Death and Dying

Can We Talk … About Death? (from Next Avenue)

Posted on by Dr. Toni

Credit: Elle Moulin for Next Avenue

Katie Couric has regrets. Even to this day.

When the former TV news anchor spoke at Georgetown University at an event titled “The Healing Power of Communication” in August, 2019, she said she wished she had talked more to her late husband, Jay Monahan, about his impending death before he succumbed to colon cancer at 42 in 1998.

“It was just terrible,” Couric said. “After nine months of trying desperately to figure out some way to manage it, he lost his battle — and it was devastating.”

She explained that she’s writing her memoir and recently had drinks with Monahan’s two doctors to “revisit” those days.

“I told them how guilty I felt about so many things about Jay’s illness and that we never really discussed, you know, even entertained the idea that he might die. I was so afraid to give up hope, and make him give up hope, that we never discussed the alternative, which I really regret,” Couric said.

For example, she said, “He never wrote a letter to our girls” — daughters Ellie, 28, and Carrie, 23.

“I honestly believe that we, as a species, will do better if we come to terms with our mortality earlier in life.”

The fine line between maintaining hope and offering a reality check is tricky territory, said Dr. John Marshall, oncologist and director of Georgetown’s Ruesch Center for the Cure of Gastrointestinal Cancers, who was interviewing Couric at the event.

“As soon as we enter that world, we see the light go out,” Marshall said. “We don’t like doing that. So the balance of being on point and brutal, if you will, and factual, versus that maintaining of hope…”

“It must be a dilemma,” Couric responded. “For me, I erred on the other side — trying to protect Jay from information he had a right to hear.”

So, which is more important: knowing the reality of your situation or maintaining hope?

Most of us don’t want to hear bad news, especially this kind of bad news. And most of us don’t want to talk about it, or plan for it. And yet, in recent years, the thinking about this is beginning to change as our aging population starts changing its views of death. More hope, less grim reaper?

Is Dying About Control?

HBO’s documentary Alternate Endings: Six New Ways to Die in America, released Aug. 14, 2019, explores some of the ways Americans are finding meaning as life ends. And all of the ways show that the key is taking control of as much, or as best possible, of the end of life.

The documentary includes new types of urns, personalized obituaries, eco-friendly caskets, drive-thru funeral viewing, living wakes (which force people to say things to each other while still alive), space burials, green burials (in which the body is wrapped in biodegradable material in a shallow grave), memorials in an underwater “reef vault” and a seriously ill man who opts to take advantage of physician-assisted death to end his life peacefully and surrounded by family.

It’s all part of a $16 billion U.S. funeral industry that is being disrupted.

“The baby boomer generation has had a greater degree of control over their lives than any other generation before them,” Alternate Endings filmmaker Matthew O’Neill told Axios in an Aug. 10, 2019, article. “It’s because every topic that’s taboo — be it sex, be it drugs — it’s all on television and it’s all being talked about. And death is the last taboo.”

Is Dying About Hope?

The film was released around the same time as the book A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death by Dr. BJ Miller and Shoshana Berger was on The Washington Post’s Top 10 bestsellers list. The book includes practical advice (take your favorite quilt to the hospital) and wisdom (“love” is what matters most in the end).

Miller, too, addresses the idea of hope.

“I honestly believe that we, as a species, will do better if we come to terms with our mortality earlier in life,” he said in an interview on the Today show Aug. 5, 2019. “Get used to exercising hope within the framework of life being short and precious.”

Boomers do seem to be getting better about not only facing death, but also embracing it. The Conversation Project, Death over Dinner project, Death Cafes — all have been propelling us towards a more open view of death for nearly a decade. Remember how Swedish Death Cleaning became “a thing” two years ago?

Maybe It’s About Hope and Control

De-stigmatizing death. Having a “good death.” Those are the goals.

The United Kingdom’s Academy of Medical Sciences installed “The Departure Lounge” in a London mall in May. It was designed to look like a departure lounge at an airport, complete with all that baggage we have, with the idea of getting people to talk about death. “Why can’t we say the ‘D’ word?” the website asks.

Packaged versions of the pop-up installation are now being offered to community groups across the UK to start a national conversation about death and dying.

As a student in Georgetown University’s new Aging & Health master’s program, I was treated to a guest lecture in our first semester by Becky Hsu, an assistant professor at Georgetown, who spoke to us about the Chinese concept of a “good death.”

Hsu explained that she had spent time in China with a woman who had already bought the outfit she wants to wear for her death: pants, shirt, shoes, earrings and purse.

The woman has an embroidered pillow picked out for her head to rest on. She had a portrait taken that will be displayed at her funeral. All of these things are neatly wrapped in a cardboard box that she proudly shows off to friends and family.

Explained Hsu, “It’s a happy thing.”

