Being with a Dying Person - A Sacred Event

For me when I was a medical student, a resident physician or a physician in practice and now as a bereavement professor, one of the most sacred experiences was that of being with a person during their final stages or life. Being able to walk with someone through the dying process is one of the most challenging and sacred of experiences.

This is the reason that I've selected the topic of Being with a Dying Person as the another topic for Sacred Life Sundays.

Sharing the End of Life
Sharing the wonder and the terror of being on the edge of being is bearing a witness to a person's final journey. Walking with a loved one or a patient on this sacred final path is a very extraordinary and intimate experience, as we learn the importance of just being.

Former New York Times book review editor and essayist, Anatole Broyard offered some wise first-hand insights about being with a person at the end of life in his essay "Doctor Talk to Me." In this article he encourages people, doctors in particular, to open their hearts to the dying patient with a reminder that...

Not every patient can be saved, but his illness may be eased by the way the doctor responds to him...
In learning to talk to his patients, the doctor may talk himself back into loving his work.
He has little to lose and much to gain by letting the sick man into his heart.
If he does, they can share, as few others can, the wonder, terror and exaltation of being on the edge of being.

Being a Healing Presence
Often the most difficult role of a physician or a family member is knowing when to "let go" with someone at the end of life and just "to be." We may feel as though we have little to offer the dying patient, yet these wise words from Anatole Broyard, a dying patient, can help us to realize that illness may be eased by the way the doctor (or the family) responds to the patient.

There is a healing power in human presence in simply being.

Just Be

Be yourself and relate person to person.
Be ready to listen again and again.
Be respectful.
Be aware of feelings and non-verbal cues.
Be present.
Be comfortable with silence.
Be human.
Be genuine.
Most of all--Be there.

© Kirsti A. Dyer, MD, MS

Sharing the Silence
Dr. Rachel Naomi Remen offers the following description of being and sharing true intimacy.

We experience intimacy not by sharing words,
but by sharing the silence.

In the end of life what matters, what makes the difference, is taking the time to slow down, to hold a hand, to give support, to just be and to share the silence.

Sacred Life Sunday
This post is one of the Celebrating Sacred Life Sundays Post, a weekly celebration of what is sacred and special in our life. See the first post on Sacred Life Sunday to read more.

______________________________

Sources:
Dyer, K. Healers and Healing. July 1998. At: http://dying.about.com/od/poetry/a/healers.htm
Ostaseski F. How to be with a Dying Person. On Our Own Terms. 2000, Educational Broadcasting Corporation/Public Affairs Television, Inc. At: http://www.pbs.org/wnet/onourownterms/articles/withperson-tools.html
Being a Supportive Friend to A Grieving Person, North Central Florida Hospice, Inc. 1996. http://www.journeyofhearts.org/jofh/kirstimd/friend.htm
Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patient who suffer. WJM 1999:171:260-263. At: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1305864
Broyard A. Doctor Talk to Me. New York Times. August, 26 1990.

Image Source:
Julio Cid. Being Hands. Used with Permission

Coping with Sudden Death - A Series of Recent School Shootings

In the past few weeks we've seen another series of school shootings in California, Florida and now in Illinois. Friends, Family, Schools are left trying to figure out how to help the survivors cope with these sudden traumatic losses.

The Sudden Death Shatters Our World in an Instant

A sudden death is one that occurs without any forewarning; it is unanticipated.

A traumatic death, in addition to being sudden, can also be violent, mutilating or destructive; the traumatic death can be random and/or preventable or may involve many deaths.

The sudden, accidental, unexpected or traumatic death shatters the world as we know it. It is often a loss that does not make any sense.

In an instance life is forever changed. Survivors (those left behind) are left with the knowledge that life is not always fair and that sometimes bad things happen to good people. The sudden, traumatic death leaves the survivors feeling shaken, unsure and vulnerable.

Each type of sudden loss, whether a shooting, a heart attack, a car accident or a terrorist attack, leaves survivors bereaved, dazed and vulnerable trying to make sense out of the insensible loss. As survivors of sudden or traumatic death begin to process the loss, they experience a grief response.

After a Sudden Loss - Focus on the Basics

When facing the aftermath of a sudden death, it is important for the survivor to take care of him/herself following a sudden loss by focusing on the basics the body needs for day-to-day survival:

• Maintain a normal routine. Even if it is difficult to do regular activities, try to anyway.
• Putting more structure into a daily routine will help one to feel more in control.
• Get enough sleep, at least plenty of rest.
• It may be helpful to keep lists, write notes, or keep a schedule.
• Try and get some regular exercise. This can help relieve stress and tension.
• Keep a balanced diet. Watch out for junk food, or high calorie comfort food binges.
• Drink plenty of water.
• Drink alcohol in moderation. Alcohol should not be used as a way of masking the pain.
• Do what comforts, sustains and recharges you.
• Remember other difficult times and how you have survived them. Draw upon the inner strength.
• Take it one hour at a time, one day at a time.

