Why Throw A Living Memorial?

My husband turned 70 this week and the pre-Corona plan was to throw him an Honor Dinner (or Living Memorial) to celebrate his life. Now you might be asking what is the difference between an Honor Dinner and a birthday party. Quite simply it is the sentiment expressed.

Let’s think about a regular memorial for a minute. A loved one has died, the family is grieving, there are pictures of the loved one set out. At some point there is conversation beyond awkward condolences and people start to reminisce. People share stories of the first time they met the loved one, and they share what this person added to their life.

For me, during a loss, this last part has always been my favorite. My favorite because it is here my healing begins. The knowledge that my loved one was loved by others is reassuring, consoling and comforting. I often find myself wondering though, “did she know they felt this way about her?”

I come from an English, German, Irish and Croatian cultural background. Take a look at those again. Not a single solitary culture that is known for expressing emotion! Stoic x4. On top of that our people tend to die suddenly in car accidents or from sudden illness. We aren’t prone to long term illnesses. While that is a good thing, the drawback is there is no anticipatory grief period, no forewarning that death is around the corner. Which means there is little time to prepare and say goodbye. So many loving thoughts remain unsaid until after death. Although that is very healing for the grieving loved ones to hear, the true power of those loving words lay in sharing them with people while they are alive.

Because of my history with these sudden losses, I am one to not leave things unsaid. My friends and family are accustomed to it, but for new friends it takes some getting used to. It is for this reason that I love Living Memorials. Not just for those who know death is around the corner, but for anyone! It’s not something you do at every birthday, but it is good for those big numbers.

Due to CoVid we had to do my husband’s Living Memorial online. I created a Facebook group and instructed people to create a video expressing their sentiments, toast him, roast him or share memories/stories. The point was to express more than simple birthday wishes. I wanted this man to know exactly what he contributed to the lives of others. I wanted him to see the expression on their faces and hear the inflection of their voice; not just read words on a screen. Having it in a group rather than on his page would enable him to use it like a memory book he could refer back to frequently.

While not everyone was comfortable being extremely sentimental, we had quite a few contributors. The look on his face as he watched each video and read each post was priceless. There are no words to accurately describe it. If I had to, I would say it was a mixture of appreciation, love and pride. He was truly touched that anyone would take the time to do this.

In retrospect I think a slightly modified structure would have rendered a result closer to what I intended. I think asking people to share their favorite character trait of my husband, along with their birthday greetings would’ve been less intimidating for guests. I also think that had we been able to do it in our initial format – an honor dinner – with similar instruction, it would’ve been easier for people to really share some more sentiment.

My husband is filled with joy for the experience and that was truly my goal. I highly recommend this for anyone wanting to provide a meaningful celebration for a loved one’s birthday.

In the end it doesn’t matter if it is called a Birthday Party, a Living Memorial, an Honor Dinner or a Hoe Down. If it is making memories, sharing emotion and making people feel loved then it is part of the living well path and that path leads to dying well.

Peace Be With You,

Jade

Best Death Possible (part two) – A Daughter’s Mission

The Difference A Doula Makes

An experienced Death Doula is someone familiar with many faces of death. While death is universal in its presence, it is individual in its experience. In my situation, a Doula would’ve been outside the grief circle, someone who could hold space for me as I expended my energy fighting for my mother. He or she would be able to offer perspective and guidance to spark ideas like bringing my mom’s personal items into the hospital, taking pictures, and bringing in music. A Doula would’ve been grounding for me.

It all happened in a week; Tuesday to Tuesday. When my mom was admitted no one suspected she wouldn’t be coming home. It was too fast for any of us to catch up, we only had a week; but that week will be with me the rest of my life.

We think of Death Doulas, or End of Life Doulas or even hospice as being appropriate only when death is imminent. Our most important work, however, happens long before that time. I chose to refer to myself as a Sacred Attendant, simply because that is what it feels like to me – attending the Sacred. Acceptance of death needs to be woven throughout our lives. It is not a final chapter of our story, but more like a character in the background without the knowledge of its time of arrival, nor the circumstances of it. Conversations about death cannot be reserved for some imagined time in the future when death appears imminent. They also need to include more than just the ideal circumstances because that just isn’t probable. Weaving death positive awareness into things like birthday celebrations, traumatic events, or illness could help remedy experiences like ours.

Thing 6 I’d change is doing a death plan. That first night when she said was scared, I would’ve stayed at the hospital. I would’ve pulled out a notebook and written down all the things she would want at her funeral. I would write a letter she’d dictate to whomever she wanted. I would’ve asked what songs she wanted at the service and what readings she wanted. I would’ve updated her living will with Health Care Representative (Proxy) designation. I would’ve asked her important questions regarding what she wanted to leave behind for all of us. I wouldn’t have hesitated to discuss this because we didn’t think it was time.

As a result of my experience with my mother, and with so many others, I created LIFE’S Book, an opportunity to create a death plan and so much more. Completing something like this with my mother would’ve not only established her wishes, but it would’ve been a bonding time for us. It would’ve also provided some guidance for others who didn’t know what to say while visiting. My mother could’ve asked them to simply pick up the binder and pick a page.

The Gift Of Time

Working in hospice I saw the Gift of Time in action. In a death denying society, the Gift of Time is bestowed upon those who chose to acknowledge time for letting go and embrace it. Peace comes with the embracing of death. Understanding that it is no longer a time to fight against the disease or circumstance, but to fight for magic in the last days. It is here that the term ‘good death’ was coined. A death free from suffering and in the comfort of their own home or home-like environment, surrounded by friends and family.

However, there are so many other types of death happening at any given time, don’t they deserve magic too? People die in car accidents, from falls in their homes, from assaults, and from sudden illnesses like stroke or aneurysms. Where are the good deaths for these people? Where is the dying-specific emotional, spiritual, and soul support for these folks? And what of those who lie down to nap one day and never wake up? Where are the goodbyes for their families? Their last words? And what of those who live alone with no one to ‘surround’ their bedside and care for them in their own home? What of them? Where are their good deaths?

They say there are no do-overs in life, and yet I see Life as one big do-over. Every day I get the chance to do things differently than the day before. I learn from my past experiences, I do not view them as insufficient or lacking in any way. The things I wished to do differently led me right where I am today, offering my support to others to reduce these events, by having conversations earlier than ‘imminent’. By doing this differently, I am honoring my mother’s death.

