Preparing for COVID-19 because it IS personal

The COVID-19 virus is coming to a home nearby. How near? And how serious? Even if the curve is flattened, the reality is that people will get sick, and people will die. The deaths could include me or Ted. That is a reality.

This morning my dear colleague Elizabeth Dougherty shared an EXCELLENT article, This Pandemic is Personal, by Dr Ira Byock.

Ira writes that he has graduated into a high-risk group of “elderly people”. (When I checked last, I was 23 and Ted was 29, but we sneezed a few times, turned around, had a wonderful family and some great adventures, and voila, Ted is joining that group of “over 70” in the next few years and I am just a bit behind him.) He writes that 1 in 5 of elderly people who become infected do not survive.

I may not be able to control if I die, but I can control what I do to prepare. 

When I teach, we sometimes discuss the pros and cons of a sudden death vs a steady more predictable decline, a stuttering up and down decline, and a long slow lengthy decline. There is usually a group of people who like the idea of a sudden death. Then the discussion follows that sudden death is difficult for family.

On January 23, 2020, our 30 year old son, Geordie Murray, died a sudden accidental death. I know only too intimately the things that I wish we had done, could have done, would have done, had we known in advance that he was going to die. I know only too well that there are things that Ted and I can do now to decrease the burden on our loved ones, and increase their likelihood of healthy grieving, if we do die “suddenly”.

This time of social hibernation provides us with opportunities to prepare. And looking in the face of death may enrich our living.

This afternoon, inspired by Ira Byock’s article, Ted and I will sit at the table and review our will, organize our papers, share our passwords. We will talk about how we can best connect with family and friends. Then we will go for a walk on our country road and discuss ways to stay healthy.

Please read the article by Dr Ira Byock and then return and comment below on this blog. We need to talk about this.

With warmth, a great big virtual hug,

Kath

I could certainly be one of the many tens of thousands of Americans who will die in the next few months…. mainly because I’ve graduated into a high-risk group.

While all adults are at some risk, Covid-19 is far more lethal to elderly people. I’m 69 and my wife is 73. At our ages, upwards of one in five people who become infected do not survive. … Given the anticipated shortage of mechanical ventilators – we’ll need between three to 10 times the number available – and the fact that older patients who require mechanical ventilation usually go on to die, triage guidelines will likely not offer advanced life support to people my age.

…Life is a precious gift, but a fleeting one. We live each moment, but just a heartbeat away from eternity…. I go about my days, filled with meetings – now all by video conference – calmly aware that this could be the last month of my life….

My path forward is clear. In the days ahead, I’ll express my love in preparations. As a doctor, I know well what those will entail. I teach this stuff frequently….I can tell you a lot about what happens in real (this) life after we die, and how we can affect what happens.

I explained that since we’re inextricably connected to others, playwright Robert Anderson’s observation applies, “Death ends a life, but it does not end a relationship.” After you die, the people who love you will grieve. They will miss you and go through a range of emotions when they think of you; which they will do often. They may have regrets or satisfactions or both. Thought of in this light, yes, there’s a lot we can do to affect how people live in the wake of our deaths and how we remain in their lives. 

It’s now time to take those lessons seriously. My wife and I will finally complete our “in case of death” file box. We model ours on the one that my mother left for my sister and me. The day after she died suddenly, we found it sitting next to the telephone in the kitchen of her retirement condo. Ours will include our will, the title for our cars, the deed for our house (not copies, the actual documents), our bank account numbers, passwords for financial and social media accounts, along with instructions about what to do with our bodies and how to access the money we’ve set aside to do so.

Our family has started having Byock Family Visit Zoom calls so that we can visit and grow together through this period of social isolation.

I’m also using my confinement to reach out to people I care about but haven’t had a conversation with in years. Mostly it’s to let them know I value our relationship and to reminisce, but also to leave nothing important unsaid. Since no relationship is perfect, it’s a chance for me ask for forgiveness for past mistakes and transgressions. It’s an opportunity to let others know that I forgive them – any misdeeds and hurt feelings are water under the bridge – and to say thank you and I love you.

Buddhist meditation teachers and seriously ill patients have both taught me that in facing death, we can begin to live fully. I’m going to do everything I can to stay safe and survive this pandemic. If I die, I want the people who matter most to me to know how I really feel. To every extent possible, I intend to joyfully celebrate life and the people I love in the very face of death.

Ira Byock, MD, is chief medical officer of the Institute for Human Caring of Providenc

Original article by Dr Ira Byock available here

COVID-19 – living with and facing death

The COVID-19 virus is coming to a home nearby. How near? And how serious? Even if the curve is flattened, the reality is that people will get sick, and people will die. The deaths could include me. That is a reality.

