death – Jewish Independent

We must plan for our death

While our ultimate death is a certainty, when and how we will die is unknowable. And though death is inevitable, it remains a taboo subject for most. None of us knows what the future will bring. It is better to be prepared, so that if you become unable to make medical care decisions, your designated family members and healthcare providers, if you have talked to them, will have the knowledge and confidence to make those decisions for you.

As long as you are capable of understanding and communicating effectively with your doctor, nurse or other healthcare provider, you will be asked to make your own healthcare treatment decisions. But a serious accident or illness can result in you being incapable of making your own healthcare decisions at the time care is needed. This is why thinking about your preferences and talking to your future decision-makers now is so important. Making an advance care plan is a choice that will help alleviate some of the stress your family and friends could face if they are required to make important decisions for you, including who, exactly, you want your doctor to approach to learn about your wishes.

Advance care planning begins by thinking about your beliefs, values and wishes regarding future healthcare treatment and talking about them with selected family members or friends, as well as your doctor. When people you trust know what is important to you, it will be easier for them to make treatment decisions on your behalf.

Healthcare providers will always offer medically appropriate healthcare based on clinical assessment. They will want to ensure that any symptoms like pain, dizziness, nausea, bleeding or infection are understood and addressed. As long as you can understand and communicate, your healthcare provider will explain the medically appropriate care best for you, including any risks, benefits or alternatives. They will also ask if you have any questions and if you wish to accept or refuse the proposed healthcare treatment.

Some of the hardest decisions deal with the use of life support and life-prolonging medical interventions. These can include a ventilator to help with breathing, tube feeding, kidney dialysis, or CPR to restart the heart and lungs. If you were to have a life-threatening illness or injury, would you want to accept or refuse CPR? All, some, or no life support or life-prolonging medical interventions? A trial period of life support and life-prolonging medical interventions, allowing a natural death to occur if your condition is not improving?

Your advance care plan should at a minimum include these three things:

Having conversations with selected family members, friends, your family doctor and, if applicable, your spiritual leader, about your beliefs, your values and your wishes.
Writing down your beliefs, values and wishes for future healthcare treatment.
Writing down the contact information for the people who qualify to be on your temporary substitute decision-maker list (see below), or, if you prefer, the contact information for the representative you have chosen and named in an enhanced representation agreement, which is the one that allows you to name a person to make personal-care decisions and some healthcare decisions, including decisions to accept or refuse life support or life-prolonging medical interventions for you. (If you choose to have a representative agreement, I recommend you seek legal advice).

Bear in mind that your health and personal circumstances will change over time. As long as you are capable, you may change or cancel your advance care plan at any time and for any reason. Be sure to notify your doctor and your family members/friends of all changes you make.

Palliative care

When thinking about what to cover in your advance care plan, you might want to expressly include your wish to receive palliative care if you are suffering from a serious illness or condition. Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain and stress of a serious illness, whatever the diagnosis. The goal of palliative care is not to prolong life, nor to shorten it. The goal is to improve quality of life for both the patient and the family, and can be provided in a variety of locations, including the patient’s home, in a hospice, in a residential care facility or in a hospital.

Palliative care is provided by a team of doctors, nurses and other specialists who work with a patient’s other doctors to provide an extra layer of support. While often associated with end-of-life situations, palliative care is appropriate at any age and at any stage in a serious illness and can be provided alongside other appropriate treatments.

Many people choose to stay at home right to the end of their lives while receiving in-home palliative care from specialized healthcare providers. But if you are in the last few months of your life and feel that you are no longer able to manage at home, a hospice may be a good option for you. Hospices are meant to feel more like a home than a hospital. They are designed and furnished to provide a peaceful, homelike environment for you and your family while you receive end-of-life palliative care.

For more information on the delivery of palliative care in each of these settings, search the B.C. Health Ministry website or contact your local health authority.

Medical assistance in dying

Medical assistance in dying (MAiD) was made legal in Canada in 2016. It provides eligible patients who are experiencing intolerable suffering due to a grievous and incurable medical condition the option to end their life with the assistance of a doctor or nurse practitioner.

If your beliefs and values allow you to consider MAiD in the face of intolerable suffering, you should start by speaking with your doctor or your local health authority. For a variety of reasons, not all doctors will provide MAiD, and no one is required by law to do so. For some, MAiD may conflict with their personal beliefs or professional ethics. However, a patient can expect to be provided with information on how to access this service. Healthcare providers must not discriminate against patients with beliefs or values different from their own, and must provide an effective transfer of care to another healthcare professional who does offer MAiD.

To be eligible for MAiD, a patient must meet all of the following criteria:

be registered under B.C. Medical Services Plan
be at least 18 years old and capable of making healthcare decisions
have made a voluntary request for medical assistance in dying that was not made under any external pressure. This request must be in writing and signed and dated in front of two independent witnesses
have given informed consent after having been informed of the other means that are available to relieve their suffering, including palliative care, and
on assessment by two independent doctors or nurse practitioners, are determined to have a grievous and incurable medical condition, which means they have a serious and incurable illness, disease or disability; they are in an advanced state of decline that cannot be reversed; the illness, disease, disability or state of decline causes enduring physical or psychological suffering that is intolerable and cannot be relieved under conditions that the patient considers acceptable; their natural death becomes reasonably foreseeable. (On Feb. 24, 2020, the Liberal government of Canada introduced a bill to further amend the Criminal Code to, among other things related to MAiD, allow eligible persons to pursue a medically assisted death whether their natural death is reasonably foreseeable or not.)

A patient who has requested MAiD must be given the opportunity to withdraw their request throughout the process, including immediately before the medical assistance is administered, and this withdrawal need not be in writing or in any other particular form. Just an indication of a change of mind will do. And be aware that only patients who are themselves capable of giving consent can request MAiD. A request by a substitute decision-maker or by way of an advance directive is not valid.

Start the discussion

There is much more information available on end-of-life options than touched on in this article, and many matters not covered herein, but there is enough here to allow you to begin a conversation with those in your life who you want to make decisions for you when you cannot.

This is a lot to cover in one conversation. You can have as many conversations as you need – just get started before unwelcome circumstances make it too late. You will be doing yourself and your loved ones a big favour.