I was just getting my feet wet in the local community network groups talking about dying and death and…

Then CoVid19 Hit

The deathbeds now are even more sterile and are missing most or all family and friends. Fear of death hangs in the air like grey clouds in the Michigan winter sky. Still there is no acknowledging it. No preparations. No magic moments within conversations. Not even while quarantined together have there been conversations about death wishes. There’s just been blaming, conspiracy theorizing and more denial.

What’s emerged is a grief crisis. Compounded complicated grief where before there would be straightforward grief. On top of losing loved ones, we are losing our traditions for grieving. No matter your spirituality, religion or culture every aspect of grieving has been affected. Everything from not being able to be at the bedside to hold a hand, to not being able to have a funeral, with a million things in between.

This results in bereavement counseling being more important than ever. A counselor or a group to hold space to offer comfort and support. There will be more turbulent feelings. More uneasiness. More anger. More regret.

We will shortly be coming upon the first death anniversaries and the grief crisis will hit people unexpectedly. How we honor those anniversaries will be most important and if we do it right, will spark new traditions by creating meaningful ritualistic ceremonies to honor that date. We can only hope that by the time the first of the death anniversaries from this pandemic time roll around that the pandemic has subsided enough to allow more ritualistic ceremonies.

This is something I am preparing. This is something most end of life consultants are preparing.

My Mission

Ask 100 people what their idea of a ‘good death’ is and statistics say that 80 of them will say ‘at home surrounded by family and friends’. Some might even choose a facility with a ‘home-like environment like a hospice house, surrounded by family and friends’. Perhaps because they don’t want their family to have to live in the place where they died, or maybe they do not wish to burden their loved ones with caring for them. Whatever the case most people will not say ‘in a hospital’ and yet that is where 60% of deaths take place.

Why?

Some of it is due to death phobia. The medical community, in particular, has a hard time considering death, as was evident with my mother’s team. They are taught that death is an enemy to fight against at all costs. That cost is too great however, when it robs people of precious time with loved ones.

My mission is to offer the ‘best death possible’ for everyone. None of us can change the circumstances surrounding our death or that of our loved one. However, within the scope of that circumstance we can offer the best death possible.

The best death possible means embracing the circumstances as they are and doing it ‘your way’. It doesn’t mean giving up, so much as it is giving in to the flow of life. I have had the privilege of witnessing many magical life-changing moments that took place at a bedside. I want to bring that to anyone who wants it.

Unlike a hospice referral, to employ a Death Doula there is no need for a terminal diagnosis and 6 months natural life expectancy prognosis. The decision rests solely with the individual or family to initiate at any time. It can be initiated years before the actual death, making preparations, having conversations, and creating legacies. This starts building a relationship with someone who is then familiar to you at the end of life, providing all that much more comfort.

Embracing a best death possible philosophy provides opportunity for patients and families of trauma victims the same Gift of Time as hospice patients and families. It offers the same post-death follow up and support as well. It offers something more than what has been offered to date. A Sacred Attendant or End of Life Doula isn’t meant to replace Chaplains or Social Workers, it is something additional that offers a broader blanket of comfort care to a patient and their families. The service isn’t paid for by insurance or Medicaid/Medicare, so it isn’t restricted by regulations for reimbursement. The Attendant is free to provide whatever non-medical service is right for the individual and the family unit, and to provide it as long as necessary. She or he is not limited to a ‘justified’ one hour visit once a week.

Think what peace of mind this service could be to a son who lives 1,000 miles away from his mother who has dementia and lives in a facility. That he can have someone trusted to be there as many times a week as he wants.

What comfort it could be to a daughter from out-of-town to have in-town support as she lovingly cares for her father in his home.

What clarity it could bring a family whose members all seem to be on different pages.

What a difference it would make in the hospital to have compassionate end of life support available to individuals with sudden illness or decline, or traumatic injury and their family units.

And what of this…what if hospitals offered this service to family units right now, BECAUSE of CoVid protocols and restrictions? Why not give families something to replace a small bit of what has been taken away? It’s the right thing to do.

The services of Death Doulas, End of Life Doulas, Sacred Attendants, etc… will be unique to the individuals that provide them. In overview terms, they provide non-medical support to clients and families. Specifically, they might make a well-timed phone call or text; Be a visitor who is comfortable sitting in silence; Ask just the right question at just the right time; Or offer a listening ear you are not afraid to bend. These are the tangibles every End of Life Doula (EOLD) might offer. The innumerous intangibles are impossible to list here though because they are less about doing and more about being.

Peace Be With You…And May You Be Peace

If you or anyone you know feels they would benefit from this service please speak up to your doctors, your medical team or locate your nearest End of Life Doula through the End of Life Collective https://collective.round.glass/End-of-Life/about or the National End Of Life Doula Alliance https://www.nedalliance.org/ or reach out to me personally at healingritesofpassage@gmail.com or via the contact form on this site.

Best Death Possible – Part One -A Mother’s Death

Today, December 13, 2020 is the fifteenth anniversary of my mother’s transition. Until this time I haven’t shared the details of my experience of her death.

There are so many things I would do differently, most are details that would matter only to me, however one thing I believe could’ve changed the outcome.

I want to say right off though, you can’t be a doula and be a daughter at the same time. You just can’t. There are family dynamics, emotions, fears, hopes, anticipatory grief, expectations, and underlying currents at work that you can’t, as a daughter, step out of enough to BE a doula. That said, it doesn’t mean you can’t be a great daughter, in attendance, advocating and emotionally supporting your mother, but I wasn’t that either.

I know this is long so I appreciate you even considering to read it all. It is not meant to be an all inclusive recount of the events, but rather a highlighted exploration of needless trauma. If I were to write it as an account of the experience there would be many many more details about the emotional and relational aspects.

Tuesday

It started on a Tuesday with a call that Mom was in the Emergency Department with difficulty breathing. I was at work and rushed over as soon as I could. I found her in a cubicle sized exam room when I arrived. She had her chemotherapy appointment a day or so before and said she just wasn’t feeling right and was having a hard time breathing.

When her cardiologist came in my mother introduced me like this, “Dr. Kramer, this is my daughter Judy. She hates chemo.” To which he replied, “Yes, it is nasty stuff.” He stated that Mom had congestive heart failure and they would be running additional tests.

