Category: EOLU Blog

Latest articles by Karen Wyatt MD

EOLU Blog

What Death Doulas Offer at the End of Life

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And why you need to know about their work

In my position as a retired hospice physician I often hear stories of end-of-life experiences that did not go well for patients or their families, both in the hospital and at home. When people describe the challenges they’ve faced, even when working with a local hospice, I tell them that a death doula might have made all the difference. But most have never heard of a death doula and have no idea what they do.

Unfortunately many people are unaware of this rather new field of deathcare that is poised to change how people and their loved ones navigate death, dying, and what comes after. But I’m here to tell you about it so you can have more options and make better decisions for yourself and your loved ones when you are in a time of need.

What Is a Death Doula?

A death doula is a non-medical guide who offers emotional, spiritual, and practical support before, during, and after death. We often say that death is much more than a medical experience—it is a personal, emotional, spiritual, familial, societal experience that we have largely chosen to ignore for the past century. Most people at the end of life need far more than medical care alone can offer.

Hospices have been created to help with the medical aspects of care and also offer social work and chaplaincy support. But in this modern world of Western medicine, hospice staff members are often carrying heavy caseloads and may have constraints on the time they can spend with patients and families. Many gaps in care can arise for those being served at their time of greatest need, which leads to the stories of suffering I’m often told.

Unlike hospice nurses, who manage the medical aspects of end-of-life care, death doulas aren’t bound by institutional rules or time limits. They show up and fill in the gaps during those times of great need. In the best of worlds they work alongside the hospice staff, each offering their expertise and collaborating for the best care possible. But when the hospice staff experiences pressure to shorten visits, the death doula is more able to focus on presence for as long as needed.

What Do Death Doulas Actually Do?

The services offered by death doulas vary widely and some may choose to specialize in one area or another. Some doulas sit at the bedside, some hold space in advance when illness is newly diagnosed, some serve the dying directly through the last breath, others assist families and caregivers with after-death plans.

What unites them is a passion for changing how we care for people at the end of life. The people called to this work are devoted and excel at being present during times of suffering with love and compassion. Here is a list of some core services provided by death doulas:

  • Death education – helping people understand the dying process, physically and spiritually, including early in the process of illness
  • Advance directives & planning – guiding people through end-of-life paperwork with compassion
  • Ritual design – creating meaningful vigils, farewells, or legacy ceremonies
  • Family support – helping loved ones navigate grief, guilt, and decision-making
  • Hospice augmentation – providing what hospice often can’t: time, touch, storytelling, bedside presence
  • After-death guidance – assisting with body care, home funerals, or grief rituals
  • Meaning-making – helping the dying reflect on life, purpose, forgiveness, and legacy

Why This Work Is Still So Unknown

While the modern death doula movement got started in the early 2000’s, the work of providing support to the dying is ancient and used to be available in every neighborhood and village. But modern healthcare and burial practices that emerged at the turn of the 20th century caused a dramatic shift in illness and death care away from the family home and into institutions. So over the span of a half century we lost all the intrinsic knowledge of how to care for our own dying loved ones—and we made death taboo, the very aspect of life we used to hold near us so tenderly.

The death doula movement is trying to revitalize the “old ways” of being with dying in a new form—not necessarily a next-door neighbor, but a trained helper who can show up at your door in a time of need with just the right tools to offer. Most people are unaware of death doulas and many communities lack access to this kind of care because the movement is still young. But things are changing and we can help them change faster—by talking about death doulas and sharing what’s possible. And also by getting training ourselves so that we can be the ones holding presence when the people we love are at the end of life.

Why Everyone Needs What Death Doulas Offer

It’s hard for most of us to imagine what the end of our own lives might be like. If we have not experienced the death of someone close to us we have no idea what it involves and what it takes to make the last breath as peaceful and loving as possible. That’s one reason why so many people are caught off guard when they suddenly find themselves caring for someone 24/7 with absolutely no training or understanding of what’s happening.

Take it from those of us who have been through these scenarios many times—you will need support when someone you love is dying and at the time of your own death. You’ll be better off if you spend some time now learning about the work of death doulas and if there are any in your community.

Some aspects of death care that you may not think of now—but you will need later—include:

  • Permission to grieve—not just at the time of death but throughout the process of illness
  • Time to reflect on life and relationships and what is needed for healing old emotional wounds
  • A sense of meaning and tying up loose ends; making sense of the events of life and how they have mysteriously unfolded for you
  • Guidance when systems fall short, which they inevitable will; you will have impossible decisions to make and will need support through that process
  • A calm, compassionate presence that can change everything for the people going through loss; a tragic experience can become sacred in the presence of love
  • A role model for how to show up for one another—not just in dying, but in living with more depth

“If you don’t need a death doula today, you will someday. Or someone you love will. And when that time comes, I hope you know they exist.”

Death Doulas and Modern Technology

At this time of rapidly expanding technology and artificial intelligence there is even more need for the human touch and heart-based presence of a human death doula. While AI may be able to augment the work of doulas by recording advance directives, researching funeral poetry and customs, or offering tips to caregivers—in the quiet moments and the liminal spaces where the breath falters and the veil is thin—the touch of a human hand, the tear that falls on a cheek, the softly whispered blessing, are not replaceable.

Death doulas may choose to use AI themselves to augment their training, to learn about unfamiliar cultural or religious death traditions, to find recipes for a client’s special dietary needs, or the perfect prayer for a vigil. But they should not fear the technology—the need for human presence will never disappear.

How to Choose a Death Doula

Remember that there are many different types of services offered by death doulas, so be clear about what type of help you need. Consider factors like training, area of specialization, availability, experience, and certification when making a choice. Many doulas will offer a free consultation to get acquainted before you decide who to hire.

Check with local hospices, palliative care facilities or community websites to find out if there are doulas in your area. In addition the following organizations have national doula registries where you can search within your state and community:

Be sure to talk to your loved ones if you’re interested in the possibility of hiring a death doula. Let them know that everyone benefits when the right care and assistance are available. And now that you know about death doulas pass this information on to others who may need it as well.

You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully,
but also to live until you die. 

-Cicely Saunders

Check out my next post on Substack where I’ll explore how AI might help us deepen our own death awareness. 

EOLU Blog

Five Gifts to Give Yourself this Holiday Season

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by Karen Wyatt MD

Another December has arrived and once again we are busily preparing for the holiday rituals that will take place as the year winds to an end. This is a perfect time to stop for a moment and really think about the meaning of your own celebrations, so that you don’t end up spending a fortune in time and money with nothing real to show when it is over. 

This is the year that you should dedicate yourself to staying in the present moment as much as possible, no matter how crazy and hectic your schedule becomes. If you race through each day of the season, mindlessly completing the items on your to-do list, you can become exhausted, depleted and resentful and totally miss the joys of this special time of year. But you can thrive throughout this busy season by following a few simple suggestions.

The solution is to give yourself some special gifts this year. I’m not talking about gifts that cost money or are indulgent, like a spa day, a fancy night on the town, or an exotic vacation – though those things may be just what you need right now. But these are some splurges for the “Soul” – activities that will help you find special meaning for yourself during the holidays:

  1. The Gift of Solitude

No matter how busy you are, take some time out to be totally alone during part of one day or evening. Try to find a place to go where you will not be around other people and turn your phone off or leave it behind for at least one hour. I live in the mountains and it’s easy for me to snowshoe on a trail above my house and walk in solitude for an entire day. But if you live in a city you may have to be creative: find a park where you can sit in an out-of-the-way grove, visit a little-used section of your local library, or find a time when you have your home to yourself, with no internet, television or radio to distract you. 

The idea is to be totally alone with your thoughts for one hour. During that time, take some deep breaths, think about the holiday that is approaching, reminisce about good times in the past, and contemplate what is most important to you about this season. Think of at least one thing you love about the holidays and plan how you can emphasize that activity or feeling in your life this year.

2. The Gift of Spontaneity

Be watchful for opportunities to do something special that is not on your to-do list: wander through a local neighborhood to look at the lights, stop to listen to carolers on the street corner, take in the special window displays downtown, make a snow-angel or build a snowman if you live in a cold climate.

