And a time to cry….

 

I wrote this reflection on Jan 31 ,2020, a year and a week after our son Geordie died,

At this one year mark, I #GIVETHANKS for family, friends and colleagues who supported and encouraged us, buoyed us up, laughed and cried with us, mourned with us, and comforted us. They are all excellent examples of #CompassionateCommunities and of #Griefliteracy. 

As I look back on this year, I consider that this year was a time to cry ( #TIMETOCRY ) – this was a year of sorrow. I allowed myself to feel it, embrace it, go with the flow – go with the flood of tears. This first year was my time to cry. There were times when I did not cry, and there were times when tears came frequently and in abundance. And there were times when I laughed and cried at the same time.

I like the idea that tears wash out toxic waste – that must make me pretty clean!!

The metaphor of helping large physical wounds to heal can help us understand ways to support a person to heal following loss.

The healing of large open wounds (for example pressure sores caused by lying in one position for too long) can be facilitated by:

  • allowing the open wound to heal from the base up (vs trying to suture the edges together as one would with an incision),
  • permitting the serous fluids produced at the site to moisten the wound bed,
  • providing the person with good nutrition, and
  • positioning the person to avoid direct pressure on or near the wound.

Grief is a whole person, natural process by which a person adapts to life without the person/object that has been lost.  Grief is the healing process. Like wounds, grief may be supported by:

  • allowing the wound caused by the loss to remain open, to not try to cover it up, suture it up, and fix it quickly. In other words, allowing the wound to heal from the inside out.
  • allowing sorrow to be felt and experienced and allowing tears to flow. Perhaps tears also provide nourishment to our soul.
  • providing good nutrition – providing healthy food, casseroles, salad, nourishing drinks support the griever to do the work of grieving,
  • permitting, encouraging time away, away from work, away from major stresses (compassionate leave) and decreases pressure on the whole person supporting healing.

Being open to the sorrow, permitting tears to flow, striving to eat (or provide) healthy foods, have all helped this year in healing my wounds, in grieving my loss.

Moving into year two

And now… As I move into year two from Geordie’s death…On a head level I am hoping that I will cry less and feel less sorrow in the coming months. (A counsellor smiled when I said this and suggested to me that that might not be possible. That I may not have control over that sorrow :)) But, I would like to give it a try. (Perhaps you, like the counsellor are thinking, “Well good luck with that Kath! You do not get to choose!”)

In scriptures there are references to learning that happens “in your heart and in your mind.” I sometimes joke that “my head got the memo that Geordie is just fine in this place of life after death but my heart did not yet receive the memo – hence the tears”. So, perhaps this year, I will see about helping my heart get the memo.

My plan of the moment is this: When I am talking or reflecting and find myself starting to cry, then I will ask myself if this conversation or this reflection is helpful and if I want to “go there”. I will ask myself if I want to cry or if another road might work better for me in that moment. If I want to take a different road, I will breathe deep, change my tone, speak from my head and not my heart, and continue with that conversation…. OR …. I will suggest that we change the topic or change the reflection.

One week into this plan I am finding that asking myself these questions is giving me options, and allow me an escape from the ongoing sorrow.

In defense of tears…. I need to be very clear…

It is not that I think that crying is bad, or that tears are bad! Not at all!! As I mentioned above, tears can help provide moisture and nourishment. And I am queen of crying! It is just that crying can feel soooo exhausting. And sorrow is so sad…. and for a while I would like to try something else. Geordie was all about living fully, and facing life head on. So, in the coming weeks/months I will just remember that I may have a choice to cry or not to cry, to talk or not to talk, to reflect or not to reflect…. and can chose what would be the best for me at that time.

I #GIVETHANKS for friends and family who have permitted me to cry as much as I like over this past year and they encourage me to continue to cry as long as I need/want to.

I #GIVETHANKS for those who have expressed appreciation for my sharing of my grief and have allowed me to be open in my grief. 

