Managing Grief And The Holidays

Here come the holidays- and the grief

Let’s manage it!

The holidays are around the corner. Well, 2 corners on the calendar, but it seems to be speeding up, doesn’t it? There is even a shortage of the foods many look forward to, which is adding to that sense of needing to be ready. 

But what about those of us who have had losses this year? Covid has taken a toll on all of us. Even if you escaped illness and loss, we all faced the loss of parts of our year. And in some families the politics surrounding the pandemic has splintered the normal gathering now that we can finally have a gathering again. 

Acknowledging grief at this time of year can be kind of awful. It can be awkward as some of us stumble over what to say- do we say the names of those missing? Do we talk about them? Do we just keep busy and hope nobody will bring it up? What do we do with our own sadness right now? 

As a grief therapist I want you to know you have permission to talk about the loved ones who are missing from your table, and to include them in your special days. Teach the littles in your family that grief is normal and part of life, and that it is not scary. If yours is a family that does not talk about loss you can be the rule breaker this year. Trust me- there will be a lot of that across the country and the globe. 

There are great children’s books you can read to normalize the experience of someone missing. Try “The Invisible String” – or “The Invisible Leash” if a beloved pet is missing. If you need more ideas ask your counselor at Central Counseling Services- we have grief resources!

Some other ideas:

• Light a memorial candle. Invite children and other friends/family to share memories.

• Write a card or letter to the person who died.

• Write memories on strips of paper and use them to create a paper chain in colors for Thanksgiving, Hanukkah, or Christmas. 

• Hang a special decoration in memory of the person, such as a wreath or stocking, or set out a special menorah for them and take turns through the eight nights lighting the candles and sharing a memory.  If a stocking is used, family members can place cards or pieces of paper with memories inside.

• Buy a gift the person would have liked and donate it to a charity, or a meal to a food program or senior center. 

• Giftwrap a box and make an opening in the top for family and friends to share written memories. At a special time the box can be unwrapped and the memories shared.

• Set a special memorial place at the table during a holiday meal.

• Create a memorabilia table or corner where you can place photos, stuffed animals, toys, cards, foods, and any other kinds of mementos.

• Share one of the person’s favorite foods or meals. Food can be a great spark for sharing memories, as well as a sense of security. 

I hope your holiday season is special as we navigate back into family and friends to celebrate. If you find yourself struggling, Central Counseling Services has therapists available to help, including clinicians for anyone who does not have insurance through our new nonprofit branch. We can be reached at (951) 778-0230

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As a therapist and a social worker I work from your strengths to enhance the skills you already have and to address the issues holding you back or disrupting your life. My goal is to assist you in reaching a more satisfying state in your life, to reduce your stress, and to make home a better place to be. My specialties include working through grief and loss (including children's grief and anticipatory grief), chronic illness issues, depression and mood disorders, trauma recovery, adoption and infertility issues, and geriatric and aging issues. I have extensive experience in sexual assault recovery. I am available for crisis intervention in the workplace. I am a speaker/trainer and have provided training to parenting groups, educational support groups, community groups and employer groups. Some of my topics include Alzheimer, dementia, caregiving 101, child abuse reporting laws, parenting the adoptive child and trauma recovery. I currently, facilitate a dementia support group (see events page) and I worked with a group to develop the City of Riverside into a "Purple City" to help people with memory care issues. I am a member of the National Association of Social Workers (NASW) and I am Certified as a Grief Recovery Method® Specialist.

Traditions Are Everywhere, Make Self-Care One Of Yours!

The last few days different traditions have taken place around the world. Here in the US, lots of kids went Trick or Treating on October 31 for Halloween. Other parts of the world celebrated All Saints Day on November 1  (celebrated in honor of all the saints, known and unknown) which is followed on November 1st and 2nd  by Day of the Dead or also called  Día de los Muertos, a more Latin American custom where it is      believed that the souls of the dead return to visit their living family members.

Most of these holidays are related to honoring our deceased. Many of us have experienced significant losses this past year to year and a half due to the COVID 19 pandemic.

