Author: A.R. Schiller

A.R. Schiller is a home-based hospice social worker in a large metropolitan area.
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My biggest fear, part 2: What I’m trying to do about it

Hello again.  Last week I revealed my biggest fear (related to the work I do in hospice.  I won’t get into all of my other deeply seated fears.  I’d need a couch for that.).  As you may remember, it turned out to be caregiving:  needing it and receiving it.  And, last week, I promised that this week I’d tell you what I’m trying to do to minimize the chances that my fears will become realized.  So, here goes:

First, I do what I can to try to make sure I don’t need care in the first place.  Indeed, the only consistent piece of advice I’ve ever heard from anyone who works in the health field is this:

Don’t get sick.

I’m not really sure how to do that, but as my main issue is the chronic back pain I mentioned last week, I’ve become pretty focused (some might say obsessive) on that.  I spent a lot of time (and some money) going to see various doctors, physical therapists, witch doctors (not quite, but close), etc.  I learned three things from that adventure: 1)my problem was inflammatory in nature, 2) doctors don’t know everything, and 3) no one is going to care as much about your health as you do (or at least as much as you should); i.e., you probably want to take charge of your own health.  After deciding not to go on some heavy duty meds a couple of the MD’s wanted to put me on (one side effect: leukemia), I did a bunch of research, drastically altered my diet, started taking way too many vitamins, and reluctantly started exercising.  It’s been a couple of years, and in general I’m doing much better.  It’s been great to be in less pain.  My body (and mind) are functioning better than they have in decades.  So that’s all good.

But my main motivation behind all of it was to not be an invalid.

I don’t know if it will work, but it’s all I can think of to do, so I’m doing it.

Of course, there’s no guarantee that it will.  And even if my back pain doesn’t get out of control, let’s face it: something else is probably going to get me, at some point.

So, then what?  What happens if–or, more likely–when I do need care?

Well, looking around at my patients, almost all of whom do need care, there seem to be two factors that I can control that determine how easy or difficult it is to care for them:  their size and their personality.

Really large, heavy people face a lot of challenges in life, and it doesn’t get better when they’re sick.   And actually, it doesn’t really get better when they die, either.  One of the worst things I’ve seen in hospice was funeral home workers attempting to get an obese body down a narrow flight of stairs.  Anyway, more on point, if you are very large, and can’t move on your own, it helps to be very rich, because you are probably going to need a few people to help move you about.

I know that size isn’t under every one’s control, but at the moment it is under my control.  So, I try to remember that when I start digging into the chocolate.

As for personality:  it’s a lot easier to care for somebody who is really nice to be around. People who are viewed as incredibly kind often have an excess of people gathered around them, trying to help out.  Not always, of course.  But it’s a lot more likely.  Lately I seem to have a number of families in which the patient is an extremely difficult person to like.  The family members do their best to care for them, but eventually they just can’t take it any more.  And that’s when I have to start calling nursing homes.  And it’s probably no surprise to hear that nursing home employees have favorite (and not-favorite) patients, too.  In fact, occasionally hospice workers do, too.   We treat all of our patients well.  But we’re only human–we dole out our love, too.

So, I do try to be pretty nice to my loved ones.  I don’t always succeed.  I did just start listening to You’re Wearing That? Understanding Mothers and Daughters in Conversation By Barbara Tannen.  It induced me to make a conscious effort to do what I can to have a good relationship with each of my daughters as they grow older.  There’s no guarantee that I’ll succeed on that front, either, but it would be really great if I did.  It would be wonderful to get along well with my daughters for all the joy that it would bring to our lives.  Plus…well, there’s a good chance I might be asking them to change my bedpan at some point.

I’m not counting on that, though.  Not only would I rather not have my children have to give up their lives to care for me, but at the moment, they’re not old enough to cross our street by themselves.  And so, for my 40th birthday I asked for–yep, you guessed it–a long term care policy.  Actually, it’s a life insurance policy with a long-term care rider.  We do sometimes get patients with the typical long term care policy, and in general, they end up being useless, at least in the hospice population.  They often don’t kick in for 90 days, which a lot of hospice patients don’t have.  And there seem to be a lot of things they don’t cover.  There’s also no guarantee that that company will even be around when you need it, after you’ve paid into it for 20 years.  And if you don’t use it, well, there goes 20 years worth of premiums.  Of course, I’m sure some of them are quite good.  I’m happy with the policy I got (or at least getting.  I’m still paying for it.  It’s not cheap.), and it has laid to rest half of my fears about caregiving, in that I know I’ll have the care I need if/when I need it.  At least for a few years.

My parents, who are fortunate to be in good health, also have it, or something similar.  They share my deep fear about caregiving.

The thing is, my husband didn’t sign up for it.  So there’s that.

I haven’t figured out how to address the other half of my fear: providing care.  I’m sure I’ll have to provide at least some, unless I end up needing it first.  And while it does scare me, I have seen some–actually, many–people do it with such love that it looks to be a thing of beauty.  I don’t know if I’m up to the task or not, and of course, a lot of it will depend on what the task actually is.  Caring for a sweet 85 lb semi-mobile grandmother is one thing.  Caring for a 250 lb person who has dementia “with behavioral disturbances” (as we euphemistically put it) is something else. So, like most things in life, I guess I’ll just have to see how it goes.

Anyway, that’s it for me for now.  As I mentioned last week, I’m going to take some time off.  I hope that you have a wonderful beginning of summer, and if you’d like to know when I’ve re-emerged, sign up for the email alerts on the right hand side.

And, as always, thanks for reading.

 

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The only thing that really scares me

Hello again.  Summer is just about here, which means the kids will be out of school, and I need to study for my licensing exam.  I should also get going on that book I’m supposedly writing.  More pressingly, I also need to switch out our winter clothes for summer ones, a task I started weeks ago but thus far have only succeeded in making things look messier than they usually do.  Anyway, all of that is to say that after next week,  I’m going to take a break from the blog for a while.  I’m not quite sure how long, but if you sign up for the email version of the blog on the right hand side, you’ll be the first to know when I take my head out of the sand.

Anyway, before I go I thought I’d share with you the only thing that I’ve seen in hospice that really scares me.  Next week I’ll tell you what I’ve tried to do about it.

So, what really scares me?  It’s not death.  It’s not dying.  It’s not leaving behind those that I love, or having them leave me (though that is a very sad thought).  It’s not even getting dementia, at least not in and of itself–which is something that scares almost everybody.

