Greeting Death: Mindful Living in Sickness and in Health

Slow Down and Live

2012-02-17T06:45:00.000-07:00

On muggy Missouri summer nights, when it was too hot to be inside, my sisters and I played our favorite game. Kathe may have invented it. As the oldest she liked to organize us. It might have been my idea since I remember being influenced by my Dad's tendency to do things slowly and intentionally. If Kristy made it up there would have been singing involved. Kelli watched from her playpen.

We would hide behind the big rock near the end of driveway and wait for a car to come by, while lightening bugs danced above the field grass and illuminated the dust hanging in the air. To pass the time we told scary stories: An old woman lived alone and found a stranger in her attic... Late one night there was a knock at the door and a man covered with blood...

When we heard the crunch of tires approaching, we crouched behind the rock, grabbed hands...quietly counted...1..2..3..then jumped up and shouted,

"Slow Down and Live!"

Our game ended when an elderly neighbor claimed he nearly had a heart attack and did not want to die in front of the Dannar girls. Our apology to him included a basket of cherry tomatoes from our garden and a promise not to do it again.

That gravel road is now a fast-paced street, with a constant flow of traffic. Car lights and street lights pierce the night sky, making lightening bugs invisible. The open fields were divided, subdivided and parceled into tiny yards. Air-conditioning results in closed windows in cars and houses.

Slow Down and Live resurfaced after forty years when my sister Kathe was diagnosed with terminal cancer. As adults we all returned home frequently to spend time together again. During the year of her illness we reminisced about our rural upbringing and wondered why we felt driven to deliver that message, when our life was so slow-paced and simple.

Life is noisy and fast-paced;often chaotic and too stimulating. A quiet, peaceful spot may not be right outside your door. But, it is out there somewhere, waiting for you to claim it as yours.

My daughter, Sara, enjoying a quiet moment

My current favorite spot to reflect, meditate and drink in nature is a strip of desert near our home in Tucson. I often walk there early in the morning, repeating my mantra....

Slow down and live.

Rose Knows Holidays

2012-02-02T10:07:00.000-07:00

Happy Groundhog Day!

And now for something completely different! Today my grand-daughters, Fern (7) and Rose (5) celebrate Groundhog Christmas, which was born three years ago when Rose attempted to explain Groundhog Day to her older sister.

That hilarious conversation, relayed to me by my wonderful daughter, Sara, inspired this poem.

Learn something today from a child. Your life will be enriched.

Rose Knows Holidays

Fern climbed out of bed, “Happy New Year Sister Rose!”

“Oh my goodness”, Rosie cried, “I must find my holiday clothes!”

“Happy New Year to you…Happy NewYear to you", Rose sang and played.

She lit the candles on the cake andserved everyone lemonade.

“I know you love Valentine’s Day”, Fern saidto Rosie in the bath,

“Oh, my goodness!”, Rosie cried,”We’ll need to make a path!”

She grabbed the flag and led theparade passing by

Overhead grand fireworkscompletely filled the sky.

“Soon we’ll hide the Easter eggs”, Fern announced one day to Rose.

“Oh my goodness!”, Rosie cried, “I know what I will be! Just what do you suppose?”

She smiled, and thought for abouta minute and a half,

She disappeared, then reappeared,in a hat and silly mask.

“I can’t wait for fireworks!”,Fern said to Rose on the swing.

“Oh, my goodness!”, Rosie cried,“I do hope I get a wing!

She smacked her lips and rubbedher tummy,

“Turkey with all the fixin’s, nowthat is what I call yummy! “

“Rose, our September birthdays are next in line,wont’ that be fun?”

“Oh my goodness!”, Rosie cried, “Yes! I think I’m almost done! “

Red, orange, green, yellow andblue,

“I colored all of these eggs Fern;the best one is for you!”

“What should I be for Halloween?” Fern asked Rose one day as they danced.

“Oh my goodness!”, Rosie cried, “I know, I know, just letme take a chance!”

Soon the roomwas filled, from the ceiling to the floor,

“I love you”said the big red hearts that hung down from the door.

“What are youthankful for this year?” Fern asked in November.

“Oh, mygoodness!”, Rosie cried, “Now I remember!”

She grabbed thebells and whistles, and sang a little tune,

“For oldacquaintance be forgot”…. she danced around the room.

“Go to sleepdear sister Rose, but listen for the reindeer,

“Oh, mygoodness!”, Rosie cried, “I can’t believe it’s been a year!”

In her big strawhat and sunglasses, she sang out all of her wishes,

“If Santa seeshis shadow, we’ll have six more days of Christmas.”