This morning my dear colleague Elizabeth Dougherty shared an EXCELLENT article, This Pandemic is Personal, by Dr Ira Byock. Ira writes that he has graduated into a high-risk group of “elderly people”. He writes that 1 in 5 of elderly people who become infected do not survive. When I checked last, I was 23 and Ted was 29, but we sneezed a few times, turned around, had a wonderful family and some great adventures, and voila, Ted is joining that group of “over 70” in the next few years and I am just a bit behind him.

I may not be able to control if I die, but I can control what I do to prepare. 

When I teach, we sometimes discuss the pros and cons of a sudden death vs a steady more predictable decline, a stuttering up and down decline, and a long slow lengthy decline. There is usually a group of people who like the idea of a sudden death. Then the discussion follows that sudden death is difficult for family.

On January 23, 2020, our 30 year old son, Geordie Murray, died a sudden accidental death. I know only too intimately the things that I wish we had done, could have done, would have done, had we known in advance that he was going to die. I know only too well that there are things that Ted and I can do now to decrease the burden on our loved ones, and increase their likelihood of healthy grieving, if we do die “suddenly”.

This time of social hibernation provides us with opportunities to prepare. And looking in the face of death may enrich our living.

This afternoon, inspired by Ira Byock’s article, Ted and I will sit at the table and review our will, organize our papers, share our passwords. We will talk about how we can best connect with family and friends. Then we will go for a walk on our country road and discuss ways to stay healthy.

Please read the following article by Dr Ira Byock and then return and comment below on this blog. We need to talk about this.

With warmth, a great big virtual hug,

Kath

Original article by Dr Ira Byock available here

I could certainly be one of the many tens of thousands of Americans who will die in the next few months…. mainly because I’ve graduated into a high-risk group.

While all adults are at some risk, Covid-19 is far more lethal to elderly people. I’m 69 and my wife is 73. At our ages, upwards of one in five people who become infected do not survive. … Given the anticipated shortage of mechanical ventilators – we’ll need between three to 10 times the number available – and the fact that older patients who require mechanical ventilation usually go on to die, triage guidelines will likely not offer advanced life support to people my age.

…Life is a precious gift, but a fleeting one. We live each moment, but just a heartbeat away from eternity…. I go about my days, filled with meetings – now all by video conference – calmly aware that this could be the last month of my life….

My path forward is clear. In the days ahead, I’ll express my love in preparations. As a doctor, I know well what those will entail. I teach this stuff frequently….I can tell you a lot about what happens in real (this) life after we die, and how we can affect what happens.

I explained that since we’re inextricably connected to others, playwright Robert Anderson’s observation applies, “Death ends a life, but it does not end a relationship.” After you die, the people who love you will grieve. They will miss you and go through a range of emotions when they think of you; which they will do often. They may have regrets or satisfactions or both. Thought of in this light, yes, there’s a lot we can do to affect how people live in the wake of our deaths and how we remain in their lives. 

It’s now time to take those lessons seriously. My wife and I will finally complete our “in case of death” file box. We model ours on the one that my mother left for my sister and me. The day after she died suddenly, we found it sitting next to the telephone in the kitchen of her retirement condo. Ours will include our will, the title for our cars, the deed for our house (not copies, the actual documents), our bank account numbers, passwords for financial and social media accounts, along with instructions about what to do with our bodies and how to access the money we’ve set aside to do so.

Our family has started having Byock Family Visit Zoom calls so that we can visit and grow together through this period of social isolation.

I’m also using my confinement to reach out to people I care about but haven’t had a conversation with in years. Mostly it’s to let them know I value our relationship and to reminisce, but also to leave nothing important unsaid. Since no relationship is perfect, it’s a chance for me ask for forgiveness for past mistakes and transgressions. It’s an opportunity to let others know that I forgive them – any misdeeds and hurt feelings are water under the bridge – and to say thank you and I love you.

Buddhist meditation teachers and seriously ill patients have both taught me that in facing death, we can begin to live fully. I’m going to do everything I can to stay safe and survive this pandemic. If I die, I want the people who matter most to me to know how I really feel. To every extent possible, I intend to joyfully celebrate life and the people I love in the very face of death.

Ira Byock, MD, is chief medical officer of the Institute for Human Caring of Providence health system. His books include Dying Well and The Best Care Possible.

— Published on March 19, 2020

 

Is this the perfect time for you to read, review and reflect on dying and the “what-if” questions?

Daily we learn more about the COVID-19 virus. We hear about outbreaks, number of cases and number of deaths on a global and local level. The topic of death is on the table in a very real way.  Death due to COVID19 is a reality for those who are very frail and vulnerable. People living with multiple serious illnesses AKA co-morbid conditions are at high risk. And to share what seems like a secret, whether we die from COVID19 or something else, now or later, we all will die.

So…. if you have the luxury of hibernating and reflecting and are looking for a most meaningful project, I highly recommend that you:

  1. Read Dr Atul Gawande’s book, “Being Mortal”
  2. Review the Serious Illness Conversation Guide
  3. Engage in Advance Care Planning, and
  4. Engage in conversations!

