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While the Hollywood image of dying often features a loving family gathering around the deathbed, life often presents a very different reality. In a chapter in my book – entitled “One Big Happy Family” – I talk about some of the challenges families may face at this difficult time. I often say that each of us, when the faced of a parent, becomes an exaggerated version of ourselves with both our best and worst characteristics showing up in spades. As well, conflicts that might have occurred decades before may resurface as siblings vie for attention and recognition.

End of Life University

What do you do when a family (your own or a patient’s) is crumbling due to unhealed resentments and irreconcilable differences? Find out now.

conflictpodcast

In today’s episode I’ll share my best tips for helping families move through conflict toward resolution during stressful times like the death of a loved one. I’ve had lots of experience with this work during my years as a hospice doctor so be prepared for a longer-than-usual episode!

Announcements:

slide01My new course Step-by-Step Roadmap for End-of-Life Planning is almost ready for release (just a few days away as I record this!) The course is simple yet comprehensive and will help you examine your mindset, values, beliefs, and fears about death before you make decisions about your end-of-life healthcare. Go to eoluniversity.com/roadmap to learn more and sign up to be notified as soon as the course is released.

Sponsorship:

supportonpatreon-e1412764908776This podcast is sponsored through the EOLU donation page…

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It’s 2017, so they tell me, though I have been laid up in bed since late December with a nasty virus, and have trouble remembering which day of the week it is.

In a few days it will be 20 years since my sister Carol was diagnosed with the virulent cancer that would take her life 6 months later, on July 4, 1997. I had just begun a well deserved and much needed sabbatical and was busy making plans for a research trip when my sister called to say that the cancer was back.

“Fuck, Fuck, FUCK,” I said, when she told me.

“Don’t say that,” she said.

“But it’s just not fair! You’ve done so well! Fuck, fuck, fuck,” I said again, the only words that seemed to capture the extent of my anger and grief and shock.

“Don’t say that,” she said. “It just makes it harder for me.”

“OK,” I agreed. “I’ll be on the first train tomorrow to see you.”

And so it began. The 6 month “journey” in cancerland – through endless visits to doctors and hospitals, CT scans and MRIs, biopsies, and surgery. Vomiting and K-basins. Fear. And always pain. And finally death.

So many of the details of those six months are still vivid in my mind and my heart. The endless waiting for results, the parade of PSWs and “sitters.” Dozens upon dozens of phone calls on pay phones, in the days long before cell phones. And countless conversations with Carol about what she wanted and needed. I would have done anything I could have for her. And in the end it was never enough.

Shortly after she died, I began to tell people that I had been transformed by Carol’s death. I didn’t really know what it meant, but I knew it was true. I was no longer running away from death. Four years later, I would begin what became my 15 year journey as a hospice volunteer. “My sister works through me,” I would tell friends when I first began my volunteer work with dying people and their families. Sometimes I could almost hear her telling me, “Slow down. There’s nothing you have to do. Just listen to their stories.” And I did.

And I still do, all these 20 years later. I also write and talk and speak at conferences and churches and meeting halls. I look for opportunities to share my book about caring for my sister and my elderly parents, in hopes that I can help others who are facing this challenging time in their lives.

When I first began volunteering at hospice, friends would look at me strangely as I would wax eloquent about my volunteering. Some thought it morbid, others that I was courting depression in being with dying people week after week. Few would believe me when I told them my time at hospice was the most hopeful part of my week.

More often now, people ask me what I do at hospice – what it’s like giving care to dying people, and talking with their families. More and more, of course, friends and strangers alike have experienced the death of someone they love. Or they are watching their aging parents coming to terms with their loss of independence and failing health. Perhaps they have received a difficult diagnosis themselves. Now they too want to talk about death and dying.

And so I will continue to write, here and elsewhere, about life and death. I’ll read the latest books on the subject from the library, and watch movies about “d and d.” I’ll continue to give talks wherever I can,  and I’ll look forward to hearing other people’s stories.

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Yesterday, I had the opportunity to be part of the first annual Provincetown Book Festival. There were wonderful readings by poets, novelists, memoirists, and others, great discussions, and a book fair, where authors displayed and sold their books. Along with 14 other authors, I spent the beautiful sunny day sharing my work and selling and signing my book.