Tony DuMoulin is a founder of the law firm of DuMoulin Boskovich, where he practised commercial and real estate law for 40 years. He has a long history of involvement in Jewish organizations and municipal projects. DuMoulin is on the executive board of Jewish Seniors Alliance, in whose magazine, Senior Line, this article originally appeared in July 2020, Vol. 27(2).

Consider soul maintenance

In a recent article, I learned that Gal Gadot, the famous Israeli actor, says the prayer Modeh Ani (“I give thanks”) when she wakes up. Even famous people can be grateful for “getting their souls back” each morning.

In ancient times, sleep was considered analogous to death in some ways. As a study in contrast, the Christian response for children was: “If I die before I wake, I pray the Lord my soul to take.” The Jewish response is “Hey! Thanks so much for keeping me alive each morning!”

I have always been a morning person (annoying, I know). Although my household is busy every day, we always manage an unconventional communal Modeh Ani as we go out the door. Maybe it was before catching the school bus in those pre-COVID days or, now, just before we take a walk with the dog. In any case, by the time my kids are lining up for their pandemic screening checks and hand sanitizer, we’ve sung this happy and grateful prayer.

Once something is a part of our routine, Jewish or not, we often don’t reflect on it again – but it’s worth remembering. Reading that Gadot, also a mom, embraced a similar routine was sort of heartening. Then, I happened to be studying Daf Yomi, a page a day of Talmud, and an interesting question arose in Eruvin 70a. What if one made an arrangement with someone so that there would be an eruv, a symbolic communal space, that allowed for carrying on Shabbat, and that person died? What happens then?

Almost immediately, the Talmud discusses the person’s heir. There’s no elaboration on the details, the heir was apparently known to everyone. There’s no mention of the executor or the lawyer the family must hire. There’s none of that. I imagined what it would be like if somebody near to me died suddenly on Friday afternoon, and what might happen next.

Thousands of years ago, people didn’t live as long. They lacked the kind of warnings we usually have now, through medical diagnoses and tests and surgeries. Mortality in general was higher, although everyone still dies. Rather, without modern medication and medical interventions, one expected a fair number of infants, children and adults to die before their time.

The recent rise in COVID cases in my home province of Manitoba and the rising mortality numbers have brought all this back into focus. In the last little while, two men in their 40s have died here. My husband and I are in our 40s. We have kids in grade school. We have a dog. And a house. And….

Based on recent experiences with the deaths of relatives and friends, we often had an idea ahead of time that the person was ill or that things weren’t looking good. Yet it isn’t unusual to hear of family members still tying up the deceased person’s affairs for many months (or years) later.

This pandemic is a sobering wake-up call. A hundred years ago, during the flu pandemic, young parents died very suddenly and left orphans. There were children, spouses, siblings and parents who remained. We’re facing something similar in 2020.

On the one hand, we’re lucky because Judaism offers us very sturdy mourning practices. We’ve continued to innovate, too, relying on technology to mourn together. The last few days, I have joined a rabbi online as she says Kaddish. She waits, patiently, until she sees 10 people pop up, viewing her Twitter or Instagram live feed, thanks everyone for helping her, announces her mother’s name, and begins Kaddish. Given the pandemic’s enormous effects, this has been an intimate and surprisingly moving way to support someone in need, virtually.

On the other hand, we’re out of practise with the notion that somebody can just “up and die.” Most of us don’t have immediate plans in place, but we should. Parents all over the world are scared by the notion that they might fall ill, die and leave their kids and spouse alone. This goes way beyond how one will have an eruv on Shabbat if someone dies on a Friday afternoon or on Shabbat.

Do we have up-to-date wills in place? Emergency plans for our immediate families and long-term ideas of how to get support for those left behind? There are a lot of questions and they are scary. What’s worse, though, is that the panic caused by thinking about this can cause us to turn irrational and erratic. Fear can make us hard to be around. We become the people who can’t manage basic, polite social encounters, such as social distancing at the grocery store.

What’s the antidote? Well, while careful estate planning helps, nothing really prepares us for sudden illness. No amount of religious rituals can make us immortal. However, many circle back to countering the fear. Some of us say Modeh Ani, to be grateful – for each morning, a ray of sunshine, a toddler learning to count or an older kid triumphant after a hard test at school. It’s a taste of really good sweet potato pie or an unexpected hug.

In other words, take the win when you can get it, wherever you find it. Sometimes, it’s whimsy, like knitting a pair of mittens with lots of colours, polka dots and a thumb ring. It’s remembering why we say a prayer, even if we rush it or say it at the wrong time.

We can wears masks and social distance and wash our hands, but, right now, our souls also need positive, meaningful time and spiritual support. The next time your car needs an oil change? Consider routine soul maintenance, too.

Joanne Seiff has written regularly for CBC Manitoba and various Jewish publications. She is the author of three books, including From the Outside In: Jewish Post Columns 2015-2016, a collection of essays available for digital download or as a paperback from Amazon. Check her out on Instagram @yrnspinner or at joanneseiff.blogspot.com.

Camp helps lift spirits

A moment of levity during the taking of Justine and Stewart Silver’s wedding photos. (photo from Justin Silver)

The late Stewart Silver was born and raised in Montreal. He had worked as a standup comedian, and moved to Toronto in hopes of furthering his career. Justine Silver grew up in a Houston suburb. In late 1990, she followed her sister, who had moved to Toronto, and, there, she joined Jewish online dating site Jdate. So had Stewart.

“There was a thing where you had to describe your perfect date,” recalled Justine. “Profile after profile included long romantic dinners and were all gushy and gross … but his said, ‘Yeah, after we grab a drink, we step out of the restaurant and trip over a big bag of money.’ I was like, ‘Oh my gosh … that’s the perfect date!”

The couple took their time getting to know each other and, after a year and a half, got married.

To all appearances, Stewart was a healthy 44-year-old. He had biked up hills in Christie Pits Park the day before he had a fatal heart attack while the couple was having a conversation on Nov. 16, 2011.

Left shocked and widowed, Justine embarked on a healing path, including taking a hiatus from her event-planning business.

