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"Grief begins not with death, but the moment we sense something precious slipping away." "If you don't grieve, you cut the lifeline to ever feel alive again." "Grief is the map. It tells us the life we had before is gone, and it helps show the way to the next place." These pithy sayings by the great, late, Irish writer John O'Donahue cut to the core of my truth. They flew eloquently out of his mouth during an interview with Krista Tippett on On Being. In my experience as a human, and as a doula, and as a conscious dying educator, Grief is indeed a great teacher and guide.  We need to lean heavily on grief in order to go on living.  If we try to repress or deny it, it finds its way back to us, demanding to be faced.  There is no way around it. We must go through it. Grief is with us every day, in the tiny and monumental losses we face. It is a silent friend, like sorrow. The process of grief is so very non-linear, that we need to hold on tight and trust that it will guide us. Grief reminds us that all we have for sure is groundlessness. Enjoy the wild ride, with all its up and down bumps, with its tears and laughter, with its aloneness and connectedness!

Did you ever think you would become a Conscious Elder?  I hear people in my Death Cafes talk about how much the spiritual path has opened for them, precisely as their body struggles with decline. Poetic irony abounds. I saw how a friend's 98 year-old mother welcomed her one day-old great granddaughter with an earned wisdom and grace, and complete joy. I watched how my 102 year-old client, who is bed-bound, dances with her hands to the sounds of the music that has been present throughout her life. Though she speaks little, her humorous jab at me made us both laugh with real pleasure. There are many treasures of the years of later life.  As I step into my elderhood consciously and intentionally, I see myself releasing the past so that it no longer controls how I feel or act now. My mind is a tad quieter, which gives me more space for the calm of eldering. I am more open to play and beauty and gratitude. My spiritual practice stays close to me. I love teaching my course, Spiritual Dimensions of Nearing Death, and I am reminded that every day is a spiritual dimension of nearing death. What does your Conscious Eldering look and feel like to you?

Today I had an uncomfortable memory and realized I had not forgiven my mother's third husband for making the last year of his life a living hell in 2012 for her. My sister, who was very close to my mom, was dying of metastic breast cancer that had gone to her brain. My mom wanted her close by so she could visit her.  At 88 years of age, it was too hard for her to get to Washington DC. We moved my sister from her apartment in DC to a facility near my mom in Ft. Lauderdale, Florida, for her last days. For those 16 or so weeks, my mom's life revolved around making breakfast and lunch for her husband, then making a treat to bring to her daughter, then driving fifteen minutes to the facility and spending a few hours sitting bedside, then driving home and making dinner. My mom dropped 40 pounds fast. She kept going, but the emotional toll of her first-born being so very sick, the endless healthcare hassles, and all the caregiving was very, very tough. Then she made the cardinal sin of picking up something for dinner because she was too tired to cook. That was the final straw. Her husband knew what she was facing every day and the agony in her heart. He saw her dragging herself out of bed and wasting away.  But he was mad. He felt he was not getting enough time and attention. He did not like being left alone for so long. He didn't clear the table of his dishes, so she had to also face that after a long day.  But he was absolutely outraged that his dinner was compromised. It sounded unbelievable to me. I checked in on them as soon as I landed from California to help out again with my sister. In fact, my mother's partner of 28 years was so incensed that he told me he would leave my mother if she didn't tend to her responsibilities to him.  After picking up my jaw from the floor, I immediately got them a personal chef. That lasted 5 days before the chef was fired by the man of the house.  My mom kept going for another month until her precious girl, after celebrating her 60th birthday with pastrami on rye in bed, could no longer speak. There were 18 tumors roiling in her brain.  A few weeks later, she was released from the pain that wracked her and died peacefully. My mom called me to tell me the news as she held her hand. About six months later, my mother's husband at 93, was brought to the same facility. His body was failing. He refused adult diapers, and she could no longer care for him at home.  She faithfully drove to see him every day. One long day, after arriving home and eating a nosh and doing his laundry, she drove back to bring him clean clothes. She put his clean sweatpants on and kissed him goodnight. It was dark when she got home.  Early the next morning she got the call from the facility that he had died in his sleep. She took comfort knowing he had clean pants on. My mom died 5 years and 2 hours after my sister. She always missed her baby girl and her husband.  With this writing, I forgive him.

I have a 99 year-old client who is sharp as a tack! He says he has dementia. While the computer that is our brain may be slowing down, and our thought to speech processes can get cobwebby, but this is not dementia.  Forgetting where we are in a conversation, stumbling to find the right words, delays in our ability to verbalize our thoughts are not dementia. I often cannot come up with names of people, books, films, and so far it is kind of funny and doesn't seem to matter all that much. But I don't worry that it is a sign of dementia. (Not yet, anyway!) Dementia is described as a complex decline in the brain and I find this helpful to remember when communicating with people with cognitive decline:  • The hippocampus (short-term memory) may shrink early — that’s why people with dementia forget what they had for breakfast. • But the amygdala (emotion) is often intact longer — so people with dementia can still feel love, fear, kindness, joy. • The posterior cingulate cortex helps link past and present — and when it struggles, time gets blurry. The past and present are not so distinguishable, and so people with dementia may be remembering something from their childhood or when their spouse was alive, while speaking about it as if it was happening in current time. • The default mode network (responsible for self-awareness and reflection) may become fragmented — but sensory and social responses can still thrive. • The prefrontal cortex might misfire — so logic, planning, and inhibition go dancing out the door. But music, touch, and non-verbal communication can still speak volumes. We are complex creatures and our brains are proof!  Let us be gentle with ourselves and each other as we fumble around, trying our best, to find the words to express what matters most, our love. If you are interested in finding out more about my work and services, please go to my website .

