Have You Planned Your Funeral Yet ...?

Stop all the clocks, cut off the telephone,

Prevent the dog from barking with a juicy bone,

Silence the pianos and with muffled drum

Bring out the coffin, let the mourners come.

Funeral Blues

WH Auden

Hello, Everyone,

This morning, I attended the funeral of a friend's husband. Paul was a highly intelligent, accomplished and kindly man and the service's beautifully planned readings, stories, hymns, prayers and homily all flowed together to reflect the man he was. Being at that service reminded me, once again, of the importance of planning our funerals, committing those plans to paper and talking about them with our loved ones. 

Despite having lost my elder brother, both parents, my husband, my young nephew, my mentor, and my best friend, I have yet to plan my own service. What makes us (me) so reluctant to approach this task, especially when we know how much it can help our families when they are shaken and bereaved?  For some of us, the problem is anxiety about the whole notion of death and dying. For others it is the belief that funerals are for the living so they should plan the service. Others struggle with the unattended grief of earlier losses and can't bear to contemplate thoughts further loss, theirs or others'. Others, still, worry about religious differences within their families that could lead to conflict over their plans and so  shy away from the conversations. And still others, who have no religious background at all, have no idea where to start when it comes to planning a funeral ritual so they avoid it altogether.

But there are real advantages to planning ahead our end-of-life ceremonies and rituals. The first is its positive impact on loved ones. Pre-planning greatly reduces the stress of their decision-making after our deaths (as well as their guilt about not knowing our wishes). It also allows us to personalize the ceremony - to tell our story, comfort loved ones with our favourite readings and music, create space for healthy mourning and find ways to celebrate what we've valued in our lives. (While religious traditions may dictate much of what will happen in a service, there are usually personal choices available regarding music, readings and speakers.)

Here are a few things we can consider as we plan our own ceremonies:

1. What kind of ritual do I want?  A funeral service followed by burial or cremation? A funeral service followed by graveside service? A memorial service after burial or cremation? A service in my own home? A funeral service in the city where I die and second service in another locale? Something other than a service? Do I want my body present? Do I want the coffin open?

 2.  Do I want any additional ceremonies? A viewing, a wake, a visitation, a reception after the service, a one year anniversary commemoration?

3.  How closely do I want to observe my religion's mourning rituals?

4.  Where do I want the ceremony to be held? (Plus a second choice in case it is necessary) Where do I want my remains to be buried/scattered? 

5.  Who would I ask to officiate? (Plus a second choice) 

6.  Who will be my pallbearers (6)?

7.  Who will tell stories or deliver eulogies (3)?

8.  Who will read prayers, poems or other readings (3)?

9.  The readings I want to include are (3)

10. Music I want to include - prelude, postlude, songs, hymns, solos to be played/sung during the ceremony

11. What types of flowers would I like to be used to decorate the room/coffin?

12. Do I want a headstone, memorial bench or other marker? How would I like it inscribed? 

13. Are there favourite charitable organizations where a donation could be made in my name?

14. What are the groups I've belonged to that should be notified of and invited to the ceremony? (with their contact information)

15. Who are the people my family may not know who should be notified and invited? (with contact information)

16.  What wording do I want for my obituary, where do I want it placed, and for how long? 

17. Do I want my body or ashes repatriated - to the country where I was born? To the place where my grandmother or spouse was buried?

As you can see, there are actually many places where our input can make a difference.

That said, we should also remember that, as important as our planning may be, it is equally important to give loved ones explicit permission to make changes in our plans should the need arise. I have worked with more than one person whose guilt over changing funeral arrangements has helped to trigger complicated grief. Gifting your family and friends with your wishes, plus the room to move, will reduce their stress considerably.

And now, having written this post, I can safely say that by the end of the week I will have planned my own funeral service. I hope that you will take this opportunity to reflect on the questions above and give yourself (and your family) the gift of doing the same.

Colour Your Stress Away ...

Life is about using the whole box of crayons.

RuPaul

Colours are the smiles of nature.