“It’s been quite some time since then and there’s been grief bursts,” said Silver. “In the early days, there was a lot of therapy and some peer support groups. Then, I found Camp Widow and have been to a few of those. I was pleased it wasn’t at all associated with any religion and was welcoming…. There was one in Tampa, and so a couple of widow friends that I had met up with, here, in Toronto, in a peer support group for young people who’d lost their spouses under the age of 55 … decided to make a whole trip of it. We went to the beach, museum, and then to Camp Widow. It’s a very transformational experience when you feel that you’re surrounded by people who understand the topsy-turvy world that you’re starting to barely understand yourself.”

The first camp Silver went to, in Tampa, was in the spring of 2018. Then, in November 2018 and November 2019, she attended the camps in Toronto. She and her friends have already signed up for the next November 2020 camp in Toronto.

While it’s called a “camp,” the weekend is more like a conference, with people coming together for sessions on various topics.

“One of the neat things I like at Camp Widow is that the name tags, everyone has one, but there are a couple features to it,” said Silver. “One of them, there’s a ribbon at the bottom. For example, in my work as an event planner, if you’re a presenter, your ribbon will say ‘presenter,’ or, if you’re on the organizing committee, it will say ‘organizing committee’ or ‘volunteer.’

“But, these [also] have the number of years ago that your loss occurred. So, for me, that was six years. So, let’s say it’s a teal ribbon. All of a sudden, you notice the six-year people … and there’s a bond, because you’re in a different place than, say, the six-month people. Everyone is compassionate to everyone else, but it’s just a really interesting way to bond with people.”

As far as the camp schedule, there are some group meals, as well as meals on your own. There are various types of sessions offered.

“There are tracks, like for people who are five years out, one year, or one to five,” said Silver. “I can’t remember the exact breakdown, but you can decide to go to everything along a certain track, or you can decide in the moment what you’ll do, which sessions you’ll go to. Then, there are some networking evening events, different ways of getting to know people.”

One is designed like speed-dating, but not for that purpose. You get the chance to talk to someone for a certain amount of time, and then you move on to the next person and chat with them. “It’s really interesting to see where the commonalities fall,” said Silver.

On Saturday night, there is a banquet with a theme and people dress up – some participants may not have gone out since their loss. After dinner, each person says the name of their loved one out loud, while some 200 others quietly listen. Then, there is a dance, which gives the opportunity to destress and socialize. The DJ doesn’t play any music that could potentially trigger anyone’s grief, like slow songs.

At the camp, there are people from their mid-20s to people in their 70s and 80s; people from all religions, cultures and political leanings.

For Silver, Camp Widow “creates community and support amongst widows and widowers…. Sometimes, when you’ve lost someone, it can be very isolating, which can be in different and unexpected ways. I wouldn’t say never, but it doesn’t go away. The intensity definitely lessens and you find new ways to live with grief. And there are plenty of people who, we say, are ‘re-partnered.’ When you’ve been widowed and then you meet someone else and you have a boyfriend/girlfriend, wife/husband or partner, we say you’re ‘re-partnered,’ because we don’t think that means you’re not still widowed.”

The camp provides tools and connections that widows and widowers may not otherwise find on their own.

“I feel camaraderie in sharing my story and being heard, or hearing someone else’s story and being helpful to them,” said Silver. “At this past Camp Widow, I did an art thing. I can do crafty things OK, but I’m not really an artist. But, one of the workshops I went to was all about healing through art and it was just a whole different facet. We all had paint and they set it up so well…. We had a white piece of paper and I got white paint and I painted a white heart. Then, I put a line through it – a squiggly line, like it was broken – and you could barely see it … like you couldn’t see that my husband had a heart problem…. Then, everyone shared in the room what theirs was about. When you do that, it’s like opening up a wound, and then the scar heals better next time.”

Six months ago – eight years into her healing journey – Silver and her older sister, Eileen Jadd, who is a social worker, started the charity Good Grief Bereavement Healing Services.

“We have a roster of counselors in different parts of Toronto for bereaved people,” said Silver. “We’re also offering workshops on eye movement desensitization, which is a thing for trauma victims. It really helps you compartmentalize the trauma, so you can talk about it without being retraumatized. So, we’re doing a workshop on that.

“We’re starting a group on sibling loss and, eventually, will have a physical building. We want to have a centre, so people who’ve lost someone, it’s like a snap of the fingers and they’ll know where to go. When you know there’s an accident, you know to dial 911. We want it to be, ‘Wow, you’re in need, you’ve lost someone, and you know exactly where to go.

“I think widows and widowers need their person’s name to be said. People are so afraid of saying it, because they don’t want to bring it up in fear. But, they want their names to be said, so that’s a big part of it. I happen to talk about Stewart all the time, but a lot of people don’t have those opportunities in their own lives.”

In addition to talking about him when memories arise, Silver said, “Every year, I go to shul and I say his name and a prayer for him, and commemorate it that way. I remind people that we got married in that synagogue, and I remind people that he was a person that existed and stood in that space with me, and that his influence is still there. Just because he’s not standing next to me in that moment … he’s still there. In those ways, we talk about him.”

Camp Widow is put on by Soaring Spirits International. For more information, visit soaringspirits.org, campwidow.org, widowedresilience.org and goodgriefhealing.ca.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Making death a friend

I used to wake up each morning wondering if I had Alzheimer’s yet. I dreaded the thought. Who wouldn’t? I used to imagine the torment of dealing with cancer; the diagnosis, the surgery, the chemotherapy, the radiation, losing my hair! I no longer think that way. I am no longer holding my breath waiting for the diagnosis that will lead me to my imminent death. What happened? I am now a cancer survivor; that is, after two years, my gynaecologist told me that I can now come in for a checkup once a year, rather than every six months.

Let me backtrack. I was diagnosed with endometrial cancer in October 2017. After denying the symptoms for three months, I finally went to my family doctor, then to the gynaecologist, then for an ultrasound examination, then a biopsy. The diagnosis: endometrial cancer, stage 2. I asked the medical students who board with me while doing their electives at Vancouver General Hospital about the cancer, the treatment and the prognosis. The most encouraging of their comments was, “Well, if you have to have cancer, that is the best kind to have.” Really?

My son came from Ontario to be with me for the surgery, a hysterectomy. My gynaecologist was excellent. I experienced one bad night in the hospital. I wanted to get out of the hospital so badly that my blood pressure went sky high (white-coat syndrome). I had to sign several waivers in order to march out of the hospital – against their advice. I never looked back.