As I realized how many of these different traditions occurred over the last week, I became intrigued with how different cultures view death. In America we are familiar with the traditional funeral where family members, friends and relatives gather around the body (often wearing all black) and later there is a ceremony held in a church, synagogue or temple with a rabbi, priest or other officiant leading the service. At other times, instead of a funeral, there is a memorial service, which is much of the same structure as a funeral although the deceased’s body is not present at the service. Because a memorial service occurs after the remains have been cared for, there is often more room for creativity. This is because the family can take more time to plan a ceremony and decide how they want to pay tribute to their loved one. More recently there is a trend of honoring the dead with a celebration of life ceremony which is usually a more relaxed and party-like atmosphere with guests sharing stories about their loved ones.

The celebration of life sounds similar to South American people honoring their dead by holding a ‘vela’ where guests share memories of their loved ones while eating and drinking.

In Africa, most believe in ancestors (the dead who continue living and guiding their family in the afterlife) and they believe that the ancestor will become a wandering ghost if a proper funeral or burial didn’t take place. With lots of different tribes (over 3,000) and countries, there are many different traditions.

The different countries in Asia have their own specific way in viewing death and have their own unique rituals and customs. For example, in China, mirrors are removed, and cloth is hung on the doorway of their homes. Which has some similarities to Russia, where before funeral mirrors are covered and clocks are stopped to avoid more death in the family. That’s similar to the changes made to sit Shiva in the Jewish tradition.

In Western Europe, the traditional mass followed by a grave burial are influenced by beliefs in a higher power that influences funeral traditions.

I am so in awe about so many different ways and traditions to honor our death. What is important in any culture, I think, is taking care of ourselves in those difficult times too. Partially this might be accomplished by having your family and/or friends around you for support. But selfcare also consists in making sure we eat, get sleep, regular medical care and hopefully are able to go outside in the fresh air. Other possibilities for selfcare could be: finding a hobby, watching a funny movie, reading a book, cuddling with a pet, and/or not working during your time off.

Let’s try a self care activity: Pick a window and spend a few minutes looking outside. Notice what’s happening. What shapes, colors, patterns do you see? Do you notice anything new?

Creating the tradition of self-care, not only in the difficult times when someone died, but any time is important.

To discover more about the importance of self-care and/or ideas for self-care, don’t hesitate to reach out to myself or my colleagues at Central Counseling Services. We are here to guide and help you find the right selfcare tradition for you. You can reach us at (951) 778-0230.

Ilse enjoying nature to practice self-care.

I earned my Master degree in Clinical Psychology from Vrije Universiteit Brussel. Yes, that’s in Belgium where there is no IN-N-Out or 91 freeway. I’m a member of the California Association of Marriage and Family Therapists and California Association for Licensed Professional Clinical Counselors. That allows me to provide extra resources and educational opportunities to give you the best care you deserve.

I welcome clients from all cultural backgrounds, family structure, beliefs and ages, and work with most issues. My colleagues and clients call me the “resource Queen.” That means if even one client needs a resource or a new approach, I will find it and we will use it. My commitment is always to provide my clients with the best care and most current resources.

Call our office at (951) 778-0230 to set up an appointment. The office is open seven days a week, and I am available weekdays. I will see you soon.

Today is the first day of the rest of your life, let’s make it:

● great

● worthwhile

● count

● awesome

● wonderful

....... it’s up to you!

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Ilse Aerts, M.S., LMFT # 96211, LPCC # 6135,CCTP, CATP

The loss of a pet

The bond shared by humans and their animals is indescribable. The grief resulting from their loss profound. What is it about these wet nosed and furry pawed creatures that touch us so deeply? Is it their ability to without words communicate genuineness and gratitude? Is it their ability to lower our inhibitions or perhaps their silliness that lifts our spirit?

Minnie the Therapy Yorkie

I have the privilege to work along Minnie the therapy Yorkie. Her presence in client sessions is invaluable particularly when working with traumatized clients. As my pet, she brings me joy and laughter. She’s always there waiting at attention to see if I will toss the ball or play chase. She’s such a goofball, but don’t let her diminutive size fool you, she’s a terrier, a hunter and my guardian angel. Minnie is also my rainbow fur baby. Many years before her, I had Lolita a beautiful apple head tea cup chihuahua.

Lolita was my soul mate.  When she died, a piece of me died too. Till this day when I talk about her my eyes well up. What made her so special was how empathic she was. When I was sad she was sad, when I was happy so was she. After her death I was unable to connect with any other dog and didn’t think I would have another as a pet, her loss and my grief were too deep. What made the difference as I grieved her was the support of understanding friends.

