Going Light

John Grey, a thoughtful and entertaining blogger/smallholder over at Going Gently, mentioned in a recent post that “going light” is a Welsh phrase for the accelerated wasting process that happens during the last days and hours of dying.  During this time it often looks like they’re starting to disappear right before your eyes.

The phrase really struck me, not just because it’s the loveliest way of describing this transition I’ve ever heard, but because it’s also the most accurate.  That’s exactly what the rapid changes look and feel like with both the body and spirit of someone who’s dying.

I’m going light now, Ma.  I’m going light.


(Image: dan / FreeDigitalPhotos.net)

copyright Dia Osborn 2011

Surprise Worms On The Trash Can…a.m.

I walked into the kitchen this morning to discover a batch of small, white, maggoty-looking worms crawling across the stainless steel lid of the trash can and rolling their plump, fleshy, little way down the sides and across the kitchen floor.  It was disturbing.  Especially coming straight out of a deep sleep.  From my initial fog, I wildly wondered how the stripped carcass of a cooked chicken I’d thrown away last night could possibly decompose that fast.

However, upon reluctantly opening the lid with my latex-glove-protected-hands, instead of the fetid stench I feared my quivering nostrils met an almost minty fresh aroma.  I realized with dawning relief that these were not maggots after all, but a type of garden pest that is usually invisible, hidden within the cell walls of a leaf.  I’ve been battling an infestation of these tiny creatures among my spinach and swiss chard crops, and these ones must have hatched off a bunch of infected leaves I threw in the trash a couple of days ago.

My friends, I give you a rare (low-video quality…sorry!…) glimpse of the leaf miner adult worm stage.

A Curious, Amazing Thing That Often Happens Just Before Death

Image by Vlado

Both the hubster and I were there with the family, at the house, when our good friend, Mr. B, died a couple weeks ago, and I wanted to tell you about something amazing that happened right before he passed.  Actually, this type of dying event is common and it frequently (certainly in every case that I’ve been involved with) lifts the spirits of those who are there to witness it.

It was nearing the end and Mr. B had been unconscious for close to a day and a half.  The hubster, driven by the common, but often unspoken, instinct displayed by loved ones to never leave their dying person alone, was taking his turn sitting beside the bed and holding Mr. B.’s hand.  The family was scattered throughout the house, cleaning up from breakfast, while Mrs. B was on the other side of the room discussing something with their son.  She’d just finished and was walking past the bed on her way out to the kitchen when Mr. B. suddenly, the hubster later told me excitedly, squeezed his hand.


“Like this!” he said, grabbing my hand and crushing it in a way that sent shooting pains up my arm.

“Ow!”  I snatched my hand away and glared at him.  “That hurts!”

“I know!” the hubster started nodding vigorously, relieved that I got it. “That’s just what it was like!  He did that to me, too!”

And suddenly I did get it, and I was amazed.  My mind flew back to the last hour when Mr. B. lay there helpless and still; pale, shrunken, and almost gone.  He’d grown so weak he fell into a final coma from which he couldn’t seem to climb back out, but then somehow…in that last minute…he powered back up anyway.  He’d grabbed onto the only thing available, the husbster’s hand, and squeezed it so hard that the hubster had to sit up and pay attention.

“He opened his eyes and locked onto mine…and I just panicked,” the hubster admitted.  “I didn’t know what was going on but I sure didn’t feel like I was the last thing he needed to see.  So I called Mrs. B. and she was right behind me.  She sat down and took his hand, spoke to him gently telling him she was there, and then a few seconds later Mr. B died while gazing into her eyes.”

The husbster paused, reflecting for a moment, then looked at me and said, “I feel like that’s what he really wanted, y’know?  That’s why he squeezed my hand.  He knew it was time to go and he wanted me to get Mrs. B. for him.”

Later, Mrs. B told me the same thing.

“It happened just as I was walking past the bed,” she mused.  “I think he knew it.  I think that’s why he made his move right at that moment.  He wanted to tell me good-bye.”

It’s well known within hospice circles that the dying are far more aware of and, in a lot of cases, far more involved in the timing of their actual departure, than most people realize.  Hearing seems to be the last sense to go and the dying often still respond to auditory stimuli…familiar voices, favorite music, sensitive information (which is why it’s so important to exercise caution when speaking within their hearing btw), etc….even from the depths of coma.

I love this…the fact that our relationships with one another don’t just stop because one of us loses consciousness.  The connections we build are so much more complex, beautiful, delicate, and tenacious than that.  It often feels…there in the rooms of the dying…like some vast and luminous web has been spun around us, supporting and binding us at a thousand, twinkling, alternate, junction points so that, even if we can no longer speak or see or touch, our love still travels easily along the other pathways, the ones that haven’t collapsed.

My mother awakened in her last moments, too (even though that was scientifically impossible with all the heavy sedation she was under,) her eyes opening for one last, brief glimpse as my brother read a passage aloud from the Upanishads.  My grandmother was decidedly more active about her’s.  After three days of coma (and six solid hours of heavy labor where she seemed to be stuck in her body and unable to leave) she finally sucked in one last, mighty breath, opened her eyes, and let out a yell on the exhale, as though she’d stripped off her helmet, mounted the sound, and was riding it wildly out of her own mouth in a last, triumphant charge.   I remember how I sat there stunned for a moment…and then burst out laughing.  With relief.  With applause.  With joy.

But my favorite story, the one that always cracks everyone up, involves the last moments of The Feisty One, an elderly German woman whose final words probably best sum up the sheer shock-and-awe effect of the transition from life into death.  She was what we call a colorful character; a regal prima donna who commanded everyone, was disdainful of doctors, dismissed all the symptoms of her decline with contempt, and who kept telling me that really, it was all just a bad case of constipation and she’d be up and around again soon. 

And then, she insisted, I’m going to cook you a real German meal.

I adored this woman.