Both! End of Life Doulas help hospices achieve their mission! Hospice nurses and aides are angels! They are caring, empathic healthcare providers with full case loads and many restrictions.  What do they need to ensure their clients have as good and peaceful death as possible?  Their clients need more time.  Doulas have the time and can be there whenever needed. We can help make the emotional and physical transition to hospice. We can stop at the store for them. We can sit with the dying person and listen, and reaffirm end of life wishes. We can talk with the family about what to expect.  We can share information so they can decide about body disposition. We can coordinate with the hospice team. We can be part of the medical aid in dying team. We can help with home funerals, funeral homes, memorial services.  Let's support hospice services to do what they do best, caring and monitoring and providing prescription comfort care for the person who is dying.  So that people can die in peace.

My friend of 30+ years is going through it big time. Her partner of 20+ years is dying. In two weeks- or perhaps two months- she will join the growing ranks of solo elders. After age 75, an astonishing 43% of women live alone. My friend is understandably anticipating his death just as much as she is bargaining with his illness to move to the back burner, giving them more time together. She is sleeping at a hotel near the hospital so she doesn't have to do the daily hour long drive. Her adult son is helping. She has a strong community. She accompanied her former husband, her best friend and her mom to the gates of death. But still.  There is no way around this. This is it.  A good partnership is ending; there is grief; there is pain; there is fatigue; there is love. The road is narrowing and the end is in sight. The days are so very long for her, the caregiver, and the remaining time she has left with her partner so short. She talked for a long time and I listened. They had done so much end of life planning and had made tough decisions.  I wondered aloud if they had said their goodbyes. If they had shared their gratitude, their forgiveness and breathed words of love together. If there was anything left undone that could result in regret for her after his death. When there is so much focus on the body and its sometimes dramatic but often stealthy demise, it is easy to put off those conversations for a better time. In the wise words of American Buddhist teacher Frank Ostaseski in his book, The Five Invitations, holding on to and leaning hard into these five things can help: 1. Don't wait, live fully now;   2. Welcome everything, push away nothing, accept all experiences without judgment;   3. Bring your whole self to the experience, be authentically present;   4. Find a place of rest in the middle of things, cultivate calm amidst chaos;   5. Cultivate don't know mind, practice openness and not-knowing to allow for growth. I wish him peace on his journey. She knows she will be okay after he dies. She wants to travel with a close, new widow friend. I wish her peace on her way.  May we all know peace at the end of our lives.

If you hate poetry, you will love Andrea Gibson, who died in July at age 49. I dare you to read this! Love Letter from the Afterlife By Andrea Gibson My love, I was so wrong. Dying is the opposite of leaving. When I left my body, I did not go away. That portal of light was not a portal to elsewhere, but a portal to here. I am more here than I ever was before. I am more with you than I ever could have imagined. So close you look past me when wondering where I am. It’s Ok. I know that to be human is to be farsighted. But feel me now, walking the chambers of your heart, pressing my palms to the soft walls of your living. Why did no one tell us that to die is to be reincarnated in those we love while they are still alive? Ask me the altitude of heaven, and I will answer, “How tall are you?” In my back pocket is a love note with every word you wish you’d said. At night I sit ecstatic at the loom weaving forgiveness into our worldly regrets. All day I listen to the radio of your memories. Yes, I know every secret you thought too dark to tell me and love you more for everything you feared might make me love you less. When you cry I guide your tears toward the garden of kisses I once planted on your cheek, so you know they are all perennials. Forgive me, for not being able to weep with you. One day you will understand. One day you will know why I read the poetry of your grief to those waiting to be born, and they are all the more excited. There is nothing I want for now that we are so close I open the curtain of your eyelids with my own smile every morning. I wish you could see the beauty your spirit is right now making of your pain, your deep seated fears playing musical chairs, laughing about how real they are not. My love, I want to sing it through the rafters of your bones, Dying is the opposite of leaving. I want to echo it through the corridor of your temples, I am more with you than I ever was before. Do you understand? It was me who beckoned the stranger who caught you in her arms when you forgot not to order for two at the coffee shop. It was me who was up all night gathering sunflowers into your chest the last day you feared you would never again wake up feeling lighthearted. I know it’s hard to believe, but I promise it’s the truth. I promise one day you will say it too– I can’t believe I ever thought I could lose you.

Here are 10 little-known signs your body is screaming for estrogen These signs are identified by Dr. Michelle Sands. I indicated on each line how much I resonate with each symptom. Which ones do you resonate with?  Dry, itchy eyes (yes a bit) Joint pain and stiffness (yes a bit) Urinary urgency or leakage (yes a lot) Frequent UTIs (yes, sometimes) Insomnia (yes, sometimes) Loss of motivation and drive (yes, a bit) Electric shock sensations (yes, a bit) Ringing in your ears or tinnitus (nope) Restless legs (yes, a bit) Burning mouth or tongue sensation (yes, a bit) There is finally a huge amount of functional and integrative health information that understands menopause. So many smart women doing the research and developing the science that finally grasps the significance of menopause in our lives.

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?