Writing, for me, is both a gift and a skill. It is a gift in the sense that it comes naturally. It is a skill in the sense that I have worked hard through the years to develop it.
As a writer, my greatest strength is using written words to clearly, thoroughly, and passionately communicate the message of an individual, group, or business. I listen carefully, research what experts in the field are saying, and then sculpt original material that leaves my clients saying, "That's exactly what I wanted to communicate, but I just didn't know how to write it."
I find tremendous personal satisfaction in writing content that becomes a tool my clients are able to use to propel them and their message forward. Whether that be in a best-selling book, a website, promotional brochures or any other number of written communication pieces...I can write it all.
Monday, March 29, 2010
Ed Gungor: On Death and Dying
PHYSICAL SIGNS OF A FAILING BODY
The Death and Dying Process
A Last Resort
I wish there were a place for gracious dying
A high place with a distant view
Where we could gather for a celebration
Of life and death and friendships, old and new.
I’d like a place where there would be good music
Good food and wine—and laughter, games and fun,
And quiet talk with friends, and good discussion
Of what will happen when this life is done…
-Helen Ansley At Age Ninety
When it comes right down to it, if we’re honest and willing to go there, most of us are at least a bit curious about the manner in which we will die. Many of us would even prefer to know specific details of our final moments. And, if we are caregivers for a terminally ill loved one, the more we know, the more equipped we feel to face each uncertain day. Because we have no role models to walk with us along death’s journey, no end-of-life midwife who has personally labored through the dying process, answers can be hard to come by. Many answers are simply beyond our grasp.
“Death,” it has been said, “belongs to the dying and to those who love them.” Just as in the birth of a new baby, the moment of death is such a beautifully intense event, that if an observer were to quiet himself long enough to listen to the unseen presence in the room, he would gain a glimpse into a grand celebration. The one who has died is the guest of honor and a great cloud of witnesses is the cheering section. Such thoughts are comforting, but they won’t wipe away every tear. Saying goodbye to someone we cherish is never easy.
Nurse practitioner Joan Furman who has devoted her entire career to providing care for the dying, as a young nurse had a near death experience. While in the hospital suffering with severe laryngitis, she was exposed to a lethal gas that caused her severely irritated throat to swell and her voicebox to close. She remembers feeling terrified, gasping for air, and then suddenly watching her own resuscitation efforts from the corner of the ceiling. Here’s how she describes the moment:
"My limp, unconscious body was on a hospital bed facing me, with two doctors and a nurse on my right side…I felt so at peace, so surrounded with love and safety that I had no desire to return to my body. In fact, I had a detached curiosity about it all. I liked it there at the corner of the ceiling…I understood with all of my being, not just intellectually, that I am more than my body. My body was a vehicle, and I had literally left. Being out of it produced less sentiment than trading in an old car."
Reentering her body, Joan felt tremendous fear, desperation for air, and wondered why it had to happen…why she had to go back. She soon thereafter recovered fully and chose to dismiss her experience as a hypoxic hallucination. It was only after similar stories began to emerge in medical journals that she allowed herself to trust what really happened. Now, absolutely convinced that life continues after the death of the body, Joan shares her story in hopes of easing the fears of her dying patients. She describes the process of death as a journey toward complete wholeness and permanent healing, something that we need not fear. Although for many, this is not the case.
American surgeon, author of How We Die, and professor of bioethics and medicine at Yale University School of Medicine, Sherwin Nuland, believes that our uniqueness in life extends to the way we die. As a physician, Nuland has witnessed countless deaths, each one happening in a distinct way. Some die suddenly and unexpectedly. Some die after a prolonged battle with a disease. Others, although it is technically unacceptable to label as such, simply die from old age. “Every one of death’s diverse appearances is as distinctive as that singular face we each show the world during the days of life.” Even in death, people hold true to their personalities. It is highly probable, therefore, that we will deal with our own dying just as we have handled all other challenges in life.
When we become familiar with the wide range of diseases and the innumerable outcomes of their ways, perhaps the dying progression will become less frightening and the decision-making process less “charged with half-knowledge, anxiety, and unjustified expectations.” Although we do not know the exact details of when and in what way death will occur, we have gained sufficient wisdom through observation to state with assurance that no one need enter his final moments with fear and pain . We do recognize the physical signs of impending death, but only God knows the specifics.
How Do We Die?
If we were to categorize death, the most simplistic way of doing it would be to say there are two kinds of death—a fast death or a slow death. Having a fatal accident or heart attack would result in a fast death when one is alive, then the next minute has died. A slow death happens after a prolonged battle with a terminal illness, or as a result of old age. Thomas Jefferson, at the age of seventy-one, wrote a letter to
John Adam who was seventy-eight at the time. The letter said, “But our machines have now been running seventy or eighty years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way; and however we may tinker them up for a while, all will at length surcease motion.”
There is not one system of the body that is immune to the aging process. Even cells with the capacity to rejuvenate gradually and eventually shut down. Medical advancements are tremendous, but many in the health care community, as Nuland says, “simply miss the point.” Scientists cannot eradicate the dying process; they can only prolong the inevitable.
In centuries past, people were accustomed to death because it visited them often. The general attitude was one of acceptance and ars moriendi or belief in the “art of dying.” During those days when symptoms appeared, the only choice was to simply let dying take it’s course and to do it in the best way possible—at peace with God. Physicians were ones who practiced the art of medicine, using their skills and knowledge to guide patients with dignity to their final breaths. Today, physicians in their rescue saving efforts have, by and large, lost touch with their limitations as mortals.
The philosophy of hospice care is different. Hospice workers emphasize dignity and do what they are able to alleviate pain, offering terminally ill patients the opportunity to live their final days to the fullest. Culturally, westerners are reluctant to talk openly about death, and are certainly reticent to accept a terminal report. It is a very uncomfortable subject because something in us wants to maintain control of our destiny. We value youth, beauty, competition and individuality. Death to us represents physical weakness, loss of power and uncertainty...none of which we appreciate. Our cultural bias interprets death as a failure.
Other more traditional cultures, however, treat death as an extension of living, bearing testimony of a well-lived life and as an opportunity to begin again. The dying are given space to resolve conflicts, to celebrate, to prepare for their final journey, and to acknowledge that their life had great meaning. Fortunately, hospice care has done a tremendous job in reshaping our ideas of the dying process and how one navigates it well. It is indeed possible to die well, if we so choose.
Barbara Karnes, an award-winning hospice nurse and end-of-life educator, is considered a hospice trailblazer in America. Having walked through the dying process with countless patients and even alongside her own parents, Barbara’s observations are now considered an authority when it comes to caring for terminally ill loved ones. Barbara teaches that dying a gradual death, whether from old age or from disease, is very similar to infant development. It happens gradually and with fairly predictable markers. Time plays an important role—death from old age usually takes longer than death from disease—but ultimately, the outward physical signs of the dying process are the same. A person dying of a disease may display such signs for months; whereas, a person dying of old age may display signs for years.
The Signs
With a terminal disease or old age, significant physical changes begin to develop one to three months prior to death. Such changes are often reflected by food intake, increased sleep and decreased social interaction. These three areas are fairly reliable indicators of the amount of time a person left.
The true reason we ingest food and water is to live. If our body is dying, it will have less and less need of either, so it naturally refuses both. One to three months prior to death, the body will begin weaning itself from food by rejecting proteins such as beef, chicken and fish. Next to go are fruits and vegetables. Eventually, the only kinds of food a dying person wants to eat are ice cream, puddings and cream soups. At the end, food will be rejected entirely. Upon entering this phase, death is only weeks away.
The final element to go is fluids. At this point, no bodily system is functioning as it should and is in the process of permanently shutting down. Many assume that dehydration is painful and causes significant suffering. This is a myth. When a person becomes dehydrated, calcium levels in the blood naturally rise. When calcium becomes too high, a person will simply close his eyes to sleep and not wake up. Most people, if given a choice, would prefer to die in their sleep. Excessive calcium in the blood allows that to happen. It is a God-given anesthetic that brings comfort to the dying and enables the process to occur painlessly.
Food and water connect us to the earth. By letting them go, the body is preparing to die. It no longer wants nourishment, hydration or the energy they provide. Naturally, it is very difficult to watch a loved one die of disease but to see him waste away from starvation or dehydration feels completely unacceptable. However, force-feeding and/or hydrating actually cause the dying process to become more complicated. The best response, no matter how emotionally difficult, is to simply let it happen. It is better for your loved one.
Increased sleep is a second indicator as to where a person is in the dying process. It begins with the addition of an afternoon nap and soon progresses to both an afternoon and morning nap. Then, the dying person naps in the morning, afternoon, evening and all through the night. Eventually he is asleep more than awake and becomes non-responsive. Because he is sleeping around the clock, it is very easy for him to become confused and disoriented, unable to distinguish between reality and the dream world. It is not uncommon for him to talk about things unfamiliar to us…people and places from his dream world.
The third indicator, social withdrawal, occurs two to four months prior to death. The dying person becomes disinterested in the outside world, from current events, sports, etc. This disinterest then turns into a withdrawal from people—refusing to see visitors and limiting interaction with family or close friends. It is as if the dying person is loosening his ties to the people in his life in order to move toward a new home in eternity. It is also likely he is doing this to protect himself from the emotional pain of saying goodbye. In his final weeks, he may even become antagonistic and push people away so “it won’t hurt so much.”
Sometimes it is helpful to read how more traditional cultures view the dying process. Although we do not adhere to Buddhist teaching, it does offer an interesting perspective as to how the body gradually shuts down.
The Labor of Dying
The process of dying is often compared to the labor women endure when bringing a new baby into the world. There is no magical length to the birthing process, nor is there with dying. Some women have quick labors; others may labor for a day and a half. “So it is with the labor to leave this world. Some of us get out of our bodies more easily than others.”
Labor to leave our bodies usually takes one to three weeks. Some of the signs that your loved one is in labor are: he sleeps with his eyes partially open rather than closed (keeping eyelids closed or open requires energy); his breathing patterns change (also known as start and stop breathing); when resting, he puffs by blowing air out through his lips; he becomes restless and picks at his clothing or sheets (a sign of fear); his body may develop a fever or become cold and clammy; mottling sets in (bluish black discoloration of the hands and feet that progresses to a ring around the knees, often with splotches across the back); incontinence or loss of bladder and bowels; and non-responsiveness.
Fear, pain and unfinished business make it much more difficult for a person to die peacefully. Fear can create tension and extend one’s dying process, as can unresolved conflicts or guilt. All of these are like ropes tying our loved one to the earth and prolonging his labor. Physical pain locks up the body and does not allow the dying to relax. By alleviating pain, your loved one is able to simply rest and let go.
There is no need to worry about drug addiction when a terminally ill patient is taking strong dosages of narcotics for pain relief. It simply is best to take medications on a regular schedule, rather than wait until pain becomes severe and very challenging to get back under control. It is much more difficult to manage this way. We gain nothing by waiting and it is unnecessary to suffer when medicine is available.
In the final sacred moments of dying, your loved one will be breathing very slowly. He will be non-responsive and his eyes will be partially open. His arm or shoulder may slowly move. He may make a frown. These small movements are usually followed by one or two long breaths. It may seem as if there will be more breathing, but then he will gasp and let out one or two final breaths, expelling the last bit of air in his lungs. And, then the end has come.
In the twenty-four to thirty-six hours prior to death, after days of labor, for no known reason, your loved one may appear to temporarily recover or rally. He may wake up with energy, request food, receive visitors, and seem to be doing much better. Then, his time to die comes and the hopefulness that he has recovered is gone. No one can explain why this happens. We can only contemplate. Perhaps it is God’s way of allowing us to have a few final good days together to say the things we need to say, and to remind ourselves that the path of death leads to a new day and complete wholeness.
Walking through the painful process of watching a loved one age or battle a terminal illness is undeniably heartbreaking. Yet, in the midst of the natural emotions associated with dying, “remember, the dying process is an inevitable and largely passive one. Massive intervention at the eleventh hour will only prolong a physically and emotionally painful process. It may eke out a few extra hours or even days of suffering for your loved one, but the end will be no different.” Each person ought to have the opportunity to die well and with dignity. The more we know about the process, the more likely we will be able to achieve that end. When we clearly understand the signs, wise decisions will help us make the very most out of the time remaining…a gift to our loved one and to ourselves.