Her daughter-in-law was the one who told me the story of The Feisty One’s last moments.  How she’d had a burst of energy and talked for something like fifteen hours straight, all through the night and well into the following morning, before falling into a coma.  How she then just lay there, finally quiet, for a day and a half, her breathing growing increasingly labored and shallow.  And then how, right at the end, she drew one last breath and opened her eyes again, staring at them all in complete surprise, before exclaiming, “Shit…SHIT!…SHIT!!!”  After which she collapsed back against the pillows again and promptly died.

I can only imagine how those may very well be my own sentiments exactly some day.

copyright Dia Osborn 2011

Refugee Spiders Helping To Protect Pakistanis From Malaria

Here’s an odd and wonderful story.

Wired UK posted an article today about one of the stranger consequences of the major flooding that took place in Pakistan in 2010.  Evidently, there are submerged areas of the country where the threatened spider population took to the trees and spun draping canopies of webbing which completely cover them.  If you love great photography go take a look at the eerie, beautiful pictures included with the article.

But the most amazing part of the story is the report from Britain’s Department for International Development who is currently working there in Pakistan.  They say there are far fewer malaria carrying mosquitoes in the vicinity of these trees, in spite of the standing, stagnant water surrounding them.

The concentrated spider populations are helping to control the burgeoning mosquito population.  How’s that for a lovely side effect?  This strange partnership between trees and spiders is creating living, arboreal shields against disease for the people living nearby.

I love this; how tragedy can transform a creature we usually regard as a danger and/or a household pest into a profound gift of protection.   I’ll remember this the next time I pick up a shoe to crush one, and instead catch it in a jar and place it carefully outside…in honor of its little, eight-footed Pakistani brethren who are (however unintentionally) protecting my own devastated and suffering brethren across the world.

One small way of gratefully participating in the web of life.  (No pun intended.)

Photo UK Department for International Development

copyright Dia Osborn 2011

A View From The Edge, Part I

It’s tax season and I’m buried.  No time for writing much of anything but expletives on the bathroom wall, so the next few posts will be an excerpt from the book.  I’d love to know what you think!

Chapter 5:  A View From The Edge

Journal entry:

…I lay there on the hard ground in the cold and dark, peering up into a universe unimaginably deep, and watched as the stars shifted and flowed across the heavens.  I was comforted—remembering I’m a part of something far bigger than just this ordinary, deeply beloved world.  And it’s like that for me, again, in the dying world.  Where I get the opportunity to peek out beyond this small life, if even just for a moment, at something that’s both so vast and yet impossibly, delightfully hidden most of the time–disguised by our bodies and abilities, memories and choices.

By everything we keep mistaking as ourselves.

With the advent of palliative and hospice care we’ve seen the first glimmers of change but, by and large, the modern, western medical paradigm still looks at dying as a failure and a waste.  The metaphor I hear employed most frequently outside of hospice, by medical professionals, media, friends and neighbors, is that death is the enemy and all of us must wage a war against it.  Either individually within our own, dear body or as a group using the big guns of scientific advancement and policy change.  The metaphor of war is a powerful one, invaluable for generating the will necessary to marshal our resources for a single minded, all out attempt to get better–to survive and thrive as an individual or a society.

But what many don’t realize is that the cost of a martial metaphor is a high one.  In a war whose sole aim is to preserve life, those who perish anyway die as casualties and losers.

It was always difficult to watch—the myriad ways this sense of failure manifested in the people I helped care for.  Some felt bewildered and abandoned by a system that only seemed interested if there was still a possibility of cure.  Others, that dying was their own fault and a punishment of some kind—because they didn’t get a second opinion, have more insurance, take better care of themselves, screen often enough or for the right disease.  Some felt unlucky because they didn’t respond to the drugs or treatment the way they were supposed to.  Others felt guilty because they’d just grown too exhausted and frail to fight anymore.

It seemed more than a little strange to me.  Dying is already such hard work.  Why in the world would we adopt a way of looking at it that actually increases the suffering involved?  Perhaps it’s the natural outcome of our separating dying from life, of deeming the first as a terrible and monstrous thing and the second as our only sanctuary from it.  Whatever the cause, an unintended outcome of focusing wholly on the protection and preservation of life—of regarding our natural transition into death as a sinister and horrible collapse—is that we’re unwittingly multiplying everything about dying we fear most.

It’s ironic. While the duration and quality of life have unquestionably improved over the last century, the quality of dying has been in a corresponding decline.  All our efforts to delay and defeat death have unintentionally prolonged the process so that it now takes longer than ever.  It involves new and novel layers of suffering caused by an ever-multiplying array of interventions, requires increasingly complex—sometimes unbearable–choices, and costs so much more that it frequently not only strips surviving loved ones of any remaining resources but leaves them crushed under a staggering burden of debt.

Over the years I noticed that frequently, especially in the case of a last minute referral, by the time a dying person and their loved ones washed downriver to us, we were among the first people they’d encountered who weren’t afraid of the mists gathering around them.  Every good hospice team has a host of important jobs to do but one of the first is the simple act of trying to normalize what’s taking place, to convey in both words and demeanor that in fact, everything is still okay.  We see and welcome whoever it is wholeheartedly because they are, regardless of what’s happening, still alive and vibrant and real.  If there’s enough time, if they’ve been referred for end-of-life care early enough, that wild, spinning-out-of-control feeling people so often experience in the deteriorating pursuit of a cure has a chance to stabilize, allowing them to find firmer ground so they can return to the rest of their lives.  It can make all the difference between someone fully embracing whatever time they have left or just gritting their teeth while sliding over the cliff.

I began to wonder if the transition from living to dying need be quite this traumatic.  Could there be some way to weave the acceptance of dying still largely unique to hospice and end-of-life care into the branches of medicine which focus primarily on cure?   I started casting about in my mind for a bigger metaphor than that of war I could employ, one that would contain both my longing and reverence for life as well as a deeper wisdom and regard for death.

