Don't judge this blogpost - it isn't morbid even if the title sounds so. 😅 But warning - it's really hard-hitting!
For some context, I like to read books about death and mortality, and have written about this topic several times throughout the years. Thinking about our own mortality makes us appreciate life more and gives us mental clarity about our priorities in life. And I've always thought I have achieved some level of clarity already - until I randomly stumbled upon a book called "Preparation for Death: Prayers and Consolation for the Final Journey (Excerpts from St. Alphonsus Liguori)".
How I discovered this book was accidental. One lunch break, I went to a Catholic bookstore looking for communion bread as someone asked me to buy some. Unfortunately, communion bread was out of stock, but since I was in the bookstore already, I quickly scanned books on display and picked some to buy just on the basis of the titles. The book "Preparation for Death" was one of the many books I bought.
Days after, I have this 90+-year old neighbor who asked me for suggestions on what else to put in his bucket list. Thinking that he was probably bored, I asked him if he wanted to read some books so I could lend him, and he said yes. At first I was thinking - should I include the book "Preparation for Death"? - as he or his wife might get offended why I am lending such book! 😅 In the end, I decided to include it but I had to deliver the books personally so I have a chance to explain why I have that kind of book, and again, it's because I am fascinated by the topic of death/mortality.
Guess what? My 90+-year old neighbor read it right away, finished it so fast, and he liked it so much that he messaged me he is going to the bookstore to buy 10 copies to give away to friends! Wow...
Finally, I got the chance to read the book this week and I wanted to share some key points, excerpts and realizations. I hope these snippets would also allow you to reflect about your life and priorities:
Our most important duty on earth is to make sure we save our soul so we go to heaven and be with God when we die. But we often overlook this especially when we're young as we think we'll live long enough. We get busy with life goals, career goals, financial goals, health goals... Yes, some of us do have spiritual goals, but shamefully, it's just one of the areas in life. And we typically do bare minimum on our spiritual goals (e.g. going to Mass every Sunday and holy days of obligation), thinking we could intensify our efforts in serving God when we retire and have more time. The thing is, we could die anytime.
If we're able to excel in doing projects or giving stellar performance in our day jobs, why shouldn't we exert focus and effort to save our souls more often? If we're able to do comprehensive performance appraisals every year or undergo annual health check ups, why aren't we doing a regular assessment on how we are doing in the eyes of God? If we are able to set higher targets or higher standards every year, why do we keep on backsliding when it comes to sinning? Why aren't we regularly setting higher standards for our soul?
When we lose something like money on an investment, we get restless, lose sleep and exhaust efforts to figure out how to recover what we lost. When we offend or hurt someone, we get bothered and anxious, and won't have peace of mind until our apology is accepted. But when we sin and offend God, how come we are able to sleep normally even if it takes months and years before we confess? And we're able to even joke about it or laugh about it? Insane, right? What have we become??? 😢 We got everything so wrong. 😩 If we lose our soul, we lose everything. "For what will it profit them if they gain the whole world but forfeit their life? (Mt 16:26). We need to keep on repeating this verse in our heads so we are reminded that our only duty on earth is to save our soul and be with God for eternity.
Oftentimes, we take time for granted. When asked how are we spending our spare time, some reply "by killing time". That's time lost which could have been used for something worthwhile and good. When you know you're dying, won't you beg God for another year, another month, or even another day or hour of extension? Except that our death can come as a surprise - thus, we might not even get a chance to negotiate with God. Any time not spent in some way for God is lost time.
When we sin or offend God for the sake of our own pleasure, we make pleasure our god. It's a sign that we put more value to our pleasure over how much we value God. 😭
On the day we die, we shall lose all our earthly possessions - honors, riches, pleasures. What we can take with us to eternity are our acts of virtue and the good things which we have done during our lifetime. To see the true value of earthly goods, we need to look at them from the perspective of our deathbed. We won't be able to bring any of our material possessions in the afterlife. Another great reminder from Jesus: "But store up for yourselves treasures in heaven, where neither moth nor rust consumes and where thieves do not break in and steal." (Mt 6:20)
We need to pray in order to preserve our soul. When we are tempted to sin or when we are in a state of sin, we shouldn't stop praying, in fact, we need to pray even harder - to ask God's help so we don't get lost. Jesus said: "Pray without ceasing." (1Thes 5:17). Because if we die with a mortal sin/state of sin, we don't have any excuse if God asks us - if you didn't have the strength to resist the temptation, why didn't you ask for My help? If you fell into sin, why didn't you ask for My forgiveness? 😭 We have 24/7 access to God - there is no excuse not to talk to Him and ask Him for His help especially if we find ourselves in constant temptation or constant exposure to occasions of sin.
When we pray, we need to pray with (1) humility, (2) with confidence and trust in God, and (3) with perseverance. "So I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours." (Mk 11:24) Sadly though, we oftentimes pray only for temporal favors like money, health and earthly goods. 😞 We should pray more to ask for spiritual graces like pardon and divine love.
Reflect on the commandments of God and examine yourself on how you have lived according to the commandments. Examine your motives to see if you are too attached to worldly things, to any particular person, to any special honor, to your home, to your money... Recall as fully as possible the sins you may have committed and go to confession in full sorrow. Banish from your heart all sinful affections, all feelings of anger and hatred for others.
What we can do to keep ourselves in God's grace? Pray often, go to Mass frequently and receive Holy Communion often, read the Bible and meditate on teachings, go to confession, make visits to the Blessed Sacrament, have a devotion to our Lady (ask for her help to pray for us!), examine our conscience daily and read spiritual books, among others.