Summary of the Death and Dying Process
Timeframe: Physical Stages of Dying
One to Three Months Prior to Death
• Withdrawal from the world and from people
• Decreased food intake
• Increased sleep
• Going inside self
• Less communication
One to Two Week Prior to Death
• Disorientation
• Agitation
• Talking with Unseen
• Confusion
• Picking at Clothes
• Physical Changes
1. Decreased blood pressure
2. Pulse increase or decrease
3. Color changes; pale, bluish
4. Increased perspiration
5. Respiratory irregularities
6. Congestion
7. Sleeping but responding
8. Complaints of body feeling tired and heavy
9. Not eating, but taking few fluids
10. Fluctuating body temperature hot/cold
Days or Hours Prior to Death
• Intensification of 1-2 week signs
• Surge of energy
• Decrease in blood pressure
• Eyes glassy, tearing, half open
• Irregular breathing, stop/start
• Restlessness or no activity
• Purplish knees, feet, hands, blotchy
• Pulse weak and hard to find
• Decreased urine output
• May wet or soil the bed
Minutes Prior to Death
• Fish out of water breathing
• Cannot be awakened
The Death and Dying Process
A Last Resort
I wish there were a place for gracious dying
A high place with a distant view
Where we could gather for a celebration
Of life and death and friendships, old and new.
I’d like a place where there would be good music
Good food and wine—and laughter, games and fun,
And quiet talk with friends, and good discussion
Of what will happen when this life is done…
-Helen Ansley At Age Ninety
When it comes right down to it, if we’re honest and willing to go there, most of us are at least a bit curious about the manner in which we will die. Many of us would even prefer to know specific details of our final moments. And, if we are caregivers for a terminally ill loved one, the more we know, the more equipped we feel to face each uncertain day. Because we have no role models to walk with us along death’s journey, no end-of-life midwife who has personally labored through the dying process, answers can be hard to come by. Many answers are simply beyond our grasp.
“Death,” it has been said, “belongs to the dying and to those who love them.” Just as in the birth of a new baby, the moment of death is such a beautifully intense event, that if an observer were to quiet himself long enough to listen to the unseen presence in the room, he would gain a glimpse into a grand celebration. The one who has died is the guest of honor and a great cloud of witnesses is the cheering section. Such thoughts are comforting, but they won’t wipe away every tear. Saying goodbye to someone we cherish is never easy.
Nurse practitioner Joan Furman who has devoted her entire career to providing care for the dying, as a young nurse had a near death experience. While in the hospital suffering with severe laryngitis, she was exposed to a lethal gas that caused her severely irritated throat to swell and her voicebox to close. She remembers feeling terrified, gasping for air, and then suddenly watching her own resuscitation efforts from the corner of the ceiling. Here’s how she describes the moment:
"My limp, unconscious body was on a hospital bed facing me, with two doctors and a nurse on my right side…I felt so at peace, so surrounded with love and safety that I had no desire to return to my body. In fact, I had a detached curiosity about it all. I liked it there at the corner of the ceiling…I understood with all of my being, not just intellectually, that I am more than my body. My body was a vehicle, and I had literally left. Being out of it produced less sentiment than trading in an old car."
Reentering her body, Joan felt tremendous fear, desperation for air, and wondered why it had to happen…why she had to go back. She soon thereafter recovered fully and chose to dismiss her experience as a hypoxic hallucination. It was only after similar stories began to emerge in medical journals that she allowed herself to trust what really happened. Now, absolutely convinced that life continues after the death of the body, Joan shares her story in hopes of easing the fears of her dying patients. She describes the process of death as a journey toward complete wholeness and permanent healing, something that we need not fear. Although for many, this is not the case.
American surgeon, author of How We Die, and professor of bioethics and medicine at Yale University School of Medicine, Sherwin Nuland, believes that our uniqueness in life extends to the way we die. As a physician, Nuland has witnessed countless deaths, each one happening in a distinct way. Some die suddenly and unexpectedly. Some die after a prolonged battle with a disease. Others, although it is technically unacceptable to label as such, simply die from old age. “Every one of death’s diverse appearances is as distinctive as that singular face we each show the world during the days of life.” Even in death, people hold true to their personalities. It is highly probable, therefore, that we will deal with our own dying just as we have handled all other challenges in life.
When we become familiar with the wide range of diseases and the innumerable outcomes of their ways, perhaps the dying progression will become less frightening and the decision-making process less “charged with half-knowledge, anxiety, and unjustified expectations.” Although we do not know the exact details of when and in what way death will occur, we have gained sufficient wisdom through observation to state with assurance that no one need enter his final moments with fear and pain . We do recognize the physical signs of impending death, but only God knows the specifics.
How Do We Die?
If we were to categorize death, the most simplistic way of doing it would be to say there are two kinds of death—a fast death or a slow death. Having a fatal accident or heart attack would result in a fast death when one is alive, then the next minute has died. A slow death happens after a prolonged battle with a terminal illness, or as a result of old age. Thomas Jefferson, at the age of seventy-one, wrote a letter to
John Adam who was seventy-eight at the time. The letter said, “But our machines have now been running seventy or eighty years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way; and however we may tinker them up for a while, all will at length surcease motion.”
There is not one system of the body that is immune to the aging process. Even cells with the capacity to rejuvenate gradually and eventually shut down. Medical advancements are tremendous, but many in the health care community, as Nuland says, “simply miss the point.” Scientists cannot eradicate the dying process; they can only prolong the inevitable.
In centuries past, people were accustomed to death because it visited them often. The general attitude was one of acceptance and ars moriendi or belief in the “art of dying.” During those days when symptoms appeared, the only choice was to simply let dying take it’s course and to do it in the best way possible—at peace with God. Physicians were ones who practiced the art of medicine, using their skills and knowledge to guide patients with dignity to their final breaths. Today, physicians in their rescue saving efforts have, by and large, lost touch with their limitations as mortals.
The philosophy of hospice care is different. Hospice workers emphasize dignity and do what they are able to alleviate pain, offering terminally ill patients the opportunity to live their final days to the fullest. Culturally, westerners are reluctant to talk openly about death, and are certainly reticent to accept a terminal report. It is a very uncomfortable subject because something in us wants to maintain control of our destiny. We value youth, beauty, competition and individuality. Death to us represents physical weakness, loss of power and uncertainty...none of which we appreciate. Our cultural bias interprets death as a failure.
Other more traditional cultures, however, treat death as an extension of living, bearing testimony of a well-lived life and as an opportunity to begin again. The dying are given space to resolve conflicts, to celebrate, to prepare for their final journey, and to acknowledge that their life had great meaning. Fortunately, hospice care has done a tremendous job in reshaping our ideas of the dying process and how one navigates it well. It is indeed possible to die well, if we so choose.
Barbara Karnes, an award-winning hospice nurse and end-of-life educator, is considered a hospice trailblazer in America. Having walked through the dying process with countless patients and even alongside her own parents, Barbara’s observations are now considered an authority when it comes to caring for terminally ill loved ones. Barbara teaches that dying a gradual death, whether from old age or from disease, is very similar to infant development. It happens gradually and with fairly predictable markers. Time plays an important role—death from old age usually takes longer than death from disease—but ultimately, the outward physical signs of the dying process are the same. A person dying of a disease may display such signs for months; whereas, a person dying of old age may display signs for years.
The Signs
With a terminal disease or old age, significant physical changes begin to develop one to three months prior to death. Such changes are often reflected by food intake, increased sleep and decreased social interaction. These three areas are fairly reliable indicators of the amount of time a person left.
The true reason we ingest food and water is to live. If our body is dying, it will have less and less need of either, so it naturally refuses both. One to three months prior to death, the body will begin weaning itself from food by rejecting proteins such as beef, chicken and fish. Next to go are fruits and vegetables. Eventually, the only kinds of food a dying person wants to eat are ice cream, puddings and cream soups. At the end, food will be rejected entirely. Upon entering this phase, death is only weeks away.
The final element to go is fluids. At this point, no bodily system is functioning as it should and is in the process of permanently shutting down. Many assume that dehydration is painful and causes significant suffering. This is a myth. When a person becomes dehydrated, calcium levels in the blood naturally rise. When calcium becomes too high, a person will simply close his eyes to sleep and not wake up. Most people, if given a choice, would prefer to die in their sleep. Excessive calcium in the blood allows that to happen. It is a God-given anesthetic that brings comfort to the dying and enables the process to occur painlessly.
Food and water connect us to the earth. By letting them go, the body is preparing to die. It no longer wants nourishment, hydration or the energy they provide. Naturally, it is very difficult to watch a loved one die of disease but to see him waste away from starvation or dehydration feels completely unacceptable. However, force-feeding and/or hydrating actually cause the dying process to become more complicated. The best response, no matter how emotionally difficult, is to simply let it happen. It is better for your loved one.
Increased sleep is a second indicator as to where a person is in the dying process. It begins with the addition of an afternoon nap and soon progresses to both an afternoon and morning nap. Then, the dying person naps in the morning, afternoon, evening and all through the night. Eventually he is asleep more than awake and becomes non-responsive. Because he is sleeping around the clock, it is very easy for him to become confused and disoriented, unable to distinguish between reality and the dream world. It is not uncommon for him to talk about things unfamiliar to us…people and places from his dream world.
The third indicator, social withdrawal, occurs two to four months prior to death. The dying person becomes disinterested in the outside world, from current events, sports, etc. This disinterest then turns into a withdrawal from people—refusing to see visitors and limiting interaction with family or close friends. It is as if the dying person is loosening his ties to the people in his life in order to move toward a new home in eternity. It is also likely he is doing this to protect himself from the emotional pain of saying goodbye. In his final weeks, he may even become antagonistic and push people away so “it won’t hurt so much.”
Sometimes it is helpful to read how more traditional cultures view the dying process. Although we do not adhere to Buddhist teaching, it does offer an interesting perspective as to how the body gradually shuts down.
The Labor of Dying
The process of dying is often compared to the labor women endure when bringing a new baby into the world. There is no magical length to the birthing process, nor is there with dying. Some women have quick labors; others may labor for a day and a half. “So it is with the labor to leave this world. Some of us get out of our bodies more easily than others.”
Labor to leave our bodies usually takes one to three weeks. Some of the signs that your loved one is in labor are: he sleeps with his eyes partially open rather than closed (keeping eyelids closed or open requires energy); his breathing patterns change (also known as start and stop breathing); when resting, he puffs by blowing air out through his lips; he becomes restless and picks at his clothing or sheets (a sign of fear); his body may develop a fever or become cold and clammy; mottling sets in (bluish black discoloration of the hands and feet that progresses to a ring around the knees, often with splotches across the back); incontinence or loss of bladder and bowels; and non-responsiveness.
Fear, pain and unfinished business make it much more difficult for a person to die peacefully. Fear can create tension and extend one’s dying process, as can unresolved conflicts or guilt. All of these are like ropes tying our loved one to the earth and prolonging his labor. Physical pain locks up the body and does not allow the dying to relax. By alleviating pain, your loved one is able to simply rest and let go.
There is no need to worry about drug addiction when a terminally ill patient is taking strong dosages of narcotics for pain relief. It simply is best to take medications on a regular schedule, rather than wait until pain becomes severe and very challenging to get back under control. It is much more difficult to manage this way. We gain nothing by waiting and it is unnecessary to suffer when medicine is available.
In the final sacred moments of dying, your loved one will be breathing very slowly. He will be non-responsive and his eyes will be partially open. His arm or shoulder may slowly move. He may make a frown. These small movements are usually followed by one or two long breaths. It may seem as if there will be more breathing, but then he will gasp and let out one or two final breaths, expelling the last bit of air in his lungs. And, then the end has come.
In the twenty-four to thirty-six hours prior to death, after days of labor, for no known reason, your loved one may appear to temporarily recover or rally. He may wake up with energy, request food, receive visitors, and seem to be doing much better. Then, his time to die comes and the hopefulness that he has recovered is gone. No one can explain why this happens. We can only contemplate. Perhaps it is God’s way of allowing us to have a few final good days together to say the things we need to say, and to remind ourselves that the path of death leads to a new day and complete wholeness.
