DYING, SURVIVING, AND AGING WITH GRACE

Suicide, homicide, physician-assisted suicide, violence (including domestic violence), sudden death (from accidents and otherwise), dementia and other forms of lingering illness -- complex and difficult endings may bring complicated losses and complicated grief. You'll find some resources to deal with such losses here.
• Useful links
• A reading list

Aircraft Casualty Emotional Support Services (ACCESS, connecting those who have survived or lost loved ones in private, military and commercial plane crashes and other aviation tragedies with individuals who have lived through similar losses)

Ambiguous Losses (scroll down to find text) from the e-book Complicated Losses, Difficult Deaths:A Practical Guide for Ministering to Grievers by Roslyn A. Karaban

Anti-Violence Partnership of Philadelphia (helping children and youth resolve conflict nonviolently; helping victims and their families rebuild their lives in the aftermath of violence)

Assisted suicide, arguments for and against:
• Should an incurably-ill patient be able to commit physician-assisted suicide? (BalancedPolitics.org)
• Hastening Death, information and arguments for and against physician-assisted suicide (from online edition of HANDBOOK FOR MORTALS by Joanne Lynn and Joan Harrold
• Tread Carefully When You Help to Die: Assisted Suicide Laws Around the World (Derek Humphrey, author of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (Euthanasia Research and Guidance Organization, ERGO, which publishes other books on the subject)

At the end of a loved one's life, why is it so hard to let go? (Craig Bowron, Washington Post, 2-22-12). Craig Bowron is a hospital-based internist in Minneapolis. "When families talk about letting their loved ones die 'naturally,' they often mean 'in their sleep' — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something."

Biology of Suicide (NPR, audio and transcript, part of its End of Life series: Exploring Death in America)

By My Own Hand by Anita Darcel Taylor (Bellevue Literary Review). Taylor writes that for those who go through the hell of manic depression, suicide is simply a tool to end great pain -- an "earned choice."

Compassion and Choices (supports, educates and advocates for choice and care at the end of life -- improving pain and palliative care, enforcing living wills and advance directives, and legalizing aid in dying)

Compassionate Friends (national self-help organization for help grieving the loss of a child of any age). Resources include a Chapter Locator and online brochures on topics ranging from Understanding Grief, Sudden Death, Surviving Your Child's Suicide or Homicide, The Death of an Adult Child, Death of a Special-Needs Child, Adults Grieving the Death of a Sibling, Suggestions for Various Professionals Dealing with Someone's Loss of a Child. Compassionate Friends' credo: The Compassionate Friends credo: "We reach out to each other in love to share the pain as well as the joy, share the anger as well as the peace, share the faith as well as the doubts, and help each other to grieve as well as to grow. We need not walk alone. We are The Compassionate Friends." Here Linton Weeks describes the healing that goes on at a Compassionate Friends conference. He writes: "No matter how your child dies, there is an undeniable sense of failure among bereaved parents. Jan and I are haunted by Stone's and Holt's violent, senseless deaths, and all of the wrongs that can never be righted. Including the biggest of them all — we could not save our sons from death. We should have been the ones who died first, not our precious boys. We carry that guilt in our already shattered hearts, and we relearn every morning when we wake up that the loss of our children is something we will never get over. Or past. Or through." The Compassionate Friends conference brings together parents isolated from their friends, family, work by pain and inexperience with such loss.

Darcy at Her Days’ End :A beloved dog afflicted with the disease of old age brings her owner face to face with responsibility in its purest form (Verlyn Klinkenborg, NYTimes, 12-18-09)

End-of-life decision-making
Resources for when terminal or life-threatening illness requires decisions about what individuals, families, and professional caregivers should do -- posted by the Association for Death Education and Counseling:
• Death with Dignity: The Oregon Experience by Susan Hedlund
• The Art of Dying: A Mind-Body Transformation by Danielle Schroeder
• When to Refer to Hospice by Lisa Wayman
• Compassion & Choices: Choice and Care at the End of Life, including the blog entry A dying patient is not a battlefield (by Theresa Brown)
• Five Wishes lets your family and doctors know:
* Who you want to make health care decisions for you when you can't make them.
* The kind of medical treatment you want or don't want.
* How comfortable you want to be.
* How you want people to treat you.
* What you want your loved ones to know.

