On Death and Dying: My Personal Story
Something that people don’t want to deal with is confronting the fact that their parents are going to eventually die. In our culture we don’t encourage people to talk about death because we honor youth and vitality, not old age. Consequently, many people have never had a discussion with their parents about what happens when they are in place where their health fails, where they are not going to continue to live. Because we don’t think about or talk about what people’s wishes are, we are ill prepared to honor those needs and desires at end of our lives. The first time that I had that conversation with my parents was when we started to talk about the importance of having a health care directive. They were already in their 80’s but we had never discussed what they wanted. It was very clear from my discussion with my Dad upon filling out his healthcare directive paperwork, what his wishes were. One thing that he made very clear to me was that upon getting ill, if he found himself in the hospital, he wanted to make sure that there were no forms of artificial means used to sustain his life if he was going to die anyway. He wanted to be allowed to just die naturally. Here’s the tricky part, in a health care directive you are required to identify a person to act as your agent on your behalf if you are unable to communicate about your wishes. A person can identify someone or number of people to serve as their agents. In my case, my father decided to identify both my older sister and myself as the agents to fulfill his wishes and desires if he was unable to do so.
When my father shared with me that he had elected to identify both my sister and myself to serve as his agents, this initiated a whole different conversation between us. I asked him to please explain why he had decided to have both my sister and myself to be his agents on the health care directive. My Dad explained, true to his nature, that he thought this was the fairest way to deal with the responsibility and burden. My response to him questioned his decision in appointing two individuals who had never been able to make decisions without conflict. My mother was not a part of this conversation. I then said to my Dad that I thought that it was crucial that instead of doing what he thought was fair, he should evaluate which of his children would be able to execute his wishes without allowing their own emotions to get in the way. I pointed out to my father that he ought to reconsider his decision. I told him that I wasn’t willing to have my name equally involved with making decisions with my sister because that would cause conflict and would reduce my ability to act as his agent. I asked him to respectfully withdraw my name on the health care directive as his agent. This same issue was the case for both my parents. After my father thought about it he came back to me a couple of days later. He had decided it was in his best interest to just have me be on his directive and that’s how the situation was resolved.
Two years later, my father was diagnosed with late stage pancreatic cancer and was hospitalized. They attempted to do immediate surgery but the cancer was inoperable. While in the hospital his condition worsened, and a decision was required regarding honoring his desires to not have his life maintained artificially. I was required to pick the date and the time when his life would be stopped. What are the life lessons involved in this situation? I would say one is the importance of having that conversation ahead of time, before your parent becomes ill. The other take away is to encourage your parent to choose the right agent for the job. The third lesson is to not be afraid to talk to your parents about dying because it is natural and part of our life process. Make sure your parents have a current will and make sure you have a copy of a will. Yes it’s cheap and convenient to create online but you’re far better off getting an attorney to write your will if you are able. Also very critical is the documents that make up the advanced health care directive. This consists of several items and in most states the forms are readily available and free. Usually, these consist of a POLST or Physician’s Orders for Life Sustaining Treatment, a general power of attorney, and a health care directive that specifies wishes regarding health related scenarios.
If you are having family conflicts or struggles in caring for your aging loved ones, please give Dr. Davis a call. His personal experience in dealing with these issues helps to give him a unique and valuable perspective on the subject matter. He is recognized aging expert and gerontologist. His patient, kind and knowledgeable manner will immediately set you at ease.
I’ve just been talking to colleagues here in Marin County about helping to educate our community about anxiety, a problem that affects so many. Here is some information we’ve gathered to put on our local Psychological Association site to help everyone get a better understanding about anxiety.
Does this sound familiar? Many adult children caring for aging loved ones feel that tension and worry. They may also have penetrating, recurring thoughts. These recurring thoughts and worries can arise from day to day activities or specific events. Anxiety can physically manifest itself in symptoms like sweating, rapid heartbeat, dizziness, and trembling.
When these symptoms are extreme, a person might feel that she is suffering from a heart attack. Psychologists might call the more pronounced forms of anxiety a disorder that needs care and treatment. Those suffering from the more severe form of anxiety may find it challenging to accomplish even the simplest of tasks for fear that something bad may happen to them or the possibility that something might go wrong. They have trouble staying in the moment or living for now. They focus on the “what if” scenarios. They complain that they can’t turn off racing thoughts through the mind that evoke a sense of panic. Besides the negative emotional toll on the mind that anxiety can take, the physical residual effects are detrimental as well. Symptoms might include weight loss, weight gain, hair loss, and stomach discomfort, back or other pain.
Excessive, irrational fear and dread are hallmarks of a problem that can benefit greatly from treatment. The good news is that there are many good treatment options for anxiety. One treatment option that clinical psychologists offer is called cognitive behavioral therapy. This technique helps a person change the connection between specific thoughts and their irrational fear and dread. The ability to self-monitor one’s own thoughts can help the person gain control over their emotions. This directly aids in stopping the perpetuation of anxiety or depressive feelings.