Me and my wild and wonderful girls.....

First Time

2012-01-14T13:00:00.000-07:00

Happy New Year, and welcome to my first posting in 2012....

This experience, long before I became a nurse, has stayed with me and influenced my fascination with an amazing part of life--the end, as we know it.

First Time

“G’mornin’ Doodler. Ready for another day of saving lives?” Dad offered me toast, then the weatherreport, fresh from the gray transistor radio on the pine kitchen table. He poured milk in his coffee, “Mostly sunny,high seventy-two, twenty-percent chance of an afternoon shower. Not bad for October.” I felt guilty that theone day he could sleep in, he was up to drive me to work. His morningweather reports, delivered in his quiet, thoughtful manner, were his way to send his four daughters off each day, properly prepared for the outsideworld.

I hatedgetting up before dawn, especially on weekends. I hoped the eight hour day shift--on fourhours sleep--would be an easy one. Daddropped me off under the red canopy at the county hospital as the sun scaledthe treetops. He pointed to the thirdfloor nursery windows and reminded me I was born there, seventeen years ago.

“RememberDoodler, if it’s worth doing, it’s worth doing right.”

“Thank Godfor the day shift! It’s been a hell of anight.” The nurse’s aides, uniformsstained with blood and vomit, were exhausted and eager to leave. I worked with that group all summer, and thenswitched to the day shift when school started. I knew a bad night on the geriatric unit could lead to a challenging day.I crossed my fingers.

The kitchen staffpushed food carts down the wide halls and delivered breakfast—oatmeal andpoached eggs. The housekeeping crew moppedthe tiled floors and banged trash cans together as they emptied them. Nurses and doctors made rounds.

I was sureeverybody wished they were somewhere else. I wanted to turn the clock back twelve hours and be at the Sky-Hi drive in, fooling around with Donin the backseat of his ‘66 Chevelle, while Bonnie and Clyde robbed banks, thendied together.

“You’regoing to do special duty today.” Thecharge nurse said. “Only one patient. Just stay with her and try to keep her quiet. She was loud and restless all night. No one near her got enough sleep.”

“Should I batheand feed her?” I asked.

“No, sheprobably won’t live through the shift. Justbe there with her.” I had never sat witha dying person before and suddenly I wished I had the typical assignment of sixpatients to bathe, feed and exercise. My stomach grumbled as I entered herroom. I longed to be at the breakfasttable with Dad. I reviewed everything the charge nurse told me:she is actively dying, her family has been called, and she shouldn’t have anythingto eat or drink. Just stay with her andkeep her as quiet as possible.

“Hello. I’m your aide today. Are you comfortable?” No response. What astupid question! She’s dying. Of course she is not comfortable. I realized I had no idea what to say ordo.

I did notwant to look at her damp, pale face, with her gray hair matted across herforehead. The side rails rattled as her small,frail body thrashed. The sound of her head against the metal made me wince andfeel nauseous. I snatched flannelblankets from the chair and padded the rails. She grabbed my hands and clutched them to her chest. I recoiled at her rotten breath and eyesstaring at something only she could see, as she brought my face close tohers.

“J. E. C. T.N.E. A.” In a raspy whisper she was telling me something, by spelling it out. Herdry mouth struggled to produce each sound. “P.L.E.T.”, she continued to gripmy hands hard. When I managed to pullaway, I turned on the call light to summon help.

The chargenurse arrived and jokingly asked me if I had seen a ghost. “She’s trying to tell me something. I got scared.” The nurse chuckled and told meabout her early experiences with death. She checked her pulse and breathing, and whispered, “It won’t belong. Call me when she’s gone.”

I pulled achair close to the bed and began to listen again, this time with a paper towelin hand to write down the letters as they came.

She grabbedmy hand again, this time with less intensity.

“R. C. O. M.P.L. E. T. I. O. N.P.R.O.”

I pulled myhand away and ran to the door. I yelledfor the nurse and stood there shaking, holding the paper towel until she appeared. We walked together across the room.

She wascurled on her side, with her hand resting on the flannel blanket, where my handhad been. No thrashing. No pulse. No respirations.

I stood bythe window; outside the sun continued to rise, offering warmth and light. Notbad for October.

I looked atthe paper towel in my hand and read, PROJECT NEAR COMPLETION.

Tackling Barriers, Trying New Things

2010-12-31T05:55:00.001-07:00

:Does time really move faster as you age? It seems like my September birthday was a month ago. I apologize to those who have asked for updates on my quest to tackle barriers and try new things as I prepare for my 60th birthday. Perhaps the time has passed quickly because I have been so busy....