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A Facebook story: A mother's joy and a family's sorrow. Ian Shapira, Washington Post, has edited and annotated Shana Greatman Swers Facebook page to tell her story from pre-baby date nights to a medical odyssey that turned the ecstasy of childbirth into a struggle for life.

Farrah Fawcett's Long Goodbye (Jim Rutenberg, NY Times, 5-27-11). Dying of cancer, she authorized a documentary of her final days. "Ms. Fawcett had intended the film to address shortcomings she saw in American cancer treatment and to present it in art-house style....After [Ryan] O’Neal and NBC gained full control of the documentary, the film took on the feel of network celebrity fodder — at once more glossy and more morbid....Many scenes addressing the American medical system were scrapped or truncated." Her final story became the object of a lengthy battle.

The Good Short Life by Dudley Clendinen (NYTimes, 7-9-11). Living with Lou Gehrig's disease (ALS) is about life, when you know there's not much left. And Writer Dudley Clendinen has chosen not to go to the great expense and limited potential of extending his life--but to enjoy what he can of it, while he can. He learned he had the disease when he was 66, and Maryland Morning, an NPR news station, has been airing conversations with him about how he and his daughter Whitney have been dealing with the disease and its implications. Listen to the podcasts

The Guardians: An Elegy by Sarah Manguso. “A bittersweet elegy to a friend who ‘eloped’ from a locked psychiatric ward . . . [Manguso] explores the extent to which we are our friends’ guardians and, in outliving them, the guardians of their memory . . . Manguso’s writing manages, in carefully honed bursts of pointed, poetic observation, to transcend the darkness and turn it into something beautiful. The results are also deeply instructive, not in the manner we’ve come to fatuously call “self-help” but in the way that good literature expands and illuminates our realm of experience.” —Heller McAlpin, Barnes and Noble Review

HALOS, a support group for families and friends who have lost a loved one to homicide (not a therapy group and not associated with any religious group)

Homicide Outreach Project Empowering Survivors (HOPES program), William Wendt Center for Loss and Healing, Washington DC

In death, a promise for the future. As her world diminished, Elizabeth Uyehara signed her body over to researchers to help unravel the mystery of Lou Gehrig's disease. (Thomas Curwen, Los Angeles Times, 8-28-10, on the course of Uyehara's ALS and on what happens when organs are donated for science)

KOTA blog (poems of grief, Knowing Ourselves Through Art)

'The Last Good Nights'. (John West tells Diane Rehm and radio listeners John West tells why, and how, he assisted his parents with their suicides. He offers a first-hand account of the decision no child wants to face and explains why he followed through on his parent's desire to choose death with dignity. He also tells the story in his book The Last Goodnights: Assisting My Parents with Their Suicides

How the mother of a slain 9-year-old sank into despair, then sought justice (Neely Tucker, Washington Post 1-20-10, part 1. Slow-loading. Part 2: Carol Smith fought for justice after daughter Erika's murder in Silver Spring

Lives Cut Short by Depression (Daniel Ofri, Well, NY Times 6-9-11)

'Making Toast': Simple Gestures for Moving On, National Public Radio story and review of Making Toast by Roger Rosenblatt, which E.L. Doctorow describes thus: "A painfully beautiful memoir telling how grandparents are made over into parents, how people die out of order, how time goes backwards. Written with such restraint as to be both heartbreaking and instructive."

The Mercy Papers: A Memoir of Three Weeks by Robin Romm (a young woman's raw unflinching account of losing her mother to cancer--with no sugar coating, as one reviewer puts it)

Music for Funerals and Memorial Services. This could be a healing part of the process of burying the dead. Here are links to samples of selections that may help you remember the good times, and mourn the end of the life.