The hospital was full, she would wait hours in that cubicle sized room until a patient room opened up. I was working a relatively new job as a therapist in a psychiatrist’s office, and had to return to work, but visited her between patients later in the day. I found her that time in a room that I would’ve sworn was a janitor’s closet earlier that day. It was set off by itself long past any other patient rooms, and as far away from any staff as you could get. We sat for a while and talked about what the doctors were saying and what tests were going to be done. She waited until I was halfway out the door, late for my next appointment, to say, “I’m afraid.” I replied, “I bet you are. This is scary.”

Thing 1 I would change. I would’ve turned around and stayed with her. It turns out the patient I was late to see had cancelled and it was not the policy of the office to call and let therapists know when scheduled appointments cancel. My last appointment of the day was a no show. So, yes, I would’ve stayed with her. I would’ve explored that fear more. I would’ve been a great daughter who was attentive, present and emotionally supportive.

Wednesday

When I returned on Wednesday I found her in a different room wearing a rebreather mask. She was worried about the Christmas cookies she had committed to baking for the hospice she volunteered for. The same hospice I worked for just months before starting my new job. She wanted me to call the volunteer director and let her know the cookies wouldn’t be done.

At this point the diagnosis changed to add pneumonia to the congestive heart failure. I remember seeing the x-ray of her lungs…It looked as if they were wearing woolen sweaters. Where there should be clear darkness, there was fuzzy white. They started her on antibiotics.

Thursday

When I returned Thursday she was on a different type of mask. Her breathing was no better. Her lungs were no better. I knew from my years of working as a hospice social worker that chemo compromises the immune system and that if she was not responding to the antibiotics in 24 hours it was not good. I emailed my Aunt because my father was not ready to call the family in for visiting. My Aunt was not only my father’s sister, but she was my mother’s best friend since long before they were married. There was no way I wasn’t going to tell her what I knew.

By Thursday night the medical staff was out of options. The pulmonologist wanted to do a bronchoscopy to get a biopsy of her lungs to see what kind of infection it was so they could target the treatment. The problem is that after the bronchoscopy she would need to be on a ventilator for an undetermined amount of time. This is something my mother was adamantly opposed to.

Ten years prior she completed a Living Will specifically declining artificial life support. As we discussed the treatment options around her bed she spoke as loudly as she could through that mask that she did not want to be on a ventilator. However, she was ignored. My father is a very intimidating man and overrode her decision; insisting the doctor do the test. Later on, when I would bring up the Living Will Mom signed to attempt to advocate for her, he jumped up, towered over me and yelled, ‘WHAT piece of paper?’

When everyone left the room my mother again reiterated to me that she did not want to be put on a ventilator. We talked about it awhile. I encouraged her to talk to her husband, again, but she wouldn’t. So, I walked her through a process to get her to a place of peace about being on a ventilator short term, if it meant possibly finding an answer. She made me go to her house to bake up the cookie dough she had started.

During this whole time I needed to also be present for my twelve-year old daughter. I had pulled her out of school twice during this time because I wanted her to have every option to have last memories with my mother. Every day my mother got worse and every day I thought would be her last. I was also keeping my mother’s older sister informed who was living in a nursing home. I continued to keep my other aunt informed, as well.

Friday

Friday morning they did the bronchoscopy and by Friday night she looked like a blown-up balloon. During the bronchoscopy they pierced her lung and she was filling up with air. Bloody drainage came from the chest tube and she was indeed on that ventilator. Her doctor went out of town so we were left with an associate. The results of the bronchoscopy were inconclusive so an infectious disease doctor was brought on to determine whether or not to try fungicides or to start her on penicillin, which she was allergic to.

Saturday

By Saturday she was in multi-system organ failure and treatment options were still being discussed with my family. I was hearing lab results familiar to me from my work in hospice. I started to push the medical team about these things and realistic expectations. She agreed to be on the ventilator for a period of three days. She was only continuing to decline since. I failed at keeping her off the ventilator; I would not fail at keeping my promise that it would be short term. That night my father decided that my mother should not be left alone and he wanted me to stay at the hospital.

During the night my mother woke up on the ventilator and wanted my sister, my father and my husband there. She didn’t want to talk until they were there. She wanted my sister and I to get along. She wanted us to watch over our father. She wanted him to stop smoking. She wanted my husband to take care of me. And she wanted to say I love you to all of us.

The staff set me up in a room far away from my mother’s to stay. I wasn’t allowed to sleep in a cot or recliner next to her bed. What was the point of staying if not in her room? It was all too much for me by that time. I called my Aunt in the middle of the night because I just didn’t have anyone else to talk me off the ledge I was on. I’ll never forget the comforting voice on the other end of the phone saying, “Hold on. I’ll be there tomorrow” as I sobbed for the first time.

Sunday

Sunday morning came and there had been further decline. We as a family started talking about removing her from the ventilator, only to find out there was no supporting documentation in her chart by the doctors. Apparently what they were finally saying to us and to the nurses was not what they were documenting. So, again one by one we had conversations with each doctor about her condition and the reality of needing to let her go. By Sunday night we were talking about taking her off the ventilator Monday.

Monday

Monday came and there were faith-based hoops to jump through to get the approval to take her off the ventilator. This was the first time we spoke with anyone from palliative care and I only remember it being one brief conversation. Her doctor returned from out of town and was surprised that she had not recovered. He made his first call to her oncologist who said, “Sometimes patients respond to chemo like this. Give her steroids.” This was an emotionally devastating blow because she had been in multi-system organ failure for days now. Her cardiologist said she would likely not wake up and would need long term care placement if she did recover.

I mean it when I say my mother would rather be dead than be institutionalized living on a ventilator.

Thing 2 I’d change. I would’ve called her oncologist myself the first day she was admitted. She kept saying that she felt fine after chemo but then a day later she didn’t. I wrongly assumed that the medical team INCLUDED the oncologist. I do believe this one thing could’ve changed her outcome.

By Monday afternoon we had everything in place. I was prepared to let her go that afternoon and then I was told that it would be another day. My father wanted to wait until Tuesday.

I lost it.

I have never sobbed so hard, either before or since, as I did then. It was all so exhausting and now to make my mother suffer another day seemed cruel. I just kept yelling, ‘she deserves better than this.’ I understand – now, outside my own grief – that he needed a day to prepare. He had not been able to grasp reality days before as I had been. I had been fighting for days to end her suffering, while he’d been fighting to keep her here.

