Sunday, August 2, 2020

Don't Say "I Know How You Feel" -- Suicide Grief is Different

"Don't say, 'I know how you feel."

As much as I knew my midwife’s assistant was hurting, too, and trying to find connection, she didn’t truly understand what I was going through; I felt unseen in the complexity of my fresh grief. 
“Don’t place value judgments on the suicide, such as ‘It was a selfish choice, a sin, an act of weakness, or a lack of faith or love or strength.'

But don’t feel afraid to say the name of the person who died, to share your memories of that person, to create space for the survivor to share their own memories, to honor their loved one’s life. Let the grieving person say what they need to say, feel what they need to feel.

[Executive director of the Suicide Prevention Network based in Minden, Nevada Debbie] Posnien suggested: “Listen with your heart, maybe hold their hand, look into their eyes, let them know you feel their pain.” Saying that you feel someone’s pain may seem similar to “I understand what you’re going through,” but those words more fully honor the complexity of the survivor’s experience — they mean “I understand you need support” and they mean “We’re going to walk through it together.”

Saturday, August 1, 2020

When a Spouse Won't Agree to Your EOL Plan

A woman wrote to Slate's Dear Prudence to say that her husband won't talk to her about end of life choices or support her wish to have a DNR and palliative care only if she gets COVID-19.

There may be more you can do to ensure your wishes are respected even if your husband never comes around. Having a DNR is a great start, but you may also want to draw up a living will, which can address treatments beyond just resuscitation, such as ventilation, tube feeding, dialysis, and antibiotics. You can also set up a trusted friend or relative with power of attorney. The Mayo Clinic has a rundown on the difference between a living will and a DNR directive, as well as what you might need to enforce and validate both.

It should be easier to insist that your husband have a practical conversation with you about end-of-life care if you’re not also worrying that your fate lies in his hands. You can tell him: “I know you don’t want to think about either of us dying. Death is going to happen whether we plan for it or not. I can’t force you to talk about it, but if we avoid the subject forever, it won’t make death any less real. It will just mean that I have to make plans alone, and I would rather go through this part of our lives the way we’ve gone through the last 40 years—as partners. I want you to know which directives I’ve established with my medical proxy, and I’ve made a copy for us to review together. I know you’re not up to acting as my advocate yourself, but I want you to know what you can expect. Can you give me an hour of your time to discuss this?” If you think it would help to have a mediator, you might schedule an appointment with your doctor to review your various directives and ask your husband to join you. That way he won’t have to participate in anything he finds too overwhelming, but you’ll have the peace of mind that he knows what’s going on. I hope you can find ways to get through to him: It’s easier to get through even the most painful scenarios if you have a companion, and he needs you as much as you need him.

Friday, July 10, 2020

COVID-19: The Tragic Loss of Coronavirus Patients’ Final Words

Zeynep Tufekci writes in The Atlantic:

Of all the wrongdoings of this pandemic, the one that haunts me most is how people are left to die alone. Health-care workers have been heroic throughout all this, but they do not replace the loved ones whom the dying need to be with, and speak with, even if only one last time.

A hallmark of COVID-19 has been the speed with which some patients have crashed, going from feeling only a little sick to being unable to breathe, sometimes in the space of a few hours. Such a crash often necessitates intubation, a process that then renders one incapable of speaking. Many people on ventilators are also heavily sedated and unconscious, to keep them from pulling out the invasive tubes going down their throat. Thus, sometimes with little warning, all communication is lost, and more often than not, a patient is without family or loved ones when this happens....

It’s also not just that the dying deserve to be heard or that their wisdom is valuable, but that the living need to have the chance to hear them—to let go on their own, mutual terms.

The Tragic Loss of Coronavirus Patients’ Final Words



Friday, July 3, 2020

COVID-19: Will We Finally Start to Talk About Advanced Directives?

Joel Rowe writes in The Atlantic:

I am a resident emergency physician in New York City, and I’ve lost count of the number of times I’ve had to pick up the phone to inform the family of a patient with the coronavirus that their loved one was close to death. Recently, when an elderly woman arrived with what my colleagues and I identified as severe COVID-19, her prognosis was grave. I went to the ambulance bay, away from the cacophony of the emergency department, to call her relatives to tell them that even our most advanced interventions would not help her. The news was understandably difficult to absorb. The family reflexively asked us to “do everything,” rather than heeding the gentle recommendation that we focus on preserving her comfort.

We placed a tube in her throat to connect her to a ventilator, inserted catheters in her veins to administer medications that would sustain her heart, and performed chest compressions to temporarily supply blood to her vital organs. Our team tried for 45 minutes to resuscitate the patient as her lungs and heart gave out.