When we come to serve God, prepare for more testing as enemies will intensify efforts - they will try harder to make us fail. Saint Paul says that "our struggle is not against enemies of blood and flesh, but against the rulers, against the authorities, against the cosmic powers of this present darkness, against spiritual forces of evil in the heavenly places." (Eph 6:12)
We need to avoid occasions of sin - people, places, things - that cause us to sin. The devil is scheming when it comes to tempting good people - he doesn't use a chain to bind a person right away. He will use first a thread, a single hair, then a cord, then finally a chain to drag a person to sin (especially in committing sins against purity). Thus, we need to be more conscious in avoiding all occasions to sin (even the smallest ones that appear to be harmless on the surface).
Look more often and look long at the Crucifix. When saints pondered the death of Christ, they had little difficulty in giving up everything they owned, their pleasures, their families, and even their lives.
In summary - we were not put on earth to enjoy, pursue self-gratification, make money, grow rich, accumulate assets, become powerful, reward ourselves... We are here to become the best souls that we can be (and help other souls too!) so many souls will be with God in heaven after this transitory stage on earth. So why are we more concerned about earthly goals and things, instead of our final destiny? Why are we prioritizing and spending more time crossing off worldly goals, leaving little or no time for our spiritual life? We carve out time for work to earn, spend time with our families and friends, and pursue goals and accomplishments, but guess what? At the hour of our death, no amount of wealth or accomplishments or power can save our souls, and no amount of prayers by our family and friends can help deliver us from hell if our soul is condemned. 😭 Yes, God is all merciful, but again - what if we won't have the chance to ask for His forgiveness when death unexpectedly arrives? It's all up to us now. The great news is - we still have the chance to correct our ways while we're still alive. Help us to be good souls, God. 🙏 🙏
November 1 is All Saints' Day and November 2 is All Souls' Day. And although we pray for our dearly departed all year-round, let us also find time to pray for those souls who have long been forgotten. 🙏
Here's a short prayer I once found in a prayer book which I saved on my mobile phone and printed out too and keep by the altar for easy access. It just takes a few seconds to pray but the small deed goes a long way.
Prayer for the Most Neglected Souls Jesus, for the sake of the agony that you endured, during your fear of death, at the Garden of Gethsamane, at the Scourging, at the Crowning with thorns, on the way to Calvary, at your Crucifixion and death, have mercy on the souls in Purgatory, especially on the souls who are completely forgotten. Deliver them from their bitter pains, call them finally to yourself and embrace them in your arms in Heaven. Amen.
Have you ever had any paranormal experience like feeling the presence of deceased loved ones?
When I was a kid, maybe about 10 years old, an aunt passed away and I overheard my mom talking to another aunt that my younger cousin (the favorite of my deceased aunt) felt the presence of my deceased aunt. One night (just a few days after our aunt passed away), my cousin was sleeping and he was awakened by someone pulling the end of his blanket. My cousin was 8 or 9 at that time and I knew he was telling the truth but at the same time, I don't know what to make of the story coz it doesn't make sense, right? Through the years, I would hear similar stories of blanket-pulling experiences but being a logical person, I still can't comprehend the phenomenon.
Then last week, I received an SMS that a good friend passed away and I was so shocked. I can't believe he's gone. The thought of knowing you'll never be able to talk to a friend is heartbreaking.😢
Like most of my good friends, we don't see each other regularly but we catch up at random times throughout the year and during special occasions. Our last phone conversation was before Christmas when he was on his way to my place to bring his Christmas gift for me but I already had other get-togethers scheduled that day so I wasn't able to meet him. Of course, I blamed him for not giving me a heads up coz otherwise, I would have been able to fix my schedule better.
Our last SMS conversation was when we opened the Christmas gifts we gave each other. We still exchanged Christmas and New Year greetings but only generic greetings. I was preoccupied with something else over the holidays so I didn't really have time to send personalized greetings to a lot of people. I just replied back to those who greeted me.
I was so shocked by his sudden passing away. What could have possibly caused his death? I knew he had cancer a long time ago but he has been on remission for more than 10 years. I don't remember him telling me he was sick again. Other common friends started messaging me to ask what was the cause of his death coz they knew we're in touch. But sadly, I didn't know.
Later on, I found out that he sent a message just before Christmas to selected people (I know of at least 2 from our common circle) about his health condition and his request for prayers for healing - though his cause of death was cardiac arrest, not that of his sickness. Some people were asking me during the wake if I got his message and I said no. I joked that maybe he didn't think I am prayerful enough or maybe we weren't that close after all as everyone thought. 😅
Anyway, the next day (4th day of his death), I was tracing an old message thread with a supplier on FB messenger and as I was scrolling through my FB messages last year, I saw my friend's name. Guess what? He did send me the message about his declining health condition, how he was in pain 24/7 (but not due to cancer but another sickness) and his request for prayers for healing! 😭 The message was marked opened but I never remember reading it. 😩😩😭😭I have this habit of sometimes opening messages, then when I get distracted (e.g. someone suddenly talks to me, or a call or another message suddenly comes in) or when I think the message is a forwarded message, I would just make a mental note that I'll read it later. And sometimes, I forget until the sender follows up.🙈
I felt super, super guilty! Imagine, in his mind, the message was read but I ignored his cry for help. 😭😭😭 So I asked for St Pio's intercession that night to send him a message - that I was terribly sorry and guilty for not being there for him coz though the message was marked as "read", I failed to read it. And to also tell him that he should have messaged me via SMS coz he knows I don't use FB in the first place. And that he should have badgered me for such an important concern. I know right, I really had to make hirit - just like in our regular conversations. Haha... Then I told St Pio that I wanted to know if (1) he got my message and (2) if he accepts my sorry. Then I slept at 1:30am.
