Healthy Dying

This post was inspired by a recent Tricycle article, “Death as a Spiritual Experience.” Our culture is so death phobic, yet paradoxically so entertained by violent death, that the idea of healthy dying seems counterintuitive. The much touted public health concept of “Healthy Ageing” conveniently omits the final chapter — dying, which would seem to contradict, or at least undermine, the goal of health.  How could dying possibly be healthy?

The rational solution to the problem of assuming that dying must be unhealthy, is of course government approved “physician-assisted” dying or euthanasia.  An alternative approach, which considers dying a natural process and an opportunity for healing, is of course palliative care. Offering support to patients and families through the illness, dying, and bereavement process alleviates a measure of suffering by offering to mend  breaches of connection, or heal relationships between family members. These include breaches within the self, failures to connect with, and love parts of yourself you have always despised. The transition out of the body that we call dying will be much more painful for all concerned until we accept all those parts. Doing so restores us to wholeness, or health.

Tibetan Buddhism is one of the few religious practices that directly confronts the experience of dying with a forensic, phenomenological approach that takes the transition to other vibrational realities seriously. Christianity also takes it seriously but is based on the third person perspective, or the idea that we each can mystically participate in the dying experience — the Passion — of the Christ. Doing so does not necessarily demand that we be the witness to our own dying, though.

And Vipassana teacher Larry Rosenberg points out: “most of us are imbalanced when it comes to death. We haven’t come to terms with the nature of our bodies, and we don’t see death as a natural process. So we have all kinds of funny reactions to it: excessive joking, or avoidance, or preoccupation in a morbid way. Death awareness practice can bring us into balance.”

tibetan-book-of-the-dead

We can practice for dying simply by becoming aware of our breathing — of each outbreath that might be the last, and then the next and the next and the next. Making all our living in awareness of the outbreath a practice for dying enables us to  directly experience the present moment, rather than experience in a mediated way, as narrated, or not be experienced at all.

I aspire to experience all my dying: after all, it may be the only time I do it in this body, and it would be a shame to miss out!

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Catholic caregiver blog. Tuesday, St. Peter Damian

Tuesday — Meeting with OAS for approval of IAHPC membership application. Trip to DC.

Jawdroppingly beautiful sunrise this morning after a very rough night with little sleep.  Impossible to photograph the layers of light behind the bare black branches, but it was riveting, and I’m glad I moved the bed to face east to catch it as I pray the office with my cup of tea. And the Communion Antiphon was Psalm 9:2-3 “I will recount all your wonders,/I will rejoice in you and be glad,/and sing psalms to your name O Most High.”  O most definitely, as I would be entirely lost without you.

The first reading was from Sirach, as it has been for the past week — warning us that “when you come to serve the Lord, /stand in justice and fear,/prepare yourself for trials./Be sincere of heart and steadfast.” That is my intent as I do this service work, both for Ruth and for the wider world.  I was tormented last night with the euthanasia debate and kept telling myself to put my worries in God’s hands, as I cannot solve it myself.

The Sirach reading continues “incline your ear and receive the world of understanding…Wait on God with patience, cling to him, forsake him not;/thus you will be wise in all your ways.” My main concern is that, if our advocacy position is to force people to defer physician assisted dying and euthanasia until palliative care is mainstreamed and all the providers trained, etc., then we are effectively forcing them to suffer without proper care.  That seems to be a deeply unethical advocacy position.  I realise it is the responsibility of the healthcare institutions and the state (not ours) to develop the policies and train the providers, but what if they don’t?

It is our responsibility to lobby and advocate as skilfully and persistently as possible for palliative care, but what if our advocacy falls on deaf ears?  Can we in all good conscience oppose calls for medically assisted dying and euthanasia, thereby forcing people to suffer, essentially in abandonment and neglect?  And as Sophia pointed out in our conversation yesterday, the Belgian position has palliative care covered, and still includes euthanasia. Perhaps we need to join forces with the euthanasia lobby but make our support conditional on the fact that they also lobby for PC?  Interesting that Age Platform Europe does not have a position on euthanasia since its members have multiple positions.

