Tuesday, November 21, 2017

Celeste Headlee The Mistake I Made with My Grieving Friend

Celeste Headlee's new book We Need to Talk describes some of the things we say to try to show empathy but instead redirects a conversation in a way a person in pain does not want to hear.

"I had totally failed my friend. I had wanted to comfort her, and instead, I'd made her feel worse. At that point, I still felt she misunderstood me. I thought she was in a fragile state and had lashed out at me unfairly when I was only trying to help. But the truth is, she didn't misunderstand me at all. She understood what was happening perhaps better than I did. When she began to share her raw emotions, I felt uncomfortable. I didn't know what to say, so I defaulted to a subject with which I was comfortable: myself. I may have been trying to empathize, at least on a conscious level, but what I really did was draw focus away from her anguish and turn the attention to me. She wanted to talk to me about her father, to tell me about the kind of man he was, so I could fully appreciate the magnitude of her loss. Instead, I asked her to stop for a moment and listen to my story about my dad's tragic death."

Celeste Headlee The Mistake I Made with My Grieving Friend

Tuesday, November 14, 2017

The Lies of the Deathbed Scene (and Also the Truth) | Balder and Dash | Roger Ebert

From a beautiful, moving essay by Noah Gittel about the death of his father:

"The simple practice of caring for him made me love him more than ever before. He was on a heavy dose of morphine the day we took him off life support, and after the doctors left the room, I sat with him and stroked his beard, which the doctors had let grow back to its normal length because there was no reason to keep it trimmed. I started talking, saying all the things they suggest. “I love you. I forgive you. Forgive me. Thank you. Goodbye.” He opened his eyes and rolled them over in my direction. Did he see me? Had he ever seen me? I kept talking, He closed his eyes and did not open them again. For all of my grappling with my feelings, and for all the lies that cinema tells about the death of a family member, this was as close to a "Magnolia Moment" as I was going to get. And yet frogs did not fall from the sky. He slipped away, and I am left searching the movies for answers, still struggling to make sense of a relationship that I couldn’t find the courage to scrutinize while he was alive. The credits have rolled, but I’m still waiting for the movie to end."

The Lies of the Deathbed Scene (and Also the Truth) | Balder and Dash | Roger Ebert:

Saturday, November 11, 2017

Dying May Not Be as Awful an Experience as You Think

Does the very idea of death worry and frighten you? There may be reassurance from a new study that finds those fears might be exaggerated. In fact, the research shows, death is often described as a peaceful, "unexpectedly positive" experience by those who approach it. Death is one of life's guarantees, yet it's something people often avoid talking about, according to study author Kurt Gray. He's an assistant professor at the University of North Carolina at Chapel Hill. "There's almost an unspoken assumption that death is something to be avoided at all costs," Gray said. But his team found that the abstract concept of death may be scarier than the reality.

Dying May Not Be as Awful an Experience as You Think

A nurse with fatal breast cancer says end-of-life discussions saved her life - The Washington Post

And while this metastatic cancer will one day kill me, the advanced-care planning conversations I have had with my health-care team have been lifesaving since my diagnosis. I use the word “lifesaving” advisedly because that is what these conversations are truly about. When done well, they can shape care in ways that give people with serious illness a chance at getting the best life possible. This kind of conversation initially helped my care team understand what was important to me and helped clarify my goals of care. Faced with an incurable disease and a prognosis where only 11 to 20 percent survive to five years and there is no statistic for 10-year survival because it so rarely happens, I came to understand that my priority was to seek a “Niagara Falls trajectory” — to feel as well as possible for as long as possible, until I quickly go over the precipice. Quality of life is more important to me than quantity of days, if they are miserable days.

A nurse with fatal breast cancer says end-of-life discussions saved her life - The Washington Post

Tuesday, October 31, 2017

Aging Thoughtfully: Martha Nussbaum and Saul Levmore on Retirement, Romance, Wrinkles, and Regret

Aging Thoughtfully; Retirement, Romance, Wrinkles, and Regret is a new book by Martha Nussbaum and Saul Levmore that thoughtfully explores what Robert Browning called “the last of life for which the first was made.” As we approach our sixth, seventh, and eighth decades, how do we think about what we have learned, what we still want to do, what we no longer want to do, what our legacies will be, how we want to die?

The two law professors draw on books, movies, philosophy, economics, and opera and the book is filled with insights about the ways we find meaning and connection as we think about the past and as we make decisions about the future. In an interview, they answered questions about late-life romance, growing old with grace, and making end of life decisions.

Do you have a favorite example of growing older?

SL: Warren Buffett has grown old with such grace and openness to new ideas.

MN: A common weakness of aging is that people exaggerate their prior defects, being less constrained by how other see them: the excessively talkative becomes insufferably so, the narcissist becomes virtually psychopathic, the nasty and inconsiderate more inconsiderate still. I love it when people really learn something and become better. My late colleague Bernie Melzer, who apparently used to be pretty tough and nasty in his youth, was so graceful, serene, and gentle as he aged. He listened to others more, and tried to understand his own past (as the youngest prosecutor at Nuremberg) in a way he had not done before.

