Sunday, August 20, 2017

Death Doula Diary: Working At The Bookends of Life

I'm so often asked what it's like working with death, both those who are aware they're nearing the end of days, accompanying them through their death vigil, and working with families caring for their own dead....Something almost magical happens for many who are dying. Once they get through the initial shock of a diagnosis, once they've processed where they are, and what this means, and made some decisions, and begun to get some of their ducks in a row, there is a something incredibly powerful.They nearly always reach this stage where more than anything, they want to squeeze every drop of living out of every day that remains. And doing this work? You get to be a part of that journey, a part of that beauty and magic and wonder. Yes, there's a bittersweet element to it, but oh, the sweet parts? Are so very sweet!And no, it isn't this way every time; it's far more likely to happen for clients who transitioned to or have a plan in place for palliative care. If they're yet fighting to survive, and if that fight involves an endless merry-go-round of treatment, they're likely caught up in that rig-a-ma-roll - and all too often folks aren't transitioned to palliative care when they should have been - but that will be a different diary entry, one all about cure versus care.But oh, when someone reaches this space; when they've come to terms with the reality of their mortality, and they're free to look at what remains, from a deeply authentic place? These folks are oftentimes some of the most fully present, deeply alive people you will ever encounter. Time and again I am told something like, "Cancer gave me a gift, a gift I wish I'd long ago been smart enough to realize I'd always had: It helped me realize what really matters. Oh, if only I'd realized this sooner. But at least I have now, and I'm going to make every last minute count."Being around these folks, yes, it can be bittersweet, yes, but oh, how beautiful it can be, and how glorious to engage so frequently with folks who are living from a place of such depth, such authenticity.

Death Doula Diary: Working At The Bookends of Life

Sunday, August 13, 2017

In Barbara Cook’s Final Days, Her Friends Came to Sing at Her Bedside - The New York Times

"In the days before Ms. Cook’s death on Tuesday, friends from her legendary career delivered a fitting farewell: More music. Vanessa Williams and Norm Lewis, who starred with Ms. Cook in the 2010 Broadway revue “Sondheim on Sondheim,” were among those who came by her Upper West Side apartment and sang to her. Josh Groban, Hugh Jackman, Audra McDonald, Kelli O’Hara and others sent audio and video recordings full of memories and melodies. "

In Barbara Cook’s Final Days, Her Friends Came to Sing at Her Bedside - The New York Times:

Friday, August 11, 2017

"Flunking" Hospice

To qualify for hospice care, two doctors must certify that a patient is expected to live no more than six months. But patient James B. Nelson discovered that sometimes the doctors are wrong.

"It was decided that I was not dying fast enough," he told Arizona Public Media in 2015. "And so, to put it most succinctly, I flunked the hospice program."

Nelson died a few months after giving that interview, but his situation isn't all that unusual.

Government reports show that the median rate of hospice patients discharged before death has climbed steadily since at least 2000, peaking in 2012 and 2013 at almost one patient in five, though more recently the percentage has declined somewhat. But the rate actually varies widely from one care organization to another. Some hospices discharge less than 2 percent of their patients prior to death, while others discharge more than 80 percent. Non-profits have lower rates of live discharge than for-profit hospices. Regionally, live discharge rates are highest in the South.

It's important to understand, though, that when patients are discharged from hospice, they don't necessarily go anywhere. Hospice agencies, whether they are independent or affiliated with an institution like a hospital, usually deliver services to patients in their homes.

1 in 5 hospice patients discharged

Thursday, August 10, 2017

A Smile at the End of Life

When a dying man wants new front teeth, what do you do?