Walking through the painful process of watching a loved one age or battle a terminal illness is undeniably heartbreaking. Yet, in the midst of the natural emotions associated with dying, “remember, the dying process is an inevitable and largely passive one. Massive intervention at the eleventh hour will only prolong a physically and emotionally painful process. It may eke out a few extra hours or even days of suffering for your loved one, but the end will be no different.” Each person ought to have the opportunity to die well and with dignity. The more we know about the process, the more likely we will be able to achieve that end. When we clearly understand the signs, wise decisions will help us make the very most out of the time remaining…a gift to our loved one and to ourselves.
Summary of the Death and Dying Process
Timeframe: Physical Stages of Dying
One to Three Months Prior to Death
• Withdrawal from the world and from people
• Decreased food intake
• Increased sleep
• Going inside self
• Less communication
One to Two Week Prior to Death
• Disorientation
• Agitation
• Talking with Unseen
• Confusion
• Picking at Clothes
• Physical Changes
1. Decreased blood pressure
2. Pulse increase or decrease
3. Color changes; pale, bluish
4. Increased perspiration
5. Respiratory irregularities
6. Congestion
7. Sleeping but responding
8. Complaints of body feeling tired and heavy
9. Not eating, but taking few fluids
10. Fluctuating body temperature hot/cold
Days or Hours Prior to Death
• Intensification of 1-2 week signs
• Surge of energy
• Decrease in blood pressure
• Eyes glassy, tearing, half open
• Irregular breathing, stop/start
• Restlessness or no activity
• Purplish knees, feet, hands, blotchy
• Pulse weak and hard to find
• Decreased urine output
• May wet or soil the bed
Minutes Prior to Death
• Fish out of water breathing
• Cannot be awakened
Ed Gungor: On Death and Dying
The Grief Paradigm
"I tell you the truth, you will weep and mourn
while the world rejoices.
You will grieve, but your grief will turn to joy.
A woman giving birth to a child has pain
because her time has come;
But when her baby is born she forgets the anguish
because of her joy that a child is born into the world.
So it is with you: Now is your time of grief,
but I will see you again and you will rejoice,
And no one will take away your joy."
John 16:20-22
A Time to Grieve
Grief is a difficult concept to comprehend because—far too simply put—it’s painful. We would prefer for it to pass by as quickly as possible, or better yet, be something more along the lines of a singular response to a loss followed by a short period of sadness. But, truth be told, grief is much more complex than that. It is as diverse as the people who bare it. It takes on many expressions and cannot always be contained in a small box of systematic phases. Rather, “grieving is the entire emotional process of coping with a loss, and can last a very long time.” It hurts.
Grief, according to scripture, is a part of the human experience. We come from the land of broken toys where we wear out, we break and we die. Loss is inevitable in our land, just as labor and delivery are inevitable to a woman full term with child. We labor through a dying process, we die, and then we, according to Christian belief, live again. This place of grieving between death and resurrection is a painful and lonely. Nevertheless, it is part of our journey. Each of us will walk through the “valley of the shadow of death” as we say goodbye to a loved one, and when we ourselves die. Yet, our hope in the midst of unwelcome grief is that our pain will one day carry us to a place of eternal and unquenchable joy…a joy no experience nor person can take from us.
Learning to grieve well is a life-long process, just as is persevering under hardship. Grieving well through a full spectrum of emotions requires gentleness and patience with our selves. We cannot expect pain to simply disappear overnight; it takes time. There is no single answer to our grief; nor is there only one way to grieve. We each process experiences differently. The common denominator though is that every one of us needs support and understanding. Attempting to go at it alone and unprepared will only prolong the process. Grief can be a very lonely road, so we need to know our loved ones are with us. And, it’s helpful to seek out knowledgeable professionals who are able to provide information and definition to our experience. These two positive elements create an environment for us to grieve well.
To clarify, it’s important to note that the terms grief, mourning and bereavement are often used interchangeably; however, each has a different meaning. Grief is one’s inner and personal experience of and response to loss. Mourning is the outward expression of that grief, in addition to cultural and religious customs and rituals surrounding death. Mourning is also defined as the process of adapting to loss and adjusting to the death of a significant person. Bereavement refers to the state of having suffered a loss and to the experiences that follow the death of a loved one. It is the time after a loss during which the person experiences grief and exhibits mourning.
Grief is a “process that occurs over time and involves a wide range of emotions, as well as thoughts, behaviors and physical sensations.” It is normal to feel “a sense of shock, emotional numbness, sadness, despair, anxiety, guilt, loneliness, helplessness, relief and yearning.” Grief affects our entire being. It would not be unusual to think that our terminal news is inaccurate, that it couldn’t possibly be happening. Or, to feel confused, disoriented, have trouble concentrating, or even temporarily think you are “going crazy.” Tightness in the chest and/or throat, nausea, dizziness, fatigue, vulnerability, trouble sleeping, uncomfortable in social settings, irritability, aggressiveness, restlessness, lack of interest in everyday affairs…all of these are very normal responses to a loss.
The Lance Armstrong Foundation, www.livestrong.org, provides an informative perspective on the concept of loss and how it affects our whole persons. Losses impact our physical bodies, our emotions, our relationships and well as, in practical terms, our finances. Such losses are spelled out in the following chart:
Physical Losses
• A part of your body or a body function
• Changes in your ability to have sex
• Energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
Emotional Losses
• Sense of security (in your health, in your future)
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Goals, hopes or dreams
• Faith or spirituality
• Your sense of life as safe and predictable
• Habits, such as changes in daily routines, or life “the way it used to be”
Social and Relationship Losses
• Relationships with friends, family members or co-workers
• Sexual relationships
• Your ability to have your own biological child
• Loss of certain roles (For example, you can no longer earn money for your family, or you can no longer prepare all of the family meals.)
• Loss of other terminal friends
Financial Losses
• Job or job opportunities
• Financial security
• Insurance
• Ability to work
Throughout the remaining pages of this chapter, we will focus our attention on the term grief as it relates to our inner and personal experiences as patients responding to a terminal diagnosis. It is our hope that these honest, although painful, discussions will enable us to navigate through our final acts of living with dignity, peace and hope.
Elisabeth Kubler-Ross
A handful of researchers over the past 50 years or so have helped to define grief. They have given words to our experience by collecting and categorizing common responses to tragic personal loss…responses that are as innate to human beings as breathing.
Perhaps the most well known thanatologist, Elisabeth Kubler-Ross, in 1969 published a book titled On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. The book is a collection of research that Kubler-Ross and four theological students gathered by observing and interviewing terminally ill patients. From this research, she developed a five stage grieving paradigm, which articulates common occurrences of terminally ill patients. It also clearly communicates how other tragic personal losses—the untimely loss of a job, a divorce, drug addiction, etc.—can create instances where grief is present.
After hundreds of conversations with terminally ill people, Kubler-Ross noted five phases of grief that were frequent among the patients:
1. Stage One: Denial and Isolation
2. Stage Two: Anger
3. Stage Three: Bargaining
4. Stage Four: Depression
5. Stage Five Acceptance
These phases, she claimed, do not necessarily occur in the order listed, nor are all of the stages encountered by every patient. However, according to her observations, each patient will at the very least go through two of these stages at some point in his journey. “Often, people will experience several stages in a ‘roller coaster’ effect, switching between two or more stages, returning to one or more several times before working through it.”
Kubler-Ross described these five phases of grief as “coping mechanisms” that commonly overlap as we manage our loss. This process is a highly personal matter; therefore, words such as “you should be over this by now” or “you’re taking too long,” or “you haven’t waited long enough” ought to be cautiously and meticulously avoided. We should never feel pressured to progress through the grieving stages in a set amount of time based upon another’s opinion of what is or is not satisfactory. Instead, we need to hear words of hope—even with a terminal diagnosis—that it is possible to live to our last day with purpose and significance. Such hopefulness is the very thing that will sustain us through prolonged suffering.
The ultimate goal in the grieving process is to move into a place of peaceful acceptance of our terminal condition. This requires energy and labor. By letting go and allowing a shift to take place in our hearts and minds, we will be able redirect our energies from the struggle to survive to our struggle to end well.
Stage One: Denial and Isolation
When we first receive the news that without a miracle we will die, it is quite common to respond with “That’s impossible. You can’t be talking about ME! It cannot be true.” Kubler-Ross terms this universal reaction to devastating news the Denial and Isolation phase. Almost all patients from time to time use denial as a coping mechanism. Just as we do not have the ability to gaze at the sun for long periods without damaging our eyes, we also cannot spend every moment of every day facing death. Denial acts as a shock absorber and provides space for us to gather ourselves so that, in time, we are able to respond appropriately. We all occasionally need a break where we are able to contemplate more cheerful things, to daydream about happier places and unlikely aspirations. It just helps.
While in denial, some of us may put on a happy face to disguise our growing depression. We may briefly talk about our situation, but then abruptly change the subject. Every terminal patient at times needs denial to cope, particularly at the beginning when numbness sets in. Ultimately, though, this numbness will fade and we will begin to recuperate from the shock in order to move towards embracing our diagnosis. It helps to face our fear of death “when it is still miles away” rather than “when it is right in front of the door.”
Stage Two: Anger
Denial for the majority of people will eventually turn into anger. After questioning how this terminal illness is possible, the most natural question to ask next is “Why me?” followed by, “Why couldn’t it have been someone else?”
Anger is usually quite difficult for family members, close friends and health care providers to understand. Such individuals are frequently on the receiving end of our bursts of anger. When released, we direct our anger at the ones closest to us. It sprays out unexpectedly, like a machine gun firing in all directions without a specific target. “This doctor is no good! The treatment isn’t doing what it’s supposed to do! The nurses are lazy! Can’t they see I’m in pain here?” Every little thing makes us want to explode internally and externally for no apparent reason. Everywhere we look, we find aggravations and something to complain about.
No one is perfect. That being said, what we as terminally ill patients need most from our loved ones and caregivers when passing through our struggles with anger, is for them to remember that what we are really angry about is our sickness, not them. We need multitudes of grace because what we’re experiencing is the most difficult battle of our lives. Considerate loved ones will try to put themselves in our shoes for a time, and then perhaps understand the source of our anger. They’d be angry, too, if their plans were permanently interrupted; or, if all of their dreams for the future would never be possible. They’d also be angry if the rest of the world just seemed to carry on without them as if they had already died…but they hadn’t.
We know our anger is often irrational but by allowing us to express it, we will eventually calm down. When we receive kindness, respect and attention we feel understood and significant—still human beings who just happen to be living inside a body with a terminal sickness. Anger is a natural part of our journey.
Stage Three: Bargaining
Anger eventually will give way to a third coping mechanism called bargaining. This stage is helpful because it allows us to temporarily evade reality…but only for short periods of time. Otherwise, if prolonged, bargaining can become unhealthy to our souls. This phase comes after we have told ourselves that it is impossible for us to be terminal and after our bouts with anger…when reality has settled in. In this phase, we are very much like a child bargaining with his parents who have denied a wish. After a couple failed attempts to persuade them to change their minds, a child may rethink his strategy and try another way, such as make promises to change or to do more.
As a patient who uses bargaining, we may say something like, “If God has decided to take me from this earth and he did not respond to my angry pleas, he may be more favorable if I ask nicely.” The rationale becomes a hope that if we enter into some sort of private agreement with God that he will perhaps postpone the inevitable. Bargaining is a tactic we know is farfetched but we do it anyway, hoping to be rewarded for good behavior, granted an extension of life or a few days without pain.
From a spiritual standpoint, bargaining may be a red flag needed to draw attention to unresolved guilt in our lives. Because we view dying through the lenses of a Biblical worldview, sin, we believe, is the root cause of our death. In order to live again, we must confront it through the cross and repentance. Whether we recognize it as such, bargaining conversations with God may actually be pleas for forgiveness, in which case, a prayer like the following just may be of help:
"Jesus, something in me is nudging me to say YES to you. I want to do that. The Bible says that if I declare you as the one in charge of my life—as Lord of my life—then help from heaven will come—that I will be “saved.” I’m so open to that. Jesus, be my Lord—right here, right now, over my current set of circumstances—be my Lord. Forgive me of my sin. Cleanse me from the pursuits that I know are wrong. I surrender to you and welcome you into my life. I am yours!"
By properly addressing matters of the heart where guilt frequently buries itself, many people have been able to pass through quickly or avoid altogether the next phase, which is depression.