Tuesday

Tuesday morning came with yet another blow. My mother’s case now needed to be sent to the Ethics committee for approval to remove her from the vent. Why at each turn there was another hurdle someone didn’t foresee I did not understand. It was a Catholic hospital and they didn’t explain in advance the protocol to remove the tubes once in place. I was livid and unable to get face time with the bureaucrats causing my anger.

Tuesday afternoon the tubes were removed. My sister, my father and I were around her bed with our hands on some part of her when she exhaled for the last time, some 45 minutes after the machine was turned off.

I Did The Best I Could

Thing 3 I’d change. Her transition was sterile and un-ceremonial. Aside from the blanket I’d bought her for Christmas and gave her early, there were no personal effects. Nothing of my mother was in her death. I’d have music playing. She loved music. Johnny Mathis maybe or Ann Murray. Maybe Johnny Cash. Or maybe some Boots Randolph. I would’ve brought crystals to surround her. Anointing oils to bless her journey and thank her body for its service. I would’ve chosen a poem or a prayer to recite with all of her family present, not just the three of us.

Thing 4 I’d change, though not necessarily in order of importance…I’d take pictures of her in the hospital. Especially before the ventilator. She would’ve hated it though – no make up, hair unkempt, face mask pressed into her cheeks. As it is though I don’t know when the last picture of my mother was taken.

Despite these things I’d change, I know I did my best, but I still don’t feel it was good enough. We all did the very best we could within a system fraught with death denial. My energy had been used up on decoding the things that weren’t being said, forcing them into the air where my family could pluck them at their ready, then begging for the right things to be done.

This is why thing 5 I’d change, not in order of priority, is hiring a death doula (or better yet I wish the hospital had this service.) This one change would’ve made all the other changes for me. A Death Doula, a Transitions Doula, an End of Life Doula, an End of Life Specialist, a Sacred Attendant…whatever name they go by they offer the same thing – holding dedicated sacred space specific to the transition of loss and supporting the best death possible.

(Continued in Part Two- A Daughter’s Hope)

Ask The Death Witch – Seeing Dead People

A worried daughter asks, “What do we do when my mom hallucinates? She keeps seeing her dead father.”

These are not hallucinations.

There is a reason it is called ‘crossing over’ when people die. In every way it is a crossing over to ‘the other side’. In the process of crossing over they have one foot in both worlds, thus they have eyes that see into the other dimension.

So, your loved one isn’t hallucinating seeing her dead father, he has come to visit her.

When transitioned loved ones come to visit, it’s part of what I call ‘pre-admission visits’, to prepare the one who is readying to die. Just like live visitors come to see her and offer support so too, do transitioned visitors. It’s no different. We have transitioned loved ones around us all the time, most of us just can’t see them.

This also happens in reverse, where she will visit on the other side. You might notice times when she seems so close to death, non-responsive, breathing shallow, but then will wake up out of it. You might be at her bedside thinking she is about to take her last breath and then she is clear as a bell. During the times of intermittent non-responsiveness I envision the dying take little tours around the next dimension…getting the lay of the land, if you will.

Although there is a literal moment of death, one minute when someone is alive in this world then not alive in it the next, not all death happens like a light switch. Sudden death, of course, is just like that. Traumatic events, like car accidents, or sudden events like strokes or heart attacks, can take the living to dead in the blink of an eye.

But dying is actually a transition that takes place over weeks, and sometimes months, not just days. Think of dying, like taking off your shoe. There is a process your foot takes to get out of the shoe. Your whole foot is not in the shoe one moment and then totally out of it the next. No. First your heel is released, then the arch of your foot and then lastly the ball of your foot and then your toes. At one point your foot is half in and half out of your shoe. The Soul leaving the body operates in much the same manner.

It is believed even in sudden death that our transitioned loved ones are there to escort us to whatever happens next. Some will dismiss this as a result of brain chemistry and the release of biological chemicals. Ok, but by that logic then aren’t all of our life experiences dictated by the release of chemicals like dopamine, endorphins and hormones? Does that make those experiences any less?

Now to answer the actual question of what to do…

Support her experience. Ask what they are saying to her, what they are doing, or what she thinks they want. If she says they want her to go with them, then tell her it’s ok for her to go. If she says she isn’t ready, then ask her why? What does she need to get ready?

You will find valuable information in these conversations. You might discover an underlying worry that you can help appease. You might find out she is waiting for a long distance relative to get there. You might find she has other unfinished business you can help her complete.

The time you have with someone at the end of their life’s journey is a gift. Please don’t waste it by being afraid to have conversations. There is no greater time to have heart to heart conversations, because their last words will stay with you forever.

Peace Be With You,

Jade

What The Lack Of End Of Life Planning Really Costs

I want to share a deeply personal story.

At the time of his death my daughter’s father and I had been divorced for four years.

During our 23 year marriage, because of my career, we always had open discussions about dying and death. We were open with our daughter about death, never shielding or protecting her, but instead arming her with coping tools and information.

Those conversations included directives regarding limited aggressive treatment, as well as life ceremonies and general care wishes. We had watched people fair poorly with chemotherapy and that was specifically something he had voiced against.

I had remarried, while at the time of diagnosis Allen remained single, but dating. We remained friends and much of my belongings remained in storage at the home we had once shared, including our daughter’s childhood memorabilia.

He was an avid ‘health nut’, so when he was diagnosed with stage 4 lung cancer in November of 2013 we were all stunned. Almost immediately he got engaged, with a projected date a year out.

He started chemotherapy treatment and began to decline swiftly. His fiancé kept his phone and isolated him from his family as much as she could, but needed the oldest daughter’s cooperation to sign for medical procedures when he was no longer able to due to the development of a rare secondary cancer of the spinal fluid that spread to his brain causing seizures and cognitive impairment.

My daughter was called to the hospital in April, 2016, because the outlook was not good. I ended up meeting her there the next day. We stayed a few days and had some good conversations with him despite his disorientation and intermittent incoherence. It was clear he was tired; like tired with a capital T. My daughter and step-daughter (who had been estranged most of her life) discussed their wishes for their father and decided on a plan of care, because it seemed as if his fiancé was not vested in his health, but his wealth.

Two hours after we left his eldest called to state that the fiance´ presented her with a family consent to marry. She called my daughter and they decided not to give consent. If their father had intended to marry, he would have done so urgently upon receiving a likely terminal diagnosis of stage 4 lung cancer. He would not have put it off for a year.

Apparently, however the eldest daughter was persuaded to give consent after receiving ‘assurance’ that a Will was made. She did not ask to see the Will, if she had she would’ve immediately recognized her father’s signature had been forged, badly.