I told Dr. Monaco we have a terminally ill patient who needs to eat and that cosmetically, replacing the front teeth would do a lot to lift his spirits. Dr. Monaco didn’t hesitate; he told me to bring Mr. Sacchetin in and that there would be no charge for his services. When I told Mr. Sacchetin, he was deeply moved.”
Rager’s husband came to the Center first thing that Tuesday morning to bring Sacchetin to his appointment. Monaco took the dental impression and fitted Sacchetin with a “flipper,” an appliance that is commonly used for patients who require something the same day, whether due to trauma or extraction. It was ready that afternoon.
“My heart really went out to him. As soon as I saw him, I knew it was the right thing to do,” said Monaco, who not only waived his fee but also covered the lab costs out of his own pocket. “I was eager to help out in any way I could for someone in need like that,” he added.
When he got his teeth back that afternoon, Sacchetin turned to Monaco with a huge smile of thanks and said, “Beautiful.”
Monaco said the experience nearly brought him to tears. “It really showed that human part of all of us that says ‘I want to leave this world with a smile, looking the best that I can.’ He was so happy when the flipper went right in with a perfect fit, and it was so important to me that he was happy.

A Smile at the End of Life

Monday, August 7, 2017

Rules for Social Media Posts on Death -- Let the Family Take the Lead

 "When someone dies  — whether suddenly or after a prolonged illness, via natural causes or an unnatural fate, a young person in their prime or an elderly person with more memories behind them than ahead — there is one universal truth : The ripples of people who are affected is vast and, at times, largely unknown to all other parties. A death is always a gut punch with varying degrees of force and a reminder of our own mortality. Most people are moved to express their love for the deceased by showing their support to the family and friends left behind....This isn’t breaking news, and you’re not trying to scoop TMZ. Listen, I know you’re hurt. Guess what? Me too. I know you’re shocked. Guess what? Me too. Your social media is an extension of who you are. I get it. You “need” to express your pain, acknowledge your relationship with the deceased, and pray for the family. Yes. However... Please give us a minute. We are shocked. We are heartbroken. Give the immediate family or circle a little time to handle the immediate and time-sensitive “business” related to death. In the minutes and early hours after someone passes away, social media is most likely the last thing on their minds....I caution you to wait and then wait a little longer before posting anything. This may seem trivial, silly, and not worth talking about, but I promise you it isn’t. If the person is married, let the spouse post first. If the person is “young” and single, let the partner, parents, or siblings post first. If the person is “old” and single, let the children post first. If you can’t identify the family/inner circle of the person, you probably shouldn’t be posting at all."

Please read this before you post another RIP on social media.:

Sunday, August 6, 2017

CONFESSIONS OF A FUNERAL DIRECTOR » 10 Pieces of Advice for Picking Up a Dead Body

"Never, ever rush the family.  I always tell the family, “You have as much time as you need.”  Permission is so key.  But word’s aren’t enough.  Your body language has to say the same thing.  So, if the family is waiting on a relative to arrive from an hour away, or if they just need an extra half an hour with the deceased, take a deep breath, relax, find a seat on the sofa, and let grief run its course."

CONFESSIONS OF A FUNERAL DIRECTOR » 10 Pieces of Advice for Picking Up a Dead Body

The doctors who assist in suicide on what it's like to end a life

Building a system for assisted death from scratch, Li found, was a daunting task. To protect doctors who wanted nothing to do with the practice, she created a specific MAID team for UHN: 18 people to do the assessments and 13 to do the procedure itself. When a patient requests a medically assisted death, the front line doctor alerts the team, which takes over the end-of-life process. Two doctors perform the assessments. A third performs the procedure.
Figuring out the best method for death was also complicated. In Oregon, where assisted death is legal, doctors can write patients a prescription for a lethal oral medication and then walk away. Canadian physicians were surprised to learn that the barbiturates used in that protocol weren’t available here. Instead, doctors and nurses deliver a series of drugs intravenously, a process that is far more intimate than writing a prescription. Assisted death, the polite euphemism used to describe the act, is really a misnomer. Doctors don’t “assist” in a death; they are the active agents. “We are doing euthanasia,” says Li. “We are actively ending a life. And it’s very new to us.”

The doctors who assist in suicide on what it's like to end a life