What’s Your Hurry?

You would think that if you were nearing death but pain-free and not depressed, you first choice would be to stand anywhere but the head of the checkout line that the Angel of Death was in charge of. If anything, most of my hospice patients jostle to stay at the back of the line or pretend there is no line in the first place.

But every so often, a hospice patient says to me, “When I wake up each day, why am I still here?” Or more generally they will ask, “Why am I still alive?” Or more directly, “I have said all my goodbyes and accomplished everything I wanted. I am at peace with the end. I am ready.” In other words, the spirit is ready before the body. I suppose it is a bit like getting all ready to move out of a home, with the van all packed up to go, but then an unexpected delay at the new locale forces you to stay put indefinitely, and you even have to unpack a few things as you wait in limbo.

Since there is no way I can sneak them ahead in the line, as hospice “neither prolongs life nor hastens death,” what can I tell them? How can I as a chaplain respond to “Why am I still here?” As with any discussion where the answer lies within the individual asking it, all I can do is ponder along with them and wrestle with this existential question together. I may suggest answers I have heard elsewhere, which may in turn help them pull up their own concern. I may open with, “sometimes there are loose ends where something is not resolved. Social workers have told me that you cannot be finished until you have looked back on all the crucial things in your life, or until you have reconciled with someone important.” Usually I get a “no not that” to such remarks, but saying nothing can be even more unsatisfactory to them because I suppose a crummy answer beats nothing at all. So we go on brainstorming. What still gives them meaning now? What memories keep coming back? Is there something else your family needs to hear from you or you need to hear from them?

One time when I was with such a patient, she suddenly reached into herself and came up with her own answer: “Maybe I am still alive because there is some future good news in my family that will fill me with much peace and contentment.” Not only was that a magnificent answer for her, I think it is one that all of us should keep in mind.

THE ENCHANTED ONES

Karen B. Kaplan:

Hospicediary.com is something of a nursing counterpart to my own blog. Amy Getter has been blogging since 2011. Her guest post below is about how pets are masters of the bedside vigil, providing comfort in various ways to their owners.

Originally posted on hospicediary:

My mother always said that the animals were enchanted, and in another life they will be able to tell us, the humans, all the things that they know, though we give them so little credit. I hear people say, “Animals are very sensitive” and I’d like to add, I am pretty certain that animals really do know things that we, with all our evolutionary advancement, don’t!
I have a visual of a very ancient man, returning home from the hospital to die in his own living room, with his very ancient Great Pyrenees dog lying beneath his bed, only cajoled away for a few times a day, to eat something and to relieve himself outside, hurriedly returning to his master and the sentinel post beneath the bed. And today, another visual, of the King Charles Spaniel lying atop his beloved human mother, with his arms outstretched across her, his face…

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Why I Am a Stuffed Shirt about Jeans at a Funeral

When it comes to officiating funerals, I am fairly easygoing and liberal about what goes on. Toss your dear aunt’s earrings after the lowered casket? Sure. Play a recording of the deceased’s singing from a recital in her teens? No problem. But one time at a graveside service, my eyes helplessly kept returning to the attire of the next-of-kin, who moreover was delivering the longest and most heartfelt eulogy of the occasion. My eyes were roving thus because a pair of jeans was taking the star role in his ensemble.

As far as I could discern, this mourner was not conveying anger or disrespect toward the deceased through sartorial signals. His eulogy did not hint at his relief and joy at finally getting rid of the %&*!% Nor was he rebelling against ritual or religion, though he may have been indifferent to social convention when all he cared about at that heightened moment was the loss of his loved one. Besides, haven’t we all seen jeans and other informal wear at religious services and weddings? I myself was not much bothered on such occasions, but this time I inwardly fretted that the perhaps well-intentioned gentleman did not have a sense of propriety. I felt that the final frontier for jeans should stop short of a funeral, especially for the chief mourners themselves. But again why was I thinking like such a stuffed shirt about it? One might say formal clothing contributes to respect for the dead, which may enter into my complex of feelings. Jeans can communicate the message, “I am not taking this seriously or deeply or at least I am pretending to myself not to.” Or more simply, “I don’t care.” Yet as his eulogy showed, he certainly did care deeply.

But there must be more to this clothing issue for me (and for you?) besides that. After all, as a loved one approaches death, the relationship can be more intimate than ever as final reflections are voiced, meaningful and poignant events reviewed, and goodbyes are uttered. Informal clothes imply such closeness. Once the funeral begins, however, most of us create distance from the departed and everyone else present with an upgrade in our dress. Perhaps the subconscious impulse operating here is our acknowledgment that a great divide has opened up between ourselves and our lost loved ones. We stand in humility and in fear and in in awe and yes even in wonder at this Separation of separations.