In addition, to forging the Will, the woman obtained Power of Attorney during the same time period. She changed the beneficiary on his retirement accounts. She got a judge to marry them with the familial signed consent form. Lastly, four days before he died, while he was in a coma, she used her POA to add her name to the deed of his residence.

The memorial service was arranged with little to no input from the daughters. It was not at all representative of the man we knew. Calls and texts to the widow went unanswered. I was never able to retrieve my belongings or that of my daughter. My daughter was not given the opportunity to receive any of her father’s belongings and despite being named in the forged Will, did not receive anything, though her sister and her cousin did.

All of his belongings were reportedly sold or given to unnamed individuals, not family, including a car that he promised to our daughter.

Turns out you can do a lot of illegal things, including forging a will, and unless someone has money to contest it, you get away with it.

This widow lived off the insurance and pension for a year and in that year married someone else.

Granted this is an extreme case, colored by the shadiness of a true gold-digger, but it could have gone so differently had he completed an end of life plan ahead of time.

These are just some of the things he had control over at one point:

  • completing a Last Will And Testament when of sound mind
  • establishing Health Care Directives including Medical Power of Attorney and Living Will
  • creating emotional estate planning documents
  • complete an end of life plan
  • pre-planning Celebration of Life ceremony
  • completing legacy projects

Regarding end of life planning, many people take the position, “I have time” or “I don’t care, I’ll be dead.” It is important to note how our decisions, and especially our lack of decision making, can wreak havoc on our loved ones and complicate their grief.

To Tell, Or Not To Tell The Children, There’s No Question

It is our job as parents to protect, nurture, and guide our children into whole human beings. It is our responsibility to do this to the best of our ability. If we do it right, the parenting role will take us outside our comfort zone more often than it doesn’t. Sometimes stretching us into improved versions barely resembling the old.

We know it isn’t best to take the easy way out and give in to whining, or temper tantrums, or tears when enforcing bedtime, curfew, or homework. We establish house rules and expect there will be resistance in the teen through young adult years, while we live under the same roof. Still, we know that it is best not to give in just because they will be upset.

That same truth appears here – where we are talking about a parent’s terminal diagnosis or life-limiting illness.

Navigating the rocky terrain of life-limiting illness and terminal diagnosis is a challenge none of us fantasize about. Most don’t spend time thinking about how to handle such a situation in advance. There’s no play book, no manual, and certainly no instruction sheet for reference. When it comes to our kids, though, we have to get it right – and we only have one chance. What we give them during this time will shape who them become as adults.

“We’re Not Telling The Children”

If this is you, this your fear talking. You want to keep things as they are, falsely, in an effort to deny what is happening. In an effort to hold on to yesterday for one more day. But it isn’t fair to your children.

I know you think you are doing the right thing, but you are doing the easy thing. There is nothing on Earth harder than breaking your child’s heart. You tell yourself you are doing the right thing, by delaying that broken heart as long as you can. What you are really doing though is postponing that broken heart until such time as you are either gone, or too weak to be able to support their processing.

You don’t tell the children so you won’t have to deal with their pain – not so they won’t have to deal with yours…that’s not what we do as parents.

Now is when you’re children need to know. Not tomorrow or next week, because I promise you tomorrow, or next week, or the week after will bring the day you most dread when it will be too late.

Tell them when you are diagnosed. Let them be a part of your healthcare and support team. Including them early on prevents them from being at the ‘can’t we do something stage’ when you’ve already determined there isn’t. You don’t have to have all the answers when you tell them. The fact you let them in on the process will allow them to deal with whatever comes along.

You are leaving them and that is inconceivable. However, they are going to have to live a whole lifetime without you. They are going to need every second possible to grasp that and to gain the tools necessary to make it through some important milestones and intense challenges.

They will feel powerless in all this – much like you – so give them opportunities to feel empowered. Give small children small jobs, like being “Mom’s water pitcher manager”. Give older children tasks that play to their strengths like making Dad’s favorite play list or a favorite sandwich. Allow them to feel they serve a purpose in supporting you.

Give them space to process and opportunities to express their fears, feelings and faith. They will need help navigating these emotional waters, give them as much time possible to do that by telling them as soon as possible. They need you, now more than ever, in order to cope with losing you. After all who better to teach them?

When you keep the truth from children you deny them the maximum time possible to process their anticipatory grief and to cherish their time with you.

“They’re Too Young To Know What’s Going On”

No child is ever too young to know when something is changing. Even infants are affected by grief, as they pick up on the emotions and energy in the environment and in their caregivers. They will need extra soothing, comforting and nurturing to calm their distress. Infants and toddlers need extra physical comforting because they cannot process linguistically yet. They might need to be held more. They might need extra reassurance about mundane things. They’ll need to sleep more. They’ll need you to honestly deal with your own feelings because they will sense the discord if you are not.

The older the child the more aware they will be of the non-verbal cues in the household. No, your three year old will not process the same information as your sixteen year old. They still need to be part of the process, though.

Why Tell Them When It’s Only Going To Hurt Them?

Because every child knows the temperature in their own house. Every child I’ve ever worked with, knew things were bad long before the divorce papers were filed. Yet, every parent felt so sure that ‘the children didn’t know anything’. So, many children end up in therapy for ‘behavior problems’ only to find out they are lost in an emotional forest because they experience congruence: “I sense something is wrong, but everyone says it’s all fine.” The truth of their experience clashes with the lies of adults and creates chaos internally. If you ever wondered how ‘gaslighting’ got it’s start, here it is.

If this is true, then it is more true when a parent is terminally ill. Our children are comprised of our blood and DNA. They know things about us. They know when we are not being honest and truthful. They know when we don’t feel well. And most of all they know when we are afraid.

It’s more than ok to share that with them – it is necessary for their emotional wellbeing.

When we are diagnosed we are not the only ones…everyone else in our life receives the diagnosis as well.

When we don’t share the truth with others we take away their rights. Yes. Their rights. Their right to support us as they desire. Their right to take care of us like we’ve taken care of them. Their right to have as much time possible to process feelings and anticipatory grief. Their right to share this experience with us. Their right to their own experience of our dying and death.

When we don’t share truth with others we take their freedom. The freedom to choose how to say good-bye, how to spend their time, and how to grieve. We rob them of the opportunity that comes with time, too. The opportunity to share the words on our hearts, to make lasting memories, and to bear witness to and for one another.