I was a little concerned that people in a vacation spot like Provincetown might not be interested in buying a book about caregiving, death and dying. What surprised me was how many people shared their own stories with me – deeply personal intimate stories of illness, caring for parents, and coming to terms with death.

Many of the people who approached my table shook their heads when I told them what the book was about – not because they weren’t interested, but because their parents were dead. “I cared for my parents into their nineties,” one woman said. “And we cared for my partner’s parents too. It was a long stretch.”

Not surprisingly, given the fact that daughters by far and away do the work of caregiving in comparison to sons, most of the people who stayed to talk with me were women. Now in their 60s, they were beginning to think about their own aging process, and who might care for them. “I better give that book to my kids,” one woman laughed. “It’ll be their turn soon.”

For those women who don’t have offspring to whom they can turn, the options may be more limited. Nieces (and nephews) may be willing to take up the task of caring for their aging aunts (and uncles) – but it’s likely they’ll have their own parents to worry about already.

As Baby Boomers, many of us are fiercely independent, and dread the thought of becoming a burden on our children or family members. I urge readers of my book to begin talking about these issues now, before it’s too late, and we find ourselves in a state of emergency. What heartened me about yesterday was how many people were more than willing to have these discussions – with one another, with other people who approached my table (and my fellow writers, and with me.

A couple of women who came by the table said that the topic of my book was just too close to home. Two women had recently been diagnosed with cancer, and were undergoing treatment. A stark reminder of how present cancer and other illnesses are in all our lives.

This willingness to talk openly about life and death is one of the reasons why I love being in Provincetown. Yes, lots of people are here to spend their days at the beach, before relaxing at the tea dances, restaurants, and bars, but many others still carry the memories and images of how AIDS devastated this town in the 80s and 90s. Provincetown has a higher proportion of people with HIV/AIDS than the rest of the country, and year round Provincetown residents work with and support the services that sustain people with HIV/AIDS. They are more than willing to share their stories with me over a glass of wine at the bar where I love to write.

Sometimes I worry that too many people have their heads buried in the sand when it comes to illness, death and dying (as in, if I don’t talk about it, it won’t get me!) Being able to have talks such as the ones I’ve had here in Provincetown give me hope that some people are embracing the opportunities to talk.

PS: The book fair got terrific coverage in the Cape Cod Sunday Times!

Here’s the link to the story:

http://www.capecodtimes.com/news/20160918/authors-drawn-to-provincetown-book-festival#ReaderReaction

 

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An article I wrote was just published on a wonderful site called KevinMD. Here’s the link:

http://www.kevinmd.com/blog/2016/09/helping-hospice-present-much-important-busy.html

As always, I’d love to hear your thoughts.

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When my father was dying, I often found myself saying, “I wish someone would tell me how this ends.” It wouldn’t take more than a minute before I’d catch myself. I knew very well how it would end. I knew it would only end when my father died. Whether peacefully (as it mercifully turned out) or with enormous suffering (as I rarely see at hospice), it ends in death.

And the fact was, I wasn’t ready for him to die yet. He was still of sound mind – at 94 – though his body had begun to fail. He was no longer able to go to a restaurant to eat dinner – one of our favourite activities. Eventually he stopped having “cocktail hour” with me – the only one of his four daughters who enjoyed this ritual with him. Still, we could sit and watch television together – Who wants to be a millionaire? Golf and curling – things I relished with him and would not be caught watching otherwise. I clung to those shared rituals like a drowning woman. Indeed, most days I felt like I was drowning.

Anything was better than losing my father – this man of wisdom, of knowledge, of family history.

Like the families I meet each week at hospice, I knew all too well where this was leading – but the routines of caregiving, be they cooking or grocery shopping or making phone calls, can distract us however briefly from the ultimate point of this journey. The person we love is dying. The person we love will no longer be in our lives. The person we love will leave us – forever.

Somehow we have to balance that knowledge along with carrying on the activities of caregiving. In fact, those activities are essential to providing care and maintaining our own sanity.