Ann Oldenburg

 By Ann OldenburgAnn Oldenburg, who started her career at The Washington Post and was a longtime culture writer at USA Today, is assistant director of the journalism program at Georgetown University. An advocate of lifelong learning, she is a member of the first cohort of Georgetown’s new Aging & Health master’s program.@annoldenburg

Growing Into Contemplative Seeing

Posted on by Dr. Toni

Dualistic thinking is the well-practiced pattern of knowing most things by comparison. And for some reason, once you compare or label things (that is, “judge” them), you almost always conclude that one is good and the other is less good or even bad. In the first half of life, this provides ego boundaries and clear goals, which creates a nice clean “provisional personality.” But it is not close to the full picture that we call truth.

Dualistic thinking works only for a while to get us started, but if we are honest, it stops being helpful in most real-life situations. It is fine for teenagers to think that there is some moral or “supernatural” superiority to their chosen baseball team, their army, their ethnic group, or even their religion or gender; but one hopes that later in life they learn that such polarity is just an agreed-upon game. Your frame should grow larger as you move toward the Big Picture in which one God creates all and loves all, both Dodgers and Yankees, blacks and whites, Palestinians and Jews, gays and straights, Americans and Afghanis.

Non-dualistic thinking or both-and thinking is the benchmark of our growth into the second half of life. This more calm and contemplative seeing does not appear suddenly, but grows almost unconsciously over many years of conflict, confusion, healing, broadening, loving, and forgiving reality. It emerges gradually as we learn to “incorporate the negative,” learn from what we used to exclude, or, as Jesus put it, “forgive our enemies” both within and without.

You no longer need to divide the field of every moment between up and down, totally right or totally wrong, for or against. It just is what it is. This inner calm allows you to confront what must be confronted with even greater clarity and incisiveness. This stance is not at all passivity. It is, in fact, the essential link between true contemplation and skillful action. The big difference is that your small and petty self is now out of the way, and if God wants to use you or love you, which God always does, God’s chances are far better now!

Adapted from Falling Upward: A Spirituality for the Two Halves of Life,
pp. 146-148

OCT31

The 5 Things That Spook People Over 50

What to do about the scary stuff that makes middle-aged spines shiver posted by Donna Sapolin

Forget things that go bump in the night, global warming, Congressional paralysis, creepie crawlies and assault weapons. There are five other worries that make the hearts of middle-aged folks leap into their throats on a regular basis. The good news is it’s totally within our power to chase these evils away — or, at least, diminish their hold on us.

1. Declining memory Sporadic forgetfulness, slower reaction times and other glitches in cognitive processes can result from an aging brain. Some symptoms may point to dementia and Alzheimer’s; others shouldn’t trouble you.

On the bright side, the latest research tells us there are many things we can do to take advantage of the brain’s natural plasticity to reverse the aging process, sharpen our abilities and ward off debilitating brain disease. Examples:

Preserve mental health and acuity by engaging with the arts, particularly dance.
Eat less saturated fat from animal products, which cause the brain to produce beta-amyloid, a protein that contributes to Alzheimer’s. Instead we can consume brain-protecting foods like Vitamin E-rich nuts (about 1.5 ounces or 8 milligrams a day will do), vegetables, beans and a small amount of fruits and whole grains.
Exercise! Walking briskly just three times a week for an hour has been shown to boost the connectivity within brain circuits.
Get a good night’s sleep. A recent study, published in the journal Science, proves that during sleep the brain cleans out the toxic cellular waste products it creates during the day, thereby preventing their build-up. Remain curious, challenge yourself to learn new things and explore things you’re passionate about. By deepening knowledge and skills, we help our brains to thrive.

2. Increased loneliness and isolation Society is now afflicted with a growing isolation epidemic. More adults 50 and older are not only living longer, they’re living apart from family members, divorcing, and becoming separated or widowed. In addition, they begin interacting with fewer people, a fact of midlife.

But people who describe themselves as lonely are at far greater risk of developing dementia and other health problems. It’s vital that we seek out ways to engage with others. Here are some ways to do that:

Make new friends, both young and old. Sign up for classes, get active in social media platforms, hit the gym and join networking groups. Above, all, open your mind and heart to the possibility of fresh connections.
When retiring, think about living close to your friends and family members instead of moving far away, as so many people do.
Rehab your relationship dynamics by following Dr. Terri Orbuch’s (aka “the love doctor”) expert advice on Next Avenue. Overhauling unhealthy habits and participating in therapy sessions may be among life’s more difficult missions, but they can help you secure peace of mind and critical emotional nourishment.
Consider a communal living arrangement — the options are numerous and include co-housing, NORCs (Naturally Occuring Retirement Communities) and living with one or more roommates.
Mentor others. We can derive great satisfaction from passing on our knowledge and, in the process, forge enriching bonds.