Leigh Hunt

Life lesson from the nursery: Broken crayons can still colour.

Author Unknown

Hi everyone!

For the past few months, I've been experimenting with offering workshop participants mandalas, Celtic knots and other intricate designs to colour - and I've been amazed by the positive response. People love them and comment on how the colouring helps them to focus and relax throughout the day. Kinesthetic learners are especially happy to have "something to do" as they listen to mini-lectures and participate in group discussions.

Colouring takes us back to another time, a time when choosing colours and mixing tints and shades could provide respite from childhood stressors. It is a form of self-soothing and relaxation. Thought to de-stress us by activating areas on both sides of our brains, the relaxation of colouring particularly lowers the activity of the amyglala, a part of the brain that senses and deals with threat. When we colour, the gentle repetitive motions soothe us and the colouring experience shifts us from a state of perceived threat back to a state of calm.

Colouring can be seen as a form of active meditation. Our mindful attention to the colouring pushes aside current stressors and future worries. The Aurora University (Illinois and Wisconsin) website offers the following steps for meditative colouring to their stressed students:

1.  Start the session with a smile. Don't skip this step just because it sounds a little silly. In fact, studies have proven that smiling even when you are not happy can raise your level of endorphines (mood-enhancing chemicals) in your brain. So start smiling!

2.  Find a design to colour. Any colouring book will do, or print a mandala to colour. Mandalas are complex, symmetrical geometric designs that originated thousands of years ago in India. They are fun to colour and beautiful to look at once done.

3.  Choose your colouring supplies. You can use crayons, coloured pencils, markers or even chalk. Don't think too much about the colours you are selecting. Let the colours choose themselves. You will be amazed at the colour combinations when you're done. 

4.  Allow yourself to experience the movements, hear the sounds of the crayon on the paper or feel the marker glide across the page. As thoughts, pictures or worries pop into your head simply acknowledge them and return your focus to colouring. Colouring will always bring you back. With a little practice, you will find that you can easily achieve a deeply relaxed state while colouring.

Some people wonder if drawing and colouring their own pictures on a blank page would produce the same relaxing results as colouring in a colouring book but a small study in 2005 in the Art Therapy journal seems to indicate that structured colouring-in, whether of a mandala or a plaid pattern, has a greater impact on anxiety levels than unstructured colouring.

Recognition of the relaxing properties of colouring has led to a recent boom in colouring books for adults. Scottish illustrator, Johanna Bradford's intricate best seller, Secret Garden: An Inky Treasure Hunt and Colouring Book has sold 1.5 million copies worldwide and Enchanted Forest: An Inky Quest and Colouring Book came out in February. Other well-loved colouring books include:

1.  Celtic Patterns to Colour by Struan Reid

2.  Animal Kingdom by Millie Marotta

3.  Colour Me Calm and Colour Me Happy by Lacy Mucklow and Angela Porter

4.  The Mindfulness Colouring Book by Emma Farrarons (Sized for pocket or purse)

5.  The Mandala Colouring Book by Jim Gogarty

6.  Dream Catcher: A Soul Bird's Journey and Dream Catcher: The Tree of Life by   Christina Rose

7.  Colour Me Good London Colouring Book by I Love Mel

8.  Natural Wonders: A Patrick Hruby Colouring Book by Patrick Hruby

For those of you who would like to try a little colouring before making the financial investment in a colouring book, here are some free mandalas to copy and colour. Enjoy!

National Family Caregiver Day 2015 ...

Hi Everyone!

Today is National Family Caregiver Day 2015, a day to celebrate the millions of unpaid family caregivers who give of their time, strength, love and futures in order to provide care for those who are ill, frail or disabled.

These caregivers are not a homogenous group with the same experiences, needs and feelings, rather, people, old and young, with highly complex, complicated and individual stories, people whose lives are changed considerably, often dramatically, by the experience of caregiving.

