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One day last month, I coughed 276 times in a day. And peed 16 times, 5 of which demanded that I rise from sleep. It was a bad day. I had been having a lot of bad days. For about three months my asthma and interstitial cystitis had gotten signficantly worse. A constant cough and overactive bladder have plagued me for thirty-ish years. The natural herbs, acupuncture, bee pollen, occasional albuterol and pyridium no longer worked. I felt defeated and hopeless. Living well until we die is my motto. That was feeling pretty hard to do when every day my physical quality of life was seriously compromised. What is a death doula to do? Since then I have gotten on an inhaler, tried a heavy drug that wiped me out, and seen a speech therapist who taught me to slow my spasms to cough by exhaling slowly instead of giving in to the spasm.  I also have met with a pelvic floor physical therapist and taken an online pelvic floor strengthening class and completely changed my normal breathing to contract and pull up my pelvic floor upon exhalation.  I also have been getting treatments on a medically approved and designed system for strengthening the pelvic floor and decreasing urinary incontinence called Emcella.  The exhalation of my breath seems to help both my coughing and my bladder, leading me to believe that the root cause of both problems , could be related to my nervous system. I have seen a huge improvement. I still have a long ways to go. But yesterday I coughed only 16 times. I had to get up only twice at night to use the bathroom the last three nights. Things are looking up! I feel hopeful again! Here is to healthy aging and helpful practices! Here's to calming exhalations! And here's to living fully until we die!

My mom got her wish for death on April 25th, 2017, exactly 5 years and 2 hours after her eldest daughter, one of my two sisters, died. She was 94 years old.  She had a great death. A brilliant, life-affirming death. She wanted to die. She embraced it. She was ready and open. A few weeks earlier I begged her, tongue in cheek, not to die while I was out of town in NYC for a week. Two days after I returned, she took to her death bed after ‘a cardiac event’. I rushed to her side and she looked at me and said weakly, “ See? I gave you New York! Now its my time.” I had moved her out to be near me four years earlier from Florida, also known as “God’s Waiting Room”. She gave up her house, car, cooking and cleaning. Her 3rd husband had died a few months earlier. She had taken care of him and my sister for the prior year. She was worn out from caregiving with advancing COPD.  When she arrived at her new home near me in the Bay area, she was convinced she had a year left to live. She remarked, "Can you believe I've lived this long?" She was warm and very loving, always with a big smile for everyone, especially if they had chocolate. Every Saturday I took her to get her hair done, followed by a family dinner. She loved pastrami sandwiches and hamburgers. A wheelchair lived in my trunk so we could go to the coast or to a museum or Macy’s for bargain tops for her. She was on hospice for 2.5 years. The hospice nurses fought over who would get to see her each week as they all loved her so much. She loved getting showers the aides provided and chatting with the man who delivered her oxygen. The other residents adored her stylish clothes and jewelry. But in her last year, her ability to hear faded, walking exhausted her, and her COPD progressed. She slept for 8, 10, even 12 hours. She fell six times in as many months and started to complain about outliving her body. We had to have the facility’s nursing team administer her meds, which she had until then proudly taken care of herself, due to her short term memory loss.  My mom started to feel her life lacked purpose or meaning. Her desire to live was waning. Her fear of death became secondary to her desire for it. She started the process for medical aid in dying.  I got to sit with her for most of those eight days on her deathbed and tell her how much I loved her. She sang me the song, “Don’t cry for me Argentina” and told me she loved me 'with all her might.' She was so full of love and positively glowed. She gradually became less responsive and needed more meds. She was ready to go and was at peace. She took a breath and then there simply were no more. When I miss my mom, I am quickly filled with the love we shared in those last days. Her readiness and willingness to meet death moves me still. I miss her with a tender and quietly joyful love. My mom gave me life and the gift of unconditional love for all her days. She gave me an amazing and awesome gift in how she died. I am forever grateful.

Do you have someone who cuts your hair just the way you like it?  Or a massage therapist that you see when you need some healing touch?  Or a trusted psychotherapist or lawyer or doctor that you call upon as needed? That's what an end of life doula is for- someone you know and trust, who can be there if you are going through the loss of someone you love or if you become sick.  Someone you can review your advance care directive with; who understands your end of life wishes; who knows your closest family and friends, who gets that you need space and time to grieve loss in your own way.  Someone who will be there the way you want to be supported, as you end your time here on earth. I think everyone should have a doula, as birth doulas usher in new life, death doulas help accompany us out. It helps everyone in the circle of life and death.

