Gratitude and Living Your Legacy Now

photo by snowpeak

I guess I would say, as I have before in a blogpost tribute to a friend who died not long ago  that death can be a very powerful teacher for the rest of us who are still living.  What do our lives mean?  Does meaning matter in our lives?  Each of us answers that question in our own way.  I would like to defer to an expert here – Rabbi Abraham Joshua Heschel l who discusses this in the article “What Death Should Teach Us About Life and Living.”  One of the themes raised in Rabbi Heschel’s article is looking at death as gratitude for existence – how do we cultivate “heaven on earth?” He suggests that

the meaning of existence is to reconcile liberty with service, the passing with the lasting, to weave the threads of temporality into the fabric of eternity.  The deepest wisdom man can attain is to know that his destiny is to aid, to serve. We have to conquer in order to succumb; we have to acquire in order to give away; we have to triumph in order to be overwhelmed. Man has to understand in order to believe, to know in order to accept. The aspiration is to obtain; the perfection is to dispense. This is the meaning of death: the ultimate self-dedication to the divine. Death so understood will not be distorted by the craving for immortality, for this act of giving away is reciprocity on man’s part for God’s gift of life. For the pious man it is a privilege to die.

Now that we are all here, in the present – what does “today” mean to you? This Ted video is breathtaking, it has Louie Schwartzberg’s  time lapse photography of flowers, clouds and a story as well.  The story is about how we answer the question: What is a good day? His suggestion is to open your heart to all the gifts of life that this world is right now, go out and see them, let the gifts flow through you and bless others with your smile of gratitude and the presence of your open heart.  Watch it here 

I thank Joan Therese for sending this link to me.  The most exquisite pearl from this necklace?  Learn to respond as if today was both the first day and the very last day of your life.  Willa Cather’s quote comes to mind here: “I shall not die of a cold.  I shall die of having lived.”  If we die of having lived, can we not choose what to value, what to hold dear? An Albert Schweitzer quote comes to mind: “the tragedy of life is what dies inside a man while he lives.”

So  – how is it that we can live now, so that when our time comes (or we are with our dear ones and it is their time to leave) we can gracefully look back and say our farewells?  “We’re all here to do what we’re all here to do.”  The Matrix Reloaded 2003.  Each of us must discover that for ourselves.  This usually isn’t easy and it can take some time, but don’t wait until retirement to start this exercise – start small and do a little bit every day.  A little bit of what exactly?

Gratitude

Did you know that gratitude is the only “get rich quick scheme that really works?”  That’s a quote of Ben Stein’s from the book “Thanks” by Robert Emmons.  This gratitude thing is also a two-way street, according to Zig Ziglar: “the more you recognize and express gratitude for the things you have, the more things you will have to express gratitude for.”

And speaking of being grateful for each day, here is a beautiful video about Lou Cunningham about her experience with coming to grips with her impending death and her experience with hospice. Watch it here   I particularly liked her portrayal of hospice nurses and support staff as midwives to the dying.  This is a term I have used before and I think it is very appropriate.  My favorite quote that she shared was from Ralph Waldo Emerson “all I have seen teaches me to trust the creator for all I have not seen.”  Acceptance of how things are often involves trust – trusting in the face of our uncertain future.

I couldn’t write this kind of a post without quoting Dr.Seuss!  “Don’t cry because it’s over, smile because it happened.”

Kindness

This issue of the Health Care Chaplaincy e-newsletter is about compassionate end of life care for all patients and features bioethicist Stephen Post, Ph.D., author of The Hidden Gifts of Helping: How the Power of Giving, Compassion, and Hope Can Get Us Through Hard Times,   which is about the transformative power of doing good (transformative for the doer).  I wouldn’t want to leave out another favorite quote about gratitude – G.K. Chesterton’s “act with kindness, but do not expect gratitude.”

Being With Nature

Along the theme of being in nature and cultivating the sense of wonder and gratitude as Schwartzberg’s Ted video, I found this recent article in Scientific American intriguing “How Hospital Gardens Help Patients Heal

I’ll add more to this list in coming posts. . .  So if you really want to get hands-on with this kind of thing, like I suggested in an earlier post Write Your Own Obituary,  you may want to read Carolyn McClanahan’s 3/23/12 article in Forbes Magazine, the last of a four part series on end of life planning.    What she has to say about three funerals she went to in a short space of time is instructive: if you have an illness which allows you to plan for your funeral and service or celebration of life following your passing, do the planning to ensure it is something that will be part of the final chapter, a closing to your book of life, that only you can write.  May we all be able to live our lives “on purpose” and find the courage to ask, to be, and to reach out into community.

©Barbara Cashman, LLC  www.DenverElderLaw.org

Looking at the End of Life – legal, medical and emotional considerations

What is a “good death?”  Well, it depends on who answers – a doctor, a patient, or a family member.    Planning may be very helpful, for those who are inclined to talk about such matters beforehand, and the planning process can be very helpful in light of the likelihood of encountering “unexpected events.”     Who decides this, how do we make the decision and why do we make a particular decision?  I know, this is a lot of questions . . .