Family caregiving is one of the most rewarding, satisfying and, at the same time, most stressful and depleting endeavours most of us will ever undertake. Caregivers, the backbone of our healthcare system,  need and deserve all the encouragement, emotional and practical support, and resources we can give them so that they don't have to carry the costs of caregiving on into the rest of their lives.

What are these costs? They can include physical illness or injury; mental illness; posttraumatic stress; chronic sorrow; compassion fatigue; missed educational, job or volunteer opportunities; job loss; loss of retirement funds; loss of experiences and relationship quality with the care recipient or friends and family; depleted parenting; loss of identity and self-actualization; loss of recreational and leisure time; loss of sustaining spiritual or philosophical beliefs and many others.

On the other hand, there are important gifts that can be found within some caregiving experiences - development of new skills and competencies; greater self confidence; an appreciation for the smaller, simpler things of life; psychological and spiritual growth; recognition of the importance of self care and the greater wellness that flows from it;  new friendships and support systems; and greater transparency and intimacy in relationships.

Today, and all month, there will be programs and celebrations for family caregivers offered through support agencies and organizations across the country. Here are just a few:

1.  Canadian Caregiver Coalition:

The CCC are offering a series of podcasts sharing caregiving strategies and tools as well as a tweet chat. They have also created a poster on Care & Work: A Balancing Act.

2.  Canadian Virtual Hospice:

The Cdn Virtual Hospice eNews newsletter for April is entirely devoted to supporting caregivers.

3. Family Caregivers Network Society: 

BC's Family Caregivers Network Society is offering free webinars throughout the spring on topics such as Guilt & Frustration, Care Planning 101, Letting Go, and Respite.

If you have a family caregiver in your life, please take some time, today, to contact him or her with a message of love, support and understanding. It can make all the difference in a caregiver's day.

Resources for Spring Renewal ...

Hi Everyone!

Spring is here early on the West Coast with flowers blooming, only a little rain and warmer-than-usual temperatures. With Spring comes a plethora of opportunities to learn and grow and this year is no exception. Here are a few wonderful opportunities to blow out the cobwebs and let a little sunshine in:

1.  The Enneagram and Somatic Awareness: Using Body Intelligence to Relax Type Structure 

This two day workshop, on April 18 and 19 in Seattle, is sponsored by Enneagram in Seattle and features two of my favourite Enneagram teachers, Terry Saracino and Marion Gilbert from Enneagram Worldwide.

As the workshop brochure says:

Those of us who have worked with the Enneagram for many years have discovered how truly difficult it is to influence our reactivity. When we are faced with challenging life circumstances, we find ourselves falling into our type structure's patterns of overreacting, even though we know better.

The workshop will introduce you to the Somatic Awareness Practice which will build your "felt sense" and enable you to free yourself from automatically following your highly ingrained cognitive-emotional impulses and re-enacting your type patterns. 

For more information click here. 

2.  Reclaiming Awe: A Workshop on Mystery and Intuition

This new Rachel Remen workshop for health and service professionals is designed for those who feel their work no longer inspires or has meaning for them, for those who miss a sense of wonder and aliveness day to day.

Rachel Remen, MD, the author of Kitchen Table Wisdom: Stories That Heal and other popular books, has offered restorative workshops and conferences for healthcare professionals and service providers for many years. This new workshop will help you to find and tell your story of mystery, honour intuition as a legitimate way of knowing, recognize the unexplainable in your everyday work and to reclaim a sense of awe and wonder in your work and in your life.  

The 2 1/2 day workshop will be held at the Acqua Hotel in Mill Valley, California on May 21-23, 2015. 

 For more information click here.

3. 5th Annual Care4You Conference: Be a Change Agent

This two day Kingston, ON conference on Compassion Fatigue is designed to "care for those who care for others". This year it will focus on the theme of Creating Change Agents. You will learn how to make positive changes at home and at work. Managers will learn strategies to engage their teams and to enable sustainable organizational health.