Many pet parents suffer the loss of a beloved pet alone and in silence due to the embarrassment of acknowledging the impact pets have in our lives. Many pets have long lifespans of over 20 years or more!  The grief resulting from the loss of a pet is not to be taken lightly and it should be no cause for embarrassment.

Many pet parents schedule their day around their pets’ routines, we socialize, exercise and depend on them for assistance with medical issues and emotional issues. Other animals we form bonds with include service animals, dogs who are part of law enforcement, search and rescue teams and military dogs trained for special missions. There are even dogs who are companions for other wild animals to aid in the wild animal’s conservation. Their value and impact in our lives should not be underestimated.

Acknowledging the significance of the loss of your pet and its impact in your life moves you toward working through the grief. Finding supportive persons are not only sounding boards, they are often like-minded individuals who have mourned a pet and can direct you to resources to help fill the voids left by the loss. The following list compiled by Best Friends Animal Society has resources that may be helpful when dealing with pet loss. They include hotlines, support groups, websites, web pages, web articles and books.

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by Susana Anaya-Baca, LCSW

If you are having issues with grief, anxiety, panic and depression, Minnie and I, are here to help. We at Central Counseling Services Murrieta, look forward to journey with you on your path to mental wellness. For appointments, I may be contacted at 951-778-0230. We are located at 29970 Technology Drive #116 Murrieta, CA 92563.

Susana Anaya-Baca, LCSW joined Central Counseling Services as a therapist in 2018. She is a graduate of California State University Long Beach School of Social Work where she earned her Master in Social Work with a concentration in older adults and families (OAF). She is a Licensed Clinical Social Worker (LCSW#69056) and is licensed to practice psychotherapy in California since 2015. She is fluent in Spanish.

Ms. Anaya-Baca has experience working with a wide range of individuals and settings. Prior to entering private practice, she practiced as a clinical medical social worker with individuals and families facing life-limiting illness in the area of home health, palliative care and hospice. Susana is a member of the National Association of Social Workers.

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MEDICAL EMERGENCY
If you have a medical emergency, call your doctor or 911 immediately

All information, content, and material are for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. The information provided is not intended to recommend the self-management of health problems or wellness. It is not intended to endorse or recommend any particular type of medical treatment. Should any reader have any health care related questions, promptly call or consult your physician or healthcare provider. The information presented should not be used by any reader to disregard medical and/or health related advice or provide a basis to delay consultation with a physician or a qualified healthcare provider. You should not use any information presented to initiate use of dietary supplements, vitamins, herbal and nutritional products or homeopathic medicine, and other described products prior to consulting first with a physician or healthcare provider. Susana Anaya-Baca, LCSW disclaims any liability based on information provided.

6 Things NOT to Say After a Death.

What not to do when someone is grieving?

We have had a lot of deaths that impact this community recently- both public figures and personal losses that impact the community in a widening ripple. We have had tragic accidents, suicides, and overdoses, in addition to the well-known celebrities with stars on Hollywood Boulevard. Many of those deaths seem to invite comment in public forums, especially social media. The comments made in those forums have an impact- social media, texts, and email has more power than any of us really want to admit.

So, what should we not do after a death?

How do we make sure our reaction does not make someone’s grief harder or make them feel that they can’t talk about their loss? How do we make sure our teens can talk about suicide issues without feeling judged? Here are some strong suggestions from a therapist who specializes in recovering from loss:

    Watch your use of common phrases

1. Don’t tell someone that their loved one is in a better place; don’t assume the griever has a faith tradition, or that they are particularly fond of God or anyone else following the loss of their loved one; don’t ask why they are still grieving – grief is its own process for each person. When they are grieving nobody wants to hear they should be happy or relieved- even if they are in some way.
2.   Don’t use the death to make political statements or to judge the person who died. Overdoses are a tragedy, not a way to lecture others about drug use and what it does. The death makes it clear what can happen. The survivors need support, not to feel that they can’t talk about them without harsh words being the response.
3.  Don’t say anything negative about the person who died. That belongs to the immediate survivors, should they choose to share those thoughts.
4. Please do not discuss the manner of death in a judgmental way. Suicide is a tragedy, not a selfish act inflicted upon the survivors. It follows after much struggle, and you cannot understand the thought process of the person who made that decision. Don’t judge them for it. Don’t make the survivors feel guilty. They have enough to cope with.
5. Don’t feel a need to fill in the silences. The very best thing you can do for a person who has had a loss is to hold space for them. Just be there. Words are unnecessary, and often get in the way.
6.  Don’t stop saying the loved one’s name- survivors need to know they counted, and still do. The loss does not end with the funeral.

