Saying Good-bye: A Natural Death

A couple of years ago the husband of a dear friend of mine suddenly became seriously ill. A few days later it was clear he would die soon. He was being treated in the ICU of a small hospital--complete with all of the typical bells and whistles that make up that landscape: vital signs monitors, IV fluids, EKGs, bright lights, loud noises....


That is the exact scenario that can be devastating for the dying person and the loved ones: a frantic time to try to figure out the best decisions for all.


What happened next, the day he died, still amazes me.


He decided he wanted no further treatment. His condition was too serious for him to be transported home. Instead, he stayed in the ICU and the focus of care became hospice/palliative in nature.


When I arrived his favorite quilt warmed him, his dog snuggled beside him, and his family-- three generations, including some former in-laws-and a few friends, surrounded him. Nursing staff remained available, but kept a distance to allow closeness without distractions. Soft lights and quiet voices helped the ICU to become sacred space.



The end of his life was free of frantic measures to save him, replaced by honoring his wish to be allowed a natural death. His death mirrored the way he lived his life: peaceful, surrounded by loved ones.




In the 1960s (when the use of defibrillators became common practice) the term, "Do Not Resuscitate" became a commonly used physician's order to denote a decision not perform CPR as a life-saving measure.



Since the advent of hospice/palliative care, a newer term "Allow Natural Death" (AND) is now used by some health care providers.


I will soon write more about the differences in these two approaches to end-of-life.


It is possible to have your final wishes honored. Knowing what they are makes all of the difference.


Thoughtful preparation and communication helps make sure that happens.

What have you got to lose?

We have everything to gain for ourselves, and in the process we can give a powerful gift of less complicated grief for our loved ones by reducing some of the trauma.

Senses Wish List

I received a note from a reader who shared a wonderful story about being with her grandmother during her final months, as she faded away from Alzheimer's. She responded tenderly and appropriately to her grand-daughter's touch. It became a way they communicated, when other means of connecting vanished.

Several years ago an old friend called to say his mother was dying. She was alert, but weak and frail, being cared for by family and hospice staff. I had not known her well, but he asked if I would visit her. I took Gardenia scented hand lotion. To my surprise she asked if I would massage her hands as we talked.

"Is that gardenia?" she asked.

She smiled and told me about her senior prom, sixty years before. Her date gave her a gardenia corsage. It was her first time to receive flowers from a beau. The scent held a special place in her heart. She had not told that story before.

She gave me permission to touch her, which deepened the meaning of the time we spent together.

We relate to the world around us through our senses.

Sight...Hearing....Taste....Smell....Touch....

Why not create a Senses Wish List?

Picture yourself with a magic wand.

Whatever your senses desire is at your command.

What/who do you want to see?

What brings joy to your ears?

What taste lingers on your tongue?

Do you want to be touched? If so, how?

What do you want to smell?

Go deeper.....

Are you in a familiar bed covered with a wool blanket or a favorite quilt?

Do you want a bedside lamp or overhead light?

Is the TV on?

Are others talking? Are you included in the conversation, even if you aren't verbal?

What does your skin feel like?

What is the temperature of the room?

Here are some things I have shared with my family/friends, in the event I am not able to communicate to them:

• I do NOT want a TV on!! (So many times in hospitals the TV is on for distraction or to give something to talk about...that is fine for those who want it, but it would drive me nuts!)
• I hate overhead lights--especially fluorescent ones! Please, please just a small bedside lamp, which is turned off when I need to rest. Sunlight and moonlight please me tremendously!
• Music....please, lots of it! Some old rock and roll, a little Mozart, some Celtic, a bit of bluegrass, anything by Simon and Garfunkel. But the best would be live: anything my daughter Sara plays on viola, friends/family singing hymns, my grand-daughters singing anything they want, campfire songs, some guitar, ukulele or flute....it all sounds wonderful to me today as I imagine it.
• Flannel sheets--even in summer--would be lovely.
• Please moisten my lips with lip gloss. Feed me water, unsweetened drinks...especially Jasmine green tea.
• Hold my hand.
• Talk to me. Believe I can hear you.
• Know that I love you and appreciate all you are doing for me.

The task at hand is for us to understand what we want, then communicate that and give our loved ones permission to respond to our senses.

As a nurse I have been at the bedside of many dying persons--in hospitals, at home, in hospice care, with family members. The angst of family members at that time can be relieved by knowing some of these things before the final days.

It is a gift we are all capable of giving.

Find a quiet spot. Spend a few moments thinking about each of your senses. Write down preferences.

Share your discovery with your loved ones. Listen to their responses. Answer questions.

Celebrate your courage by pleasing at least one of your senses right now! See how that feels...savor the idea that you are sharing that important information with the ones who love you.

I found by doing that I am more likely to create an environment NOW that pleases me. And that makes me a nicer person to be around!

