While engaged in activities together—looking through catalogues and travel magazines or scrapbooks and photo albums and talking about memories with your terminally ill loved one, or while listening to music together or working on a simple puzzle together or enjoying a coin collection, or painting with watercolors, or baking, (or other activities)—you can feel out the mood and address specific topics over time…when it feels right:

Are there any members of the family you have not seen for a prolonged period who you want to see [before death]?

Are there any members of the family you have not talked to for a prolonged period who you want to talk to [before death]?

Are there any members of the family whose relationship with you is troublesome? If so, why is it troublesome and do you want it to be different? If so, would you mind if I made some efforts to reconcile the trouble?

Do you want to name a specific person to make decisions for you if and when you lose the ability to make decisions for yourself?

How do you feel about your religious affiliation? Would you like to communicate with a priest or minister or rabbi?

Do you have a will? Do you have any desired changes?

Are there any personal assets that would be better distributed as gifts before death to avoid delayed use during probate?

Are you worried about the availability of sufficient finances to cover family needs in the first few months of probate? If so, can something be done to transfer funds in such a way as to make them more readily available to the family until the probate is completed?

Do you have insurance that is unknown to the family?

Do you have a living will?

Do you want to be kept alive as long as possible using modern technology or do you want to be allowed to die if the disease causes you to lose the ability to think and make personal decisions?

Do you want to be given nutrition and hydration through a feeding tube in order to prolong your life?

Would you want to be an anatomical donor of body organs if the nature of the disease permits it?

What religious or other memorial service do you desire? Is there anyone in particular you would like to have speak at a funeral or memorial service?

How do you want to be remembered in an obituary, a eulogy, etc.? And, how would you prefer those left behind handle the mourning period?

…

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

As he faced the finality of death, it was natural for him to want to review the life he had lived—to look back and catalog his accomplishments and failures in life…financial, occupational, societal, and interpersonal—to understand the past—a final opportunity for him to resolve and come to understand the conflicts of earlier life.

For him the process was silent (while snuggled in bed with the blankets around his ears, he contemplated the past) AND oral (with his caregivers and daughter he shared tidbits of his thoughts), conscious AND unconscious (his life-review showed up in his dreams), and lengthy.

Invariably, each individual will fall short of what they wished to achieve no matter how successful their life may seem to others.

If the life is seen as a success and accepted, death will be accepted as well (in the sense that fear of it will be mitigated and serenity and wisdom will result).

With your beloved, stress the positive memories and stories:

“How would you like to be remembered?”

“Looking back, what do you consider to be the most important events in your life?”

“Why do you look at that as being such an important event?”

As your beloved recites stories, write them down or make a videotape or audiotape for future generations to enjoy. When the conversation dwindles, keep the thread going by saying, “That’s interesting. I want to hear more.”

And have soothing and meaningful music playing in the background—hearing specific music can help people remember meaningful times from the past and provides a comforting background when words just aren’t needed.

Because music reaches a deep, non-rational part of the human spirit, it can affect feelings such as grief, fear, anxiety, sadness, and anger, releasing those blocked or painful feelings and stimulating positive ones such as hope, love, and gratitude. Sharing music together can lead to sharing of the emotions that the music brings up. Acknowledging these emotions together can help bring closure to old issues and enable reflection.

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

Many dying loved ones who come to fully accept they have an untreatable illness, which will cause their death, still find ways to maintain hope.

This can take the form of:

Hoping to live to see a particular event (like the upcoming birth of a family member),

Hoping to be released from the hospital or moved to another facility,

Hoping to achieve the resolution of a particular problem,

Hoping to find a cure for their illness,

…

Many physicians and families, after discussing and agreeing on the futility of future therapy, still continue to go ahead with therapy knowing the risks far outweigh any potential physical benefit. The argument is that the therapy is appropriate as long as it does not present a significant risk to the patient and is not associated with significant suffering.

Hope is maintained.

