Milestone Depression

I never was one to attach a lot of meaning to holidays or birthdays, they were just another day, another year. Sure I enjoyed celebrating with loved ones but they remained just another day. I even recognized birthdays as a milestone of survival. However, my outlook on holidays drastically changed over the last couple of years for two particular days - my birthday and New Year's. Now I enter a period of mourning around these days in anticipatory grief over what the future holds.

I have always wanted my parents to outlive me and there were times that this was nearly the case. I fear the real possibility of outliving my parents. And as I age, this fear has intensified. My birthday and New Year's have become to serve as painful reminders of this fear as I become another year closer to my fears becoming reality. I no longer enjoy these days, instead I become overwhelmed with fear and depressive feelings - spending hours sobbing while my mind is consumed.

As a child and teenager, there were times that my doctors were amazed at my survival of times that I wasn't expected to live through. Afterwards, I was convinced that I would not live past age 21. When I turned 22, I was overcome with feelings of bewilderment and grief at passing 21. I had come to accept my death and was prepared for it. I didn't know what to think about continuing onward with life when I was utterly convinced I wouldn't see 22. My health was still precarious enough that it wasn't unreasonable to think my life was limited. Age 21 has come and gone and now, I find age 40 to be a prime limit to my life. At 40, my parents should still be living and they would be recipients of my life insurance policies that would allow them to be taken care of financially and medically in their older years. My parents' comfort and security is more important and means more to me than a long life for myself nor do I want to endure the loss of my parents. As selfish as that may be, their loss is a tremendous fear of mine and I truly believe they would handle losing me better than I would handle losing them.

And so for the day of and a few days past my birthday or New Year's I am overcome with mourning for another year added to my age and my parents' ages. This state doesn't stay for long but it is long enough to remove any joy these holidays may have held for me in the past. I try to remind myself during these days to enjoy the time that we do have together and no one knows the future. After a couple of days the intense feelings extinguish themselves until the next year when they are renewed with acuity once again. The fear remains with me on a daily basis in the back of my mind, however, not as acute as on these particular holidays. Most days it is easily manageable as I practice reframing my bothersome thoughts and distract myself with activities. It's important to focus on the present so that we don't get lost in the fears of the future.

My Death is Acceptable

I'm comfortable with death. Anyone who knows me will hear me casually talk about death, particularly my own. It happens. I think it would be astounding if we were all accepting of death. It's natural and we are all going to make that passage at some point so why not accept the inevitable. Why stress about our own future deaths when we can enjoy life now and rest in the peace of the future?

I've faced my own death when I was a child and a teenager. In grade school, due to the negligence of ER staff it was missed that I was experiencing a life threatening blockage. Instead, I was dismissed as a whiny child and sent home with pain medications. The following day my parents returned me to the ER and this time the ER staff completed more thorough testing to discover my small intestine was wrapped around itself and surrounding organs. As a result of the delay in treatment, part of my small intestine - including my jpouch- died and my doctors deemed it a miracle that I had survived.

In high school, after my straight pull thru surgery I had so many adhesions from my previous surgeries that a stricture was created around my small intestine. I was constantly barraged by vomiting and excessive diarrhea. To the point that my body couldn't maintain. I was going to the doctor every week for regular lab monitoring resulting in frequent hospitalizations to try to stabilize my out of control electrolytes. The reality was that I was slowly dying. My doctor later told me that she never knew if she would see me at my next weekly appointment, if I would live from week to week.

I recall one morning, the sunlight hitting me on the couch where I spent most of my time as I was too weak to climb the stairs to my room. I remember surrendering to a sense of peace and serenity that I've never experienced before or again since. I sensed death yet it was so serene, it was lovely. I felt safe amidst my world of unknown and uncertainty. And then I was overcome with a sudden urgency to share my goodbyes with my mother. My mother laid my head upon her lap and stroked my hair as I gazed up at her and told her my goodbyes. Her eyes welled with tears as she listened. I was ready. I was at peace. Within the next day or so, I was back in the hospital once again. My doctor told me I was at risk of a heart attack or brain seizure at any moment.