The Unanswerable Whys

Following a traumatic death or sudden loss, people are left wondering "Why?" It is difficult to find a good answer to this unanswerable question.

When faced with the unanswerable “Why” in the past, I have found the thoughts of Rabbi Earl Grollman on this topic to be very helpful in coping with this most difficult question. He says:

“Why must life be one of sorrow?” “Why?” There are no pat answers. No one completely understands the mysteries of life. Even if the question were answered, would your pain be eased?

There is no satisfactory response for an unresolvable dilemma. Not all questions have complete answers. “Unanswered Why's” are a part of life. The search may continue, but the real question might be “How [do I] pick up the pieces and go on living as meaningful as possible?”

Sources:
Dyer KA. 2002. Dealing with Sudden, Accidental or Traumatic Death. Journey of Hearts.
Dyer KA. 2001. 9-11: United in Courage & Grief. Ways of Coping then Helping. Journey of Hearts.
Dyer KA. 2001. 9-11: United in Courage & Grief. Why does my heart Feel so bad? Journey of Hearts.
Grollman RA. Why? Journeys Newsletter. Washington D.C.: Hospice Foundation of America, March 2001, p. 3.

Image Source: Broken Egg. Modified Microsoft Image.

CarePages - Connect, Share, Care

Journey of Hearts has paired up with CarePages to give our viewers their own place online to create a page to connect, share and care during challenging times. Visit the custom Journey of Hearts CarePages to get started.

What is a CarePage?
A CarePage is a personal, private web page that can be used by family and friends to stay connected and enhance communication when a loved one is facing a long-term illness or at the end of life.

Using a Care Page
Creating a CarePage can be a way of generating support, providing information and updates easily. I think the greatest benefit may be that of holding the loved one in everyone's thoughts so they can do better and get healthy, or feel the love and support of family at the end of life.

You can use our custom Journey of Hearts CarePages to keep family connected when a loved one is facing a challenging illness, or at the end of life.

For More Information

• Journey of Hearts CarePages
  
• Squidoo Lens on CarePages

New Quotes of Grief, Loss & Comfort - A Reminder to live in the Present

From time to time I will be adding additional Grief, Loss & Comfort quotes to the site, to enlarge our collection. Here is one that I came across recently, a reminder how rapidly death can arrive, and to focus on the present moment.

Death can come at any minute, in any way.
We do not know what is in store tomorrow, or,
whether there is a tomorrow, or even a tonight!
But still, we have the golden present.
Now we are alive and kicking.
What should we do now? Love all, serve all.

Swami Satchidananda

For More Grief, Loss & Comfort Quotes see our rotating quotes at the bottom of the page.

Dyer KA. Grief, Loss & Comfort Quotes *Check out the bottom of the blog* http://grief-loss-info.blogspot.com/2007/07/new-blog-feature-grief-loss-comfort.html

More on Helping Children Cope if Harry Potter Dies

Apparently I had a lot of thoughts on the upcoming Harry Potter Book, "Harry Potter and the Deathly Hallows" and the possible impact a death of any of these fictional character friends may have on young readers. As parents we'd like to shelter our children from the pain of dealing with a death.

More on Helping Children Cope with the Death of a Friend
After writing yesterday's post on Children are likely to Grieve Over Any Deaths in the Latest Harry Potter Book for this blog more from the position of a grief and loss expert, I contributed some additional thoughts on Helping Children Cope if Harry Potter Dies for the Type-A Mom site, more from the position of being a concerned parent, who is also a grief and loss expert.

This newest blog includes more reasons for concern, why the death of Harry Potter is a big deal along with the Tips for Helping Children Deal with the Death of a Beloved Fictional Friend.

Helping Children Cope with Death and Dying
Perhaps the important thing for parent to remember in the likelihood that several of these characters dies is to try and support your child and help him or her cope with the loss of a friend.

Much as we might like to shelter our children from the realities of death and dying as a parent, the reality is death is a part of life. Last spring, my daughters had to cope with the death of their grandfather.

Read the New Article and Bookmark it
Visit the Type-A Mom site to read Helping Children Cope if Harry Potter Dies.

While visiting the Type-A Mom site, be sure to Digg the article, Babblz the article and add it to your favorite bookmark site.

Source:
Dyer KA. Helping Children Cope if Harry Potter Dies. Type-A Mom Site. July 19, 2007.

Photo Source: Joel Terrell. A Mother and Son Moment. Royalty Free Use.