Sometimes family members choose to keep knowledge of the terminal nature of the disease from a loved one because they do not want their beloved to be aware of the life expectancy…they want to maintain hope.

I’ve known people who have died quickly after being given bad news from family and physicians but I’ve also seen people spurred on to “fight like hell” and outlive their life expectancy.

Would you want to know if you had a terminal illness? Or would you want your family to keep such information from you?

What if you had Alzheimer’s disease in your family (or another disease) and you could have a test to find out if you were likely to develop it as well, would you take the test?

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

In my last Blog post I shared some of Henry’s story of existential suffering and the feelings he expressed to his daughter in the time leading up to his death, and said I’d share some ideas for relieving mental suffering.

Hearing the following reassurance from a physician or health care team, “My job is to make sure you remain comfortable and will not have to suffer bad [physical] pain,” can help many terminally ill patients who suffer existential pain…and certainly helped alleviate fear in Henry.

And it became the role of Henry’s daughter to make sure the medical team would follow through with the relief of pain symptoms experienced by Henry…right to his death.

Despite the fact Henry had transferred authority to his daughter for his financial and personal care, his daughter continued to ask Henry for his advice and wishes in issues he was involved in the past so that he knew and believed he was still important. And she reassured him he would continue to make decisions for himself and he would certainly be consulted on all.

And when Henry revisited the issue of his perceived failures, it was helpful for her to introduce the concept of forgiveness and to give permission for self-forgiveness.

She also took the responsibility to transmit Henry’s thoughts to other parties directly or through written communication when it was difficult for him to write or speak at length (she even helped him send cards by purchasing them for him and addressing them and gave him the opportunity to sign them before she placed stamps on them and mailed them…).

Using an idea from one of the following examples, Henry’s daughter also reminded her father that it was a privilege for her to return some of the aid he had given her and others in the past:

“You fed me when I was young and showed concern for me when I was sick. This gives me a chance to pay you back. It is a privilege, not a burden.”

“I heard you express concern about not having always been there for us in the past and you wondered if some family members will desert you now. In that recent Christmas letter to each of your children (and to me in person) you apologized for difficulties and transgressions you placed upon us over the years…and, speaking from my heart, I can promise you I will stay involved with you to the end and carry out your wishes. It is a privilege, not a burden.” 

“You were there for me and my children when we needed you. Now I can be there for you. I consider it a privilege, not a burden.”

“We’ve worked it out Dad. I’m going to do A, James will do B, William will do C, and Caroline and Henry Junior are coming to stay for a few days the first of next month to give us a little break. We’re all happy to work together to help you in your time of need. You were always there for us.”

“Don’t worry Dad. If it gets to be a little too much for us we can always get an aide to help, but right now we don’t think that will be necessary. We want to do it ourselves. It’s a privilege, not a burden.”

As Henry lost his strength, he accepted a greater degree of help from others. But at first he was worried about losing his dignity and was uncomfortable about relying on others to move him, wash him, fetch things for him, take care of his body excretions when he could no longer control himself, and finally, feed him. One day he realized his limitations and embraced assistance from others when he heard, “You took care of your wife for so long and asked nothing in return, and if you’re ready now we will do the same for you.”

How better to show love?

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

Henry is facing the reality that his existence in this world is about to end—he is terminally ill.

As the weeks pass, he feels himself becoming weaker and realizes his time is short and his accomplishments are almost over.

He can no longer control his own existence.

It is an unavoidable loss.

For several months he has been expressing a range of emotions to his daughter… unhappiness (with pleasure at times, depending on the happenings of the moment), hopelessness (he wants to be in the same facility as his aged wife but realizes there is no availability and he suspects they may never live together again), futility, meaninglessness, disappointment, remorse, death anxiety, disruption of personal identity (“What makes me who I am?” “What are my values?” “I know I’m starting to forget…”)…And fear:

Fear of becoming a burden,

Fear of family desertion (of dying alone) perhaps, his daughter surmises, because Henry was controlling of relationships in the past, was often not there for his family members in the past (and when he was there he was sometimes abusive) and now he fears family members will be resistant to extending help (will want revenge),

Fear of losing dignity,

Fear of shortness of breath,

Fear of nausea…

And especially fear of pain more than pain itself.