Stage Four: Depression
Once we have waited unsuccessfully for an answer to our bargaining pleas, when we have undergone an additional surgery or hospital stay, or when our symptoms intensify and we grow weaker, smiling is more difficult. Denial, anger and bargaining are replaced by “a sense of great loss.”
Depression, according to Elizabeth Kubler-Ross, comes in two packages: reactive depression and preparatory depression. Reactive depression is an immediate response to a past loss. A woman lost her breasts to cancer and wonders if she is as much a woman as prior to surgery. A man lost his leg in a hit-and-run accident and wonders how he will ever function normally again. A woman caring for her ailing husband reenters the workforce and grieves that her children will no longer have her best hours of attention each day. These are all examples of reactive depression—a response to a loss from a past event. The source of reactive depression is usually obvious to a considerate health care provider, friend or family member who takes time to listen. Such a person can help alleviate guilt or wrong thinking that often accompanies depression, by speaking words of objective truth or by doing small practical things to remove one’s need to worry. Elizabeth Kubler-Ross says this about how to respond reactive depression:
Our initial reaction to sad people is usually to try to cheer them up, to tell them not to look at things so grimly or so hopelessly. We encourage them to look at the bright side of life, at all the colorful, positive things around them. This is often an expression of our own needs, our own inability to tolerate a long face over an extended period of time. This can be a useful approach when dealing with the first type of depression in terminally ill patients. It will help such a mother to know that the children play quite happily in the neighbor’s garden since they stay there while their father is at work. It may help a mother to know that they continue to laugh and joke, go to parties, and bring good report cards home form school—all expressions that they function in spite of mother’s absence.
Preparatory depression is different than reactive depression. It “is one which does not occur as a result of a past loss but is taking into account impending losses.” With this kind of depression, the emotions experienced are actually tools that we use to help move us into acceptance. This kind of depression is necessary and has the capacity to spare everyone greeting an impending loss, a tremendous amount of needless suffering.
When in a state of preparatory depression, it is better that our loved ones and health care providers refrain from trying to get us to look for the silver lining in our clouds. This kind of diversion takes us away from contemplating our coming death, which we need to do. Just as it would be considered inappropriate to urge a grieving son or daughter to see the positive in his or her parent’s passing, it is equally inconsiderate to urge a terminally ill patient to focus on the bright side of things. We need this phase of depression to help carry us through the full grieving cycle and on to a place of acceptance.
Preparatory depression is a time when we are grieving the loss of everyone and everything we cherish. By allowing us to express our sadness in the manner in which we choose, the burden becomes lighter for us. We are grateful to those who will be with us, listen to our words or allow us to sit quietly for extended periods of time. When silent, we are processing our experiences internally, so please refrain from trying to cheer us up. Hold our hands, stroke our hair, pray for us and remember we are thinking primarily of the things to come, not necessarily the past. When you respect our wishes, you are helping to prepare us emotionally to die…and this graciousness is a priceless gift.
Stage Five: Acceptance
With support, we will eventually enter into a frame of mind that is neither angry nor depressed about our soon-coming end. Rather, we will have come to terms with the inevitable, and upon expressing our feelings and mourning the loss of everything meaningful in this life our contemplation will give way to what Kubler-Ross describes as “quiet expectation” or acceptance. Achieving this phase of grief is colossal.
Acceptance ought not be mistaken for happiness. If anything, it is a phase devoid of feeling for us. We have labored through the dying process and through the very painful stages of grief, and are now at a point where we’re ready to let go forever. As one patient shared, this is a time of “final rest before the long journey.” Things of this world matter very little now that we have released it all.
More importantly, at this point, focus ought to be redirected to our family members who are now in a position where they need support saying their goodbyes and contemplating life without us. It is very difficult for them to understand how our ease of dying is directly connected to our ability to disengage from significant bonds with those we care about most. This is why acceptance is so difficult for those left behind.
It is often a challenge for our health care providers and loved ones to know when to push us to keep fighting, and when to let us go. Dying wasn’t a part of the original plan, so we naturally resist it. We especially resist when we don’t want to say goodbye or admit defeat. There are those who fight for life until their last breaths. There are others who resign themselves to defeat even before a terminal diagnosis is given. Regardless, the day will eventually visit every one of us…for some, sooner than later. So, when the time does arrive for us to die, if we persist in the denial or anger phases, it will be only that more difficult to die peacefully. Acceptance is a gift from God that brings us back to the place where we first began...resting peacefully and comfortably in his hands.
Others on the Subject
The field of thanatology has developed significantly in recent years, beginning with Elizabeth Kubler-Ross—who provided a strong foundation upon which many others have built—and added to by individuals such as Bowlby and Parkes, Worden, and Wolfelt...to name a few.
In the 1980’s British psychiatrists John Bowlby, MD, and Colin Murray, MD reworked Kubler-Ross’ five stage grieving paradigm into a four stage cyclical grieving process. Those of us suffering a significant loss may successfully cycle through the stages, but then when a memory surfaces or we experience a trigger—a holiday, birthday, anniversary—we reenter the cycle once more. This can occur many times and unexpectedly.
Bowlby and Murray’s Four Phases include:
1. Initial phase: Shock and Disbelief
2. Second phase: Searching and Yearning
3. Third phase: Disorganization and Despair
4. Fourth phase: Rebuilding and Healing
Harvard Medical School psychotherapist and researcher, J. William Worden, PhD, who specializes in terminal illness, suicide and child bereavement, has created a list of four basic tasks for adapting to loss.
These tasks are:
1. Accepting reality of the loss
2. Experiencing the pain of grief
3. Adjusting to an environment in which the deceased is missing
4. Withdrawing emotional energy and investing it into another relationship.
According to Worden, walking through these four basic tasks is what will restore “equilibrium” and complete the cycle of bereavement. It is not necessary that these tasks occur in the order presented. Rather “they can be concurrent, cyclical, or overlapping, and we—the grieving ones—will work on them with much effort until regaining balance.”
Dr. Alan Wolfelt is the founder and director of the Center for Loss and Life Transition (Fr. Collins, CO) and is a well-known grief care provider and educator. He offers a postmodern take on grief: each individual grieves in a manner that is unique to him, and there is therefore little predictability or phases that fairly articulate a universal grieving experience. The griever, as was the case for Kubler-Ross and her team, is the teacher and the support-giver is the learner.
Final Thoughts on Grief
When it comes to grief and it’s affects on human beings, it truly is impossible to institutionalize, categorize and apply common thoughts to every person experiencing a tragic personal loss. There is just no “one shoe fits all” for this deal called grief. As different as each of us is, the ways in which we express our pain and move toward relief, vary even that much more.
For some strange reason, though, we often expect ourselves to grieve as the textbook explains or as a role model, like a parent, instructed us. If we each give a unique expression of our innate talents through work choices—and other examples are in abundance—then, at the very least, we can strongly expect to grieve distinctively.
It does help to hear from grief professionals that there are widespread experiences with sorrow that create common bonds and tie us together. What is still necessary though, according to Darcie D. Sims, co-founder and president of Grief Inc., is to “create a new language for grief…a language that speaks honestly of grief’s pain and crushing despair. We need a language that speaks of the painful promise and of the hope that is cast by the memory of love given and received. We need to create a language of HOPE…” Most importantly, we must learn to be patient with our selves and with each other. Grief is a life-long journey. We may never fully “get over” our losses, but we can rest assuredly that we will be comforted through them. There is an outstanding promise from God that one day our grief will be replaced with never-ending joy. We all have something wonderful to anticipate, and this is the true source of our hope.
"I tell you the truth, you will weep and mourn
while the world rejoices.
You will grieve, but your grief will turn to joy.
A woman giving birth to a child has pain
because her time has come;
But when her baby is born she forgets the anguish
because of her joy that a child is born into the world.
So it is with you: Now is your time of grief,
but I will see you again and you will rejoice,
And no one will take away your joy."
John 16:20-22
A Time to Grieve
Grief is a difficult concept to comprehend because—far too simply put—it’s painful. We would prefer for it to pass by as quickly as possible, or better yet, be something more along the lines of a singular response to a loss followed by a short period of sadness. But, truth be told, grief is much more complex than that. It is as diverse as the people who bare it. It takes on many expressions and cannot always be contained in a small box of systematic phases. Rather, “grieving is the entire emotional process of coping with a loss, and can last a very long time.” It hurts.
Grief, according to scripture, is a part of the human experience. We come from the land of broken toys where we wear out, we break and we die. Loss is inevitable in our land, just as labor and delivery are inevitable to a woman full term with child. We labor through a dying process, we die, and then we, according to Christian belief, live again. This place of grieving between death and resurrection is a painful and lonely. Nevertheless, it is part of our journey. Each of us will walk through the “valley of the shadow of death” as we say goodbye to a loved one, and when we ourselves die. Yet, our hope in the midst of unwelcome grief is that our pain will one day carry us to a place of eternal and unquenchable joy…a joy no experience nor person can take from us.
Learning to grieve well is a life-long process, just as is persevering under hardship. Grieving well through a full spectrum of emotions requires gentleness and patience with our selves. We cannot expect pain to simply disappear overnight; it takes time. There is no single answer to our grief; nor is there only one way to grieve. We each process experiences differently. The common denominator though is that every one of us needs support and understanding. Attempting to go at it alone and unprepared will only prolong the process. Grief can be a very lonely road, so we need to know our loved ones are with us. And, it’s helpful to seek out knowledgeable professionals who are able to provide information and definition to our experience. These two positive elements create an environment for us to grieve well.
To clarify, it’s important to note that the terms grief, mourning and bereavement are often used interchangeably; however, each has a different meaning. Grief is one’s inner and personal experience of and response to loss. Mourning is the outward expression of that grief, in addition to cultural and religious customs and rituals surrounding death. Mourning is also defined as the process of adapting to loss and adjusting to the death of a significant person. Bereavement refers to the state of having suffered a loss and to the experiences that follow the death of a loved one. It is the time after a loss during which the person experiences grief and exhibits mourning.
Grief is a “process that occurs over time and involves a wide range of emotions, as well as thoughts, behaviors and physical sensations.” It is normal to feel “a sense of shock, emotional numbness, sadness, despair, anxiety, guilt, loneliness, helplessness, relief and yearning.” Grief affects our entire being. It would not be unusual to think that our terminal news is inaccurate, that it couldn’t possibly be happening. Or, to feel confused, disoriented, have trouble concentrating, or even temporarily think you are “going crazy.” Tightness in the chest and/or throat, nausea, dizziness, fatigue, vulnerability, trouble sleeping, uncomfortable in social settings, irritability, aggressiveness, restlessness, lack of interest in everyday affairs…all of these are very normal responses to a loss.
The Lance Armstrong Foundation, www.livestrong.org, provides an informative perspective on the concept of loss and how it affects our whole persons. Losses impact our physical bodies, our emotions, our relationships and well as, in practical terms, our finances. Such losses are spelled out in the following chart:
Physical Losses
• A part of your body or a body function
• Changes in your ability to have sex
• Energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
Emotional Losses
• Sense of security (in your health, in your future)
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Goals, hopes or dreams
• Faith or spirituality
• Your sense of life as safe and predictable
• Habits, such as changes in daily routines, or life “the way it used to be”
Social and Relationship Losses
• Relationships with friends, family members or co-workers
• Sexual relationships
• Your ability to have your own biological child
• Loss of certain roles (For example, you can no longer earn money for your family, or you can no longer prepare all of the family meals.)
• Loss of other terminal friends
Financial Losses
• Job or job opportunities
• Financial security
• Insurance
• Ability to work
Throughout the remaining pages of this chapter, we will focus our attention on the term grief as it relates to our inner and personal experiences as patients responding to a terminal diagnosis. It is our hope that these honest, although painful, discussions will enable us to navigate through our final acts of living with dignity, peace and hope.
Elisabeth Kubler-Ross
A handful of researchers over the past 50 years or so have helped to define grief. They have given words to our experience by collecting and categorizing common responses to tragic personal loss…responses that are as innate to human beings as breathing.
Perhaps the most well known thanatologist, Elisabeth Kubler-Ross, in 1969 published a book titled On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. The book is a collection of research that Kubler-Ross and four theological students gathered by observing and interviewing terminally ill patients. From this research, she developed a five stage grieving paradigm, which articulates common occurrences of terminally ill patients. It also clearly communicates how other tragic personal losses—the untimely loss of a job, a divorce, drug addiction, etc.—can create instances where grief is present.