Ruthie Foster - "Travelin' Shoes"

A few years ago I was interviewed on a radio program. Between segments the host played "Travelin' Shoes" by Ruthie Foster. I had not heard it before and was immediately taken with it.

Some of you wrote and asked me about choosing music for my funeral--which, of course, I hope is years from now--so I thought I would pass along this link to "my" song. Or at least one of them. I want lots of music!!

The lyrics grab me. The music thrills me.

Gonna shout, Hallelujah, done, done my duty.

That is what I hope for at the end of my life...to go out feeling like I have done my duty.

And, since the only real known part of living is that we die, preparing for it seems to be my duty.

Here is the link to the song....

Ruthie Foster - "Travelin' Shoes"


Yes...shout Hallelujah!

Early Teachers

I decided to become a nurse when I was ten. I didn't know any nurses and had no personal experiences with illness. I just knew that was what I wanted to do and actively looked for care giving opportunities. I found several obliging animals--fallen baby birds, rabbits caught in traps, turtles hit by cars. The ones who didn't survive were tenderly buried under a nearby bridge, each given a proper ceremony and grave marker.

At fourteen I became a hospital volunteer. Dressed in our pink and white striped pinafores and starched white blouses, after school my friend Pat and I sold newspapers to patients.

"Newspaper today sir?" I called out as I entered the room of an elderly man, without legs.

"Girlie, why would I need a paper? I am no longer a producer, just a consumer. My time has come. Please let me go."

I ran to find a nurse. She explained he was a cranky old man who was demanding to be sent home to die. His wishes were being ignored as antibiotics coarsed through his body, to make him stable enough for admission to a nursing home.

She explained it was unlikely that he would ever see his home again.

His plea haunted me. I asked my mother what he meant by consumer and producer. She
helped me understand the message he clearly wanted someone to hear: he felt his usefulness in this lifetime had ended and he wanted to be free to refuse treatment and die on his terms.

That was forty years ago.

I am concerned that we have not progressed very far when it comes to honoring the wishes of a dying person.

A Living Will and/or Advanced Directive helps family members make informed decisions on your behalf. Unfortunately, health care providers--usually guided by fears of litigation--often over-ride the documents.

What can you do to make sure your wishes are honored? First, know what you want in the event you are not able to make your own decisions. Then...and this is the really, really important part--communicate that to your family, your health care provider, your clergy, your attorney. The documents provide limited directions. Additional information makes it more likely that your wishes will be granted.

Now is time to have the conversations. Whether sick, healthy, old, young....now is the time to begin the exploration.

You can change your mind at any time. As you learn more about options, accepted medical practices, and more, your opinions may change.

It is a process to prepare for death. Not an event. Today I am healthy and have certain beliefs about how I want decisions made for me if needed. If I become ill, injured or disabled, my directions to my family may change.

Initiating the conversations NOW only makes it easier as I age and my level of health and independence may change.

One thing I don't expect to change: feeling that I am making it possible to be treated tenderly, and compassionately, with my family and health care providers honoring my wishes, brings me peace and comfort today.

Now...off to marvel at another stunning sunrise!

New Beginnings: Greeting Death

Welcome to my new site!

I will use this spot to journal my thoughts and ideas as I write a book that explores the value of acknowledging our own mortality, including planning for end-of-life.

I am middle-aged, healthy and dream of becoming a great-grandmother.

This morning I watched a spectacular Lake Huron sunrise from the north shore of Bois Blanc Island in northern Michigan. I stood nearly breathless as another new day cracked through the shimmering horizon.

It would have been easy to jump ahead to all of my plans for the day--friends arriving, feasts to prepare, checking the pantry for s'mores ingredients, wondering when I would find time to write.....

In the midst of those thoughts, I listened, again, to the music I have selected for my funeral. I hope by the time it is needed the current electronic format is obsolete! But, since I have no way of knowing when I will watch my last sunrise, I take comfort in the preparations I have made.

It all starts with admitting that we are all going to die. That part alone, is a process, not an event. Some days that idea flows smoothly. Other days perhaps the idea is banished.

Keep at it. Keep trying on the notion that death is something we don't escape.

It is the common ground that binds us all.

I will include resources I find helpful. I look forward to hearing from you-experiences, wisdom, concerns, questions....all are welcome here.

What leads one to delve deeply into the topic of death?

For me, early experiences as a nurse and more recent experiences as a family member, as well as traveling to other countries, has shaped my current views and concerns about our reluctance to admit our own mortality as a culture.

So....I invite you to come along with me on this exploration.

I promise you, talking and thinking about our own death does NOT make it happen sooner.

Really. I am pretty certain of that.

For me, there is peace in imagining my death. And comfort in knowing I have a folder of information prepared for my family and friends so they will be able to create a final service for me that encourages a healthy celebration of our relationships, a time to mourn and a time to heal.