How to Get Over Grudges Before You are on Your Deathbed

As a hospice physician I have had the experience many times of sitting with a patient at the very end of life who was struggling to forgive someone they hadn’t seen or spoken to in years. I’ve recognized that the passage from life to death is a difficult process and going through it with a lighter load of emotional and spiritual “baggage” is helpful. So, many patients are motivated to leave behind their anger and resentment even toward people they’ve spent their entire lives hating.

My patient Anne told me several times that she had already forgiven her sister Mary even though they hadn’t spoken to one another for years. She told me that Mary had always been a troublemaker who had hurt her many times in the past, but again, she insisted that she had forgiven her. However a few days before she died Anne desperately wanted to talk to Mary to tell her that she loved her “just as she was.” Anne admitted that she had been carrying a grudge toward Mary all of her life and that she now recognized that true forgiveness meant changing how she viewed and talked about Mary.

While dying was a powerful motivator for Anne to tie up her own loose ends in life, I’ve realized that getting over grudges doesn’t have to wait until our final breaths are taken. In fact, if we manage earlier in life to actually forgive those who have harmed us we can enjoy the benefits of letting go of negative memories and making room for more positive and joyful feelings. Science has validated this idea by showing in studies that there are physical and emotional gains from the practice of forgiveness.

The problem is that it is not easy to get over the wounds of the past. In fact our brains are hard-wired to hold onto the negative events from the past as a form of protection and our egos are resistant altogether to the idea of letting someone “off the hook” who has harmed us.

So forgiveness is a practice that takes work to accomplish. But it’s so important that I’ve spent my entire adult life working on forgiveness as a spiritual practice. And I also included it as one of the “7 lessons from the dying” in my book What Really Matters. I’ve learned that there are several mindset shifts that have to take place in order to forgive. Here are some of the shifts in thinking that are necessary and a practice that can help you begin to forgive:

Life is a classroom.

The first step toward being able to let go of grudges is to begin to see that life is simply one learning opportunity after another. During our time here on Earth we are presented with a series of challenging lessons and we can choose whether to learn something from them or not.

The people in our lives who cause us the greatest difficulties are actually teachers who can help us grow if we choose to see life from that perspective.

You’re not entitled to a life free from difficulties.

We often believe that the harm that has come to us throughout the course of life should never have happened, that it wasn’t fair or deserved. We hang on to our grudges against other people as a badge to prove how we have been victimized by life. It is true that life isn’t fair but it was never intended to be. We are participants in a cycle of life that contains both birth and death and an equal measure of pain and joy. So we cannot expect that we should avoid pain in our lifetimes and we need to learn to get over being angry that this how things are.

The past no longer exists.

Whatever happened before this very moment exists now only in your memory. You are using your own energy and life force to keep your memories of the past alive and if they are negative memories they can exhaust you, making it impossible to enjoy all the positive little moments that life could offer you right now. No matter what has happened in the past this present moment is brand new and you have the opportunity to enjoy it if you choose. Look around and you’re bound to see something beautiful in your life if you are not totally depleted from carrying around your old resentments.

You can make yourself whole again.

Even if the person who has harmed you in the past has no remorse for their behavior, you can heal the anger you carry for them. You don’t have to sentence yourself to years of “hard labor” hauling the burden of that person’s bad behavior in your life. He or she may never apologize or even recognize the pain that has been caused but you can let go of it anyway. In fact the best revenge as has been said, could be a life well-lived and fully enjoyed in spite of pain and difficulties.

It’s not your job to punish other people.

Life will bring those who have hurt you plenty of difficulties of their own—you can release them from your anger without worrying that you are letting them “off the hook.” Don’t waste your time and energy wishing suffering on others because that will only punish you further. Don’t allow other people to continue to bring harm into your life by hating them—hatred is bad for your health and doesn’t bring you satisfaction anyway.

Look at life experiences from different perspectives.

One healing practice for forgiveness is the “4-View Process” in which you intentionally look at experiences through different lenses. Use your journal to write about 4 Views of the situation that is causing you pain. The 3rd-person view describes the facts of the event as a reporter might write in a newspaper article; the 2nd-person view is from the vantage point of the person you have a grudge against; the 1st-person view looks inside your own memories of the event for other hidden feelings; and the Galaxy View is the perspective of a wise teacher or guide who is helping you see ways you can grow from this experience and find compassion and love within your pain.

Rituals can help you let go.

To finally release an old grudge it can be helpful to use a ritual that symbolizes being done with the past and moving on to this present moment. Some useful practices include burning sticks or pieces of paper in a campfire to represent clearing away what you no longer want to carry, floating flower petals down a stream, or blowing leaves or seeds into the wind. These physical actions can create a powerful shift internally as you mark the transition that has taken place.