After hundreds of conversations with terminally ill people, Kubler-Ross noted five phases of grief that were frequent among the patients:
1. Stage One: Denial and Isolation
2. Stage Two: Anger
3. Stage Three: Bargaining
4. Stage Four: Depression
5. Stage Five Acceptance
These phases, she claimed, do not necessarily occur in the order listed, nor are all of the stages encountered by every patient. However, according to her observations, each patient will at the very least go through two of these stages at some point in his journey. “Often, people will experience several stages in a ‘roller coaster’ effect, switching between two or more stages, returning to one or more several times before working through it.”
Kubler-Ross described these five phases of grief as “coping mechanisms” that commonly overlap as we manage our loss. This process is a highly personal matter; therefore, words such as “you should be over this by now” or “you’re taking too long,” or “you haven’t waited long enough” ought to be cautiously and meticulously avoided. We should never feel pressured to progress through the grieving stages in a set amount of time based upon another’s opinion of what is or is not satisfactory. Instead, we need to hear words of hope—even with a terminal diagnosis—that it is possible to live to our last day with purpose and significance. Such hopefulness is the very thing that will sustain us through prolonged suffering.
The ultimate goal in the grieving process is to move into a place of peaceful acceptance of our terminal condition. This requires energy and labor. By letting go and allowing a shift to take place in our hearts and minds, we will be able redirect our energies from the struggle to survive to our struggle to end well.
Stage One: Denial and Isolation
When we first receive the news that without a miracle we will die, it is quite common to respond with “That’s impossible. You can’t be talking about ME! It cannot be true.” Kubler-Ross terms this universal reaction to devastating news the Denial and Isolation phase. Almost all patients from time to time use denial as a coping mechanism. Just as we do not have the ability to gaze at the sun for long periods without damaging our eyes, we also cannot spend every moment of every day facing death. Denial acts as a shock absorber and provides space for us to gather ourselves so that, in time, we are able to respond appropriately. We all occasionally need a break where we are able to contemplate more cheerful things, to daydream about happier places and unlikely aspirations. It just helps.
While in denial, some of us may put on a happy face to disguise our growing depression. We may briefly talk about our situation, but then abruptly change the subject. Every terminal patient at times needs denial to cope, particularly at the beginning when numbness sets in. Ultimately, though, this numbness will fade and we will begin to recuperate from the shock in order to move towards embracing our diagnosis. It helps to face our fear of death “when it is still miles away” rather than “when it is right in front of the door.”
Stage Two: Anger
Denial for the majority of people will eventually turn into anger. After questioning how this terminal illness is possible, the most natural question to ask next is “Why me?” followed by, “Why couldn’t it have been someone else?”
Anger is usually quite difficult for family members, close friends and health care providers to understand. Such individuals are frequently on the receiving end of our bursts of anger. When released, we direct our anger at the ones closest to us. It sprays out unexpectedly, like a machine gun firing in all directions without a specific target. “This doctor is no good! The treatment isn’t doing what it’s supposed to do! The nurses are lazy! Can’t they see I’m in pain here?” Every little thing makes us want to explode internally and externally for no apparent reason. Everywhere we look, we find aggravations and something to complain about.
No one is perfect. That being said, what we as terminally ill patients need most from our loved ones and caregivers when passing through our struggles with anger, is for them to remember that what we are really angry about is our sickness, not them. We need multitudes of grace because what we’re experiencing is the most difficult battle of our lives. Considerate loved ones will try to put themselves in our shoes for a time, and then perhaps understand the source of our anger. They’d be angry, too, if their plans were permanently interrupted; or, if all of their dreams for the future would never be possible. They’d also be angry if the rest of the world just seemed to carry on without them as if they had already died…but they hadn’t.
We know our anger is often irrational but by allowing us to express it, we will eventually calm down. When we receive kindness, respect and attention we feel understood and significant—still human beings who just happen to be living inside a body with a terminal sickness. Anger is a natural part of our journey.
Stage Three: Bargaining
Anger eventually will give way to a third coping mechanism called bargaining. This stage is helpful because it allows us to temporarily evade reality…but only for short periods of time. Otherwise, if prolonged, bargaining can become unhealthy to our souls. This phase comes after we have told ourselves that it is impossible for us to be terminal and after our bouts with anger…when reality has settled in. In this phase, we are very much like a child bargaining with his parents who have denied a wish. After a couple failed attempts to persuade them to change their minds, a child may rethink his strategy and try another way, such as make promises to change or to do more.
As a patient who uses bargaining, we may say something like, “If God has decided to take me from this earth and he did not respond to my angry pleas, he may be more favorable if I ask nicely.” The rationale becomes a hope that if we enter into some sort of private agreement with God that he will perhaps postpone the inevitable. Bargaining is a tactic we know is farfetched but we do it anyway, hoping to be rewarded for good behavior, granted an extension of life or a few days without pain.
From a spiritual standpoint, bargaining may be a red flag needed to draw attention to unresolved guilt in our lives. Because we view dying through the lenses of a Biblical worldview, sin, we believe, is the root cause of our death. In order to live again, we must confront it through the cross and repentance. Whether we recognize it as such, bargaining conversations with God may actually be pleas for forgiveness, in which case, a prayer like the following just may be of help:
"Jesus, something in me is nudging me to say YES to you. I want to do that. The Bible says that if I declare you as the one in charge of my life—as Lord of my life—then help from heaven will come—that I will be “saved.” I’m so open to that. Jesus, be my Lord—right here, right now, over my current set of circumstances—be my Lord. Forgive me of my sin. Cleanse me from the pursuits that I know are wrong. I surrender to you and welcome you into my life. I am yours!"
By properly addressing matters of the heart where guilt frequently buries itself, many people have been able to pass through quickly or avoid altogether the next phase, which is depression.
Stage Four: Depression
Once we have waited unsuccessfully for an answer to our bargaining pleas, when we have undergone an additional surgery or hospital stay, or when our symptoms intensify and we grow weaker, smiling is more difficult. Denial, anger and bargaining are replaced by “a sense of great loss.”
Depression, according to Elizabeth Kubler-Ross, comes in two packages: reactive depression and preparatory depression. Reactive depression is an immediate response to a past loss. A woman lost her breasts to cancer and wonders if she is as much a woman as prior to surgery. A man lost his leg in a hit-and-run accident and wonders how he will ever function normally again. A woman caring for her ailing husband reenters the workforce and grieves that her children will no longer have her best hours of attention each day. These are all examples of reactive depression—a response to a loss from a past event. The source of reactive depression is usually obvious to a considerate health care provider, friend or family member who takes time to listen. Such a person can help alleviate guilt or wrong thinking that often accompanies depression, by speaking words of objective truth or by doing small practical things to remove one’s need to worry. Elizabeth Kubler-Ross says this about how to respond reactive depression:
Our initial reaction to sad people is usually to try to cheer them up, to tell them not to look at things so grimly or so hopelessly. We encourage them to look at the bright side of life, at all the colorful, positive things around them. This is often an expression of our own needs, our own inability to tolerate a long face over an extended period of time. This can be a useful approach when dealing with the first type of depression in terminally ill patients. It will help such a mother to know that the children play quite happily in the neighbor’s garden since they stay there while their father is at work. It may help a mother to know that they continue to laugh and joke, go to parties, and bring good report cards home form school—all expressions that they function in spite of mother’s absence.
Preparatory depression is different than reactive depression. It “is one which does not occur as a result of a past loss but is taking into account impending losses.” With this kind of depression, the emotions experienced are actually tools that we use to help move us into acceptance. This kind of depression is necessary and has the capacity to spare everyone greeting an impending loss, a tremendous amount of needless suffering.
When in a state of preparatory depression, it is better that our loved ones and health care providers refrain from trying to get us to look for the silver lining in our clouds. This kind of diversion takes us away from contemplating our coming death, which we need to do. Just as it would be considered inappropriate to urge a grieving son or daughter to see the positive in his or her parent’s passing, it is equally inconsiderate to urge a terminally ill patient to focus on the bright side of things. We need this phase of depression to help carry us through the full grieving cycle and on to a place of acceptance.
Preparatory depression is a time when we are grieving the loss of everyone and everything we cherish. By allowing us to express our sadness in the manner in which we choose, the burden becomes lighter for us. We are grateful to those who will be with us, listen to our words or allow us to sit quietly for extended periods of time. When silent, we are processing our experiences internally, so please refrain from trying to cheer us up. Hold our hands, stroke our hair, pray for us and remember we are thinking primarily of the things to come, not necessarily the past. When you respect our wishes, you are helping to prepare us emotionally to die…and this graciousness is a priceless gift.
Stage Five: Acceptance
With support, we will eventually enter into a frame of mind that is neither angry nor depressed about our soon-coming end. Rather, we will have come to terms with the inevitable, and upon expressing our feelings and mourning the loss of everything meaningful in this life our contemplation will give way to what Kubler-Ross describes as “quiet expectation” or acceptance. Achieving this phase of grief is colossal.
Acceptance ought not be mistaken for happiness. If anything, it is a phase devoid of feeling for us. We have labored through the dying process and through the very painful stages of grief, and are now at a point where we’re ready to let go forever. As one patient shared, this is a time of “final rest before the long journey.” Things of this world matter very little now that we have released it all.
More importantly, at this point, focus ought to be redirected to our family members who are now in a position where they need support saying their goodbyes and contemplating life without us. It is very difficult for them to understand how our ease of dying is directly connected to our ability to disengage from significant bonds with those we care about most. This is why acceptance is so difficult for those left behind.
It is often a challenge for our health care providers and loved ones to know when to push us to keep fighting, and when to let us go. Dying wasn’t a part of the original plan, so we naturally resist it. We especially resist when we don’t want to say goodbye or admit defeat. There are those who fight for life until their last breaths. There are others who resign themselves to defeat even before a terminal diagnosis is given. Regardless, the day will eventually visit every one of us…for some, sooner than later. So, when the time does arrive for us to die, if we persist in the denial or anger phases, it will be only that more difficult to die peacefully. Acceptance is a gift from God that brings us back to the place where we first began...resting peacefully and comfortably in his hands.
Others on the Subject
The field of thanatology has developed significantly in recent years, beginning with Elizabeth Kubler-Ross—who provided a strong foundation upon which many others have built—and added to by individuals such as Bowlby and Parkes, Worden, and Wolfelt...to name a few.
In the 1980’s British psychiatrists John Bowlby, MD, and Colin Murray, MD reworked Kubler-Ross’ five stage grieving paradigm into a four stage cyclical grieving process. Those of us suffering a significant loss may successfully cycle through the stages, but then when a memory surfaces or we experience a trigger—a holiday, birthday, anniversary—we reenter the cycle once more. This can occur many times and unexpectedly.
Bowlby and Murray’s Four Phases include:
1. Initial phase: Shock and Disbelief
2. Second phase: Searching and Yearning
3. Third phase: Disorganization and Despair
4. Fourth phase: Rebuilding and Healing
Harvard Medical School psychotherapist and researcher, J. William Worden, PhD, who specializes in terminal illness, suicide and child bereavement, has created a list of four basic tasks for adapting to loss.
These tasks are:
1. Accepting reality of the loss
2. Experiencing the pain of grief
3. Adjusting to an environment in which the deceased is missing
4. Withdrawing emotional energy and investing it into another relationship.
According to Worden, walking through these four basic tasks is what will restore “equilibrium” and complete the cycle of bereavement. It is not necessary that these tasks occur in the order presented. Rather “they can be concurrent, cyclical, or overlapping, and we—the grieving ones—will work on them with much effort until regaining balance.”
Dr. Alan Wolfelt is the founder and director of the Center for Loss and Life Transition (Fr. Collins, CO) and is a well-known grief care provider and educator. He offers a postmodern take on grief: each individual grieves in a manner that is unique to him, and there is therefore little predictability or phases that fairly articulate a universal grieving experience. The griever, as was the case for Kubler-Ross and her team, is the teacher and the support-giver is the learner.
Final Thoughts on Grief
When it comes to grief and it’s affects on human beings, it truly is impossible to institutionalize, categorize and apply common thoughts to every person experiencing a tragic personal loss. There is just no “one shoe fits all” for this deal called grief. As different as each of us is, the ways in which we express our pain and move toward relief, vary even that much more.