Soon enough we will experience what one family recently termed a “wake-up call.” When I asked him what he meant, he spoke eloquently about the impact that another patient’s death had had on him. “This is why we’re here,” he said. Not that he had really forgotten. Not that any of us is likely to forget for long.

And so we do our best, showing up as our best selves. This is what I hope I did for my father. And it is what I see families doing, week after week, at the hospice where I volunteer.

 

 

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When I was first training to be a hospice volunteer (in 2001), one of the most important lessons the leaders drummed into us was the centrality of boundaries. We were reminded repeatedly that we were not a family member, a close friend, or even a not-so-close friend of the residents. In short, we were not in the “inner circle.” That space was reserved for those who were closest to the person who was dying, be they family of origin, by marriage, or by choice. As death grew nearer, we were to maintain a distance, making room for those in the inner circle to spend time with the resident before they died.

I had no problem with this lesson, since I had struggled with boundary issues when my sister was dying and a woman we had hired to assist with her care started to feel that she was as close to Carol (or perhaps even closer!) than we were.

We were also repeatedly instructed about confidentiality and never speaking about what happens in hospice with other people. What wee weren’t really prepared for is how to be when we know one of the people who is admitted to the residence.

As someone who lives in the same neighbourhood as the hospice where I volunteer, it’s perhaps inevitable that people will be admitted with whom I am familiar, whether as neighbours, colleagues, or local activists. When that has happened, I’ve made a mental note in my mind, mostly by way of acknowledging the sorrow and loss they must be facing. I make a point of not indicating I’m familiar with them, out of respect for their privacy and the tremendously challenging circumstances they are facing. I hold them in my heart, and continue with my work both inside and outside of hospice.

A while ago, a woman was admitted with whom I had more than a passing acquaintance. We had been colleagues once upon a time, members of the same neighbourhood, and friends of friends. I was saddened to see that she had been admitted and wondered how I should be. Should I avoid her room as much as possible out of respect to her privacy? Or should I go and greet her and help make her feel welcome?

I chose the latter option, as I knew in my heart it was the right one. I knocked on her door, came to the side of her bed, and said something like, “I’m sorry to see you here – though I’m glad you can be here.” She asked how long I had been volunteering and I told her. And she told me what a wonderful place it was. We spoke for perhaps five minutes, then I left her to rest while her family went to lunch.

For the rest of my shift, family and friends visited her, and I steered clear except to respond to the call bell.

The following week, as so often happens when someone decides to come to hospice, she was much weaker, and a note in the book indicated that only wanted to see her family. Despite my desire to go in and say hello, to offer my “expertise” or “wisdom,” I knew that was much more for my own needs than hers and I resisted.

This is often the litmus test for me when I am facing such a decision at hospice. I ask myself this question: “Are you going to see the resident (or say this brilliant thing) because it will support or help them? Or are you doing it because of a need of your own? To feel helpful and needed. To be validated in some way. To feel connected.”

I really do ponder those questions before going to a room or saying or doing something, especially as a patient nears death. Most of the time, the answer is that I can be of service to the patient, whether by sitting at the bedside when they are alone or singing songs or reading the Bible (or poems or any book that’s evident in their room). And I can feel certain that I am not breaching any boundaries and getting myself “in trouble.”

It’s inevitable that we will meet people we know in the hospice work that we do. Indeed, in rural hospices and small communities, it is unavoidable. The important thing is not that we avoid people we know or pretend we don’t know them. Rather it is respecting the honour and privilege we have been given in being able to accompany people when they are dying. Sometimes that means doing the dishes or making up beds or getting more ice to make ice chips. And sometimes it means making space for family members (supporting them if we can) and respecting their time with the person they love.

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Yesterday was my father’s birthday – the 24th of May. When we were young, he taught us the poem that he grew up with: “The 24th of May is the Queen’s Birthday. If we don’t get a holiday, we’ll all run away!” I think of that little ditty whenever his birthday rolls around.

In honour of my Dad, I wanted to repost a piece from my book. It’s a story that I read whenever I am giving a talk – my way of reminding people to find the joy in the midst of caregiving, and to savour those moments, however fleeting they may be. It’s also my way of bringing my father with me wherever I go.