I was in deep sleep when suddenly, I felt that there was someone tugging the end of my blanket. It was as if someone was lifting the end of my blanket to create ripples coz I could feel the ripples as they moved towards the top of my blanket. My immediate thought was that I was just dreaming and tried to move my feet by slightly kicking (coz if you're having a nightmare, the first thing that you have to do is to try to move your extremities - toes or fingers). I was able to easily move my feet so I knew that I wasn't having a nightmare but the ripples continued - it's as if the ripples won't stop until I get up. I woke up groggy and a little agitated (coz I love to sleep and I don't like it when my sleep is interrupted), and I immediately sat up from my bed to check what was going on but there was no one at the foot of my bed. My friend's last Christmas gift to me though was at the foot of my bed. But I dismissed everything coz what I felt happened didn't make sense. I was alone at home so nothing could have happened. It was just all a dream.
I re-positioned on my bed to sleep and went back to close my eyes. My right arm was resting on top of a side pillow, when suddenly, I just felt my right arm jerk and it fell on the bed. My side pillow got pulled! I couldn't explain how that could have possibly happened coz there is a wall on my right side and there is so little space between me, the pillow and wall so I could not have done it unconsciously. Then it occurred to me - could this be the sign that my friend got my message and he accepts my sorry (or was getting back at me so we're even)?! Coz it's similar to all the blanket-pulling stories I've heard before and I couldn't believe it would happen to me someday. But I didn't get scared ... though it would have been better if it were a simpler sign like a butterfly, or a flower or some kind of object we share common interest in. 😆
Now here's the thing - when I told a couple of our common friends about it, they said they would have freaked out if it happened to them. During the funeral, one of my friends also confessed to me that when his dad passed away, he had a similar experience. While asleep, her head pillow suddenly got pulled out and her head fell outside of the bed. She said it was her dad's way of saying to change for the better coz she and her dad had a love-hate relationship. But she said she doesn't want to experience something like that ever again so to make sure our friend doesn't make his presence felt to her, she's going to wear something red when she sleeps to make her invisible to spirits or won't attract spirits (or something like that).
So after I got influenced from my friends that the experience was scary, I prayed to St Pio to tell my friend - no more signs and no more felt presence, please! Haha... 😂 And for him to enjoy his afterlife journey and that I would continue to pray for him. And I also moved his last Christmas gift to me to another location. 😅
In case you want to send a message to a departed loved one, you can ask for St Pio's intercession. Trust that your message would reach the intended recipient. No need to ask for any sign. 😅 Incidentally, when we entered the cemetery during my friend's funeral, guess what was the nearest street to his final resting place? St. Pio Street. What a coincidence, right?
Anyway, before you go, I hope you spend a few seconds to say a short prayer for your departed loved ones too:
Eternal rest grant unto them, O Lord. And let perpetual shine upon them. May they rest in peace. Amen.
I know the topic of death is morbid but call me weird, but I like to read books about mortality. As they say, the more you face mortality, the more you appreciate life. In fact, I remember reading before that a common denominator among those who make it to the list of happiest places on earth think about death everyday such as the Bhutanese. Yes, ironically, thinking about death everyday could have positive effects. Knowing that you have limited time on earth which could just end any time without warning makes you value your life better and treat time preciously. Maybe this is also one of the reasons why I never get bored or lonely. 😜
My latest read that is mortality-related is about death rituals in various parts of the world. In our spot on earth, our practice is to place the dead body in a glass-covered coffin, have a wake for a few days, and bury the dead in the cemetery. In the last few years, cremation has also become more common. But these two are nothing compared to what I learned from the book “From Here to Eternity” by Caitlin Doughty. The rituals got me so curious that I ended up researching online and reading more about some of the individual rituals. Sharing with you those I found really interesting.
Toraja, Indonesia
In Toraja, Indonesia, between the period of death and funeral, the body is kept at home and this period could take several months or even several years.😱 During this period, they also consider the person only sick and not yet dead.
While at home, the family cares for and mummifies the body. The family members bring food to the corpse daily, change the clothes and they speak to the body as if the person were still alive. Speaking to a corpse is a way for them to stay connected.
The Torajan guide who accompanied Doughty for example, shared that his dead grandfather stayed in their house for 7 years before he got buried.😱 And guess what? He and his brother slept with the dead corpse of their grandfather on the same bed. In the morning, they put his clothes on and stood him up against the wall. Every night, they laid him on their bed.
The Torajans also have a ceremony held every few years (every 3 years I think) called ma’nene’ (ma-ne-ney) wherein they take out the mummified bodies of their dead from tombs, clean them, change their clothes, serve them food and give them things which the person liked when he/she was still alive e.g. if the dead person used to smoke when he/she was still alive, they would stick a cigarette on the corpse’s mouth during the ma’nene’.
Again, their practices sound really strange to most of us but when you hear the stories of the Torajans, such ritual greatly helps them in dealing with the loss of a loved one especially when the death is unexpected. When I researched online and saw some photos, you could truly see the love, joy and pride the Torajans have for their loved ones’ corpses.
Barcelona, Spain
In Barcelona, Spain, the rituals are somehow similar to ours because they also hold wakes (or maybe we got the concept of wake from them having been under Spanish colonization). Anyway, for their wake, they have 2 options:
(1) Spanish style viewing wherein they display their loved ones in a coffin surrounded by flowers behind one large pane of glass (like a department store display window); and
(2) Catalan style wherein they slide the open coffin into a Snow White display case in the center of the room.
For either setup, they maintain a steady temperature around the body of 0 to 6 degrees Celsius because the bodies are not usually embalmed as they are buried within 24 hrs. And because corpses are not embalmed, decomposition time is faster, thus, ground graves and mausoleums in Spanish cemeteries are usually for lease for a minimum of 5 years (which is roughly the decomposition time vs embalmed bodies which take about 20 years' transition time). Then when the corpse has decayed down to bones, it is transferred to a communal pit so the vacated tomb can be reused by newer corpses. That's what you call grave recycling. What a nice concept.
Nepal, Tibet
The ritual in Tibet for me is the most unusual. It made me cringe the first time I heard about it. But once you try to understand their underlying belief, it does make sense.