For some strange reason, though, we often expect ourselves to grieve as the textbook explains or as a role model, like a parent, instructed us. If we each give a unique expression of our innate talents through work choices—and other examples are in abundance—then, at the very least, we can strongly expect to grieve distinctively.
It does help to hear from grief professionals that there are widespread experiences with sorrow that create common bonds and tie us together. What is still necessary though, according to Darcie D. Sims, co-founder and president of Grief Inc., is to “create a new language for grief…a language that speaks honestly of grief’s pain and crushing despair. We need a language that speaks of the painful promise and of the hope that is cast by the memory of love given and received. We need to create a language of HOPE…” Most importantly, we must learn to be patient with our selves and with each other. Grief is a life-long journey. We may never fully “get over” our losses, but we can rest assuredly that we will be comforted through them. There is an outstanding promise from God that one day our grief will be replaced with never-ending joy. We all have something wonderful to anticipate, and this is the true source of our hope.
The Business Owner: Aerospace and Defense Industry Update
Aerospace and Defense M&A Trends
According to the American Institute of Aeronautics and Astronautics (AIAA), the Aerospace and Defense Industry maintains its competitive edge by continually evolving and focusing on new and expanding technology. Expansion areas include but are not limited to micro/nanotechnology, network-centric warfare, intelligence gathering systems, energy optimized aircraft and equipment systems, and testing of alternative fuel sources for aircrafts. Nanotechnology, for example, in recent years has grown into one of the most well-resourced research fields with funding at over 700% of its 1997 level.
The AIAA reports:
"Active areas of research include nano-devices and -systems, nanoelectronics, nano-manufacturing, nano-materials, and nano-sensors. In addition, there is great interest in the environmental, health and safety aspects of nanotechnology. Current research activities include the ability to combine multiple 'nano' disciplines to create new, synergistic applications of nanotechnology."
Aerospace was specifically identified in the President’s FY04 budget by the U.S. National Nanotechnology Initiative as a field in which nanotechnology has the potential to enable a wealth of innovation, particularly in materials/structures and intelligent bio-nanomaterials.
The pressure for innovation in the Aerospace and Defense Industry increased significantly after 9/11 and during the subsequent wars in Afghanistan and Iraq. Of course, a greater focus on national and global security was reflected in US companies as contractors reorganized in order to meet new defense department requirements.
PricewaterhouseCoopers reports that defense deal-making, which was strong during the years following 9/11, actually stalled in 2008 as new market realities became apparent. In 2007, for example, there were 77 private equity deals in the US resulting in a total value of $16 billion. In 2008, there were 31 private equity deals resulting in a mere 2.4 billion total value...a $13.6 billion difference. In 2007, there were seven $1 billion plus deals in the US; in 2008, there was only one—the General Dynamics Corp Jet Aviation deal.
Civil aviation is also took a hit in 2008 as the demand for air travel and air cargo services declined, and jet fuel costs soared in the summer months. Companies such as Boeing and Airbus responded with “modest production cuts” which trickled all the way down the chain of sub-contractors and industry workers.
PwC predicts an even lower year for 2009. Cash flow and reserves is the priority for larger companies, which may leave smaller companies in a bit of trouble, looking for buyers. “Looking forward, concerns about global capacity, cancelled orders, flatter defense spending and technological challenges associated with the manufacture of the new generation of aircraft will influence deal-making.”
Grant Thornton presents a slightly different forecast for the Aerospace and Defense Industry. In fact, it claims that M&A activity was actually strong in 2008 and maintained its position as one of the best performing industries…standing in “stark contrast to U.S. M&A activity as a whole, which declined by a third in volume terms from the prior year.” Overall, according to Thorton, the industry outlook “remains positive” as A&D industry sales grew 2% during the year, which is a new high.
Commercial and military markets showed modest growth in 2008, and sales in 2009 are predicted to increase by 7% “a result of strong backlog, a cautious approach to capacity increases and 2008 sales being depressed by work stoppages at Boeing. Longer term, Boeing remains confident of continued 5% annual growth in air travel.” And, despite reductions expected in defense spending for Iraq, military sales are predicted to increase 4% in 2009 due to a “significant lag between budget cuts and current purchases.”
With conflicting forecasts and uncertainties, perhaps the best advice we can offer our subscribers for the coming months is, as PwC suggests many companies will do, to take on a tempered yet optimistic “wait and see” attitude until concerns have an opportunity to play themselves out. The market will eventually bounce back and as the AIAA claims, the A&D Industry will remain a forerunner globally because of its commitment to research and innovation. Who knows where nanotechnology will carry us in the next decade!
According to the American Institute of Aeronautics and Astronautics (AIAA), the Aerospace and Defense Industry maintains its competitive edge by continually evolving and focusing on new and expanding technology. Expansion areas include but are not limited to micro/nanotechnology, network-centric warfare, intelligence gathering systems, energy optimized aircraft and equipment systems, and testing of alternative fuel sources for aircrafts. Nanotechnology, for example, in recent years has grown into one of the most well-resourced research fields with funding at over 700% of its 1997 level.
The AIAA reports:
"Active areas of research include nano-devices and -systems, nanoelectronics, nano-manufacturing, nano-materials, and nano-sensors. In addition, there is great interest in the environmental, health and safety aspects of nanotechnology. Current research activities include the ability to combine multiple 'nano' disciplines to create new, synergistic applications of nanotechnology."
Aerospace was specifically identified in the President’s FY04 budget by the U.S. National Nanotechnology Initiative as a field in which nanotechnology has the potential to enable a wealth of innovation, particularly in materials/structures and intelligent bio-nanomaterials.
The pressure for innovation in the Aerospace and Defense Industry increased significantly after 9/11 and during the subsequent wars in Afghanistan and Iraq. Of course, a greater focus on national and global security was reflected in US companies as contractors reorganized in order to meet new defense department requirements.
PricewaterhouseCoopers reports that defense deal-making, which was strong during the years following 9/11, actually stalled in 2008 as new market realities became apparent. In 2007, for example, there were 77 private equity deals in the US resulting in a total value of $16 billion. In 2008, there were 31 private equity deals resulting in a mere 2.4 billion total value...a $13.6 billion difference. In 2007, there were seven $1 billion plus deals in the US; in 2008, there was only one—the General Dynamics Corp Jet Aviation deal.
Civil aviation is also took a hit in 2008 as the demand for air travel and air cargo services declined, and jet fuel costs soared in the summer months. Companies such as Boeing and Airbus responded with “modest production cuts” which trickled all the way down the chain of sub-contractors and industry workers.
PwC predicts an even lower year for 2009. Cash flow and reserves is the priority for larger companies, which may leave smaller companies in a bit of trouble, looking for buyers. “Looking forward, concerns about global capacity, cancelled orders, flatter defense spending and technological challenges associated with the manufacture of the new generation of aircraft will influence deal-making.”
Grant Thornton presents a slightly different forecast for the Aerospace and Defense Industry. In fact, it claims that M&A activity was actually strong in 2008 and maintained its position as one of the best performing industries…standing in “stark contrast to U.S. M&A activity as a whole, which declined by a third in volume terms from the prior year.” Overall, according to Thorton, the industry outlook “remains positive” as A&D industry sales grew 2% during the year, which is a new high.
Commercial and military markets showed modest growth in 2008, and sales in 2009 are predicted to increase by 7% “a result of strong backlog, a cautious approach to capacity increases and 2008 sales being depressed by work stoppages at Boeing. Longer term, Boeing remains confident of continued 5% annual growth in air travel.” And, despite reductions expected in defense spending for Iraq, military sales are predicted to increase 4% in 2009 due to a “significant lag between budget cuts and current purchases.”
With conflicting forecasts and uncertainties, perhaps the best advice we can offer our subscribers for the coming months is, as PwC suggests many companies will do, to take on a tempered yet optimistic “wait and see” attitude until concerns have an opportunity to play themselves out. The market will eventually bounce back and as the AIAA claims, the A&D Industry will remain a forerunner globally because of its commitment to research and innovation. Who knows where nanotechnology will carry us in the next decade!
The Business Owner: Press Release
The Business Owner
FOR IMMEDIATE RELEASE
Contact:
David Perkins
Phone: 1.918.493.4900
Email: david@thebusinessowner.com
Website: www.thebusinessowner.com
The Business Owner
Tulsa-Based Award-Winning Business Publication The Business Owner Is Getting a Whole New Look and Feel and Will Soon be Available Electronically Free of Charge
Tulsa, OK, March 16, 2009 – The Business Owner, a multiple award-winning periodical, is getting a fresh new look and feel, and will soon be available in an electronic format Free of Charge to its subscribers. Awards the publication has earned include: 2008 Hermes Creative Award for Best E-Journal and Overall Writing and Publication; 2008 Apex Awards for Excellence in Writing and Best E-Journal; and 2006 US Small Business Administration Oklahoma and Region IV Publication of the Year.
The Business Owner has been in circulation since 1977. It serves as a credible source of relevant information and expert advice that is easy to read and applicable to a wide range of industries and company sizes. It is written with owners in mind—ones who are committed to growth, resistors of the status quo and who are determined to succeed even in economically challenging times. Owners are busy people who need information that is straight-to-the-point and values their time, which the publication does in an outstanding way.
The Business Owner is currently receiving an exciting new facelift, transitioning from a one-way communication tool to an interactive resource where business owners are invited to receive as well as contribute their insight, knowledge and advice on an endless range of business topics. For those who enjoy reading a hard copy of The Business Owner, it will continue to be made available for an annual subscription fee of $299. This version is also undergoing a fantastic redesign and will be printed in four-color, on heavy stock, glossy paper. It’s certainly a publication subscribers will be proud of and look forward to receiving every other month.
The Business Owner will soon have completely new branding and all the currently printed expert advice will be available on a fresh and exciting new website. The site will provide access to a wide range of information in one location and most importantly, when business owners need it. If cash flow is a concern, owners will be able to simply search for cash flow topics and read current and past publications that deal with the subject. Tax season is upon us, so by simply searching for tax advice, owners will have multiple articles on the subject available to them. Subscribers will no longer need to collect stacks of journals and wonder which issue contained the information they need today. All of the articles will now be held in one location: www.thebusinessowner.com.
In addition to a new website, David Perkins is also very excited to introduce a brand new electronic version of The Business Owner which will be made available to its subscribers Free of Charge. Qualifying business owners who subscribe to the periodical will be invited to participate in an online forum. This forum will provide a place for owners to connect with fellow owners, at times offering advice and insight to situations that arise on a day-to-day basis, as well as receive advice from others who have successfully navigated some of the challenges every business owner encounters. Qualifying participants will also be invited to attend monthly hour-long board meetings where they hear from experts on a wide range of topics, and speak to subjects where they have personally achieved success.
For more information, visit www.thebusinessowner.com or contact David Perkins at david@thebusinessowner.com or 918.493.4900.
FOR IMMEDIATE RELEASE
Contact:
David Perkins
Phone: 1.918.493.4900
Email: david@thebusinessowner.com
Website: www.thebusinessowner.com
The Business Owner
Tulsa-Based Award-Winning Business Publication The Business Owner Is Getting a Whole New Look and Feel and Will Soon be Available Electronically Free of Charge
Tulsa, OK, March 16, 2009 – The Business Owner, a multiple award-winning periodical, is getting a fresh new look and feel, and will soon be available in an electronic format Free of Charge to its subscribers. Awards the publication has earned include: 2008 Hermes Creative Award for Best E-Journal and Overall Writing and Publication; 2008 Apex Awards for Excellence in Writing and Best E-Journal; and 2006 US Small Business Administration Oklahoma and Region IV Publication of the Year.
The Business Owner has been in circulation since 1977. It serves as a credible source of relevant information and expert advice that is easy to read and applicable to a wide range of industries and company sizes. It is written with owners in mind—ones who are committed to growth, resistors of the status quo and who are determined to succeed even in economically challenging times. Owners are busy people who need information that is straight-to-the-point and values their time, which the publication does in an outstanding way.