September: If you are a woman and have not attended the annual Women's Week at Deer Valley YMCA camp in Pennsylvania, I encourage you to JUST DO IT!! deervalleyymca.org. If you look closely at this photo you will see parallel lines above the trees--the camp's zip lines. With my daughter (who directs the women's programs) ahead of me/encouraging me, and a group of wonderful fellow-campers on the ground cheering, I climbed the pole and zipped across the lake. I would do it again in a heartbeat. What a rush...! During that week I led the daily "Morning Watch" group, which I have done several times. This year we explored the question "Who Am I Now?", from a spiritual perspective. And, for the first time, I added singing to the group. Another new thing! We sang a song each morning that I learned last winter in the Tucson Women's Chorus. Each woman interpreted the words individually, which created lively discussions. The song lyrics: Woman am I...Spirit am I...I am the infinite within my soul..I have no beginning and I have no end....all this I am. I would love to hear your thoughts about the lyrics.

Klara & Peter in DC

Veterans near the WW II memorial

October: Peter and I drove to Washington DC to attend the One Nation Working Together rally--an uplifting experience in the midst of heartbreaking divisions. The presence of many military veterans, especially older/compromised ones, inspired me to renew my commitment to activism.

Back in Michigan, we enjoyed several Bois Blanc Island visitors, then closed up the lodge for the winter and headed south. In Columbia, Missouri--my hometown--my mother and I spent a beautiful fall afternoon on the Columbia College campus. We both attended classes when my father worked there. My mom graduated from high school at the end of World War II. Both of her older brothers are war veterans--one was in a prison camp and missing. for a year. She met and married my dad, also a war veteran, shortly after high school, and became a mother to four daughters (I am the second one).

Just a couple of college girls...

Mom in our former psychology class room

If I ever wonder where I get my drive to try new things, it doesn't take long to come up with the answer. My mother started college thirty years after high school, around the time my dad took up motorcycle riding. Mom agreed to enroll in a psychology class with me, and continued to take classes on her own--when she wasn't traveling the country with dad on the back of his motorcycle.

Speaking of traveling, when I left Mom's I decided to take a bus to Denver, where I was scheduled to meet Peter. Another one of those things on my "to do" list...not sure why. I had wanted to take a train, but there wasn't a reasonable route. The fourteen hour greyhound ride was....well....interesting. I boarded the bus with a group of men released from prison that morning. They were easy to spot in the crowd: the only ones without cell phones, inadequate clothes for the crisp autumn air, personal belongings in paper bags. Unfortunately, I didn't get to talk to any of them (they got off a couple of hours into my trip). Mom and I recognized the profile because we have a family member in prison. She met him there, at the same bus station, a couple of years ago when he was released. As I ponder this spot I am in my life--turning 60 and exploring what my role is now--I can imagine becoming more involved in prison issues. My experiences as a family member, a visitor and an advocate always leave me frustrated and angry. I am blessed to count several former inmates as my current friends and teachers.

November: Peter and I attended the annual American Public Health Assoc (APHA) meeting in Denver. I had not been to a meeting for several years and it was good to be back in the company of 12,000 folks devoted to public health issues. As I listened to the current concerns and needs for public policy change, I was again inspired to consider re-entry into nursing.

Peter ready to head to Tucson

We left Denver, spent a few days in Durango with former Michigan friends, then drove to Tucson---home for the winter.

I have wanted to experience a hot air balloon ride since I was a little girl. I am a serious Wizard of Oz fan and grew up in the mid-west. When a Tucson friend suggested we do one over the desert, I was thrilled. Another opportunity to check off something on my life list. The 90 minute ride provided time to imagine life from a new perspective...familiar but different, distant but present. I felt safe, so I relaxed and enjoyed the ride.

December: The best Christmas gift EVER was the arrival of my daughter and family. Ten days immersed in the world and lives of Fern (6) and Rose (4), and their wonderful parents, along with my sweet husband, Peter.

Christmas dinner with family and friends

Food for Santa and reindeer

What adventures, challenges, surprises will the New Year bring?

Happy Birthday to Kathe

2010-09-11T07:38:00.000-06:00

My older sister, Kathe, died of colon cancer in 1999. Yesterday she would have celebrated her birthday. I wrote the following piece shortly after her death to thank my dear childhood friend, Janie, who was Kathe's favorite nurse.

