The Needs of the Dying
David Kessler, is a grief expert, and has helped thousands of people, in their darkest times, to live happy and fulfilled lives.
He is also the author of six books, including coauthoring two books, with the famous Elizabeth Kubler Ross.
"David’s personal experience as a child witnessing a mass shooting while his mother was dying in a hospital helped him begin his journey. For most of his life, David has taught physicians, nurses, counselors, police, and first responders about the end of life, trauma, and grief. He facilitates talks, workshops and retreats for those experiencing grief. However, despite his vast knowledge on grief, his life was turned upside down by the sudden death of his twenty-one-year-old son. It inspired him to write his newest book, Finding Meaning".
The Needs of the Dying is a book written about helping us through the last chapter of our lives, which identities several key areas of concerns, such as:
The need to be treated as a living human being.
The need for hope.
The need to be free of physical pain.
The information below is taken from Lumen Learning course, where they talk about 3 aspects of death. Read more about the physiological death, the social death and the psychic death. These aspects do not happen simultaneously.
"One way to understand death and dying is to look more closely at physical death, psychological death, and social death. These deaths do not occur simultaneously. Rather, a person’s physiological, social, and psychic death can occur at different times (Pattison, 1977).
Physiological death occurs when the vital organs no longer function. The digestive and respiratory systems begin to shut down during the gradual process of dying. A dying person no longer wants to eat as digestion slows and the digestive track loses moisture and chewing, swallowing, and elimination become painful processes. Circulation slows and mottling or the pooling of blood may be noticeable on the underside of the body appearing much like bruising. Breathing becomes more sporadic and shallow and may make a rattling sound as air travels through mucus filled passageways. The person often sleeps more and more and may talk less although continues to hear. The kinds of symptoms noted prior to death in patients under hospice care (care focused on helping patients die as comfortably as possible) is noted below.
When a person no longer has brain activity, they are clinically dead. Physiological death may take 72 or fewer hours.
Social death begins much earlier than physiological death. Social death occurs when others begin to withdraw from someone who is terminally ill or has been diagnosed with a terminal illness. Those diagnosed with conditions such as AIDS or cancer may find that friends, family members, and even health care professionals begin to say less and visit less frequently. Meaningful discussions may be replaced with comments about the weather or other topics of light conversation. Doctors may spend less time with patients after their prognosis becomes poor. Why do others begin to withdraw? Friends and family members may feel that they do not know what to say or that they can offer no solutions to relieve suffering. They withdraw to protect themselves against feeling inadequate or from having to face the reality of death. Health professionals, trained to heal, may also feel inadequate and uncomfortable facing decline and death. A patient who is dying may be referred to as “circling the drain” meaning that they are approaching death. People in nursing homes may live as socially dead for years with no one visiting or calling. Social support is important for quality of life and those who experience social death are deprived from the benefits that come from loving interaction with others.
Psychic death occurs when the dying person begins to accept death and to withdraw from others and regress into the self. This can take place long before physiological death (or even social death if others are still supporting and visiting the dying person) and can even bring physiological death closer. People have some control over the timing of their death and can hold on until after important occasions or die quickly after having lost someone important to them. They can give up their will to live".
Do you, or someone you love, have a serious illness? Or....are you just interested in learning more about starting an End-of-Life conversation?
The following articles states that "Planning for your final days is hard, but its an invaluable gift to caregivers and loved ones".
Dying is 100% guaranteed. We will all experience a death and we will all die. Most everyone has a story to tell and how they were impacted by a death - good or bad.
Considering how we would like to die is an important conversation that the majority of Americans are not having. However, in a survey, most people stated they would like to die at home, surrounded by loved ones.
In order for our wishes to be met, we need to have these conversations and discuss our priorities with our physicians and loved ones. Otherwise, we risk leaving these decisions for the important people in our lives to guess what we would want.
Read more on how to start these conversations, or contact me.
Atul Gawande is a renowned surgeon, writer and public health leader.
He was a practicing general and endocrine surgeon at Brigham and Women's Hospital and a professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health.
In 2022 he became Assistant Administrator for Global Health at USAID. From 2018-2020, he was CEO of Haven, the Amazon, Berkshire Hathaway and JP Morgan Chase healthcare venture.
In addition to being a staff writer for The New Yorker, he has written four New York Times best selling books:
Complications, Better, The Checklist Manifest and Being Mortal.
Being Mortal shows how medicine has truly transformed the dangers of disease to being manageable. However, this books talks about, when it comes to aging and death, medicine can often run counter to what it should do.
Being Mortal is a must read for everyone, especially those that are engaging with End-of-Life discussions that deal with options, wishes and priorities.
Anders Nilsen poured his grief into his notebooks - which included short cartoons and vignettes, after the death of his fiancé in 2005.
What transpired over the years is a 54 page typed and handwritten notebook exploring the evolution of his grief, called "The End: Revised and Expanded".
Anders shares in this article that he had to create his own rituals for his grief, and that "I had to clear space in my life for death".
Making space for grief, taking time to be with the emotions, not rushing or putting a timeline on what it "should" look or feel like, will allow you and your loved ones a safe place to "be with grief".
What ways have helped you be with grief?
As a Death Doula/Midwife, I want to share with individuals and families about varying options at End-of-Life.
So many individuals wish to die and home, with their loved ones near them and the comfort of their home. However, it is not always possible, and for some, it is too difficult to honor these wishes.
When making these kind of decisions, it is important for all concerned to speak compassionately and openly about the opportunities and challenges that may lie ahead, and be honest about the care that is needed.
Hospice can help to support the families, along with additional support of a Death Doula/Midwife.
It is important that the individual and their support interview hospices and doulas. Continue to interview until you find the one that fit your needs.
'This is what my grief looks like': The healing power of art a reality for York man
There is no correct way to grieve, and there are various ways to express your grief, and this gentleman, and his friend, found a way to help them release their imaginations and emotions.
Does this resonate with you?
It can be hard and difficult to talk about End-of-Life wishes, and therefore decide not to talk about them at all, or just share a few of your preferences.
However, when we do not have candid conversations and share with our loved ones about our wishes, the chances of these decisions being followed through on are very small.
It's great that some of you have completed some forms (usually by request of a lawyer), but its imperative to sit down with someone (death doula) and go line by line and discover what each lines means to you and your preferences.
After you have completed this first step, congratulations! However, you still need convey this information to your loved ones, and especially, your Health Care Proxy.