That was on a Wednesday. On Thursday morning, a friend picked me up and we attended the advanced Hebrew class at the Jewish Community Centre of Greater Vancouver, as usual. On Saturday, I drove to the supermarket. On the way to the cashier, I bumped into my gynaecologist, Nancy Mitenko. She had a surprised look on her face, so I said, “Hi, it’s Dolores, your patient.” “Oh,” she said, “I know who you are, what are you doing here?” We both laughed. I felt great.

My physical trainers and my family knew of my situation but I did not tell my friends and associates about the diagnosis, the surgery or the radiation until it was almost over. I discovered that the reactions of most people to the situation is fear, for themselves, as they empathize with me. I read the look on their faces as panic and dread. It made me want to comfort them. At that point, I did not have the patience to tend to their anxiety. I knew exactly what they were feeling because I used to experience that dread when I thought about cancer.

Several months later, February 2018, I began radiation therapy at the cancer centre at VGH – 25 sessions, convenient parking in the building, pleasant technicians who, generally, were on time with their appointments; the hardest part was drinking the four glasses of water before the procedure. The treatments were painless, but, they did cause some side-effects, which were manageable. This month, at my two-year checkup, Dr. Mitenko told me that I am clear. “See you next year,” she said.

I have been on an intense learning curve, researching cancer treatments, analyzing my feelings about what had happened, dissecting my behaviours and my capacity to proceed under duress and, especially, I have given much thought to dying and death. The idea of dying does not frighten me anymore. We all will die, it is just a matter of when and how we will approach the process. I now assume that cancer may eventually reappear in my body, why not? The denial I experienced has been banished. I accept my death as inevitable – but I have taken control of the process.

I have given instructions to my sons to donate my body to the University of British Columbia Medical School’s body donation program, having completed all the forms necessary for that to happen. I have joined the organization Death With Dignity, which has a chapter here in Vancouver. I attended a meeting of DWD and was informed of the MAiD program, Medical Assistance in Dying. I have read about the requirements of the MAiD program and now know of several doctors who participate in it. I made an appointment with my lawyer in order to update my will and the various documents related to my requests for treatment and care if I should become incapacitated. My four sons have been advised of all these procedures and have the most up-to-date documents.

I am not in the least bit sad, or anxious or depressed. Rather, I am proceeding to do exactly what I wish to do with my life. I have a plan. I feel that I now have some control of my life and my dying and my ultimate death. This is empowering.

I recently celebrated my 80th birthday with a large, extended-weekend celebration including dinners, a party and a brunch. Three of my four sons were there, as well as my daughters-in-law, and five of my nine grandchildren. The most important element of that weekend for me was to watch the relationships between them deepen and become more meaningful. I am grateful to have lived this long. Anything more will be a bonus. I have accepted my mortality, I do not feel greedy, I do not ask for more. I am happy to welcome each day, to contribute to my family, to volunteer for the causes that I feel are important, to make a difference wherever and whenever I can. Death is my friend, and accepting the inevitable has freed me to be the most that I can be.

Dolores Luber, a retired psychotherapist and psychology teacher, is editor of Jewish Seniors Alliance’s Senior Line magazine and website (jsalliance.org). She blogs for yossilinks.com and writes movie reviews for the Isaac Waldman Jewish Public Library website.

The Ornithologist

Raizel does not like to leave her apartment during the long, cold, season. She sits perched at the windowsill, torn bits of challah portioned beside her on the ledge, waiting for her feathered friends. A robin’s egg blue pashmina draped loosely across her thin shoulders.

On the Esplanade below, her neighbour Malka is carrying grocery bags on her way back from St-Viateur. It’s almost Shabbat and she is hurrying home to prepare the flanken, matzo ball soup and lokshen kugel. Raizel, on the other hand, makes cholent. She has everything she needs. Sometimes a bit more, sometimes a bit less.

Before Abe passed, Raizel would prepare a proper erev Shabbat meal; never went without kreplach or tzimmes. Now, she doesn’t even light the candles. There’s no one to say the brachah with, no one to make Kiddush. It’s all too quiet. She goes to bed early. When the children call, she’s taken the phone off the hook; doesn’t want them to know she’s alone in the dark.

In the morning, Raizel props open the bay window and rolls over the heavy oak desk chair. The one Abe sat in for 62 years preparing client accounts and tax returns; the threadbare cushion still warm. She picks up the binoculars, placing her elbows firmly on the ledge, and straightens her arthritic back. The air is fresh. A light snow is falling. The parade of black-capped chickadees, blue jays and purple finches remain hidden until she drizzles sesame seeds and the bread along the sill. But, today, she is looking elsewhere. They will have to wait.

Scanning the park, past the wrought iron fencing and its pointy spires, and past the rose garden buried under tufts of snow, she spots Malka. And Chaim, trailing close behind. A pleasure to see him. Raizel first began to notice Chaim only after her daughter bought her the binoculars, “to give her something to look at,” her daughter had said, “since she was refusing to go out.”

At first, Raizel thought she must be imagining things, thought maybe she should call Dr. Lipschitz to make an appointment. But, no, it was him. Chaim would swoop down close behind Malka, a few feet off the ground, his arms gently flapping, like a midnight black crow. He would accompany Malka as she walked along the stone pathway, always just as far as the gate leading onto Fairmont Avenue. And he would be dressed for the season: pastel peach plumage in summer and shimmering black feathers fringed with vanes of barbs in winter; how did he know?

Raizel and Abe had gone to the funeral, they went to the shivah, they consoled Malka and her children; there was no doubt, Chaim was gone. But now, here, there he was, fawning over Malka all over again, her constant companion. Raizel had been curious how it was that Malka couldn’t see Chaim, didn’t seem to even know he was there. No hidden smile, no look back, no small wave. Nothing. So, it was strange when Malka started spending so much time promenading around in the park, no matter the weather, or time of day.

Raizel felt a little chilled. She had been watching them for nearly an hour. She pushed the window closed and began to set the table for lunch. Cholent. It would warm her up.

Before sitting down to eat, Raizel picked up the binoculars again and scanned the apartment. Would she be so lucky? Would it be one or two for lunch today?