It’s also not getting sick or disabled, though we’re getting warmer. I’ve spent a lot of time thinking about illness, both chronic and terminal.  I don’t think a chronic illness has to be the end of the world.  Some of them, of course, are really difficult to live with.  But I think with work, both internal and external, most of us learn to manage.  Sometimes people even feel that some good comes from it. I’m not that afraid of illness or disability, per se. I should add that I fully acknowledge that any and all of the things just mentioned can be terribly hard and awful, and I certainly would prefer not to experience any of them. And if and when I do, I’m pretty sure I’m not going to have an easy time of it.

That being said, it’s more the asking/finding/getting help that scares me.  And, to be honest, the idea of having to provide help, too, is worrisome.  At least at this phase of my life.

And so what scares me is this: caregiving.

Pretty much every patient we have needs caregiving at some point.   Now, I’ve done a little caregiving myself–after college I had a very part-time job as an unofficial nurse’s aid for a bed-bound (rather heavy-set) lovely woman.  She was delightful, and much of the time was enjoyable, but getting her out of bed to use the toilet was no easy feat.  I also see people providing care for people every day I work.  It can be an act of love, and some people do it amazingly well.  But depending on the patient and their needs, it can be very challenging.  Especially if the patient is combative or very large.  Then it can become almost impossible for one person to handle on their own.

Now, if you only need help for a month or two or three before you die (or get better), that’s one thing.  Assuming you are not completely isolated, you will probably have some family or friends that will offer to help you out, and/or you might be able to afford to hire somebody.  But say you need 24 hour care for six months.  Or a year.  Or ten years.  What are you going to do then? Family and friends who provide hands-on care for people day after day after day for year after year become incredibly worn down.  It actually takes years off of their own lives.  Many of the caregivers I see don’t seem all that healthy.  Many are in and out of the hospital themselves.  It can be really, really hard work.

And of course, they can’t hold down a job when they’re caring for someone 24/7.  Nursing homes…well, some seem to be pretty decent.  But they’re not cheap.  And hiring someone is also pretty expensive.  Around here, a live-in caregiver (which is cheaper than hiring someone by the shift) is about $220/day.  (And, BTW, sometimes they are not allowed to give medications.)  Now, if you’re very wealthy, that’s not a problem.  And if you are very not wealthy, and receive public aid, you can qualify to get some free caregiving (from what I’ve seen, it’s about 20 hours/week), or you can move to a nursing home that has available Medicaid beds and your care will be covered.  But if you’re in the middle, well, then, cash in those savings, baby.  And pray you don’t live forever.

So this is what scares me:  having my husband or I become ill or disabled in a way that we need a great deal of care.   It scares me on a financial basis, and it scares me on the basis of the simple nature of caregiving itself.  I’ve had a chronic back condition for decades, and occasionally it will flare up to the extent that I can’t walk for a day or two.  It’s relatively minor, but when it flares up, I’m pretty helpless.  Not only does it hurt, but I also have to have somebody help me do everything, because I can’t move.

It is a really, really crappy feeling.

My husband is great at a lot of things, but a natural caregiver he is not.  I remember being a newlywed and having to ask him to carry me to the bathroom.  Not a good time.  For either of us.  So if I really have some sort of severe health issue, we are going to have a lot of things to work through.

To be fair, I know enough about caregiving to know that I really don’t want to do much of it myself, either.  I love supporting people emotionally and logistically who are struggling with illness.  I could do that forever.  But the actual day-to-day, hands on care?  Sure, for a day or two, maybe couple of weeks or even months, no problem.  Caring for a dying loved one can be an incredible balm to the soul.  You can learn so much from caring for someone else.  But caring for them for more than a few months?  Maybe I would feel differently if it were for a loved one who needed my help.  Perhaps some other instincts would kick in.

But just looking at it now, well, I’d much rather write about it than do it.

So that is the thing that scares me: needing or providing care, and having to pay for it.  Next week, I’ll write about what I’m doing to make some of that a little less likely.  In the mean time, enjoy the beginning of summer.  And, as always, thanks for reading!

 

 

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On Veterans and the VA

Hello again.  Last Monday was Memorial Day, and I inadvertently took the day off from the blog.  Instead, in honor of our veterans, we plied our neighbors with beer and cider and burgers.  I don’t believe that any of them were veterans.  In fact, in my personal life, I really don’t know anyone involved in the military.  That doesn’t mean, though, that I don’t have a few thoughts about it.  I actually meant to write this column for Memorial Day, but as I mentioned, I was too busy eating and drinking.  So, I’ll share them now.  And yes, at least some of them have some connection to end of life care, albeit a tenuous one.

So, first off, let’s talk about the fact that I really don’t know anybody involved in the military, at least nobody who has served in last 40 years.  My kids’ school had a poster honoring our veterans, and students and teachers brought in pictures of family members who served or are serving.  There were five pictures, and four of them were of grandfathers (or great-grandfathers) who were in WWII.

So, what’s up with that?

We live in a fairly affluent, fairly liberal, (slightly less) fairly diverse suburb.  I’m sure there are people involved in the military, I just don’t know them.   But my point is that I think it’s very interesting that the men and women who go into the service do not come from all over.  They come from certain parts and pockets of our country.  Joining the armed forces  can provide amazing opportunities that for some people would otherwise be out of their reach.  But, of course, it can also exact excruciating sacrifices.  And not all of our communities are affected equally.

I know that observation isn’t mind-blowing.  But for me, and possibly for you, too, it’s important to remember that wars aren’t just fought on TV.  People come home injured, physically and emotionally, and it affects them and everyone they love and their entire community.  And sometimes they don’t come home at all.  Often, it is the communities that have few resources to spare that are hit the hardest and most often.  For those of us, like me, who are fairly oblivious to those sacrifices, they are hypothetical.  But for many parts of the country, they are anything but.  And it seems very unfair that the burden isn’t shared more evenly.

At least, though, it seems like as a country we have gotten better at supporting our vets, at least attitudinally, even if we don’t support whatever war we are waging at any given time.  I’ve had a couple of Vietnam Veterans as patients lately, and they were seriously traumatized by both their experiences during the war, and the reception they received afterward.  They could never move beyond it.  It’s horribly sad.