Just today there was a new public celebrity death. (Chester Bennington of Lincoln Park Fame) The comments are already starting. Think before you join them. This is an opportunity to provide support in your own circle, and to make a positive impact at a difficult time.

If you need more assistance Jill Johnson-Young, LCSW is a grief recovery specialist.

©2017 All rights reserved

Thanksgiving When You Don’t Feel Thankful

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That’s quite a title, isn’t it? If you are reading this you may be simply curious about a therapist writing a blog about not feeling thankful… or maybe this is a year you are not ready to see the holidays arrive. If that’s you, this one’s for you.

The holidays are a great way to reconnect with family, to have a "Friendsgiving" with those who aren’t family but probably should have been, to share old traditions, welcome new folks, watch a game (and argue about the game), argue more about politics (Okay, probably not this year), and to be with

"your people",

whoever they may be. It’s a time that is supposed to smell like baking and food and cinnamon. The leaves are supposed to turn (except here in California we have to travel to see that sight), and sweaters should appear as we sit by a fire.

 

Except for some people, it’s none of that. Those are my people. As a grief counselor, I spend this time of year with clients missing loved ones, some with losses only weeks ago. New clients find me online after searching for bereavement and loss therapists. They bring in children trying to make sense of what death means. Teens come in trying to figure out how to go to church next month when they are no longer sure God exists or, if he or she does, then why they should pray to someone who took their mom or dad or best friend. Others come in who created a family with their furry family members, and a special one who meant everything to them has now crossed the Rainbow Bridge.

For my people, the grievers, the survivors, the ones still in shock about what just happened, the holidays are not all fireplaces and fuzzy socks and pumpkin pies. They are a collective sense of:

•       Panic- crowds are too much for them
•      Sadness- they miss someone so much that “celebrating” is unfathomable
•      Anger- their loved one died, and everyone else at the table has their person with them. Or someone at that table has told them to get past it, to be happy their loved one is not longer in pain, or that they should celebrate that they are healed now. Or, even harder, someone at the table did not show up before their loved one died.
• Exhaustion- they just have no energy for events or memories or cooking. Or even smiling.
•   Fear- what happens if they need to cry? Or leave?
• Stress- death can be expensive. They may not be able to afford the stuff that makes the holidays.

Grieving people are frequently encouraged to attend the events and to be strong or to smile and celebrate the memories. It’s easy to say and expect that. It’s not realistic for many. So here are my rules for the holidays when you wish they would just go away this year.

1.     You do not have to host

2.     You do not have to attend

3.     You may take your own car if you do attend that way you can leave if you feel overwhelmed.

4.     You owe no apologies for not attending or for leaving

5.     You need to rest more

6.     You need to take your vitamins, drink fluids (not too much alcohol please), and take care of yourself

7.     Shopping can wait, or be done online. You’re probably not sleeping, so shop at 2am.

8.     Church/temple/meetings/mass is not required

9.     Socializing at #8 venues is not required of you do attend

10.  Take time out to remember your loved one, and talk about them. They are still part of your holidays- and they always will be.

11.  You have permission to not follow traditions, or to change them.

You can’t avoid the holidays- the grocery store, post office, bank, TV, and coffee shop have seen to that. But you get to choose how much and if you participate.

I am here to help if you need some extra support . Call me at Central Counseling Services, (951) 778-0230, or find us at centralcounselingservices.com

Grief Doesn’t Come in Stages

I was recently asked by a researcher about how to help people who are still in deep grief a year or even ten years after a loss. I have to admit I was a bit taken aback.  As a therapist, and especially a therapist who specializes in grief and loss, I find the concept of bereavement lasting more than eighteen months at the outside a bit hard to fathom.  As we talked more, she described what she saw as “grief” or “bereavement.” That’s when I had my “ah-hah” moment. We weren’t speaking the same language. In therapist-speak, I reframed her thoughts and tried again.