(MORE: 9 Most Common Regrets of the Living and Dying — and What to Do About Them)

3. Big debts, little savings The 50+ crowd is facing a perfect storm: the prospect of living on a fixed income at the exact time that government entitlement benefits are at risk of being curtailed and health care needs and costs are soaring.

Many are counting on their ability to continue to work well into older age, yet they will need to sustain good health and secure employment despite the known difficulties of landing a job after the age of 55. Suggestions:

Analyze how much money you will need to retire and still be able to afford the lifestyle you expect. A good online calculator, like the Ballpark E$timate from the Employee Benefit Research Institute, can help.
Work on reducing debts, especially credit card bills, which carry high interest rates.
Prioritize saving. Evaluate all aspects of your lifestyle to see what you can cut back and then apply the ax. This may even mean downsizing your home. You should also contribute as much as possible to 401(k) accounts, reallocate your investments to reduce related fees and build a health care emergency fund.
Hire an astute financial adviser to help you devise a smart plan, which may include delaying Social Security benefits.
To find a job, implement these well-proven strategies: shorten your resumé and incorporate keywords into it, spend more time networking and less time using broad-based job boards and develop a strong, positive online presence.

4. Greater physical frailty and risk of illness The majority of us are carrying extra pounds; many have high blood pressure, diabetes or high cholesterol; and our knees, feet or back may be aching.

There’s no question that the aging process itself leads to increased frailty, but lifestyle behaviors magnify and accelerate health problems. Changing just a few of our habits can go a long way toward enhancing vitality and longevity. Here’s how:

Opt for a Mediterranean diet that emphasizes olive oil, fish, legumes, fruits, vegetables and unrefined grains — and vastly reduce your consumption of sugar and salt.
Try intermittent fasting, which provides enormous health benefits: Eat a Mediterranean diet (about 2,200 to 2,400 calories a day for men; 1,600 to 1,800 per day for women) five days a week and consume only a quarter of your usual calorie intake the other two (non-consecutive) days.
Sit less. Recent studies have shown that sitting more than three hours a day can cut life expectancy by two years even if you exercise regularly during the week. Get up at least a couple of times every hour when working at the computer or watching television and move around. Also, stand up while talking on the phone.
Instead of skipping your workout session because of aches and pains, learn how to adjust common exercises to accommodate your infirmities. To make exercise a priority, schedule your sessions in your calendar and find a workout buddy, which will help keep you motivated.
Reduce stress by practicing meditation, allowing yourself to focus on one task at a time, using relaxation apps and choosing to be happy.

(MORE: 30 Questions to Ask Yourself Before You Die)

5. Death Every day, we get a step closer to “the end.” Although we are living longer than ever, by this point many of us have witnessed the passing of one or more loved ones and the final stage is all the more real and perhaps also scarier to us. To reduce your fear of death:

Take serious inventory: Think about how you would like to spend the second half of your life, what you would like to accomplish and what regrets you would like to resolve. Dr. Lissa Rankin advises that you be “unapologetically you.”
Connect with the most vibrant part of yourself — the child-like spirit that is endlessly curious, appreciates adventure and learning and dives readily into new things. Allow your dreams and passions to ignite you.
Practice forgiveness, which is about remembering and telling your story, confronting and absorbing it fully, refusing to give in to anger and revenge and holding on to your humanity.
Stop fighting your enemies. Anger and hostility and the underlying aspects of ourselves that fuel these emotions hold us captive. They are our worst enemies. We can transform our experiences with adversaries into deep learning experiences by recognizing that they are, in fact, our teachers.
Mend rifts with adult children and parents. Give up the need to be “right” and work on yourself (perhaps with the help of a professional counselor) to avoid repeating the same offenses. This will help you shape a new, healthier dynamic.

Remember, some of the fiends that haunt us are of our own making. But even if they aren’t, we can take action to bust the boogeymen.

‘Living Memorials’ Allow Tributes Before Loved Ones Die

Posted on by Dr. Toni

Gaining in popularity, the gatherings differ in types and purpose

Living Memorials

Credit: Adobe

Linda Singer has had ovarian cancer for nine years. In recent months, her health has worsened significantly. Rather than dwelling on looming death and planning a traditional funeral service, the Atlanta woman chose the opposite course: a celebration of life.

So, on Jan. 12, more than 100 of her friends came from around the country with anecdotes and remembrances to share while Singer was still around to hear them.

“Everyone was upbeat and happy, and Singer had such a good time,” says her friend, Joy Harris, who, like most of Singer’s friends, calls her by her last name. Harris took care of the logistics for the gathering. “The room was just full of love. If you didn’t know anyone there and walked in the room, you would feel the love,” she says.

Such gatherings are becoming increasingly common for the terminally ill and their loved ones, most of whom have attended countless post-death, standard-issue services, wistfully hoping that somehow, the recently departed could hear the accolades heaped upon them.