Finding the Joy

Bette Davis first popularized the observation that “getting old is not for sissies.” I would add that caring for your elderly parents is not for sissies either.

It is painful to watch our parents’ health and independence diminish with each new day. It is a struggle to maintain a calm, patient outlook when our lives feel overburdened and crazy.

Yet it is essential that we not let their situation overwhelm us. Though there will be times when we feel like we can’t go on, there are also moments of pure joy and delight, moments of tremendous meaning and poignancy that remind us why we are doing all this in the first place.

As I was writing about my father as he was dying, I was surprised by how many such moments existed. As I slowed down to his pace, as I opened myself up to what was actually happening, I was able to let go of my frustration and just be with him. (Hint: I often kept a pad of paper and pen on the couch beside me when I visited my father. The first page contained my to-do list. But I would often flip to the following page, and scribble down phrases and words and stories that my father would say. Since he spoke very slowly – all his life but even more so when he was in his nineties – I could actually record many conversations almost verbatim.

On the days when I rushed to my father’s apartment, dreading his “I thought you had decided not to come” greeting, I might miss the humor implicit in his instructing me where to find the money for my trip to the mall. Or the irony in his instructions regarding our choice of take-out meals. Or the combination of pathos and love in our efforts to pay his bills together.

These are the moments that become the memories which sustain us through the grieving process after our parents are gone. These memories will survive far longer than the sting of a sharp word. But we can only see them if we are in the present, not fretting about or dwelling on the past, or obsessing on the imagined future.

Sometimes these moments happen when we least expect them.

Each time I visited my father, we began the same way.

“Is there anything you need me to do, Dad?” I would ask. Usually my help involved a shopping trip to the mall. On this particular day, the request was very different.

“I don’t think so,” he said. And then, a long minute later: “I do have a request of you that I’ve been too embarrassed to make.”

“Oh,” I said, a little taken aback. “What is it?”

“I would like you to cut my toe nails. I can’t bend over to reach them anymore, and they’re getting uncomfortably long.”

“Where do you want me to do that?” I asked, trying to hide my unease.

“In the bathroom,” he said. “In the middle of the night, when I wasn’t sleeping, I amused myself with deciding that I would soak my feet while sitting on the bath seat.”

He preceded me to the bathroom to prepare himself. When he called my name, I joined him. I don’t think I had never been in the bathroom at the same time as my father.

When I walked in, he was sitting on the edge of the bathtub, his feet resting on a large brown towel. His grey cotton pant legs were rolled up above his knees to reveal dozens of purple and blue bruises on intensely veined thin white legs.

“Do you need anything else, Dad?”

“Bring me a bowl of water. You can use the dishpan under the sink. It’s not getting much use these days.”

I returned with the square brown plastic dish pan, which I proceeded to fill with warm soapy water. I set it down on the bathmat in front of him.

“Here you go, Dad,” I said. “Just like Madge.” The Palmolive woman from TV. “You’re soaking in it,” Madge would tell the customers in her upscale salon who always responded in horror to learn they were soaking their hands in dish detergent.

“How would you like me to do this, Dad?” I asked when he had finished soaking his feet.

“However you like,” he directed. “The nail clippers are there on the sink.”

I picked up the set of nail clippers and inspected his foot.

“Where do you want me to start, Dad?”

“Your choice.”

Some choice, I thought. The big toes were enormous and terrifying. The nails must have been an inch thick and hard and yellowed despite his efforts at soaking. I wondered how long it had been since he’d had his nails cut. I didn’t ask. I chose the baby toe. I began by facing him but soon discovered that the angle was too awkward. I moved my body between his legs, resting one arm on his leg. It felt strangely intimate. I proceeded, toe by toe, cutting and shaping, trying my best not to cut him. Left foot, then right. One toe at a time.

“Well, Dad,” I said, moving towards the door to inspect my handiwork. “I think we’re done. How do you like them?”

“Perfect,” he said. Then, not missing a beat, he added, “Do you paint toenails as well?”

All these years later, I still smile as I remember my father’s wry humour, relieving any discomfort I might have felt. It was his own particular, understated humour that I miss and cherish all at once.

 

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