Something that would not only arouse and inspire me to live but also reassure and cradle me when I die.

*          *          *

In the fall of 2001, after years of navigating the ups and downs of a deep depression, I decided to try a new and novel treatment option.  I was nearly paralyzed again—all the diverse and multiplying anxieties that had flourished in me over time eventually consolidating into a single, more efficient terror of just leaving the house—and one day it occurred to me that I was at a threshold.  I was either going to have to take some drastic, even reckless action to counter the trend or else surrender to life as a shut-in.

So the day my husband suggested that we hike into the mountains separately for a spiritual retreat, to spend three days and three nights alone with God at 9,000 feet in autumn during bow-hunting season without flashlight, fire, or food, something desperate leaped up inside me shrieking YEEEES! Cal had been doing this kind of thing for years, had invited me to join him every time he’d gone in the past, but somehow it never held much allure for me.  So it took him off guard at first when I agreed–he thought I was just messing with him.  But once he realized I was serious he became so excited that later, when I came to my senses, I didn’t have the heart to back out.

To be honest though, deep down I didn’t want to back out.  I’d reached the point where the constant, chronic fear I was living with finally seemed worse than anything that could conceivably happen.  It no longer sounded as bad to me; freezing to death, being impaled on a stray arrow, mauled by a drought-starved bear, trampled by a rutting, bull elk, falling off a cliff, going into hypoglycemic shock from lack of food, burning alive in a forest fire, being struck by lightning, buried in a snowstorm, or captured and toyed with in unspeakable ways by some caricature of a deep-woods crazy. Nothing I imagined anymore could possibly be worse than spending the rest of my life locked in the bedroom cowering under a blanket.  It had become unbearable, losing access to everything I loved drip by drip, the slow suffocation of walls closing in.  The time had come to summon all my fears to sit down in a circle with me–time to either break the back of the depression or die trying–and frankly, I didn’t care anymore which one.

It can be both a devastating and invigorating place to reach, the feeling there’s no longer anything left to lose.

Next week:  Chapter 5 Part II

copyright 2010 Dia Osborn

A Dream of Her Dead Beloved

image by Salvatore Vuono

I arrived at a patient’s house one morning to be greeted by the news that Adelle, 104 years-old, had seen her husband last night in a dream.  It was a vivid, full screen, Technicolor kind of dream that she couldn’t stop talking about once she woke up.  Father of her children, love of her life and dead for over 40 years, she told me how healthy he looked in a tone of mixed surprise and delight, her face luminous with a happiness I hadn’t seen there in the year I’d helped to care for her.

Usually, she didn’t remember her dreams—in fact she was remembering less and less of just about everything.  Nearly blind and almost deaf, her retreat into the chambers of stillness and shadows had been recently accelerating.  We’d all noticed.  The complex web of threads that had once moored her here to the people and places she loved was unraveling, while her physical senses, whose job it had been to reach outward and connect her to the things of this world, were now reversing and cutting her off.  Spinning closer and closer around her like some kind of growing cocoon.

A shower fog thick with shimmering and whispers slowly curled around us there in the bathroom as I toweled her dry. 

It was like nothin’ I ever seen before she confided softly and I felt a little breathless myself at the strange radiance lighting her face.  Her words helped lift a growing load from my heart.  She’d been turning inward, slipping away from us to struggle alone across the borderlands for so long that I was relieved she was finally coming within reach of the other side.

Adelle lived a long, clean, healthy life and her heart, while ancient, was still strong and vital.  For over a hundred years that had been a good thing.  But now, as the rest of her body was slowly grinding to a halt, her persistent, tenacious heart had unexpectedly become a liability.  It was yet another of those odd reversals that take place in the dying world—how good health can turn out, at the end, to be something unlucky.  I saw it a few times in those with unusually strong physiologies.  There was a man with the strength of an ox whose cancer advanced to a degree of horror before his heart finally (finally!) gave out.  And another woman centenarian whose muscular control and mind had long since failed but whose heart (Oh, fabulously strong, pulsing, galloping heart!) continued it’s pounding on and on.

It puzzled me, how one organ could be so oblivious to the fact that its fellow body parts were dropping around it like flies.

Or, even more bewildering, why we would step in and medically intervene with a heart or any other body part that was paying attention and trying to shut down.  Propping them up with the brilliant science and medicine we’ve developed over the decades and thereby unintentionally furthering a degree of suffering that was never naturally intended, aggressively slamming shut every other door that offers a kinder and more timely exit.

I’ve been viscerally struck by the dear and true friend that various acute diseases turn out to be as we decline and fall apart.  Even with as miserable as things like diarrhea, flu and bacterial infections are in the short term, they can save us from an equally miserable and far, far longer dying process.

Adelle was blessed with an extraordinary heart.  She was the last of her generation by a long shot, and now longed to catch up with those who had gone ahead…more than ready to leave but forced to linger on and on.  I don’t understand, in the grand scheme of things, why her journey entailed the extended suffering that it did and it’s not my job to judge it in any way.  (Thank god.)

But I’d grown to love her and in my heart I couldn’t help but feel she’d endured enough…enough joy and grief, love and loss, strength and pain, enough long, long life.  She was ready to go and as far as I was concerned she deserved to.  She’d earned it.

I was glad her beloved had come.

Van Gogh

copyright 2011 Dia Osborn

Fecal Implants? Seriously?! (Yup.)

rectal bulb syringe


I live for this kind of stuff.

Slate online published an article a couple days ago titled The Enema of Your Enemy is Your Friend by Emily P. Walker. It reveals an unusual, frontier-type of treatment for an intestinal infection called Clostridium difficile that’s killed a lot of people over the years, and which 1.3 percent of patients are estimated to contract during a hospital stay.

Death by diarrhea.  Not a fun way to go.