Forgiveness may be one of the most difficult tasks we are given the opportunity to learn during this lifetime but it is also one of the most rewarding. You can reap the benefits during the last hours of your life if you want to wait until that moment to let go or you can start whittling away at your grudges right now. The choice is yours to make, but trust me, you have no idea how good forgiveness feels until you’ve tried it!

Download The Forgiveness Toolkit for some additional support in getting over your grudges.

 

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The Minimalist Approach to the End of Life

Learn how a new lifestyle trend can revolutionize the way we approach our last days.

In recent years the minimalist lifestyle has been trending throughout the United States, particularly among the millennial generation. Unlike their parents who sought after material goods and wealth as part of “living the dream,” many younger people are choosing to live a simple lifestyle with fewer possessions, tiny homes, and less waste and consumption.

According to author Joshua Becker: “Minimalism slows down life and frees us from this modern hysteria to live faster. It finds freedom to disengage. It seeks to keep only the essentials. It seeks to remove the frivolous and keep the significant. And in doing so, it values the intentional endeavors that add value to life.”

While minimalism provides a more relaxed and meaningful way of life to its youthful followers, this movement could also be an answer to today’s current healthcare crisis surrounding the end of life. With an emphasis on simplicity and intentionality, the guiding principles of minimalism provide a framework for changing our approach to the later years of life and the process of dying and death. Here are some of those principles and how they might be applied to decision-making at the end of life:

Less is more

The current default mentality of our healthcare system seems to be “if some is good, then more is better.” A patient arriving in an emergency room anywhere in the country in the midst of a cardiac arrest will receive full-bore, defibrillated, intubated, catheterized, crash-cart care unless an advance directive and/or a healthcare proxy is available in the moment to refuse that care. And a cancer patient is likely to be offered treatment up until the last breath is taken, even when there has been no improvement from that treatment.

In this medical system more care will almost always be offered and carried out unless patients and their representatives are able to say “no” to that care. The patient’s best defense is to adopt the “less is more” mindset of minimalism and recognize that in many situations more care creates more side effects, more expense, more suffering, and more stress on patient and family.

Opting for less care can create space and time for enjoying moments with loved ones, contemplating what really matters in life and savoring the small pleasures that bring joy and meaning to existence. Less care can mean more quality of life if you approach it with intentionality and informed decision-making.

To be a “minimalist healthcare consumer” you must have an advance directive that spells out your wish for less rather than more care. You must communicate this desire to your medical providers, your healthcare proxy and your loved ones.

But you also have to address your fear of suffering, aging, illness and death, because those fears can drive you to choose more care when faced with a crisis. Complete your paperwork but also do your inner work to confront your deep-seated and normal anxieties about the end of life so that you will be ready to face the natural passage from life to death. You should also practice the “less is more” mindset during your later years by making careful decisions about the non-emergent healthcare you receive from your provider during routine office visits.

Eliminate the non-essential

Throughout your later years as you seek out medical care keep asking: “Is this essential?” Question every treatment or diagnostic test that is recommended to you and demand to know why it is necessary, how it might benefit you, and what could happen if you don’t do it. Don’t accept a procedure or test until you have had time to do your own research or get a second opinion. Some standard recommendations that have been accepted in the past such as the annual physical exam and routine screening procedures are now being questioned as they have been shown to result in over-diagnosis and excessive treatment.

If you take prescription medications ask if they are still necessary and if you can systematically discontinue some of them to see if they are helping or worsening your symptoms. Studies show that seniors who take multiple medications are more likely to experience negative side effects and even unnecessary death from the combination of potent drugs.

Find a primary care medical provider who agrees with your “less is more” philosophy and will help you create a sensible and simple plan for managing your healthcare needs. Don’t seek out specialty care unless your primary care provider says it is necessary. You have a right to say “no” to medical care and to find a practitioner who supports your right.

Individualism

While minimalism may be a trendy lifestyle with many people following the same guidelines, its principles encourage each person to find their own path to simplicity. As you begin to advocate for your individual philosophy of less medical care in later life it’s important to know yourself and seek out what is best for you.

Spend time thinking about the experiences of aging and dying that you may have witnessed with loved ones in the past. What would you like to be different in your end of life? How can you create a better path for yourself that reflects your unique wishes and desires?

For example, if you are a solitary person and prefer to live alone for as long possible then you will need family or community support to make sure you can safely stay in your own home as you age. If you enjoy social interactions with others you might choose to be in a senior living center in the future and you will need to provide for that option financially.

Get organized

One hallmark of minimalism is “keeping everything in its place.” This principle applies especially to your plans and paperwork for the end of life. Complete your estate plan, will, and advance directives and make sure those documents have been shared with the appropriate professionals and loved ones.

Decide what type of “less is more” funeral and burial or cremation you would like to have, perhaps a simple home funeral and green burial, and put those preferences in writing too. Keep your paperwork organized and accessible, including insurance forms, birth and marriage certificates, military discharge papers, titles, deeds, banking and investment information, online accounts and passwords, and medical records.