In addition, psychologists help people learn breathing and relaxation techniques that can be used to eliminate, manage and assuage anxiety. In some cases especially when anxiety has been present in a patient’s life for many years, medications maybe the best way to provide rapid relieve of emotional symptoms. Newer anti-depressive mediations called selective serotonin reuptake inhibitors (SSRI’s) are often used as a first line of defense in the treatment of anxiety disorders. People often report experiencing less anxiety and improved mood from taking these medications within two to four weeks.
It is critical to understand that medications do not cure anxiety or anxiety depressive disorders. Professional treatment (“psychotherapy”) is needed to develop new coping methods, along with a deeper understanding of the complex workings of one’s mind. Once a person learns the techniques, successful alternative action strategies can assure and sustain ongoing changes for the better.
The heavy pressures of caring for aging parents in declining health, the rising demands on one’s time and the sadness of seeing a parent get worse over time can make anyone anxious. If the symptoms you are feeling are getting in the way of doing what you need to do in your life, don’t wait to get professional help. The problem is likely to only get worse over time.
Anxiety is often irrational and cannot be treated logically. Many people do not truly understand anxiety disorder, and think they can just will themselves to be cured. Or maybe the anxiety symptoms will just magically go away if they try to no longer think about them. Most people can’t cure themselves. There is no need to suffer when help from a professional can relieve the emotional pain. If these symptoms sound like what you are feeling, reach out. You can find a professional to help you through your local Mental Health Association or your insurance provider. Low cost services are available in many counties for those who do not have insurance or who are low income.
If your aging parent worries are getting you down and you need advice and support, contact me at firstname.lastname@example.org
Is Dad OK? What is clinical depression?
Clinical depression is the most common of mental conditions, which can be treated, but among elderly aging parents, it is one of the most overlooked. Sometimes, it’s because physicians don’t recognize the signs and symptoms. Sometimes it’s because of an overall attitude of society that perhaps feeling low is just part of getting old. The danger in overlooking clinical depression is twofold.
First, quality of life that could be improved isn’t, and unnecessary suffering goes on.
Second, the alarming fact of elder suicide looms. Clinical depression is both an emotional occurrence and a physical event. The physical component is triggered by brain chemistry, and can be helped.
Feeling low doesn’t have to be a permanent part of getting older. There are many elderly aging parents who are able to take aging in stride, and accept the many limitations that accompany getting along in years. Aging is frequently marked by losses. Loss of spouses, siblings and friends, as well as losses of physical strength and abilities can lead to sadness. The sadness associated with loss can often be lessened with time. But what if Dad, who lost his wife last year, just doesn’t seem to care about anything anymore? If more than a year has passed since loss of a spouse, and an aging parent still seems unable to move forward, it may to be time to see the doctor for a checkup.
If you are able to accompany Dad to the doctor, mention the problem specifically. Loss of enjoyment of things one normally likes is one of the symptoms of clinical depression. Other symptoms include feeling sad for extended periods, loss of appetite, sleeping too much or not enough, eating too much, difficulty making decisions, steady weight loss, or unusual weight gain, irritability, outbursts of temper which are not normal, and withdrawal from friends and family.
Clinical depression is one of the most treatable of all mental health problems. Many excellent medications can make a great difference in one’s mood and ability to participate in life. Counseling or talk therapy can also be a great help in managing feelings of loss and grief and in helping an aging parent to get through the grieving process.
If Dad is just not getting back to the way he was, and has an alarmingly long, ongoing period of sad mood and other symptoms, encourage him to see his doctor. Plan to go with him to be sure he doesn’t gloss over the problem. Many elders are unaccustomed to talking about their feelings. They may lack the basic vocabulary to describe them. The adult child can offer gentle assistance with this difficult area. If unchecked, clinical depression can become a downward spiral with no end. It can become worse and more miserable for the depressed person as time passes.
Addressing clinical depression in an aging parent can lead to relief, and improved quality of life. It is a loving act to suggest that the problem can be improved. It may take the initiative of a son or daughter to get help for Dad, but the effect of help if well worth your effort.
THE TEN RED FLAGS
Do you or a loved one experience any of these symptoms on a persistent basis?
1. Persistent feelings of sadness, hopelessness and emptiness
2. Feelings of worthlessness and guilt
3. Loss of interest in activities that used to be fun and rewarding
4. Lack of energy
5. Sleeping too much or too little,
6. Eating too much or too little
7. Poor concentration and focus
8. Irritability and restlessness
9. Persistent physical aches and pains, such as headaches, stomach problems
10. Wish to die or thoughts of suicide or self-harm
If you or a loved one experiences any of these symptoms, you should consider consulting with your physician and a mental health provider.
Dr. Mikol S. Davis, Psychologist
My Dad been gone a long time, but I always feel a little pang during my day. I miss him. My father was a complicated, brilliant, difficult, witty and amazingly brave person.