Henry is experiencing existential suffering (mental suffering).

Existential suffering can lead to suffering in Henry AND frustration for his health care workers and for his family as members try to blame the medical community for its failures to meet Henry’s needs.

But there is a difference between fears of the dying process (that terminally ill people like Henry typically feel) and fears related to being dead (that healthy people ponder—heaven versus hell, whether we have a soul or not and what it is comprised of if we do have one, nothingness…).

When we are healthy, we normally think periodically about death only to dismiss the thoughts for later consideration. This becomes ever more difficult to do when the time remaining is clearly running out. When one is dying, it is hard to repress thoughts about what lies ahead. Accepting the reality of death is a lonely battle for each individual.

In my next Blog post I’ll share some ideas for relieving mental suffering in the terminally ill.

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

Good friends are like stars…you don’t always see them, but you know they are always there.

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

“Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.”

~Norman Cousins (1915-1990)

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

Bob Schriever, co-founder of the Sudden Cardiac Arrest Association, was refereeing a high school football game seven years ago when he went into cardiac arrest, died and was revived.

He, too, questions the dream explanation (as Laura did in my last Blog post—she had a near-death experience and says she floated out of her body had saw deceased loved ones).

“Why are so many people dreaming the same thing? How can so many people, and there’s hundreds of thousands of people who have experienced this, how can we all be dreaming the same thing and describe the exact same thing?” Asks Bob.

Bob says these experiences are so profound that only someone who has gone through them can truly understand.

Seven years later, he is still consumed with his own near-death experience.

“I think about that every morning when I wake up, first thing, during the day, I don’t know how many times and every night before I fall asleep. I think about that. People do not understand or appreciate what we go through.”

For Laura, it’s a daily struggle to put the pieces back together again.

“I’ve been someplace that not everybody can go, and there’s not a lot of people you can sit down and have that conversation with,” Laura says. “My own daughter tells me, ‘It’s freaky, Mom.’ I’ve literally lost friends over this the minute they hear it.”

Laura says she became depressed once she left the hospital because her perspective on her entire life changed. She still gets depressed, she says, and is on medication.

“I actually went to my doctor and said to her, ‘I think I’m losing my mind. This can’t be really happening,’ you know, and she said it’s OK, it’s very hard to understand when you’ve been through an experience like that.”

Laura has joined the cardiac arrest group, hoping that connecting with others who understand what she’s been through will allow her to come to terms with what happened to her that day and allow her to heal and move on.

Have you had a near-death experience?

What are your thoughts?

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

For Laura Geraghty, April 1, 2009, started out just as any other day. It was sunny but cool, she remembers.

The mother of two, also a grandmother, was at her job, driving a public school bus in suburban Boston, Massachusetts.

Her passengers, special-needs children, were wheelchair-bound.

Seemingly in good health and in good spirits, Laura was finishing up her late-morning run, transporting a student and teacher back to Newton South High School, when she realized she was in trouble.

As she was pulling into the school parking lot, she began having sharp stomach pains. She was able to park her bus, but she kept feeling worse.

The pain “went right up my arm and into my chest, and I said, ‘Uh-oh, I’m having a heart attack,’ ” she said.

The teacher ran from the bus to get help. Gail, a nurse, and Michelle, a CPR instructor arrived moments later with the school’s new automated external defibrillator.

Laura, barely conscious, was fading fast. She was weak and having trouble breathing. And then she went into full cardiac arrest.

“Her eyes were wide, and all of a sudden she stopped talking to us,” Michelle said. “I grabbed the two pads, stuck them on her, started it up, and I’d say within 20 seconds, she had her first shock.”

They performed CPR while they waited for paramedics.

At that point, Laura says, her body died. She remembers watching the scene unfold—as if from above.

“I floated right out of my body. My body was here, and I just floated away. I looked back at it once, and it was there.”