Live in the moment

A benefit of the minimalist approach is the ability to live lightly and with fewer burdens from the past and worries about the future. When you can live more fully in the present moment you are free to take in the small joys and pleasures that are available to you, like the beauty of a sunset, a bird singing outside your window, or the comforting aroma of dinner cooking on the stove.

However, living in the present moment takes work. You have to consciously let go of the past by giving away things you no longer need and making room for a new way of life. This applies to medical care at the end of life too—perhaps you will decide to discontinue treatments or procedures that have been part of your routine for a long time. Or you might part ways with a medical provider who doesn’t support your choice of a minimalist approach to the end of life.

As part of the medically minimalist lifestyle you will need to adjust to the normal changes of aging and learn to embrace them rather than seeking a medical solution to every ache and pain. Find modalities such as yoga, massage, relaxation, and imagery that can keep you comfortable without taking additional drugs. You may find that you receive positive “side benefits” from these practices rather than the negative side effects of many medications.

Prioritize what really matters to you

As Joshua Becker stated above, minimalism focuses on letting go of what is superficial and keeping those things in life that are significant. You have to determine what really matters to you in order to choose the components of your new less-is-more lifestyle.

This prioritization applies particularly to the non-tangible things like your relationships with loved ones and the time you spend with them. Would you prefer to stay in the community where you have lived for many years? Or would you consider moving to be closer to family as you age? These choices will play an important role as you let go of the complexities of the past and move toward a simpler way of life in the future.

No matter how old you are it’s never too early to start thinking about what is most important to you in life and making those things a priority. When you give your time and energy to the deeper and more significant aspects of life you will find it much easier to let go of all the things that don’t really matter to you.

Find Your Purpose

The key to successfully maintaining a minimalist lifestyle is recognizing that life has a greater purpose than just the accumulation of material possessions. When you know your own purpose you can make choices that support that purpose rather than interfere with it.

The healthcare decisions you make for yourself are important because your time, energy and finances can potentially be drained in later life if you pursue unlimited medical interventions in a quest to reverse aging and prevent death at all costs. The minimalist approach reminds us that the purpose of life is not to live as long as possible, regardless of the circumstances, but to live a life of meaning and quality for as many days as we can. Again, the emphasis is on the meaning and quality of life rather than on the quantity; another example of “less is more.”

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While minimalism as a lifestyle may not suit everyone, it is certainly worthwhile to apply some of these minimalist principles to the later years of life as we contemplate how to make the most of our last days. As a general rule if we focus on what is simple and has the greatest meaning for us we will be guided to make wise choices for the end of life that reduce stress, wastefulness and suffering from unwanted medical care.

You can start your minimalist approach right now no matter what situation exists for you right now. Think of one thing in your life that you no longer need and let go of it today; then repeat that process each day from now on. The more you practice living simply the easier it becomes as you free yourself from old burdens. Perhaps when you reach the end of your days you will arrive unencumbered, free to move on through the final passage with lightness and ease—that at least is the hope for all of us.

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How Reading About Death Can Change Your Life

A new reading group about death, dying and the afterlife intends to increase death awareness across the country.

(Note: This post previously appeared on Medium.com)

For more than a century modern society has been intentionally oblivious to the reality of death. Once dying and death were removed from the home and every-day life by the increased availability of hospitals and funeral homes, it was relatively easy to shove death out of awareness and make it a taboo subject. There was even a belief for a time that thinking about death was pathological and destructive.

But now we know that death awareness—including thinking and reading about death—has positive benefits, thanks to research that has been done in recent years. An article by Kenneth Vail and colleagues from the University of Missouri includes a review of multiple studies on the impact of becoming aware of death and the findings are impressive:

Death awareness leads to increased helping behaviors.

People who had recently been reminded of death were more likely to help a stranger in need. In fact, increased death awareness correlated with an increase in positive factors like compassion, tolerance, and empathy. When we understand that life is fleeting we tend to focus more on the things that really matter, which includes the wellbeing of others for many of us.

Those aware of death are more likely to care about the environment.

Again the understanding that life is fragile can lead us to care more about all of life, including the natural life that surrounds us and the life of our planet as well. Those who do not deny that death is part of the cycle of life are more inclined to be careful with that life in all its forms

Death awareness corresponds with compassion toward those from other groups.

Studies have shown that members of certain fundamentalist religious groups who experienced an increase in death awareness were more likely to exhibit compassion and tolerance toward those of other religions. Peace becomes a more valued commodity when we recognize that our lives have a limited time frame.

Awareness of death leads to healthier behaviors.

It may seem obvious but studies have validated that people who are aware of their mortality tend to make better choices for their overall health. Quitting smoking, increasing exercise, doing breast self-exams, and even using sunscreens are all behavior changes that have been linked to death awareness. We cherish life more when we know if won’t last forever.