3. The Gift of Wisdom

Spend some time reading from one of the great Wisdom texts available to us: the Bible, The Bhagavad Gita, The Kabbalah, I Ching, The Gospel of Thomas, Tao te Ching, the poetry of Rumi, or countless other sources. Immerse yourself in the beautiful language and thoughtful sentiments in these ancient writings. As Rumi wrote: “Let yourself be silently drawn by the stronger pull of what you really love.”

4. The Gift of Hunger

This may not sound like a gift at all, but I encourage you—just once during the holidays—to skip a meal. In this season of baking, feasting, partying and frequent overindulgence, it is an interesting experiment to go without eating for part of a day. When you have felt hunger for a few hours you will actually appreciate the abundant food that surrounds you and remember those who are not so fortunate at this or any other time of the year. You might even want to donate the money you save from that meal to a local soup kitchen or charity.

5. The Gift of Stars

Though it may be difficult for some, depending on where you live, I recommend going to a place one evening where you can look up and see the stars. Lie back for a brief time and study the vastness of the universe, reminding yourself how small we really are here on our beautiful planet. All of the rushing, shopping, buying, wrapping, baking, and entertaining that fill up your schedule are not really important when you consider the entire expanse of creation. But the Love that you feel and share with others rises above everything as what really matters during this holiday season. 

And finally, no matter which of the above gifts you choose to give yourself this year, spend some time writing about the experience in your journal. Remember to express your gratitude every day for this amazing life and all the blessings that have been showered upon you, during these holidays and all year long. May you have a December to remember as you bring this year to a close and share your gifts with the world!

And please accept a small gift this year: if you are interested in starting a journal or enhancing your journaling practice, you can download the “Journaling Starter Kit” at the link below (no obligation – you don’t even have to sign up!) Enjoy this gift of reflection and may your days be blessed with what really matters!

Journaling Starter Kit

Happy Holidays!

EOLU Blog

Something from Nothing: Grieving My Mom During the Holidays

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By Karen Wyatt MD

As the anniversary of my mother’s death approaches I’m reflecting back on that first year after her death and how I navigated grief through the year, including the holidays. I was with Mom for the week before she died and had the privilege of shepherding her through that transition—a moment I had been preparing for since I first became a hospice physician. I knew many years ago that I would be with my Mom on the day she died and that it would be one of the most important days of my life.

Her death itself was actually joyful, though it was a process that took a great deal of inner work on her part, which has also been true for many of my hospice patients. Mom had been ready and waiting to “go home” for the previous 5 years and was relieved that her time had finally come. So as she took her last breaths I had to celebrate on her behalf, that her struggle was coming to an end, even while my heart was breaking as each thread of our physical connection slipped through my hands and I confronted the enormity of that loss.

For days after her death I was in a heightened state of consciousness—sensing her presence everywhere around me, exquisitely aware of the beauty and fragility of absolutely everything in existence. Every portal of my being was wide open and love poured freely into and out from my heart as I delicately negotiated those tender days.

But within a few weeks I had retreated into the protective cocoon of grief, while I went through the motions of daily life, numb and slightly dazed. I could no longer recall what it felt like to be in that incredible state of lightness I had experienced immediately after her death and I concluded that it had simply been a symptom of sleep deprivation. 

Over the next few months I kept myself incredibly busy as I joined a mastermind group, traveled to a publicity summit, became a radio show host, produced a digital workshop and created an online interview series, along with doing speaking engagements in various parts of the country. I stayed constantly on the go and rarely took a moment off, even when I was “on vacation.”

I was proud of myself for being so resilient and productive. I didn’t realize that I had actually been hiding for all of those months from the grief that was mounting up inside me. But then everything fell apart: my radio show was cancelled, the interview series ended, my mastermind group moved on without me, my publicity contacts stopped communicating and I had run out of speaking engagements. 

Winter weather had arrived, the holidays were looming, my calendar was empty and I had nothing to show for a year of exhausting over-commitment and frantic busy-ness. I suddenly recognized how short the days had become as I laid awake for hours in the darkness, lost in my own emptiness.

“This is my first holiday season without Mom,” I thought to myself, remembering how much she loved these times of celebration and always made each moment feel so full … full of love and joy and laughter. And now, though I had the financial resources to buy anything I wanted or needed, I could not even begin to fill this emptiness that haunted me deep in the darkness.

How had she done it? What “magic” had she created to make each moment of anticipation before a special holiday feel so extraordinary, so full of meaning?

Searching for answers, I unpacked a box of some of her prized holiday decorations I had “inherited” after she died: a glittery ornament she and my grandmother had pieced together from old greeting cards; a tree-shaped wall hanging she and her sister made from broken green and brown glass (beer bottles my grandfather found in the trash behind a local dance hall) and adorned with old costume jewelry; various vases and candle holders she had crafted from discarded plastic bottles and glass jars, decorated with scraps of lace and fabric.

I had found these “treasures” of hers to be deeply embarrassing when I was a teenager and my friends from across town would visit our little house. They lived in huge homes, fancily decorated with porcelain figurines and hand-painted glass ornaments, which no one was allowed to touch. Yet my mother, oblivious of our humiliating low social status, proudly displayed her homemade trinkets as if they were priceless works of art.

Lost in these memories as I held the fragile greeting card ornament in my hands, I suddenly realized what my mother had been able to do all those years ago …

She had created something from nothing …

She had excelled at making each day seem special, even though her resources were limited. She managed to create little miracles everywhere she went, though her pocketbook was empty. She took things that were unwanted and discarded and gave them new purpose and meaning, finding the hidden beauty in everything. 

She did this even with the destitute families she met who needed a place to live—she allowed them to move into the little rental house she owned, knowing they wouldn’t be able to pay their rent for several months. “You will make it up later when things are going better,” she would tell them. And her grateful tenants, relieved that someone finally saw something of value in them, almost always repaid her.

As I arranged my mother’s treasures on a shelf in my living room, I suddenly knew what I needed to do. I would find my way through this grief that was smothering me by doing what Mom would do: make something from nothing for the holidays.

That night when the sun went down and the temperature dropped well below freezing, I placed two buckets of water out in the snow.  They froze around the perimeter and remained hollow inside, forming beautiful sparkling ice lanterns that glowed with the light of the candles I placed in them.

I situated these ice lanterns at the top of my driveway, where they illuminated the path toward home in the deepest darkness of night though they were composed of “nothing” but water. Each evening as I trudged through the snow to light them I took comfort in the warmth emitted by those tiny flames and found hope that perhaps this light will also guide others who are wandering in the dark shrouds of grief toward the home they are seeking.

Though Mom will never again be with me physically and I will never again open a present from her on a special holiday, I have received the most important gift she could ever give me: the ability to cherish what really matters in life, to find the hidden beauty in everything, to make something from nothing. 

And that has become my path through this process of grief: to continue to honor Mom’s memory by offering up whatever I have as a gift to the Universe, free from self-judgment and embarrassment, cherishing each moment as a priceless work of art, creating always:

Something from nothing …

Light in the darkness …

Fullness within the emptiness.

It is all I can do right now … and indeed … all that needs to be done.

EOLU Blog

How Family Movie Night Can Lead to a Conversation About Death and Grief

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by Karen Wyatt MD

Recently there has been a growing focus for individuals in our society to look at their hopes and desires for the end-of-life and put those wishes into writing. The Five Wishes document and The Conversation Project Starter Kit, along with many online options, have helped people think about that day when life will come to an end and put those thoughts and feelings into writing.

But the most important step in the end-of-life planning process is to talk about those wishes with loved ones and that conversation is often difficult to initiate. How do we start talking about death with people who aren’t sure they want to discuss it? How do we address the experience of loss and grief, which is also often avoided in our society?

One idea is to use a film, perhaps during a family “movie night,” to help introduce the topic and get the discussion started. Films project the stories of characters onto the screen and allow us to look at difficult subjects from a distance without feeling personally involved. The stories portrayed in movies can also inspire the imagination, stir up emotions and provoke deep thoughts—all of which can be helpful during a conversation about death and grief.

Here are some suggestions for creating a special “movie night” exploration of death and grief: 

  • Allow ample time 

    Choose a night when nothing else has been planned so there will be time and space for the conversation to unfold naturally after the film.