And that, of course, brings us to another sad story: our VA system.  Even I, who has a second home under a rock, have heard about the scandals affecting the VA.  I know the VA can do wonderful things.  A fair number of our patients are veterans (usually older ones), and the VA provides them with medical care and nursing homes and burial benefits.  (I’m sure they provide other benefits, too, but that’s what’s relevant for our hospice patients).  However, the men I’ve talked to don’t seem to be very pleased with their experiences.  One of my patients, who can barely move off of his sofa, still troops over to the VA every month or so for tests and medical care.  He waits there all day long, surrounded by patients who are screaming in pain, despite the fact that he made an appointment a month earlier.  I couldn’t tell which was worse for him: traipsing around the hospital all day long when he can barely breathe, or listening to the wails of those worse off than he is.  I had another patient who was counting the days until he had Medicare so that he could stop going to the VA.  He felt that the care that he received there was inadequate, and was hoping to get a second opinion that might give him a second chance.  I don’t know if his care was inadequate or not, but the thought that he might die because he couldn’t get the care that he needed was eating him up inside.

He never made it to Medicare–or back to the VA.  He declined too quickly.  He was only in our program for a week.

These are just anecdotes.  I certainly don’t mean to bash the entire VA system, of which I know very little.  I know it is very large and does a lot of good.  I’ve been involved with some researchers and physicians who work at the VA, and they have all been excellent and dedicated.  It just appears that the system is not meeting the needs of our servicemen and women.  And that….I mean, come on.  These veterans have agreed to give life, limb and soul for our country, no questions asked.  The least–the very least–we can do is guarantee them quality, timely care when they come home. That is the only just and moral response to their sacrifice.

I know no one disagrees with me on that point.  It would just be nice if the system served veterans as well as they deserved to be.  It really is shameful, in the truest sense of the word, that it doesn’t.

*******

Over Easter we drove out-of-state to visit family and on our way home we stopped at a rest stop.  Headed toward the door, I was in the lead, (as always, racing for the bathroom) with my two girls and husband a few steps behind me.  Two men and a woman, all dressed in army fatigues, were approaching the door as well.  We were almost there at about the same time, and one of the guys and I both put our arms out to get the door.

At the last minute, I decided to speed up.

I held the door open for the soldiers  (and my husband and kids, too, of course).

Those of you who know me know that my physical stature is anything but imposing.  My eight year old is almost as tall as I am, and she’s of average height.

The incident was, in a word, awkward.  The troops and my husband looked embarrassed.  Luckily for me, I don’t happen to embarrass easily.   It would have been a perfect social psychology experiment.

“Thank you,” the three people wearing fatigues said to me.

“No, thank you,” I said.

And I meant it.

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Working in Hospice, Part 4: The (Bigger) Challenges (i.e., Yes, ok, it can be depressing)

Hi again. As I write this, I’m staring out the window of the library, amazed that it finally looks (and feels) like Spring. Yippie! Here I sit, inside, writing about death. Oh well. I’ve got an hour and a half while the kiddos are at a birthday party, and one has to take the time when one can.

So, over the last few weeks, I’ve written about what I love about working in hospice, big and small, and then what the day-to-day challenges are that I find myself dealing with. What that leaves us with is what you’ve probably been wondering about all along: what it’s like to deal with the dead, dying and bereaved on a regular basis.

People often tell me that my job must be a difficult one, and that they certainly couldn’t do it. I don’t know if they could or they couldn’t, and as I’ve written, it’s not as bad as one might think. But, yes, I’ll admit it. Sometimes it is hard. And yes, even depressing.

I think for me, the bigger challenges come in two main forms: my role in the family, or lack thereof; and the effects of being immersed in sadness on a regular basis.

So, I’ve been working in hospice for a little over three years, and I like to think that I’ve grown in that role over time. As such, that first issue no longer plagues me as it once did. That being said, I have lost some sleep over it in the beginning, and I’m guessing that it will happen again sooner or later.

Here’s the thing about being the hospice social worker. Most people who sign up for hospice do so because they want the nursing visits, the equipment, supplies, meds, etc. They may or may not want a social worker. They may not even have any idea what I do. I am always very aware that I am an invited guest in their home. I may want to join them in their journey, to explore their fears and dreams, to guide them to acceptance and a “good death.”  But that doesn’t mean that the patient or the family has any desire for me to do that.

I spend a lot of time engaged in the delicate dance of trying to meet the patient where they’re at. I actually got into hospice as a way of gaining enough clinical experience to eventually have a private therapy practice. It took me about 30 seconds on the job to realize that there is a big difference between having someone show up in your office to “talk about their issues” and working in hospice. First of all, I am usually asking to see my clients, not the other way around. Some people really want to talk about what this journey is like. And other people want to do anything but.  My job is to try to provide support in whatever way works for them.  That might be having deep heart-felt chats about death.  Or it might be bringing them a hot fudge sundae and trying to find a working remote so they can watch Judge Judy while we don’t talk about death.

That, in itself, is not that hard for me. The problem is when I, or our team, sees glaring problems, and we are powerless to do anything about it. The nurses and I are “mandated reporters,” so if there is an issue of abuse or self-harm then we are required to report it to the authorities (as long as the person is a child or over 60 or unable to make decisions for themselves. Otherwise, they’re kind of on their own). But there are a lot of gray areas. A lot of times the issues surround what some call “denial.” The hospice team sees the writing on the wall, but the patient and/or the family refuses to/can’t see it, and won’t plan for the future, or they try to pursue futile treatments. Sometimes the hospice team has been forbidden to talk about end of life issues, or use the word “death,” or even “hospice.”

Many times I have felt like these families view me as the angel of death hovering over their shoulders. Some people barely tolerate my somewhat subtle, gentle attempts to get them to prepare for the inevitable. Most of the time I think that the only let me keep coming back because I can be pretty sweet and I smile a lot and occasionally bring a sugar-based product. And sometimes I’m funny. Or maybe they’re just too polite to tell me “no.”  (Though, some of them do tell me “no.”)

I don’t mind kind of just hanging out and watching Judge Judy, but when I see people in pain because they refuse to take any medications (or someone refuses to give them any), or when there are young children involved and they have not been adequately prepared, or when I know someone is going to end up calling 911 and try to have a dying person brought back to life and all that is going to happen before they die is that they are going to have their ribs broken, it can be hard to watch. I am a firm believer in patient autonomy, which fits very well with the hospice philosophy. I know that all I can do is meet the patient and her family where they are at, and let them know that they don’t have to go it alone. Where they go on their journey isn’t up to me.

But, still, it can be hard to watch.