The results of these studies show us that our entire society can benefit from getting out of denial and becoming more openly aware of death. In fact, it appears from this information that many of the problems that currently afflict humankind could be alleviated with better awareness of and education about death.

One of the ways to increase death awareness is through reading books that provide factual information about all aspects of the end of life. In addition inspiring stories about the end of life can help us see beyond our fears and get comfortable with the reality of death. Books have the capacity to take us outside our usual experience and expose us to new ideas that stretch our boundaries.

In addition, by reading the stories of others who are coping with mortality we learn that all of us face the same struggles as humans here on planet Earth. The challenges we share are far greater than the differences that exist between us.

 “You think your pain and your heartbreak are unprecedented in the history of the world, but then you read. It was books that taught me that the things that tormented me most were the very things that connected me with all the people who were alive, who had ever been alive.” – James Baldwin

By reading books about death and dying we can increase our own death-awareness and prepare ourselves to be a source of information and inspiration for others.

To foster this type of positive growth through reading a unique new reading group called “A Year of Reading Dangerously” has been created for 2018. The group will explore death, dying and the afterlife by reading one book on these subjects each month during the year and holding online discussions about each book.

You can join more than 700 people around the world who are all learning about death together by signing up here. You have much to gain by reading about death … in fact, it will change your life!

 

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Why Some People Don’t Die in Peace

(Previously published in the Huffington Post)

Throughout my career as a doctor working with patients in hospitals, nursing homes and hospices I have had the opportunity to witness the dying process on many occasions. I have learned that even though the outcome of this process is always the same—the death of the physical body—there are many different ways to die.

In fact, each individual has a unique experience at the end of life. For some patients death is a welcome ending to a life well-lived, for others death is reluctantly accepted even though they don’t feel ready to let go of life, and some approach death kicking and screaming all the way. They “rage against the dying of the light” as observed by poet Dylan Thomas in a poem he wrote for his dying father.

Though I have seen that patients receiving hospice care often die with greater comfort than those in the hospital, there are still people who struggle all the way to their last breath, even when they are surrounded by loved ones at home. What makes the difference? Why are some people not able to be at peace when they die? Here are some of my observations from years of hospice work and my recommendations for ensuring that you have a peaceful death:

They haven’t thought about the end of life

We live in a society where death is still a taboo subject. Many people go through life without consciously considering the fact that they will die one day and are shocked when they receive the news that death is approaching. Since they’ve never thought about death they have no idea what type of care they would like to receive at the end of life and find it difficult to make clear choices for themselves while dealing with the stress and fear caused by a terminal diagnosis.

Recommendation #1: Begin to think about the reality that every living thing on this planet eventually dies and then spend time contemplating the fact that you too will die one day. The Bhutanese people have a practice of thinking about death 5 times a day and have been named “the happiest people” on earth. So make a point of thinking of death on a regular basis, perhaps reading books and watching films to help you get more comfortable with the idea of death.

They haven’t put their wishes in writing

Those who haven’t thought about death also have not made plans for the end of life or completed an advance directive. A recent study has shown that two out of three Americans have NOT put their end-of-life wishes in writing, which means they are more likely to receive expensive and unwanted care during their last days. According to a survey by the CDC, most patients do not want to die in a hospital attached to machines, but that is only possible if they have made the decision ahead of time and completed an advance directive.

Recommendation #2: Start by completing your own paperwork now for the end of life, such as a living will, estate plan, and funeral plan. Think through the options for care that might be available to you and formulate your own opinions—what is important to you? What are your wishes for your last days on earth?

They haven’t talked to their loved ones about their preferences

During a healthcare crisis many patients are unable to speak up for themselves about their end-of-life choices. If family members don’t know the patient’s wishes they will find it difficult to make appropriate decisions for their loved one on a moment’s notice. In my experience, uninformed family members are more likely to defer to medical providers when end-of-life decisions must be made and are also likely to experience guilt and conflict with one another over those decisions.

Recommendation #3: Once you’ve decided what you want for yourself at the end of life it is vitally important that you have conversations with everyone in your life that may be involved in making decisions for you. The more you talk about it the more you will create peace for yourself and for your loved ones when the time comes.

They have been unhappy all their lives

There is a saying in hospice that

people die the way they’ve lived.

I have observed that patients who have held onto bitterness and disappointment about life tend to be unhappy during the dying process as well. Since they had never learned how to be at peace with the circumstances of life, when death is near they remain angry and inconsolable. Woody Allen wrote for the movie Annie Hall that life is “full of loneliness, and misery, and suffering, and unhappiness, and it’s all over much too quickly.” This epitomizes the attitude of the unhappy patient at the end of life, who hated every moment of being alive but is now furious that it is coming to an end.

Recommendation #4: The antidote to this type of misery is to learn to find happiness within yourself long before life reaches its end. Each of us is responsible for creating our own joy in life, even if life hasn’t turned out as we have hoped. Conduct your own “experiment” and figure out what makes you happy—then cultivate those things in your daily life and you will look back one day to find that you have led a life filled with joy.