Featured speakers at the June 9 and 10 conference include:

a. Stephane Grenier, Mental Health Advocate, Canadian Armed Forces (Ret)

b. Sherisa Dahlgren, Holistic Healing Expert & VP Clinical Programs, Joyful Heart Foundation

c.  Pat Fisher, Organizational Health Specialist & Co-Executive Director, TEND Ltd

d.  Francoise Mathieu, Compassion Fatigue Educator & Co-Executive Director, TEND  

For more information click here. 

4.  Stop, Breathe and Think 

And for those of us whose extra money will be going to Revenue Canada or house insurance this Spring, here is a learning opportunity that's simple, fun and FREE. (You pay only if you want the advanced level of meditations.) 

Stop, Breathe and Think is a wonderful website and app that customizes meditations for beginners. If you're trying to do more mindfulness meditation and need some help starting out, this is the place for you. You can go through an emotional check-in and then the site offers appropriate meditations for your current emotional state. 

Simple enough for kids to use, it's a great structured and supportive way to start a meditation practice.

For more information click here. 

So, happy almost-Spring and enjoy!

Jan

It's a Matter of Choice: Considering Physician-Assisted Death ...

Ultimately, in our view, when beneficial medical options for cure and for palliative care diminish, the patient, after being properly informed, increasingly becomes the final arbiter in accepting or rejecting these options.

Gerrit Kimsma, MD and Evert van Leeuwen, PhD (2004)

Hello, Everyone,

I'm late with this post after waiting for and then pondering how to respond to the Supreme Court's decision to allow physician-assisted death in Canada. In the end, I think all I can do is to tell my husband's story and to highlight a few important concerns.

On September 30, 2004, my husband of almost twenty years died three weeks after stopping all treatment but palliative care so that his viral cardiomyopathy could run its course. It had been 7 years since his diagnosis and he'd spent the last 3 years confined to bed. He was not clinically depressed and, despite a considerable amount of grief, had been a wonderful role model for how to live life fully and well with ever diminishing energy and abilities. He taught us how to live well and, when the time came, how to die well.

When he told me of his decision to stop treatment, he put it this way. "I feel like a weary traveller on a railway platform waiting for the train. The only thing that makes me sad is knowing that you won't be coming with me." He was exhausted, suffering and ready to die. Any exertion, even listening to music with a quick tempo, caused him chest pain;  every few days he was subjected to the uncontrollable and excruciating pain of catheter changes with a hypersensitive bladder; and the loss of control, pain medication and diminishing oxygen to his brain triggered frequent posttraumatic stress flashbacks to his childhood in wartime England. He had had enough and, although I didn't ever want to lose him, I supported his choice so his suffering could end.

Would he have chosen a physician-assisted death if it had been available at the time? I honestly don't know. But, aware of his lifelong desire to have and carefully consider options in any situation, I think he would have wanted to consider the possibility. (And I'm quite sure that I will want to consider the possibility for myself when the time comes.)

Several things concern me as we wade into the early days of implementing this decision. Three of the most important follow. The first is that we need to see physician-assisted death as part of the continuum of care rather than as a separate choice over and against disability-support and palliative care. Such dualistic thinking will only cause more grief and suffering to patients and families. It is not a matter of either-or but of both-and. Yes, we must improve the quality of and access to sufficient and wide-ranging disability, palliative and hospice care but that doesn't mean that we cannot also provide assisted-death to the few whose suffering cannot be eased and who request that final option. As Dutch physician, Kimsma and medical ethicist, van Leeuen, put it in Physician-Assisted Dying: The Case for Palliative Care and Patient Choice:

(Placing euthanasia in opposition) to palliative care in the way critics have suggested fundamentally disregards the wishes of the patient in the face of death.

Surely that is not our purpose in providing end-of-life care?

A second concern is that we should make our choices regarding the implementation of this decision based on research and compassion rather than on our fears. For example, we know that despite some fears that people will be "put to death" in terrible circumstances, in-depth interviews with patients and families in other jurisdictions point to assisted-death as a moving and positive experience with less traumatic grief experienced after the death than that found in counterparts whose loved ones had died a "natural death". Other studies tell us that physicians can have a very difficult time, emotionally and in relationship with their families, in the days before and after assisting with a death, calling into question the fear that they will become inured to the experience and begin to make such decisions too easily. There are many cases in which our fears regarding physician-assisted death can be allayed by the facts. So, let us be sure to examine the evidence before allowing fear to determine our actions.