When we keep the truth from children we are not shielding them, we are isolating them.

If you or your spouse has been diagnosed with a life-limiting illness or has received a terminal prognosis, you and your kids have already been dealt a crappy hand. Don’t make it worse by stealing precious time from one another because it is painful. It’s going to be painful no matter what. You can’t control the wounding, but you can control the bleeding, so to speak. Every decision you make regarding sharing, or not sharing, the truth with your kids impacts them in one of two ways: either helping the healing process or complicating the grieving.

Here’s something else.

Tell the children because they already know. And if they already know, then they also know you aren’t telling them the truth. And if they know you aren’t telling them the truth, they can’t trust you to tell them truth in the future.

And that is the most damage you can inflict in a parent/child relationship.

We cannot protect our children from a diagnosis. We can only help to arm them with appropriate tools to come through this to the other side.

This loss is something they will walk with the rest of their lives. It is important we do this one thing right because there are no do-overs. We only get one chance to say good-bye.

Jade

Holistic Support Specialist, Interfaith Minister, First Responder Chaplain, Shaman, Energy Healer, Licensed Social Worker (ret)

A Dialogue About Death

Every story ever written has a beginning, middle and an end. Every author considers the end when first sitting down to write a storyline; However in the greatest story an individual will ever author, the end is often left unscripted.

We can’t write death in on our calendars and begin to plan when it seems ‘timely’. On the day we are born our death is written onto our calendar in invisible ink.

Modern day society chooses to approach death as if acknowledging it is morbid, preparing for it hastens it and accepting it is giving up.

Talking about your end of life care preferences when death is a remote possibility, supports decision making about end of life care when death is a probability, and promotes healthy coping during end of life when death becomes an inevitability.

In December 1974, my uncle was home from his work as a missionary priest in the Amazon, when an aortic aneurysm ruptured and he died in his sleep. I was nine years old, in the kitchen, as the discussion of burial arrangements took place and there was question about where he should be laid to rest. I said I knew where he wanted to be buried.

Every year my uncle hosted our family reunion on the grounds of the Villa Redeemer Monastery in Glenview, Illinois. On this property was a small cemetery and on one of our walks through the grounds that summer, my uncle told me he would someday be laid to rest there.

Because he shared that with me, I was able to share that with my mother. It was a small conversation that made a big difference to my mother in her grief.

Perhaps because my grandmother grew up on a farm where death was recognized as a part of life; Perhaps because my mother’s brother died at four years of age; Perhaps because my mother grew up during WWII; Perhaps because my own father died when I was three…perhaps for all these reasons, death was not a taboo subject in my house growing up, nor has it ever been a taboo subject in my own home as an adult.

Embracing mortality has emotionally prepared me to make life and death decisions in unexpected moments. This preparation does not make decision making easier – it does however, make it less complicated.

When we live in denial of mortality we create an illusion that creates complications during times of crisis. It requires that our psyche do some serious catching up in very little time, and oftentimes there isn’t enough time to actually catch up.

The internal dialogues might look like this:

Prepared: (death is a real possibility) “No. No. NO! I can’t believe this is happening. I knew this day would one day come, but today? I’m not ready. I’ll never be ready. I can’t make these decisions. I don’t want to make these decisions. We talked about what to do, but I don’t want to.”

*breath*

This isn’t about me. It’s about Mom and living life on her terms. It’s so hard to imagine this, but Mom has always been clear about what she wants.”

(death is a probability) “I don’t want to believe that I have to do this, but I know what Mom wants. She’s told me all along. She doesn’t want to merely exist. She doesn’t want to be on machines. She doesn’t want to be a burden. She wants to live life on her terms. If she can’t be an independent active participant in life, she said she didn’t want to prolong her death. She prepared me for this, but my heart is breaking.

*breath*

I don’t want her to suffer for me. I want her to be peace-filled.

(death is inevitable) “I’m sorry Mom for the things I did that hurt you. Please forgive me, hurting you was never my intention. Thank you, for teaching me what friendship means. I forgive you, for all the things I was ever angry about. I love you.”

*breath*

Mom, it’s ok to let go, if you need to. I’m here. I’m right here.”

(death comes)

Unprepared: (death is a real possibility) “No. No. No. No. NO! I won’t believe it! We have to keep fighting. You have to keep fighting, Mom. You are a survivor! You got this! Yes, keep her alive at all costs. Don’t give up on her. It isn’t her time yet. I’m not ready yet.”

There has to be something else we can try. Why is she getting worse instead of better? What are you doing?! Why aren’t you helping her?”

(death is a probability) “Mom, I know you are tired and suffering but you have to keep fighting. This isn’t over yet. You still have so much to do. I need you. Your grandchildren need you. I am not prepared to say goodbye so you have to keep fighting, ok?”

You are not a quitter! Don’t you give up on me!”

(death is inevitable) “I can’t believe this is happening. I knew this day would one day come, but today? I’m not ready.

I’ll never be ready.”

(death comes)

I didn’t even have the chance to say good bye…”

Preparation is not morbid. It does not hasten death. It needs to be seen as the natural order of authoring our lives.

Just as preparation does not manifest death, it also does not guarantee the circumstances of our death. We cannot foresee details, but we can verbalize the atmosphere we’d like it to have. Because at birth our death is already added to our ‘to do list’, it is appropriate to have ongoing open conversations about what we might want to include and exclude from that atmosphere.

Amidst the COVID-19 pandemic our mortality has never been more undeniable. Take this opportunity to begin having conversations, exploring your fears, beliefs and hopes about your own death. Tell your loved ones what your preferences are to ease their emotional burden when the time does come. Your loved ones may not have certain choices regarding your end of life care, but at least they will have your Voice as guidance in making the really tough ones.

It may not come during this pandemic – we all hope that is true – but clearly, death is happening all around us now. We might still live in fear of it, but we can no longer deny the possibility, probability and inevitability of our mortality.

It is in embracing the existence of our death that our best living begins.

Pandemic Traumatic Grief

To a certain degree there is trauma in every loss, whether it is the unexpectedness of it, the suffering of it, the impact of it, the violence of it or the massiveness of it. Every loss has an element of trauma to it.

It is the magnitude of the event that makes it traumatic.