Beautiful Dreamer

For my thirteenth birthday my sister Kathe, 15, gave me nail polish, and a lecture that boys would like me more if I didn’t play in the dirt with them and was more lady-like. Kathe practiced what she was preached: matching shoes and purse, fashionable clothes, perfect black curly hair, careful make-up and freshly manicured nails. She danced gracefully to Bobby Vinton tunes, and knew enough French to sound intriguing while teasing the boys.

The polish sat unopened on my dresser for years. My short, bare nails suffered from building tree houses with boys. I wore jeans most of the time. Nothing matched. I danced wildly as I listened to The Rolling Stones. My unruly blond hair was usually tucked behind my ears. Instead of flirty foreign phrases, I swore at the injustices I saw around me. I never quite made it to the level of sophistication that Kathe achieved and recommended for me. It took both of us until we reached adulthood to realize our differences, accept our individual personalities, and celebrate the women we had become.

Years later when she was dying of cancer, we laughed a lot about her efforts to civilize me. At 49 she was facing death with a level of grace and sophistication that was familiar to her, while I was struggling with all of my raw and untamed forces that wanted to stop the world, turn back time and erase the awfulness of the present.

Kathe was hospitalized several times during the year of her illness. Janie Kemper, RN became one of the most important people in her life. Her many years as an oncology nurse resulted in her ability to give her patients the things they need the most to face a life-threatening or life-changing illness or prepare for death.

Janie noticed early that beauty and femininity were Kathe’s life blood. She would announce her arrival to Kathe’s room by saying something like “Girl that polish has got to go! It does not match your scarf!”, or “You have got to check out this wig! It is so you that it scared me when I saw it!” Then Janie would open the box of manicure supplies she brought in with her, or pull a wig out of her pocket. She and Kathe would be transported to a beauty parlor where Kathe felt womanly, alive, artistic and healthy. Kathe would be able to leave cancer and her baldness behind for a while. They would gab, giggle, and be girly— familiar and necessary parts of who Kathe had always been. Janie gave Kathe opportunities to preserve her dignity and her sense of self. Following Janie’s lead, several other nursing staff comforted Kathe by massaging her with her favorite lotions during the night, her most challenging and scary time.

Several times Kathe was gravely ill, hardly responding to us. Janie would arrive and Kathe would rally, wanting to talk about hair, nails, perfume and bubble baths. Kathe knew she was dying, talked about it freely and wanted to know that she would not lose that important part of herself in the process.

Janie taught us, Kathe’s whole family, to tap into her needs and provide her an environment that gave her control to be as beautiful and dignified as possible. She encouraged us to bring in anything that would help Kathe continue her role as beauty consultant. For years Kathe had been involved in the Miss Missouri pageant, acting as sponsor and assistant to the contestants. Kathe’s hospital room became a beauty queen’s haven, ripe with colorful scarves, mirrors, make-up, exotic clothes, dance music, jewelry, flowers and boxes of chocolate.

One evening Kathe’s daughter dressed my husband in wild scarves and paraded him down the hospital corridor. That led to other patients being curious about what was going on in her room. Soon patients, families, nursing staff and housekeeping staff stopped by and discussed their fashion and beauty needs with Kathe. She advised them, sharing her wisdom and experience with them, always stressing their best features and how to highlight them.

Janie gave Kathe, and all of us, a priceless gift by understanding what Kathe needed, in addition to all of the cancer treatments available. She needed to maintain her self-identity as a woman with a mission to beautify the world. Her job wasn’t finished yet and cancer didn’t need to end that part of her persona. Janie’s insight into that need, her ability to use humor and honestly communicate with all of us resulted in Kathe dying with perfectly manicured nails, a wig that looked like her own gorgeous curls, and smelling like Channel Number 5, her favorite fragrance. Most important though, she had the peacefulness that she had done what she was here to do—make the world a more beautiful place. One of my favorite photographs was taken by Janie a few months before Kathe’s death. She captured Kathe’s vitality and glamour while surrounded by her three sisters and our mother.

Janie didn’t have to give what she did. She could have focused on Kathe’s illness, rather than on her life. It is challenging to be with someone who is dying and it is easy for clinicians to avoid tough topics. I will be forever grateful to Janie for her approach. And occasionally I paint my nails and smile.

Klara, Kelli, Mom/Luci, Kristy, Kathe

Happy Birthday to Me...removing barriers, moving toward 60

2010-09-02T14:30:00.000-06:00

A couple of days ago I drove north from Ann Arbor, Mich to our home on Bois Blanc Island. The air conditioner in my VW doesn't work so I arrived four hours later at the ferry in Cheboygan dripping wet, eager to jump in Lake Huron. Ahhh...heaven.