In recent years, Charlotte Eulette, international director of the Celebrant Foundation & Institute, has seen a steady uptick in the number of “living funerals” her celebrants have been asked to coordinate and/or perform. In general, memorials are morphing before our eyes: A National Funeral Directors Association survey found that more than half of 1,000 people it polled had attended a gathering in a non-traditional place during the last year.

“[Americans] are looking for personalized funerals, where personal lives unfold, about what they liked, their history and challenges, important moments, hopes and dreams for their family,” Eulette says.

Living Funerals for Different Reasons

More and more people are opting to have that sharing experience before their bodies have “slipped the surly bonds of Earth,” looking for an amalgam of commemoration and celebration.

And some have other agendas, as Eulette noted: “People might have things they want to give away … Someone might want to treat the honoree with a favorite song. Everyone has their gifts to give and get.”

These kind of tributes are not new, even if they are new to many, if not most, Americans. Eulette pointed out that “a lot of ancients and indigenous (people) have done this.”

The popular memoir Tuesdays with Morrie included a living funeral, and in the 1990s, the Japanese began holding such rites, called “seizensō,” in lieu of traditional funerals.

Eulette says at least two factors have fueled the more recent popularity of living funerals. She cites Princess Diana’s death in 1997 and 9/11 as “tipping points on how we grieve, with people wanting to personalize these experiences.” Meanwhile, the mindfulness movement has changed how many people view death and the end of life.

Spirituality and Joy

Robin June Hood saw that firsthand when her husband, John Shields, decided to hold a living wake just before his assisted suicide in Victoria, British Columbia, which was chronicled in The New York Times.

“All I did was send out an email to his friends that this is what he wants, to come at such-and-such time and bring your wishes for a good voyage,” Hood said. “It was an encouragement of everybody, who also will die, that it was OK, to welcome them into his exploration of the next journey.”

The Celebrant Foundation’s Penny Allport served as officiant at the observance, which had spiritual and festive aspects. She brought a Tibetan prayer shawl on which people could place their blessings, but Allport ran into a snag right away.

“I had prepared notes, and they were in my purse behind the door, and then they wheeled John in and put him in front of the door so I had no access,” she explains. “So I recited a prayer that I had written and was something people had never heard. Then I asked for others to speak, and a woman opened up a Rumi poem, and it was the exact same poem that was in my purse.”

After each person spoke, “John [a former Catholic priest] would say something profound about that person. It was a current that was so deep in him. … He created this liminal space and invited everybody into it,” Hood says.

The remembrance then became more convivial. “It was an Irish wake. John was Irish, and he wanted Irish music and … there were Irish beers floating around,” says Allport, adding that it reminded her of similar traditions in other cultures, where “it’s not so controlled. It’s carrying the emotion and magic and potency for that particular person.”

Time to Share Stories

Singer’s celebration also was filled with good cheer, says her friend Pat Coggins.

“People were telling such great stories. Like one summer when she was young, she and a friend boiled peanuts and sold them at events at a park. One time they got approached by a cop who said ‘Do you have a license to sell these?’ Linda is really quick-witted and turned to her partner, Denise, and said ‘Did you not bring that license, did you leave it in the car?’ And in the midst of them arguing, the cop got another call and just left them,” Coggins recalls.

“It wasn’t like a memorial. It was truly, as she called it, a celebration of life. People were able to eat, to dance. She was able to walk around and spend as much time as she could with her friends and family. There were no tears, lots of laughter, lots of camaraderie,” she says.

Living funerals take many forms. Some are held in churches or synagogues, some even in bars. Potlucks are popular options.

Timing, of course, is a key factor. Waiting too late can make the event, well, too late. Harris says she was concerned about Singer. “I didn’t know if she was going to make it,” she says.

Allport had a client who was very private and had only a son in her family circle. “She could have died alone with her son and myself,” Allport says, “but her sharing with her community was that the space opened up for an authentic and real experience, by slowing down and having less sense of urgency. She and her son made soup, and children came and brought licorice and sat on the couch with her, and they brought a card blessing her in her afterlife. And I thought ‘wow, we need children at these things.’”

For those who time it right, these commemorations can provide solace, joy, closure, relationship resolution and perhaps more than anything else, precious face time.

At Shields’ wake, “Everyone was elevated by it,” Hood says. “It was almost like a blessing that went in two directions. It’s a pretty incredible opportunity for people to have love reflected back to them.”

 By Bill WardBill Ward is a freelance wine, food, travel and lifestyle writer. His “Liquid Assets” column runs in the Minneapolis Star Tribune, and he has a wine website, www.decant-this.com, with a blog and a travel-itinerary service. He won a James Beard Award in 2004 for a series on Italian regional cuisine. He lives in the Minneapolis suburb of Hopkins, Minn., with his wife, Sandy.