If it wasn't for the unimaginable sense of peace I experienced that morning, I might still be scared of my own death. But instead, it left me in awe to embrace my own mortality. When my time comes, I'm ready. If I don't meet all the goals I have set forth in time, that's okay. I will live without regrets. I do, however, have a preference for my expiration date. I'd like to walk on by the age of 40, for my own personal reasons.

And so it's hard me for to understand the fear others hold about death. I particularly have an extremely difficult time understanding why others are so uncomfortable with my acceptance of my own death. In fact, when others repeatedly question my own acceptance it begins to infuriate me. Do we question that another is scared of their death when that person states so? No. Then why would we question someone who states they accept their own mortality?

To be honest, if I were to develop cancer that required chemotherapy for survival...I'm not sure I would elect to undergo chemotherapy. I'm very tempted to simply let the cancer run its course. It's not a wish for death or a means for suicide. I'm just simply comfortable with death and quite frankly I have an intense fear of outliving my parents. My preference is to not outlive my parents and yet my parents are one of my main priorities in my life. I feel as though my life purpose is to remain as independent as possible so that I may meet my life needs and those of my parents. Therefore, I'm conflicted about accepting such an opportunity should it arise - torn between my preference and my sense of duty to remain living in order to provide any future caregiving needs my parents my require.

I've been embraced by the warmth of death and so regardless if my time comes sooner or later, I will accept and welcome my transition into the after world. The present world will have its frightening moments that challenge us. However, we need not feel frightened or challenged by our own mortality. May we all rest in the peace that is waiting for us when our time nears.

Protecting End of Life Wishes

One of the most important things we can do for ourselves is to discover how we want to live. However, this understanding not only includes how we walk this earth but also how we leave this earth. There is great honor in being privileged to walk the journey of life alongside another person and in respecting their journey.

Recently my beloved great uncle passed away. As my parents, myself and others walked alongside him, he shared his life and afterlife wishes with us. He did everything within his earthly power to ensure his wishes were known and established prior to his passing. In spite of his insistence and clarity, there remains individuals determined to undermine the wishes and efforts of my great uncle. His wishes and efforts that allowed him peace of mind for leaving this earth.

The struggle to protect his wishes emphasized the deep need for end of life planning. Such planning is not age dependent; it is life dependent. I began preparing my own end of life planning during my teenager years and regularly update my documents to reflect any changes and maintain currency throughout the years. Our life journeys may end abruptly and our loved ones who walk alongside us may realize and respect our wish but without legal documents stating and supporting our wishes, there is risk for obstacles in spite our life companions best efforts to honor us.

When discussing advanced directive and durable power of attorney forms with clients, I often am told "my family knows what my wishes are". Unfortunately, verbalizing wishes is not always enough to ensure our wishes our honored. Our doctors do not and are not always allowed to honor our previously verbalized wishes without legal documents stating our wishes.

End of life planning has many caveats for exploration and completion. It is more than simply verbalizing our healthcare wishes in broad generalities. It includes establishing someone to make decisions on our behalf if we're unable to do so ourselves - financially, medically, and physically. It includes directing the distribution of assets, establishing care for dependents, determining medical wishes and service preferences upon our death.

The laws and processes surrounding end of life planning and ability to establish ongoing legal matters, such as guardianship for a dependent, vary from state to state. Thus it is essential to thoroughly obtain and understand what is allowed and required within your area of residence.

Leaving our life companions without legal protection to honor our wishes leaves the door open to not only our wishes being dishonored but also unnecessary stress, legal filings, difficult decisions, potential conflict, and costs that all can be abated by completing end of life care.

When we walk alongside another person we are privy to sharing deeper aspects of ourselves while gaining insight and wisdom not learned elsewhere. This is a mutually shared benefit as the walkee and life companion learn and share their needs, wants, fears, and wishes with one another. It is when we let our egos fall to the wayside and instead listen to what another person needs from life that we are allowed to share one of the greatest gifts we have - respect and honor.