The legal question of “who decides” is by reference to several factors that include: the ability of the person receiving medical care to provide informed consent; whether there is an agent under a medical power of attorney (Power of Attorney for Health Care) and who is a surrogate decision maker or a proxy decision maker  capable of deciding for someone.

The medical questions tend to arise from whatever sources inform our decisions around health care at the end of our lives.  Here’s a good question – do doctors die differently than the rest of us? The answer is more often than not “yes.”  What we can learn from them?  Carolyn McClanahan’s article in Forbes posted 3/2/12 read it here  is a good start.  Here is another article that highlights the fact that many doctors shun the treatments so frequently offered to patients and their families.   This is not an issue of doctors not following their own advice, patients and families choose which options will be selected – but instead illustrates that doctors tend to be much more realistic about likely outcomes for such medical interventions and often more concerned about quality of life.  But it’s not really quite that simple – is it? Doctors as patients and doctors as doctors are two different matters.  Illustration please!

Doctors giving a diagnosis of a disease that is terminal may be reluctant to deliver the bad news.   Another sad truth is that most doctors view death as a “medical failure” and as the hospital-based internist who wrote this article observes,  many family members of ailing elders look to doctors to “use their physician superpowers to push the patient’s tired body further down the road.”    Sadly, many adult children have a very difficult time “letting go” of a parent.  This is compounding situation to an already difficult scenario.

Now for the last question – the emotional considerations of end-of-life.  Here is a list of some facts, with emotional implications.

Death is real and we each face it alone.  If we have been living our lives, charting a course of changes throughout and experiencing the full range of emotions we are lucky to experience, we may feel better equipped to face or cope with another’s final change, the transition to death.  What are some of the feelings of those who face their death with ?

“soul needs” include feeling heard by others, feeling cared for and connected to them and emotionally safe to express feelings – basically what we all want while we are alive!

“emotional needs” can include addressing any or all of the following feelings:

 

being afraid to die;

they are a burden to caregiver, family or community;

that they missed opportunities and their life has been wasted;

wanting to contact former friends or estranged family members;

anger at being cheated out of the length of their life;

perception of being lost and alone, and desperate for someone to ask how they feel;

angry at or feeling deserted by God; and

desperate to die and “get it over with.”

 

Emotions can also spring from any of the five stages described by Elisabeth Kuebler-Ross: denial, anger, bargaining, depression and acceptance.

We can say goodbye to someone and make peace with them before it is too late.

I have mentioned Dr. Ira Byock’s “four things” to say in previous posts (and I’m sure I’ll mention them again!):

Please forgive me

                                I forgive you

                                Thank you

                                I love you

It’s best to think about this goodbye, because it will be the last one said to the dying person, and it will last the rest of your life!  In the meantime, keep talking to each other and asking questions – even if you can’t answer the question . . .

©Barbara Cashman, LLC

Hospice Care and Quality of Life

What is hospice care?  the word “hospice” comes from the Latin hospitium which the Romans used to describe as a place where guests were received with lodging and hospitality and they are believed to have existed since there were efforts to care for the sick and dying.  The pioneer of the modern hospice movement in this country was Dr. Florence Wald, who joined a group that formed Hospice, Inc. of New Haven, Connecticut, the first hospice in the U.S.  [From Hospice: Past, Future and Ethical Considerations, by Amy Corcoran and Jennifer Kapo in The Penn Center Guide to Bioethics at 775 (2009: Springer).

Why is it still so difficult for many people to talk about hospice care? I think the answer is simple – it has to do with our lingering taboo against open communication about death and the dying process.  I think this taboo is long overdue for being tossed out of our culture, and that is the reason for my writing about it.  Are you wondering about how hospice care is accepted in mainstream medicine in the U.S.? More information on the Medicare hospice benefit is available here  and did you know that over 90% of hospices in the US are certified by Medicare?

What is the difference between hospice and palliative care?  Both are focused on maintaining quality of life for the patient, and treating the person as an individual with dignity, and not focusing as a set of medical challenges to be overcome.   According to the National Hospice and Palliative Care Organization (NHPCO), hospice focuses on caring, not curing, and the care is usually provided in the person’s own home if possible, and in other instances may be provided in a hospital, nursing home, or freestanding hospice facility. The stated focus of hospice care is based on the belief that each of us has the right to die pain-free and with dignity, and to provide assistance to our loved ones to allow us to do so.  Hospice care often involves helping a person be comfortable by addressing pain management as well as physical and emotional suffering, and typically a team-based approach (doctors, nurses, social workers and chaplains) provide care for not just the individual but for their loved ones as well.  In addition to Medicare, hospice care is covered under most private insurance plans.

Palliative care is the medical term used for the kind of care provided for dying people in hospice care, but it also encompasses care at any stage of an illness or condition that addresses quality of life and managing physical and emotional pain and suffering associated with the illness. Unlike hospice care, palliative care can be appropriate for persons in any stage of a disease, it is care designed to relieve symptoms without having a curative effect on the underlying disease or condition.  Both hospice and palliative care focus on a person’s quality of life, but they are not the same type of care.