The traditional treatment for C. diff is a course of antibiotics but for the unlucky who fail to respond, fecal implants are another up and coming possibility.  And before you wrinkle your nose and shake your head in disgust please consider that, in the small amount of documented research available so far, the outcomes are surprisingly good.  From the article:

“It’s true there’s been no major clinical trial of fecal transplants, but the procedure appears in the medical literature at least as far back as 1958… Now we’re beginning to see some more extensive studies. Mark Mellow, a gastroenterologist at INTEGRIS Health in Oklahoma City, recently presented a paper showing that 15 out of 16 C. diff patients whom he’d provided with a fecal transplant remained disease-free after five months. Several other papers presented at the meeting showed similar positive effects, and in every case, symptoms disappeared almost immediately after the transplant.”

Evidently, it works because the foreign feces helps to repopulate friendly flora in the infected intestines.  (Want to know the best feces to use?  Borrow it from a person who lives with you.  Their flora and your flora are the most likely to be a good match.)  In a clinical setting the donated matter is first screened for disease and then mixed with a saline solution to the consistency of a “milkshake.”  (The article is not only informative, it’s fun to read.) Then it’s pumped into the colon where it does it’s magic.

But there’s also an alternative:

“And then there’s the do-it-yourself crowd.  All you need is a bottle of saline, a 2-quart enema bag, and one standard kitchen blender. Mike Silverman, a University of Toronto physician who wrote up a guide to homespun fecal transplants for the journal Clinical Gastroenterology and Hepatology, says it’s entirely safe to do the procedure this way, provided that a doctor gets involved at some point to screen the donor sample. He felt he needed to draw up the instructions because administrators at his hospital wouldn’t allow their doctors to perform a procedure that hasn’t been validated in a large, peer-reviewed study.”

But as Ms. Walker points out in the article, these studies are proving hard to come by.  Pharmaceutical companies not only have little reason to shoulder the substantial costs involved (there’s not enough profit potential for them), there’s actually a disincentive; a natural remedy like this would replace an antibiotic treatment.

Gotta love our health care system’s fabulous cast of skewed incentives.

Needless to say, I’m endlessly fascinated when conventional medicine turns off the beaten path to consider the unusual.  If this treatment turns out to be as successful as it looks like it could be, it would place it right up there with the simple elegance of biosurgery; the use of maggots in destroying necrotic tissue in a slow or non-healing wound.

My hope is always that the adversarial stance so often adopted between different healing modalities will eventually soften and reverse.  It sure seems like the more hands we have on deck, the more solutions we’ll find for not only treating illness, but increasing health, thereby enriching everyone’s quality of life.

UPDATE:  October 29, 2011

It looks like this treatment may be starting to get the acceptance (and application) it deserves.  I just found a headline article on msn.com called Sounds gross, works great: Fecal transplants cure nasty C. diff infections citing the benefits and growing use of fecal transplants.  The article mentions a success rate of 90% for the treatment (yowza!) yet says the transplants are still looked at as a “treatment of last resort.”  I wonder how much of that is due to doctor’s skepticism and how much is patient’s resistance?

In any case it’s interesting to note how quickly fecal transplants are gaining traction as a viable treatment.  With C. diff infections on the rise, the availability of a treatment with a 90% success rate is a godsend.

UPDATE:  July 6, 2011

And now, a recent positive write-up in a professional journal!  The journal Pediatrics published an article on June 14, 2011 covering the case of a child who was successfully treated with a fecal implant.

For those researching, here’s an online physician’s resource called HCP Live, with a couple of other potentially valuable links.  Good luck!

UPDATE:  March 24, 2011

Because I’m getting a lot of hits on this post I thought I’d update it whenever new information comes in.  Today, I received a comment from Kathy Suszek who is a nurse case manager “working with a gentleman who just had the fecal implant done, he tells me his results are “wonderful”. Had 1-2 loose bowel movements, in the past few wks, but much improvement.  Just wanted to share news that is positive for a change.  His provider has had 14-out of 14 success stories.”

UPDATE:  May 2, 2012

Here’s a great article titled Fecal Transplants: They Work, The Regulations Don’t published in Wired Magazine, December of 2011.  In it the author talks about a couple of early trial results on fecal transplants as well as some of the regulatory hurdles involved in getting serious studies launched.  The success rates for this procedure so far are absolutely amazing, but it’s difficult for people to find doctors working in institutions that are broad minded enough to allow it.

I did find this video posted by Integris Digestive Health Center in Oklahoma City where they consider administering fecal transplants to those with recurring C. diff.  

copyright 2010 Dia Osborn

When Something More Important Than The Parachute Failed

image from Wikipedia

While I was browsing around yesterday researching skydiving and back-up parachutes, I came across a news story from February 2009.

It told the tale of a skydiving instructor, George Steele, who died of a heart attack mid-jump. Now, that piece of information alone would have made me sit up and keep reading because, even though I naturally link skydiving and the possibility of death in my mind, I don’t usually think of it as happening due to a heart attack.  But the story actually gets far more interesting from there.

It turns out this skydiving instructor was not alone when he died.  He was doing a tandem jump and had a novice strapped to his chest.  Now this piece of information electrified me.  Like a lot people out there, I’ve considered doing a tandem jump (someday) as a bucket list kind of thing.  But of all the risks I ever thought might be involved, the instructor strapped to my back having a heart attack was never one of them.

By now I’m on the edge of my seat.  I want to know more.  I have to know more.

Turns out the newbie, Daniel Pharr, was a 25-year old soldier trained how to respond in a life-threatening situation.  His instincts proved up to the task.

The two were the last of the group to jump out of the plane.  After a minute or so of free fall Steele pulled the chute.  Everything became very quiet, which Pharr commented on, and Steele replied to.  And it was shortly after this that Steele’s heart quietly failed.  Pharr soon realized Steele had become non-responsive so, going off of what he’d seen on TV (and our mother’s told us TV would just rot our brains) he grabbed the right steering toggle and guided them safely to the ground about a third of a mile away from the designated landing site.