Read “On Being Mortal” by Dr Atul Gawande

Dr. Gawande will help you understand the challenges of dying in a health care system that aims to cure all.

In his book, Dr. Gawande clearly identifies the challenges of dying in a death-denying society. Move this incredible, engaging, easy to read book to the top of your list. It may help you to shift your thinking and see all health care decisions from a different perspective. Consider your health, consider the health of those you care for and care about. What questions does this bring forward for you?

Review the Serious Illness Conversation Guide

Dr. Gawande and team at Ariadne Labs developed the “Serious Illness Conversation Guide” to assist health care professionals to talk with patients and family members about the individual, their illnesses, what to expect, and prepare them to make informed decisions. Read through the guide, consider your own health, the health of those you care for. What questions do you want to ask of the health care team? What do you feel inspired to do/say/consider?

This may lead you to consider, “If I were suddenly to become critically ill, what would my priorities be? My goals? What are my fears about death? What is most important to me”

Engage in Advance Care Planning

Advance Care Planning will help you develop a clearer understanding of what you might want as your health declines, and will help you assign a Substitute Decision Maker who will speak for you and advocate for you, if and when you are no longer able to speak for yourself. Going through the process of your own Advance Care Planning will help you develop a deeper understanding of the challenges and decisions that the person and family must address.

If you are caring for a friend or loved one, work with them to engage in these conversation,  to help them to identify determine the care they want and do not want. You may want to bring in member of the health care team to help facilitate the conversation.

Know that Advance Care Planning conversations are not optional; they are essential. With current technology, it is possible to record the conversations in an audio format as well as written record.

There are many excellent resources to help with Advance Care Planning discussions. Of course, there are the fun “Care Planning Cookies” available  through Life and Death Matters ? to stimulate conversations about care giving preferences.

Michelle Pante and Reena Lazar are cofounders of WILLOW, and offer resources for exploring your    Offer a workbook to help you explore death and what it means to you.

The SPEAK-Up resources from the CHPCA, are part of their Advance Care Planning program. In the US, one of the favorite resources is Five Wishes.  The Chinese American Coalition for Compassionate Care created a card game based on the “Five Wishes” go to “Heart to Heart Care Deck” The card game, like the Care Planning Cookies, stimulates discussion while having fun.

Engage in conversation

Social hibernation does not mean social isolation. As you read, review and reflect, engage with friends, family and community in conversation. Use technology to connect and record your thoughts.

Speaking up now will help you know what you want, will help others know what you want, and will help the health care team to provide care that best honours who you are.

Do you have a favorite resource that you use? Please share!
Do you have a related experience or story? Please share!

Sharing – my birthday surprise from friends who figured that I needed to engage in conversation!!

Thanks to my very very dear friends who decided that the best way to celebrate my birthday was to paint an image of me wearing a thong on my birthday cake! (The artist is WENDI! The co-conspirators are Bonnie and Frankie!)

 

 

 


Reflections on “social hibernation”

As the world responds to the COVID-19 virus, as travel and group gatherings are discouraged and conferences are cancelled, Ted and I are hibernating. There could not be a better time for us to be called “closer to home”. We are so grateful that we were able to hold Geordie’s funeral at a time when people shared emotions and tears and hugs freely and without concern for spread of germs.

On the news we see photos of crowds in the stores, empty shelves, and hear of people trying to prepare at the last minute for who-knows-what. I hear on a quieter level, of people who have prepared in advance for earthquakes, power outages and other emergencies. And I think of parents who no matter how prepared they are, are facing huge changes with school, planned activities, caregiver arrangements and who do not know what changes might be announced in the coming day, while managing the chaos of kids. I also think of those who are less mobile, including the frail and elderly who may or may not have community to reach out to. And I think of those who are homeless (AKA vulnerably housed) who may at the best of times find it difficult to survive – especially on a cold windy day like today in Victoria.

We, as Canadians, have been asked to respond by self isolating and “social distancing.” To stay home and not go out to socialize, travel or do activities. I’m viewing this instead as “social hibernation” and that fits well for me, as the winter holidays often provide opportunities for snuggling in, reflecting, preparing and planning for a new year. Perhaps with this extended time in social hibernation, those “to-do” lists that never seem to get done, will find their way to the top of the pile. For Ted and I, our days and nights will include the work of grieving (i.e. lying on the couch and pondering).

My question for you….in a time of social hibernation, how can we connect with one another?

My immediate thoughts include long walks outside, meeting for a cuppa something via zoom or facebook or other group chats.
Tomorrow we are planning a group get together that will include the sharing of an inspiring quote – and see where the discussion goes from there.
We have decided not to drive to Alberta, and so we are also planning to meet online with a few of our kids to enjoy a cuppa hot chocolate together and share some memories or discussion that will center on Geordie and how we are all doing.

What are your ideas?