So, that’s one challenge.  The other big issue is that yes, death can be beautiful, etc., etc. I’ve written about that before. But I will admit, too, that it can also be sad. Very, very sad (the two aren’t mutually exclusive, either). And, over time, I have noticed that sadness creeping into me, slowly seeping into my soul. Some deaths are bigger losses than others–there are a few of my patients that I got to know very well, and I loved them, and now they’re dead. I miss them. Others I barely even met. But death after death after death adds up. And some of them are horribly tragic. Others not so much. But some of the stories that I’ve heard–and they’re not even always my patients–they make me want to cry. Sometimes I do cry.

And so what do I do with this sadness that seems to be in the very air that I breathe? Well, given that I’m writing a blog about this I obviously don’t try to avoid it or pretend it’s not there.  I’m pretty comfortable sitting with it.  I’ll probably write more about that some other time.   I also do yoga and cuddle with my family and all of our many dogs and cats and watch funny TV shows (though my favorite comedian, Louis C.K., has started to make shows that occasionally make me want to cry, too.  I’m pretty sure he’s a genius.  The Kroll Show is a recent favorite, too, though I’m not sure he’s a genius.  He does crack me up, however, despite my best efforts not to like him at all.). Sometimes I eat too much chocolate. Actually, I often eat too much chocolate. And I feel grateful for the life and health that I have.  (And then, of course, I get nervous that I may be screwing it all up by eating too much chocolate.)

But yes, it can be depressing and hard. I admit it. Not all of the time, of course. But sometimes.

Now, though, it’s time to go back out into the sunshine and pick up the kids and stop thinking about death for a while. Perhaps I’ll find some chocolate to nibble on, too.

Actually, I’m pretty sure I will.

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Working in hospice, part 3: Challenges (the little ones)

Greetings!  So, the last two weeks, I wrote about things I love about working in hospice, both little, and big.  To make it easy, I’ll just keep going with that formula. So, this week I’ll talk about some of the day-to-day challenges about hospice.  Then, next week, I’ll delve into some of the larger issues.

While previously I wrote about how much I love making home visits, it does pose some challenges, and none of them are very pleasant.  Once again, control raises its ugly head:  we have no control over our patients’ home environments.  And this can cause some issues.  I am far from a neat freak, but some people’s homes are really kind of disgusting.  It’s hard to blame them:  my house is kind of messy now; god knows what it would look like if I were sick or dying.  We in hospice can do what we can to get someone in to clean it a bit, but still.  I remember hearing about a patient who smeared feces all over the place (apparently on purpose).

So, there’s that.

Along with the mess, bugs are sometimes a problem.  Roaches, obviously.  But more worrisome is the constant threat of bedbugs, as they like to hitch rides on friendly hospice workers.  I carry around garbage bags in my trunk for the times when we suspect there might be bedbugs, so I can immediately take off my clothes once I’m home and tie them up tight before I wash them.   “Death with Dignity” might be the official hospice motto, but “Travel Light” is a close second.

Oh, and some of the neighborhoods are not…great.  I love that I work for an urban hospice, as I’ve written before.  The diversity is amazing and wonderful.  But some of the neighborhoods are not safe.  We have a really high murder rate here, and a lot of those statistics are based on what goes on in some of the neighborhoods that we visit.  Depending on where I am, drug deals on the corner are not uncommon.  I always go to these neighborhoods before noon.  Winter is better than summer.  I don’t like the summers.  We obviously try to be safe, and will go with other team members if it seems like there is a safety issue.  If it gets to be too bad, we may not be able to provide care for these families, which is also too bad.  We don’t have a lot of patients who live in these areas, but we do have some.  (I should add here that they often tend to be some of my favorite families.)  There is a hospice license plate available here, but I don’t think any of us have one.  In some people’s minds, hospice =  good drugs, and that is not something you want to advertise.  We never have drugs on us–they are always delivered to the home by a pharmacy–but that’s a hard conversation to have if someone has already made that assumption about you.  So, at times I am on a heightened state of alert.  Nothing’s happened to me, and I certainly hope that nothing will.  But it can be stressful.  If it’s stressful on me, a gal who only enters those areas now and again, I can’t imagine what it is like for people who live there, and deal with that level of fear and uncertainty every day.

As I’ve mentioned before, my coverage area runs the gamut, covering both the bottom and top five percent.  And while I don’t usually worry about my safety with the top five percent, it’s not always easy on that side of town, either.  Expectations tend to be very high, and you run the risk of being treated like the hired help (I guess we sort of are, but no one wants to feel that way, including the hired help.)  Many of these families are lovely, but I do remember once being asked if I provided chauffeur services.  Upon learning that I did not, the family dismissed me, saying that they did not think they needed my assistance.

Here’s another fairly petty job hazard:  Last week I mentioned that sometimes people shower me with praise when they learn that I work in hospice, telling me what a special human being I am.  This is always very heartwarming, of course.  However, it’s sometimes paired with their own experience of hospice.  And this is completely understandable.  It’s just that sometimes I’m not really able to listen to those stories in the way that they deserve to be listened to.  Like when I dashed into the Container Store between patients and stupidly forgot to take off my name tag.  It turns out that the cashier had a family member in our hospice, and shared her story with me.  That was very sweet, but, you know…I had like five minutes, four of which I spent waiting in line to get to her in the first place.  I hate cutting people off when they are sharing their loss, so I end up being late for whatever I’m rushing off to do.

And, at the risk of sounding completely heartless, sometimes I don’t actually want to hear those stories.  Most of the time I do, and I love that people share them with me.  But sometimes….well, I get a lot of death on my job.  Sometimes I just want to hang out with my kids at the park, or drink a cup of tea in peace.

But, you know, there are worse things.

Actually, really the worst thing (of these little problems) is this:  I happen to be someone with a tiny bladder.  I also happen to be someone who drinks quite a lot of liquids, especially in the morning.  You may see where I’m going with this…  I am always looking for a bathroom.  And, as you might understand from my first paragraph, sometimes you don’t want to use your patients’ bathrooms.  And I go through a number of neighborhoods where I don’t want to stop at the McDonald’s to use those bathrooms, either.  So, at times I find myself planning my day to accommodate my frequent potty breaks.  Some people who do home-health just try not to drink anything during the day.  That sounds like that could lead to them needing home-health themselves, but I can see the appeal.  I personally like to stay well-hydrated.  And, as a result, my most pressing concern is not usually meeting the needs of the dying, or any other lofty goal that would warrant my inclusion in the group of “special people” that I am often assumed to belong to.