Karen Schauber is a family therapist practising in Vancouver. Her earlier writing is non-fiction and details three decades of psychosocial and analytical cases. Flash fiction is a new adventure for her, and her work has been published in literary magazines and anthologies, including Brilliant Flash Fiction, Bending Genres, CarpeArte, Ekphrastic Review, Flash Boulevard and Blood Puddles: An Anthology. The upcoming Group of Seven Flash Fiction anthology, celebrating the Canadian modernist landscape painters, is her first editorial flash venture. Schauber manages vancouverflashfiction.weebly.com and can be reached at karenschauber.weebly.com.

Teaching about death

Dr. Jessica Zitter has both written a book and a movie about death and dying. (photo by Rikki Ward Photography)

Dr. Jessica Zitter, who works as an attending physician at a public hospital in Oakland, Calif., struggled with her job’s protocols for years. Until the day a nurse opened her eyes to the possibility that there was a better way, one that involved more compassion in the treatment of patients.

Zitter comes from a long line of doctors.

“They were into the art of medicine,” she said of the mentors she had when she first began her studies. “By that, I mean the art of surgery and intervening, and of doing things in a very precise way. There was something about that that I found heroic, and I wanted to be part of that world.

“So, I went to medical school – pulmonary and critical medicine – which I thought of as the most heroic of the specialties. I went on to start to focus on the machines, technologies, protocols and things that were part of the trade of being a pulmonary critical care physician. I tried to really perfect them … [thinking that,] if I use these perfectly, I’ll be able to help a lot of people.”

But, as she went along, she started to think differently. At first, she suppressed the feeling. “It was truly uncomfortable,” she said. “It caused me a lot of suffering.”

Zitter was using techniques and protocols on people who were not going to benefit from them, knowing full well that they would not benefit from them. Not only was she following her training, but she also wanted to please her patients – give them mainly good news and information about various procedures, instead of telling them the whole truth about their condition.

“I didn’t want to tell them, ‘Hey, I don’t think you’ll survive,’” said Zitter. “I didn’t want to say that because it’s too sad. I would communicate about things that were more practical like, if this happens, we will try this.”

A pivotal moment

Zitter’s approach changed after an encounter in the intensive care unit with a nurse from the family support team, called Power to Care.

“One day, I was about to put in a line [catheter] into someone who was really, really sick and likely dying, and the woman who headed that family support team was standing in the doorway watching…. I was about to put the needle in and she put her hand up to her face and she said, ‘Call the police,’ on a pretend telephone…. She said, ‘Call the police. They’re torturing a patient in the ICU,’” said Zitter. “And that was my epiphany moment. All these moments, I had this doubt. This was like a relief – you’re right, I am torturing the patient. What the heck? There was a clarity there that was really powerful.

“But, the sad truth is that I still put that needle in. I still put that catheter in that woman. The force of what I call the end-of-life conveyor belt is so powerful … not only the conveyor belt itself, but the drive to ‘protocolize,’ heaping on treatments … the culture in the hospital. It’s hard to break out. It’s hard to stop and take a pause, and say, ‘Wait a minute. What the heck?’”

The intervening nurse, Pat Murphy, in some ways became Zitter’s mentor on what it meant to be a doctor.

“I came to it late and from a place of profound dissatisfaction and moral distress, and I was just extremely lucky that I happened to be in one of four hospitals where this movement was starting to take hold,” Zitter told the Independent.

“And, I happened to have been open to it,” she added. She was able to get over her “human defence of not wanting to look stupid or like I didn’t understand … and to be able to say, ‘OK. Teach me.’

“I feel lucky that those two things were in check at that time,” said Zitter. “Not to say that I wasn’t filled with shame and embarrassment about what I’d been doing all that time, but the psychology…. Once you admit there’s a problem, then find a way to fix it.”

After years of immersing herself in this new paradigm, Zitter felt ready to share what she had learned. She published a book about it, called Extreme Measures: Finding a Better Path to the End of Life, in 2017.

As she was writing it, Zitter realized that, if a picture can impart a thousand words, maybe a movie would be able to convey even more. So, she put together a 24-minute documentary, Extremis.

Of the award-winning film, Zitter said, “It really shows the issues that come up in an ICU…. There is also a discussion guide that goes with it, so people can watch it and then come away from it with some lessons learned.

“This movie reaches a wide audience about really advanced care planning,” she said. “A lot of synagogues are using it, medical schools and nursing schools.”

Death education

Zitter was asked to teach sex education at both of her daughters’ schools.

“I want them to be able to make the best decisions they can make about their bodies and their health, and to be empowered to live the best they can,” she said.

But what about death education?

Extremis came out in late 2016. “It was nominated for the Oscars and a lot of my kids’ friends were watching it. And all these kids were really blown away by the movie and they were having a positive response to it,” said Zitter. “It made me think, ‘Why the heck aren’t we teaching kids about death? Why aren’t we having a conversation in high school, just like with sex ed?’ So, a friend of mine designed ‘death ed.’ We did it in her kids’ and my kids’ schools. It was really impactful.”

Zitter would love to see such a class in every school in the United States and Canada, along with other heath education classes, so everyone can have the opportunity to learn about a range of issues and discuss them.

Both the teachers and the students appreciated the lesson on death education, said Zitter. “There were no negative responses. Although some kids cried, and it was terrifying at first, they would then say, ‘That was sad, but I’m OK.’

“I was like, ‘It is sad that we are all going to die.’ But, you know what? It’s really good for these kids too, [because] it’s part of life. If we pretend no one’s going to die and don’t let our kids go to funerals, etc., we aren’t doing anyone a service.”

So far, Extremis has been translated into 90 languages and has been shown in 160 countries.

“We’ve got to tell people what’s actually happening and try to understand,” said Zitter. “I use myself as a prime example…. Why was I putting that catheter into a woman I knew was dying? What are these factors that are propelling me to do things that don’t make sense to me? The idea is to be more conscious of it, aware of it, and change it.”

For more information about the movie and the book, visit jessicazitter.com. The film trailer can be found on YouTube.

Rebeca Kuropatwa is a Winnipeg freelance writer.

On death and dying

Rabbi Laura Duhan Kaplan, director of inter-religious studies at Vancouver School of Theology. (photo from Laura Duhan Kaplan)

“Most of the world’s religions speak of dying to self,” said Dr. Eloecea, a Christian psychotherapist speaking at the Inter-Religious Conference on Spiritual Perspectives on Death and Dying at the Vancouver School of Theology May 22-24. “If we can do this before the time death approaches, suffering is greatly diminished for ourselves and for those around us.”