Searching for a cure at any cost and advocating heroic measures often take a steep toll in terms of quality of life.  It is a good idea to have a conversation about these matters in the context of making a durable power of attorney for health care or an advance directive.  If you are wondering about doctors in Colorado who provide palliative care, the Life Quality Institute  is a local organization that provides, among other things, educational presentations about end-of-life issues has a list of such providers available here.

Perhaps you are at a loss for what to say to a dying person, how to interact with them.  I liked the advice of Joan Halifax  who urges us to look beyond our own fears and into that person’s heart.  Her book, Being With Dying (published 2009is a beautiful work, and a pdf available here has some great ideas about how to use the gift of language to express ourselves, and the gift of presence to express compassion for a dying person.

I think my favorite book right now is The Four Things That Matter Most, by Ira Byock, M.D. (2004: Free Press).  Dr. Byock wrote the Foreward to Being With Dying, and he identifies the Four Things quite simply as:

Please forgive me.

I forgive you.

Thank you.

I love you.

Of course, the first thing he says after introducing these four things is not to wait until the end of someone’s life (often we have no idea when that will be) but rather that these things apply at any time during our lives.  They, like all the wisdom from many commentators on the end of life, have much relevance for the beginning and middle parts of our lives.  Can you imagine starting a conversation with a loved one with these words?  These words are powerful medicine!

April is Donate Life Month – Are You a Registered Organ and Tissue Donor?

Have you seen the bumper sticker that says “recycle yourself?” perhaps not – it’s much more common to see the Donate Life license plates or the little red heart on your Colorado Driver’s License that indicates you are a registered organ and tissue donor.  April is Donate Life Month  – so please read on!  If you haven’t signed up yet because you still have questions about it, you can go here  to get the facts about organ donation.  Keep in mind that you should discuss with your family about the decision so they are clear about your wishes.  Why?  When you register by signing a donor card (on the Colorado driver’s license it’s indicated with a little heart with a “Y” in it just below your signature),  your family members will be clear about your wishes to donate.  If you’re a Colorado resident, click here to get information about how to register.   The Mayo Clinic has a good article here  busting some myths about organ donation, and the Donor Alliance recently released a local study conducted in Denver, Aurora and Pueblo.

A recent New York Times article is about a new policy in Israel that gives registered organ donors priority to receive transplants.   Israel’s change in policy was based was based on some unique facts of its religious population, but the cooperation of the religious communities resulted in a highly successful public awareness campaign, which swelled the numbers of registered donors.  Signing up for this is easy and you can save lives and enhance quality of life through a donation – signing up has never been easier, and this has increased the rolls of registered donors – but there’s still a long way to go.

There’s an interesting Pittsburgh Gazette article from February here and  Donate Life America, the national nonprofit that advocates for people to register as organ and tissue donors has been reaching its goals of adding donors in recent years, but it has set its goal for 2012 to register 20 million new donors.  Will you be one of them?  Talk about leaving a legacy! This is everyday heroism in action – turning tragic events into opportunities to save others’ lives.  Don’t forget to sign up!

Write Your Own Obituary

Many of us who focus our practice on estate planning encourage our clients to write an ethical will or include a testament in their will. Is it “over the top” to write you own obituary while you are taking stock of what is important to you in terms of your property, end of life decisions and choosing trustworthy agents for your durable powers of attorney?  I would say no, not at all, and many people would agree.  What do YOU want to be remembered for?

You may have had the opportunity to write a funeral notice or obituary for a deceased parent or other relative.  For many of us this was quite difficult, so if we’re already doing the “heavy lifting” of making a comprehensive estate plan – why not include the obituary as well?  A helpful tip about writing your own obituary might include “remember, it’s not a job application,” so your résumé may not be appropriate; and you may want to think deeply about what you want to be remembered for – considering all the different people and facets of your life.  Click here for some helpful tips. If this still sounds like too much for you, you might consider taking stock of your life right now (after all, dying is part of life) or giving yourself another 20-50 years and coming up with an unconventional demise – as in another helpful article.  The writer Brad Meltzer’s Ted video is very thought-provoking, you can view it here and go through his exercise.  I like his legacy-based approach, which focuses not on what you did for yourself (your education, etc.) but what you did for others.

How to get started? You can stick with the more traditional template for the obituaries and funeral notices that you typically find in the newspaper, or you can go beyond that into what Meltzer suggests – look at your personal, family and community legacies (the “who” of remembrance), and beyond that into the “what” – the actions for which you want to be remembered.  Things like what you do for perfect strangers, for other people. Are you living what you want to be remembered for right now?  This is where the transformation can take place, because each of us has the choice about how we live right now, to be remembered for your kindness, acts or charity and the like – that is true immortality.  I think of G.K. Chesterton’s quote here: “There is a road from the eye to the heart that does not go through the intellect.”  I must thank Sue for giving me this idea for the post, in an  indirect sort of way.