No, for me, my biggest (little) problem with my job is this: I don’t have a toilet in my car.

Next week: some slightly more profound (though certainly less frequent, and sometimes less urgent) challenges.

As always, thanks for reading.  And, I hope all of you Moms out there had a wonderful Mother’s day.  I know I did.

 

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Working in hospice, part two. The sappier stuff.

Hello again.  Last week I wrote about some of the day to day joys that come with working in hospice–at least for my tea-drinking, friendly, introverted self.  Hospice was such a breath of fresh air after working in research, where I sat in a room by myself and stared at a screen all day, talking to no one.  I think I work a lot harder now, but I enjoy it a lot more.  Next week I’ll write some about the challenges that come with my job, big and small.  But last week I said I would write about what it’s like to work with people who are dying.  And so, as promised, here’s my take on it:

When people ask me what I do, I get one of two basic reactions.  One is filled with respect and awe.  “Oh, wow, that’s wonderful,” I hear occasionally.  “My grandfather (parent, sibling, etc.) was in hospice, and it was such a good experience.  It really takes a special person to do that.”  I have to say, I never received such a gratifying response when I told people that I did research.

Then, there is the other reaction.  “Oh,” people sometimes say with a furrowed brow, frowning, taking a step back, their revulsion and discomfort clearly palpable.  “Why would you do that?  That sounds awful.  Isn’t it depressing?”  That is the reaction, incidentally, that I received from my parents and in-laws.  My husband likes to call me the Angel of Death.

Both of those responses point to the same thing: working in hospice is not for everybody.  Are we in hospice “special?”  Well, I suppose so, in some ways.  To make a career in hospice, you need to be comfortable with death, and also comfortable with the idea that you can’t fix everything–i.e., our patients are going to die.  And those seem to be things that not a lot of people are comfortable with.  I think it’s human nature to a) avoid death and b)want to fix things.  I can tell you that I personally a) don’t want to die any time soon, and b) try to fix things all of the time.  But when it comes to death in general, the idea that all of us are going to die at some point, and some of us sooner rather than later, doesn’t bother me.  I’ll probably spend some time in another post trying to figure out why that is.  I also, however, don’t believe that dying is easy, at least not very often.  And, perhaps more importantly, I don’t harbor the illusion that there is much of anything that I can fix around the end of life.  It’s a hard time.  It’s not always hard on the dying, but at the very least it’s usually hard on the family.  It’s hard and it’s sad and sometimes it’s even awful.  I’m not going to fix that.  It just is.  All I can ever hope to do it try to spread a little comfort around, maybe make it a little easier.  Sometimes all I can do is help people feel a little less alone.

That’s the only expectation I go in with.  And when I feel like I’ve helped someone feel a little less alone, then I feel good.  As it turns out, it’s really important to me to have a job where I feel that we do good work, that we spread a little comfort around.  And, most of the time, I feel that way about the work we do in hospice.  So that is incredibly rewarding.

One of the things to bear in mind is that we at hospice come into the picture after a person has already been given a terminal diagnosis.  We were not there when the patient was vibrant and healthy.  We were not there when they went through the often laborious and frustrating process of figuring out what is wrong with them.  We were not there when they held on to the hope that treatment after treatment would save them.  We were not there when they were given the bad news that they only have six months or less to live.  We start out expecting the patient to decline and die.  It is not a shock to us.  We are not trying to prevent it from happening, which is what everyone else had been doing prior to us arriving at their door.  So we start out at a different point, and with different expectations.  We are free from the pain and suffering that occurred previously.  And, perhaps most importantly, we never held onto the hope that the patient would survive.  We are a (relatively) clean slate when we show up, ready to walk with the patient to their death.  I could not be the hospice social worker for my parents, or my spouse, or, god forbid, my child.  I would be too emotionally invested. I would probably be a wreck.  But, I could be yours.

I think all of us in our hospice realize what an honor it is to be with people at the end of their lives.  I know that sounds sappy, but it’s true.  What a privilege it is to be able to be part of such a sacred time.   As I’ve written before, death, like birth, can be very beautiful.  You get to bear witness to the whole range of human emotions.  But underlying almost all of those emotions is love.  It’s so heartening to witness so much love.  It’s awesome, in the traditional sense of the word.  Not depressing, as many people seem to think.

I also don’t find my work to be overwhelmingly depressing because I often have a lot of fun with my patients and their families.  Not everyone who is “dying” or caring for the dying is spending every day wiping away tears, at least not all day, every day.  A lot of our patients are just kind of hanging out.  A lot of them are really fun to talk with .  I have never been much of a “laugher;” I find a lot of things funny, but I was never one to do a lot of laughing.  That is, until I started working in hospice.  Now I laugh quite often.  Not “Ha, ha, you’re dying,” (obviously).  But I often have a really good time with the people I meet.  Just because there is death lurking in the corners does not mean that there isn’t joy and good humor.  Sometimes death even spurs it on.  For example, just the other day one of my patients jokingly asked me if hospice provided bikini waxes.   Getting very serious, I explained that actually, they were mandatory.

(In case you were wondering, they’re not.)

We all laughed at that.  Even me.  Everyday life goes on for my patients and their families, even if it’s not going to go on for some of them much longer.

Perhaps, though, the biggest benefit that I derive from working with our families is a constant sense of gratitude.  I face death all of the time.  I know it’s coming for me at some point, too.  I don’t ever pretend that it’s not.  My 40-year-old, apparently healthy self could get hit by a bus while crossing the street to see my 105-year-old cancer patient.  And by spending my day going around visiting the dying, I cannot help but be grateful for my ability to get in and out of my car, drive around, drink tea, listen to murder mysteries, and then go home to my incredible family.

I know what life looks like without those gifts.

And I’m very thankful that I have them.

 

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What is it Like to Work in Hospice? Part One: The Little Perks

So, what is it really like to work in hospice?  And, the ever popular follow-up question: Isn’t it depressing?

I get asked this a fair amount, so I thought I’d spend some time writing about it.  Of course, I can only speak for myself.  I should probably tell you that I’ve been doing it for a little over three years, part-time.   I think that’s important to know, because I write this from the perspective of someone who doesn’t do this all day, every day, year after year after year.  I’m not burned out.  And, as you might guess, I think this is a field in which it is quite possible to get burned out.  If any of you readers have a different perspective that you would like to share, I’m all ears!