This was turning into such great story!  Double surprise twist with a happy ending.  Dia, I told myself.  It doesn’t get much better than this.

But wait! she answered.  It does!

Turns out Daniel Pharr’s first thought, when he recognized the danger he was in, was , “So at that point I realized I was just going to have to do what I had to do to get down to the ground and try to help him.”

The article had been great up to that point but this part totally knocked my socks off.  I was inspired.  I was in awe.  I couldn’t help but compare what my own response would have been because…well…it just wouldn’t have been as good.  I’m self aware.  I know my own mettle.  I’ve been in enough emergency situations to realize that I’m primarily driven by self-interest.  Oh sure.  If my kids were involved I’d be a little more noble (as long as they hurried) but otherwise I’d be swelling the herd stampeding for the door.  I probably would have been cursing the poor guy for having a heart attack.  But not Daniel.  Oh no.   Daniel was thinking just as much, if not more, of his partner than he was of himself.

Pharr’s evolution from victim to survivor to hero was like food for the secret, emaciated Better Person languishing inside of me.  He gave me hope, a guiding star.  I fell in love with Daniel Pharr on the spot and wished him, wherever he was and whatever he was doing, continued good fortune and everything blessed and best in life.

But having spent all this time telling you the rest of this stuff, here’s the aspect of the whole story that I really wanted to highlight:

It looks to me like, as deaths go, George Steele got to die a really good one.  Yes, he was only 49-years old and sure, he probably didn’t want to die and most likely wasn’t prepared for it.  But having said all that, clearly he got to do it doing something he loved.  In his relatively short life he’d already done over 8000 jumps.  He’s already taken numerous people out for tandem jumps, sharing in the thrill, exuberance, joy, and rush of all those he introduced to his passion for the first time.  And even though at the end he was doing a tandem jump, he was lucky enough to be doing it with someone experienced and savvy enough to survive the dangers his sudden death created.

But even with as great as all that is, this is what really got me: George Steele didn’t die alone.  When he took his last breath, he got to do it with another warm, pulsing, vibrant, strong, caring, enthusiastic companion strapped to his chest, someone sharing in the same sense of wonder, excitement, and joy that he was feeling himself.  Here’s how Pharr describes what turned out to be Steele’s last moments, floating up there in the sky:

“He pulled the chute,” Pharr said. “It got super quiet. It’s eerily quiet up there. I made the comment to him, ‘It’s surprising how quiet it is.’ And he’s like: ‘Welcome to my world.'”

Welcome to my world. Those were the last words he ever spoke.  I only hope mine will be so great.

I’m not happy for George Steele that he died.  At all.  But I am very happy for him that when he did, he died well.

copyright 2011 Dia Osborn

P.S.  By the way, when asked Daniel Pharr mentioned he’d be willing to jump again himself, but his family put the kabosh on it.  What a guy.

Teaching Stories and Working with Dying Bodies: Context Helps A Lot

“Let me light my lamp,”

says the star,

“And never debate if it will help to

remove the darkness.”

– Rabindranath Tagore

It’s here my friends.  Autumn.  Not the calendar date which arrived weeks ago, but autumn in the trenches, where I’m scrambling to strip-harvest the last of the tender vegetables, get the cold frames covered, and dig out all the wood stove accoutrements from the garage.  Last night was our first frost and I woke up this morning reluctant to slip out from under the down comforter to a chilly house.

It was time…finally time…for the first fire.

We heat primarily with a wood stove and…let me just say before anyone gets their panties all in a bunch…we use a high-efficiency, EPA certified stove, that gets maximum energy capture with minimum greenhouse gas and particulate matter emissions.  We also live in the mountain west where pine beetles are killing off wide swathes of our forests, so our fuel consists of dead trees that would otherwise provide fuel for catastrophic forest fires spewing greenhouse gases and particular matter into the sky.  We have a back up furnace for burn bans, use only clean, seasoned wood, keep our stove and chimney clean, and burn hot fires.

While it’s not a perfect source of energy we believe, used responsibly, it’s one of the wiser choices for our neck of the woods.

It’s also a high maintenance way to heat a home which wouldn’t work for a lot of people but it’s satisfying for us.  It’s like a dance that spans the entire year.  Splitting wood in the spring, cleaning the stove in summer, stoking fires through fall and winter, and collecting ash for the garden once spring returns.  We work our way through the seasons of cold and dark, waking and sleeping to the ebb and flow of temperatures in each load.  It’s like a slow waltz with wood, axe, oxygen, and match as partners.

It’s also a lot cheaper than our ancient electric furnace.  Très bien.

Staring at the crackling fire this morning I flashed back to a story I heard long, long ago.  It was a teaching story which has helped me a lot over time, as any good teaching story should.  Thirty or so years ago I met an elderly monk one night, at a time when I was in a lot of pain.  I was pushing my dinner aimlessly around my plate in the college cafeteria when he just he showed up.  (It was not a Catholic school and had no proximity to a monastery.  Kinda spooky.)  We wound up talking in the library into the wee hours of the morning and, even though we covered a broad range of topics that night, I only remember two things:

1)  When we stood up and hugged good-bye I rubbed his back with my hand like I would a friend and afterwards, when I realized what I’d done, was aghast.   It’s not that Father Monk looked in any way offended but while I had no idea then, and still don’t today, what is the proper etiquette for hugging a monk, I assume you’re not supposed to fondle them.

And 2) he told me the story of the Log and the Flame.

I had just told him about an experience of heightened awareness I’d been having since I was a small child, one I was having increasing difficulty integrating into my everyday life.  The experience itself had always been luminous and joyful, but as I’d gotten older the contrast afterwards was becoming a problem.  Once the experience ended, the regular, daily world looked pretty bleak by comparison and I’d fall into a depression that could last for days.