They are holding on to old regrets and resentments

Many of my dying patients have been ravaged by feelings of guilt and remorse over events of the past. They either have felt a deep need to make amends for some previous action of their own or they have been burning inside with resentment toward another person. Those who have not found their way to forgiveness have remained in this painful state of guilt and blame until their last breath.

Recommendation #5: It is never too early to start working on letting go of old wounds so that you can avoid the overwhelming negativity of resentment at the end of life. Develop your own daily practice of forgiveness and you will find much more peace in your life now, as well as during your last days.

They feel entitled to a different outcome

Some of my patients have been angry about the fact that they were dying because they spent much of their lives doing things they believed would “prevent” them from dying. They devoted themselves to a restrictive diet or intense workout plan or even strict religious practices in order to live life “the right way” and avoid something “bad” from happening to them. When they ultimately had to face the fact that they were going to die anyway they felt cheated and betrayed. They had fallen for a false belief that their healthy habits would somehow entitle them to avoid death.

Recommendation #6: It is important to come to terms with death, and your fear of it, earlier in life so that you don’t waste time and energy trying to prevent what is inevitable. Develop a practice of thinking about death as a necessary part of the life cycle and something not to be feared, but to be respected. Journaling, prayer and meditation can be helpful tools as long as they focus on the reality of death and are not serving as bargaining chips in a futile attempt to avoid death.

They rely on the medical system to make choices for them

Those patients who have avoided thinking about death generally have also not taken time to educate themselves about their own health issues. Without knowledge and information as a tool to guide decisions, they are disempowered when they must engage with the medical system. They don’t know what questions to ask or what alternatives to explore so they simply place all decision-making in the hands of their care providers. These patients may end up with more treatment than they want and encounter more suffering than necessary because they didn’t have the confidence and information they needed to help determine their own course.

Recommendation #7: While doctors are well-educated about disease and treatment modalities, they know very little about you, your life path and what options might be best for you. When you receive a chronic or terminal diagnosis it is your responsibility to learn as much as you can about your options by asking questions, reading and studying, and requesting second opinions. You are the only expert on the subject of “you” so don’t give up your power to another person, no matter how impressed you are with their credentials.

In summary, by looking at why some people don’t die in peace we have seen what is necessary in order to have a peaceful death. Being consciously aware of your mortality, working on your past issues, making plans and completing paperwork for the end of life, communicating with loved ones, and empowering yourself with knowledge are all important steps toward an end of life that offers comfort rather than chaos. But it requires work and dedication on your part to prepare now for what will be coming in the future.

Of course there are other reasons why some people don’t die in peace: they may have pain and other symptoms that haven’t been managed well, they may be alone and have no one to comfort them, they may simply be overwhelmed by the hand that life has dealt to them. But these are issues that may be addressed by finding support from hospice or palliative care workers, if that type of care is available (and reliable) in the community, though there are reports that hospice staffs are stretched too thin in some areas and care at times falls short of what it should be.

But you can improve your own chances of getting good end-of-life care by doing your own inner work, becoming an advocate for hospice and palliative care in your community, holding those organizations accountable to best-practice standards, and supporting causes that help people find peace in their lives. It’s never too early to start!

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A Simple Ritual to Ease My Grief

The Aramaic word for grief can also mean “to wander.” When I was left wandering and bewildered after the death of my niece a small ritual helped me find my way again.

A few months ago my niece died of breast cancer at the young age of 47. I was somewhat prepared for her death because of her 14-year journey with cancer and the inevitable decline she had been experiencing for several months. Yet in reality death always arrives like a lightning bolt that pierces to the core.

There is no way to prepare for death’s appearance or to be unmoved by the jolt: your loved one is next to you in one moment and then gone after a single breath. You don’t know you are at the end until the end has already passed.

So the news of Tracey’s death hit me hard with a mixture of emotions—disbelief that she could really be dead at such a young age, pain for her son and her parents as they coped with this loss, guilt that I hadn’t done more to help, and a trace of relief that finally there was no more uncertainty and no more agonizing over what suffering the next hour or the next day would bring to her. Her journey here was finished.

As life would have it, with its curious synchronicities and juxtapositions, I was scheduled to do an interview with two women who had written a guidebook to end-of-life rituals just a few hours after news of Tracey’s death reached me. I didn’t even consider postponing our conversation because I knew that this timing, though difficult, was perfect.

My guests, Donna Belk and Kateyanne Unillisi, talked about the importance of rituals for making sense of life’s tragedies and painful events and they shared their suggestions for creating our own simple rituals. I understood deeply the importance of this subject and that I needed to somehow find a way to mark this day with some special ceremony, though I had no idea where to begin.