The high the next day was a refreshing mid-70s, perfect hiking weather. As I left the house I spotted a dead tree across the driveway. It was a hot, still night, but the landscape here is so rocky it doesn't take much prodding for a tree to fall. Roots here typically sprawl out among the rocks rather than work against them to go deep.

I had a few options to deal with the tree. I could wait for my husband and friends to arrive tomorrow and have the men take care of it. There are neighbors nearby who would have helped. Or, I could find a saw in the barn and do it myself.

With the tree across the driveway I am trapped here. I had planned to drive eight miles to the general store/pizza place/ice cream stop (our version of a mall--one stop for everything) and celebrate my 59th birthday with my beloved island community.

As I reflect on my life--the good, the bad and the truly mysterious-- the bad times pale in comparison to my immense blessings, which are far more than I deserve. I do not take those things for granted.

One year until that landmark number sixty. As I consider the past, contemplate the future and celebrate the present moment, I understand that I sometimes allow self-imposed barriers to prevent me from trying new things, taking chances, taking risks.

Singing? Love it, but only last winter was I brave enough to join a women's chorus, after decades of wanting that. The spring concert was a dream come true for me.

Writing for others? A passion, but I stop short of trying to get things published.

Optimal health? Sure, in theory I want that. In practice I have some serious changes to make.

Dance lessons? On my "to do" list for years.

And, the list goes on....

So TODAY I begin my quest to tackle barriers--real, imagined, self-imposed.

With an old rusty saw in hand, I conquered the first one. It took an hour. My muscles ache. And I am smiling like a kid with a new bike.

Now...who's going to buy me a beer?

Food Legacy: Recipes for Life

2010-07-08T04:49:00.003-06:00

What will I remember about this 4th of July week-end? Without a doubt it will be Adele's gazpacho--the best I have ever eaten, and Adele.

The next day she gave me a gift that will also help me remember the meal: fifteen people working together to prepare a holiday meal in a beach house on Lake Huron--ideal weather, a few lightweight fireworks, tons of laughter, a bit of teasing, young folks flirting, older ones remembering, some political opinions, sun-burned backs, sangria.....

The gift? Her gazpacho recipe, handwritten that morning, in her elegant 90 year old penmanship.

I started collecting recipes about 40 years ago. The clippings from magazines and newspapers, the recipe cards from friends/family and yeast packets with scrumptious sounding breads, all used to be neatly organized in a long basket. A few years ago I dropped the basket, which dumped everything onto our farmhouse kitchen floor.  The sections "Favorites from Grandma's Kitchen", "Fun Things to Make with Sara", "Early Garden Harvest" etc. were instantly homogenized.   I scooped everything into a grocery bag and planned to reorganize them soon. But I got distracted by the convenience of looking up recipes online.

Last year I discovered the bag in back of the pantry when we moved from the farm. Again, I  vowed to restore order to my collection. Someday.

When I received Adele's recipe I pulled out my bag and began to sort.   Within minutes I felt like old friends--many of whom are deceased--were sitting around my kitchen table.

I spotted my sister's handwriting on a card labeled "Kathe's Chocolate Mints". She loved fanfare and drama, and created Martha Stewart-like celebrations for even the most mundane occasions. She introduced that recipe to our family when she was a young mother, determined to create the perfect home, complete with homemade bonbons. Kathe died in 1999, but her special sweet treats are made every Christmas by my daughter, Sara, who started making them years before Kathe died. Even before her illness, the chocolates were part of her legacy.

One thing we all have in common, beside the fact we will all die, is that we all eat. Nurturing our bodies with nutrients sustains life. Part of our self-identity comes from our relationship to food.

Do you cook/bake? Grow your own food? Buy local? Prepare certain foods for certain occasions?

Do you identify as a healthy eater? A compulsive eater? Someone who occasionally splurges on a favorite food?

We will leave behind perceptions of who we were, always with an element of mystery. Our family and friends will regret that they didn't ask for more details and stories that only we could have told. A food legacy -recipes, stories, favorites--is only one way to share important aspects that make you uniquely you.

I am not suggesting we give up the Internet, but these treasures that surround me tonight--handwritten cards or printed recipes with personal notations--will always mean more to me than a Google search result.

I want my grand-children to know that their ancestors produced food by working in gardens and fields. And to eat some of the same foods that were always a part of special occasions.

A man who I did not know well, but admired for his kindness and generosity, died last week. Tonight I found the following recipe that he wrote for me a couple of years ago.