First, she was asking about how to reach acceptance in the five stages of grief. The five stages of grief from Kubler-Ross are marvelous for those who are dying. She created that model for anticipatory grief, not for those left behind. It works well to help dying patients prepare for their goodbyes and death because it facilitates discussions that need to happen. Dying people can and do need to reach the point where they can accept that their illness is terminal and that they need to say what needs to be said before they are gone. I have used that model as a hospice social worker more times than I can count, and it truly does frame the needs of the dying person for the family.

 That being said, I never ever use "acceptance" in my work with grieving people. I work toward recovery, completing unfinished business, and integration of the loved one in a new life. The sense of loss never really ends, but it doesn't have to hurt so much when the regrets are resolved. The intensity diminishes. My model for grief is a "U" with all the emotions of humanity around it, and lines running every which way. I prepare my clients for moments that sneak up and burst onto the scene like a wave you were not expecting. It happens even years later.

That's missing, not grieving. And that's normal. 

Society tends to view grief as a short period of funerals and ceremonies, and then when it's all over the person with the loss is left to figure it out, and face questions like "but it's been a month- aren't you feeling better yet?" People are uncomfortable when the loved one's name comes up, and many times try to avoid it. Every grieving person loses some friends who simply can't be around someone who has had a death.  It’s simply not in their toolkit to cope with death. Eventually, all of us have to, but some will avoid it if at all possible, even at the cost of a friendship. That’s another loss of the bereaved survivor.

At the same time, society has beliefs about how grieving people "should" act. Widows and widowers are “supposed” to be sedated, sad, and alone for at least a year. They are told not to change anything for a year. I have never found out who the "they" is who made up those rules. I encourage my clients to break them. Parents who lose children are expected to have another child to replace the lost one or be grateful that they have other kids to not feel their loss as much. Even a pet's death means we are supposed to run out and adopt a new furbaby. Those beliefs truly get in the way of a person grieving the way they need to. It's their loss. They get to choose. Unfortunately, friends and family have gotten the memo from "they" and do not want rules broken. It makes it more difficult than it has to be for the primary griever.  So.....Go Break Some Rules

If you need more help with grief and loss I have created an online year-long grief program; called Your Path Through Grief. You can find more information on this program at http://www.yourpaththroughgrief.com/

 

What Do You Do When Mom is No Longer Here?

Mother’s Day When You’ve Lost Your Mom

As I was meeting with clients throughout the last week there’s been a consistent theme- motherless kids missing mom, and facing the Hallmark extravaganza of the year: Mother’s Day. Walk into the grocery store and there are more flowers than the Valentine’s Day array. Social media? A nightmare. Pinterest? Don’t even think about it. Stop for a meal somewhere? Mother’s Day specials everywhere. Even the casino where we went to play Bingo yesterday had “Mother’s Day Bingo.” What?

It doesn’t matter if you lost your mom last week or a decade ago, this week you will be reminded at least every hour of every day that she’s gone. What do you do with a day created to make mom feel special when she’s not here?

If you’ve recently lost your mom, this will be a new experience. You may be casting about for how to handle it, or fielding calls from people wanting to include you so you won’t be alone. There’s a rule for this: You can decide how you want to spend this Sunday, and if you want to do something to remember your mom or simply take a time out until next year. Folks with recent losses typically don’t do all that well in a large group or with big expectations heaped on them to respond to a certain event or moment. They need and “out,” so they can get away if it feels too overwhelming. If you are that person, and you decide to go to an event, you may want to drive yourself or have a friend take you with the understanding that if you give the signal you will both exit, as quickly and graciously as possible so you don’t feel obvious. The first motherless Mother’s Day is your call- you get to decide what you want to do.

If this is not your first day without mom it can still rekindle the loss with all the focus on the day. If you need to find a card for a daughter who’s now a mom or for a mother-in-law you have to get past all the cards you can’t send your own mom. You may be facing all the joy of the day with grandkids or other family who are celebrating with their moms and find yourself wishing your mom was there to see all of it. If you attend church there may be a moment where flowers are given to moms. Or white flowers to those who lost their mom. The gestures are touching, and loving, and meant to be kind, but they can still sting, can’t they?

So what do we do, those who are missing a mom or a special mom-type who is no longer here to be celebrated for their role in your life?

