“X” is for Xing Part 3 The Ultimate Xings (Dying and Death)

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Since Further Shore was founded out of my desire to provide education about supporting the dying, “X” is for Xing is the best place to address the biggest elephant in the room; everyone dies. The definition of dying is the process of bodily termination; death is the irreversible cessation of all vital bodily functions. Readers may be wondering why dying and death are part of the ABC’s of Living Well. It is because these matters, while not popular and often taboo, represent the final chapters of living life; an end point that we will all one day face. Sometimes death is unexpected, as with a fatal accident, heart attack, or other sudden trauma. This post will focus on dying in hospice at home, where death is expected and loved ones are providing care. I know from personal experience that learning about dying in the middle of caring for a hospice patient can be extremely stressful, especially when it’s the first time doing that. Learning about dying before death occurs can be both comforting and empowering for the dying, and for family members and friends providing care. So, take a deep breath and let’s explore these ultimate Xings.

Understanding what hospice service entails is are a good place to begin. Hospice is a Medicare program that’s available when two physicians certify a life-limiting illness with life expectancy to be six months (or less). Should a patient survive beyond six months, the case is re-evaluated, and service can continue with recertification of the terminal diagnosis. The interdisciplinary hospice team includes medical director(s), nurses, social worker, personal care providers or certified nursing assistants, chaplain, volunteers, and others trained and certified to provide support. The team is there to serve the patient, and their care circle (including family or friends).

Hospice provides useful equipment, suggestions and/or prescriptions for nutraceutical, natural, and/or pharmaceutical medications, guidance for religious or spiritual activities (if desired), recommendations for appropriate social activities for the patient and their care circle, education about the dying process, appropriate physical care, respite care, and other supportive services. Hospice care is all about achieving a good death, including palliation for pain, anxiety, nausea, respiratory distress, and other uncomfortable symptoms associated with the body shutting down. To learn more about the physical changes that occur when dying, visit “About Dying” on our website.

When caregiving or holding space for a loved one in hospice, remember that they are facing the ultimate Xing. For most people, a good death is a dying process that is free from pain and suffering, on all levels:  physical, emotional, mental, spiritual, and ontological levels of being. A good death may mean that one is able to make peace with unfinished business or to say thank you and goodbye to loved ones. A good death may include being free of ontological concerns regarding “not being or existing” once the body ceases to function. Since most living beings are biologically hard wired for living life, dying may not be an easy process. To become comfortable with the uncertainty of death takes immeasurable courage. The best we can do as caregivers to palliate ontological distress is to offer supportive listening, compassionate witnessing, and calm presence. To learn more about psychological, emotional, or ontological aspects of dying, and appropriate ways for caregivers to respond, visit “About Dying” on our website.

The final Xing, death, is what happens at the end of the dying process. Thoughts, opinions, or feelings about what happens when we die are widely varied. There are those who believe in the afterlife, reincarnation, or soul transmigration. Some believe there is a uniquely individual consciousness that continues on, albeit in a different or changed form. Others believe that life and consciousness end with bodily death. These different views about death can be comforting to the bereaved. Taking up a position about death may also help to relieve ontological distress about personal mortality. From where I stand, death is the ultimate Xing, an unsolvable mystery that requires radical acceptance and trust. I can aspire to a good death by engaging any of the practices in the ABC’s of Living Well. But a good death is not guaranteed. Trusting the greatest mystery is what palliates my ontological concerns. What helps you to find comfort with the ultimate Xings (dying and death)?

In closing, I want to say again that the way we navigate our little Xings in life, will help us practice for the bigger (and the ultimate) Xings. Reflecting on the questions in Part 1, practicing the meditation in Part 2, and studying the materials about dying on the Further Shore website will contribute to a stronger sense of your relationship to crossings of all kinds, and enrich your understanding of the physical and metaphysical aspects of dying and death. This, in turn, increases your knowledge and hopefully improves your confidence if you are called to serve someone in hospice at home. It is my hope that “X” is for Xing will increase your inner peace.

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