    • Keep it cozy

    Make sure the seating arrangements are comfortable for everyone, provide snacks and beverages, and minimize outside distractions that might take attention away from the film and the conversation.

    • Select the film carefully

    Consider the age and comfort level of the people you want to engage in conversation as you make your choice. Also be clear about your objective: do you want to inspire a discussion about death in general or do you have specific topics to bring up such as hospice care or living fully at the end of life or facing grief after the death of a loved one?

    For example, The Bucket List is a great film to kick off a conversation about how to live life fully when you know you are going to die. His Three Daughters shows the difficulties of family dynamics when one member is dying. Terms of Endearment focuses on the mother-daughter relationship and portrays the dying process and the grief that follows. Many holiday movies like The Christmas Checklist focus on characters who are experiencing grief when others are celebrating. If children are part of the conversation, The Lion King, Coco or Up could help address issues of grief after loss and the fact that death is a normal part of life.

    • Have a few questions ready 

    Don’t force the conversation but be prepared to get it started with your own comments or questions. For example ask “What’s on your bucket list?” or “What would you give as a gift if you knew it was your last Christmas?” or “How do you think Mufasa’s death changed Simba?” or “How did the Christmas Checklist help Emily process her grief?”

    • Do it again

    In case your first movie night conversation doesn’t go as well as hoped, plan to try again with a different film and a different approach. These conversations are challenging but extremely important so don’t give up on the idea! 

    Since death is a natural and universal part of our human existence we really should be talking about it on a regular basis. Get creative and imagine how you might bring up the discussion after other films your family might watch together. Remember that families who have talked about death are more likely to have positive experiences when a loved one reaches the end of life. It’s definitely a conversation worth having!

    EOLU Blog

    What Forrest Gump Teaches Us About Death and Dying

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    by Karen Wyatt MD

    The classic movie Forrest Gump (1994), directed by Robert Zemeckis, has been described by some as a profound social commentary and a historical depiction of southern culture, and by others as a model of man’s resiliency. But on closer look, Forrest Gump, the tale of a simple man negotiating a complex world, can actually be interpreted as a film about death and dying with some important lessons for us to learn on this subject.

    Throughout the film Forrest tells stories of historical events that involve the deaths of various iconic figures such as Elvis Presley, John F. Kennedy, Bobby Kennedy, Martin Luther King, and John Lennon. He matter-of-factly talks about each man’s death and sums up his own lack of explanation for these tragedies with “for no particular reason” or “I don’t know why,” reminding us that death is a mystery that very often cannot be understood from a rational perspective.

    But Forrest also faces death on a personal level as he must endure the loss of three of the most important people in his life: his Momma, his “best good friend” Bubba, and his beloved Jenny, who won his heart the moment he first laid eyes on her. As we watch Forrest cope with death in his uncomplicated and imperturbable manner there are certain lessons that shine forth for each of us about death and dying:

    “You never know what you’re gonna get.”

      This is the corollary to Forrest’s most famous adage: “Life [and also Death] is like a box of chocolates.” One of our greatest struggles is the fact that life and death are uncertain. We have no way of knowing when or how we will die and must live with our questions and take our chances as we move through this world. 

      Even if we demand control over death by choosing to take it into our own hands, there are still no guarantees: the method we choose to hasten death might fail, we might change our minds at the last minute, or we might even die by some other cause before the date of our planned death.

      So we have to reach into the box of life, not knowing what we will get, and make the best of whatever we draw out. Forrest is okay with this reality of life and models for us, in his Zen-like fashion, that sometimes not-knowing and simply accepting things as they are can be the highest form of wisdom.

       “If I’d known this would be the last time we’d talk I’d have thought of something better to say.”

      These are Forrest’s words as he reflects on his last moments with his “best good friend” Bubba who dies during a firefight in Vietnam. Forrest reminds us that our words may be the last gift we will ever give to our loved ones and we should choose them carefully. Any moment with someone we care about could be our final opportunity to express our love and admiration, so let’s not waste a single one. The last words our loved ones hear us utter need not be profound or deeply wise, but wouldn’t it be sweet if those words spoke of love and compassion?

      “It’s my time—just my time.”

      With these few words, Momma explains to Forrest in simple terms that death has its own time frame, as the verse from Ecclesiastes 3:2 states, there is “a time to be born and a time to die.” Momma accepts her dying with calmness and fearlessness that reassure Forrest and help him see that even a painful loss can be perfect in a way. 

      Lieutenant Dan believed that “his time” was to die during the war as a hero, but when Forrest saved his life he had to recognize eventually that his path had something else in store for him. We really cannot say what the timing of death will be or should be—we can only observe it and marvel that death always arrives with its own sense of mystery. 

      “Death is just a part of life.”

      Forrest recalls these words from his Momma as he copes with losing his dear Jenny. At this point in the story it becomes clear that this simple truth has been an important message of the entire film: Death cannot be separated from life. 

      In fact, death is a necessary part of the cycle of life and should be accepted as a natural, though painful, process. Forrest is able to grasp this concept and use it as his lens for looking at all of the events of his own existence, which is evidence that life and death are not necessarily difficult to understand. But we tend to complicate them by overthinking and overreacting emotionally to the circumstances that occur. Forrest teaches us to take a step back and look at life and death without expectations or attachments.

      “I couldn’t tell where Heaven stopped and Earth began.”

      When Jenny asks Forrest if he was ever afraid in Vietnam, he ends up describing to her all of the beautiful moments he remembers from that experience and also from running back and forth across the country multiple times. 

      He recalls several times when nature’s beauty was especially astounding such as when the stars came out on a clear night, a gorgeous scene was reflected perfectly upon a still lake, and the sun rose and set with all its vivid colors.  These are the moments when we recognize that Heaven is not a place to transition to—Heaven is always right here, right now, within our own perception of life and death.

       “I don’t know if we each have a destiny or we’re all just floatin’ around accidental like on a breeze. Maybe both happening at the same time …”

      With this final musing, Forrest sums up the key message of this movie: life can be like a feather floating on a breeze, randomly swayed and directed by gusts of wind that shift direction without warning. But life also, like each feather, has a purpose and a reason to exist. And both are happening at the same time. 

      When we can grasp both of those concepts, as Forrest has, we will have mastered the key to enlightenment and also the answer to the fear of dying. We don’t have to worry about death—we will float there on a breeze, but in that process we will also fulfill our greatest purpose. 

      EOLU Blog

      Why I Think About Death Every Day

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      by Karen Wyatt MD

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

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

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

      Gratitude for every moment of life

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

      Restructured priorities

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

      Taking responsibility for my life

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

      Looking within myself for answers

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

      Finding joy in being alive

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

      Being prepared for anything

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

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

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

      EOLU Blog

      What to Do When a Loved One Refuses Hospice Care

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      by Karen Wyatt MD

      When it was time for Doris, an 85-year old woman with biliary cancer, to be discharged from the hospital, her physician suggested to her and her family that she be admitted to hospice care. But Doris refused hospice care even though her family members strongly supported the doctor’s advice.

      It’s not unusual for a patient to have concerns about signing on to a hospice for care and for families to get caught up in a struggle as they try to find the best care possible for their loved one. There are many reasons a patient like Doris might say no to hospice and it’s important for care providers and family members to try to understand her feelings. Here are some steps to take if you find yourself dealing with a loved one who refuses hospice care:

      Listen without judgment.

      Begin by calmly listening to whatever the patient needs to say. Don’t argue or try to persuade her to change her mind—just listen to see what you can learn about her feelings.

      Ask why she is not comfortable with hospice.

      If she hasn’t told you yet her reasons for saying no, ask her why. But again, don’t argue with her reasoning. Careful listening will help you understand her better and get a glimpse of how she views end-of-life care. She may have misconceptions about hospice or she may have had a traumatic experience with death in the past. Provide her with a safe space to express her feelings even if you don’t agree with them.

      Validate her emotions.

      Let her know that you understand why a decision to begin hospice care can be frightening and overwhelming. Don’t push or rush her to choose hospice but agree that she has the right to turn it down.

      Gently provide reassuring facts.

      Once you understand where her resistance is coming from you can gradually begin to provide additional factual information about hospice. Again, don’t argue—just mention some of the details about hospice and how it functions as a way of answering her fears. For example, many people fear that accepting hospice care means that death will come more quickly. In this situation you might explain that a study has shown that patients who receive hospice care actually live longer than patients with an identical diagnosis who do not receive hospice care.