My third concern is based on the physician studies noted above. If we are to begin offering patients physician-assisted deaths, it is vital that we first have conversations about what comprises adequate support for the health-care professionals involved. It will be important to put our knowledge of compassion fatigue and burnout to use in creating the best possible support for these caring people.

I believe that if we are open-minded, reflective, compassionate and wise, physician-assisted death can become another important tool for providing comprehensive and compassionate end-of-life care.

How to Make & Keep New Friends ...

The ultimate touchstone of friendship is not improvement, neither of the other nor of the self, the ultimate touchstone is witness, the privilege of having been seen by someone and the equal privilege of being granted the sight of the essence of another, to have walked with them and to have believed in them, and sometimes just to have accompanied them for however brief a span, on a journey impossible to accomplish alone.

Hello, everyone,

The above quotation is from a lovely new book of prose called, Consolations: The Solace, Nourishment and Underlying Meaning of Everyday Life, written by the much-loved poet, David Whyte.  In it, he writes short but profound reflections on fifty-two words from our everyday lives - from alone to ambition, denial to disappointment, forgiveness to friendship and vulnerability to joy.

While reading the four pages given over to friendship, I was reminded of a workshop participant who approached me after a workshop last fall to say that he had enjoyed the day but that several of the resilience suggestions had involved doing activities with friends or "self-care buddies" and he didn't have any friends, other than his wife who was living with a life-threatening illness. I was stunned, both by my thoughtlessness in not considering that possibility and by the depth of his sorrow and isolation.

In fact, this gentleman was probably not the only person in the room feeling a lack of connection. Those of us who have experienced the kind of trauma or loss that created our hypersensitive empathy as helpers, can also have difficulty forming and sustaining close relationships - until we've done some of our healing work. The same primary traumatic stress that contributes to our compassion fatigue also gets in the way in our everyday relationships.

But we need those relationships. Friends are necessary to our health and well-being and to our compassion fatigue resilience. As David Whyte says, they stand witness to our lives. They also help us through difficult times. They celebrate our successes. They show us the world through a different lens. They boost our mood. They improve our health. And, at their best, they help us to become our best selves.  

Once we've done some of our healing work, we can practice developing healthy friendships. Here are a few steps to try:

1.  Meet some new people:  The first step is to find people with common interests. This means determining your own interests and then finding ways to meet others who share them. You might want to try volunteering (in an area different from your work if you have a high trauma exposure there); take a class; join a club; walk a dog in a dog park; invite a neighbour, someone from your spiritual community or a work colleague to go for a walk or to a movie; try carpooling; connect with your alumni association; look for old acquaintances on the internet; attend art gallery openings, book readings, lectures, or music recitals or go to favourite recreational or sporting events. 

2.  Learn to engage in conversation: Not everyone has had the opportunity to learn how to converse with others. If you don't know how, or are feeling rusty, try one of these suggestions to open a conversation. Remark on the surroundings or the occasion. Make an honest compliment. Ask an open-ended question (one that requires more than a yes or no answer). Notice anything you have in common with the other person then ask follow-up questions. Keep the conversation light during the early days and avoid potentially divisive topics like politics or religion. 

Learn to pace the sharing of your personal history. It's generally not helpful to share your deepest, darkest secrets on the first meeting because you might then feel too exposed to meet again. Share just a bit of yourself at a time and then imagine yourself sitting on your own shoulder observing the interaction. If your information is received kindly, then you can risk sharing a little more. If it is received disrespectfully, note that and don't go any deeper.

The flip side of conversation is listening and it pays to learn to listen well. Really pay attention to what the other person is saying and encourage them to continue, using verbal cues like saying "yes" or "uh huh". (Note that it is not "good listening" to immediately follow someone's story with one just like it from your own life. People don't necessarily hear that as an empathic response. Continue to keep the focus on them for a while.) 