Bill's Apple Cake

Spread 1 can of apple pie filling in 13x9" cake pan.

Mix together in a separate bowl: 2 c. flour, 1 c. sugar, 1 tsp salt and 1 1/2 tsp soda: then sprinkle over pie filling.

Beat together: 2 eggs, 2/3 c. oil, 1 tsp vanilla, 1/2 c. nuts. Pour over dry ingredients and even out batter.
Bake at 350* for 40-50".

Caramel icing: melt 2/3c. butter or margarine and 1 c. firmly packed light brown sugar. Stir in 1/4 c. milk. Bring to boil and simmer for 3 minutes. Remove from heat and let cool before spreading on cake. Enjoy the fruits of your labor!!

Farewell my friend. Thank you for the recipe. You will not be forgotten.

Patients as Teachers

2010-06-25T14:11:00.000-06:00

Patients are often my best teachers. Many years ago, as a young idealistic nurse, a 40 year old man named Richard taught me more than any professor could have about embracing mortality. He was admitted to the neurology unit for diagnostic tests due to persistent, but vague symptoms. During the night shift prior to his exam he asked me to call a priest before he was taken to the operating room.

He explained to the priest and me that he felt he was going to die from the procedure. We tried to reassure him, but he calmly said "I want to be prepared to face the music". He talked about how hard it would be for his family, that he didn't want to leave them, but he just had a gut-level feeling that he couldn't ignore.

During the procedure a massive brain tumor was diagnosed, requiring emergency surgery. He died several weeks later, at the start of my night shift. He never fully regained consciousness.

I wrote the following poem shortly after his death and have continued to be influenced by the lesson I learned from him: listen to the message--no matter where you think it comes from.

When we face the fact that we will die, instead of avoid admitting that, we can learn more about our lives and that can allow us opportunities to prepare ourselves and others.

Music

The night before surgery
You told me
My heart knows I need to
To face the music

Life just unfolding
Wife and kids
Hopes and dreams
Music to your ears

I am a new nurse
A young bride
Dreaming of longevity
And happy endings

Now you are dying
You know and I know
Though we speak
without words

I want to run
Not death, not now
Not like this
I am not ready

Hand in hand
Death claims you
The warmth of your hand
Lingers on mine

I have not broken news like this before
Your family arrives
Our tears flow
I no longer want to run

Pet Loss: Good-bye Dear Jake

2010-06-01T05:44:00.000-06:00

It is good to be back in Michigan! In December Peter and I loaded Jake, our 15 yr old Lab/Shepard mix, in the car and drove to our new winter home: Tucson, AZ.

We were concerned about Jake's comfort and ability to make the trip, but he tolerated it well and seemed revived soaking up the sun in our new yard.

It was hard to watch him lose the strength to get in the car, the ability to manage stairs, the comfort of being around other animals. As his senses faded his anxiety escalated.

Our vet helped us assess his condition and needs. We had hoped he could make it back to Michigan, but by April we knew it was time to euthanize him.

We have had other pets euthanized--it is never an easy decision.

The reason I decided to write about Jake's death here is this: Reactions to the loss of a beloved pet is as multi-faceted as any other loss.  Everyone is entitled to view their animals, and the loss of them, however they want.   I caution you though to not make assumptions about what that loss is like for others.

Some of the comments people made when Jake died offended me. Really, really offended me.  Some of them were made by the professionals who were assisting us with the process, some by friends.

Here are some examples:

---Referring to Jake as my "child". NO...he was my loved and valued pet. He did not come close to being in the same category as my child.
--Questioning our decision to euthanize--some thought we waited too long, others thought we were too hasty. It is not their business, unless their opinion has been requested.
--Telling us their personal stories of pet loss (often the re-telling proved traumatic for the person and they would then need comforting). In the midst of trying to make the right decision no one needs to have things complicated by a tearful story.

Pet loss, like other grief, is a personal journey. Let the person take the lead in conversations. Listen. Listen well.

We were lucky to have many, many people do just that. Let us guide the conversations.

I especially want to thank Dr. Lee Fike (Tucson) http://www.leefike.com/ : thank you for your compassion, wisdom, guidance and patience. Your  method of euthanizing in stages allowed us the opportunity to see Jake at peace to be able say good-bye in our home, as we listened to music that comforted us. Thanks also to our dear friend Helen Costa (Ann Arbor) who was always just an email away, willing to answer questions and help us explore options. And, many others who said just the right thing, at the right time.

Today we will spread Jake's ashes in Michigan and celebrate his awesome, sweet spirit.