Integration of any kind of extreme reality presents a challenge.  I’ve often heard people describe the shock and disorientation they felt when traveling for the first time between a wealthy country and one where grinding poverty is endemic.  The gap between the two worlds is huge and can raise a storm of new thoughts and emotions that need time and effort to wrestle to the mat.  The same dynamic exists when someone wins the lottery, or visits the dying for the first time, or enters a prison, or any other environment that lies at the opposite end of a spectrum.

This holds true for extremes of internal experience as well as external.  When I was a child the feeling of wonder and belonging that the heightened awareness gave me was easy, because I was already living in the imaginative, magical universe of childhood.  But as I entered adolescence the contrast grew more stark and by the time I went to college the wide swings of emotion involved (feeling loved and luminous one moment, then stranded, dark, and alone the next) were getting hard to deal with.

I couldn’t figure out how to rope and ride that particular whirlwind.  I needed some guidance.

Father Monk was the right man for the job.  As soon as he heard my description of the experience he nodded in understanding, then proceeded to talk about the wild swings I was having in Christian terms of purification.  It sounded kind of like a colon cleanse only spiritual.  Then he told me the story of the Log and the Flame.

When the log is first laid on the flames, he said, the two are separate and distinct, but then the fire begins to catch the bark and wood.  As it spreads and encircles it, the log starts to sizzle and hiss and then, as the fire penetrates deeper, the wood blackens and moans, cracks and crumbles.  It’s a difficult process for the log to go through but eventually, the wood glows red and then dissolves as it’s transformed into the flame itself.

I gotta tell you here…I liked it.  Not only as a constructive context for framing the struggle I was having, but as a truly dynamite teaching story as well.  Turns out it works in all kinds of situations because, as archetypes go, fire is pretty universal.  Back then Father Monk’s story helped me sort out and harness what was good in the experience I was having, as well as clearly identify the challenge involved so I could develop some tools to manage that part of the swing.

But I also remembered the story years later when I was working with hospice, and it gave me a whole new perspective on what was happening to the bodies that were basically disintegrating beneath my hands.

Watching a body separate from the life it’s been housing takes some getting used to.  It really does.  As graphic processes go, dying has to be up there with the best of them.  The sights, sounds, textures, and odors involved require some aggressive acclimation and nobody is fine with them at first.  Nobody.

But once I grew familiar with the symptoms and my gag reflex subsided, I relaxed and found myself surrendering into the journey these people were taking.  On a few occasions, while standing by their bedsides and gently, oh-so-gently, bathing their shrinking, wasting bodies, I even had that experience of heightened awareness again, where it felt like I was falling into some great stillness that cradled the room.  It reminded me of standing up in the mountains at night bathed in starlight and silence, the Milky Way brilliant and arcing across the sky.  Everything just suddenly felt so big.

And as I slowly touched and turned them, wetting and wringing the washcloth before laying it’s warmth over another patch of quivering skin, tenderly washing away the sweat and sloughing skin, the fecal matter or encrusted blood, I would notice it again.  How they seemed to be faintly glowing there in front of me, like there was something radiant just under their skin that made them look translucent, and every time it took my breath away.

It reminded me of the story of the Log and the Flame.  Only in this case it was like these people were the logs and the flame was something inside them, illuminating them as their bodies slowly dissolved.  It was extraordinary to watch and, while I have absolutely no idea what was causing the phenomenon, I found the beauty in it reassuring.  It helped me care for them better, turning my sadness from something heavy and dragging into something sweeter, more poignant, and clean.  I tumbled head over heels in love with them, each time.  Fell in love with their beautiful, crumbling bodies that were busily transforming into something else.

I think that’s the hallmark of a great teaching story.  It provides a bigger context to help explain not only the beauty, but the darker, harsher aspects of life that are always taking place, too.   It offers a map, a guide, to help navigate through events that can otherwise be confusing, overwhelming, or destructive.   The Log and the Flame was that kind of teaching story for me, one that’s continued to help across decades, and I wanted to take a moment, with a first-fire crackling merrily in the background, to look across some thirty-odd years and thank you again Father Monk, for such a great gift.  You have no idea how much it’s helped.


copyright 2010 Dia Osborn

Run Over By The Amish

Well, I missed my Friday deadline and may miss next Friday’s as well.   Blogging while traveling is proving far more difficult than I thought it would be.  Serious discussions about dying, assisted suicide, and the like are just going to have to wait until I have the time to treat them with the respect they deserve.

So…in the meantime.  Last night we had dinner with old friends of the hubster.  During the meal one of his friends (an avid bicyclist) told us a story of being run down by some Amish horses gone wild.  Iowa has a large population of Amish and near the communities it’s common to see their buggies tooling along on the shoulders of the highways.  The horses are used to the sounds of car traffic and have always seemed calm and well controlled whenever I’ve driven by them.

Image from Wikipedia

But while they’re fearless around cars, evidently the horses are spooked by bicycles (who knew?) so when the bicycling friend and two of his buddies rode past an Amish family in their wagon one afternoon, the horses panicked.  They threw the wagon and family of four into a ditch before doubling back and stampeding down the highway headed back for the barn.  Our friend was unlucky enough to be riding dead in their path and, because of wind noise, didn’t hear them coming up on him from behind until they ran right over the top of him!  He said one second he was peddling along, minding his own business, and the next he was waking up in a hospital with a broken ankle and numerous cuts and bruises.

Imagine his surprise to find out the exact nature of his traffic accident.  Of course now that everything’s healed he clearly enjoys telling the story and who can blame him?  You have to admit it’s a good one.  How many people can claim they’ve been run over by the Amish?

In any case I guess the moral of this story is, for the safety of everyone concerned always beware when riding your bicycles around horses.

copyright 2010 Dia Osborn

A Sense of Presence (Can you feel me now?)

Uncle George, husband, father, friend, and legendary storyteller.