As a three year old, I woke in the middle of the night due to a loud noise and ran into my parent’s room for solace. Instead, I found my father lying tangled in the bedsheets on the floor. I didn’t understand what I was seeing. To me he was sleeping on the floor, so I tried my three year old best to wake him up. Shaking him and calling his name and telling him to wake up. When that didn’t work, I ran into my grandmother’s room, woke her up and told her ‘something’s wrong with Daddy’.

Traumatic grief.

What made it worst is that no one ever talked with me about it. I didn’t speak for three days and did not say the words ‘good bye’ again, that I remember. I suppose their thought was that I was three and was too young to remember. Yet, at fifty-five I still remember it as clearly today as I did that night.

Traumatic grief.

The common experience of devastating natural disasters such as hurricanes, tornados, earth quakes and tsunamis is that what was absolutely known one moment is absolutely gone in the next. The landscape of our lives, our homes and our city skylines are completely destroyed and eliminated – physically and emotionally.

Traumatic grief.

September 11, 2001 when the first plane struck the twin towers in New York City, New York, USA, there was grief…”How could this awful accident happen?” Before we could even process that grief, the second plane hit and the question turned to a statement, “This was on purpose.” As the following two planes were identified as part of the plan, the new revelation brought more grief.

Traumatic grief.

With the realization that there would be more recovery than rescue, our trauma compounded. With the information that insurance companies did not cover ‘terrorist attacks’, our trauma compounded. With each last voicemail messages shared, our trauma compounded.

Traumatic grief.

Today a biological siege is upon us.

We are at the mercy of an enemy we cannot see, but who’s damage is leaving bodies in bags and crushing spirits. We panic at the subtlest of symptoms because information is nebulous at best, ever changing at worst. The emotional, mental, financial and social landscape of our lives has changed almost overnight.

Unlike weather related natural disasters we have no visual evidence of destruction available on the news to help us move from the initial denial stage of grief. While in denial, we can’t possibly make the right decisions to ‘stay safe, stay home’, because we are still reaching back for the life that so swiftly disappeared. It is almost as if we see the old life before us and we struggle to realize we are looking at a memory.

Others who are not in denial, those who are in an anger stage, see these choices as irresponsible and stupid. They will blame those in denial for the ongoing worsening of the situation. The anger stage causes increased bullying, trolling and arguing. This compounds trauma.

We find ourselves bargaining ‘too little, too late’ into our new reality. We stay home from work, but make needless trips out into the community. We stop hugging and shaking hands, but hold parties in the park. Still in the throws of denial we attempt to create a reality that is less dissimilar from our ‘before’ reality, than what currently is. This often looks to others like we just refuse to follow the rules. And it might be true, but this is grief and everyone follows grief in their own way, in their own time. You can’t mandate people to move through grief faster than they can.

As the new reality is absorbed and the magnitude of the trauma is processed, depression sets in. Add in the social distancing and isolation requirements of quarantine with stay at home mandates, the traumatic depression is compounded.

Our normal remedies for such things are not available with social distancing, isolation and quarantine in place. So the damage/danger rises. The trauma compounds.

In addition, we have the financial upheaval this creates individually, locally and globally. The trauma compounds.

Our healthcare professionals are being asked to perform super humanly. They are not staying at home, staying safe, because they can’t. We need them on the front lines and they have stepped up. They sacrifice their needs for the needs of the whole which is more than the system does for them.

When this is over these heroes, who gave their all, will not have the opportunity to recuperate, because healthcare needs are always present. There won’t be the opportunity to sit on the couch watching netflix or play board games with their children. In fact, many will develop PTSD. The trauma compounds.

What does acceptance look like in a scenario like this?

It looks like neighbors having dance parties in driveways, virtual celebrations of life for loved ones, individuals making hundreds of respirator masks for healthcare professionals, teachers teaching online, neighbors checking in on neighbors. It looks like people moving from busy to being. It looks like calm within the chaos.

It looks like creating a new reality that holds more reverence for life and relationships. It looks like a society that takes care of the whole not the few. It looks like healers stepping forth as a new kind of hero.

It also brings with it a new acceptance of our mortality, the need to plan for it and discuss it more openly. Our death, while we do not need to hasten it, we cannot deny its inevitability. The discussions about advanced care decisions and end of life ceremony and disposition preferences have been taboo for far too long. Now, we are faced with what the end of life community has begged you to understand.

Not only is the date of our death unknown, unimaginable and unpredictable, but so too are the circumstances of our death. We may or may not have forewarning, and any forewarning will likely be only weeks, days or mere hours in advance. And if you are not listening close enough you may not even hear the forewarning when issued.

Every day has a birth and a death written in it’s sunrise and sunset. Every day you too carry your birth and death with every inhale and exhale. It is a luxury to think your next breath is a given. It is a luxury to think your tomorrow is a given.

This is part of what compounds our traumatic grief during this time. Because left and right we are now forced to face mortality as the death toll is announced. The truth is though that we are a society almost desensitized in our traumatic grief. Soaring murder rates, increased poverty, mass shootings, terrorism, war and violence against women and people of color has all contributed to our collective trauma. So, once again, our trauma is compounded.

Our experience with death is changed right now. We don’t even have the basic right to have someone at our hospital bedside, much less the choice to have a funeral or memorial with all loved ones in attendance.

This is not the time necessarily for discussing whether or not you’d prefer lavender or peppermint essential oil diffused in your bedroom in your last days. It is, however, the perfect time to seriously discuss where your quality of life line lies. What aggressive measures you would or would not want taken should it come to that.

It is the time to make sure your legal documents are in order, your passwords are accessible to a trusted person and someone knows something about your wishes regarding your final resting place.

It is also the time to do some emotional estate planning. Write letters to loved ones to be read at a later date, at your celebration of life service, or by a loved one at a wedding or milestone birthday. Create photo albums, scrap books or slideshows. Document who is who on the backs of every photo. Allocate special items to special loved ones. Secure arrangements for the care of your beloved pets upon your death. Make a collection of poems, bible passages or other writings that bring you comfort.

Just doing these things will empower you, helping to move you through your traumatic grief and nurture acceptance.

The world as we knew it is over, that’s true; that in and of itself is a traumatic loss. Within us lies the capability to create a new world, though.

Let’s make sure we create a better one. #traumatotranscendent

We're Failing Families

Are We Failing Families At The End Of Life?

Of course we are failing families at the end of life!!

Death and dying are treated as medical events rather than holistic ones! Conversations around the emotional and spiritual aspects of dying and death are completely shut down, circumvented or worse totally dismissed!

