MGU 288 | Grief Process

 

Trigger warning: This episode is a deep conversation on death and suicide is mentioned.

Throughout our journey in this lifetime, we all experience losing our loved ones, and sometimes we aren’t prepared for it. It’s important to know how to deal with such disasters and process our grief. In this episode, Jason Wrobel and Whitney Lauritsen talk with Beth Cavenaugh about the most uncomfortable topic they have ever addressed. Beth is a Certified Hospice and Palliative Care nurse and educator with over 14 years of experience caring for terminally ill patients. She shares her personal journey on death and grief during her mother’s final moments and how terrified she was to be her caregiver managing her pain and honoring her wishes. Tune in and learn the power of processing our emotions and accepting our fate.

Listen to the podcast here:

Mastering Acceptance: How To Process Your Grief During End Of Life With Beth Cavenaugh

I was simultaneously having breakfast enjoying a delicious smoothie bowl to try and give me some energy because I knew we were going to be having a conversation with our guest. Her name is Beth Cavenaugh. She’s a hospice nurse and she has some heartfelt and sagacious perspectives on end-of-life care that we are going to get into. Beth, as I was preparing and reading a little bit more about your work and what you do, I took a deep dive down the rabbit hole of your blog and your website, BethCavenaugh.com.

As I was sitting there enjoying my breakfast and reading your blog posts, I spontaneously started crying in my smoothie bowl. It was such an interesting moment because I literally just started welling up out of nowhere. Although truth be told, it wasn’t out of nowhere. I was reading specifically two of your blog posts. One was so visceral to me. It was Travel Metaphors at the End-of-Life. I want to preface this by saying that I have not yet had the honor or the privilege of caring for a loved one at the end of their life.

When the grief is bubbling to the surface, you stay there to bear witness to the suffering. Click To Tweet

The people that I’ve lost in my life have been sudden, car accidents and unexpected things. I haven’t yet had that opportunity to care for someone in hospice. As I read this article that you wrote, this blog post about Travel Metaphors, you were talking about this man named Jack and his Maglite under his pillow. Also, some of these interesting things that you’ve noticed that people focus on at the end of their lives.

As I was done crying and finished my breakfast, I sat for a moment and I thought, “That was interesting. Why did I spontaneously start crying? It can’t be for no reason.” I want to lead with something that I’m admitting to myself for the first time that I subconsciously knew, but I’ve never spoken the words. I am terrified of my mother and who I consider a father figure, my mentor, dying. I’ve had conversations with both of them about their will, their estates and being the executor of their estates.

This conversation with you is perfectly timed. Beth, the first question, with all of that said, is it normal and how would you speak to someone who has this fear that I’ve now identified and spoken publicly for the first time of caring for our elders or our parents because I’ve never done it? Reading your blog post has given me some comfort, but I’m still feeling terrified about this inevitability. For someone who’s never done this before, where would you lead someone? How do we start with this conversation?

It's a privilege to be with people at the end of life. Click To Tweet

They are two very different things. The fear of being with your mom when she’s dying and fear of being the executor of her state. It might be scarier to be the executor of the estate. When my mom was dying, I was age 28 and she was 58. I had been a nurse for two years and I’d been with some patients by that point who had died before. I was terrified to be her caregiver and be responsible for managing her pain, shortness of breath, and honoring her wishes. The more you step towards leaning to the discomfort and know that it’s scary and keep showing up, you can have some of the most profound moments of your life and your mom’s life. The greatest gift that you can get is to take care of somebody you love at the end of their life.

I know it’s terrifying and scary. That was in 1998. It’s a long time ago that my mom died but I never will regret that time with her. It was probably some of the best moments that we ever had, those last three months of her life when she was dying. It’s because we developed this intimacy as I was taking care of her that we had never had. She certainly didn’t disclose everything to me that was going on in her brain, but she was open, honest, receptive, vulnerable and real.