Children are likely to Grieve Over Any Deaths in the Latest Harry Potter Book

There have been hints that two of the major characters in Harry Potter, including possibly Harry himself, will be killed in the last of the Harry Potter books, "Harry Potter and the Deathly Hallows" due out on Saturday July 21, 2007.

Author J.K. Rowling is expected to kill off two characters in this last book as a way to indicate to readers that the Harry Potter series is finally over. There is a concern that young fans of Harry Potter and his friends may have difficulties coping with the death or deaths if their favorite characters are killed off.

Is it Death for Harry Potter?

Deaths of Public Figure can become Teachable Moments
When Steve Irwin was suddenly killed in September last year I was the Death, Dying and Bereavement Guide at About.com. I wrote about talking to a child about the death of the Crocodile Hunter, as being a teachable moment* for parents to share with their children.

With J.K. Rowling's plans to kill off one or more of the Harry Potter characters another teachable moment* may emerge--an opportunity for parents talk with their children about death. It is likely that many children will be saddened by the loss and truly grieve any of the death(s) in the Harry Potter book.

These teachable moments* can be an excellent opportunity for parent to explain the dying and death to a child. In the latest case, parents will probably need to address the death(s) of one of their "friends," the Harry Potter characters.

*A teachable moment is a moment of educational opportunity: a time at which a person, especially a child, is likely to be particularly disposed to learn something or particularly responsive to being taught or made aware of something.

Coping with the Death(s) of a Harry Potter Character(s)
For avid Harry Potter fans it may be very difficult for them to cope with the death of one or more of their characters. Even though parents may take the realistic view that “it’s just a book” the Harry Potter characters are very real to children, and they may be saddened and distressed. Parents, counselors, teachers, psychiatrists and children’s camp leaders are anticipating a lot of teary fans after reading the final book.

Children can experience different emotions in response to a death, even the death of a fictional character. Some will become sad, many will cry, other will become distressed. Other children may not appear to be distressed, rather will take the deaths in stride (or more likely may not want to talk about it). These are all normal reactions to a death.

Depending on the way the death(s) occur, many children may be confused disappointed or distraught. Parents should be sure that they know about how the deaths occurred, in order to answer questions. Read the book or check the fan sites for details.

How to Help Children Cope with a Death
According to child and adolescent psychiatrist Dr. David Fassler:

The death of a well-known public figure can be hard to comprehend or accept. Understandably, some young children may feel sad or confused.

As parents, teachers and caring adults, we can best help by listening and responding in an honest, consistent and supportive manner.

When trying to help a child cope with death it is helpful to:

• Know what is going on with the death (In the case of Harry Potter, read the book or synopsis).
  
• Answer his or her questions about death in simple terms.
• Not minimize the loss.
• Listen to your child.
• Be supportive if the child is emotional. (A normal response.)
• Be supportive if the child is not emotional. (Also a normal response.)
  
• Be available when the child is ready to talk.
• Let your child have time to grieve, be upset and talk about what they are experiencing.
• Give your child different ways to express the loss--verbal, written, creative, musical and physical.

Additional Resources to Help Children Cope with Death

• Helping Children Cope with Death - By Kirsti A. Dyer MD, MS, FT from Journey of Hearts.
• Talking to Children About the Death of a Public Figure - By Dr. David Fassler, from the American Academy of Child and Adolescent Psychiatry.
• Helping Children Cope With Loss - A shorter article from the National Mental Health Association
• Talking To Children About Death - An extensive article from Hospice Net, based on a Key Not Speech by J.W.Worden PhD
• The Child's Loss: Death, Grief and Mourning - From Dr. Bruce Perry of the ChildTrauma Academy.
• Helping Children Cope with Death - Online version from MADD (Mothers Against Drunk Driving). Also available as a downloadable PDF File brochure.
  

Sources:
Meltz BF. What is a parent to do if Harry or Ron dies? July 18, 2007. The Boston Globe.
Dyer KA. Talking to a Child about the Death of Crocodile Hunter, Steve Irwin ~ A Teachable Moment. September 10, 2006. Dying.about.com
Definition. Teachable Moment. Encarta® World English Dictionary [North American Edition] © 2007.

Photo Source: Harry Potter and the Deathly Hallows. The Leaky Cauldron. http://www.the-leaky-cauldron.org/

Give the Gift of Life through Organ Donation - A Way to Creatively Cope with Grief

(Blogcatalog asked all members to blog today, Wednesday July 18, in the first world wide blogger social campaign to raise awareness about organ donation and the issues surrounding organ donation. Here is the entry for the Grief, Loss & Transitions Blog from Journey of Hearts. In addition to providing information on becoming an organ donor, I have also included information on how the families of the organ donors cope.)