The next morning I took a long walk on a path next to the Blue River and thought about Tracey. I was filled with regrets – Why hadn’t I visited her one last time? Why hadn’t I called her for that talk about forgiveness that I knew she wanted to have? Why hadn’t I been there more for my brother?

As I walked more and more slowly, weighed down with all of the guilt I was heaping on myself I suddenly heard laughter—and it was unmistakably Tracey’s laugh. I felt as if she were standing right next to me and I heard her say “I understand everything now! It’s all okay.”

In that moment I was surrounded by joy, peace and love. I looked down and saw beautiful flowers I hadn’t noticed before at the side of the path: fragrant wild roses in bright pink, Tracey’s favorite color. I instantly knew what to do next and asked Tracey to join me.

I began to gather wildflowers from the banks of the river and was surprised by the variety I found growing there when I really stopped to look: mountain lupine, bluebells, yellow daisies, poppies, chicory, cinquefoil, wild geranium, blue flax, columbine and more.

By the time I reached a small stream that flowed gently into the rushing river I had a handful of blossoms of many colors. I spread them out on a tree stump to create a mandala of sorts—an array of beauty and a reminder that life changes constantly but ultimately continues on.

I said a prayer for Tracey and for all of our broken hearts that were missing her so dearly on that day. Then I dropped each blossom—one at a time—into the stream and watched it drift gently away. With each flower that tumbled into the stream I felt a lessening of the burden of grief and a gradual influx of peace. And all the while I heard the faintest hint of laughter floating on the breeze.

 

 

 

 

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5 Questions to Ask Before Naming A Healthcare Proxy

You may already know what kind of healthcare you would like to receive when you reach the later years of your life. But, to ensure that your future healthcare wishes are followed, one of the most important steps you can take is to name someone you know as your “healthcare proxy.” This person will speak for you if you are unable to communicate and will make sure your medical providers know your preferences.

This crucial role shouldn’t be entrusted to just anyone, so it’s wise to make a careful decision. After all, your oldest child or nearest relative may not be the best person for the task, even if that person seems like a logical choice. Write down the names of several people you are considering for your healthcare proxy and then ask these 5 questions about each of them:

1. Does she understand my healthcare wishes?

A recent study at Yale University showed that only about 20% of the healthcare surrogates they interviewed accurately understood the wishes of the patient they represented. To speak on your behalf your proxy must have a very clear grasp of your preferences. Pick someone who not only comprehends what you have chosen, but who also recognizes why you have made your choices.

2. Does he agree with my wishes?

Ideally your proxy should be in agreement with your decisions and have no concerns about them in order to advocate for you. Some people may be able to support your wishes even if they don’t agree with them, but you need to be certain that your feelings will take priority in any situation that may arise.

3. Will this person be available to speak for me in an emergency?

Your healthcare proxy may need to travel to the hospital on short notice at inconvenient times to speak on your behalf. The person you choose for this role should be someone who is flexible and cares enough to go out of the way for you.

4. Is he or she emotionally strong enough to make a decision in a crisis situation?

The person you choose may have to make difficult decisions for you on the spur of the moment. Make sure your proxy will not allow their own grief feelings to interfere with acting on your behalf. They may also have to stand up for you if family members and medical professionals disagree with your choices so choose someone who can handle those challenging situations.

5. Do you trust this person?

Your own “gut feeling” is important to assess when you consider your choice for healthcare proxy. Make sure you trust this person completely since you may be putting your own future in his or her hands. If something doesn’t “feel” right to you about this person, spend some time thinking of someone else who is a better fit.

No matter who you end up choosing to be your healthcare proxy, that person needs to understand the requirements of this important role. Schedule time for a long conversation and bring along your wishes in writing. Be prepared to answer any questions that arise and suggest a follow-up discussion if needed. You might want to download and print this helpful handout: Guidelines for a Healthcare Proxy.

Your next steps are to put your wishes and the name of your healthcare proxy into writing by completing the appropriate advance directive (or living will) forms for your state of residence. Then share them with your family, friends, clergy and healthcare providers. Congratulations on taking the time now to protect your future wellbeing and increase your peace of mind.

 

About the Author:

Dr. Karen Wyatt is a hospice and family physician who writes extensively on spirituality and medicine, especially at the end-of-life. She is the host of End-of-Life University Interview Series and author of “The Tao of Death” and the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying” Connect with her at karenwyattmd.com, on Facebook at fb.com/KarenWyattMD and on Twitter @spiritualmd

 

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Why I Think About Death Every Day

I was 16-years old when I first began to think about my own death. A classmate of mine died from a fall while hiking, which caused me to recognize that it is possible for a young person (including me) to die at any time. For the first time, death became real to me and since that event I have thought about death every day. In fact I might say that I have kept “death on my shoulder” like the character Billy Jack from the movies of the same name that were popular in the 1970’s.