I felt lucky that I was able to be with her. That’s why I continued this work because I know how powerful it can be at the end of somebody’s life. You were talking about the travel metaphors. There’s also this divine sacred space that shows up at the end of one’s life. To be part of that journey is special, too. You will be afraid and it will be scary, awkward, clunky and you will feel like you can’t do it. You keep showing up and taking breaths and doing it. It’s part of loving somebody.

I’m grateful you’re here, Beth. I feel in some ways that this is the first time in my life I’m considering the inevitability of this. Whitney and I, as best friends, have been having conversations about our mortality. I’m having these conversations with my mom and my mentor, Michael, who’s essentially my father. I call him my father. It’s that space he holds in my life. Part of it is thinking about their care, their comfort, and how I can best be there for them when the time comes is a mirror into my own mortality.

MGU 288 | Grief Process

Grief Process: Some people hope they die in their sleep so they don’t have to mentally process it. We will never know how our brain reacts until it happens to us.

 

Death is a strange thing in that way because there’s an awareness of the inevitability of it. Yet, I’m having more experiences whether it’s in meditation or having conversations with my older loved ones, where now it’s more real than it’s ever been. It’s not that I feel close to death, not even that my mother or my loved ones are in a state where they’re close either. Maybe it’s the passage of time and having these conversations that are open, vulnerable, and loving where I’m like, “I’m going to leave this body as well.” I meditate on death a lot. It’s not necessarily in a morose or a macabre way. I’m thinking about it more than I ever have in my life, which is interesting to observe. Do you find that one of the reasons it is challenging for people is because it perhaps forces you to consider your own mortality as well?

Definitely. Most people don’t like to go down that road and think about it. I see it all the time with hospice patients and families who are surprised when a terminal diagnosis happens at age 90 even. For me, when I was taking care of my mom and my dad, my dad was taking care of my mom as well, but he never believed that she would die. He felt like his role was her cheerleader. His role was to feed her steak and eggs and get her healthy. He never believed that she would die. When she did die, I felt like he was surprised. That happens a lot. Even when patients are on hospice like my mom was for months, the hospice nurse comes in and talks to us about hospice care, the end of life and what end of life signs are, and what medications to give, you can be in a state of denial the whole time.

That leads me to something else: denial about your own mortality and how often people are surprised that they’re dying. I thought about this and I still feel removed from it. Thinking about your own mortality is a bizarre thing. How does your brain process it? I don’t know if it was a COVID-related or some disaster. Something cued it in my head and I was like, “I wonder what that’s like.”

Disaster is different from body failure because generally, you have at least some time to process, even if it’s a few days. If there’s a disaster, you might not even have a chance to think about your death. It just happens. Some people hope that happens to them or they die in their sleep, so they don’t have to mentally process it and have that fear. I was reflecting on, “It’s such an interesting thing that we will never know the answer to until it happens to us how our brain even reacts and processes.”

Nobody ever says 'I wish I had more money' at the end of their lives. Click To Tweet

Jason and I have talked about this several times. Especially, Jason, with your work on longevity. We know so many people who are obsessed with optimizing their bodies. It’s this coping mechanism. It’s like, “Maybe if I can optimize my body, I can live as long as possible and prevent death.” The truth is we see healthy people get sick. We see people have accidents. We see even people who think that they’re safe enough to avoid death through risk-taking die despite everything that they tried to prevent it. None of us have any idea when that time will come, yet many people live their lives almost feeling invincible. I’m curious how that comes up in hospice. Is working in hospice a time where people are accepting or are they still in denial? What are some of the emotions that are expressed during that time?

I want to circle back to the one thing that you said about optimizing your body. There’s nothing wrong with optimizing your body so that you can have a good quality of life however long you have left. I’m always trying to be as strong as I can. As a nurse, we’re always lifting, hoisting, helping people get up and out of bed. I’m always trying to optimize my body so that I can live in this body in the way that I want to live in the world as much as I can prevent things and make my life better. I’m a fan of optimizing the body. That makes sense to me.