I am glad he is home.

Living With a Terminal Illness

2010-01-06T19:38:00.010-07:00

I woke up today thinking about my dad, born on this date in 1916. He died in 1999, but I still learn from him.

He faced his death the way he lived his life: as a practical thinker with a curious mind, who was quietly stubborn with a huge generous heart.

Dad was diagnosed with multiple myeloma on his 80th birthday. During the next three years he paved the way for others to talk with him about living with a terminal disease as he went through a range of treatments, hospitalizations and kidney dialysis.

He kept detailed records of doctor visits, lab results and weight/appetite changes. Education and compliance were as important to him as chemotherapy. The more he understood his condition, the more empowered he felt to make informed decisions and suggest additional treatments to his health care team. He was determined to live as long as possible, but didn't deny his own mortality.

"Death is a natural part of life", he told me one evening as we reviewed his most recent physical changes. He was hospitalized for kidney failure, which necessitated starting dialysis. The day I had feared had come. My heart was broken.

"I've had such a good life" he said, as he listed the things most important to him: his family, his home, his friends.

I asked him how we could help him now.

"I want to be home, to be comfortable, to be with my family."

We hoped he would tolerate dialysis well. From home, he went three days a week to a clinic where he endured a four hour procedure in order to survive. Due to his advanced cancer the treatments quickly became more than he could handle.

When the decision was made to stop dialysis we knew he would die within a few days. The night before he died a steady stream of family, friends, neighbors came. He extended his thin, frail hand to all, smiled and thanked everyone for visiting him.

I watched in awe. In his own quiet way he had maintained control over the end of his life. He knew what he wanted from the time he was diagnosed three years prior to his death. He must have spent a lot of time imagining the end, preparing himself emotionally and spiritually. His willingness to talk with others helped prepare us too.

The next morning he was no longer conscious. It was clear that death was close.

In his own bed at home, surrounded by family, he peacefully took his final breath. He died the way he had hoped he would.

Happy Birthday Dad....Your wisdom and grace taught me how important it is to live fully, live honestly, live facing death instead of fearing it.

Pregnancy/ Newborn Loss

2009-12-16T06:33:00.010-07:00

My wise and wonderful niece reminded me yesterday of the need to recognize the loss that is felt when a pregnancy ends in fetal/newborn death. Her sensitivity comes from personal experiences several years ago. Today she has two beautiful, healthy children and there is no doubt she cherishes those little darlings. She and her husband remember and acknowledge the losses they experienced, as part of the fabric of their lives.

As a young, single, idealistic nursing student I expressed an interest in writing about pregnancy loss to my obstetrics clinical instructor. Peering over her bifocals she suggested I choose a more positive topic, perhaps "Bonding with your newborn" or "The Health Benefits of Breastfeeding"

I persisted.

She reluctantly agreed.

I was allowed to informally talk with women who were hospitalized following delivery of a healthy infant, but who also had a history of fetal/newborn loss.

During the time I taught tips on newborn care I managed to ask some version of the following questions: How were you supported when you experienced an earlier loss? What was your grieving like? Did others acknowledge your loss/grieving? How did your health care provider meet your needs?

The responses ranged from dismissing the loss as a legitimate reason to grieve, to profound sadness, feeling alone, isolated and misunderstood. Many reported that family, friends and even husbands/partners, did not view the loss as a significant one. Often they were encouraged to move on emotionally and begin planning for the next pregnancy.

The women were eager to talk, surprised they were being listened to and have the loss acknowledged. They often expressed shock at their tears as we talked, sometimes saying "I shouldn't be feeling this way, after all I have a new healthy baby now".

As health care providers, family, friends, partners, we need to be sensitive to parents who experience fetal/newborn death.

If you have personal experience with this type of loss, I send you my condolences.

The resources for coping with fetal/newborn death are plentiful, and at your fingertips. Please consider exploring websites (try searching fetal death/grieving/support or other related terms), local support groups, talking with health care providers, sharing your feelings with a trusted friend, meeting with clergy, journaling, creating music...or whatever moves you along in your recovery process. If you meet with resistance or denial, please don't let that stop you from trying another avenue. Please feel free to write to me.

If you know someone who has experienced a fetal/newborn loss (perhaps even a long time ago), gently acknowledge it and listen closely to the response. Be available and let her take the lead.

We can't fix it. But we can be part of the healing that comes through healthy grieving for any loss.

Many years after my nursing school experience, when I was a young mother, a friend experienced a first trimester loss.