A funeral is a time to ponder what the life of the deceased was all about and what our relationship with the deceased amounted to, and what we could be doing with our own lives going forward. At that funeral, if you get right down to it, the offending jeans, being the most everyday clothing possible, minimized the out-of-the-ordinary elements of that day. Funerals are a rare opportunity for families and communities to reflect and to mourn, to make amends and to show gratitude and love. Let us not have informal wear blur the distinction between heightened awareness and mere routine.

Reprinted from my March 11, 2015 guest post in a blog about Jewish burial societies called Expired and Inspired, in the Jewish Journal. The original article appears in: http://www.jewishjournal.com/expiredandinspired/item/why_i_am_a_stuffed_shirt_about_jeans_at_a_funeral

A Garment You MIGHT Wish to Be Caught Dead In

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Karen B. Kaplan:

Guest blogger Joanna Shears caught my attention because she writes about death in an even jauntier tone than I. In her Twitter profile @winding_blog, she styles herself as a “promoter of death positivity,” and in her blog she largely focuses on creative funeral planning. This September 26, 2014 post of hers is about designer shrouds and how we ourselves can be the designers!

Originally posted on The Winding Sheet:

As I’m always banging on about the importance of preparing for your own funeral in advance I thought it was time for me to shut up, put my money where my mouth is and get on with it. Having thought long and hard about what kind of disposal and ceremony I want I have decided on an eco woodland burial (hopefully in the same woodland as my nan). I’m super passionate about funerals that give something back to the earth instead of taking from it. I don’t want to be buried in a big wooden lead-lined coffin and if anyone even thinks about embalming me I’m coming back to haunt you!

With this in mind I have decided to forego a coffin completely and be laid to rest in a shroud (aka winding sheet). These days shrouds can come in all different designs and shapes and materials but basically a…

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How To Be Alive And Like It Too

The lower you go down on a trampoline, the higher you go into the air. Perhaps this dynamic of one extreme begetting another is at play in the heating up of opinions on assisted suicide. I think the more that technology allows life to be extended at all costs (literally and figuratively), the less we feel in charge of our final days. Hellish stories abound of health professionals keeping people alive by tortuous procedures who cannot communicate their potential wish to discontinue them. In other words, it is coercion. But assisted suicide can involve coercion as well.

I think fear fuels both extremes. The futile treatments and withholding of pain medications which may shorten life is about the fear of death, whether originating from the one dying or their loved ones. It is an attempt to escape killing the fear rather than letting the person die. But the wish to legalize assisted suicide stems from the fear of facing the remaining days of a life so dreadful that it would be worse than death.

There is a middle ground despite the vested interests of some institutions and health care professionals to keep it hidden. There is an alternative to actively prolonging life or finding an escape clause in a death ahead of schedule. Rather than work to ban one extreme or the other, I think our efforts should be to make that middle ground so attractive that patients and their families will resort to the extremes less and less. (I feel the same way about abortion. I am not in favor of banning it. Instead, society should make alternatives available and attractive. In both cases, assisted suicide and abortion, I am talking about incentivizing life.)

While not a cure-all so to speak, hospice is that middle ground. How ironic that uninformed individuals think that going on hospice means “giving up.” I never have heard anyone refer to assisted suicide that way. If someone contemplating assisted suicide is reading this, then can you at least “give hospice a try” before going the “nonrefundable” route? See what the nurse can do about pain. See what the social worker and chaplain can do about feelings of guilt and depression regarding emotionally and financially depleted caregivers. See what the whole hospice team can do to join your search for any potentially remaining sources of meaning. Some unexpected reason for living may turn up. As for the other extreme, hospice is the gateway to appropriate pain relief such as morphine that other types of care preclude due to fear of legal consequences, addiction (obviously an irrelevant concern for terminal patients), or ignorance. It is also a safeguard against “treatments” that increase or prolong suffering. Not only are many if not all such treatments not allowed in order for patients to remain on hospice, the hospice team is available to address their or their loved one’s fears behind the desire to pursue such treatments.

As with any fears, the more we lay them bare, the more each of us will restore control of our destiny.

How to Avoid “Comforting” the Bereaved with Uncomforting Sayings

Announcement on March 22nd–Just in: on this date my post called Why I Am a Stuffed Shirt about Jeans at a Funeral is the top trending one in the Los Angeles Jewish Journal. The link is: http://www.jewishjournal.com/expiredandinspired/item/why_i_am_a_stuffed_shirt_about_jeans_at_a_funeral

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This week’s guest post is by professional listener  Mr. Marc Wong:

Have you ever found yourself tongue-tied, in the middle of an awkward silence, with someone else who is going through an emotional situation? In moments like these, it’s easy to say something wrong and make people feel worse.

Fortunately, there’s a simple way to determine what to say. If you wouldn’t say it in a movie, then you shouldn’t say it to an upset friend.