[M]y patients and their families are facing the sudden decline that can occur in people with COVID-19, and many are not prepared. Before the pandemic, my colleagues and I conducted end-of-life conversations or delivered bad news over the phone only in very rare circumstances. I would take a patient’s family to a quiet room, sit face-to-face with them, and offer a hand to hold. Now the comfort I can offer the family, in some cases living mere blocks away, is limited, since relatives are rarely allowed in the hospital during coronavirus surges. Such restrictions exist for everyone’s safety, but they can make end-of-life decisions that much more difficult. When family members see the physical condition of their loved one, that’s often when the gravity of an acute situation truly sinks in. Without witnessing this reality, disbelief is common. “You can’t be talking about my dad,” one family member said to me over the phone. “There’s no way you have the right person. Please tell me this is a mistake.” No one should be making decisions about end-of-life care under such stressful circumstances.
In the absence of an advance directive, physicians always “do everything” to save someone’s life; it is our ethical and legal mandate. But in the final days or hours of an illness, when the body is permanently failing, disrupting the dying process without an advance directive in place can feel especially troubling. CPR is not like it is in the movies. Effective chest compressions, for instance, regularly break ribs. Invasive measures are justified when a patient has decided that they want them—and many patients choose that route. But they aren’t what everyone might wish for as they lie dying. When I know a patient’s wishes, I can work with a family to achieve them, even over the phone. In the end, I want my patients to die with dignity, whatever that means to them.

The Pandemic Should Change the Way We Talk About Dying

Sunday, May 31, 2020

Processing Grief -- With Movies

This has been a time when things were hard and films have been there as a comfort blanket and psychological reset. I have watched many films during this lockdown that have offered this: Booksmart, What We Do in the Shadows, Game Night to name three. And it has led me to dwell on how cinema has helped me process grief.

It does not have to be a "great" movie and it does not have to be about grief. Here is what he has to say about the dumb action movie about a prehistoric fish, "The Meg."

The Meg is a dumb film. It’s surprisingly bloodless and clearly has had an edit or two to reshape it before it reached cinemas. But as I watched a giant shark decimate the waters of a packed beach I knew this had been the right choice. There is not an ounce of our reality in this Jason Statham vs. prehistoric shark flick and it helped me detach from the day and the news we had received. Cinema helped me when I needed to, as it would many times again.

Sometimes grief helps you to experience a film as the film helps you process grief.

"Parasite" is a much sadder watch when revisited. Maybe I was emotionally raw but you feel the pain and anguish that is at the film’s core, the rage that seems to course through it is more potent than ever.

Cinema and Grief

Saturday, May 30, 2020

From the Gravestone of Artist Gwen Frostic

Michigan artist Gwen Frostic: Here lies one doubly blessed -- she was happy and she knew it.

Jim Breuer Cares for his Father

Former SNL cast member Jim Breuer talks about taking care of his aging father.

[W]hen his car was finally taken away, he stopped shaving. He stopped bathing. He would sleep all day long. That literally was the beginning of killing my father. His giving up the car was throwing in the flag—it’s over. Now I have to be dependent on everyone else.

So I knew if I left him alone, nobody would sacrifice what I would do. [I had to] clean him, shower him, get him on the bus. Now he has to go to the bathroom. We pull over. Oh, shoot. He didn’t make it. Clean him again. But you know what? We laughed so hard. There were times where I cried. I knew if I didn’t do this, he had nothing to live for. [At shows], he talked to people. I saw how much life it gave him.


I learned sacrifice. I learned the importance of life, the importance of getting rid of our own pride and selfishness. The greatest thing that I had in my life was those moments with my dad that I sacrificed. I looked at him as a soldier. He’s a wounded soldier. It’s my duty as a human to take care of this soldier.

I learned more about my father in his last 5 to 6 years than I ever did my whole lifetime. One of the things I did, I would go, “Dad, I know you don’t know how to work YouTube, but wait until you see this concert. I found Hank Williams in 1940. And look at this.” Then that brings on memories and it brings happiness and it gives him a little extra breath in life. He’s not concentrating on “I want my car. I want to drive.” Now you’re just spending time. [I had] the greatest memories of a lifetime just watching this. It’s like watching a child grow—except for we were never taught that this is what we’re supposed to do for parents.


The minute I got rid of the attitude of “you need to do this” and “you need to do that.” I just realized the more I gave him love, the more I just spent time, the more I played his music, the more I took him out for a little drive and [asked him for advice], he felt important. It gave him meaning, it gave him purpose.

I Took My 84-Year-Old Dad on a Comedy Tour. It Changed Our Relationship Forever