My big sister took her own life (Ali Grant, Globe & Mail, 4-8-10). "uicide. My beautiful big sister, Isobel. Dead by her own hands at 62. Literally the unthinkable happening. My mind was unable to allow for the possibility that she would kill herself, in spite of the daily conversations we had, in spite of my knowing that she was struggling with pain, both physical and psychological. "

Out of This World (Pulse: Voices from the heart of medicine). Fourth-year medical student Katelyn Mohrbacher on the family's and medical staff's experience with an eighty-year-old man in a persistent coma.

Physician-assisted suicide. Listen on Interfaith Radio to"Bioethics and the Legacy of 'Dr. Death,' which includes interesting segments on dying with dignity (individuals having some control over when they die, particularly if they're heading toward the painful end of a terminal condition: After a segment in which Michael Schermer tells how our brains are hard-wired for "beliefs," listen to Should Doctors Hasten Death? (starts at 21 min 36 seconds), in which bioethicist Art Caplan explains the pros and cons of one of the most controversial practices in both religion and medicine. (You can listen to full segment here . A third segment is Making the Choice: Merrily's Story (begins at 33 min. 46 sec.). One important point: Knowing that they have some choice allows patients who are terminally ill to relax and accept the natural course of death; only 10% of those who knew they had the option to end their life with medication did so.

Remembering Denny (Calvin Trillin writes about the life and unfulfilled potential of his Yale classmate and former close friend Roger "Denny" Hansen, a Rhodes scholar, academic, and State Department employee whose great promise ended in middle age with his suicide)

Sick and Tired (Paul Rousseau,Pulse: Voices from the heart of medicine). A mother being kept alive by transfusions is sick of them and must decide whether to continue for the sake of her daughter.

Sad End to a Long, Slow Slide (Corey Kilgannon, New York Times Regional edition 8-12-07), a loving couple dies together

Suicide and suicide prevention
• Complicated Grief in Survivors of Suicide Loss (American Foundation for Suicide Prevention). Watch free video of webinar on subject.
• Copycat suicide (Wikipedia entry)
• Families of Military Suicides Seek White House Condolences (James DAO, NYTimes, 11-25-09, on pressure to change a hurtful policy)
• Preventing Suicide: A Resource for Media Professionals (PDF, World Health Organization)
• SAVE (Suicide Awareness, Voices of Education), suicide prevention
• Suicide and the Media (New Zealand Ministry of Health, tips on media coverage to reduce risk of encouraging suicide in at-risk individuals)
• Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop (CDC)
• Suicide Prevention (many useful resources from Centers for Disease Control and Prevention, CDC)
• Suicide Prevention (National Institute of Mental Health)
• Teen Suicide Prevention Campaign (American Foundation for Suicide Prevention). Watch these brief public service announcements (PSAs)
• Recommended reading


Taking Chance Home (Marine Lieutenant Colonel Strobl's simple and moving account of escorting the remains of Lance Corporal Chance Phelps home from Dover Air Force Base). You can watch HBO's film based on the story, Taking Chance, starring Kevin Bacon.

TAPS (Tragedy Assistance Program for Survivors)

Unflinching End-of-Life Moments, review in NYTimes of HBO documentary about physician-assisted suicide (to air summer 2011), How to Die in Oregon, which showed at the Sundance Festival.

"Although I’m not ready to admit it, my father is dying. As cancer takes over his body, we sit together – talking, enjoying the garden, and watching old movies. I’m trying to get a handle on the situation and how I feel about it, but my emotions are a tangled, jumbled mess. All at once I feel isolation, profound sadness, panic, anxiety, anger, frustration, helplessness, fatigue, and, ironically, occasional joy and humor.

When I set out to review Dying: A Book of Comfort, I worried that I might be too close to the topic. But as I read passages in this anthology, my mixed feelings began to come into focus. I realized that perhaps I’m just the kind of person who should be reviewing a book like this. Read straight through, Dying: A Book of Comfort was a spiritual exercise for me. Some chapters let me look at dying from my father’s perspective. Other chapters simply gave me the perspective of people who have been through this before me and my family.

