It's always hard to know what to say after a death, here are 6 things you should never say.Read More
The holidays are a great way to reconnect with family, to have a Friendsgiving with those who aren’t family but probably should have been, to share old traditions, welcome new folks, watch a game (and argue about the game),Read More
Warning: this post refers to the December 2, 2015 shooting at the Inland Regional Center in San Bernardino, California. It is meant to help people who were not directly involved in those events, but who are nonetheless experiencing emotional distress.
On the morningof December 2, 2015, the unthinkable happened here in the Inland Empire. Two armed people entered the Inland Regional Center, killed 14 people, and wounded over 20 more. I was talking to Sherry in the waiting room when Jill came out of her office and told us the awful news of what was happening just a few miles away. Stunned as I was, I had clients to see and that's what I concentrated on. As long as I was busy with the problems of others, I was fine. Only when I was about to drive home to Redlands and my husband texted me that the FBI was investigating a house on Center Street did I feel any fear. I arrived home safely, of course, watched the news and took phone calls from family and friends. The next morning I drove past Center Street on my way to an early appointment. The street was cordoned off with yellow tape and police cars. According to the morning news, the house on Center had been a "bomb factory." I was suddenly so nauseated that I had to stop and get a soda to settle my stomach. When I got home I curled up on the couch under a blanket, cried, slept for hours, and woke up feeling like I had been hit by a truck. I watched a little news, talked with my family, went to sleep very early and had nightmares. The next day I was functional again. The whole event seemed surreal.
As a therapist I recognized these as normal stress reactions. I was not at the Regional Center, and I don't know any of the dead or wounded. But this happened in my community and it hit me hard.
Each person reacts to terrible things in her or his own way, and everyone has a different threshold for what constitutes a traumatic event. Some will shake their heads and go on with their day, others will go to a vigil, hug their kids, look at the sunset, or have a stiff drink. Others may react as I did, but think, "I wasn't there. Why am I feeling so bad?" or worse yet, "I shouldn't be feeling so bad." But the fact remains that they are feeling bad. In the wake of a public trauma, it's important to be honest with ourselves about how we are doing. Here are some common reactions:
Insomnia or sleeping more than usual
Loss of appetite
Being easily startled
Feeling fearful for no reason
For most people, these feelings will soon fade on their own and life will go on. Self care practices such as exercise, time spent with family and friends, meditation, prayer, volunteer work, reading, hobbies, and focusing on the here and now can all help. However, if symptoms persist for more than a few weeks and interfere with your daily life, then it's time to see a therapist to discuss your level of anxiety and/or depression. It's ok to need a little extra help, and talking with a therapist can be very reassuring.
In short, even if you are not directly involved in terrible events, you can still be affected by them. It's part of being human.
Grief and loss doesn't start after your loved one has died. It begins when the realization becomes real that their death is approaching, whether far in the future from a long-term illness, or when a death occurs with little notice. In the ER, the ICU, at home… when that realization happens grief begins. It’s called “anticipatory grief” but, in reality, it’s grief, with all its emotion and sadness.
In the time before death occurs, there are things that need to be considered, both from the loved one’s perspective and to address your concerns. This will address the dying person’s needs. I’ll follow it with a blog about your needs as you support your loved one.
What Does A Dying Person Need at that point?
· The need to “settle up” with the people so as to die in peace, with them and with myself.
Settling up emotional accounts
All of us have unfinished business left over from our years on Earth. Approaching death is the last time to make amends, check in, or say the things that have been left unsaid.
If someone can’t be reached, letters can be left, and even dictated. Elaborate isn't necessary. Peace for the person dying is.
· An advocate for their end of life decisions
End of life decisions need to be written well in advance of the dying process. They aren't valid if you aren't of sound mind without a doubt.
Enforcing a living will or other decision making documents can be difficult if there is division in the family.
It’s hard to not provide hydration of nutrition if it’s been days or weeks. Someone has to ensure the dying person’s wishes are followed. That may have to be you.
· The environment the dying person desires
Some people are extroverts, even when dying. Some are private, even if the family wants access. The dying person should have the kind of environment they lived with and following their wishes. And someone has to ensure it happens.
Things to consider:
- TV or movies
- Bedroom or living room
- Home or hospital
- Spiritual folks
· A safe space to talk or a safe person to talk to about death
Family and friends are often reluctant to face up to the reality of the terminal illness and death: even if they are not, their experience is not the experience of the dying person. If they are still capable of talking, they may need someone to talk to about their fears and terrors, hopes and vulnerability. It may not be family. It may be a nurse, a friend… it’s up to the person who needs to do the talking. They don’t need their decision to create conflict. It’s their decision.
· Spiritual support- or NO spiritual support.
Some find it comforting. Some find it presumptuous to assume they need spiritual support. Some do not have a faith they rely upon or believe. The dying person needs, and deserves, to have their needs followed at this point. If family needs to listen to religious music, say prayers, light incense… no matter- if it’s not something the patient wanted or participated in, it belongs outside the door. It’s the patient’s death- nobody else’s.
· Pain management/comfort measures
A dying person deserves to have pain and discomfort resolved. They may not be able to tell you what they are feeling, but their body can to some degree. Blood pressure, fever, grimacing, tightened muscles, low oxygen saturation, irregular breathing. Those and so many more are indicators of the patient’s body being uncomfortable. Can you fix the breathing? Probably not. But you can add oxygen. You can administer pain medications and anxiety meds through sublingual administration. You can add a subQ IV to administer meds without adding fluids that could create respiratory distress. You can massage. Make the bed softer. Use a cool washcloth. Turn on a fan. Add a blanket.
Families tend to be especially distressed about morphine and other meds. They are not going to kill a dying person. They make the muscles relax so breathing is less stressed. They relieve pain. If your loved one has asked for comfort measures, they don’t want to die in pain. Allow the medical professionals to guide you. Ask questions.
· Food? Fluids?
At the end of life, the body has a process of its own as the systems shut down. It no longer needs food. It doesn't thirst. The mouth may need moistening. Oral care is still necessary. But if a dying person says they don’t want food or fluids- believe them. It’s hard to watch. You are still hungry. You are still thirsty. They are not. Honor their body and their needs. Forcing fluids can cause choking and even pneumonia, hastening death.
· Visions supported
Many people who are dying will report that they are seeing loved ones who died before now, or angels. Don’t question or deny that. There have been studies that say they may be caused by hypoxia or changes in brain chemistry. The studies, however, cannot include dying people. We don’t know this experience. We do know it’s common and brings comfort. Tell them you are glad they are there.
o Your voice
The last sense to die is hearing. If your loved one would want you there, talk to them. To the end.
This is most likely the hardest of all. No matter the disease or the pain, very few of us really want our loved one to really die. The fact is they are going to die. Tell them it’s ok. Tell them you’ll be ok; you’ll take care of business they left behind; you’ll carry their memory. Tell them what you will miss most and how much you loved them. But tell them they can go.
It’s not easy to sit while someone you love is dying. It’s a gift if you can.
The holidays are supposed to be happy, joyous, and festive. They are imagined to be filled with visits with family and friends, maybe a trip to a tree farm or to an aunt’s house for latkes, presents that have been thought about and carefully purchased.Read More