At breakfast Ruth was telling some story and said “I can’t believe I was once able-bodied” and then started to cry. I said, well, now you are able-souled. We got over that moment, but it will be good if we can talk more about it bit by bit.  Euthanasia is such a fruit of modernity.  Watching “Call the Midwife” and Sister Monica Jones used the phrase “ostentatious silence.”  We both loved it.  It is perfectly rational that moderns want euthanasia as a right, in a world without God.  Euthanasia and physician assisted dying are the fruits of modernity.  I don’t want to be against anything: I just want to be for it: for palliative care, for connection, for solidarity.

Today we celebrate the feast day of Peter Damien, who I did not know about until I looked him up — 11th Century Benedictine, who wrote a piece on “The perfection of Monks” calling them to be “smeared with pitch” both inside and out, like the Ark. The pitch is the inner lining of love, and the outer lining — how we act to others.  Inwardly united to God in love. If only one side is smeared with pitch “they cannot be saved from shipwreck in the deluge”, since they don’t have the double lining for protection.It’s a call for unity in love, basically.  It seems he had a very adventurous and political life, riddled with disunity and faction. Poor man.

saint-peter-damian

Catholic caregiving blog — President’s day

We discussed sorting through the piles of paperwork in the apartment today, and touched on the Advance Directive, which Ruth has not filled out.  She said Alex and Max were her proxies, and I asked did they know what she wants? She started to answer and then broke down…I said sorry, that was insensitive, I am usually so cold-blooded about this. Then when she composed herself, she talked about not wanting to be kept alive on machines if there was no hope of recovery, for instance if she had surgery and it went wrong, or if the course of the disease made any quality of life unlikely. But if there was hope of recovery and quality of life, then yes, she would want to be resuscitated. We will revisit and fill out the forms before I leave. Clearly she has been thinking about her death, though, and is disturbed by it. I cannot imagine confronting death, as she is doing, without a coherent spiritual or religious framework.

Praying the joyful mysteries today I stopped trying to make something happen and had the humility to just pray before the mystery of of the miracles of the Annunciation, the Visitation, the Nativity, the Presentation, and the Finding of Jesus in the Temple.  Such extraordinary events, and we make them so routine and ordinary and forget the miracles.  Without prayer, my life would be a mire of misery, so I am extraordinarily grateful.  After spending the day inside, Ruth and I went for a cruise outside around the dogpark. The weather was mild and pleasant, the squirrels bustling around, birds declaiming whatever birds declaim. We checked out the daffodils just emerging from the still chilly soil, and were grateful for the companionship and fresh air.

Today I actually managed to do quite a bit of work — edit the letter from Willem, Lukas, Liliana and myself, have a long talk to Sophia at ADF about the Dignity Campaign, finish the blog on palliative care, and do all the necessary emails.  I also talked to Willie and Victoria about the caregiving/visiting arrangements when I return to Europe at the beginning of March.

 

Catholic Caregiver blog

Reading Dorothy Day’s “Duty of Delight” yesterday inspired me to keep this journal of caregiving for Ruth and the spiritual struggles that accompany such caregiving.  First, the practice entails giving oneself away kenosis, and practicing patience, which Catherine of Siena called “That royal virtue, that lovely virtue that is never scandalised or shaken or toppled by any contrary wind or by any diabolical temptation.” (Letters) All the challenging people, she says are “instruments of virtue and progress toward perfection” who help  us acquire patience.  I was absurdly pleased when Ruth said to me the other day that I was “very patient.”

I did lose it yesterday though, when after she had fallen in the hall in her effort to go to the bathroom by herself, and had to be dragged feet first back to the bed since I could not pick her up,  she then she attempted to do it again.  As if she had forgotten how challenging and frightening it was to try and get her up by our combined effort and strategy.  I told her I realised she needed to be independent, but that she was being inconsiderate to do this to me again.  Then I wondered if the dementia is beginning and whether she forgot that she had fallen and had to be dragged across the floor with a pillow under her head to keep it from banging with every step.

