Elders,
Picked up the newspaper this morning and found this article and thought it may spark something to provoke some thought within us.
Blessings,
Gary L. Parker
"Blessing Eagle"
THINGS TO TALK ABOUT WITH CAREGIVERS BEFORE YOU DIE
By Theadora Davitt-Cornyn
Friday, September 18, 2009
“For many years, the Conejo Valley Unitarian Universalist Fellowship has had training programs for lay ministry, and just as in professional ministry, part of that involves preparation for one’s own celebration of life ceremony, complete with music and readings, as well as addressing issues around end-of-life questions such as those being discussed in the media right now.
Included are topics like living wills, medical power of attorney, advanced medical directives and so on.
I have also included my own preferences for pain management and hospice care, should that be necessary, and should I be incapable of making my wishes known. The below are borrowed from Kevin Drewery, a dear seminarian who just passed away much too soon very recently:
It is my desire to be comfortable. If I cannot communicate with my doctor, family or friends, then I want my attorney-in-fact, family and friends to know the following:
— I ask that medical treatment to alleviate pain, to provide comfort, and to mitigate suffering be provided so that I may be as free of pain and suffering as possible.
— If my temperature is above normal, I want a cool, moist cloth put on my head.
— I want my mouth and lips kept moist.
- I need to be kept fresh and clean at all times.
— I desire to be massaged with or without warm oils as often as you think will help maintain my skin integrity and provide for my comfort.
— I want to have my favorite music played when possible.
— I want my personal care such as nail clipping, hair combing and teeth brushing and shaving as long as they do not cause me pain.
— I want to have religious readings read to me when I am near death.
— I hope my family and friends would consider that:
— I enjoy your company and want you with me when possible. I desire that one of you stay with me when it seems that my death may be imminent.
— Please continue to talk to me about daily happenings and events even if you think I don’t understand, because I might be able to understand.
— Please don’t be afraid to hold my hand or hug me.
And I added that — at death, if possible, I would prefer to have family and friends stay nearby me for as long as that seems appropriate. Additionally, I soon intend to add new information from my seminary years about the Threshhold Acapella Choir to be on hand if possible, as well as information about the availability of “green burials,” all in the Bay Area.
I realize this conversation might be very uncomfortable for some, but there will come a time inevitably for each of us that we would like to have prepared for, yet, without planning, we may not get that chance. I would encourage folks to have those communications with loved ones and doctors long before the need ever arises.
In gratitude for Social Security, Medicare, all the good doctors, nurses, hospitals and hospice care our society offers.”
— Theadora Davitt-Cornyn lives in Oxnard.
Gary,
I really like this article. As a hospice chaplain, I have a couple issues with it.
I find that towards the end, our patients are spending more time on "the other side" than on "this side". It's like they brighten up like they are invited to a wonderful party and they are getting ready to go. I think that there is a common error at the end where family members (by their touch and their presence) keep their loved one connected to this side, when the truth is that the dying one is ready to go.
That's why my experience is that most deaths occur when a loved one goes out to have a cigarette or to take a pee. They come back to find their loved one dead - usually they feel guilty for abandoning the vigil and leaving their loved one alone... when really, that's what the dying person is waiting for - a chance to die without an audience -
I think that dying is private like going to the bathroom is private. Anyway other than that, I really like what your friend has to say about dying a good death, and setting it up in a good way.
Loving you, and my best to Jen.
Ken Plattner
This is insightful. One thing the Elderly have is experiences. Sharing these such as Ken did is invaluable
Recently I have spent hours in a variety of waiting rooms in oncology, radiation and cancer treatment centers. Interfacing with medical professionals and observing their interaction with seriously ill patients is added to, by this insight.
My wife and I discuss the what ifs around this inevitability called death. Updating wills and the desires around physical assets is important. In this time of fractional families, from divorce or death this question can result in disputes between heirs. We want to avoid this. I call this personal responsibility. I have learned that two unexpected emotions show up after a person dies, Greed and Anger. We chose to be aware of this and do everything possible to ameliorate this possibility.
During this time of great emotion by all...(except the departed, I believe) pressure is on to accomplish the necessary. This involves the services, celebration of life and as we have seen recently at the national level, the sainthood of the departed.