Let me use one of my favorite movies to explain this. It’s called “A Few Good Men.” Jack Nicholson was nominated for an Oscar for playing the arrogant Colonel Jessop in the movie. In the climactic courtroom scene at the end, he yells the famous line at Lieutenant Kaffee (played by Tom Cruise), “You can’t handle the truth!” Lieutenant Kaffee doesn’t back down. He bears down on Jessop, and ultimately gets him to confess to the crime.

But imagine if Colonel Jessop had simply said, “Maybe it was all for the best.”

And Lieutenant Kaffee agreed, “You’re right. Let’s just move on.”

And the jury returned a not guilty verdict for the wrongfully accused and the movie ended.

This vastly unsatisfying alternative ending helps to explain why we shouldn’t say certain things when we’re comforting someone (and in the case of the movie, confronting someone.). Karen Kaplan, in her Feb 16, 2015 interview on the Homestead Hospice radio show, explored the subject of how to listen to people who are grieving. A well-meaning person might say one of the following to their friend:

“At least they died peacefully.”

“Feel better. They’re not suffering anymore.”

And of course, “Maybe it was for the best.”

Unfortunately, these comments don’t honor the pain, suffering, confusion, and efforts of the grieving. Imagine the characters saying these things in the middle of a movie. It would never work. The comments come from nowhere and just throw you off.

You see, the delicate emotions we feel in a movie are similar to the real emotions that life thrusts upon us. What works or doesn’t work in movies is similar to what happens in life. We can’t magically make things better or help the process along with a few simple comments.

The truth is, these comments are more about our haste to put an upbeat spin on things, to end the awkwardness, or even to vent our own fears and confusion. But it’s tough for our friends to deal with our stuff on top of their own turmoil.

What we can do is to share the pain and discomfort. We can share the journey. We can offer a hug or other concrete assistance. If we really don’t know what to say, we can just keep quiet and be an audience, which is often more useful than we realize. We can walk by our friend’s side and allow them to discover at their own pace, their own dignity and courage.

—- Marc Wong helps people unleash the power of listening. Web: www.8steplisten.com Twitter: @8Steplisten (Twitter is how I originally met Marc. We share an interest in enabling compassionate listening.) Have a romp through his site to see some engaging graphics and more on his movie imagery.

Marc Wong, author of "Thank You for Listening: Gain Influence & Improve Relationships, Better Listening in 8 Steps".

Marc Wong, author of “Thank You for Listening: Gain Influence & Improve Relationships, Better Listening in 8 Steps”.

My Fascination with Detractors

As I was setting up my display table for a book reading at Crane’s Mill Retirement Community, a woman hurried over to point to the subtitle of my book and say, “Why would anyone want to know what other people said at the end?” As I answered, I had the feeling that no answer would do, because after I did so, she retorted, disappointment marring her face, “That’s what I thought you would say,” and took off before I could refine the dialogue further. My answer had been, “As we hear what people say at such a poignant and intimate time, we can gain some insight as to what is important and meaningful to ourselves, and ponder how we want to spend the rest of our own lives.”

I wonder what she was after, and why she was so unsatisfied by my answer. Shall we speculate? (I say “we” because you can respond in the comments section after this post.) If she had lingered longer, perhaps our dialogue would have gone like this:

Me: What do you wish I had said?

Her: Well I’m not sure, but that is the expected answer.

Me: (Nodding in agreement) Uh-huh. A canned answer.

Her: (Flustered) Well no it’s you see it’s just like wanting to know what is going through a prisoner’s mind before they get executed.

Me: What would be scary about finding out?

Her: Oh I don’t know about scary. Some things are better left to the imagination.

Me: My curiosity does get the better of me sometimes.

Her: I suppose there’s no harm in that. But why about such a….such a (look of distaste on her face) subject.

Me: I guess finding out what people think towards the end makes you uneasy. Maybe for you it’s not like what people say who are about to start a new job or how are about to retire or who are trying something else that’s new for the first time.

Her: Yes, those are different.

Me: (I keep quiet, wondering if I’ve struck gold.)

Her: This is too close to home. (She pauses and I refrain from any potential diversions from what she needs to articulate.) It’s private. We shouldn’t know about what other people say. It’s like, I don’t know, it’s like catching someone in their pajamas. Like you first said, it’s a very personal time.

Me: When someone is dying, or looking back on their life as a whole, it can be very intimate. And when we hear about these conversations, we can feel very vulnerable and unprotected. Perhaps you have lost a loved one recently. I hope, though, that in the spirit that I reveal these encounters, that readers will feel accompanied and understood rather than intruded upon.

Her: (She nods and thanks me, leaving me wondering what even deeper layer would evolve if we were to speak at a future time. Had she lost someone recently? Had that person not talked with her towards the end and left her feeling alienated? Had she herself not broached important but scary subjects and regrets not having done so while she still had the chance? Perhaps she did not like my initial answer because it reminded her that she failed to make use of that intimate and irretrievable time.)

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You: (If that woman had engaged in a dialogue with you about her repugnance at finding out what other people say at the end, what other direction might it have gone?)