      Arrange for her to meet someone from hospice.

      Invite a hospice staffer to meet her and answer questions. Connecting with a real person who represents the hospice team can go a long way toward reassuring the patient that hospice care is provided with compassion and empathy as well as expertise. During that face-to-face meeting you can bring up some of your loved one’s questions to show her that you are on her side and share her concerns.

      Respect her wishes.

      Let your loved one know that she has control over her own decisions and that you will honor her choices. She needs to feel supported or her resistance to hospice might increase if family members apply too much pressure.

      Offer alternatives.

      If palliative care is available in your area see if she might agree to accept that rather than hospice, since she will be able to continue curative treatments while receiving palliative care. Some patients may also agree to be admitted briefly to a home care service for evaluation of their potential for improvement. This temporary measure could buy some time while your loved one adjusts to the idea of hospice care.

      Ultimately no one should be pressured into receiving hospice care if it doesn’t meet her preferences. But most patients who initially refuse care from hospice end up agreeing to it eventually and feeling good about their choice. We must allow patients the freedom to choose their own course with whatever timing is best for them. Showing respect for their right to make decisions for themselves is an important step to help patients embrace their own individual end-of-life process.

      EOLU Blog

      How Hospice Care Can Bring Families Together

      kwyattmd

      by Karen Wyatt MD

      When Gail and Gloria admitted their elderly mother to hospice as she neared the end of her life, they mentioned that they had a younger brother who had been estranged from the family for the past twenty years. The sisters agreed that they did not want him to be notified of their mother’s condition or to be part of the decision-making process. But then they learned from the hospice nurse that their mother had confided her deepest wish: to see her son again and to have her children reconcile their relationships. Finally Gail and Gloria agreed to reach out to their brother and ultimately the three of them were able to heal their differences and care for their mother as a united team. The sisters admitted that they were relieved to see their mother truly at peace at the end of life after they welcomed their brother back into the family.

      Stories like this are repeated on a daily basis within hospices around the country. In fact one of the most rewarding aspects of working in hospice is the opportunity to see how families come together and strengthen their bonds when they learn that a loved one is nearing the end of life. Even families that have experienced stress and tension for years have managed to heal their differences when they are called to be at the bedside of a terminally ill family member. Here are some of the ways in which hospice helps to foster this type of reconciliation:

      Teamwork is necessary to provide care.

      A patient who receives hospice care at home must have family or paid caregivers available around the clock, which takes cooperation to arrange. Family members have to create a schedule for care and decide how to meet the needs of their loved one. This allows an opportunity for negotiation, which can bring out the best (or sometimes, the worst) of each person in the family.

      Priorities shift at the end of life.

      As patients and their families face their own mortality they often come to see that what really matters at the end of life is different than what mattered before. In the case of Gail and Gloria, their determination to keep their brother away soon faded when they saw how much their mother wanted them to forgive one another. Suddenly their old anger and resentments were no longer the most important issue driving their decisions and they began to see their relationship in a new light. 

      Focus is on the needs of the patient.

      When families come together to help a loved one they tend to focus their efforts on what is best for the patient, and harmony between family members is always better for the wellbeing of the patient than conflict. Dying people often want to know that their children, parents or siblings love one another and will take care of each other after they are gone. These wishes at the end of life can be powerful motivators for family members to heal their relationships.

      Hospice staff helps with communication.

      The hospice team includes a social worker, chaplain and often a counselor who are trained to help families with communication. These staff members can facilitate family discussions and mediate when conflicts arise. In our hospice we frequently reached out to estranged family members on behalf of our patients to invite them to reconnect with their loved ones. With help, the majority of these families were able to find peace after many years of disruption.

      Caregiving can foster forgiveness.

      The act of caring for an ill loved one requires determination and sacrifice, but also leads to deeper connection and intimacy. As family members work together to provide care and meet the needs of the patient they may soften their hard edges and let go of their demands for perfection from one another. This is a scenario that then leads to forgiveness as each person recognizes their interdependence and finds value in being close rather than being at odds with one another.

      Hospice teams model compassion.

      One of the greatest benefits of working with hospice is the heart-centered focus of the people who make up the hospice team. The nurses, aides, chaplains, social workers, volunteers, and even the administrators of the hospice are all trained to be comfortable with death and have developed their capacity for compassion as well as their medical expertise. When hospice team members visit their patients, family members have the opportunity to observe how to be present with a dying person and how to bring love and calmness to any situation. This powerful learning experience is available to families who choose to admit their loved ones to hospice at the end of life.

      Of course, not every family will find a way to come together in peace and reconciliation when their loved one nears the end of life. In fact, some families are split even further apart over conflicts around how and where their loved one should receive care. But the likelihood of healing family disruption is increased when a decision to utilize hospice is made early on in the end of life process. It takes time to let go of past difficulties and find forgiveness so it’s never too soon to begin working toward that outcome. Patients and families both benefit from having more days together to focus on love, care and respect as life is nearing the end—and hospice team members are the perfect teachers and guides for that journey.

      EOLU Blog

      When You Can’t be Present for a Last Goodbye

      kwyattmd

      By Karen Wyatt MD

      When my niece died in hospice in another city a few years ago I was unable to travel there to say goodbye before her death. I was crushed that I didn’t have one last opportunity to hold her hand and tell her I loved her, but as it worked out that visit was just not possible.

      In an ideal world many of us would like to be with our dearest loved ones at the end of their lives, to say goodbye and “I love you” one last time. But in this day and age we live very busy lives that often take place many miles away from our families so there are times when we cannot travel to be present for those special and fleeting moments.

      Some of us may even go to great lengths to get to another city only to find that we missed the final breath by a few hours. This distressing reality can lead to unresolved guilt and grief as we blame ourselves for not being there. But here are some things I’d like you to know about the dying process based on my many years of hospice experience:

      • Dying has a unique time frame.

        Even with the best of medical knowledge we cannot accurately predict when a terminal patient will die. I have seen patients live far longer than seemed medically possible and also patients who died much sooner than expected for no obvious reason. Don’t blame yourself if you cannot be there at the “right” time since you have no way of knowing in advance when that time will be.

        • Dying is an internal process.

        In the last few days before death patients tend to turn inward and focus on the personal work they need to do in order to let go of life. They enter into a semi-comatose state where they seem to be having experiences that we cannot understand. They may express a desire to see a particular family member, but often they are preoccupied with their own process and don’t need much interaction with others. Most likely your loved one is not focusing on whether or not you are physically present in the room.

        • Each person’s preferences are different.

        Some people want to be surrounded by loved ones as they prepare to die, but others need to be left alone in order to complete the work they are doing. We usually cannot predict who will want to be alone in advance and even patients themselves, when asked about it ahead of time, don’t realize that they may need solitude during those last moments. Some people who have always been very social find that they no longer want to interact with others when they are ready to die. 

        While you may want to be there to say goodbye it’s possible that your loved one is content to have fewer visitors at that time. In fact one woman I know spent every moment at her mother’s side so that she would not die alone. But the mother took her last breath during a brief period when her daughter went outside for a few minutes. Apparently she needed to be alone to finally let go and her daughter simply had to accept her choice.

        • Sometimes dying patients seem to delay death

        Again without any medical explanation, some dying patients seem to be able to postpone the time of death in order to “wait” for a loved one who is expected to visit. I have seen many occasions when the patient had an intense need to see someone one last time and, against medical odds, survived an amazing number of extra days, until that person arrived. If your loved one did not wait for you to come please view it as a sign that there was no unfinished business between you and don’t blame yourself for not getting there on time.

        • The dying perceive things that we cannot explain.

        In my work with dying patients I have witnessed their ability to “see” and “feel” the love that others are sending to them, even from a far distance. Many of them have explained that they feel connected to distant family members and “know” that they are loved, even if those people cannot be physically present. Trust that all of your concern and loving thoughts have been received by your dear one and forgive yourself for not being able to be in the room at the time of death.