This posting today, is one step in this journey. And tomorrow I may be writing again about the benefits of tears, and a year from now I may write that my second year after Geordie’s death was just as sad as my first….and you my friends and colleagues will get to witness that grief has it’s own timeline…

All the best to each of you in grieving, learning, loving and living. May you be supported in #compassionatecommunities. #griefliteracy.

Hugs from a virtual distance – with hopes for more hugs in person by the end of 2021!

Kath

 

 

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!)

 

 

 


A personal note of reflection

NB: This is a personal note, shared in a professional space.

Thank you for the notes, emails, thoughts, calls and concern shared since we notified you of the death of our son last month.

I was concerned that some newsletter recipients might feel that it was too personal to share, but I am such a believer in the power of community. One nurse leader/educator wrote that she was inspired by our generosity in sharing with the learning community that we have nurtured. Thank you. I believe and have experienced that when we mourn with those who mourn and comfort those who stand in need of comfort, that we are all strengthened. I understand that the word “comfort” means, “with strength” or “great strength”. We have felt stronger in connection than we would in isolation. Thank you for sharing our burden.

Interesting, that same nurse educator commented on our commitment to optimizing end-of-life care. Over the years I have taught how “end-of-life care” can mean everything or nothing, where hospice and palliative care by definition include “care during bereavement.” Over the years I would say that we might first meet a family in the ER when their loved one has died, and the hospice or palliative care that we provide could be a link to bereavement services. Even in all the talk that I do about death, I did not contemplate that it would be us who would experience a sudden death, that it would be me who would need to be reminded of bereavement services. And it was a few weeks after Geordie died that I remembered,

Oh, VICTORIA HOSPICE – we should check out their services for the grandkids and for us!”

And, how incredible to phone, and make an appointment for myself, and an appointment for a grandson to see a dear colleague Allyson, a specialist with kids and grief. And in reaching out to Victoria Hospice, I also reached out to Virtual Hospice and their site for kids grief, and to Andrea Warnick and her podcasts and online support for kids and grief. If anyone is looking for a counsellor who provides online counselling, please let me know. And if you provide online bereavement counselling, please let me know and we will connect you.

For those who are interested in how we are doing, what we are thinking and feeling, please keep reading.

Ted would say that he feels at peace. Some of that peace comes from his belief in eternal life, in the feeling that Geordie is alright, and the hope that he will see him again. Some people express concern that he is “not grieving.” But he IS grieving. He is much more an instrumental griever, and is busy working in Geordie’s workshop, sorting his tools, repairing things that need repairing, building a tool kit for Geordie’s wife and one for the baby, and getting tools and boats and and… and… ready for sale. We were also thrilled to have some of Geordie’s bonus First Nation family join us for dinner last week, and basked in their presence and spirit.

As for me…. Well, I am much more a verbal processor…. And so… I have found healing in: good long walks with friends (one on one), the sharing of stories, experiences, beliefs, hopes, worries and frustrations, meals with loved ones, lying on the couch listening to segments of the recordings of the funeral and of the “Last Night on the Trail” (an evening of story and song), reading cards and emails that have arrived, and last night I wrote Geordie a nice long letter. Overall, I still feel very grateful that we had Geordie for 30 years. I am glad that he did not suffer. At times I am cross, irritated and mad that Geordie who cared for soooo many people was soooo careless with his own safety. I am confident that he learned well how to walk by faith, and love and serve openly and without judgement – perhaps the most important lessons in life. On a practical level, I wonder how things work in the world of spirits, and what he is up to now. I am open to your thoughts if you want to connect with me and share.

I just wrote a Facebook post about social hibernation – and would love to hear your thoughts. That will be added to the blogpost soon.

It is amazing to me to think of the “learning community” that we are blessed to be part of, across Canada, the US and Mexico. Ted and I thank you so much for your words, wishes, hopes and happiness. Please let me know what you do and do not want to hear about in this personal/professional space. I am happy to hear any feedback and advice, happy to have your questions and your comments.

Until next month,

Kath and Ted