When I asked her about it, she described the private ceremony she and her partner had--she wrote a poem, he sang a song, by a fire on a beach. They decided it was too early in the pregnancy to name the baby, but felt a strong need to acknowledge it and it's death.

We both cried as she related the story. She said I was the first to ask what it felt like, and she appreciated an opportunity to talk.

In this season (just a few days before Christmas) the miracle of birth and the joy of children shapes the actions of many of us.

Please remember those who are mourning for children whose lives were so short that they are often not acknowledged.

Take a chance: let someone know about your loss, be ready to share your feelings.

Or, ask a question, hold a hand, lend an ear.

Make this Christmas special in a new way.

Tears

2009-11-21T08:13:00.006-07:00

Before moving from my hometown, Columbia, Missouri, I worked as a psychiatric nurse in a small private hospital. I was young and inexperienced, but fascinated by the power of the mind, body, spirit connection to health.

I called Dr. Anderson one evening because I was concerned about his new patient--a young woman with three small children. Her family had visited her. When they left she fell on her bed and dissolved into tears--crying longer and harder than anyone I had ever encountered.
I asked him is there was something I could give her to ease her sadness.

He explained she was overwhelmed by feelings of loss--her family was experiencing unwanted/unplanned changes.

She was grieving.

"We don't want to take away her tears. She needs them in order to heal. " he said calmly. We talked about the difference between healthy sadness (grieving) and clinical depression.
"Just be near to let her know she is not alone, but allow her to feel the pain and don't mask it. That gives her a chance to move through the grief and be whole again."

Dr. Anderson's lesson that evening has stayed with me for more than thirty years. Sometimes guiding my nursing practice, sometimes comforting me in the midst of my own grief.

Today is Dr. Anderson's funeral. His death was a shock and tragic loss to his family, friends and community.

I believe he would remind everyone to feel the pain, be near each other and let the tears flow.

Grief is personal, intense and a necessary part of healing.

Don't let anyone take your tears away.

When is a person dead?

2009-10-22T03:57:00.010-06:00

"A person is dead only when you stop thinking about them", a friend recently said as we discussed death and dying issues.

I am accustomed to rituals that reinforce the absence created by death: open caskets, funeral/memorial services, graveside ceremonies and holidays to honor them.

I immediately thought of deceased loved ones who continue to live in my life.

Several years ago friend died on her 31st birthday. Her death rocked the community who loved her deeply: shocked by the death of someone so young, talented, compassionate and courageous. Her hope was to conquer her disease, devote her life work to comforting others who were suffering, continue traveling with her husband, have children and grow old surrounded by family and friends. Without a doubt, she would have maintained being the nurturing, loving person we all adored.

She battled her illness long and hard, wanting nothing more than the chance to live her dreams.

Near the end of her life, with grace and honesty, she delved into life and death issues. She asked questions about my sister Kathe's death. As she looked at photos of Kathe taken shortly before her death, she wanted to know what it was like for her and for me at the end of her life. Her curiosity and openness allowed others to go on the journey with her.

Her husband gave me her beloved denim jacket. She had worn it as they traveled--often on their motorcycle--to countless places around the globe.

It hung silently, reminding me of her death, during the year of mourning observed by her faith.

At first it felt strange to wear it. Then she visited me in a powerful dream and it was clear she wished to be remembered as fun loving, adventurous and at peace.

I wear the jacket often now. My daughter gave me a large dragonfly pin when my grandmother died (she loved dragonflies!). It sits on the right shoulder of the jacket. On the collar is a carved wooden dove, with an olive branch. Sometimes I add Kathe's favorite scarf.

Since her death, the jacket has been to a refugee camp in Africa, weddings, an ancient cathedral in Puerto Rico (where she once visited), writing groups, women's retreats, the birth of my first grand-daughter, my high school reunion, motorcycle trips, funerals, a cross-country road trip with my childhood friend, camping, hiking, church picnics, volunteering after Hurricane Katrina.

When I wear the jacket I imagine how she might experience the event. I recall the lessons she taught me as she prepared for her death.

My connection to her, through a physical object which represents her life, has helped move me from mourning to celebration of her life.

Is she still alive?

It brings me pleasure to plan the next place I will wear her jacket.

I think she would chuckle about that.

And I enjoy hearing her laughter.

Saying Good-bye: A Natural Death

2009-08-15T07:53:00.000-06:00

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

2009-08-09T14:39:00.000-06:00

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"

2009-08-07T09:11:00.000-06:00

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

2009-08-06T03:32:00.000-06:00

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

2009-08-05T14:20:00.000-06:00

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.