        If you know you cannot be there and you have a need to say goodbye try calling on the telephone to express your love. The day before my mother died she received phone calls from two dear friends who lived far away. Even though she was semi-comatose she listened as I held the receiver to her ear and smiled at the sound of their voices. She was unable to respond verbally but I could see that she heard the message so I reassured her friends that their farewells got through to her. 

        Remember that you have no control over the timing of your loved one’s death. Follow your heart and travel if you need to and you can but don’t stress if it doesn’t work out. Your effort and your loving intention will still be perceived by your loved one in some way or another.

        Trust that your loved one would not want you to carry a burden of guilt with you and create your own “goodbye” ritual if you cannot be there in person. On the day my niece died I gathered some wildflowers and dropped them into a flowing stream while I spoke all of the messages I would have shared with her at her bedside. My heart became much lighter as I imagined her standing next to me, watching the blossoms drift slowly downstream. 

        May you too find a way to be at peace with every farewell you must speak from a distance.

        EOLU Blog

        How to Make a Difficult Decision for a Loved One at the End of Life

        kwyattmd

        by Karen Wyatt MD

        When family members are called upon to make a difficult decision on behalf of a loved one at the end of life it can be one of the most challenging situations they’ve ever faced. This stressful time is made even worse if they have never discussed end-of-life issues and have no idea what their loved one would want for themselves. Many families experience conflicts during these times that can cause feelings of blame and guilt that last for years.

        Every day in this country families struggle with difficult decisions of whether or not to continue medical treatment for loved ones who can no longer speak for themselves. In fact Pew Research Center estimates that about 10% of the general public in the U.S. will have to make such a choice on behalf of a loved one during any five-year time period.[i]

        To avoid such a crisis when a loved one becomes terminally ill it is important to have a conversation now about their end-of-life preferences. But if there’s no time left and you find yourself in the position of having to make a difficult decision for someone who doesn’t have an advance directive, here are some guidelines for how to proceed:

        Gather medical information first

        Talk with your loved one’s doctors and get as many facts as you can. Have the doctors explain the diagnosis and any additional complications that have occurred. Ask about the effectiveness of the treatment being recommended, the chances for recovery or improvement, and any side effects or additional suffering that might be caused by the treatment. Also ask what will happen if treatment is stopped and the condition follows its natural course. You might even ask the doctors what choice they would make if faced with this same decision for a loved one.

        Get expert advice

        If your hospital has a palliative care service ask for a consultation. The palliative care team usually consists of a doctor (or nurse practitioner), nurse, social worker and chaplain all of whom have been trained to help with difficult medical decisions. They can facilitate a discussion with you and other members of your family and offer their wisdom and experience from different perspectives. As a team they will help you understand the medical information and explain all options available.

        Remember past conversations

        Try to recall any past discussions you have had with your loved one when the subject of illness of the end of life may have come up. Think back to a time when your loved one experienced the death of someone close, perhaps a parent or sibling. Did your loved one seem at peace and accepting of the death or fearful and resistant? Try to recall any comments made or issues that were discussed to get some clues about the choices your loved one might make for care right now.

        Consider the statistics

        According to the NIH most Americans say they want to die at home, even though the majority still die in hospitals, nursing homes or inpatient hospice facilities.[ii]

        Also in a Pew Research Center study on attitudes toward aggressive treatment at the end of life, only a third of respondents say they would want everything possible done to keep them alive.[iii] The majority of people feel it would be acceptable to stop treatment in case of severe pain or incurable illness. Do you think your loved one would agree with the majority of people about these issues?

        Ask your loved one for guidance

        This last suggestion might sound strange if your loved one is unresponsive. But studies have shown that patients in coma are still able to hear when they are spoken to. Here is an exercise you can use to help you get in touch with the deeper wishes of your loved one:

        Sit quietly at the bedside of your love one and hold his or her hand. Take some deep breaths to help you get into a relaxed state then say aloud or to yourself, “I have a difficult decision to make and I need your help.” Close your eyes and imagine that you are holding her hand across a table while you sit together and drink tea or wine or whatever would seem natural for the two of you. See her as healthy and vibrant as you ask her what decision she would like you to make on her behalf. Keep breathing slow and deep and wait patiently for an answer from her that might give you a clue about her preferences. 

        Even if you don’t hear an answer during this exercise you will at least know that you tried to find out what your loved one would prefer and that you’ve done everything you could to make the best decision possible. Trust your intuition or “gut” feeling as you have a final discussion with the medical team.

        Be gentle with yourself

        After the decision has been made and carried out, be forgiving of yourself for whatever happens next. Trust that your loved one knows you have acted from love and done your best to make the right choice. If treatment is going to be discontinued you might create a ritual to say goodbye and thank you for the life they have lived and the love they have given.

        Whenever difficult decisions have been made it is normal to later have doubts and questions about the correctness of that choice. Recognize those feeling when they arise, acknowledge the pain, and then see that you are not responsible for your loved one’s life path even though the burden fell upon you to make a final decision. Life is a mystery and the end of life is even more mysterious. We cannot predict or control the events that happen … we simply must do the best we can with the options available to us.

        [i] http://www.people-press.org/2006/01/05/strong-public-support-for-right-to-die/

        [ii]https://pmc.ncbi.nlm.nih.gov/articles/PMC2708119/

        [iii]http://www.pewsocialtrends.org/2009/08/20/end-of-life-decisions-how-americans-cope/

        EOLU Blog

        How Being a Caregiver Helped Me With Grief

        kwyattmd

        By Karen Wyatt MD

        As a hospice doctor I have often worked with families caring for a dying loved one at home. But I have only once had the opportunity to switch places and be the caregiver myself when my mother died. That was a profound and educational experience for me as I suddenly understood personally what it was like to be with a dying loved one around-the-clock. 

        While before I had imagined what it felt like to sit up all night at the bedside holding vigil before the moment of death, I can now vividly recall the exhaustion and the uncertainty of that experience. Now I know far more than ever before what the act of being a caregiver takes and what it gives back.

        I was able to let go of little moments with her one-by-one.”

        The greatest blessing of being a caregiver for me was the opportunity to experience grief even before my mother had died. I was able to let go of little moments with her one-by-one: the last time she ate a spoonful of the custard she loved so much, the last morning she brushed her own hair, the last afternoon she shuffled through the kitchen with her walker, the last evening she sat on her recliner and listened to the news, the last night she touched my face and kissed me goodnight.

        With the arrival of each new day, something else had been lost and the little world we were sharing became a bit smaller until we were left with only the bed she rested upon and the chair where I sat next to her. But I was able to let all of it go gradually while she was letting go of life and the pain I felt was somehow bearable.

        There are other ways that the act of being a caregiver helped me:

        • Providing hands-on care and keeping my mother comfortable in her last hours gave me comfort as well. I was not just passively observing her dying process but I was helping her and it was a tremendous relief to be able to do something for her at that time.
        • I knew I was honoring her wishes by keeping her at home because she had talked with me about what she wanted at the end of life. Everything I did and every moment I spent with her felt “right” to me because I understood her preferences.
        • I was there for special moments when Mom spoke a few words or opened her eyes and smiled. Those tiny little experiences mean everything to me now as I remember our journey together to her last breaths. I am forever grateful that I didn’t miss a single moment.
        • I could give her one last gift of gratitude by enabling her to stay in her own home and have the kind of death she wanted. While there is no way to ever repay a mother for all of her years of nurturing and tender care, being there when Mom needed me was one small gesture I could make to show her my deep love.
        • We forgave one another.  Our relationship had not always been easy and there were some painful memories between us that we could never discuss. But in the middle of the night when Mom nearly fell out of bed and I was frantically trying to lift her back to safety, we connected in a moment of pure human frustration and love. Without saying a word we looked at one another and both understood somehow—life is difficult and we hurt one another along the way but nothing really shakes the deep love that resonates between our hearts. We both let go of all our resentment in that brief moment.

        These opportunities were only possible because we had enlisted the aid of a home hospice team, who made regular visits and assisted me with the care that was needed. I could not have done the work without their help and I understand more than ever the important role played by hospice staffs all over the world.

        I am a new person since caring for my Mom at the end of her life. I am a better doctor, a more compassionate wife, a more fun-loving mother, and a much wiser woman as I face my own aging. Life and death and grief … they are all what we make of them and how we take care of ourselves and others during the journey. I know this for sure now and the rest of my life will be blessed by that knowledge.