“Dying to self” refers to giving up egotism and self-centred attachments. Eloecea’s words echoed a theme that appeared in many of the sessions I attended, which was that of a holistic spiritual path of surrender and humility that unites life and death.

Rabbi Dr. Laura Duhan Kaplan, formerly of Or Shalom Synagogue and now director of inter-religious studies at VST, discussed how she had been spurred by reading Plato to take a closer examination of Jewish views of death and the afterlife. “Plato said living well is preparing for death. But what is death?” she asked.

Duhan Kaplan explained how the texts of kabbalah offer accounts of a soul’s journey after death. The soul travels through stages of physical, emotional, intellectual and spiritual purification, she said. According to Duhan Kaplan, this account of the afterlife is based both in kabbalistic theories of the soul’s development and glimpses of higher consciousness by current spiritual seekers. As Duhan Kaplan presented them, these texts are a guide to a lifetime of self-reflection, humility and non-attachment.

The stages of the soul’s ascent after death are tied to the rituals and rhythms of the traditional Jewish year of mourning that follows the death of a loved one, she said. “When I decided I would research Jewish views of the afterlife I had no idea I would discover what I did.”

Duhan Kaplan spoke of the dreams and spiritual experiences she had after the deaths of her father, mother and mother-in-law. She said the stages of her parents’ journeys offered particular gifts that related to their stages of spiritual ascent in the next worlds. The movement from the shivah period through the year of saying Kaddish to the yahrzeit and Yizkor corresponds to the soul’s difficulty in letting go, the emotional purification, the visit to the lower Gan Eden, the “paradise of understanding and good deeds,” and then the return to the storehouse of souls to merge with the divine. This description captures just one thread in the rich tapestry of connections Duhan Kaplan wove.

Other teachers at the conference presented different lenses through which spirituality relates to death. Acharya S.P. Dwivedi, poet and interfaith activist, presented the traditional Hindu view of karma, reincarnation and freedom from rebirth through non-attachment and identification with the transcendent self (atman). Dwivedi described how in the Hindu view the jiva (individual soul) moves from birth to death, experiencing happiness or suffering in accordance with the good and bad actions it commits, until finally it finds its true identity with the atman – the innermost self that is one with all of existence – and lets go, returning to its source and not again being reborn.

Syed Nasir Zaidi, Muslim chaplain at the University of British Columbia, discussed the importance in Islam of confronting and making peace with death. “Death should be our strength, not our weakness,” Zaidi said, emphasizing how thoroughly internalizing the reality of our own death and ceasing to fear it can enrich our spiritual path. Zaidi pointed out that, according Rumi, it is death that gives value to life, making it precious. Zaidi also explained that, in Islam, peace with death is accomplished through confident submission to God’s will in a life of virtue and acceptance of life’s unfolding as an expression of God. “Abraham told his children they should not die before becoming Muslims,” Zaidi said. “Obviously, this doesn’t refer to being members of the religion of Islam, but rather to having submitted to God, which is what being a muslim [submitted one] means.”

Some presenters offered specific practices. Eloecea shared a series of meditations aimed at producing positive thoughts to change the state of the brain, to shift from the egotistical self and its entrapping habits. Lynn Mills, a PhD student at Trinity College in Dublin, Ireland, Skyped in to present a liturgy for people in the early stages of Alzheimer’s, which consisted of psalms and prayers to be recited in their presence. This had two parts: the first was a morning liturgy for every day, the second a way to celebrate the person’s life before memory loss prevents them from knowing friends and family and remembering the stories they share.

A variety of other topics were covered. Mark Stein, a Jewish chaplain, tackled the issue of what to do when non-Christians (or anabaptists, who only baptize believing adults) are called upon to give baptisms for sick or stillborn children. Can a Jew baptize a child? Should they? Stein spoke of the need for chaplains to support people in these extreme situations. He spoke of the transformation this could cause in a chaplain, leading them not only to embrace a pragmatic flexibility but to an openness – seeing God’s work as something also happening beyond one’s own religion.

One recurrent issue was medical assistance in dying, about which there was a panel discussion moderated by Duhan Kaplan on the opening night of the conference. Rabbi Adam Rubin of Congregation Beth Tikvah spoke as a member of the panel. He noted the lack of a consensus about medically assisted dying across Jewish traditions, but affirmed a few core teachings. “First, because of the infinite preciousness of every life, we’re commanded to do everything we can to preserve life,” Rubin told the Independent. “Second, we must do everything we can to attenuate suffering. Some traditional rabbinic authorities hold that this imperative means that one can give a level of pain-killing medicine (morphine, for example) that might even endanger the life of a patient, in order to reduce the patient’s suffering. In addition, some authorities allow the removal of life-sustaining machines or apparatuses if they extend suffering, in order to allow the normal course of physical decline to take place. This is a tricky and controversial subject within Jewish tradition,” he said, “but the general idea is that there’s a place for ‘allowing nature to take its course’ if it is likely to reduce suffering. All of that said, there is a (rare for Judaism!) consensus in traditional Jewish law that it is absolutely forbidden to take one’s own life or to assist in taking someone else’s life.”

Rubin warned of the dangers of simplistic notions of consent or decision-making that don’t take into account the full range of pressures and emotional factors that might influence a person’s decision. “People are not robots, making ‘clean,’ rational decisions in a vacuum,” he said. “So, my approach, and my take on Jewish tradition, is that we must fight the things that might lead to someone wishing to end their life.”

In addition to the talks and panels, there was an afternoon session for musical and meditative reflections on the first day of the conference. Jewish music ensemble Sulam (which contains both Duhan Kaplan and her husband Charles Kaplan) performed, as did the Threshold Singers; the music was followed by Zen priest Myoshin Kate McCandless giving a presentation on meditation and chant in support of end-of-life care.

The keynote event of the conference, which was open to the public, was called We Die Alone and Yet We Don’t. It was a conversation with Dr. David Kuhl, facilitated by Duhan Kaplan. Kuhl is a professor in the department of family practice in the faculty of medicine at UBC. He helped design and develop the palliative care program at St. Paul’s Hospital, and is known for his 2011 book What Dying People Want: Lessons for Living from People Who Are Dying.