For information on medical end of life planning - Advanced Directive, Durable Power of Attorney, and Do Not Resuscitate Orders - visit here here. For information on estate planning, visit here

Appreciating Death

Through my own near death experiences and years of losing loved ones, death has become a far too familiar part of my life. Others view me as having a death orientation and perhaps this is true. My own health scares have left me unafraid of the passage of this life into the next realm and I've become skilled at saying goodbye to those I love. One can't help but gain this skill when the majority of your friends and acquaintances are those with chronic illness - groups I've come to surround myself with personally and professionally. I can't count the number of family, friends, and patients I have lost over the years since I was almost 2 years old.

I traveled across country with my parents to say our final goodbyes to one of my great uncles. We resumed our yearly visits 6 years ago and as my great uncle's health began to decline and he transitioned from his own home to a nursing home, we began preparing with him. He was becoming closer and closer to his 100th birthday. He was tired and he was ready. Each year we wondered if he would live to see his next birthday and each year he continued to surprise us as well as himself with his longevity. The time was finally nearing. We surrounded him and attempted to comfort him during his bouts of pain. We voiced our love and understanding to him, letting him know that it was time to let go. As we parted with him on the second night, I told him that I hoped he would find peace that night. He turned his head and looked up at me with a knowing look in his eyes. I smiled, fighting back tears, and told him how I loved him and lightly kissed his forehead one last time. That night he passed into the other realm. At age 99, four months shy of his 100th birthday, he finally gained the peace he desired for so many years.

Death is a learning process for those preparing to enter the other realm as well as for those left behind. Someone facing impending death over a period time is given a gift of self understanding - learning the depths of one's fears, hopes, regrets, personal beliefs, and gaining wisdom and insight into the meaning of life and what is truly to be held sacred and important in life, rather than the fluff. This can be a time for intense self reflection that doesn't necessarily come easily to everyone until forced to consider one's inner depths.
No matter how many times we go through the process of losing a loved one -  saying our goodbyes or worse yet the inability to say goodbye due to no forewarning and contributing or participating in the funeral services - it never becomes an easy process, simply a familiar process. We know what to expect, we learn how we obtain closure and grieve, and we learn tricks to make the process and funeral arranging easier and smoother. We learn our own preferences for our own services and what is needed for arrangements. We learn about ourselves just as much as we do about others during such proceedings. Individual personality traits become transparent - whether good or bad traits.

Through death, we are able to appreciate life. I gain closure as I grieve through the sharing of life stories of my loved one. Through this process, I'm reminded of the wondrous times of my loved one's life and fond memories together. When I think of my loved one, I don't think about their death instead I think of the stories shared.
When one of my aunts who helped raise me unexpectedly passed away, I don't remember her death and service so much as I do the weeks and months following her death as I spent multiple evenings throughout the week with my parents, aunts, and uncles sharing family stories as we sorted through her belongings. As my grandfather's body gave way to stomach and esophageal cancer, I spent as many days as possible with him. When I recall his passing, I'm not reminded of his death but of being near him, falling asleep next to him watching television in his big over sized bed like I did so many times throughout my childhood.

Death and the events following one's death are not occasions for overwhelming sadness but rather a time to celebrate and honor our loved one. A time for family and friends to come together and honor the individual's life with stories so that the individual may live on in the hearts and memories of those remaining.

Numbing

The ostomy world lost another inspiring individual with great vision and drive, who helped start a revolution of education, support and life preparedness for youth with bowel and bladder dysfunction or disorders - the Youth Rally.

In our world of chronic illness it seems that life is so ever short and although these losses aren't on a regular basis, it isn't all that unexpected either. We have a lot we are contending with for survival and quality of life - most have several diagnoses competing for treatment. Whenever one deals with the GI tract, there's always a threat of malnutrition and dehydration interfering with one's daily tasks, one's health, one's life. This is why it's so serious of an issue for so many of us - our bodies are in a battle to survive when they aren't working properly to obtain life's necessities. Cancer seems to be another common sideline occurrence, whether it's within the GI system or elsewhere. And of course for those of us with FAP, cancer's always a constant threat. This is not intended to scare or stress anyone, only for others to better understand the daily risks we live with, why it's not a walk in the park. Because of being under attack so frequently, we each find our ways to cope and we must or we'll be eaten alive emotionally and mentally as well.