So, in general, I will say that I really, really enjoy working in hospice.  And no, in general, it’s not overly depressing.  This week, I’ll write about some of the day-to-day aspects that make working in hospice enjoyable.  Next week, I’ll write about some of the bigger issues in end of life care that make hospice work satisfying.  And then,  I’ll focus on some of what we can euphemistically call “challenges.”
I’m part of the “home team,” so I visit people in their…homes.  I drive around the city and suburbs and go to houses, apartments, and nursing homes.  I love that aspect of my job.   I find it fascinating. Given that I’m a sociologist and always secretly wanted to be a real estate agent, I get a lot of pleasure from seeing people in their home environments (though I will admit that I don’t tend to get that excited about going to nursing homes).  And as I live in a very diverse city, I get to drop in on all sorts of folks.   As a white middle class gal from the ‘burbs, working in hospice has allowed me to intimately experience a wide swath of society that I would never have had access to otherwise.  And I love that, too.

Another logistic perk of being on the home team is that I get to spend a fair amount of time in the car, by myself.  This may not appeal to everybody, but I’ve become quite fond of it.  I’m very much an introvert–quite a friendly one, but an introvert just the same, and having down time in the car to recharge myself (and my phone) between visits has been life changing.  I listen to a lot of audiobooks–usually murder mysteries, actually.  (No, the irony is not lost on me.  Lately I’ve become enamored with the Inspector Gamache series by Louise Penny--I highly recommend it!)  For me, being able to stop at a coffee shop and get a cup of tea, and then drive around to my next visit, by myself, while listening to a good audiobook is pretty close to heavenly.

“Okay,” you might be saying to yourself.  “You get to look into people’s homes and unwind in the car.  Whatever.  What about hanging out with dying people?”

Yes, I’ll get to that, next week.  I like that part a lot.  But I can’t emphasize enough how important the flow of my day is.  While working in hospice is a very special, unique job, it’s still a job.  I happen to have stumbled on a job that really meshes well with my nature and needs.  I get to schedule my own day (usually), and am pretty autonomous, while still having the support of a team.  I can do my charting in my favorite coffee shops.  The ratio of social interaction to alone time is ideal for me.  If you have read the book Quiet, by Susan Cain, you’ll know what I’m talking about. I came into this work after staying at home with my children for several years.  I loved that time, too, but I had essentially no alone time in that gig.  When I don’t get enough alone time, I go a little crazy.  I would have done pretty much anything to get to drive around in the car by myself and listen to a story for grown-ups while drinking tea.

Even hanging out with the dead and the dying.

I had actually been nursing an interest in death and dying for a number of years, but had only read and researched it, not experienced it.  Looking to get more clinical experience, I shadowed a hospice social worker for a day, and discovered that I really enjoyed it.  I realized during that day that the whole purpose of hospice is to provide comfort.  There really isn’t any other ulterior motive.  And that’s a role I’m very comfortable with.  And so, in a nutshell, I drive around, drink tea, and drop in on people to see if I can make their lives a little bit better in some way.

That plays out in a number of ways.  My initial visits with families usually involve a fair amount of hospice education, and getting a sense of what their needs are and what they are going through.  Sometimes the people I meet are on the verge of death.  If that’s the case, I will try to prepare them for what’s coming, answer their questions, and provide what we call a “supportive presence.”  On subsequent visits, I work on building the relationship.  I check in to make sure that they have what they need on in instrumental, practical level: enough caregivers, equipment, etc.,  and spend time getting to know them.  I listen to their stories (which is fascinating), and also work with them on exploring their emotions and feelings at this stage in their lives.

I’m guessing that it’s that last part that makes people ask me if my work is depressing.  That, and that fact that pretty  much all of my patients die.

It’s not, though, at least not most of the time.  Why?  Well, I’ll tell you why.

Next week.

So, stay tuned.  In the mean time, go check out Still Life by Louise Penny.  The narrator on the audiobook is wonderful.  And I’ll bet you anything that by the end of it you’ll be craving a cafe au lait.  (At Starbucks, you have to call it a Misto, otherwise they won’t know what you’re talking about.)  And, as always, thanks for reading!

 

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Children and death, Part 3: Some practial advice

Hello again!  Last week I wrote about the emotions that might be swirling around for both children and adults when death comes to call.  Today, I thought it might be helpful to write a little about concrete things that you can do to make things a little easier on yourself and your children during a time when very little will be easy for any of you.

First, let me say yet again, that it’s okay to be honest about what’s going on.  Don’t make things up or deny that they’re happening.  That goes for the actual death and everybody’s reactions, including yours.  You don’t have to pretend that things are okay when they’re not.

Is there anything the dying can do before they leave us to make their departure a little easier on their children?  In some cases–when they have the time and the energy–I think so.  I should probably mention that it really helps to have the legal stuff taken care of: advanced directives, guardianship issues, etc.  I’m not going to go into that here, but it sure does help to have that locked down.  On a more interpersonal level, I’ve seen the dying work very hard to write letters or cards to their children, perhaps to be opened on future birthdays or major milestones.  We encourage children to “interview” their loved ones before they die, asking anything from what’s their favorite color to their favorite memory to what they are worried about as they face their death.  It’s great if you can tape it.  Doing something with handprints–paint, plaster–etc. I think is nice, too–really, any sort of joint project that you can keep will be treasured forever.

One thing that often seems to be overlooked is for the dying to say, out loud, that they don’t want to leave everyone.  I heard a story recently from one of our nurses about a child (an adult child, actually), expressing anger that his mother died with a smile on her face.  The nurse was so puzzled by this.  Why would he be mad that his mom died happy?  It didn’t seem so strange to me, though:  he probably felt abandoned, wondering if she wanted to die and leave him alone.  She may have been so tired of the pain and suffering that she was elated to be moving on, but there he was, still stuck on earth without her.  That’s really not that uncommon a reaction of the bereaved.  As such, if the dying can talk to their loved ones (regardless of their age) and assure them that they don’t want to leave them, that if they could keep fighting and be healthy they would, it might go a long way in consoling those that remain.  (That isn’t to say that the dying should keep fighting, just that they aren’t looking forward to leaving everyone behind.)