When a Tibetan dies, the family lights butter lamps and monks pray over the body. Come funeral day (usually 3 to 5 days following the death), the family and relatives stay at home to pray and they do not attend the funeral. Instead, it is the villagers who bring the dead body to a sky burial site via horse or a car.
Once they reach the sky burial site, the master of the ceremony performs a ritual over the body, burns incense and tsampa (roasted flour) to summon the vultures, then proceeds to chop the body in smaller pieces. 😱 The vultures feast on the dead remains. If the vultures consume the entire body, it’s a good sign as it means the person is good and did good deeds while he/she was still alive.
Chopping the body of a loved one - even if it is lifeless - is something unthinkable and shocking for us but Tibetans believe that the corpse is nothing but a discarded shell, and the spirit of the deceased has already moved on. They consider offering bodies to vultures as the last great and honorable thing to do - a way to offer your life back to earth.
Tokyo, Japan
The Japanese are well-known for being one of the longest-living in the world. But since Japan has a shrinking young population, there are 70 year olds taking care of their 90 yr old family members, and there are a lot of the elderly who also live alone. Because of this, the Japanese has a term called kodokushi which means lonely death or a phenomenon of people dying alone and remaining undiscovered for a long period of time. Sometimes it takes weeks or months before dead bodies are discovered in their homes. The first kodokushi which became national news in Japan was in 2000 when an old man was discovered 3 years after this death, and only because payments for his monthly rent and utilities stopped because the savings account from where his payments got auto-debited reached zero balance. Can you just imagine if his savings were bigger and lasted for several more years to cover his rent and utilities?
In Japan, 99.99% opt for cremation, which is one of the highest cremation penetration in the world. Because of this, there is waiting time before a body can be scheduled for cremation. It could take a week or more before it can be cremated especially in urban areas. So bodies are usually refrigerated in morgues but since there are very limited hours to visit the morgue and it’s not a proper place to mourn, the Japanese have so-called corpse hotels. In the book, the author visited a hotel called Last Tel - short for last hotel - where corpses are refrigerated and at any time you want to spend time with the body of your loved one, you can rent a room.
Now for their cremation process, what’s different with theirs is they don’t pulverize the bones. Instead, family members are handed chopsticks - one wood and one metal chopstick. The chief mourner begins by picking up bones starting with the feet and put them into the urn. Other members join and continue up the skeleton. If the skull can’t fit intact, the cremator might help break it up into smaller pieces by using metal chopsticks. The horsheshoe shaped bone in the jaw is placed in the urn last. Excess ash can be brought home or left with the cremator to be collected by ash collectors and buried in cherry groves up in the mountains.
As for Japanese burial places, they are so hi-tech. In one place where the author went, visitors have a card with a chip and when scanned at the entrance, all Little Buddhas of tombs light up in blue except for the visitor’s tomb which lights up in white so it can be easily spotted. With a click of a button in the master control, there could also be a light show depending on the season or occasion. And with another click, all little Buddhas of those celebrating their birthdays or death anniversaries could also light up. Amazing.
Then, the Japanese have also indoor cemeteries where there are pods with a traditional granite gravestone, complete with fresh flowers and incense. How is it different from the cemeteries we know other than being indoor? The gravestone in each pod has a rectangular hole. When u swipe your card, a robot behind the wall will retrieve the urn of your loved one and the tombstone bearing your loved one’s name will appear in the rectangular hole of the gravestone. How hi-tech, practical and space-saving.
Most of the rituals may sound really bizarre for some of us but even if each culture has different beliefs surrounding life and death, there is one thing in common - it’s never easy to cope with the loss of a loved one.
I've a soft spot for kids and the elderly. Kids because they are just so adorable - no explanation needed. :) Elderly because they remind me of my parents, grandparents, grand-aunties & grand-uncles, titas & titos, ninongs & ninangs (godparents), the parents of my friends, and all the elderly people (including strangers) who have touched my life and imparted words of wisdom which I never quite understood until I hit my mid-20s. So ok, they were right about almost everything! Wahaha....
Anyway, sometime last year, I heard one talk which mentioned that the elderly is one of the most marginalized groups in our society and that fewer people visit homes for the aged than orphanages. I guess people gravitate towards helping kids more than the elderly maybe because it's easier to interact with kids, the mood is lighter and activities are playful and fun. Versus when you think about the elderly, it evokes some kind of seriousness, nostalgia, and even some degree of sadness.
After realizing how marginalized the elderly are, I made a mental note to visit a home for the aged but unfortunately, I never got around doing it last year.
Last weekend, I was supposed to do other things but the idea of visiting a home for the aged just occurred to me out of the blue. I called up the home for the aged I was eyeing to visit last year and inquired what they needed. A friend and I got the supplies and headed there.
When we delivered the boxes of supplies to the kitchen, the nun exclaimed "Do you know you're an answered prayer?!". She explained to us that the day before, they didn't know where to get their food and pantry supplies so as usual, they just prayed to God and trusted He will answer them. And there we were bringing exactly what they needed. (But of course, if we didn't call to ask what was on their list, we would not have known what they needed! So if you want to be an answered prayer too, make sure to call the home you plan to visit to check in advance what they need. Haha...)
Anyway, during our visit, there was some outreach activity scheduled that morning so it looked like we wouldn't be able to interact with the elderly. :( But the nun told us we could tour the facility before we leave.
When we reached the second floor, we saw another nun who was with an elderly on a wheelchair (it seems that she opted not to join the outreach program). The nun said it was lola's (grandmother's) birthday - her 87th birthday if I remember right. To free up the nun, we said that we could take care of lola for a while.
Before we knew it, the morning outreach activity was finished and all the other lolos (grandfathers) and lolas (grandmothers) returned to their respective floors. We talked to more lolos and lolas and before we realized, it was lunch time already! We decided to stay on to assist feeding the lolos and lolas.... and we stayed on until the lolos and lolas were safely tuck in to their beds for their afternoon siesta. One thing just led to another. The nun who welcomed us in the morning was so surprised to see us still there after 4 hours. All the while she thought we have left! Haha...
