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I got so mad when Hospice called me a few months after my mom died for a 'grief check-in' call. My mom died 7 years ago and the call came 3 months later. The woman's voice on the phone was concerned; she asked how I was doing with my grief, her voice full of clawing inflections of sugary sympathy. I immediately was on the defensive. I said something like, "My 94 year old mom was ready to die. In fact she wanted to die. She gave me a gift with her readiness. So I am not in grief. I just feel love. I don't appreciate that you are assuming I am grieving and suffering and this is such a hard time. I have lost a lot of people and know grief. This is not that. Don't put that on me." I am not proud of what I am certain was a terse response, but I am proud of what my mom gave me. I never assume someone feels a certain way after the loss of a loved one. I am curious and inquire. I don't want to put any expectations on them about how to feel, nor do I assume they are 'grieving'. I want to open the space and find out what their journey after loss is like. What is your preference? How do you want people to ask you how you are doing after a deep loss? What words make you feel open? What makes you feel closed? What does grief mean to you?

The term "compressed morbidity" doesn't sound nearly as wonderful as it is. In Eastern philosophy, it refers to someone being in tune with the Tao or with nature, so they will live a long life and die fast.  Doesn't that sound wonderful? By extension, the philosophy also says that the last ten years of one's life should be the best ten years. Often in Western society, the last 10 years of someone’s life are the worst 10 years, marked by decline and loss. By another extension, if the last 10 years can be our best years, and if we are living well into our 70's, 80's, and 90's, then our 'third act,' after work and childrearing is done, when we settle into a quieter time, promises all sorts of wonderful riches, leading up to that last decade.  For me, my 60's have thus far been my best years, where I finally embrace, in my way, how to relish life and love with joy, curiosity, play and openness. Gratitude! Here's to your compressed morbidity!

Be a loud listener! A friend once remarked, "Wow. You really pay attention. I am not used to that. I don't usually listen to everything a person says. "We typically speak at the rate of about 120-150 words a minute, which is not enough data to fully occupy the brain of the person being spoken to, especially if said person is socially or otherwise anxious. Research shows that often we don't know what is going on in another person's mind. So, asking the sorts of questions that will allow a person to reveal their true selves is the key. The worst kind of questions evaluate, with the implication that you will be judged: Where did you go to college? What do you do? Were you close with X person who just died? Did you win? But were you there when Y happened? The best questions give the responder the freedom to go as deep or as shallow as they want: How is your mother? What is the best way to grow old? What was that like for you? Can you be yourself where you are and still fit in? What do you think? How did you adapt to that big change? What are you learning about in your life? So take a moment and consider: are you asking questions out of a need to evaluate and judge? do you want the other person to open up? Are your questions closed or open ended? Are you listening with your eyes, 100% engaged? Do you 'fake listen' waiting for the other person to take a breath so you can jump in with your own experience, hijacking the conversation? If you have a hard time listening, try SLANT: Sit up Lean forward Ask questions Nod your head Track the speaker. Listen loudly.

That is the eloquent sentence my dear friend and poet said to me the other night when talking about the death of his 65-year-old twin sister. He feels her absence. He feels her memory. He feels the part of him that is absent without her. He is incorporating into his being both the memory and absence of her, as well as allowing absence itself to be a space he holds. I find this terribly tender and honest, raw and true. We have holes in ourselves made by the loss of those we loved. In the holes, there is a wholeness that is the memory of them. In the memory of them, we feel the absence of them. Ultimately, we integrate the loss into our beings. There is no duality left. There is absence and memory. There is wholeness. There is love.

Today I am thinking about my dead people. The people I love that are no longer here. I am thinking about how little or much they suffered while they were dying.I I feel like most of them met suffering; knew suffering; suffered. So, I turned my attention to this amazing reflection that I use often in my classes and with clients. It's the Nine Contemplations of Death, a Buddhist writing attributed to Atisha, an 11th century Tibetan scholar. I hope you will find it as calming and meaningful as I do. The First Contemplation Death is inevitable, no one is exempt. Holding this thought in mind, I abide in the breath. The Second Contemplation Our life span is decreasing continuously, every breath brings us closer to death. Holding this thought in mind, I delve deeply into truth. The Third Contemplation Death will indeed come, whether or not we are prepared. Holding this thought in mind, I enter more fully into the body of life. The Fourth Contemplation Human life expectancy is uncertain, death can come at any time. Holding this thought in mind, I listen with utmost care to every sound. The Fifth Contemplation There are many causes of death— habits, desires, accidents can be precipitants. Holding this thought in mind, I consider the myriad possibilities. The Sixth Contemplation The human body is fragile and vulnerable, our life hangs by a breath. Holding this thought in mind, I attend to each inhalation-exhalation. The Seventh Contemplation At the time of death, our material resources are of no use to us. Holding this thought in mind, I invest wholeheartedly in the practice. The Eight Contemplation Our loved ones cannot keep us from death, there is no delaying its advent. Holding this thought in mind, I exercise non-grasping and clinging. The Ninth Contemplation Our body cannot help us at the time of death, it too will be lost at that moment. Holding this thought in mind, I strengthen my capacity for release.

In one of my recent Death Cafes, hosted by the Elisabeth Kubler Ross Foundation, a woman said something amazing. We were talking about listening and how equally powerful and beautiful the stillness is when you are heard by someone who is deeply listening to you. People were sharing what made them feel heard when their loved ones were dying. The woman offered that the discussion was reminding her that she didn't have to find the right words; all she had to do was be like her cat. He doesn't speak to her with words but she knows just what he is silently communicating! She feels his love. Be the cat!