Laura says she saw deceased loved ones, her mother and her ex-husband.

“It was very peaceful and light and beautiful. And I remember like, when you see someone you haven’t seen in a while, you want to hug them, and I remember trying to reach out to my ex-husband, and he would not take my hand. And then they floated away.”

Next, she says, she was overwhelmed by “massive energy, powerful, very powerful energy.”

“When that was happening, there were pictures of my son and my daughter and my granddaughter, and every second, their pictures flashed in my mind, and then I came back.”

What Laura had was a near-death experience, fairly common in people who go into sudden cardiac arrest.

Laura was down for 57 minutes. No blood pressure, no pulse, no oxygen, and no blood flow. She was shocked twenty-one times before she finally came back with tales of the afterlife.

According to the Near Death Experience Research Foundation, nearly 800 near-death experiences happen every day in the United States.

Dr. Kevin Nelson, a neurologist in Louisville, Kentucky, studies near-death experiences and says they’re not imagined. The explanation, he says, lies in the brain itself.

“These are real experiences. And they’re experiences that happen at a time of medical crisis and danger,” Nelson says.

Humans have a lot of reflexes that help keep us alive, part of the ‘fight or flight’ response that arises when we’re confronted with danger.

Nelson thinks that near-death experiences are part of the dream mechanism and that the person having the experience is in a REM, or ‘rapid eye movement’ state.

“Part of our ‘fight or flight’ reflexes to keep us alive includes the switch into the REM state of consciousness,” he says.

During REM sleep, there is increased brain activity and visual stimulation. Intense dreaming occurs as a result.

And the bright light so many people claim to see?

“The activation of the visual system caused by REM is causing the bright lights,” Nelson says.

And the tunnel people speak of, he says, is lack of blood flow to the eye. “The eye, the retina of the eye, is one of the most exquisitely sensitive tissues to a loss of blood flow. So when blood flow does not reach the eye, vision fails, and darkness ensues from the periphery to the center. And that is very likely causing the tunnel effect.”

Nelson is doing studies now to prove that the same effect results from fainting.

“The most common cause of near-death experience in my research group is fainting. Upwards of 100 million Americans have fainted. That means probably tens of millions of Americans have had these unusual experiences.”

But Laura says this was no dream. “I know I went someplace else. I know I went someplace else other then here.”

Dr. Bill, the emergency room doctor who shocked her back to life, agrees. “Cynics out there would say and agnostics would say that’s phenomenon that comes from a dying brain. I think that’s hogwash. I firmly believe that people experience these events.”

The man in my next Blog post, who went into cardiac arrest, died, and was revived, also questions the dream explanation.

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James

I think what is niggling away at me is seeing his suffering…that ultimate suffering that I know is leading to his death…a suffering that is painful to see in a family member.

I don’t know when his end when arrive…but I know his train is on that track.

He gave me the power to make personal and financial care decisions…but there is nothing I can do to stop what is happening to him.

Before my eyes he is wasting away…getting frail…looking more and more lethargic.

Always a proud person, he has softened…mellowed…and radiates concern and love through his eyes…and through his questions and statements—so palpable it can be plucked out of the air.

It breaks my heart to have to leave him.

Now when I look back at those recent pictures of us together, I see an illusion of emptiness behind his eyes…but having been with him, I am privileged to know there is so much more going on.

You cannot stop death.

Arranged around his room are family photos.

Near his bed is a Christmas tree. The lights have been turned off, but the tree is still decorated despite the fact the holidays have long passed—its presence gives him comfort. 

Yes, death is inevitable and it’s almost time to talk about it with him…and to discuss the meaning in the life he has lived.

To the end I will imbue a gentle cheerfulness and concern when I’m with him, and encourage him to speak his mind.

And I’ll let him know he will not be abandoned—I will stay involved…right to the end.

Melanie Hack
Author of Who Killed My Sister, My friend
Read an excerpt now
TV Shows and Clips about the Death of Cindy James