Anyway, if you're planning to visit a home for the aged or nursing home, I've compiled some useful tips below:
- Ask for advice on how to best handle each person from the people taking care of them. They know the behavior of each individual - if they are in a good/bad mood, what gestures or words would make them smile or be obedient, what words or topics you should avoid bringing up, etc.
- Do gestures that show your respect such as making "mano" (bringing the back of their hand to touch your forehead). They also appreciate any sense of touch such as holding their hands, gently rubbing their arms or shoulders, or gently stroking their hair as you talk to them.
- When you talk to them, be sure you're at eye level. If they are on a wheelchair, kneel on the floor or pull a chair so you can talk to them at eye level.
- Don't ask about their birthday. Some of them get agitated and some get overly excited when they realize their birthday is coming soon. They might have a hard time sleeping for weeks in anticipation of their birthday.
- Don't be surprised if they ask you the same questions every 3 minutes coz some of them have Alzheimer's disease already. This isn't an exaggeration. A lola asked me the same set of questions (always in the same sequence) every 3 minutes. If you begin to notice that the conversation becomes repetitive or going around circles, most likely, you're talking to someone with Alzheimer's. Just go along and answer every question as if it's the first time it was asked - every time.
- Be patient. Some could be really grouchy no matter what you do to please them. But don't take it personally. You have to remember that they have emotionally gone through a lot - some have been abandoned by their family members and others no longer have any living relatives who could take care of them. In addition to the emotional burden, imagine the physical challenges - being weak and helpless, experiencing bodily pain and discomfort, having blurred vision, loss of hearing and limited mobility. Then there's also the threat to mental health such as losing one's memories to Alzheimer's and dementia. It's ok if you weren't able to make them smile or laugh even after giving your best effort. What matters is they know someone still cares about them.
- When feeding the elderly, slice their food into small pieces and mix everything with the rice. Be attentive if they chew on something hard. Just allow them to spit it out and cup it in your hand. And don't forget to wipe their mouth clean when food leaks. When assisting them to drink, make sure to tilt the cup slowly to control the flow of water into their mouth.
- Listen to them - it's probably the most simple gesture you could do to make them feel they are cared for. The elderly love to talk a lot - they could be anecdotes about World War II, stories about their proudest moments, or sometimes their complaints about life. Just let them initiate what they want to talk about and go along with that topic. As much as possible, don't ask personal questions as it might trigger sad or bad memories - unless it's the elderly himself/herself who initiates the topic.
- Respect their privacy. Strictly no photos and videos, and no publicly sharing of their private lives and identities.
- Plan your visit during off-peak season - away from Christmas season. From what I know, donations and visitors in charitable institutions spike from November to February (around Christmas season). So better if you could time your visits in between so hopefully, there would be a steady stream of volunteers and donations throughout the year.
- Contact the home for the aged to find out what they items they need. Sometimes, they have a surplus of certain items and they lack in some. So to be sure what you bring is useful, better to check with them beforehand. Some nursing homes are also open to voluntary services like feeding, bathing, walking the elderly, giving haircuts, etc.
The home for the aged we visited is called the San Lorenzo Ruiz Home for the Elderly operated by the Little Sisters of the Poor. Here are the contact details if you wish to visit, donate or do volunteer work:
San Lorenzo Ruiz Home for the Elderly
50-B Lancaster Street
1300 Pasay City, Manila, Philippines
Phone: (632) 8329689 . (632) 8322915
When we said good-bye to the nuns, I asked one of them if she won't be having her afternoon siesta to which she joyfully replied, "No, I don't need to rest now because when I die, I will get eternal rest!" Haha... :)
Anyway, I wanted to end this blogpost with a beautiful quote I read from the book "Final Gifts". It's a quote from Dr. Cicely Saunders, founder of the modern hospice movement, of palliative care. She once said (addressed to the dying) - “You matter because you are you. You matter until the last moment of your life. We will do all we can not only to help you die peacefully but also to live until you die.”
Beautiful, right? Now if only we could, in our own little ways, help contribute to that - not only when we visit nursing homes but even in our chance encounters with the elderly. :)
My recent read is about dying and death. Call me a weirdo but I love to read books not just about life but also death.
I think about mortality a lot because it keeps me grounded not to take everyday moments for granted. Thinking about death also makes me appreciate every single day that I'm still alive.
Ironically, thinking about death isn't sad and depressing. Go research about the Bhutanese, the happiest people on earth. They think about death 5 times a day! I'm not at that level yet though - I only think about death once a day! Haha...
Anyway, going back to the book I read, it's entitled "Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying" by Maggie Callanan and Patricia Kelley. The authors are hospice nurses who take care of terminally-ill patients and after having witnessed so many deaths for 20 years, they were able to identify similar patterns and recurring themes among the dying.
For example, you've probably heard stories of people who passed away right after a family member from overseas came to visit. Or someone who passed away right after a special occasion like a birthday, or after a special milestone was achieved like a graduation of a grandchild. These are not coincidental. It's a recurring theme among the dying across different cultures. It is as if the dying person has chosen when to die. But this is just one, there are several more recurring themes.
Callanan and Kelley say the messages of the dying fall into 2 categories:
(1) Attempts to describe what someone is experiencing while dying.
The experience of dying frequently includes glimpses of another world and those waiting in it. Although dying people provide few details, they speak with awe and wonder of the peace and beauty they see in this other place. They tell of talking with, or sensing the presence of, people whom we cannot see—perhaps people they have known and loved. sometimes religious figures. They talk about the need to prepare for travel or a change, or mention some place we cannot see, or describes seeing a bright light. They know, often without being told, that they are dying, and may even tell us when their deaths will occur.