Someone, despite their grief, has to be in charge I realized this when my second wife died suddenly at age 39. Fathers, mothers, children were distraught. The funeral process, autopsies and necessary functions had to be handled. My time to grief was after these functions were taken care of, usually late at night. I knew it was important to have a process where her 3 younger children and my four could handle this surprise in their lives. I faced that with my own mother when nine so has some insight about their needs.
I learned that humor is inevitable during this process. I recall the seedy casket salesman trying to sell our young charges the $25,000 solid bronze casket as they ran around the display room shopping for their mother. Seeing humor helped my keep my head on straight during this process.
Supporting my wife when she had to move through this loss of her parents give me insight when hospice or care facilities are involved. Time to plan is available in that situation.
Everyone's situation is different during these times. I believe being responsible transcends our own demise and is best handled before the fact. Ken's input to state our desires is part of that responsibility.
Red "Soul Bear " Fraser
Ken,
I agree with you that often loved ones are present and the one dying feels like he/she can't let them go, that they need him/her.
On the other hand, I have talked with folks who have had loved ones die, particularly parents, and they tell their parent that it is okay to go now; that they will take care of anything back here and they are free to go. There are lots of ways to say that to the one dying. I like that model to openly give permission to the person to die.
Allan
I understand what Ken wrote. I haven't got such a big experience as he has. But for what I have lived, I agree totally with you, my dear Alan. I remember when my mother died. I had the feeling she did not want to go as long we did not "give her this permission”. She was already supposed to be unconscious and I spoke to her saying "It' s now the time to go Mum; don't worry about us and don't worry about Dad, we, your four children, shall take care of him, you know we shall do that; You're ready now to go, just go to the light and to meet all those who have passed before you". She died very peacefully some hours later.
François
I agree - Bless you both Francois AND Allan. Allow me for a moment to put on my Hospice Training Hat.
The experience that Allan and Francois had is fantastic... and it is somewhat unusual. Although not surprising, because most people who want to die at home are ready to have a good death. And it is a great thing when dying people AND their families choose to have a conscious experience.
Here is the conventional wisdom of what happens at death... It's as different as the number of people who go through the experience. What I have listed here is like a guideline or a roadmap of the Final Hours. Like any map, there are many roads arriving at the same destination - there are many ways to enter the same city.
Death by it's very nature takes most people into a withdrawn and solitary space. That is the norm. There is no longer any interest in eating or drinking. There is increased perspiration, often with clamminess. Skin color changes and nail beds on the hands and feet are often pale and bluish because the heart is not able to circulate blood flow at the normal rate
Then comes one last enlivening surge of what often appears like normal energy (sometimes the person will even ask for a meal) After this surge usually comes the final hours. It is not uncommon for the dying person to drop into non-responsiveness - Then comes these other responses:
* Intensification of disorientation - agitation, talking to the unseen, confusion, picking at air or clothing
* Decrease in blood pressure
* Eyes glassy, tearing, half open
* Restlessness OR no activity
* Purplish blotchy modeled feet, legs and hands
* Pulse weak and hard to find
* Decreased urine output
* May wet or soil the bed
With only minutes before death:
* "Fish out of water" breathing
* Can not be awakened
The separation becomes complete when breathing stops. What appears to be the last breath is often followed by one or two long spaced breaths and then the physical body is empty. The owner is no longer in need of a heavy, nonfunctioning vehicle.
They have entered a new city and a new life.
My wish for all of us is that we will have the kind of death that Francois describes. It's a beautiful thing to daily practice dying, so that when our time comes, it will be no problem to let go, bless our loved ones, and take our leave.
In Love and Service,
Ken Plattner
Ken, thanks for the awareness offering about the last stages before death occurs. It takes some of the fear of the unknown out of it for me.
I work as a pharmacist part of the time and facilitate self-healing work on physical, mental, emotional and spiritual levels. So, I'm aware of both sides-
Something that opened my eyes to the perfection in completion that death can be was a book- The Tibetan Book of Living and Dying by Sogyal Rimpoche. Even though the title may have an impact, I urge those interested to read it- It doesn't make a difference if you're Buddhist or not- he explains each of the stages of dying in a compassionate and understandable way and gave me alot of understanding and lessened my fear greatly.
The most helpful thing we can do for the dying is to love then and keep them peaceful as best we can- then we are truly serving them.