The Business Owner is currently receiving an exciting new facelift, transitioning from a one-way communication tool to an interactive resource where business owners are invited to receive as well as contribute their insight, knowledge and advice on an endless range of business topics. For those who enjoy reading a hard copy of The Business Owner, it will continue to be made available for an annual subscription fee of $299. This version is also undergoing a fantastic redesign and will be printed in four-color, on heavy stock, glossy paper. It’s certainly a publication subscribers will be proud of and look forward to receiving every other month.
The Business Owner will soon have completely new branding and all the currently printed expert advice will be available on a fresh and exciting new website. The site will provide access to a wide range of information in one location and most importantly, when business owners need it. If cash flow is a concern, owners will be able to simply search for cash flow topics and read current and past publications that deal with the subject. Tax season is upon us, so by simply searching for tax advice, owners will have multiple articles on the subject available to them. Subscribers will no longer need to collect stacks of journals and wonder which issue contained the information they need today. All of the articles will now be held in one location: www.thebusinessowner.com.
In addition to a new website, David Perkins is also very excited to introduce a brand new electronic version of The Business Owner which will be made available to its subscribers Free of Charge. Qualifying business owners who subscribe to the periodical will be invited to participate in an online forum. This forum will provide a place for owners to connect with fellow owners, at times offering advice and insight to situations that arise on a day-to-day basis, as well as receive advice from others who have successfully navigated some of the challenges every business owner encounters. Qualifying participants will also be invited to attend monthly hour-long board meetings where they hear from experts on a wide range of topics, and speak to subjects where they have personally achieved success.
For more information, visit www.thebusinessowner.com or contact David Perkins at david@thebusinessowner.com or 918.493.4900.
UMS: Sing for Peace Press Release
FOR IMMEDIATE RELEASE:
Contact:
Kathy Law or Nancy Davis
Phone: 1.918.622.2890
Email: kathy.law@undercroft.org or nancy.davis@undercroft.org
Website: www.undercroft.org
UNDERCROFT MONTESSORI SCHOOL
Tulsa’s Undercroft Montessori School joins 65,000 other Montessori school children worldwide for a “Sing Peace Around the World” in recognition of the United Nations’ International Day of Peace.
Tulsa, OK, September 21, 2009 – On Monday, September 21 at 10:37am, Undercroft Montessori School children, ages 3-14, will join a global wave of Montessori children singing a song titled “Sing Peace Around the World” as participants in the United Nations International Day of Peace. 65,000 Montessori children from 31 nations in different time zones around the globe will lift their voices throughout the 24-hour period of September 21 to provide an example of how it is possible for people of great diversity worldwide to dwell and work together peacefully.
The International Day of Peace was established by the United Nations in 1981 to coincide with the opening of the General Assembly, and was first celebrated in September 1982. In 2002, the General Assembly officially declared September 21 as the permanent date for the International Day of Peace, also known as “Peace Day.” This global holiday provides an opportunity for individuals, organizations and nations to work cooperatively and to perform practical acts of peace on a shared date.
Since its inception, “Peace Day” has grown to include millions of people in all parts of the world, and each year events are organized to commemorate and celebrate this day. Events range in scale from private gatherings to public concerts and forums where hundreds of thousands of people participate. International Day of Peace is also a Day of Ceasefire – personal or political. Undercroft Montessori School is proud to participate in this very important day.
Undercroft Montessori School was founded in 1964 by a group of Tulsa parents seeking the advantages of a Montessori education for their children. Montessori is a child-centered educational method based on principles of child development established by Italian physician and educator, Dr. Maria Montessori (1870-1952). It is characterized by an emphasis on self-directed activity and the use of self-correcting materials in a peaceful environment prepared for the child’s specific level of development. Many of today’s cutting-edge educational initiatives (such as hands-on learning, multi-age classrooms and open classroom environments) mirror the philosophy developed by Dr. Montessori a century ago. Undercroft is Tulsa’s oldest and largest American Montessori Society affiliated school in the area.
For more information, visit www.kathy.law@undercroft.org or contact Kathy Law at 918.622.2890.
###
Contact:
Kathy Law or Nancy Davis
Phone: 1.918.622.2890
Email: kathy.law@undercroft.org or nancy.davis@undercroft.org
Website: www.undercroft.org
UNDERCROFT MONTESSORI SCHOOL
Tulsa’s Undercroft Montessori School joins 65,000 other Montessori school children worldwide for a “Sing Peace Around the World” in recognition of the United Nations’ International Day of Peace.
Tulsa, OK, September 21, 2009 – On Monday, September 21 at 10:37am, Undercroft Montessori School children, ages 3-14, will join a global wave of Montessori children singing a song titled “Sing Peace Around the World” as participants in the United Nations International Day of Peace. 65,000 Montessori children from 31 nations in different time zones around the globe will lift their voices throughout the 24-hour period of September 21 to provide an example of how it is possible for people of great diversity worldwide to dwell and work together peacefully.
The International Day of Peace was established by the United Nations in 1981 to coincide with the opening of the General Assembly, and was first celebrated in September 1982. In 2002, the General Assembly officially declared September 21 as the permanent date for the International Day of Peace, also known as “Peace Day.” This global holiday provides an opportunity for individuals, organizations and nations to work cooperatively and to perform practical acts of peace on a shared date.
Since its inception, “Peace Day” has grown to include millions of people in all parts of the world, and each year events are organized to commemorate and celebrate this day. Events range in scale from private gatherings to public concerts and forums where hundreds of thousands of people participate. International Day of Peace is also a Day of Ceasefire – personal or political. Undercroft Montessori School is proud to participate in this very important day.
Undercroft Montessori School was founded in 1964 by a group of Tulsa parents seeking the advantages of a Montessori education for their children. Montessori is a child-centered educational method based on principles of child development established by Italian physician and educator, Dr. Maria Montessori (1870-1952). It is characterized by an emphasis on self-directed activity and the use of self-correcting materials in a peaceful environment prepared for the child’s specific level of development. Many of today’s cutting-edge educational initiatives (such as hands-on learning, multi-age classrooms and open classroom environments) mirror the philosophy developed by Dr. Montessori a century ago. Undercroft is Tulsa’s oldest and largest American Montessori Society affiliated school in the area.
For more information, visit www.kathy.law@undercroft.org or contact Kathy Law at 918.622.2890.
###
UMS: Personal Reflection Time
*An article I wrote and published in the school's bi-monthly publication.
My family really enjoys taking walks together. It gives us the opportunity to exercise, breathe fresh air and, most importantly, be together without all of the distractions found inside our home—television, computers, dishes, laundry, etc. In the Law house, family days equal time together and most often, time in nature.
I love this quote: How often is the soul of man—especially that of the child—deprived because one does not put him into contact with nature… Maria Montessori (1945). Being in nature and with Mom and Dad, seems to calm my children and draws us closer together as family. We walk and talk…mostly we talk about what we see. My husband is a tree lover and will often have our daughters collect samples of leaves. We observe birds, squirrels, of course dogs on walks with their owners, and every now and again we’ll stumble upon larger mammals such as wild rabbits or armadillos.
Being out in nature is such an enriching experience, but with it also comes risks. As a Mom, I am often most conscious of where my children’s feet are headed and how to keep them safe. One morning this past summer we were walking along a wooded path and our daughter, Arianna, had run ahead of us. As she was skipping and consumed by the moment, she didn’t notice a big bullfrog hurriedly hopping across the path in front of her. And right on his tail was a 5ft long rattlesnake hungry for lunch. Arianna came within a few feet of the snake before she heard our screams and stopped. The rattlesnake spooked, curled up and then retreated into the woods just as we caught up with our child. Let me tell you, my heart had a workout over that encounter! To this day, our youngest daughter will retell the story: “Frog…hop, hop, hop …ssssssssnake…Ari…go away!” It was quite a traumatic moment for our entire family.
As much as I enjoy walking with my family, I also enjoy walking alone in nature. It gives me moments of silence and personal reflection time not often present in a household with small children. Walking alone helps me to re-center and to decompress. Recently, while on a solitary walk, it dawned on me that I rarely raised my eyes from the path. My focus was several feet in front of me and toward the ground…I was unconsciously looking for snakes. The rattlesnake encounter with my children had altered my focus and I didn’t realize it until I had time alone to reflect.
So often this happens to us. Slowing business, a job loss, illness, challenges with our children…the list of stress we face every day is endless. Stressful encounters along our paths tend to alter our focus, drawing our attention downward rather than forward or upwards. We are all in need personal reflection time to redirect our eyes and hearts. Without it, eventually someone will suffer, and those someones are often our children.
In Undercroft’s Middle School classroom a portion of their day is dedicated to personal reflection time. Students are given time to reflect, evaluate their goals and progress, reenergize and redirect their focus. More importantly, they have quiet moments to simply be…and in those moments discover who they are. What a wonderful example! I wonder how personal reflection time and the peace that accompanies it would impact our relationships if we simply made it a priority. And, to do it while in contact nature would make it only that much richer. Just as our vehicles only go as far as they have fuel, we too need fill ups. May each of us somehow find moments in our weeks to refuel through personal reflection time!
Kathy Law
Executive Director
My family really enjoys taking walks together. It gives us the opportunity to exercise, breathe fresh air and, most importantly, be together without all of the distractions found inside our home—television, computers, dishes, laundry, etc. In the Law house, family days equal time together and most often, time in nature.
I love this quote: How often is the soul of man—especially that of the child—deprived because one does not put him into contact with nature… Maria Montessori (1945). Being in nature and with Mom and Dad, seems to calm my children and draws us closer together as family. We walk and talk…mostly we talk about what we see. My husband is a tree lover and will often have our daughters collect samples of leaves. We observe birds, squirrels, of course dogs on walks with their owners, and every now and again we’ll stumble upon larger mammals such as wild rabbits or armadillos.
Being out in nature is such an enriching experience, but with it also comes risks. As a Mom, I am often most conscious of where my children’s feet are headed and how to keep them safe. One morning this past summer we were walking along a wooded path and our daughter, Arianna, had run ahead of us. As she was skipping and consumed by the moment, she didn’t notice a big bullfrog hurriedly hopping across the path in front of her. And right on his tail was a 5ft long rattlesnake hungry for lunch. Arianna came within a few feet of the snake before she heard our screams and stopped. The rattlesnake spooked, curled up and then retreated into the woods just as we caught up with our child. Let me tell you, my heart had a workout over that encounter! To this day, our youngest daughter will retell the story: “Frog…hop, hop, hop …ssssssssnake…Ari…go away!” It was quite a traumatic moment for our entire family.
As much as I enjoy walking with my family, I also enjoy walking alone in nature. It gives me moments of silence and personal reflection time not often present in a household with small children. Walking alone helps me to re-center and to decompress. Recently, while on a solitary walk, it dawned on me that I rarely raised my eyes from the path. My focus was several feet in front of me and toward the ground…I was unconsciously looking for snakes. The rattlesnake encounter with my children had altered my focus and I didn’t realize it until I had time alone to reflect.
So often this happens to us. Slowing business, a job loss, illness, challenges with our children…the list of stress we face every day is endless. Stressful encounters along our paths tend to alter our focus, drawing our attention downward rather than forward or upwards. We are all in need personal reflection time to redirect our eyes and hearts. Without it, eventually someone will suffer, and those someones are often our children.
In Undercroft’s Middle School classroom a portion of their day is dedicated to personal reflection time. Students are given time to reflect, evaluate their goals and progress, reenergize and redirect their focus. More importantly, they have quiet moments to simply be…and in those moments discover who they are. What a wonderful example! I wonder how personal reflection time and the peace that accompanies it would impact our relationships if we simply made it a priority. And, to do it while in contact nature would make it only that much richer. Just as our vehicles only go as far as they have fuel, we too need fill ups. May each of us somehow find moments in our weeks to refuel through personal reflection time!
Kathy Law
Executive Director
UMS: Change, Is It Really All That Bad?
Change: Is it really all that bad?
*An article I wrote and published in the school's bi-monthly publication.
Several years ago my husband and I were in Inner Mongolia, China on a development project, providing educational supplies to meagerly funded rural classrooms. The schools we adopted were in terrible shape. It was not uncommon to walk into uninsulated cinderblock rooms with broken windows, poorly hung blackboards, a few pieces of chalk and old wooden desks. Indoor plumbing was rare in rural schools, which meant that outhouses were a thing of the present, rather than a thing of the past.