I prayed for forgiveness and fortitude, and had a rough night continually reminding myself to take refuge in the Lord, because by myself I am entirely powerless. And then I was rewarded this morning with the sight of her sitting up in bed when I went in to check on her before prayers, saying she had a good night, and speaking without a slur. “The Miracle of the Brain” she said.  Mswela thinks it might have been a small seizure. We had watched some of a news program on the topic of the brain the other night.  Apparently there are not enough brain donations for scientists to do adequate research.  Ruth said she was donating all her organs.  Today’s readings are the Beatitudes.  Love even, or particularly, when it is difficult, with no hope of reward.  I found a new website. https://www.catholiccaregivers.com/

I put on a load of laundry, made soup from the juice pulp, sweet potatoes and shitake mushroom stalks, and took out the trash.  Will try to get a bit of work done.  At least yesterday I got my SDG papers in for the Stakeholder Group on Ageing.  Now I am living the journey.  Ruth fell again while I went down with the trash. It was my fault for leaving the bath seat in the way. Eve and I got her up.

Went to Mass at Mary Queen of Angels.  Beautiful cathedral, nice enough service. Tentative sermon on non-violence by the deacon.  Came home to find Max and Vanessa and the girls here enjoying themselves and Ruth holding court.  It had been a successful outing to Karma’s. Max had brought some delicious octopus ceviche, and they liked my soup with smoked paprika. I had a nice talk with Pablo and Dede and will call the other boys. It is important to keep up family and friendship ties for caregiving to go well.  Isolation would be a fearful thing.

 

 

 

 

Palliative care for Papua New Guinea: A profile of Sister Tarcisia Hunhoff for World Day of the Sick: Feb 11, 2017

World Day of the Sick is a Feast Day of the Roman Catholic Church, instituted by Pope John Paul II in 1992 at Lourdes. In 2007, Pope Benedict XVI used the occasion to call for more palliative care for the sick and the dying. Sr. Tarcisia Hunhoff, a member of the Missionary Sisters, Servants of the Holy Spirit, has heeded that call, and having “retired” after her 80th birthday, will be setting up the first palliative care center in Port Moresby.

Sr. Tarcisia’s religious order has been in PNG since the turn of the 20th century, and she has worked there since 1960. When the HIV epidemic exploded in the early 2000’s, she devoted herself to the counselling, testing, training of health care workers throughout the country, traveling several times to Africa to learn about how countries there were handling the epidemic.

A former Dutch, German, British, and then Australian colony with an active slave trade during the late nineteenth century, Papua New Guinea has the highest rates of HIV infection in the region, with escalating rates of TB, HCV and sexually transmitted infections. These public health issues flourish in a post-colonial society plagued by gender based violence, teen pregnancy, and a poor healthcare system. Sr. Tarcisia says, “That’s the situation in a nutshell. It is quite as distressing as it sounds.”

Like young people everywhere, PNG youngsters are searching for a better life, especially in Port Moresby, the capitol, which like many modern cities, is a magnet for urban drift marked by social disintegration. Sr. Tarcisia says, “We find our HIV/TB patients, often totally neglected and left alone to die, in the city and its outskirts. Catholic Health Care Services provides counselling, testing, and ART for over 70,000 clients a year, and has a very effective mother-to-child prevention program.”

Yet with so much life limiting illness, PNG has no palliative care facility. Palliative care, a relatively new medical specialty that seeks to improve the quality of life of patients and families with serious illness, was almost unheard of until Sr. Tarcisia approached the Department of Health with this new idea for total care. Palliative care includes pain and symptom relief, as well as social and spiritual support when cure is no longer an option. She says, “The idea for the proposed Palliative Care Centre in Port Moresby grew out of utter distress of being unable to do what needs to be done for these neglected and stigmatised human beings, lying on the floor in a corner with no basic care.”

It has taken her some years to get started with the new building, called “ The Supportive Living Project,” because of the cultural belief in evil Sprits of the Dead, which is still very strong in PNG. The Australian Government has provided AUS $3.5 million for construction, and the PNG Department of Health will finance staff salaries and clinical supplies. Building Board permission is in the pipeline and expected any time.

Sr. Tarcisia says, “I consider this my last project since I have passed my 80th Birthday. I can only hope and pray that the Centre will be a model program, and that palliative care receives the emphasis and the finances it needs. Asked about palliative care and faith, she responds: “serving the poor has been a very rich experience for me personally. One receives more as one gives. I also hope it makes it clear to our simple people what Christianity is all about. Pope Francis is a strong advocate and knows from experience what it means to live in a desperate situation.”

I would like to thank you for promoting total care, especially to the poor and underprivileged.

Best wishes and God bless, Sr. Tarcisia, Hunhoff SSPS