(2) Requests for something or someone that a person needs for a peaceful death.
Dying persons’ requests are sometimes difficult to decipher. Their recognition of the importance of these needs, along with concern for family and friends, can cause the dying to control the time and circumstances of death until those needs are met. These requests often involve someone else; they may be for meetings or the healing of relationships. Or it's a desire to reconcile personal, spiritual, or moral relationships, and requests to remove some barrier to achieving this peace.
For #1, what are the ways the dying attempt to describe to us what they are experiencing?
- The dying often use the metaphor of travel to alert those around them that it is time for them to die. They also have a deep concern about the welfare of those they love, asking themselves, “Do they understand? Are they ready? Are they going to be all right?” It seems dying people need permission to die. If given, that permission provides great relief; its absence can make the dying process more difficult and lengthy. The dying intuitively know when—and often why—this permission is being withheld, by the behavior of those around them. This withholding indicates that those they love don’t understand their struggle, nor are they prepared emotionally to deal with the finality of their leaving.
To give the person permission, you could assure him/her that “Everything will be fine” or tell the person “Just let go. I’ll miss you, but I know you need to go now.”
- Dying people, days or hours before the actual death, often interact with someone invisible to others—talking to them, smiling, waving, nodding, or reaching out for someone or something unseen. The unseen person’s (or persons') identity often is clear to the dying. Generally they recognize someone significant from their lives—parent, spouse, sibling, friend—who is already dead. There is often a sense of pleasure, even of joyful reunion, in seeing that person again.
Some see religious figures—angels, perhaps, or spirits. Even when people don’t recognize the figure they’re seeing they don’t appear upset or frightened. They usually were calm as they talked about it, and seemed comforted and more peaceful in the presence of their invisible visitors.
There's one story in the book wherein the patient was an atheist and she saw an angel by her window. It still didn't make her believe in God or angels but she told her mom that it felt good to know that she won't die alone as someone who loves her is waiting for her.
These gestures give us glimpses of whatever dimension exists beyond the life we know.... Knowing that a dying person may be reunited with someone they cared about reinforces our hope that love and important relationships may be eternal.
So when dying people start mentioning of seeing people who have been dead for years, don't contradict them by saying they must be dreaming or hallucinating. Such comments may discourage them from further sharing their experiences. Instead, just encourage to talk more about it like what they see or how they feel, etc.
- Many dying people tell of seeing a place not visible to anyone else. Their descriptions are brief—rarely exceeding a sentence or two—and not very specific, but usually glowing. They may describe the place as beautiful or lovely, but the response to “Tell me more . . .” often is a dreamy look and a shake of the head or several false starts and then: “I can’t.” Even so a glimpse of this other place seems to bring peace, comfort, and security to the dying person—reactions shared by those able to listen and understand.
- When dying people repeatedly mention significant items used in family occasions but the timing is off, they may be trying to communicate that he/she may not make it until that occasion that's why he/she is already requesting to celebrate it in advance.
There is a story in the book where the patient kept telling his wife to "get the sparkler cake now" - the sparkler cake is what their cook bakes for them on their wedding anniversary. But the wife thought the husband was confused coz their wedding anniversary which is 4th of July was still a month away. Every time she told her husband their anniversary is still weeks away, the husband would insist to get the sparkler cake now. The hospice nurse explained to the wife what her husband was probably trying to communicate to her so she had the sparkler cake made and celebrated their wedding anniversary in advance. The husband died on June 30 and was buried on July 4, their wedding anniversary.
The authors say "in ways that are direct, or subtle, or even silent, dying people are showing us that they do know when their deaths will occur, and that they are not distressed by this information. By listening and understanding these messages, we are given unique opportunities to prepare ourselves for their loss, to deal with our fears of dying, to use well the time that is left, and to participate more significantly in this life event."
For # 2, what kind of requests does a dying person need to die peacefully?
They could be (1) Reconciliation - whether with a specific person or God; (2) Removal of a barrier standing in the way of a peaceful death; (3) Unfinished business; (4) Particular circumstances to die peacefully e.g. choosing the time of their death or the people who will be there.
The challenge though is sometimes, their requests are vague or indirect and may be missed or ignored, leading to frustration, anxiety, and sometimes agitation (which often the response is to sedate the patient).
Agitation is at its peak if the dying person is close to death and he/she realizes death won’t be peaceful without this reconciliation. This may be what occurs when someone seems to die in pain; rather than physical, the pain may be emotional or spiritual. These types of pain can be harder to relieve, and far too often go unidentified or ignored. Understanding issues that need resolution can enable us to better assist dying people and help us realize the need for reconciliation and completion in our own lives.
There's a story in the book where one day, the patient became restless and anxious and she was complaining “I can’t find the feed for the horses!”. The hospice nurse, to encourage her to explain further, asked "Why do the horses need feed?”. Then the patient answered “I’d never make them take me on this trip without feeding them first!” she answered.
The hospice nurse then tried to decipher with the patient's family what could feeding the horses meant. One of the patient's granddaughter connected it to the farm where her grandma grew up were grandma's family used horses and wagon to go around. Then they tried to decipher what could she have meant by "I’d never make the them (horses) take me on this trip without feeding them first!”. Who could be the unfed horse/s who won't allow her to go on her trip if she doesn't feed them?. They realized the horses may symbolize her children. Apparently, the patient had an estranged son. If there's even one unfed horse, she won't be able to go on her trip. So the family arranged for a reconciliation between mother and son. Since the reconciliation, the patient never mentioned about feeding horses again. The son spent quality time taking care of her mom for the next 2 weeks until the mom peacefully died.