Blessings to all,
Steve Pollock (Sacred Gold,nBlack Eagle)
Ken, I worked as a hospice volunteer for about 3 years. They worried about who to hook me up with because of my tattoos and this being a small town in the wilds of British Columbia. The first guy was a chuck wagon racer but we got along great. When he was in his death throws, his two adult sons were there to say goodbye. They smelled of horses and hay and had that men don't cry attitude. I stood on the other side of the bed. I took their Dad's hand and slowly they took their Dad's other hand. I started to grieve because I was filled with their unexpressed sadness. They followed suit with big unexpected tears. I could feel how embarrassed they were about letting out their emotions which they kept reined in tight just like the horses. All three of them were champion chuck wagon racers.
The second person, Clara, was an 80-year-old woman who'd been in a dance band. She taught me to play crib all over again. During the year of visiting her, she went from her home to a senior lodge to the hospital. Towards the end she told me, "I love you, ya know?" On her deathbed, she was in a coma of sorts gasping her last breaths. She opened her eyes one last time and gave me such a loving look and a big smile I felt bad for her daughter who had come a long ways to see her Mom. She didn't even look at her daughter and then immediately died.
Manny
Thanks, Manny. Being a whole man often enables others to find more of themselves, even if they smell of hay and horses (good smells, by the way).
Ed Alley
MY brother Elders,
Reading this posting makes me more proud to be an initiated man. WE are changing how men react to pain and sorrow.
Here is my piece. When my father died two years ago there was much confusion around his sudden death. I will say this about those days. That was the saddest time I have ever experienced. I pointed out to those who could not and did not spend much time with him that he had been ill for a long time. He was hiding it he thought. His dementia kept him from thinking clearly about treatment. His mind would tell him we will do something about this tomorrow and when tomorrow came it was the same thing over and over. The doctor told me this . I am not educated enough in medicine to know those facts.
My mother was is great denial about his sickness and ignored the obvious signs. When he died he was sitting in a chair with my mother holding him. He died in her arms. After his death She would not listen to the doctor's that he had been out so long without oxygen to his brain that there was no chance of him recovering. HE would have had to be on life support for as long as God wanted him to be here.
She refused to turn of the life saving machines. When the machine breathed for him his body would constrict very stiff and exhale fiercely. . It took four long days watching him before my mother finally gave up and turned off life support. The DR. said after disconnecting it would be a few hours before he would take his last breath and pass. IT took12 hours before his spirit left his body. In my judgment it came after my mother said to him "its Ok I will be alright, rest in peace and I will see you heaven.".
There were members of my family that was not taking time to visit Dad Each of them could not go into his room to talk much less touch him . I could see the Guilt in their faces and I felt very sad for them. Right before the unplugging I was asked by our pastor to say a final piece. I did and could not stop crying during my piece. Many members of my family said that I was taking his death very hard. NO I was showing how much I loved him and how much I treasured our times together. I so loved my father and already missed him terribly. This was the saddest time of my life so far.
This experience is something I will not put my family through. I have a living will and it states that if the doctors declare me brain dead to un plug all life support and let me pass peacefully.
This has been the first time I have talked about his passing since he died.
Thanks Manny for this opportunity to share. Ed Fileccia.
An amazing teaching piece
Why don't more people get this?
Evan
Ed,
You said: "This experience is something I will not put my family through. I have a living will and it states that if the doctors declare me brain dead to un-plug all life support and let me pass peacefully."
I want to offer the following to consider - as a retired neurosurgeon I, all too often, was in the role of "the doctor," approaching the family to make that last decision. You alluded to the many family members "who could not and did not spend much time with him." In my experience, they are the problem. The guilt these people feel usually prompts them to ask that "everything possible be done," even if it goes against the dying persons wishes. The discord this creates in the family causes the patient to be left on the machine far longer than would be appropriate. The ones who support the dying persons wishes usually defer to those who speak loudly to continue all efforts.
The solution? If we really want to spare our families and loved ones this agony we must talk to them NOW, let them know how we feel and how much we love them, and how we want things to end. Tell them that they will be acting out of LOVE and not GUILT.
Remember, the actions called for in a living will can be nullified by the request of the survivors.
John Lindermuth
White Swan
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