How should we ask and who should we ask, as you suggest Atticus ask of Cicero, for an outside assessment of whether we are still personally and professionally able to perform?

SL: One good way is as a joint activity. We choose someone about our age and accept the fact that one of us is likely to lose it and do danger before the other. Another often more appropriate method is to find a person who is much younger but who also thinks about aging. You want someone whom you will not think is telling you to step down because he or she gains from it.

MN: I think trust is so rare and so important. Basically, you look for a true friend, and that’s not such an easy thing to find. Cicero’s letters show such a long-lasting friendship, with a trust that came from shared activities, interesting differences, but also gossip, teasing, and a depth of commitment that’s rare.

In dealing with regret, how do you know when to try to make amends, do what was undone, or just let go?

SL: As I age I find that serious apologies are more valuable. I try not to explain the reason for my error – as that often sounds like justification rather than apology – but simply say that I understand the wrong.I think an apology is often for oneself as much as it is for the listener.

MN: I think it’s crucial not to believe that apology takes the place of getting on with life and making it better going forward. It’s easy to wallow in guilt, particularly for those of us raised in Judeo-Christian cultures. But guilt is useful only if it changes the future, since it cannot change the past.

You describe “the Scylla of excessive deference to ‘nature’ and the Charybdis of obsession with flight from age.” How do we distinguish between vanity and upkeep? When does trying to hold on to youth become counterproductive?

SL: An especially good question. I think for many aging people there comes the point where they are no longer holding on to youth so much as trying to be younger than other people of their age. No 75 year old thinks he is the strongest and fittest, but he might think that he bench-presses in a manner that is enviable for someone of that age. That’s not bad. So if you find yourself really thinking you are like a young person, it is excessive!

MN: Yes, totally. Essentially you need to love yourself and try to be the best that YOU can be, not someone else. But that is difficult, since we all, but perhaps especially women, are held up to rigid social expectations.

Is it true, as the song says, that “love is lovelier the second time around?”

SL: For some people no doubt, but how could that be generally? Imagine a rule that divorce or some other breakup was were required after 30 years. Would not everyone think that was an absurd requirement. People like to choose.

MN: But there is something about love in later life that is special, or at least can be: a degree of self-knowledge that’s not possible before, an understanding of time and change, a sense of humor about oneself.

What is the most constructive way to think about the past? How do we know if we are dwelling on the past for escape rather than understanding?

SL: If we learn things that are slightly unpleasant it is unlikely to be escape. It is such fun to change one’s mind or come to new views! I like the way so many older people have come to embrace same-sex marriage or other arrangements they could not fathom much earlier in life. Those are not escapes, they are wise or perhaps a quest to be young, but in a good way.

MN: It is hard to know how far searching for self-understanding in the past is valuable; I do think it has some value, but I totally agree with Saul that at any rate one must not do this in a way that precludes future-oriented curiosity and new learning.

What can we do now to keep Gen Xers from being “the elderly poor of the future?”

SL: Increase social security, though it is a costly solution.

MN: Learn from the Nordic countries, who certainly have not totally solved this problem, but at least they understand that we’re all in this world together and we must support one another.

How can we care for older people, including those who are impaired, while maintaining their privacy and dignity?

SL. What’s so great about privacy? If someone treats me with respect, I don’t mind that they know my flaws.

MN: I agree, but I do find that as one becomes well-known one is expected to be an open book, and I like to preserve a lot of space for mystery and for true intimacy, which is not compatible with blabbing everything on Facebook. My solution is that I am not on any social media, not even Facebook.

How can we help people maintain control about end of life decisions?

SL: We can ask them to make decisions in advance but of course they might change their mind(s). In the end, it is impossible except to delegate to a person who seems like minded at an earlier stage of life. Thus, some people will delegate to a religious figure but others would know that is the worst thing for them.

MN: Right, it’s the problem of trust again. Our society gives children the default position here, but children often are bad at this, because it is too upsetting.

What gives a gift of assets accumulated over many years the most meaning?

SL: Two ideas. One is that life is so much easier when one is not fearful, and one has the means to relax and do without tension (about money). A gift that provides that security is so valuable, and can be repeated to the next generation. Second, there is trust. If I give a child money with the wish that that child give it to a worthy cause, that shows great faith in the child, a nice gift.

MN: Well, I totally agree, and so for once I am mute.

Originally published on HuffPost

Wednesday, October 25, 2017

No One is Coming: Hospice

TIME reports: [A]s the industry has grown, the hospice care people expect — and sign up for — sometimes disappears when they need it most. Families across the country, from Appalachia to Alaska, have called for help in times of crisis and been met with delays, no-shows and unanswered calls, a Kaiser Health News investigation published in cooperation with TIME shows.
The investigation analyzed 20,000 government inspection records, revealing that missed visits and neglect are common for patients dying at home. Families or caregivers have filed over 3,200 complaints with state officials in the past five years. Those complaints led government inspectors to find problems in 759 hospices, with more than half cited for missing visits or other services they had promised to provide at the end of life.