I thought a lot about my encounter with Alf and the Fly this weekend, about how vivid the sensation was when I felt Alf’s presence during the memorial service.  The subject was up again because we drove down to Reno to join extended family in celebrating the life of an uncle who died earlier this year.  During a conversation with one of my cousins (a daughter of said uncle), she described a moment, while going through his things shortly after he died, when she suddenly felt like he was right there with her, giving her an intimate message of love through, of all things, an obscure word in one of the National Geographic magazines that he loved.

She, too, experienced a sense of presence.

Many of you might recognize what she described because you’ve felt something like it yourself.  It turns out that experiencing a sense of presence is fairly common, not only among the survivors of those who’ve recently died but in a variety of other settings as well.  The experience is so common in fact that it’s been given names like the third man, widow effect, and the ever magical imaginary friend of young children. There has also been a fair amount of research done on the phenomenon and I’d like to touch on a few of the studies as referenced in a fascinating book called The Third Man Factor by John Geiger.

(BTW, if you ever get a wild hair and feel like reading a variety of personal accounts of  a sense of presence, here’s a forum on The Third Man Factor website.  These examples are unique because most of them result in a person surviving a situation where otherwise they might have perished.)

Geiger’s book deals primarily with the experience of a sensed presence in extreme, survival situations but he references other circumstances where the experience regularly manifests.  Needless to say, given my focus on dying, I was particularly interested in those dealing with the widow effect, the experience of a sense of ongoing relationship with someone who’s died.  He cites one study by researchers at the University of Arizona at Tuscon in 1988, where about half of the 500 widows questioned reported sensing the presence of their deceased partner, and another survey of 227 widows and 66 widowers in Wales which produced a similar finding.

“That study, by W. Dewi Rees, published in the British Medical Journal, found that most people who had the experience reported they had visits intermittently throughout the day, while 10 percent said they ‘felt that the dead spouse was always with them.’  All said they sensed the presence of the deceased; a few also said they actually saw or heard him.  Rees found the experiences were in no way frightening, and concluded, ‘these hallucinations are…normal and helpful accompaniments of widowhood.’  Other research into widows of men killed in automobile accidents in Japan found the incidence even higher, and there, too, the researchers concluded the presence ‘may be a positive sign in helping them adapt to the loss.'”  (pp. 153-154)

Geiger also sites a larger survey conducted in the UK in 1995 that didn’t just look at widows and widowers, but included a broader cross-section of society.  It revealed that “the continuation of an important relationship after death is not confined to those who have lost a spouse.”  People reported sensing the presence of parents and other family members as well as friends.

Clearly this experience of sensed presence is widespread among the recently bereaved.  Yet prevalent or not, as most people are painfully aware, there’s a social stigma attached to talking about it.  I’ve found the majority of people, at least initially, are reluctant.  Some, deeply so.  They’re afraid others will think less of them for believing in “that kind of thing,” or worse, that people won’t believe it happened at all.   But it does happen, to a large segment of the population, and I hope that Geiger’s book will be a watershed, marking a shift in trend where it becomes more acceptable for people to speak openly about their experiences.

Because being able to speak about these experiences is important for reasons I’ll explain in a moment.

I found it interesting that Geiger himself expected a lot of resistance to the idea that the experience of a sensed presence is real and was surprised when none materialized.  He realized most people don’t doubt that the experiences are actually happening.   The controversy centers around what might be causing them.

The first thrust of The Third Man Factor is to confirm the experience itself and Geiger lays out evidence that makes it indisputable.  People are sensing something that feels like a presence.  (This is huge.  Absolutely huge. He’s finally provided a framework within which people of all intellectual backgrounds can talk about the subject.)

The second purpose aims at reconciling the traditionally supernatural elements of these experiences with possible scientific explanations and he presents some compelling evidence for the role that stress, loneliness, and neurological function play in the phenomenon.   The book is well researched and, while his conclusions ultimately raised as many questions for me as they answered, I was still wildly relieved to hear the subject discussed in a practical, factual manner instead of the half-embarrassed, half-apologetic whispers that I usually hear.

Now, let me be clear.  While I’ve long been intrigued by the dynamic tension between science and spirituality, and I’m always curious to hear what both sides have to say, on a purely practical level I, personally, don’t care what’s causing these experiences of sensed presence.  It’s not relevant to me.  It’s an interesting question, don’t get me wrong, and fun to explore when nobody’s dying.  But when someone is dying, the arguments are really just an intellectual exercise.

Once you’re in that room and it’s you or your loved one lying on the bed suffering, once it’s you facing down the maw of unbearable loss, once it’s your family that’s been swept away in the maelström of vulnerability that dying entails, you’ll probably discover that the arguments about what’s causing an experience of sensed presence aren’t nearly as important as whether or not it helps.

It’s like drowning in the middle of the ocean.  If a boat pulls up and throws you a life buoy you probably won’t care about where the thing was manufactured.  Nor will you ask to see a business card from whoever is throwing it to you.   What you will care about, deeply, is whether or not it floats and, if it does, you’ll grab it with gusto and hang on for dear life.

I think everyone should be allowed to speak openly about any unusual experience they have during the dying process.  (FYI, there are a lot of them.) Because even though no one can definitively explain them yet, they still provide enormous comfort and reassurance during a journey that’s tough at best and devastating at worst.

I’ve often felt frustrated by the fact that such a luminous, nourishing, (and it turns out commonplace) human experience is relegated to the back of the shame-closet where we stash our bogey men and under-the-bed monsters.  I don’t think anyone should ever have to feel embarrassed because they experienced something that helped them cope and heal.  Neither should anyone have to hide the fact that they’re experiencing something lovely even if it’s odd, because doing so robs the rest of us.  I’ve studied the faces of those listening when this kind of thing is shared and the effect of these stories on others is almost always one of wonder, hope, or relief.