He had to be both parents a lot as my mother was mentally ill. He was the reason we weren’t all shipped off to orphanages. That’s whet they did in those days before foster care. They sent kids to a large place run by nuns who cared for them in a non-motherly way. I never had to go. He stayed with us through all the long stretches with no mom in the home.
As a teenager, I volunteered at that orphanage. I saw firsthand what I had escaped.
He encouraged me, put me through college, told me I could make it and convinced me that in spite of a tough upbringing, I could do what I dreamed of doing.
Raising six kids was not an easy thing for a man in those days. He had help at home, some good, some terrible. I have no idea how he kept going. Drinking didn’t solve his problems, but he escaped from them as much as one can with alcohol. You do pay a price for that kind of self-medication, don’t you? He died at age 65, not so much older than I am now.
I look at his life and see his strengths and his weaknesses realistically. I am more than glad for those strengths. He taught me that you can overcome anything and rise from the ashes as many times as it takes. I loved him deeply. We shared a wonderful adult, father-daughter closeness anyone would envy. He was my guide, my mentor, my coach and my personal adviser.
He died happy, knowing that I was happy, that I married a wonderful man (still married to him 28 years later), and that his little girl had grown up to be what she wanted. He saw me evolve from a nurse into a lawyer and cheered the metamorphosis. I will be grateful to him forever.
My father taught me courage in the face of difficulty, more than any other human being I have ever met. For that, I remember him as an honorable man. I long ago forgave his faults and shortcomings, choosing instead to focus on the good he did for me, for my mother, my siblings and for a lot of other people as well.
No matter what kind of a father you have or had, today is a day to think of the good in him.
Tonight, my kids and I will celebrate the evening together at dinner. We’ll have a toast to their terrific Dad and to my Dad. I will remind them of my father’s legacy of courage and strength and wish the same qualities for them in their young lives. He passed before they were born. I’ll tell them that if I can leave as powerful a legacy with them as he did with me, they are lucky kids indeed.
Wishing all the dads who read this the best of your Father’s Day. And for your families, may they appreciate all that is the best in you.
And now from Mikol:
It’s my third Father’s Day since I lost my dad Joe D. Davis.
It’s still a little sad, and nostalgic for me.
For those who may be having difficulty this Father’s Day, coping with a Dad who is changed because of aging, or you’ve recently lost a Dad, know that there are many resources to get the support you need. At AgingParents.com, we provide advice and help in person or by phone. We’re here for you and we want you feel in control when things feel out of control. Support is just a click away.
Until next time,
Carolyn Rosenblatt and Mikol Davis,
Have you ever found yourself feeling the blues and no matter what you try you just can’t feel right? So what can you do to cure the blues?
Well, how about the TV commercials that promise to fix those blues with a magic new pill? If you are a man then you are very unlikely to seek any form of professional help. Instead you will just try to tough it out, hoping that tomorrow will bring a better day. Yet for many of us, that better day does not seem to ever arrive. So then what can you do?
Well most of us will eventually go see our family doctor and believe that maybe there is something physically wrong that the good doctor has a pill to fix us right up. The doctor gives us checkup, asssures that there’s nothing physically wrong and suggests that you might want to see a psychologist. The doctor might refer you to someone, or might not.
So, you finally get around to the decision that the blues aren’t getting any better, you’re sick of feeling bad, and you make that leap to start looking for help. How does anyone know where to start? Most people who have insurance call their carrier to see if mental health help is covered and get a list of providers. At that point, they don’t know what to, what to ask, or how to pick someone. When you’ve got the blues, it’s already hard to make decisions, let alone this one!
As a provider of 37 years worth of mental health help for people of all ages, I suggest the following, should you find yourself in need of some help.
1. Figure out if you’d prefer a man or a woman. For some, it doesn’t matter. For others, they’re definitely more comfortable with one or the other and starting to look for a therapist of your preferred gender (or LGBT) is a place to start.
2. Find someone who is close in age to you, or older. Therapists who are of similar age to yourself may share some of your life experiences and understand you better. A very young therapist if you’re middle aged, for example, might not relate well to your descriptions of what you are going through in the context of where you are in your life.
3. Look for a goal oriented therapist. Too many therapists are happy to take your money, and be listeners, but the purpose of therapy can get lost. You’ve got to define why you’re there and what you hope to get out of the experience. Defining this for yourself is a first step. Therapy is not an exercise in just talking. The idea is to help you understand yourself better and make changes. The therapist who is right for you will be one who has the skill to lead and guide, rather than simply passively listen. You can buy a mannequin if you want a passive thing to appear to listen and nothing more. Get your money’s worth from your therapist! If there are no hard questions and no suggestions, you’re in the wrong place.
If you are in distress, spend some time working on finding the right person to help you get to a better feeling place and change the way you manage those emotions. Therapy can be a lifesaver. Yes, it’s work even finding a therapist, but it’s well worth the effort.