        EOLU Blog

        How I Helped My Mother Choose Hospice Care

        kwyattmd

        by Karen Wyatt MD

        As a hospice physician who has cared for thousands of patients at the end of their lives, I had always assumed that hospice care would be an obvious choice for my mother when it came time for her to die. We had talked openly about my work for many years so I was not prepared for the fear and resistance that came up for her when it was time to choose the next steps in her medical care.

        I soon learned that while Mom thought hospice care was wonderful and a blessing for other people, she was not prepared to accept it for herself. As we talked together I learned that she had many of the same misunderstandings about hospice care that I had heard from patients and their families in my work. Before she could agree to become a hospice patient we needed to address each of Mom’s concerns and misperceptions:

        • Does hospice mean “going without” medical care?

          Mom feared that she would no longer be under the care of a doctor or be receiving attention for her medical problems. I helped her understand that hospice provides excellent care through a team approach that includes a doctor, nurse, aide, chaplain, social worker, and volunteers. Not only would all of her medical needs still be looked after, but she would actually be receiving the best possible care that focuses on the whole person, rather than just the disease.

          • Does hospice mean “giving up” on life?

          Many people, including my Mom, have the misunderstanding that hospice should only be chosen when you no longer care about life. But in fact, I explained to Mom, patients who do choose hospice are able to enjoy life more fully because their time and energy is no longer consumed with difficult treatments and uncomfortable side effects. With the excellent symptom management provided by the hospice team, patients are able to spend time with their loved ones and enjoy special moments, such as these my patients have experienced: having a picnic in the park, watching a play, attending a birthday party, or going fishing.

          • Does hospice mean going to an “old folks home”?

          Mom feared that if she chose hospice she might end up being admitted to a “home,” where she would be neglected or abandoned. I reassured her that hospice care would be provided in her own home by an attentive staff. She could be comfortable in her own surroundings with me and other family members looking after her with the help of the hospice workers. Those patients who need to be admitted to an inpatient facility still receive the same level of compassionate care that is provided in the home and can have loved ones at the bedside throughout their stay.

          • Does hospice mean being cared for by strangers?

          Mom quickly learned during our introductory meeting with the hospice nurse that the healthcare workers who are attracted to hospice work are very special people. She immediately bonded with the nurse and recognized that she would be receiving not only competent care, but also compassionate, loving care. Her fears of being neglected or mistreated vanished when she saw that during her home visits she was free to ask questions and express her wishes.

          • Do hospice patients die more quickly?

          Mom was concerned that choosing to move from curative treatment to supportive hospice care would shorten her life. But I was able to reassure her with statistics showing that hospice patients actually live longer than patients with the same diagnosis who do not receive hospice care. In my experience many patients lived more days than expected and also reported greater quality of life during those days. 

          By listening to Mom’s fears and providing her with factual information about hospice care I was able to help her choose to be admitted to a home hospice. She bonded with the staff quickly and looked forward to every visit. She set aside special books to give to her nurse that she thought she might enjoy reading and considered her a friend. 

          Mom’s last weeks of life were filled with laughter and love as she spent them in her home surrounded by the people and things she cherished. Hospice made it possible for her to stay in her home and offered support to me as her caregiver. We navigated her last days together, mother and daughter, and discovered our own special moments of healing and forgiveness that might not have been possible in a different setting. 

          During one of her last lucid days Mom, with tears in her eyes, expressed her thankfulness that she had chosen hospice because “this has all been wonderful.” She wouldn’t have had it be any other way. She wanted everyone to know that hospice eases fear and offers hope and love, which is the perfect way to spend your last moments of life.

          EOLU Blog

          Preserving My Mother’s Dignity at the End of Her Life

          kwyattmd

          by Karen Wyatt MD

          When my mother reached the end of her life she had only two requests: that she be able to die in her own home and that I be by her side. But I knew as well that it would be very important for her to retain her dignity, even as her physical health was declining. Mom had always been a beautiful woman and took pride in how she dressed and presented herself to the world. So I realized it would be important to her to feel she was at her best even in the worst of situations. 

          In my research as a hospice doctor about providing the best quality care to patients I learned that the word dignity comes from the Latin word dignitas, meaning worth or value. I understood that one of the keys to preserving Mom’s dignity would be to make sure she always felt valued and worthy of the greatest love possible as she was dying. But how could I accomplish that?

          According to studies done by Dr. Harvey Max Chochinov,[1] dignity at the end of life can be undermined by inadequately treated pain, lack of support both from family and from professionals, depression or hopelessness, increased dependency, and lack of quality of life. So using those guidelines I set out to make sure that Mom would not question her own value or worth as she was dying. Here are some of the steps I took:

          • Enlist the help of a local hospice.

          The hospice we worked with provided a nurse who made home visits to assess Mom’s pain and other symptoms and then brought us the medications and medical equipment needed to keep her comfortable. Hospice also provided a home health aide who helped Mom bathe and change her clothes and bed linens when needed. So with the help of hospice Mom had reliable professional support and care for her pain and dependency needs.

          • Maintain her self-care rituals.

          For as long as I could remember Mom had always had a nightly ritual of applying various cleansers and creams to her face, neck and eyes before she went to sleep. When she could no longer get out of bed I brought in a tray of her facial creams and helped her apply them, just as she had done every night in the past. This simple gesture helped her see that she was still the same person she had always been and that she still mattered. 

          • Invite family and friends to visit.

          A few days before Mom died I set aside some time when her closest friends and family members could stop by for a final brief visit. I fixed her hair, dressed her in her best robe and straightened up her bedroom so that she would feel comfortable having guests come in. She beamed brightly that day at the outpouring of love for her and had the chance to deliver her own messages of love to special people. She knew without a doubt that she was cherished.

          • Support her spiritual preferences.

          Mom had always been deeply religious but in the last few days of her life she began to wonder why God was still keeping her alive when she was so ready to die. She told me many stories of her prayers for other people and miracles that she had witnessed and I helped her to see that perhaps she was still alive because there were still people who needed her prayers. This thought gave her great comfort and she decided to pray for blessings for the hospice workers who had been caring for her. She went to sleep on her last night of life recognizing that she had a valuable role to play even as she was dying.

          Preserving my mother’s dignity in the last days of her life was the least I could do for her after the care she had given to me throughout my life. I learned that when we slow down, take time to listen and be present with our loved ones, they will tell us what they need in order to feel valued and worthy of our love. In the days and months following her death my own grief was easier to bear because I knew Mom had died in peace and love and with her dignity still   intact.

          [1] Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.

          Lancet. 2002 Dec 21-28;360(9350):2026-30

          EOLU Blog

          Following My Heart

          kwyattmd

          In case you missed last week’s podcast episode I’m sharing this post with you now so you’ll be aware of changes in the EOLU Podcast schedule. Because of some issues with my health I am cutting back on the number of episodes I release each month, which is why there is no new episode this week.

          It’s actually hard for me to make this change because I have been broadcasting weekly for several years now and I’m dedicated to being consistent. But life is directing me differently right now and I have to accept that. If you want to know more about my health you can listen to the latest episode on What Really Matters Podcast where I share more personal information than I normally do here on EOLU. You might enjoy some of the other episodes there too!

          For now, I’ve uploaded an old interview from the archives on my YouTube Channel – Proof of Heaven: A Neurosurgeon’s Near-Death Experience with Eben Alexander MD. I encourage you to follow the link and listen to this fascinating interview. While you’re there check out some of the other content and be sure to subscribe to the channel.

          During weeks when there’s no new episode on EOLU you can go back through the Archives and listen to interviews you’ve missed. There’s a wealth of material here!

          Thanks for all your support and encouragement as I enter a new phase on my own journey – I appreciate your understanding.

          EOLU Blog

          Blog: The Last Ecstatic Days Trailer

          kwyattmd

          THE LAST ECSTATIC DAYS is a film about a young man with brain cancer in search of community, and the hospice doctor who gives up everything to honor his dying wish.