Young children who lived too far to travel to and from school each day were able to board in dorms. Dorm conditions were even less desirable than the classrooms—small rooms with bunk beds, shabby blankets and coal burning stoves centrally located to provide heat. One would pray for a bunk in the middle of the dorm. Winter months in Inner Mongolia are bitterly cold and these rooms provided little shield from the elements.
Those in development work will tell you that one really needs to keep his/her sense of humor; otherwise, the conditions can start to get to you…especially when you know the difference. So, when driving from school to school, our team would look for reasons to laugh by telling each other funny stories in broken English (our Chinese partner spoke little English and we spoke even less Chinese).
Our Chinese partner and friend, whom we called John, is one of the most jovial guys we’ve ever met. On one of our long drives in Inner Mongolia, John told us a story that I will never forget. He claimed it was absolutely a true. I wasn’t there when it happened, so I had no choice but to believe him. The story goes something like this:
There was once an elderly Chinese lady from Inner Mongolia who spent the whole of her life growing and selling vegetables at a local market. This elderly lady had a daughter who, when of age, attended a distant boarding school. The elderly lady was very proud of her daughter, but of course, missed her dearly as the two saw each other very little throughout the girl’s youth.
Upon completion of high school, the girl did what all devoted Chinese daughters do—she returned home to care for her mother. The two quickly realized that they did not see eye-to-eye on everything, especially since one had received an education and the other had not. One such discovery came the first summer of the daughter’s return home. As was the custom while in school, the daughter made plans to go to a local bathhouse for her seasonal bath. The daughter had saved a few coins to pay for her mother and herself to bathe after a long winter.
When news came to the elderly lady that her daughter had made arrangements for the two of them to go to the local bathhouse, she immediately began to protest. “I will not go with you…I WILL NOT!” The daughter did not understand and responded by saying, “Well, of course you will, Mother. Everyone does it. Don’t you wish to be clean?” Once more the elderly woman declared adamantly, “I WILL NOT do it…I WILL NOT! One only bathes THREE times in her life—when she is born, when she marries and when she dies. I am NOT GOING TO DIE! I may be old, but I am not dead YET!”
The daughter, equally as stubborn as her mother, devised a scheme. One morning on their way to market, she tricked her mother into going to the bathhouse. When the elderly lady realized where she was, it was too late. Bath attendants were removing her outer clothing until all she had on was her long underwear (even the summers in Inner Mongolia are chilly!). Like an unhappy and protesting child, she fought, kicked and screamed: “You can’t do this to me! STOP! STOP! STOP! You can’t dooooo this to meeeee!”
Before the elderly woman knew it, her bath had ended and she was leaving the bathhouse with her daughter. At first she was very angry with her daughter, but when she finally calmed down, she began to notice how nice her body felt to be clean. “Mother, how do you feel?” asked her daughter. “I feel like a new woman,” she said. Thank you for tricking me into bathing. I wish I had done this years ago!” And, from that summer forward, the elderly woman never missed a seasonal bath…nor the wonderful feeling of being clean. The End.
And the moral of the story? For us, there are two. First, may we never forget how wonderfully blessed we are to have such a beautiful campus where our children are able to attend school. And, secondly, change can actually be a good thing. It may not always feel comfortable at the time, but ultimately, change can bring new beauty and joy to us.
When my daughter first came to Undercroft, driving through carpool and releasing her into the very capable hands of someone other than myself, was one of the hardest things I had ever done. In fact, it was hard every day for a while. Each time she whined, “Mommy, I don’t want to go to school,” for a brief moment, I wondered if I had pushed her to go to school too early. I had to keep reminding myself, “No, Kathy. You made the right decision. She is doing well and is in the very best place. Trust the process.” I am so glad I made that decision (many times over, might I add). It was a major change in our lives that eventually led me to where I am today.
Perhaps you are one of those parents who questions your decision to send your child to a private school. My encouragement to you is to watch and wait. Come to the observation room (or schedule a time in the classroom) and see your child at work. Observe how truly joyful he or she is while immersed in meaningful work, and just how much everyone in classroom community truly matters. I’m confident this will calm your questions just as it did mine.
If we’re honest, few of us enjoy change at the time of it’s happening, but when things are all said and done, often we look back and wonder why all the fuss. Change is like a nice warm bath after a long cold hard-working winter…oh so refreshing and NECESSARY.
Let change do its thing. It may just surprise you.
*An article I wrote and published in the school's bi-monthly publication.
Several years ago my husband and I were in Inner Mongolia, China on a development project, providing educational supplies to meagerly funded rural classrooms. The schools we adopted were in terrible shape. It was not uncommon to walk into uninsulated cinderblock rooms with broken windows, poorly hung blackboards, a few pieces of chalk and old wooden desks. Indoor plumbing was rare in rural schools, which meant that outhouses were a thing of the present, rather than a thing of the past.
Young children who lived too far to travel to and from school each day were able to board in dorms. Dorm conditions were even less desirable than the classrooms—small rooms with bunk beds, shabby blankets and coal burning stoves centrally located to provide heat. One would pray for a bunk in the middle of the dorm. Winter months in Inner Mongolia are bitterly cold and these rooms provided little shield from the elements.
Those in development work will tell you that one really needs to keep his/her sense of humor; otherwise, the conditions can start to get to you…especially when you know the difference. So, when driving from school to school, our team would look for reasons to laugh by telling each other funny stories in broken English (our Chinese partner spoke little English and we spoke even less Chinese).
Our Chinese partner and friend, whom we called John, is one of the most jovial guys we’ve ever met. On one of our long drives in Inner Mongolia, John told us a story that I will never forget. He claimed it was absolutely a true. I wasn’t there when it happened, so I had no choice but to believe him. The story goes something like this:
There was once an elderly Chinese lady from Inner Mongolia who spent the whole of her life growing and selling vegetables at a local market. This elderly lady had a daughter who, when of age, attended a distant boarding school. The elderly lady was very proud of her daughter, but of course, missed her dearly as the two saw each other very little throughout the girl’s youth.
Upon completion of high school, the girl did what all devoted Chinese daughters do—she returned home to care for her mother. The two quickly realized that they did not see eye-to-eye on everything, especially since one had received an education and the other had not. One such discovery came the first summer of the daughter’s return home. As was the custom while in school, the daughter made plans to go to a local bathhouse for her seasonal bath. The daughter had saved a few coins to pay for her mother and herself to bathe after a long winter.
When news came to the elderly lady that her daughter had made arrangements for the two of them to go to the local bathhouse, she immediately began to protest. “I will not go with you…I WILL NOT!” The daughter did not understand and responded by saying, “Well, of course you will, Mother. Everyone does it. Don’t you wish to be clean?” Once more the elderly woman declared adamantly, “I WILL NOT do it…I WILL NOT! One only bathes THREE times in her life—when she is born, when she marries and when she dies. I am NOT GOING TO DIE! I may be old, but I am not dead YET!”
The daughter, equally as stubborn as her mother, devised a scheme. One morning on their way to market, she tricked her mother into going to the bathhouse. When the elderly lady realized where she was, it was too late. Bath attendants were removing her outer clothing until all she had on was her long underwear (even the summers in Inner Mongolia are chilly!). Like an unhappy and protesting child, she fought, kicked and screamed: “You can’t do this to me! STOP! STOP! STOP! You can’t dooooo this to meeeee!”
Before the elderly woman knew it, her bath had ended and she was leaving the bathhouse with her daughter. At first she was very angry with her daughter, but when she finally calmed down, she began to notice how nice her body felt to be clean. “Mother, how do you feel?” asked her daughter. “I feel like a new woman,” she said. Thank you for tricking me into bathing. I wish I had done this years ago!” And, from that summer forward, the elderly woman never missed a seasonal bath…nor the wonderful feeling of being clean. The End.
And the moral of the story? For us, there are two. First, may we never forget how wonderfully blessed we are to have such a beautiful campus where our children are able to attend school. And, secondly, change can actually be a good thing. It may not always feel comfortable at the time, but ultimately, change can bring new beauty and joy to us.
When my daughter first came to Undercroft, driving through carpool and releasing her into the very capable hands of someone other than myself, was one of the hardest things I had ever done. In fact, it was hard every day for a while. Each time she whined, “Mommy, I don’t want to go to school,” for a brief moment, I wondered if I had pushed her to go to school too early. I had to keep reminding myself, “No, Kathy. You made the right decision. She is doing well and is in the very best place. Trust the process.” I am so glad I made that decision (many times over, might I add). It was a major change in our lives that eventually led me to where I am today.
Perhaps you are one of those parents who questions your decision to send your child to a private school. My encouragement to you is to watch and wait. Come to the observation room (or schedule a time in the classroom) and see your child at work. Observe how truly joyful he or she is while immersed in meaningful work, and just how much everyone in classroom community truly matters. I’m confident this will calm your questions just as it did mine.
If we’re honest, few of us enjoy change at the time of it’s happening, but when things are all said and done, often we look back and wonder why all the fuss. Change is like a nice warm bath after a long cold hard-working winter…oh so refreshing and NECESSARY.
Let change do its thing. It may just surprise you.
UMS: Will You Meet Me at the Peace Table, Please?
*An article I wrote and published in the school's bi-monthly publication.
In 1995, a man named Daniel Goleman, Ph.D., authored a book titled Emotional Intelligence. In the book, Goleman explained that one’s emotional intelligence is what he/she draws upon to properly handle feelings (anxiety, anger, fear), empathize with others (put oneself in someone else’s shoes) and to get along well socially (peacefully resolve problems). Emotional intelligence is built upon the acquisition of key relationship skills needed for success in life. It is not necessarily something we are born with; it is something we must learn and acquire through practice.
Studies have shown that children who have strong emotional intelligences are able to focus, take in new information and draw upon their long-term memories more easily than those children who do not. Simply stated, emotional intelligence is a key component to a child’s academic experience, and is a strong indicator of how well he/she will do in school and ultimately in life.
I am very proud that Undercroft is an authentic Montessori School. We provide children a meticulously prepared learning environment and concrete educational tools that form a life-long foundation in math, language and culture. Our Guides truly understand the developmental stages of children and how to tap into their natural interests that typically occur during key sensitive periods in their lives. Academically, Undercroft is top notch.
What we don’t often celebrate, however, is how our children are ever increasing in their emotional intelligences through conflict resolution skills taught in the Undercroft classrooms. Unlike many adults, our children have been given tools that empower them to independently manage their emotions and resolve conflicts that naturally arise when sharing a classroom with other children...tools that make academic achievement possible.
The next time you visit your child’s classroom, I would encourage you to chat with your Guide about Undercroft’s Peace Curriculum and how your child is growing in his/her emotional intelligence through this very important element of our school. At each level, children engage the concept of peace as it is developmentally appropriate for them. Children in Lower Elementary, for example, use the Peace Rose Ritual as a tool to resolve conflicts with their friends.
For those of you who often ask what you can do to bring Montessori into the home, here’s one way:
Choose a quiet location in the home that can be designated as the peace area. If a small table is available, this is a nice element, but not necessary. Purchase a single silk rose that will be a permanent part of the peace space. Have a conversation with your children about the peace area and instruct them to invite one another, including you, into the peace area whenever something is bothering them. Then follow the steps of The Peace Rose Ritual.
The Peace Rose Ritual
1. The child who is asking for a resolution to a conflict begins by holding the peace rose. He/she says the other child’s name, tells what has happened and how he/she feels about what happened. The other child must listen without speaking.
2. When the first child is finished, the second child holds the peace rose and repeats what the first child says. Then the second child says the first child’s name, tells what has happened and how he/she feels. The first child must listen without speaking.
3. The first child takes the peace rose again and repeats what the second child has said. They continue to talk this way, passing the peace rose back and forth and repeating what they’ve heard until a resolution is found.
4. Once a resolution is reached, both children can shake hands as a sign of peace or both hold the peace rose and say, “We have made peace.”
In all of my school experiences, I have never seen such a ritual practiced. In fact, as an adult, it is rare to find other adults with the ability to resolve conflict as effectively as our children do. Perhaps if we make a choice to go directly to the one with whom we have a conflict and use a similar concept as the Peace Rose Ritual, we may sleep easier at night as our troubles are more quickly resolved.
At Undercroft, we value our families. We know you have a choice when it comes to schools, and we greatly appreciate that you have entrusted your precious children to us.
Kathy Law
Executive Director
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