Should you take your children to see the sick and dying?  What about taking them to funerals?  Well, it depends on the kid and the situation.  You should never force a child to do either.  You don’t want to expose them to something that terrifies them–death should be sad, but not scary.  If they are willing to go, I don’t think it’s a bad idea.  It can help demystify death and help them to say goodbye.  You should be sure to explain in advance what they are going to see there.  The fewer surprises the better.  I went to several funerals as a child, and my own kids have attended some already.  I think it helped me become comfortable with death, and hopefully my kids will be, too.  Some children attend the actual death, which can also be nice –a lot of deaths are actually treated as celebrations.  Personally, though, if there is any chance that it will be messy or difficult, I would say to keep the kids away.

One thing that always stumped me until very recently was how to explain cremation to a child.  I am actually a fan of cremation, but could never bring myself to go into details with my kids.  We have three urns on the bookcase–one for each deceased kitty–and I just told them that their bodies turned to” dirt”.  I didn’t tell them that someone put Lucy, Elle, and Spencer into a fiery furnace and burned them until all that was left was ashes.  Luckily, they never really asked how our cats turned into “dirt” (another example of the wisdom of not over explaining things).  After researching, it, though, apparently you should say that the deceased’s body, which cannot feel any pain, is put in a room or machine that helped speed up the process of turning them into dirt.  You’re supposed to avoid words like “burn” or “fire.”  Here’s a resource on explaining cremation.

What should you say about the afterlife?  Well, that, of course, depends on your beliefs.  Maybe you have strong feelings about what happens, and assuming the children are your own, feel free to share them.  I don’t personally have any beliefs about it–I’m not expecting anything, though am open to being pleasantly surprised if there is something there waiting for me when it’s my time.  Not having anything celestial to share with children I talk with, including my own, I often focus on how the departed are still always with us in our hearts and minds, and as such live on forever.  It’s not the same as when they were alive, of course, but in some ways they never really leave us.  Lately, however, I’m starting to believe that there is some sort of more tangible reunion after, or at least during, death. Almost all of the dying people I interact with report seeing loved ones who have died before them.  If you read the book Final Gifts I’m pretty sure you’ll believe me. (Actually, if you ever want to feel better about death, you should read that book.  We read it in our hospice book group, and the general consensus was that dying could be amazing.) So, I now personally feel more comfortable in saying that we will all see each other again some day.

That being said, it’s really important to not talk about heaven or something similar in such glowing terms that young children try to get there on their own.  While death can be a celebration, it’s important to be clear to kids that it’s still sad, and not something to be hoped for.

So, that concludes my own take on talking with kids about death.  As I mentioned in my first post on this topic, there are some great resources out there to check out.

I’m going to take next week off as I’ll be out of town.  I’m planning to next post on Monday, April 28th.  Looking forward, I may be taking much of the summer off, too, as I need to study for a licensing exam.  We’ll see how it goes, but if there was something you were hoping I’d write about that I haven’t gotten around to yet, let me know.  I aim to please.  And, as always, thanks for reading!

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Children and Death, Part 2: When it’s not Hypothetical

Last week I wrote about talking with kids about death when you have an “unemotional opportunity,”  i.e., when nobody died, or seems likely to.  That, of course, is a nice position to be in.  But, inevitably, we will all find ourselves, at one point or another, having to deal with death in reality, as opposed to just as a possibility.  If that’s happening to you now, or is about to, I’m sorry.  It’s never easy.  I’m assuming that you’re an adult reading this–I don’t think I have a lot of young readers.  So, you are probably trying to figure out how to talk to a child while dealing with your own grief.  There are a lot of good resources out there on how to do this–there are some suggestions on last week’s post.  So, what follows is, again, just my own advice, based on my own thoughts and experiences.  This week I’ll focus on emotions: yours and theirs.  Next week, I’ll write about what to “do.”  Hopefully, you will find it to be helpful.

First, let’s assume that you, too, are sad.  Maybe you’re beyond sad.  Maybe you can barely hold yourself together.  Well, if you’re trying to take care of kids, I would suggest that you: A) Get as much help as you possibly can–don’t be afraid to ask!  It takes a village, you know.  B) Be honest with your kids.  You don’t have to pretend that you’re not sad.  You don’t have to act like everything is okay.  It’s not okay.  If you can, try not to have a complete meltdown in front of them.  Maybe do that in the bathroom with the door closed (if you’re ever able to actually close the door to the bathroom. I’m not sure ours even work that way).  Though, you know, if it happens, it happens.  But you can explain that you’re sad, and that you will cry from time to time, and that doesn’t mean that you are broken in any way.  They can cry, too, if they want to.  You don’t have to keep a stiff upper lip all of the time.

In general, being in touch with your emotions and not trying to hide them facilitates healing.  In fact, while it might be hard to see it now, grief can actually bring a family together.  Of course, it can also drive people apart.  It’s more likely to do that if people build up walls between themselves.  If you can reach out to each other in your grief–including your children–then you’re more likely to grow closer instead of further apart.

But, that being said, again, it’s important to reach out for help.  While you can come together in your pain, it’s often too much to expect another grieving loved one to support you, regardless of their age.  This often happens to parents after the death of a child.  They’re too bereft to hold each other up.  While it’s great if you can grieve together, look to others who are not so shaken by the loss to help you as well.  Friends, other family, professionals.  We have to be able to tend to ourselves, too, not just to others.  So, back to the original point:  if you are grieving, be honest about your grief with your children, but also enlist others to help you and them.  You can’t do it all.  And it’s good for your kids to know that it’s okay to ask for help.

Okay, so you can cry.  What, you may be asking, do you say in between the tears?  Well, again, honesty is a good policy.  Start by asking them what they know or think is going on.   Kids are usually aware if someone is sick, even if you’re trying to hide it.  If it is an illness, you can generally explain what’s going on, and take lots of time to answer their questions.  Again, it’s okay to say that you don’t know.  A lot of kids have misconceptions, such as cancer being contagious.  It’s a good idea to at least make sure that they’re not developing fears based on false information.   We have a nice workbook that we use at our hospice called “Changes” that goes over how the body changes during illness, and explores death in terms of change.  It allows for kids to explore their own situations, and emphasizes that that change is a part of life.

Ask them what they’re worried about.  Try to reassure them.  Emphasize that someone will always be there to take care of them.

Kids may be having all sorts of emotional reactions to what is going on, just as we all do.  A lot of times they may feel very guilty.  Kids may think that they did something to cause the death–kicking their brother, failing a spelling test, not washing their hands–who knows.  This is another reason why it’s really important to try to understand what they’re thinking about, so that you can reassure them that it’s not their fault.