          To learn more…

          Visit the film’s website: www.thelastecstaticdaysmovie.com

          Subscribe to THE LAST ECSTATIC DAYS on YouTube:  http://tiny.cc/TheLastEcstaticDaysSub

          Follow THE LAST ECSTATIC DAYS on Instagram: https://bit.ly/TheLastEcstaticDays-IG

          Like THE LAST ECSTATIC DAYS on Facebook: https://bit.ly/TheLastEcstaticDays-FB

          Virtual Screening with Karen Wyatt MD

          March 24th 4 PM Pacific

          REGISTER HERE

          EOLU Blog

          Blog: What Doctors Need to Learn About Death and Dying

          kwyattmd

          The old man and the young woman sat across from one another stiffly perched on plastic chairs, staring down at the floor – doctor and patient. The tension in the room, exaggerated by the silence between them, was almost unbearable. Then the patient, stroking a trembling, emaciated hand across a hairless scalp, spoke haltingly, “Doctor, promise me I’m not going to die.”

          According to a recent post in the New York Times by columnist Jane Brody, this type of interaction with a terminally ill patient creates occupational distress for many doctors who are not equipped emotionally to handle such a difficult situation. She states that doctors who are unable to cope with “their own feelings of frustration, failure and helplessness … may react with anger, abruptness and avoidance” toward their patients who are dying. When this occurs doctors may recommend futile treatments to patients at the end of life because they cannot connect with those patients on a human, suffering level and have nothing else to offer them.

          The article touts mindfulness meditation, a practice recommended by palliative care specialist Dr. Michael Kearney, as a solution for discontent and disconnected doctors. I wholeheartedly agree that mindfulness meditation can be a very helpful practice for calming anxiety and learning to be present. However, I believe that this problem—doctors who find themselves unable to cope with perceived failure when a patient is dying—requires a deeper and more fundamental solution: doctors need a new understanding of death and therefore, life. 

          These are the fundamental truths of death and dying that should be taught to every medical student from the first day of training:

          1. Death is inevitable.

          Every living thing on Earth will die. Death ultimately cannot be avoided or prevented, even though it can and should be forestalled when reasonably possible. The fact that every patient eventually dies creates a sense of hopelessness and futility for doctors if they pit themselves against death as an enemy—for that is a battle that can never be won. But those who recognize that the end of life is actually the final stage of human development can help their patients face their last days with dignity and make reasonable choices for their care and treatment.

          2. Death is a mystery.

          No matter how hard we try we simply cannot control or accurately predict when natural death will occur. In my hospice work I have seen many patients who lived far longer than expected, against all reasonable odds; and I have also seen patients who died much sooner than expected, from causes not related to their terminal illness. We have to accept this mysterious nature of death even while we work to circumvent it or prepare for its arrival.

          3. Death makes life more precious.

          When life is perceived against the dark backdrop of death, we can see how it shines and glistens for us, ever more precious because it is fleeting. This is the gift that our mortal nature provides us—an opportunity to cherish each moment simply for the fact that it will not last. 

          4. Dying provides an opportunity for transformation.

          In my work with hospice patients I have witnessed over and over the transformative power of love and forgiveness during the last days of life. When dying is respected as a natural part of life and time is allowed for the process to unfold, patients can turn their focus to matters of the heart and soul and find meaning in both life and death. But this does not happen when death is perceived as an enemy that must be resisted until the final breath is taken. Doctors can help their patients change focus by advising them with honesty when the time comes that pursuing further treatment is futile and will cause more harm than benefit.

           In my ideal world doctors would be educated in the wisdom of all aspects of health, including the decline of physical health that ends in death. Doctors would be the guides who help us make reasonable choices, who see beyond our fears, and who possess the compassion and tools to ease our suffering.  Doctors then would be the wisest members of our society, never deluded by the myth of immortality.

          When a doctor such as this is asked by a patient, “How can I live, knowing I am going to die?’ the answer would be:

          “You must turn your focus to those things that matter the most to you. Put your energy into living each and every moment fully rather than trying to escape death. Then when the time of your death arrives—and no one really knows when that time will be—you won’t feel bitter and deprived. You will be filled with the joy of a life of meaning—no matter how many years of life you have been given.”

          Healing takes place, not when death is forestalled, but when life is embraced and affirmed in its entirety, from beginning to end. When doctors can fully understand the nature of death and dying they will become the true healers that are desperately needed in this world. 

          EOLU Blog

          What My Hospice Patients Want You to Know

          kwyattmd

          The everyday wisdom of people just like you who are facing their own mortality.

          As a hospice doctor I have had the privilege throughout my medical career of sitting at the bedsides of hundreds of patients. I have listened to their stories, answered their questions and shared their concerns as they faced the gradual decline that occurs at the end of life. 

          But I also asked questions of my own as we sat together over those final days. Always a willing student, I viewed my patients as teachers who have explored unknown territory that I too will some day experience. Over and over again I have discovered gems of priceless wisdom in the words of the dying and have learned valuable lessons for living my own life. 

          Many patients asked me to share this knowledge with the world since they are no longer here to tell their own stories. This request led to the book  7 Lessons for Living from the Dying, where I compiled those stories into a framework for living well before we die. That book contains profound spiritual wisdom but here is some of the simple everyday advice my patients also asked me to share:

          “What seems important now doesn’t matter in the end.”

          Many of my patients discovered at the very end of life that they didn’t care at all about the material possessions or wealth they had accumulated earlier in life. In fact they felt they had wasted time and energy trying to have more “things” in their lives and wished instead that they had focused on relationships and experiences, like travel and time in nature.

          “Don’t worry so much about diet and exercise.”

          Believing they would live longer and healthier lives, some of my patients had been very strict about eating the “right” foods and staying fit. But when they got sick anyway in their later years they felt they had cheated themselves out of some of life’s pleasures. “Exercise and eat to feel good” they recommended, but enjoy the foods you love and take plenty of time to relax, rest and have fun.

          “Your doctor doesn’t have all the answers for you.”

          During the early stages of illness many patients believed that modern medicine would cure them. They pursued treatment after treatment and followed medical advice to the tee, but instead of a cure they got severe side effects and complications. These patients wished they had spent less time relying on doctors and more time learning to trust their own judgment.

          “Your life’s purpose isn’t what you think it is.”

          Finding meaning and purpose in life is one of the great challenges of our human existence. We spend our lives seeking out the “right” occupation that will allow us to achieve both success and fulfillment. But some of my patients recognized that their life’s purpose was much simpler and smaller than they had assumed, such as being a thoughtful neighbor, planting a garden or caring for a pet. Pay as much attention to the simple things of life as you do to your efforts to climb the career ladder.

          “Religion is less important than learning how to love others.”

          Some of my patients had been devoutly religious throughout their lives but began to see that path as limiting when they faced their last days. They stopped identifying themselves as part of one group or another and saw instead that we are all connected and all deserving of love. In fact, they said that loving others was the most important task of their lives.

          “Dying isn’t as scary as you think.”

          Many patients were surprised that they no longer felt afraid of death as they got closer to it. They expressed curiosity about the dying process and were able to watch it unfold without fear. One patient told me she was “dissolving” a little bit each day and turning into light, which she described as a wonderful experience. “Don’t waste your time and energy being afraid of death,” she said, “instead … enjoy being alive!”

          “You’re going to die anyway so you might as well be ready.”

          The fact that death comes for each of us no matter what we do was one of the common bits of wisdom from my patients. Many of them wished they had started preparing for it earlier in life and those who had planned ahead for death were at peace and filled with gratitude. It’s never too early to tell people you love them, to practice forgiveness, and to find joy in the simple things in life.

          While not everyone experiences peace or love through the process of dying, I found that those people who were open to it and ready to let go had by far the fewest difficulties at the end of life. Whatever you do to prepare for your later days will benefit you in the end so it’s worthwhile to start thinking about it now.

          Remember: death is the one life experience that all living things have in common. Indeed, even stars and planets eventually die. Why not embrace it and follow the wise advice of my hospice patients? A life well-lived leads to a death without regrets … and that’s worth planning for.

          Learn more about how to get ready for the last days of life at www.eoluniversity.com with Dr. Karen Wyatt.

          EOLU Blog

          Finding Meaning in a Broken Life

          kwyattmd

          Focus on the goodness of life rather than the regrets to find healing.