As an end of life doula, I have had the opportunity to think about this a lot. My number one priority would be to make sure I could end my life on my own terms before my cognitive decline made that impossible. That's why I am really excited that California's advocacy group, A Better Exit, is working on proposed changes to the current law. SB 1196 would: Eliminate the requirement whereby a person must be within six months of death; Include the option of an intravenous method for self-administering the life-ending drugs; Make Medical Aid In Dying available to people with early to mid-stage dementia who have decision-making capacity. If you or your loved one had severe cognitive decline, would you want these options so you could end your life with dignity?

My mom died seven years ago and I feel no grief. I was talking with a friend the other day, who happens to be a rabbi and is extremely verbally persuasive, who insisted that if you love someone and they die, you experience grief. If you don't, then it means you didn't love them. I have a different take on it. I had people die before my mom died. I felt what I understand to be grief. I had a difficult time accepting that they had died; I felt sorrow and a tearing inside and despair. It hurt a lot. That was grief. But when my mom died I just felt love. And I have felt that way every day since. Sometimes I miss her. But that is as close as I have come to grief. I feel her close by. I feel her in my heart. I feel her love. I feel my love for her. She was ready to die. We said our goodbyes. We expressed our love. I knew all her wishes. She was at peace. She was reaching for death and so tenderly ready. After she died, I realized grief was optional. Is grief love with no place to go? I felt a deep love and it always had a place to go. Right to her, in spirit. I keep sending her love. I feel like she is okay out there somewhere. Maybe my friend and I are just having a semantical debate. I like to think we can transform the way we think about grief by the way we think about death. Love you, Mom!

The crazy thing I want for every U.S. resident: When you register to vote or get your driver's license or register for college or the military, you fill out your advance care directive. Sounds crazy, right? But it's one of the saner things you can do. As an end of life doula, I teach workshops on filling out your ACD- advance care directive. Most of the attendees have been avoiding it for years, inspired by fear and paralysis. If we normalized the ACD, as necessary paperwork for all citizens, who also have the legal right to the comfort care provided by hospice at the end of their lives, wouldn't that be a benefit to you and your family? An ACD states your wishes in the event you are not able to speak for yourself. Things like do you want your life to be prolonged under any circumstance? Do you want pain meds even if that would mean you would not be conscious? Most importantly an ACD gives you the opportunity to say who you want to entrust as your health care proxy. Who do you choose to advocate for your wishes? Here is a link to the form by state. Don't delay!

I don't want to die with regrets. Like you, I have no idea when death will come for me. But, I can say unequivocally, I am motivated by my heartfelt desire to die with no regrets weighing down my departure. This inspired me to talk with my ex-husband after 25 years. We ended up having a year-long email exchange where we worked through what happened to us in our spectacular demise. It was very healing, for both of us. All good! I have also forgiven my partner of 23 years and myself for that which was dysfunctional in our home. Very good! Some regrets I have involve former friends and colleagues. I was less than delicate or a misunderstanding became insurmountable. In some instances I have made amends. But that is not always possible. People move away; people die. I now have a practice of self-forgiveness so that when those memories flash before my mental screen, I pause and release myself through words of forgiveness. I wasn't fueled by anything but human foible. I can let it go. In my life now, I work hard to not incur new regrets and to make amends right away if I have trespassed. I also am a lot more intentional about who I am around and the quality of the connection between us. This has been a game changer. I am becoming regret-less. It is a process. I would love to hear how you see it.

People equate hospice with death. If you think of the word 'Death,' you are not alone. It never ceases to amaze me that in the 50 years hospice services have been available to everyone in this country, the association people tend to have with hospice is not 'comfort care at the end of life', but rather 'giving up on living'. My mom was on hospice care for 2.5 years. It kept her stable and comfortable. When she was kicked off it for a few weeks for no longer needing it, her health declined precipitously, thus again qualifying her for the service. Her story is not unique. Many people are on hospice for much longer than the "6-month or less" qualifying diagnosis. But too many people wait until they are days or weeks away from death out of fear of giving in to death. They miss out on the comfort care from the heroic nurses, the aides, the social workers, the spiritual care team, and doctors. They miss out on having a team review their care. I have been a hospice volunteer working with patients at three different non-profit hospices. I have been a community ambassador volunteer at a hospice, producing programming on death and dying. I have seen and heard stories from so many families who are eternally gratefully for the hospice care their loved one received. Yes, there are fair criticisms of hospice, such as the problem that Medicare-reimbursement of their services has overly medicalized their work. Death is not a medical event. For-profit hospices have often tarnished the field, seeking profits over quality care. But you have to believe the hospice movement is not about hastening death at all; it is about deep love, compassion, honoring of the dying person so that the highest level of peace and comfort can be achieved as they prepare to leave their earthly bodies. When you hear the word 'Hospice' what do you think of?

I want to gently, kindly, lovingly say 'Yes'! If your person has the time to prepare and plan and accept dying and you get to hear their wishes, and share your love and forgiveness and honor each other then yes. Dying is not the real problem. It’s the regret, what was left unsaid, what was left unresolved. Studies show that the four most important things to communicate at the end of life touch on these themes: 1. Thank you for all you are. 2. Please forgive me for my trespasses. 3. I forgive you for everything. 4. I love and am so deeply grateful to have had you in my life. Getting to say goodbye fully is a gift not only to you and your loved one, but as you find your way after your person dies. You can bathe in the light and love. You can be carried on that beautiful, sweet, painful wind. You can move on without that person in their physical form, but always so deeply in your heart and spirit. You experience loss, deep loss, and deep