They can also feel very angry, at anyone and everyone.  They may feel abandoned by the dying or the deceased.  I’ll talk a little more about this next week, but in general, try to be understanding, while at the same time still letting them know that there are still acceptable limits to their behaviors.  Kids like to feel like someone is in charge.  But don’t take it personally, or think that they’re insensitive.  Anger is a legitimate form of grief.

So, guilt, anger…sadness of course–all possible options.  But kids may sometimes seem indifferent, or even happy now and then.  When I talk to kids who are experiencing a loss, or about to, I always reassure them that there isn’t a certain way they are supposed to feel or act.  They will feel different things at different times, and whatever it is, it’s all okay.  If they’re not crying all of the time (or at all), or if they even laugh now and then, it doesn’t mean that they didn’t love the person who died.  Everyone–adults and children–experience grief in their own way at their own pace, and it should never be judged.  In my younger days I almost never cried, and certainly never did it in public.  When my brother and I spoke at our grandmother’s funeral, he cried so much that he couldn’t finish his speach.  I, however, was completely dry-eyed.  A family friend pulled me aside after the funeral and, nodding toward my brother, said, “You know, people like to see tears at funerals.” Yes, well, thanks for telling me.   I adored my grandmother, and I miss her every day, but the tears didn’t show up for about two months. So, you know, give your kids–and everyone else, including yourself– some space.  You will all grieve at your own pace.  Just try to be there for them when they need you.

So, those are a few of my thoughts on talking with kids when there has been a death: be honest, and be gentle, both on them and on yourself.  I’ll write more about what to “do” next week.  And, as always, thanks for reading.

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Talking with Children about Death

Over the past few weeks I wrote about the loss of a beloved pet.  As I mentioned in the first post on that topic, the loss of a pet is often a “gateway” loss for children: it can be their first encounter with death.  Talking about death with children can cause a lot of anxiety for adults, and as such I think it warrants its own series.  And so, with no further ado, let’s talk about…(drumroll, please) Talking with Children about Death!

This week I’m going to write about talking with children about death when you have an “unemotional opportunity,” i.e., when nobody has died, or is about to.  The next post or two will be about talking about death when you actually are dealing with a loss.

Before I started working in hospice, my then three-year-old daughter became somewhat consumed with thoughts (and some worries) about death and the afterlife. I don’t happen to know what happens to us when we die, so like any good therapist, I tossed it back to her.  What did she think happened when we died?  It took her a few weeks, but eventually she decided that we eventually came back as new creatures –apparently, she believes in reincarnation.  She put in a request that she and I A) die at the same time, B) be reborn at the same time, as humans, with me once again being her mommy, and C) that I make sure to give her her two favorite teddy bears.  I told her that parents usually hope that their children outlive them, but other than that, it sounded great.  I would love to be her Mommy again, and that, as with most things in life, I couldn’t promise anything, but that I would see what I could do.

She seemed very relieved by all of this, and her concerns about death and the afterlife dissipated.    I think it went pretty well, all things considered, though if  I had it to do over again, I would probably say a little more to reassure her, and break things down in a more concrete way.

So, what, then, should you say to a child who is asking you about death?

What follows is my own take on things, which is gleaned from various resources I’ve read and my own experiences.  There are a lot of good sources of information on this topic.  A nice summary can be found here.  Most of my experience has been with younger children, so that’s what I focus on here.  However, kids of all ages need help understanding and handling death, and how you talk about it obviously depends on the age of the child.  Here’s a nice summary on the developmental stages of children as they relate to death.

So, anyway, here are a few general principles that I hold near and dear:

First, I think it’s good to have these conversations somewhat early and often.  You don’t have to beat them over the head with it, but it’s nice to be able to talk about death when you’re not actually dealing with the death of someone you care about.   Kids are aware of death—they hear about it in conversations, it happens all of the time in nature, and to most mothers in Disney and Shirley Temple movies.  They will probably ask you about it, and that’s a good time to talk about it.  If you act like it’s something they shouldn’t ask you about, then they will view it as something taboo and fearful.  Talking about it without fear or anger will go a long way in helping them to see it as a natural process: a sad one, but not a scary one.

Second, be honest.  Don’t try to gloss things over and use euphemisms.  That can get very confusing for kids (especially young kids).  NEVER SAY THAT THE DECEASED JUST  “WENT TO SLEEP”!!!  Every parent in the universe is hoping that their child will go to sleep tonight.  You do NOT want to have them confuse death with sleep.  It’s good to use concrete terms that are age-appropriate.  With young kids, you can explain death in terms of things that stop happening: e.g., when people die, they stop breathing, they stop eating and growing, their heart stops, etc.

Third, just tell them as much as they are asking.  You don’t need to go into lots of details.  Sometimes, the question of “Where is dear departed Aunt Jane?” can be answered simply by saying she’s in the cemetery, under the ground.

Fourth, it’s okay to say that you don’t know.  When it comes to the afterlife, if you have a religious belief you can share it.  I personally think that it’s nice to say that different people believe different things, but that’s just me.  Of course, the afterlife isn’t the only thing some of us haven’t quite nailed down yet.  A big question that often comes up is: When am I/you/everybody else going to die?  Hopefully, you don’t have the answer to those questions!  The honest answer is usually “I don’t know” (though sometimes we know it will be soon.)  What I tell my kids, who are 8 and 5, is that while everything dies eventually, it usually happens when we are very old AND very sick (making sure to distinguish between a little sick—which happens to all of us somewhat frequently– and VERY sick).  Not always, but usually.  And we can be very hopeful that we will live for a very long time.  You can talk about how your family is careful to take good care of yourselves, and are doing what you can to live for a long, long time.  Unless you have a specific reason to talk about this differently (i.e., someone young is dying or has died, or there has been an accident–stay tuned for next week), I don’t think you need to create worries where they don’t currently exist.

This leads us to my fifth suggestion.   Depending on their age, kids are pretty self-centered.  Young kids especially really want to know how all of this is going to affect them.   I think it’s really important to emphasize that no matter what happens, there will always be someone there to take care of them. Be specific; tell them who that would be: Grandma, Cousin Bob, whoever it is.

Finally, try to be patient and understanding.  Don’t freak out if you kid seems obsessed with death for no apparent reason.  It’s natural (a lot of adults are obsessed with it, too), and if you don’t treat it as something that should be freaked out about, it will probably pass.  Here’s a nice list of books for kids that might help.

Next week, I’ll talk about what to say when death is not just hypothetical.  And, as always, thanks for reading.