Which are good things, things that are in relatively short supply.  We want more wonder, hope, and relief in the rooms of the dying.  Trust me on this one.  They help.

These days, in rational society, we tend to resist things that involve Mystery.  We have our science and we like our rational explanations and we’re uncomfortable with odd-shaped things that sound weird and don’t fit.  The problem with that is, as soon as we enter the dying process we also enter the Mystery.  The two things are a package deal and the ticket covers both rides.  Everyone has to grapple with the fact that questions grossly outnumber answers at the end of life, both existentially and physiologically.

Whether these questions revolve around an experience of sensed presence, or the surprising level of foreknowledge or control many have over the actual moment of death, or the perennial biggie concerning what will happen to us once it’s all over, or the most basic question of Well…what’s causing this symptom?, one thing is certain; sooner or later something will occur during dying that everyone will guess at but no one will know.  And if that something is a sense of presence that lightens the load or eases the pain?  If it provides a pool of nourishment from which we can drink a little courage, respite, or strength?

Then perhaps the most useful explanation is simply that these experiences of sensed presence are a rare and beautiful gift at a time when we need one the most.  Maybe it’s okay to not know any more than that for now, but open both hands anyway, accept the gift, and whisper thanks.

For anyone interested, here’s a brief interview of John Geiger talking about the book, The Third Man Factor.

copyright 2010 Dia Osborn

Alf and the Fly, Part II

When we left Alf last week he was lying in state at the front of the room while the rest of us sat politely listening to the pastor (who clearly never met his subject) reiterate the sterilized summary of his life as laid out in the obituary.  I was doing my level best to stay awake and fend off the head-bob when the Fly first started buzzing around me.

This was just one of a number of remarkable photographs published in The Daily Mail. It was taken by physiotherapist Miroslaw Swietek at around 3am in the forest next to his home.

I was surprised.  For one thing, it was hard to believe that something as wildish and chaotic as Musca domestica could survive in a place like that.  The room felt as sterile and life-sucking as the sermon currently bouncing off its stark, white walls.   Call me wrong but I’d have bet good money that anything smaller than, say, a finch or a bat would have died and dropped to the floor the instant it hit the atmosphere.  Equally amazing was the fact that the Fly (fat, hairy, and droning) had to negotiate five doors and a security force of germ-phobic staff to penetrate that far in.  Truly, this was one determined fly.

However, my wonder was soon replaced by consternation.  The Fly, after buzzing in circles above my head a few times, commenced a series of land-and-crawl maneuvers targeting places like the top of my head and the side of my face.  At first I just brushed it away while still maintaining my focus on the pastor, but after the third or fourth time The Fly finally had my undivided attention.  I studied the situation.  When I glanced at our Social Worker and Nurse on either side of me it was plain they were outside the fly zone.  Neither displayed the harassed look I was rapidly adopting.  And when I looked around at everyone else in the immediate vicinity I realized they weren’t being bothered either.

Naturally, this annoyed me.   So the next couple of times I swatted the creature towards the Nurse, to see if it would switch victims and crawl on her instead.  But it didn’t.  It not only came right back at me each time, it seemed to redouble its efforts.  That was when it struck me that, for some odd reason, the Fly seemed intent on making my life, and my life alone, miserable.

It got worse.  After a few swipes the thing started dodging my hand, feinting to one side in the air before diving back in to skip across my forehead, my cheek, my nose.  Or, if I swung after it had already landed and was doing the Tinkerbell dance across the back of my neck, it would leap into the air just long enough for me to slap myself before gracefully alighting again in a swift succession of tiny steps.

The Fly was really starting to get to me.

Yet it wasn’t until it began lifting my collar to crawl under my shirt and down my back that I truly began to panic.  What the hell was this thing?  It was like no other bug I’d encountered, intelligent, crafty, and motivated.  Like something out of a Jeff Goldblum movie.   I was right on the verge of making a full-blown scene, shrieking and jumping to my feet, writhing madly while trying to slap my back and tear off my shirt, when something stopped me.  I had the strangest thought.


The Fly stopped in its tracks.  It stayed still for a moment, huddled there under the fabric between my shoulder blades, then turned around and crawled back up out of my shirt, lifted into the air, and began to fly around in front of my face in a figure eight pattern.  I couldn’t believe it.  My mind was spinning.  Just how is that kind of thing supposed to work?  My imagination took off and I wondered wildly whether Alf had temporarily turned into the Fly itself, or if he had just rigged a tiny, leather bridle and bit and was now sitting astride its back, grinning and waving at me with a cowboy hat.

It was at that point that the Alf Cloud descended.  I felt it wrap around me like something warm and soft, and then an image of him…smiling, standing with nary a wheelchair, walker, or cane in sight…exploded in my mind.  It felt like he was right there in the room.  I could almost smell the clean soap coming off him, feel something warm like body heat.  He was chuckling and I almost laughed out loud, too, but then remembered where I was.

It was odd and wonderful and such a relief.  He still felt exactly like Alf only without any of the weakness and strain.  No frustration, irritation, or pain.  He felt strong and easy and laughing, not at me but with me, like he knew that I of all people would appreciate this new-found freedom he’d found.  And I did.  I really did.  The last tattered remnants of sadness and guilt washed away and there was nothing left inside but happiness for him.

I grinned.  You rascal. And as soon as I said it, the Alf Cloud was gone.  The Fly stopped its circling and meandered away, bumping into people and chair backs and walls as it went.

I told our Social Worker about the experience on the way home and we shook our heads, wondered what it all meant, then chatted for a while about what we thought might happen when we died ourselves.  I told him I was hoping for a lot of love.  He said he’d be happy if he could still experience anything that felt like sex.

The next day when I arrived at the office our Social Worker had already been there for some time and was sitting at his desk when I walked in, studying a small fly crawling around near his coffee mug.  He glanced up at me and smiled.

I was just wondering, he said, then looked back down at the fly.


copyright 2010 Dia Osborn