“Pat McNees’s collection contains carefully selected and ordered pieces – poems, prayers, prose, and fiction. The anthology explores a range of experiences: living when you know you are dying; caring for and about someone who is dying; saying goodbye; and dealing with how it feels to be left behind. When Pat was talking with publishers about printing a bookstore version, some told her it should be a book either about dying or about grieving, but Pat saw them as part of a continuum.

“If read straight through, the book’s structure allows the reader to move through the process of dying and grieving in an arc, starting with ‘Illness as Awakening.’ Following chapters examine how people who are dying, as well as their loved ones, experience the process of dying and saying goodbye. The apex of the arc is death itself, with chapters including views on immortality and prayer. The book then moves into the ‘Journey Through Grief.’ What follows are chapters devoted to mourning the loss of a child, parent, or spouse, and to grieving a sudden death or suicide. The closing chapters have their focus on death’s aftermath – the remembering, for example, or the other ways we deal with the ongoingness of this greatest of all losses.

“McNees has kept her selections fairly short. The brevity of the passages, and their concrete relevance to the topic at hand, make the book very reader-friendly. These characteristics reflect the advice of grief counselor, Kathleen Braza, who has found that people who are grieving generally can’t read long passages or process symbolism.

“The first time I read this book, I jumped around, the way I usually read a book of poetry. I’d read a passage here and there, periodically finding one that rang very true for me. Beyond being a personal comfort to me, I found the book to be an excellent resource. I’m often at a loss for words when talking with or writing to someone who is grieving. In its pages I have found just the right passage to share with friends of mine who have lost a mother, a husband, a son.

“While McNees didn’t set out to write a spiritual book, she has created a volume that speaks to the heart. Written after her father’s death, her goal in working on this project was to create a book that would help people through the process of death and grieving. Dame Cicely Saunders, founder of Hospice, says of Pat’s book, ‘This remarkable collection, coming from personal experience and wide reading, will help many find the potential of growth through loss.’

“Dying: A Book of Comfort would make a thoughtful gift for a family or individual coping with terminal illness, someone who is grieving, or people who work with dying or bereaved. It is available in trade paperback at bookstores or in hardcover from the Literary Guild. My copy has already become dog-eared and annotated, as it travels with me to visit my father. Thanks, Pat, for the words of comfort."

~ Eileen Hanning’s review, years ago, for Signature, the newsletter of the Women’s National Book Association, DC chapter

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Complex and Difficult Endings: A Reading List

• Adorján, Joanna. An Exclusive Love: A Memoir (translated by Anthea Bell). Adorján tries to make sense of the dual suicide of her fascinating grandparents, who survived the Holocaust and the Hungarian uprising of 1956 and died in a suicide pact in Denmark in 1991.

• Ascher, Barbara Lazear. Landscape Without Gravity (about her brother's death from AIDS).

• Bialosky, Jill. History of a Suicide: My Sister's Unfinished Life (about both her sister, Kim's, life and death and about sibling loss and survival guilt)

• Bolton, Iris. My Son...My Son: A Guide to Healing After Death, Loss, or Suicide

• Boss, Pauline. Ambiguous Loss: Learning to Live with Unresolved Grief (about the sense of "frozen grief" that can occur when a loved one is perceived as physically absent but mentally present (because of desertion, divorce, or abduction, or because missing in actions) or physically present but mentally or psychologically absent (because of dementia, mental illness, or other forms of mental or emotional loss or injury).