©     We celebrate them

©     For who they were

©     For what they did for you

©     For how they helped make you who you are today

©     For the love you still carry with you, across the years

©     We remember them

©     We talk about them- not so much that it overshadows those who are celebrating with their moms, but enough to mark their place in the day for you

In my house there will be a celebration for my mom, whom I am lucky enough to still have with me. There will also be a trip to the cemetery for her mom, my late spouses, and my children’s birth mom. The kids probably won’t go, and that’s okay- they don’t feel a need to do so. I will take flowers for them, and they know it. I will also take a time out to remember my late mothers in law, and an aunt who was like a second mom to me. And then I will celebrate the day with my daughters, one of whom is now a mom herself. There will be room for everyone’s emotions, and an out for anyone who needs it. There shouldn’t be huge stress over a day that was created to honor moms. We have enough stress in our lives, don’t we?

So here’s to Mother’s Day, spent in a way that makes it okay for you, reduces your stress level, and allows you to remember your mom in a way you feel you can manage. Maybe it’s an In’ N Out day? A day at the beach? A trip to the mountains? Favorite childhood menu items at home (because who needs crowds of people forcing their children into dress clothes and fancy restaurants on the busiest day of the year?) Who says peanut butter and jelly or fried bologna sandwiches can’t be fun again? (I didn’t say healthy!)

Happy Remembering Mom Day. I am glad you had her in your life. 

Handling Strong Emotions When the Unthinkable Happens—To Someone Else

Warning: this post refers to the December 2, 2015 shooting at the Inland Regional Center in San Bernardino, California. It is meant to help people who were not directly involved in those events, but who are nonetheless experiencing emotional distress.

On the morningof December 2, 2015, the unthinkable happened here in the Inland Empire. Two armed people entered the Inland Regional Center, killed 14 people, and wounded over 20 more. I was talking to Sherry in the waiting room when Jill came out of her office and told us the awful news of what was happening just a few miles away. Stunned as I was, I had clients to see and that's what I concentrated on. As long as I was busy with the problems of others, I was fine. Only when I was about to drive home to Redlands and my husband texted me that the FBI was investigating a house on Center Street did I feel any fear. I arrived home safely, of course, watched the news and took phone calls from family and friends. The next morning I drove past Center Street on my way to an early appointment. The street was cordoned off with yellow tape and police cars. According to the morning news, the house on Center had been a "bomb factory." I was suddenly so nauseated that I had to stop and get a soda to settle my stomach. When I got home I curled up on the couch under a blanket, cried, slept for hours, and woke up feeling like I had been hit by a truck. I watched a little news, talked with my family, went to sleep very early and had nightmares. The next day I was functional again. The whole event seemed surreal.

As a therapist I recognized these as normal stress reactions. I was not at the Regional Center, and I don't know any of the dead or wounded. But this happened in my community and it hit me hard.

Each person reacts to terrible things in her or his own way, and everyone has a different threshold for what constitutes a traumatic event. Some will shake their heads and go on with their day, others will go to a vigil, hug their kids, look at the sunset, or have a stiff drink. Others may react as I did, but think, "I wasn't there. Why am I feeling so bad?" or worse yet, "I shouldn't be feeling so bad." But the fact remains that they are feeling bad. In the wake of a public trauma, it's important to be honest with ourselves about how we are doing. Here are some common reactions:

Depression

Anger

Crying

Emotional numbness

Insomnia or sleeping more than usual

Nightmares

Loss of appetite

Being easily startled

Feeling fearful for no reason

Hypervigilance

For most people, these feelings will soon fade on their own and life will go on. Self care practices such as exercise, time spent with family and friends, meditation, prayer, volunteer work, reading, hobbies, and focusing on the here and now can all help. However, if symptoms persist for more than a few weeks and interfere with your daily life, then it's time to see a therapist to discuss your level of anxiety and/or depression. It's ok to need a little extra help, and talking with a therapist can be very reassuring.

In short, even if you are not directly involved in terrible events, you can still be affected by them. It's part of being human. 

Anticipatory Grief

Grief and loss doesn't start after your loved one has died. It begins when the realization becomes real that their death is approaching, whether far in the future from a long-term illness, or when a death occurs with little notice. In the ER, the ICU, at home… when that realization happens grief begins. It’s called “anticipatory grief” but, in reality, it’s grief, with all its emotion and sadness.