Matthew Gindin is a freelance journalist, writer and lecturer. He is Pacific correspondent for the CJN, writes regularly for the Forward, Tricycle and the Wisdom Daily, and has been published in Sojourners, Religion Dispatches and elsewhere. He can be found on Medium and Twitter.

Rituals can help us with loss

My nephew L’s public elementary school principal just died unexpectedly. She wasn’t old, and it was very sudden. The school closed for an afternoon so everyone could go to a memorial service. He’s upset … as any 9-year-old kid would be. His family lives near my parents, in Virginia, so, when my brother called for grandparent backup, they went right over. They needed to help my nephew start learning and talking about death.

This is so hard, but, in some ways, we are lucky. Judaism has rituals, information and thousands of years of coping with this topic. We can joke about it, sure, but nobody comes out of this thing called life alive. Better to have some things in place ahead of time, so you’re ready for it.

There are those who try to protect kids from sad or upsetting events, and keep them home and shelter them from funerals. This is a disservice to kids, who need to learn how these things work. I experienced several deaths and attended funerals as a little kid, as close family and friends died. Watching my family members mourn, going through shivah and attending services with them to say Kaddish helped me get a grip on the losses of people I loved, even though I wasn’t old enough to do much of this myself.

By comparison, my husband didn’t lose close family members until he was a young adult in his twenties. He didn’t have a deep understanding of traditional Jewish practices, about what would happen and how. In a short span of time, he lost all his grandparents and his mother. Going through the rituals, attending services to say Kaddish and to mourn his mother, was very hard. It was a long year, and we were in grad school, far away from family. However, we used those rituals as a crutch, and it helped us get through it together.

Although my mom is retired, she worked as a Jewish educator and administrator for many years. She still helps manage arrangements for the sale of Jewish burial plots for her Virginia congregation. My mom often helps people as they deal with a sudden death, a long illness or another difficult situation. She was recently invited to talk to the Grade 6 religious school class as they studied Jewish mourning and death.

It turned out that L’s older brother, age 12, was in that class. Although he recognized many of the pictures in my mom’s presentation, he said he learned some new things, too. He recognized the 140-year-old cemetery in Alexandria, where he visits and helps out sometimes. My mom covered basic traditions, but she also talked about how we can comfort friends who lose grandparents – the real details that help us cope with loss. Most poignant for me, though, was the new story my mother told me that she’d mentioned in the class. It was a way to help kids learn to support friends with their losses.

When my mom was 12, there was a phone call in the middle of the night. She heard her dad crying, which she’d never heard before. His father, her grandfather “Poppa,” had died. Her friends at school came up to her. They were sorry to hear about his death. Poppa used to carry around big packets of Juicy Fruit gum in his pockets. He’d hand out sticks of gum to all the kids at the end of High Holiday services. Those friends helped her remember her grandfather in a loving, wonderful way.

In Leviticus, which we read each week at synagogue at this time of year, there are long lists of “shoulds” and “should nots” and instructions for how we should do things. Some of these rules seem rigid. Many aren’t really applicable in a world without ritual sacrifices in the Temple in Jerusalem. However, we have both rabbinic teachings and the Tanakh sacrifice experience. We’re offered tools for how to mourn and how to manage through hard times. That history can propel us forward.

My family and community “practised” with kids so they were ready. True, it may be bending someone’s rules to recite Kaddish in the backyard over a beloved pet who has died. It may not be exactly correct to light a yahrzeit candle and recite Kaddish over a beloved (non-Jewish) elementary school principal who has died, but this “practising” doesn’t matter to most. The Jewish rituals and traditions that exist around death aren’t really about the person who died. It’s about how the rest of us will move forward.

Death is a part of life. It’s dang hard. However, hard things don’t go away because we decide not to talk about them or face them. Instead, brave people conquer difficult challenges through facing them head on. My nephew L is one of those brave people. He uses a wheelchair, signs and uses an iPad communication device to talk – and shows such compassion. He told my mother, “Now I know how you felt when your mom died.”

This week, my nephew heard that we are about to adopt a new dog. He hadn’t realized that one of our dogs died last fall, right before Yom Kippur. He was reassured that our dog Harry was old, and very sick … and that is how most of us die. However, it’s through talking about this that we can move on towards celebrating a new “family member,” too.

Talking about death isn’t easy, but we need to do it – in calm, peaceful ways – long before something sudden happens to us or our families. Talking about death in a Jewish context and acknowledging the value of the rituals that help us cope with it may be one of the deepest ways we can celebrate life.

Joanne Seiff writes regularly for CBC Manitoba and various Jewish publications. She is the author of three books, including From the Outside In: Jewish Post Columns 2015-2016, a collection of essays available for digital download or as a paperback from Amazon. See more about her at joanneseiff.blogspot.com.

Play faces our mortality

Kelly Sheridan and Peter Wilson in The Realistic Joneses. (photo by Nancy Caldwell)

The unfortunate truth is that we are all going to die some day. How we cope with our mortality defines our approach to life. Playwright Will Eno encapsulates this concept in his award-winning play The Realistic Joneses, produced by the Mint Collective and currently running at the Vancouver Culture Lab at the Vancouver East Cultural Centre until Dec. 17.

The New York Times has called Eno, “a Samuel Beckett for the Jon Stewart generation.” His life view comes through an intellectual lens of verbal dexterity and abstract projections that, at first blush, seem disjointed and oddly out of place, but eventually morph into a revelatory and provocative perspective on death and dying. Eno is a wordsmith but it takes some time and mental effort to understand exactly what is happening on stage.

The play had its debut at Yale Repertory Theatre in 2012 and then went on to a successful Broadway run in 2014, including a Drama Desk Award Special Award.

Next-door neighbours, both with the surname Jones, live in smalltown America. Bob and Jennifer, middle-aged longtime residents, are the foils for the newly wed 30-somethings John and Pony, whose lives intersect through the tragedy of the male side of each couple having the same degenerative neurological condition that affects memory and speech. Both men are undergoing experimental treatments from a local specialist. Each knows there is no cure and deals with this reality in his own way. Their coping mechanisms define the play and expose the vulnerability and pathos of those with terminal conditions.