Another important thing we need to know - just before they die, and usually without warning, some patients can muster an unusual strength. Unfortunately, some use that strength to try to get out of bed, and subsequently fall. Afterward, the family feels a terrific amount of guilt, and may blame the fall for causing the death. A frightened and tearful family member may say: “Dad just died. He was trying to get out of bed and fell to the floor! We’ve been with him all the time, but I’d just run down to the kitchen for coffee. I feel just awful. It’s my fault; if I’d been there this wouldn’t have happened! How could this have happened, anyway? He’s been semiconscious, barely responsive for the past two days, didn’t even have the strength to hold a glass of water. He was too weak to move at all by himself! How could he get over the bed rails? I don’t understand it! How can I live with this?”
Instead of assuming the worst, it’s best to ask a few questions: What were the dying persons trying to do? Were they seeing someone or some place invisible to us? Were they trying to go there? Was someone that we couldn’t hear calling them to come?
The authors aren't suggesting that it’s all right for dying people to fall out of bed. But what they want to highlight is no one knows the reasons for this phenomenon of reaching out—and sometimes climbing out of bed—in the last moments of life. The fall may not have caused the death; the person might have died at that time, whether he fell or not. The fall may have resulted from his response to something he was experiencing while dying.
Sometimes people wait for some other reason: perhaps a grandchild’s birth, or a son’s graduation, or a family member or friend who needs to say goodbye. We've heard a lot of these stories - this is probably the most recurring theme we're familiar with. But what's new to me is the information that some people choose to die when their loved ones are away to spare them the anguish of witnessing their moment of death. Some even choose to die alone particularly those who are very private. (Uh-oh, that's me! Wahaha...)
In the book, here's a common story to illustrate when a patient chooses to die when their loved ones are away: Family member/s or friend/s has/have been by the patient's bedside for days or weeks. One random night, the patient tells them to get some rest. That same night, it is when the patient chooses to die. If you've experienced something similar, instead of feeling guilty for not being there, also consider that maybe it is how the patient wanted it to be.
That's surprising info for me - that many dying people are able to exercise some control over their deaths - of the time, the circumstances and the people present.
A long time ago, when my dad passed away and I was trying to better understand the grieving process, I read somewhere that one of the stages you undergo is guilt where you try to connect yourself to your loved one's death even if there is no direct connection. It could be thoughts like - if only I did ___ or if only I was there, maybe he would still be alive.
I like what the authors wrote in the book. They said -
Understand that if the dying person wants you there when death comes, you probably will be there; if he doesn’t, you probably won’t. So keep going about the business of living without worrying about whether you’ll be there or not, and don’t feel that you’ve failed if you aren’t there when it happens. Recognize it as the dying person’s choice and possibly a gift of sparing you.
Beautiful insight, right? Especially after knowing that the dying could exercise some kind of control over their deaths. Thus, if there's some kind of guilt, regret or unresolved feeling that has been bugging you over the death of a loved one, understand that perhaps that was how he/she wanted to go.
So many learnings from the book. Hopefully knowing all these would help us assist those who yearn for care, closure and reconciliation should the need arises.
My latest read is a book written by a neurosurgeon from Stanford University, Paul Kalanithi's "When Breath Becomes Air".
I like to read books written by doctors for several reasons:
(1) The way they talk about life and mortality is very profound.
(2) Because they are very intellectual and scientific, there's no baseless drama. If there's ever drama, there's always an authentic reason for it.
(3) No matter how scientific their brains are wired, almost always, there's a point in their lives when they begin to acknowledge the existence of some kind of spirituality.
(4) I learn a lot - not just about medicine but about life and dealth.
One of my favorite books is "Being Mortal" by Atul Gawande who's also surgeon. After reading, Kalanithi's "When Breath Becomes Air", I also have to add it to my favorite reads. Kalanithi's words made think, laugh, learn, reflect and yes, cry. You'll know later why. :(
Sharing with you my top learnings from Kalanithi's When Breath Becomes Air (in random order):
1. The difference between tragedy and triumph in neurosurgery is defined by one or two millimeters.
As Kalanithi explained, technical excellence in neurosurgery is a moral requirement. Good intentions are not enough, he said, not when so much depended on one's skills.
Cut 1 to 2 millimeters deeper and the patient may be completely paralyzed. Cut 1 to 2 millimeters deeper, the patient may not be able to speak or write. Cut 1 to 2 millimeters deeper, the patient may be able to speak but in a stream of unconnected words and phrases that don't make sense. (Thought bubble: How could even a person want to be a neuro-surgeon?! )
There was one patient whom Kalanithi met, who after his brain tumor was removed, could only speak in streams of numbers. “Fourteen one two eight,” the patient kept on repeatedly saying but no one could understand him. The patient died a few months later without anyone knowing what he meant by "Fourteen one two eight".
When the gift of language is taken away from a person, the patient becomes an isolate, something central to her humanity stolen forever. Kalanithi shares that the destruction of the sensitive areas of the brain like those that cover the language areas often restrains the surgeon’s impulse to save a life for what kind of life exists without language? he asked.
To make sure that the right spot of the brain is touched, surgeries are performed with the patient awake and talking so the patient could be asked to perform various verbal tasks. There was a time when Kalanithi operated on someone with Parkinson's disease. The target was the subthalamic nucleus, a tiny almond-shaped structure deep in the brain that is responsible for movement, cognition and emotion. Kalanithi placed an electrode 9 cms deep in a patient’s brain and it stopped the Parkinson's tremors on the left hand but then the patient said “I feel…overwhelmingly sad.” They put off the current and turned it on again but the patient still said that if feels dark and sad. They pulled the electrode out and reinserted it, this time 2 millimeters to the right. The tremor went away and the patient felt normal (no longer sad).
But there's one funny anecdote. There was this patient who had a tumor located in the language areas of the brain. The hospital's entire tumor board deemed the operation to be too dangerous but the surgeon still opted to proceed. Kalanithi felt that it was their responsibility to say no to the patient. But when he met with the patient, the patient just told Kalanithi “I want this thing out of my f*cking brain. Got it?” pointing to his head. There was no way the patient could be talked out of the operation.