In the past few weeks I have received messages from people who are completely alone in their journey. Here’s just one:

“I was told that they were very sorry but there was nothing they could do to help me and that I had less than 2 months to live. I was at that appointment by myself (well, I had my service dog who is always with me) and, having just been told that, the appointment ended and that was that. I was considered to be in such bad shape that nothing could extend my life even 2 more months so there was to be no further contact although the radiation oncologist gave me radiation to the bone marrow site to help with the severe pain. My closes family is 600 miles away so there you go, I was on my own.”

Most of us can’t even imagine how that would feel! Was she even able to process all the options presented to her at that meeting? Were there options presented at that meeting? She didn’t seem to remember so.

I offer an alternative solution as a Holistic Support Specialist, a concierge service. Available to be there at time of diagnosis or poor prognosis and able to follow along at the direction of the patient, for as long as desired. Doctors can hire me to be at these initial appointments and then patients can choose to have just that one contact, or to continue a relationship.

The last phase of life (beginning at age 60 or upon receiving a life-limiting diagnosis) brings the realization of our mortality. The generation currently entering this last phase is unlike any before with more having never married or remained single after divorce or death of spouse. They are also the first generation of DINKs (double income no kids). They also have opted for more solo spiritual paths rather than organized religious paths, thus leaving them without possible spiritual support and guidance during this time. They are also the first generation to have moved across country for work, leaving behind the family support system.

This means that those facing their mortality and their caregivers are potentially doing it alone in many ways. We can’t wait until death is imminent to implement an action plan.

If you or anyone you know has a connection in a doctor’s office or an organization that would be willing to sit down and carve out new solutions to this problem with me I am more than open and willing!

The Story Of Hope

I come into people’s lives at times when hope is challenged. I hear phrases such as, “we aren’t giving up hope”, “there’s no hope” and “it’s hopeless”. Individuals often describe feeling hopeless as well.

Hope is not a feeling.

It is something you feel yes, but in and of itself, hope is not a feeling. Think of it like ‘wet’; You can feel wet, but wet is not a feeling.

Hope is a process.

Isabelle found a lump in her breast one day while taking a shower. She noted it, felt a little concern and decided to monitor it before mentioning it to her doctor. She hoped it was nothing.

A couple months go by and Isabelle feels the lump has gotten bigger and seems to be more painful than previously. She makes a doctor’s appointment and hopes it’s nothing.

Her doctor feels it warrants further examination so sends Isabelle for a mammogram. Her doctor and Isabelle hope it’s nothing.

The mammogram indicates need for a biopsy. The doctor and Isabelle hope it’s nothing.

The biopsy comes back malignant. The doctor recommends a lumpectomy and a biopsy of the lymph nodes to determine the extent of the condition. The doctor and Isabelle hope there is nothing found in the lymph nodes and that the lump is removed successfully.

The lymph node biopsy comes back positive for cancer cells. The doctor recommends a radical mastectomy and chemotherapy. The doctor and Isabelle hope this will stop the progression of the disease.

After months of treatment the cancer has spread very aggressively throughout her body. Further aggressive treatments would deplete Isabelle’s quality of life with no likelihood of a cure. Isabelle foregoes aggressive treatment and hopes to fill the rest of her life with quality family time and be comfortable.

Surrounded by her family and friends daily, Isabelle hopes that she has enough time on Earth to leave no words unspoken, no amends not made and no doubt how much she loved life. She wrote letters to be read after her death to special individuals and hopes each one brings a sense of peace and closure to the recipient. She hopes that she made a difference in the lives of those she loves and she hopes that continues on in them long after she transitions to the next place.

Isabelle’s family and friends hope they have enough time to give back to Isabelle all that she has given to them over the years. They hope that she feels loved during the Living Wake they held for her. They hope that she knows she is not alone. They hope that she is not in pain. They hope that they will see her again some day, in some way. They hope.

Hope takes many shapes depending on the evolution of the situation. It morphs and transforms at the direction of its beholder. It relies heavily on perception and mindset. It is undeniably fluid.

Hope is ever present and can be felt by proxy. If you can’t feel it someone else can feel it for you. It is often thought of as contagious for this reason. The mere action another holding hope for you and your situation, can help you feel hope too.

Hope is not tangible. Hope is not concrete. Hope is organic and cannot be defined. It is a dance that cannot be choreographed by a few well spoken words. Hope comes from your soul.

You are either one to experience it or not. In my experience those with hope are more positive, finding all reason to hope despite the situation. Also, in my experience however, I find denial disguised as hope.

Denial is often portrayed as ‘positive thinking’. Denial is the underlying belief that if I ignore something it will not come into being. Denial is considering only the best case scenarios and suppressing the fears of the possibility of an undesired outcome.

Denial isolates and divides, but true hope unites and bonds.

Hope is not holding onto a desired outcome no matter what. True hope is holding the desire for the best outcome in one hand, while holding acceptance of the possibility of the worst outcome in the other – and preparing for both.

It is in this preparation for both that the uniting and the bonding happens.

When I consider things, I always play the what if I’m wrong? game. “If I do this thing and I’m wrong then (fill in the blank)?” And then I weigh it against “what if I do that thing and I’m wrong then (fill in the blank)?”

So, let’s play that game now.

Imagine a situation where you have been diagnosed as terminal and never consider the possibility of death because you are being ‘positive’. You never have conversations about it with others. You never express the things on your heart. You never talk about your fears. You never express your wishes regarding your services. You never make preparations.

You think about dying. You worry about it. You have no one to talk about it with though because you are being positive about it. You lie in bed at night and think of all the things that you will miss. You feel great love but do not express it because it will scare your family to think you are giving up.

At some point the treatment is deemed ineffective, causes severe side effects and reduces your quality of life. You have no energy to visit with others. Treatment is stopped and you are sent home with hospice.

You die three days later with no chance to say a quality goodbye.

How does that feel?

Now imagine a situation where you have been diagnosed as terminal and pursue aggressive treatment while also accepting the possibility of death. As you go through treatment you have open deep conversations with family and friends about your fears and your hopes. You begin to make decisions about the celebration of your life. You make a list of songs for your memorial service, last wishes about care and you even write a letter to be read at your service.

You cry and laugh with your loved ones. The whole experience draws you closer to your family and friends.

Your aggressive treatment is successful and you live several more years with these deeper relationships.

How do you feel?

Which scenario feels more hopeful now?