The action is portrayed in a series of vignettes, snapshot moments in the lives of these two generationally divided families as they forge an uneasy friendship in the dance towards death. These people are real, albeit a little weird. The dialogue is witty and fast-paced – in this play, “the words are the thing.” Despite the dark nature of the subject matter, there are some very funny moments.

Joan Bryans is brilliant as Jennifer, the long-suffering and brave wife who has given up her career to become her husband’s caregiver and tries to give his deteriorating life a sense of normalcy. Community member Charles Siegel plays Bob with an almost childlike, naive demeanor as his memory slowly fades. As the younger couple, Peter Wilson plays John, the quirky doting husband, in a maniacal sort of way and Kelly Sheridan is the scatterbrained Mrs. Jones Junior.

The intimacy of the black-box Culture Lab adds to the audience experience. The divided set is simple: one half is the backyard of the older Joneses, the other half is the kitchen of the younger duo. Lighting and sound design complement the simplicity of the production. It is smalltown in anywhere America on a summer’s eve, replete with chirping crickets, hooting owls, barking dogs and chiming church bells.

There is no easy resolution at the end of the play, no happy ending tied up with a shiny bow to send audiences on their merry way out into the night, just the thought that this is the reality of life, with all its complications, and maybe, just maybe, that’s OK.

Tickets and more information can be found at thecultch.com or by calling 604-251-1363.

Tova Kornfeld is a Vancouver freelance writer and lawyer.

We must plan for end-of-life

The Oct. 29 Jewish Seniors Alliance Fall Symposium on Preparing for End-of-life Transitions drew 160 participants to the Peretz Centre for Secular Jewish Culture. (photo by Alan Katowitz)

The Oct. 29 Jewish Seniors Alliance Fall Symposium on Preparing for End-of-life Transitions drew 160 participants to the Peretz Centre for Secular Jewish Culture. Several aspects of the topic were discussed, with Dr. Sue Hughson speaking on the importance of advance care planning, and Rabbi Philip Bregman presenting some of the Jewish perspectives to be considered.

JSA president Ken Levitt opened the afternoon, welcoming attendees and encouraging them all to become supporters or members of JSA, if they weren’t already. He then introduced Gyda Chud, JSA vice-president, who moderated the symposium, and introduced each speaker.

Hughson has been practising veterinary medicine since 1990. She has been involved in social activism in various forms over the years and currently serves as past president of the British Columbia Humanist Association. Along with her duties on the national board of Dying with Dignity Canada, she is co-chair of the DWDC Vancouver chapter. One of DWDC’s stated purposes is to “educate Canadians about all of their legal end-of-life options, including the constitutional right to medical assistance in dying … and the importance of advance care planning.”

Hughson began by pointing out that talking about dying won’t kill you and that supporting end-of-life choices is pro-choice not pro-death. She outlined the various documents that should be completed in order to plan, in advance, for orderly outcomes. Some of the documents that need to be completed are an advance directive; a representation agreement; and an enduring power of attorney. These documents should be easily accessible – keep them in the freezer, for example. If they are in a safety deposit box, they will not be easily accessed. She also suggested bringing them to the hospital so that the staff is aware of your wishes. These issues should be discussed well in advance with family and close friends so that everyone involved is cognizant of the planning.

In British Columbia, said Hughson, we have the right to a second opinion, the right to refuse treatment, the right to end our own life and the right to assisted death (if a person qualifies).

There are a number of organizations that can help expedite the planning. One is Nidus, another is Dying with Dignity. They have a lot of information on their websites and are also accessible by telephone. Other helpful aids are estate lawyers and financial planners.

One point about the representation agreement, she pointed out, is that there are two forms: No. 9 is the form for capable adults and No. 7 is for those unable to complete it on their own. In this type of agreement, you are outlining your choices, so that, should you become incapable, those acting on your behalf can carry out your wishes. You can register your documents with Nidus. It is interesting to note that eight out of 10 doctors have done advance care planning because they see the importance of doing so.

Bregman was senior rabbi at Temple Sholom from 1980 to 2013. He has been Jewish chaplain at the University of British Columbia since 2013 and serves as executive director of Hillel BC. He explained the importance in Judaism of having an ethical will, where you record the beliefs and ideas that you want to pass on to future generations. This has been a practice in Judaism for thousands of years, he said.

An ethical will can be written on paper or take the form of a video. Bregman emphasized how important it is to have the discussion about end-of-life with your family: what you want to happen regarding funeral arrangements, burial, etc. If the dying person avoids the issues because they think their family is afraid to discuss them, the dying person may feel isolated.

Bregman explained that the Vidui is said at the deathbed if the dying person is unable to say it themselves. It is a prayer asking God for forgiveness. He stated that people usually die at night or early morning, and he thinks it may be because they wish to be alone. But he has experienced what he called the awesome feeling of being present at the moment of death and being aware of the soul leaving the body. The tradition of naming children after a departed relative stems from the idea of the continuation of the neshamah (soul) in a new being, he explained.

The rabbi emphasized the importance of organ donation as helping with life. It is not against Jewish tradition, he said, and is accepted even by the Orthodox. He said people should talk with the Chevra Kadisha (Burial Society) to learn more about the traditions surrounding the preparation of the body for burial. For example, in order to be kosher, the coffin must be biodegradable. There must also be holes in the coffin for a quicker return to nature. We are, after all, only burying the vessel, the neshamah has already departed.

To a question about cremation, Bregman replied that, in Judaism, nothing should be done that is disrespectful to the body and burning is considered disrespectful by most rabbinical authorities. Regarding leaving your body to science or a postmortem, he said it is important to specify that the body be returned for Jewish burial, otherwise it will be cremated. Finally, he stated how important it is to make funeral arrangements in advance, how helpful that is for the family and, again, he encouraged everyone to become an organ donor and help save a life.

Chud then thanked the speakers and invited everyone to partake of the refreshments. A video of the entire event, as well as the PowerPoint by Jack Micner, an estate lawyer who was unable to speak at the symposium due to unforeseen circumstances, will be available on the Jewish Seniors Alliance website.

Shanie Levin, MSW, worked for many years in the field of child welfare. During that time, she was active in the union. As well, she participated in amateur dramatics. She has served on the board of the Jewish Federation of Greater Vancouver and is presently on the executive of Jewish Seniors Alliance and a member of the editorial committee.