Thursday, December 4, 2008

Ask Judy

Advice for the dying, and for those who care about them.
Judy Bachrach

Award-winning Vanity Fair writer and hospice volunteer, Judy Bachrach, answers readers' questions and offers advice for anyone needing help on the most critical part of life -- a last act that, because of medical advances and early diagnoses, many of us are consciously living out for months and even years.
It is her years of work as a hospice volunteer that compelled her to start an advice column on dying for people facing critical issues dealing with death and dying, often with little support.
"The most common and hardest part of life -- facing and dealing with death and dying -- happens to be the very area where almost no help is offered. Hospitals ignore the problem, friends and relatives often don't know what to do, and doctors seem embarrassed by their inability to keep everyone alive forever," Ms Bachrach stated.
As a funeral director and an etiquette buff, I find Judy's advice to be well researched, thoughtful, and helpful. Her site is a great resource for those of us who realize the need to face up to complicated issues surrounding dying and death.

Here are two of the many compelling questions Judy answers every week.
Dear Judy,
I’ll make this short. My breast cancer has recurred, third time; I am 37. We thought we had it beat the first time around. My oncologist has told me to “get my affairs in order.”
One of my “affairs”: My kids, 10 and 9. What do I tell them? Can I not tell them? What do I tell my mother, who has breast cancer herself, but not as bad as me. The prognosis for me is 100 percent bleak.
Sharon in Illinois
Dear Sharon,
I am so sorry about your recurrence, and sorry as well for your children — and your mother. Obviously, you must tell your mother the bad news at once: she will want to know, and she may be a help both to you and the children now, as well as much later when she can talk to the children about you, and probably (if she is well enough, despite her condition) help care for them as well.
Your children also must hear the truth, and I think they must hear it soon. Euphemisms are not a good idea. Phrases like, “Mommy is going away for a long time,” makes them think, in this day and age, that you are getting a divorce. A friend’s young children — when she told them much the same thing — asked why she couldn’t visit them on weekends.
So tell them you love them and that you are very likely dying. Tell them you have tried everything and nothing has worked. There is nothing else to do. I would also, of course, recommend a kind and thoughtful therapist for the children to see, both now and for later. That’s important. And as many relations as you can muster to be with them.
You haven’t mentioned a spouse, either present or former. If you are — or were — married, or have a steady man in your life, he should be by your side. And he should, once you are finished speaking, be there for them.
Thank you for writing

Dear Judy,
I have a dear friend with a virus in his heart — cardiac myopathy, I’m told, something I’d never heard of before. For some reason he just hasn’t been selected for a transplant. He’s dying. He lives in New York. I live on the other Coast. He says he’s too tired for visitors, and I think he’s also too depressed and plain sad.
I really do want to see him. I can fly out any time. When I phone, I just don’t know what to say except that — that I want to see him. But I also don’t want to put him out, or act like he has to see me when he’s weak and tired and sad. I don’t know what to say or do when we speak. I can hardly bring myself to call, I feel like crying all the time.
Do you have any advice?
Lucy in Orange County

Dear Lucy,
I am so very sorry about your friend. I know you want to see him once more. But he has made this much clear: he is not ready at this time for visits, even from those he loves. To be honest, he may not ever change his mind.
What you must understand is that his reluctance has nothing to do with his feelings towards you. The dying very often are weak and depressed — and patients with very severe cardiac myopathy (about 20 percent of those who get it) suffer especially overwhelming fatigue, in addition to fever, weakened left ventricular functions and bad chest pains.
In other words, visits, even from those closest to them, are tremendously taxing. Also, and I suspect this is the case with your friend, many are worried they might not be able to welcome guests as they deserve. Sometimes the disease progresses even after the virus is long gone. The immune system keeps on damaging the heart.
So for now, I’d suggest offering other forms of love and consolation. Continue phoning, no matter how difficult the conversations. But when you call, be practical. If he loves movies, maybe you might offer to rent some for him from an online video site. If you know his taste in books, you might buy and send a few. If there are prepared foods he enjoys, these too can be delivered.
In other words help out without making it seem a huge effort. He will know by these gestures how much he is loved and valued. And you will feel useful and appreciated.
Thank you for writing
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