          Jody was just 36 years old when she found out her colon cancer was incurable. I came to her apartment for our first hospice visit and saw that she was depressed and despondent over her diagnosis—as I had expected for someone her age who was raising two children by herself. She told me story after story of all the regrets she was carrying. And I just listened.

          Her life had been unimaginably difficult—in foster care for most of her childhood then finally adopted at age 12 by a wonderful couple who loved her dearly. But she had been so filled with rage she couldn’t receive their love. She experimented with drugs and alcohol and was in and out of juvenile detention for petty crimes throughout her teens. There had been other even deeper regrets, but she didn’t want to talk about them. 

          Jody was angry and bitter, but also ashamed. She believed she had wasted her life and now her children would grow up without a mother. She asked if there was any way to speed up her dying process because she could no longer face all of the emotional pain that was coming to the surface. 

          We talked about things she could do to help with grief for her children, like writing letters to them that they could open at various milestones throughout their lives. She liked the idea that she could make sure her children didn’t feel unwanted, which she had experienced for most of her life.

          I wasn’t sure how we could help Jody heal from all of these regrets. There were so many broken threads in her life and so many pieces to help her put back together. But then a little miracle happened. On my next visit with Jody she was like a different person: joyful and filled with energy and laughter. And she had more stories to tell me. 

          Jody’s adoptive sister had come for a weekend visit and had brought with her boxes of old photos and a scrapbook. The two of them spent hours each day going through the photos together and gluing them into the album as a keepsake for Jody’s children. They wrote little stories on the pages to explain the pictures, which were arranged in a chronological timeline of Jody’s life.

          She showed me each of the pages and told me entirely different stories than I had heard on my previous visit. Here was a family trip to the beach when she was 16. There was her favorite Halloween costume. And look: she was all dressed up for senior prom. Then there were pages and pages of pictures of her with her children: playing games, reading books, opening Christmas gifts, laughing, hugging, eating—all the little moments of life.

          Jody wiped a tear away and smiled at me with a radiance I hadn’t seen before. “I’ve had a good life,” she said. “And I’ve been a good mom.” 

          Here in her hands were the photos that documented all of the goodness of her life. In comparison to the magnificence of these moments, her regrets had faded away. She found meaning in the memories captured in these photos and was able to weave the broken threads of her life into a beautiful tapestry that was uniquely hers. 

          Jody died just two weeks later. But she had been able to go through the album with her children and tell them all the stories that were depicted there. And she managed to write each of them letters that they could open when they were older. They would know they were loved and that their lives mattered and that an angel would be watching over them for all of their days. 

          For most of us—like Jody—life hands us a mixture of sorrows and joys. We can view it all through the lens of regret and wish that things had been different. But we can also find ways to pick up the broken pieces and put them together to create a work of art–the likes of which has never before been seen–that might just change the world.

          EOLU Blog

          Don’t Focus on Regrets at the End of Life

          kwyattmd

          Why it’s not helpful to ask dying people what they regret about their lives and what to do instead.

          “Don’t waste your time in anger, regrets, worries, and grudges. Life is too short to be unhappy.” 

          Roy T. Bennett

          For some reason there’s been a buzz in the last few years about finding out what people on their deathbeds regret most about their lives. We hear this often: “they regret what they didn’t do more than things they did.” That’s fine to say and tends to be good advice for those of us who aren’t facing our last days. We can learn from their mistakes and pledge to live our own lives differently from now on.

          In fact, research on regret as an emotional state has shown that it may be helpful for young people as a reminder to reconsider their current path and make better choices for the future. But when regret occurs in situations where there is no chance to change the current circumstances or make things better, it can cause chronic stress and do both physical and emotional harm. Individuals who feel they have no path forward can experience guilt, self-blame, disappointment and depression as a result of spending their time focusing on their regrets.

          Regret sells

          However as a society we are drawn to learning about the regrets of other people because we fear making mistakes or missing out on opportunities. We are eager to benefit from someone else’s suffering if it means we can avoid the same path for ourselves. Advertisers rely on our fears by using regret as a motivator to sell products, such as “this person didn’t buy from us and paid more money for worse service.” We don’t want to be the foolish person who regrets their choice so we pay attention to messages like that and we buy products, books and courses that teach us how to avoid these costly mistakes.

          Not helpful at the end

          There’s nothing really wrong with this tactic except when it applies to people who are nearing the end of life. Because they may not have time to repair the past or forge a new direction in the future, they have no opportunity to truly learn from their regrets. Placing their attention on the mistakes of their lives may lead them to despair and a feeling of worthlessness as they prepare for the end, especially if you are unable to guide them beyond their self-blame.

          Do this instead

          Instead of asking “what regrets do you have from the past” we would be better advised to ask “what are you grateful for in your life” or even “are there things left undone that you would still like to address.” If the person wants to talk about regrets it’s fine to go there, but it’s not helpful to introduce the topic to them if they’re not already thinking about it. Viewing life as a series of mistakes or regretful events is painful and creates a spiral of negativity. But we can help people avoid that downward spiral and lessen their distress by asking better questions.

          Listen and find meaning

          People at the end of life generally benefit greatly from doing a life review and being able to tell their stories in a safe setting. The art of being a good listener includes helping them find meaning, connection and resolution through their own stories without judgment or shame. To truly help a person find peace at the end of life focus on forgiveness, gratitude for what life has offered, self-compassion and letting go of self-blame. But don’t ask about regrets unless you know you can lead them out of that dark place to a higher, more healing perspective.

          EOLU Blog

          Love Never Dies

          kwyattmd

          How a song about a meadowlark reconnected me to my father’s love across the vast and timeless universe.

          We had just finished dinner with two old friends we hadn’t seen in years when they invited us to check out their music room. Inside we found a stereophile’s dream–massive speakers, a state-of-the-art turntable and an enviable collection of vinyl records. We sat on lush leather chairs in the center of the room while our host began to play the songs he had selected for the evening. The sound quality was amazing and the notes washed over me as I relaxed into reverie in my cozy chair.

          He put an LP on the turntable by Kelley Hunt, an artist I’d never heard before, and not only did her soulful vocals sweep me away, but the words she sang penetrated directly to my heart. I burst into tears when I heard the opening verse:

          I′ll be calling you when the meadowlark sings
          I’ll be touching you with the warm spring rains
          I′ll watch over you like the moon in the sky
          For I know love never dies.

          Instantly I was carried back in time to the day after my father’s funeral: I had visited his grave with my baby daughter in my arms, completely devastated by his suicide death. I sat on the ground and cried from deep in my gut, releasing all the pain I hadn’t yet been able to express. When my tears were finally exhausted and my sobbing ceased I began to hear the most beautiful sound. A meadowlark was perched on the nearby barbed wire fence that surrounded the cemetery and singing its pretty melody for me over and over again.

          I realized then that the bird had been there the entire time, accompanying my weeping with his lovely song. He kept singing to me and didn’t move away, even when I moved closer. The fact that this bird was sitting vigil with me in my grief was significant because the meadowlark had figured prominently in my relationship with my father. When I was growing up we spent nearly every weekend fishing, hiking or picnicking out in the Wyoming countryside, and there always seemed to be a meadowlark present wherever we went. Dad would whistle the song perfectly as we stopped to listen for a response. And on my first trip back to our family cabin after Dad’s death, it was not a coincidence that I was greeted by a meadowlark singing on the deck. This nondescript bird with its haunting tune symbolized the unspoken bond between me and Dad–often shy and fleeting, but filled with love.

          So on that special evening as I listened to Kelley Hunt singing those words that seemed to have been written just for me I marveled at the synchronicities of life. How a friend I hadn’t seen for years–who didn’t even know my story–had selected a song that reached into the core of my being and reconnected me to Dad’s love, healing old remnants of my grief and lifting me to a state of profound joy. Love never dies. In fact it radiates around and through us perpetually, connecting us to one another with unseen threads across time and space and all boundaries. I’ve known this and written about it over and over again ever since that day by Dad’s grave: love is what really matters. And Kelley wrote a song about a meadowlark singing and my friend and I discovered that we are connected to one another in our grief and to Kelley Hunt in our knowledge that love will always find us, wherever we are. 

          Though the winds may blow
And scatter all our faith and our hope
Only one thing really matters
And that's love ... that's love

Kelley Hunt: Love Never Dies