"I wish I'd let myself be happier." One of the top five regrets of the dying is this desire for happiness.  Some people have the awareness that happiness was within their grasp if they had only been able to let themselves have it. It took me a long time to find my place of joy. I don't worry any more that I will have that regret. That reminds me of the old story of the Buddhist monk who asks their students as they strolled in nature how heavy they thought the large rock they passed was. The student replied, "Oh very, very heavy. I doubt I could lift it." The monk replied, "But it is very, very light if you do not pick it up." I always felt compelled to pick up every rock, even every boulder. Somehow, somewhere along the way, I stopped picking them up. I find myself less and less interested in picking up even the pebbles anymore.  I consider it a perk of eldering. I just prefer going for the path of ease. Alot of things that used to matter don't anymore.  I haven't given up; I just have shifted slightly. I like this place. What rocks can you put back down? What boulders can you pass up? Can you use the pebbles to seed your garden?

It is 13 years since my sister died. and In a few hours it will be 8 years since my mom died. In my tiny backyard, I wave to the cannisters that hold their ashes. The third cannister holds the ashes of my father. Earlier today I lit a candle for them to memorialize their death anniversary, also known as a yehrzeit candle.  I texted my kids so they could remember their grandma and their aunt. They sent back heart emojis. Their college education was largely paid for by their grandma and their aunt. I yearn to talk to my mom these days, more than I have in the 8 years since she died. I feel like she would have some wisdom for me.  Something I need to hear.  Something I want to know. I don't feel in touch with her spirit, but I am going to ask her to grant me her wisdom, tonight when I go to sleep. She loved chocolate cake. This was her last birthday cake 8 years and 3 months ago. She loved it. And at 94 years old, she giggled with glee as she ate it.  She knew the sweetness and deep pain of life. She knew you can't have one without the other. I had a good mom. My kids had a good grandma.  To Hikey and Barb, your memories are a blessing

So many amazing, hot women! Seventeen years ago when I went through menopause, I was hard pressed to find information about it, through holistic and conventional channels. Everything is different now!  One of the best outcomes of feminism is women in medicine and sciences. They are moving the field forward with their intelligence, synthetic thinking, humanistic approach, and making all sorts of discoveries. Now the field of perimenopause and menopause has exploded and there are so many great women scientists at the helm! Here are some of these badass women docs who have great podcasts and books that I have learned so much from: Lindsey Berkson Esther Blum Amy Killen Gabriella Lyon Rena Malik Tyna Moore Cynthia Thurlow I listen to their podcasts and have learned so much! I am so happy that my beloved daughters in 30 years will have even more information. Since I am an end of life doula and a holistic health coach, I believe in living fully until we die! Its aspirational of course but its truth. #menopause   #womendoctors   #deathdoula   #livinganddying

I am not a 12-Step person but there are two 12-Step axioms that I just love. In my 60's, I think I finally get what they mean. "Self-seeking will slip away."  and  "Half measures availed us nothing."  (on pages 84 and 59 respectively of the Big Book, thanks to my pal JTM!) If I am not always trying so hard to fix something I see as broken within myself, and can find a please of ease with myself, I can fully show up for the right here and right now. and I stopped doing things half-assed, because either I have more time to do them properly at this time in my life or I can just let them go because they are not necessary. I have choice. Doing things half-assed gets me nowhere fast.  Here is one more that I love: "Don't give up before the miracles happen!" Things are always changing and amazing things happen if you hang in there. Which axioms do you love and live by?

A woman cried in my arms when we finished her advanced care directive. "You have no idea what this means to me. I have been trying to do this for ten years. Its been so emotional for me that I haven't been able to. This is a huge relief for me." Most of the time, advance care directives (ACD) are not needed. They are there in case you cannot speak for yourself.  They define your wishes. In what scenarios would you want life saving measures? When would you prefer to die peacefully without intervention? What do you want if you have cognitive decline?  90% of us agree ACD's are very important. Only about 30% of us have them filled out.  You can find an abundance of forms online or through your healthcare provider. Who do you want to speak for you? Who do you trust to respect your wishes? Who do you trust to handle decisions for your care that you may not have anticipated? Try giving yourself a reasonable time period to do it, perhaps a month to decide on a form and another month to fill it in, and a third month to review with the person you want to speak for you if you cannot speak for yourself (health care proxy). If you find yourself having a difficult time facing it, talk to someone about it. But don't stop. Keep going. The ACD is a living document. You can change it any time.  You should review and update it every five years or so.  The important thing is to get it done.