In the time before death occurs, there are things that need to be considered, both from the loved one’s perspective and to address your concerns. This will address the dying person’s needs. I’ll follow it with a blog about your needs as you support your loved one.

What Does A Dying Person Need at that point?

·       The need to “settle up” with the people so as to die in peace, with them and with myself.

Settling up emotional accounts

All of us have unfinished business left over from our years on Earth. Approaching death is the last time to make amends, check in, or say the things that have been left unsaid.

If someone can’t be reached, letters can be left, and even dictated. Elaborate isn't necessary. Peace for the person dying is.

·       An advocate for their end of life decisions

End of life decisions need to be written well in advance of the dying process. They aren't valid if you aren't of sound mind without a doubt.

Enforcing a living will or other decision making documents can be difficult if there is division in the family.

It’s hard to not provide hydration of nutrition if it’s been days or weeks. Someone has to ensure the dying person’s wishes are followed. That may have to be you.

·       The environment the dying person desires

Some people are extroverts, even when dying. Some are private, even if the family wants access. The dying person should have the kind of environment they lived with and following their wishes. And someone has to ensure it happens.

Things to consider:

•  music 
•   TV or movies
•   Bedroom or living room 
•   Home or hospital
•  Family 
•   Friends
•  Pets
•  Spiritual folks
• Lighting
•   Scents

·       A safe space to talk or a safe person to talk to about death

Family and friends are often reluctant to face up to the reality of the terminal illness and death: even if they are not, their experience is not the experience of the dying person. If they are still capable of talking, they may need someone to talk to about their fears and terrors, hopes and vulnerability. It may not be family. It may be a nurse, a friend… it’s up to the person who needs to do the talking. They don’t need their decision to create conflict. It’s their decision.

·       Spiritual support- or NO spiritual support.

Some find it comforting. Some find it presumptuous to assume they need spiritual support. Some do not have a faith they rely upon or believe. The dying person needs, and deserves, to have their needs followed at this point. If family needs to listen to religious music, say prayers, light incense… no matter- if it’s not something the patient wanted or participated in, it belongs outside the door. It’s the patient’s death- nobody else’s.

·       Pain management/comfort measures

A dying person deserves to have pain and discomfort resolved. They may not be able to tell you what they are feeling, but their body can to some degree. Blood pressure, fever, grimacing, tightened muscles, low oxygen saturation, irregular breathing. Those and so many more are indicators of the patient’s body being uncomfortable. Can you fix the breathing? Probably not. But you can add oxygen. You can administer pain medications and anxiety meds through sublingual administration. You can add a subQ IV to administer meds without adding fluids that could create respiratory distress. You can massage. Make the bed softer. Use a cool washcloth. Turn on a fan. Add a blanket.

Families tend to be especially distressed about morphine and other meds. They are not going to kill a dying person. They make the muscles relax so breathing is less stressed. They relieve pain. If your loved one has asked for comfort measures, they don’t want to die in pain. Allow the medical professionals to guide you. Ask questions.

·       Food? Fluids?

At the end of life, the body has a process of its own as the systems shut down. It no longer needs food. It doesn't thirst. The mouth may need moistening. Oral care is still necessary. But if a dying person says they don’t want food or fluids- believe them. It’s hard to watch. You are still hungry. You are still thirsty. They are not. Honor their body and their needs. Forcing fluids can cause choking and even pneumonia, hastening death.

·       Visions supported

Many people who are dying will report that they are seeing loved ones who died before now, or angels.  Don’t question or deny that. There have been studies that say they may be caused by hypoxia or changes in brain chemistry. The studies, however, cannot include dying people. We don’t know this experience. We do know it’s common and brings comfort. Tell them you are glad they are there.

o   Your voice

The last sense to die is hearing. If your loved one would want you there, talk to them. To the end.  

o   Permission

This is most likely the hardest of all. No matter the disease or the pain, very few of us really want our loved one to really die. The fact is they are going to die. Tell them it’s ok. Tell them you’ll be ok; you’ll take care of business they left behind; you’ll carry their memory. Tell them what you will miss most and how much you loved them. But tell them they can go.

It’s not easy to sit while someone you love is dying. It’s a gift if you can.