So what happened during the operation? Instead of the usual alphabet recital or counting exercise, throughout the surgery, the patient blurted out a litany of profanity to the doctors! “Is that f*cking thing out of my head yet? Why are you slowing down? Go faster! I want it out. I can stay here all f*cking day, I don’t care, just get it out!”
The patient’s monologue kept on even after Kalanithi has successfully removed the tumor - “Why’d you stop? You some kinda as*hole? I told you I want the f*cking thing gone!”
Kalanithi at that point told the patient that the tumor was already gone. But all throughout the surgery, the patient never encountered any speech difficulty considering the tumor was big and it was in the language areas! Kalanithi's thoughts were - How was he still talking? Given the size and location of the tumor, it seemed impossible. Profanity supposedly ran on a slightly different circuit from the rest of language. Perhaps the tumor had caused his brain to rewire somehow…
Haha....
2. The physician’s duty is not to stave off death or return patients to their old lives, but to guide the patient and family, whose lives have disintegrated, and work with them until they can stand back up and face, and make sense of, their own existence.
Before operating on a patient’s brain, Kalanithi first understood his patient's mind - his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.
Kalinithi also shared that his highest ideal was not to save lives because everyone dies eventually—but to guide a patient or family to an understanding of death or illness.
He said that when a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever color how the family remembers the death, from a peaceful letting go (“Maybe it was his time”) to an open sore of regret (“Those doctors didn’t listen! They didn’t even try to save him!”). When there’s no place for the scalpel, words are the surgeon’s only tool.
For example, if a patient suffered brain damage, families usually see only the past like their memories with the person, while Kalanithi see the possible futures - the breathing machine, the possible long, painful, and partial recovery or, sometimes no recovery at all. Kalanithi tried to help families understand that the person they knew—the full, vital independent human—now lived only in the past and that he needed the family's input to understand what sort of future the patient would want.
Don't you wish all doctors were like Kalanithi?!:)
3. Brain diseases are probably the worst.
Any major illness transforms a patient’s life and his/her entire family’s life. But Kalanithi pointed out that brain diseases have the additional strangeness of the esoteric. A son’s death already defies the parents’ ordered universe; how much more incomprehensible is it when the patient is brain-dead, his body warm, his heart still beating? he asked.
4. It's important for doctors to be accurate but they must always leave some room of hope.
Rather than saying, “Median survival is eleven months” or “You have a ninety-five percent chance of being dead in two years,” Kalanithi would say, “Most patients live many months to a couple of years.” This was to him a more honest description.
Kalanithi explained that you can’t exactly tell an individual patient where she sits on the curve: Will she die in 6 months or 60? Kalanithi came to believe that it is irresponsible to be more precise than you can be accurate. He said - "Those apocryphal doctors who gave specific numbers (“The doctor told me I had six months to live”): Who were they, I wondered, and who taught them statistics?"
5. Knowing that even if you're dying, until you actually die, you are still living.
Kalanithi, at age 36, at the peak of his medical career and just about when he and his wife started talking about starting a family, was diagnosed with an inoperable Stage IV lung cancer.
Here's one of his conversations with his wife:
“What are you most afraid or sad about?” she asked me one night as we were lying in bed.
“Leaving you,” I told her. I knew a child would bring joy to the whole family, and I couldn’t bear to picture Lucy husbandless and childless after I died, but I was adamant that the decision ultimately be hers: she would likely have to raise the child on her own, after all, and to care for both of us as my illness progressed.
“Will having a newborn distract from the time we have together?” she asked.
“Don’t you think saying goodbye to your child will make your death more painful?”
“Wouldn’t it be great if it did?” I said.
Lucy and I both felt that life wasn’t about avoiding suffering.
They both decided to have a child. They would carry on living, instead of dying.
6. Until you've gone through something yourself, you don't really know.
Kalanithi shared:
As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know. It’s like falling in love or having a kid. You don’t appreciate the mounds of paperwork that come along with it, or the little things. When you get an IV placed, for example, you can actually taste the salt when they start infusing it. They tell me that this happens to everybody, but even after eleven years in medicine, I had never known.
7. Maybe in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.
Kalanithi shared that based on statistics, he might live another twelve months, or another 120 and he thought that having terminal illness would be life-clarifying. If he no longer sought to fly on the highest trajectory of neurosurgeon and neuroscientist, what did he want? To be a father? To be a neurosurgeon? To teach? However, not knowing the exact months or years made it difficult for him. If he knew he had 3 months, he'd spend time with his family. If one year, he’d write a book. If 10 years, he’d get back to treating diseases. But living one day at a time didn’t help. He didn't know what to do with a day.
He concluded that maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward, he said.
But he also added that as you go through your illnesss, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out.... You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process, he shared.
Kalanithi passed away on March 9, 2015 - less than 2 years after he was diagnosed. His baby was 8 months old then. Heartbreaking...
He had multiple organ failure and the only way he could live was to be on life support but it wasn't the life that he wanted (though his family pleaded with him). Overnight, he agreed to be on life support but the next day, he said he was ready to go. They put him on morphine and removed his life support.
His wife wrote the epilogue on his book and here are my favorite excerpts:
Paul confronted death—examined it, wrestled with it, accepted it—as a physician and a patient. He wanted to help people understand death and face their mortality. Dying in one’s fourth decade is unusual now, but dying is not.
Relying on his own strength and the support of his family and community, Paul faced each stage of his illness with grace—not with bravado or a misguided faith that he would “overcome” or “beat” cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forge a new one.
He cried on the day he was diagnosed. He cried while looking at a drawing we kept on the bathroom mirror that said, “I want to spend all the rest of my days here with you.” He cried on his last day in the operating room. He let himself be open and vulnerable, let himself be comforted. Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning.
What happened to Paul was tragic, but he was not a tragedy.