But I am not alone in my tendency to dwell on thoughts of death. In fact, contemplation of death is a spiritual practice in Tibetan cultures. Moreover when I recently interviewed a priest about the Catholic perspective on death he quoted St. Benedict as saying, “Remember to keep death before your eyes daily.”

While this might sound like a morbid practice, I can assure you that it is not. Recognizing my own mortality on a daily basis has actually changed my life in profound ways and provided many benefits:

Gratitude for every moment of life

Knowing that life is fleeting helps me appreciate each experience and every moment to a deeper degree than ever before. I no longer take life for granted and value the time I have been given.

Restructured priorities

With the briefness of life in mind I am able to focus on those things that really matter to me (like love and relationships) and let go of the superficial and trivial details that compete for my attention. I don’t “sweat the small stuff” now because I know it’s not really important.

Taking responsibility for my life

I now see that life is precious and the meaning it contains is up to me. No matter what has happened in my life, I am responsible to make the best of it and create as much love as I can. I no longer waste time blaming other people or circumstances for the problems I encounter.

Looking within myself for answers

I also have learned to seek my own answers from within rather than looking outside of myself for guidance. No one else can understand my life or my purpose better than me so I need to find my own path and follow it.

Finding joy in being alive

The French value the concept of joie de vivre, which literally means “the joy of being alive.” Recognizing that death could arrive at any time helps me cherish the gift of life. I wake up joyful each day because I am still here with another opportunity to experience life on this planet, even if I am sick or if life’s circumstances aren’t exactly what I would have chosen. Simply being alive is enough to create deep joy.

Being prepared for anything

Since I have spent a considerable amount of time contemplating my own death, it won’t really be a surprise to me if or when I hear the words “You are going to die” from a doctor some day. I have already known that fact for most of my life and I have made sure I am ready every day. While I may not be happy to hear those words I won’t be shocked or angry or depressed. Death is an important part of life and I am prepared to face that truth.

So for me, thinking about death is a simple spiritual practice that has changed and exhilarated my life. I wish I could teach everyone that but our society remains entrenched in fear and avoidance of death.

But now is the time when we need more than ever to find joy in every moment, to be grateful for all of life, to be prepared for the future, and to shift our priorities to what really matters. Now is the time to learn to truly love life by embracing the reality of death.

(Learn how you can start a simple practice of contemplation of death here.)

About the Author: 

Dr. Karen Wyatt is a hospice and family physician who writes extensively on spirituality and medicine, especially at the end-of-life. She is the host of End-of-Life University Interview Series and author of “The Tao of Death” and the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying” Connect with her at karenwyattmd.com, on Facebook at fb.com/KarenWyattMD and on Twitter @spiritualmd 

 

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A Farewell Letter From a Dying Monk

As part of an ongoing series on various religious and cultural perspectives on death, I recently interviewed a priest about the Catholic approach to dying and after-death care. During the interview he shared with our audience a letter that had been written recently by a fellow monk from his monastery, Father Mark, who was dying of stomach cancer.

That letter was a poignant and instructive guide for how to approach death with three virtues that Father Mark said he valued most in his last days on earth: comfort, grace and gratitude. Father Mark, who has subsequently died, agreed to share his words and his wisdom with people far and wide, with a humble wish that others might be helped by reading about his experience.

Father Mark’s letter can be read in full here, but the following is a summary of the lessons shared by Father Mark as he lived his final days:

“Keep death before your eyes daily.”

Father Mark interpreted this quote from Saint Benedict quite literally as he recommended a meditative approach to death to help ease fear and live fully. He himself was able to find joy and positivity even within the natural anxiety that comes from facing death full on and acknowledging its inevitability.

Be willing to hear the truth.

Father Mark described unflinchingly how his doctors told him truthfully that there was nothing more they could do for him. He listened to their prognosis and embraced the limited time left for his life without fear.

Let go of curative treatment at the right time.

When it was clear that the cancer was spreading quickly Father Mark recognized that it was time to stop treatment and focus on saying goodbye, which was the motivation for writing the letter.

Embrace palliative care.

Father Mark described how helpful his palliative caregivers were in guiding his decisions for the last chapter of his life. With their advice he expressed his love to others, made amends and planned meaningful activities while he still had enough energy to pursue them.

Be grateful for everything.

In his letter Father Mark expressed his deep gratitude for life itself, love, his community, career, and spiritual life. He looked back upon his years of life as a blessing filled with rich meaning and growth.

See beyond sadness.

Because of his belief in an afterlife, Father Mark could express his sadness for all that was coming to an end in his physical existence but also look forward to something more that would continue on. His great faith allowed him to embrace his death with wonder and awe as he prepared for whatever lies next.

Through his thoughtful words Father Mark was able to translate his dying experience into meaningful advice that can change the perspective of all who read it from fear to peaceful acceptance of death. Indeed Father Mark accomplished his goal of achieving comfort, grace and gratitude in his own final days and also transmitted those three virtues to each of us who have received them.

