for the funeral even though your parent is still with you.  But this can also be a bittersweet time of sharing because if your parent accepts what is to come, she can have some say into what she wants to have happen at the funeral and about other final arrangements.

Perhaps the strangest transition that you alone as the primary caregiver will go through will happen in the days just after the passing.  There is always a shock when your loved one dies even if it was very much anticipated.  But you will go through another drastic set of emotions that can only be described as “separation anxiety”.  

When you get that news that your parent has passed, you will suddenly feel the lifting of a burden that may have been on you for months or years.  You no longer have to worry about your parent anymore.  You don’t have to go there, take care of her food or medicine and comfort her anymore.  The lifting of that pressure can be liberating and disorienting for you.  You will feel strange throughout the funeral and the family times as well.  But keep these feelings in your heart as well because they will be sensations that only you and others who have been primary caregivers will ever be able to understand.

Saying goodbye

A few days ago I talked about my cousin who had a brain aneurysm and had, after considerable discussion with family, been taken off of life support. Her daughter asked me if I would talk to my cousin as her daughter said that would cheer my cousin up. So two days after they took my cousin off life support I was able to talk to her and say goodbye.

I did most of the talking as my cousin could not speak very much. Every now and then her daughter had to tell me what her mom had said as her voice was not picked up well on the speakerphone. I told her I thought she was a strong woman and I was sorry about the situation she was in and she said, "Yes, I am, I'm like your mom." I knew what she meant, my mom had taken a year to die, after she was told she only had a few days too live. I agreed with her that she was tough, like my mom. She also said she enjoyed all the people who were coming to see her, but that it was very tiring to have all the visitors. I said that she had all the visitors because she was a well-loved person who had many friends. I said I loved her. My cousin's daughter phoned me today to say she had passed. I cried. 

My cousin has a wicked sense of humour and even as she is on her death bed, she has time for humour. My cousin's daughter told me two stories, "I brought in my son and asked mom if she knew who he was. Mom replied, "No, I don't and then called her son over by name, and looked at her daughter and laughed." 

In the second story, My cousin's daughter left the room for a few minutes to talk to someone on the phone and when she returned her mom had pulled the blankets over her head. My cousin's daughter let out a gasp and her mom pulled the blankets down and smiled. Her daughter asked, "Mom, did you pull the blanket over your head, and her mom replied, "I guess I did."

Now some may not think the above is funny, but I do and her daughter did. If you cannot see the humour in a situation, then it may be too late for you. I will miss her and I am glad I had a chance to say goodbye.

Planning a New Year's Resolution?

We are on our way to a brand new year, lookout 2019 here we come. A few years ago a Palliative Care Nurse, Bonnie Ware,  wrote a book "The top regrets of the Dying" 

As you plan ahead, try to not have any of the regrets listed here. I know I will have regrets, but my hope is that I will learn from what Ms. Ware tells us and that my regrets will be different.  Here are the top five regrets of the dying as published in The Guardian on Feb 1, 2012, written by Susie Steiner

1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.
"This was the most common regret of all. When people realise that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Health brings a freedom very few realize, until they no longer have it."

2. I wish I hadn't worked so hard.
"This came from every male patient that I nursed. They missed their children's youth and their partner's companionship. Women also spoke of this regret, All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence."

3. I wish I'd had the courage to express my feelings.
"Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming."

4. I wish I had stayed in touch with my friends.
"Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. Everyone misses their friends when they are dying."

5. I wish that I had let myself be happier.
"This is a surprisingly common one. Many did not realize until the end that happiness is a choice. The so-called 'comfort' of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again."

As you plan your New Year's Resolutions and look back at 2018 and forward to 2019 here is something to ask yourself. What's your greatest regret so far, and what will you set out to achieve or change before you die?

Biggest regrets?

We are always getting ready to live but never living.” – Ralph Waldo Emerson

Australian palliative care nurse, Bronnie Ware, put together a list of the most common regrets people approaching death expressed, it went viral. But surprisingly, not because her article was so incredibly profound.

Quite the opposite really, as it was the simplicity that struck a chord with most people. What the article stated was that it’s the small things in life that matter; but often the things our pride, ego or desire to please others gets in the way of.

So after reading it and being reminded of what really counts, I wanted to share her findings with you too…

1. “I wished I had the courage to live a life true to myself, not the life others expected of me.”
Sometimes the easier path to take is to breeze through life, as it takes serious soul searching to work out what’s going to make you happy. Not to mention the courage to pursue it – especially if it means disappointing your family, partner or society’s expectation of you.

But it’s your life. Only you confront the reflection in the mirror each morning – so it’s worth making sure you’re happy with what you see.

(And just a reminder, if you’re not, it’s never too late to make a positive change.)

2. “I wish I did not work so hard.”
Life regrets by those approaching death

This one is especially true if you have a family.

Being a provider for someone else is a big responsibility. Wanting to have a nice house, a car, medical insurance and the option to send your kids to a good school are perfectly understandable goals.

But there needs to be a balance in this equation.

If you need to work 80 hours a week only to slump in a heap on the couch on your only day off – the fancy new car isn’t going to mean anything to your attention-starved kids.

Or if you don’t have a family, continuously working to the grind and never making time to pursue some of your other dreams – such as travel, adventure sports or falling in love – is going to leave you with a heavy heart at the end of it all.

Work isn't everything. So don’t let it be the only thing that defines who you are.

3. “I wish I had the courage to express my feelings.”
Why would you deny yourself of such a powerful expression?

As Buddha said:

“Holding on to anger is like grasping a hot coal with the intent of harming another; you end up getting burned.”

So by holding onto anger and resentment, or not letting more heartfelt statements such as “I forgive you” leave your lips – you’re only harming yourself. Not to mention messing up your inner peace… as it’s hard to be happy when you’re enshrouded by negativity!

Don’t miss a chance to let those you care about know how you feel – as you never know when that chance may be taken away from you.

4. “I wish I had stayed in touch with my friends.”
For most of us, over a lifetime, the number of sincere friendships that have had a significant impact on our lives probably won’t equate to double digits.

You know the kind I mean. The type who become like family. The ones who are always a steady rock during life’s ups and downs  – and who aren’t afraid to confront you when you’re acting out of line!

Make an effort to stay in touch with these friends.

Don’t let petty differences or life get in the way of the people who have valued you the most.

Life regrets by those approaching death

5) “I wish I had let myself be happier.”
I think on a whole, society gets happiness wrong.

It’s not the result of having waited for the right job, partner or a fat bank account to materialize.

It’s a choice. And it’s a conscious one you have to make every day. Are you going to choose to be happy, or are you going to let your happiness be washed away by the events of the day?

There are always going to be reasons to be annoyed, disappointed or angry about something.

But that’s life.

Once you realize this, and decide to choose happiness, you’ll notice it improves tenfold.

Pretty powerful!