• Brodkey, Harold. This Wild Darkness: The Story of My Death (the story of his confrontation with AIDS)

• Caplan, Arthur L., James McCartney, and Dominic Sisti, eds. The Case of Terri Schiavo: Ethics at the End of Life
(many contributors discuss the ethical issues associated with this controversial case and others like it)

• Clift, ElinorTwo Weeks of Life: A Memoir of Love, Death, and Politics. A well-known journalist combines an account of the circus surrounding Terri Schiavo's death with the personal story of the death of her husband, journalist Tom Brazaitis

• Davis, Deborah L. Empty Cradle, Broken Heart: Surviving the Death of Your Baby<

• DeVita, Elizabeth. The Empty Room: Surviving the loss of a brother or sister at any age (partly a memoir of surviving the loss of her brother Teddy to aplastic anemia)

• Didion, Joan. The Year of Magical Thinking

• Edelman, Hope. Motherless Daughters: The Legacy of Loss

• Fine, Carla. No Time to Say Goodbye: Surviving the Suicide of a Loved One

• Gilbert, Sandra. Wrongful Death: A Medical Tragedy (about the death of her husband after entering the hospital for routine prostate surgery)

• Gunther, John J. Death Be Not Proud (a young son's death from brain cancer)

• Hammer, Signe. By Her Own Hand: Memoirs of a Suicide's Daughter

• Harrison, Lindsay. Missing. During her sophomore year at Brown University, Lindsay's brother called to say her mother was missing. Forty days later they discovered the unthinkable: Their mother’s body had been found in the ocean. A page-turning account of those first forty days (dealings with detectives, false sightings, wild hope, and deep despair), then her search for solace as she tries to understand who her mother truly was, makes peace with her grief, and becomes closer to her father and brothers as her mother’s death forces her to learn more about her mother than she ever knew before.

• Hill, Susan. Family (about the death of a premature child)

• Kamenentz, Rodger. Terra Infirma (a searing recollection of his mother's life and her death from cancer, his mother "yo-yoing between smothering affection and a fierce anger")

• Kincaid, Jamaica. My Brother (account of her younger brother's death from AIDS)

• Kushner, Harold S. When Bad Things Happen to Good People

• Latus, Janine. If I Am Missing or Dead: A Sister's Story of Love, Murder, and Liberation

• Elizabeth McCracken. An Exact Replica Of A Figment Of My Imagination -- expect both smiles and tears in this story of the loss of McCracken's stillborn baby

• Morrison, Blake. When Did You Last See Your Father?: A Son's Memoir of Love and Loss

• Nuland, Sherwin B. How We Die: Reflections on Life's Final Chapter (superb explanations of the actual physical process of dying and good on why and when to stop trying to rescue the terminally ill and to let them die peacefully and in less pain and discomfort, written after Nuland realized that his physician's impulse to "rescue" prolonged the suffering of his older brother and other patients)

• Page, Patricia. Shadows on a Nameless Beach. A brief and beautifully crafted collection of essays, a memoir of the year after her son's death by suicide, her feelings of parental guilt, finding solace in walks through California's coastal landscape.

• Rappaport, Nancy. In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide. Haunted by the 1963 death of her mother, a Boston socialite, from an overdose when Rappaport was only four (the youngest of six children), the author tries to reconstruct what happened. As her brother asked: Didn't their mother know that she would leave all these shattered children wondering if it was their fault?

• Sharples, Madeline. Leaving the Hall Light On. A mother's memoir of living with her son's bipolar disorder and surviving his suicide. Read review by Dr. Jason M. Dew and interview with the author (on Women's Memoirs).

• Sittser, Jerry L. A Grace Disguised: How the Soul Grows through Loss (about the transformative grace that can come even in the face of catastrophic loss)

• Vincent, Eleanor. Swimming with Maya: A Mother's Story (how the daughter's fall from a horse ended in organ donations--transforming a mother's grief)

• Waxman, Robert and Linda. Losing Jonathan (losing a beloved child to drugs)

• West, John. The Last Goodnights: Assisting My Parents with Their Suicides

• Wiesel, Elie. Night (powerful account of surviving the nightmare world of the Nazi death camps)

• Williams, Marjorie. The Woman at the Washington Zoo: Writings on Politics, Family, and Fate (the last third is about her losing battle with cancer, saying goodbye to her husband and young children)