3.  Be a good friend:  Try to live by the golden rule in your friendships - do unto others as you would have them do unto you. Follow through on commitments. Be thoughtful. Keep confidences. Share yourself and your time within the limits of your own needs. 

Support and encourage your friends. Invest in the relationship but don't be too dependent or clingy. It takes time for a relationship to evolve - let it happen naturally and give the other person space to breathe. 

Learn to apologize and to forgive. Everyone makes mistakes and there will be conflicts in most relationships. When there's a problem, address it calmly, directly and honestly and find a way to work it through. It is this working through that deepens our intimacy.

Should any of these suggestions fail and a budding friendship not work out, try not to take it too personally. The other person may have something else claiming his or her attention or just may not be up for a new relationship at the time. If this happens, as the song lyrics say,  pick yourself up, dust yourself off and start all over again.

Good luck!

A Friend Indeed ...

Hello, Everyone,

This morning, I want to say a bit about friendship, having learned of the death of an old and dear friend, Susan (Mitchell) Voth, on the first day of this new year. (My heartfelt condolences to her family and friends.)

I met Susan in 1970 during my urology rotation in nurses' training at St Paul's Hospital in Vancouver.  I was an eighteen year old junior surgical student and she was a relatively new RN from the Maritimes who kept everyone - patients, students, staff and physicians - in stitches much of the time. While she struggled with a learning disability that made her handwriting and spelling atrocious, she had the kind of natural wisdom and intuitive knowing that made her an invaluable partner on nightshift when a patient's condition was going south and the issue hadn't quite declared itself. Her heart was as big as all outdoors and she stayed in touch with many of her patients and families over the years.

Susan and I became fast friends during my training days and were roommates, on and off, over ten years until each of us married. She and her first husband, Al, who was later killed in an airplane accident, moved to the prairies to farm and we eventually lost track of each other. I was happy to have the opportunity to reconnect with her briefly when she visited Vancouver years later after marrying her second farmer husband, Henry.

Susan was a good friend to me and I realize, now, that we understood each other so well because we  shared the effects of our particular childhood trauma - Susan had lost her mother at the age of two and I had experienced significant medical trauma and maternal separation at birth. We had also lived through many years of our fathers' alcoholism. Those shared experiences gave us a natural empathy for each other and our friendship helped fill many gaps from our younger years.

From Susan, I learned to cook, camp, canoe, enjoy a little good scotch, choose a good lobster, like pop music, socialize in large groups (I was very shy), play my guitar in public, drive a car (first a volkswagon beetle, then an MG Midget and finally a volkswagon van that took us 23,000 miles around North America in 1978),  to laugh more and worry less, and even to recognize that I had a spiritual life worth developing (though our paths-of-the-spirit soon diverged). Her family - her Dad, Helen, and siblings, Nancy, Peter and Mary - welcomed me into their homes and offered rich adventures on the ranch in Manitoba; in Cornerbrook, Newfoundland; on the St Stephen, NB - Calais, MA border; and by the sea in St Andrew's, NB, adventures that I would never have had otherwise and will never forget. I owe a debt of gratitude to each of them.

We know from the literature on trauma and social bonds that all human beings need social support to survive and thrive. When we have someone we can trust with our stories and our feelings and from whom we can receive support without judgement, we heal better and faster from the wounds of life.   Susan was one of the first of a large network of valued family and friends who have provided that kind of friendship to me. I am forever grateful.

If you have a friend or friends who have been particular supports to you, why not take some time today to think of them and their value in your life and then, perhaps, pick up the phone or write a note to tell them, specifically, how much they mean to you and why.

If, on the other hand, you're feeling isolated and alone and can't even think of a person you'd call a friend, watch this space next time when we'll look at the process of making friends. (An important skill for those who have never had many friends or whose support networks have shrunk significantly through ongoing care-giving or compassion fatigue.)