Organ and tissue donors leave a miraculous legacy. They are living proof that death can bring life, that sorrow can turn to hope, and that a terrible loss can become the greatest gift of all. Every day they lead us on a journey of hope, renewal, and transformation.

National Organ Donors Memorial

Creatively Coping with Grief - Remembering Shannon
I have been inspired for years by the courage demonstrated by Jan and Jules Broom following the unexpected death of their daughter Shannon.

Bookmark Therapy: Jan and Jules created bookmarks from a combination of Shannon's Journal entries, poetry and artwork. They have given out 1,000's of bookmarks over the years.

I keep one of Shannon's Butterfly and Dragonfly bookmarks (shown in the photo) on my desk.

Angel Garden Tree: On Shannon's first birthday in Heaven, Jan and Jules created an Angel Tree in their garden. They laminated photographs of people who had blessed their lives and attached them to a fig tree with wind chimes.

Their Angel tree has grown to include others in the remembrance and celebration of Heaven Days and Angels.

Their story of coping with Shannon's death has been featured in the Healing the Spirit book as "Shannon Lives On." This book looks at nine stories of transformation in families whose loved one became an organ donor.

---

More Gift of Life Stories to Inspire
The Gift of a Lifetime - Explores the stories of people awaiting organ transplants and puts faces on the topic of donation. The courageous people share their stories about the gift of a lifetime. At: http://www.organtransplants.org/

The Online Memorial Quilt - This online memorial gives visitors the chance to create and share an online commemorative quilt square for their loved ones.
http://www.healingthespirit.org/memorials/onlinequilt/index.php

More Donor/Recipient Stories to Inspire - This collection of stories is from the Organ Donor Site. At: http://www.organdonor.gov/stories/

National Organ Donors Memorial Website - This Website hosts a collection of online tributes to organ and tissue donors created by visitors to the site to honor a loved one. At: http://www.donormemorial.org/

---

How You Can Become an Organ Donor?
While the Death, Dying and Bereavement guide at About.com, I wrote a series of helpful articles with information on becoming an organ donor. The steps are pretty easy:

• Declare your wish on your driver's license.
• Join the donor registry if your state has one.
• Include organ donation in your advance directives, will and living will.
• Most important - Tell your family. They can be your advocate should you become a donor candidate and will be the ones doctors come to for consent.
• Tell your physician, attorney, faith or religious leader, and friends.
• Complete a donor card and carry it in your wallet.

The main thing to remember it that you need to let your family know of your wishes to donate. Be sure to read the pages on:

• Get Your Organ and Tissue Donor Card
• Make Your Wishes Known About Organ and Tissue Donation

Others Blogging to Raise Awareness about Organ Donation

• I am. Are you?
• Haiku on Organ Donation
• One Family's Perspective on Waiting for an Organ
  

More about the BlogCatalog Organ Donor Awareness Challenge

• BlogCatalog Organ Donor Awareness Challenge!
• Make History on Wednesday

Sources:
Dyer KA. Organ Donation. October 2006: http://dying.about.com/od/livingafteradeath/ss/organdonate.htm
Health Resource Service Administration (HSRA). Make Your Wishes Known. http://www.organdonor.gov/

Coping with Loss - What Can I Say When a NICU Baby Dies?

In the past several years my area of expertise based on life experiences has been expanded to include the role of NICU Parent.

I have also shifted my focus to being a professional health educator. One of the main areas of education for me is in the often overlooked areas of grief and bereavement.

My educational expertise has also expanded to include the perspective of a NICU parent. With this new area of expertise, there may be some overlap with the NICU Parent Support site, and sometimes when the Losses discussed are NICU Losses.

Coping with NICU Loss
Today a posting by NICU Doctor on "Loss" in the NICU caught my eye. This is an abbreviated version of the comments that I left.

While my specialty is Internal Medicine, I have also done postgraduate training in grief, loss and bereavement with a special interest in hospice and end-of-life care. In addition, I am a former NICU parent.

Thankfully, we did not have to face the decisions with end-of-life care with our daughter. Since this experience I have explored grief and bereavement in the NICU from the dual perspective of a NICU parent and a grief and bereavement educator.

I recently posted a blog on What can I *say* when a NICU baby dies? for friends and family with a reminder that "words can provide a source of solace, hope, comfort and reassurance--emotions much needed during the grieving process."

Here is the link from the NICU Parent Support Site Blog with suggestions for what people can *say* when a NICU baby dies. Some of these comments are generic enough to work for other people in other situations when a loved one has died.

Sources:
Dyer KA. June 2007. What can I *say* when a NICU baby dies? Neonatal Parent Support Site.
Neonatal Doc. July 2007. Loss. Neonatal Doc. http://neonataldoc.blogspot.com/2007/07/loss.html