When people are faced with many losses of life, we tend to start coping by compartmentalizing and dissociating from the event, essentially numbing ourselves. This is extremely common and necessary for anyone working the medical field and it's a mechanism I've grown quite accustomed to utilizing.
Throughout my life, since I was a few months old, I've been surrounded by death. I have lost more family and friends than I care to recall. And working in the medical field, I've lost more patients with chronic or terminal illness than I can track. Although I am saddened by the death of anyone I know, I don't grieve for everyone the same way. When I've lost very close friends and family members, I grieve heavily for months, even years but when it's someone I'm not extremely close to or I have a professional relationship with, I pay homage to their life but there isn't really a grieving period allowed. When my grandfather died, I couldn't speak of him for close to 2 years without crying. When my aunt died, all I could manage to do was attend work and school, every spare moment I had I spent with my family for months sharing family stories. When my best friend died, I didn't sleep for over 24 hours and cried incessantly with his father for close to 6 hours.

I can't menally afford to grieve so deeply for everyone though and that's when the mind protects itself and compartmentalizes experiences. And thank goodness for the mind's own capabilities! I believe this ability of the mind also lends itself to the ability of those with chronic illness or in the medical field to often have warped perceptions of life and morbid humors.
So please don't be harsh on someone if they appear to not be affected as deeply by a death as another person, it may be all the person can manage for they're own surival.

Life Lost

The loss of life isn't anything to be taken lightly, whether it's naturally or by actions of one's self or others. I've shared before in previous posts how chronic illness warps our minds and perception, even in the realms of death. I was reminded of these effects when I heard about Mindy McCready's suicide last week and listening to the negative outlash toward her decision, I felt defensive of her. She endured a lot of pain and difficulty during her life, she was in a spiral of despair and although I cannot speak for her motives, I am not first led to believe her decision was of a selfish nature as many label anyone who has suicidal ideations, attempts or completion.

One thing I've learned during my journey with chronic illness and my time with friends of similar circumstances, is that we really can't judge what others are going through. This is primarily campaigned when discussing invisible illness but it's also in regards how life affects one's mental health, especially when chronic illness is involved. One of my best friends committed suicide, the pain of his chronic health issues became too unbearable for him. Although I deeply grieved for him, I couldn't be angry with him for his decision. I understood his decision too well, I too experienced health misery so great in my life that in a spiral of depression and pain, I longed for nothing more than peaceful death and for several years was suicidal myself. It is this personal understanding that I'm in favor of euthanasia, if solely of the individual's decision without manipulation or exploitation. I am not of the mindset that we are only given things in life that we are able to handle, there are experiences that way too heavy on the body and the psyche that are unthinkable and far too damaging. Those who are able to survive such experiences, I applaud them. However for me, there are several events that I would rather seek that eternal peace than to endure such experiences. Each person is different and so is each experience - but we can all empathize with the turmoil, the despair that another feels if only we try. Instead of blaming someone for their decisions or their desired intentions, let us be there for them and help them through the darkness the best we can.

I do not say such things to cast gloom on the hearts of others, but merely to remind us of empathy for the suffering others experience and to bring insight on their decisions. There are many examples of individuals who commit suicide as a manipulative exploit, to hurt others and for their own selfish gains. But there are many who are simply so hurt themselves or threatened with heavy pain - physical or psychological - that the only peace the individual is able to see is within death.
We need to support one another and any individual with suicidal ideations or plans most often are receptive to support, if only asked about what they're experiencing. Sometimes we miss the signs of how deeply hurt someone is, how close they are to the edge. We cannot blame ourselves if we miss those signs, but we can arm ourselves so that we may be better prepared.
Please visit Suicide Awareness Voiced of Education for information on suicide, warning signs, and ways to help and support someone experiencing such deep turmoil and perhaps together, we can bring more back from the edge.