We don’t need to be Catholic or even religious to grasp the meaning of Father Mark’s teaching, for he is communicating the universal language of death:

 These are the words we were born to hear; this is the lesson we came here to learn: embrace life fully and look death in the face every day.

Thank you Father Mark for so generously sharing your last days and thoughts of life with us and for continuing, even in your death, to be an enlightened teacher.

About the Author:

Dr. Karen Wyatt is a hospice and family physician who writes extensively on spirituality and medicine, especially at the end-of-life. She is the host of End-of-Life University and the author of “The Tao of Death” and the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying” Connect with her at karenwyattmd.com, on Facebook at fb.com/WhatReallyMattersWithKarenWyatt and on Twitter @spiritualmd

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How I Found Joy Again After My Father’s Suicide

Since my father’s suicide death 28 years ago I have been on a long journey of grief with many twists and turns, detours and dead-ends, which I have chronicled in a series on my End-of-Life University podcast. After the devastation of his death I wondered if I would ever be able to feel joy again in my life. But I am here to say now that it is possible to feel joyful, alive and grateful after enduring such trauma, even though the grief will never disappear.

Lately I’ve been reading a lot of blog posts that warn readers “What Not to Say” to a person who is grieving. The authors advise against such platitudes as “Grief is a process,” “You’re on a journey,” “It will get better one day,” and “You’ll learn something from this.” I’ll admit that in the first few years after my father’s death I couldn’t even bear to hear the word “suicide” and I too ran away from well-meaning friends who tried to console me.

But so many years later … after a great deal of work and struggle … I have to say that for me, grief has been a process that has taken me on a journey and things have gotten a great deal better as I have learned many lessons about life and death. For me there has been “a light at the end of the tunnel.” And while I would never push my current perspective onto someone else who is grieving, I can wish for that person to find solace and comfort as they deal with the pain in their own unique way.

I do believe that there is value in sharing my process and what I have learned through years of grief and guilt. So these steps of mine are not meant to preach to others who are grieving, but simply to share my experience of what it has taken for me to find joy once again.

Patience

I had to learn right away that my grief would not be resolved quickly (or ever) and that it was important for me to allow plenty of time. As much as I wanted to be done with the pain and go back to living my old life, I had to slow down and wait patiently for tiny glimmers of hope to appear. Each time I tried to take shortcuts through my own healing I ended up prolonging it and having to start over again.

Grief has its own timing and cannot be rushed.

Stillness

While my mind was busy racing with “What ifs” and “Should haves” about my father’s death and my emotions were erupting on a regular basis, I wondered why I could never feel joyful. But over time I gradually recognized that joy arises from stillness. I learned to create quiet spaces in my life and in my thoughts. Eventually I spent more and more time being still and allowing glimpses of happiness to appear within me.

Create still spaces inside that joy can fill.

Facing Emotions

Many of my emotions during the years of heavy grieving were chaotic, frightening and destructive so I constantly tried to hide or ignore them. But I slowly learned that healing would come only after facing up to those feelings and going through them. I had to embrace all of my emotions as a natural part of who I am in order to soothe them and eventually lessen their intensity.

Learn to face and accept all of the turbulent emotions of grief.

Allowing Change

For several years I would say to myself every morning “Some day I will wake up and be like I used to be before …” I kept expecting the pain to just disappear so that I could go back to who I was in the past. But grief is an experience that is meant to change us. Grief holds the keys to who we are right now and who we are going to become. There is no going backwards; focusing on the past just prolongs the pain.

Grief transforms you into who you really are.

Letting go of expectations

Ultimately in my long process of healing deep grief I had to adjust my expectations. I had to recognize that life would never be the same again, I would never be the same person again, and I couldn’t expect anything to turn out the way I wanted it to be. There was a “new normal” for my life and that included finding quiet joy in small moments each day rather than over-the-top jubilation. I would learn to connect together moment after moment of simple happiness until my life became filled with what I though of as “Buddha joy,” with the slight smile and the calm presence that Buddha statues exhibit.

Real joy is simple and serene.

So after 28 years of work on my own grief, this is what I have learned. But I am still growing and changing every day so I don’t doubt that there are many more lessons ahead for me. Now I wake up every morning grateful to be alive, looking forward to what the day might hold, and in awe of the mystery of life. Grief has led me here and I honestly would not go back.

This place … this moment … this stillness … is perfect for me right now and I am in need of nothing more. For everyone else struggling with grief at this time … I see you, I honor your experience, and I hold you in my heart with love.

About the Author:

Dr. Karen Wyatt is a hospice and family physician who writes extensively on spirituality and medicine, especially at the end-of-life. She is the author of the award-winning book “What Really Matters: 7 Lessons for Living from the Stories of the Dying.” Connect with her at karenwyattmd.com, on Facebook at fb.com/WhatReallyMattersWithKarenWyatt and on Twitter @spiritualmd

 

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