I want to have a sense of completion before I die, assuming I die slowly like 90% of us do. Dr. Ira Byock wrote about this. As we approach the end of our days on earth, we withdraw from the world, then the country, then the region or community. We say goodbye to family and friends as our perspective narrows. We are spending our precious time on a smaller slice of the proverbial pie. Just the people who matter the very most. As we move towards a sense of completion, everything that is not absolutely essential falls away. We are with ourselves, with our own reckoning of self, our own acceptance of death, making our way to the transcendental and letting go.

I started thinking randomly the other day about what I will miss seeing in my two daughters' lives when I die, whenever that is.  I will miss a lot.  One daughter just got engaged and has so many creative ideas about putting on a really fun, special wedding. I love getting to hear her plans and she even wants to hear my input. It is just so sweet to be there with and for her as she takes this step in life. Honestly, and no pressure here, but I cannot wait for those grandbabies!  I got to visit my other daughter at her place of work yesterday. It was the third time I had been there in the almost two years she has worked there. And like the other times, every one of her colleagues couldn't help but tell me how much she helps everyone, how hard she works, how much she cares. I was nodding and beaming. Plus, I added, she is very beautiful. I can't wait to see all the things she does in her life and all the ways she grows and comes into herself. My favorite moment was when one of her colleagues said we looked like twins, despite our 40 year age difference! That was extra sweet because my girls are identical twins!  It really is incredible to see these two grown, lovely women, who came from one tiny egg that split way back in the first moments of conception, become two separate human beings, with different paths in life, who ask different questions from life, who have different interests and trajectories.  I honor both of their paths. May they walk with strong gaits and greet life with open hearts each day, and always come home- and to each other- for love.  I wish my mom, who died 8 years ago next month, could see them now.

I did therapy on and off for a total of thirty years. I had a very high ACE (adverse childhood events) and it took me a minute. Or two.  I received this daily Buddhist quote in my inbox a few days ago and I have since read it dozens of times. This quote is better than all the tools I learned those thirty years:  "Whenever you are experiencing an emotion, ask yourself: "Am I going to feel the emotion or be aware of the emotion?" In other words, are you going to watch it as an uninvolved observer, or are you going to participate in the emotion?" Nowadays I often can remember to do this. To just notice the feelings and get curious about them. I am much less reactive. I see my emotions as data that give me valuable information. Sometimes my partner tells me that I seem cerebral or analytical, and he is none too pleased with me, but really I am just noticing, with attachment or aversion. He is starting to realize there are benefits to my observation and non-attachment. I had a conflict with a woman a year and a half ago and I wish I had been able to do that then. I didn't. I felt anger and aversion. Now, I am not attached to the story I had told myself about what happened. Now I am happy I moved on. I didn't speak to my ex-husband for twenty five years. Then we spent a year communicating about the demise of our relationship. It was healing and I think of him with peace. I hope when I am on my deathbed that I have no unfinished business with others. I am working on that. I am also working on letting go of regrets and forgiveness towards myself. Have you observed being an uninvolved observer to your emotions? How's it going?

"I wish I had lived the life I wanted, rather than the one I thought was expected of me." That is one of the most common regrets of the dying.  That is why I tell my daughter to go for what she wants, work that she feels passionate about, that makes her feel that she is using all of herself. It’s not that she has ever been told she was expected to be a certain way. In fact, I told her she was whole and complete, and to find her way on her sweet, special journey. But how does she develop that level of discernment about what she really wants when she is pummeled by social media and movies that implicitly and explicitly value certain paths over others? I tell her she may feel drawn to the conventional, mainstream life and that is fine. It is also fine to be non-traditional, anti-authoritarian and non-conforming. There is a huge palette of choices. Her choice depends on her being honest with herself about what really makes her heart sing and what really calls her.  I hope she is relieved that her mom does not have this popular regret, although I have others! She has time. She will find her way. This is her one precious life. I love that girl.