When people come on to hospice, there’s a wide range of emotions. Most people are not ready to die unless they are in their 90s. Maybe they’ve lost a partner or good friends already and they have thought long and hard that this is their reality. They’ve processed their life and they’ve lived a good life. My patients who are old are the ones who are much more accepting of death. Under 90, all bets are off. You have fear, disappointment in your body and anger at your Creator, “Why me? Why now?” There’s a wide range. As a hospice team, we have a social worker, a chaplain, a CNA, and a nurse on staff. We know that this is part of the processing of one’s death and the reality that they’re going to die.

One of the most beautiful parts of being a hospice nurse is that we’re in their lives while this journey is going on. You build trust with your patient over time. You have a relationship with them, ideally. You can make a quick relationship in 30 minutes by talking about somebody’s death. You can build trust quickly, too. We know that part of the process is allowing the patient to wonder and go through the murky mystery of death, “Why now? What’s next? Am I ready? Am I not ready? Is there any business that I need to tidy up?” People do come to an acceptance, but not everybody. One of the goals of hospice anyway is to help people on this journey be more accepting of their death.

It’s such a beautiful thing that I’m personally grateful for. When Jason was talking about not having the experience of caring for someone, I haven’t either, but I do have the experience of my last grandparent who passed away having spent time with him in hospice. It was a tough time. He died when he was 97 and a half. I got a lot of time with him. Although we were all rooting for him to live to 100, I don’t know if he was disappointed, but the family was like, “He was so close.” Not that it matters. That’s something I’m curious to circle back, living to 100, Beth. Jason had a TV show called How to Live to 100. He’s got a lot about it. Remind me, Jason, to come back to that.

My point in bringing up my grandfather was that I had the privilege of spending a lot of time with him and seeing the journey that he went on at the end of his life. It was such an odd time because we were close and I was scared like Jason was saying, but I had enough time to process it, which is one of the greatest gifts. My grandmother, his wife, passed away more suddenly. I didn’t get to process it and I didn’t go to visit her in hospice. I don’t think she went into hospice. Even if she did, I didn’t get to go.

With my grandfather, I got to go into the hospice and I was grateful about the place they picked because the nurses were magnificent. The facilities were incredible. It was such an important experience because it was like, “I hope my parents, if they end up in hospice, get this type of situation. I hope I get to spend time with them like my dad got to spend time with his father.”

I was also reminded of this when you spoke of how it is a special moment because the last time I saw my grandfather was less than 48 hours before he passed. We sat and talked. Luckily, he was lucid. He was almost his normal self and he sat and we talked. I felt like I could ask him anything. It was a beautiful but sad memory. You never feel like you have enough time. Another interesting thing that I experienced through that process is I still wish I had more time. I’m curious about your perception of time and how both parties feel, the people that are there grieving but also the people that are in hospice themselves. What is their relationship to time that you’ve observed?

All bets are off when people are dying. Click To Tweet

I’m glad you had that time with your grandfather because that’s special, especially because he was lucid. A lot of times, we don’t have that amazing time where everybody knows it’s the end and you won’t be able to see this person again. Everything is heightened when that’s the case. You could ask him any question. I’m glad you brought that up because it showcases that people can take advantage of this sacred time in terms of the relationship and all the memories that you created because that does help with your grief. It still feels sad and it will never feel not sad, but you have these special moments. That connection helps with the grief piece.

In terms of time, I have so many patients who take a long time to die and they don’t know why. They often say out loud, “I don’t know why it’s taking so long.” I tell them, “It takes a long time to create a little human. It takes a long time for this body to exit the earth, decline and die.” That is a piece. Of course, I have a lot of patients who are not ready to go and feel like time is too short and too fast. People die in a wide variety of ways. There’s no one way that patients die. On hospice, sometimes it’s fast and sometimes it’s slow. Sometimes there’s a terminal event that we could not have necessarily anticipated. There’s a wide variety and range in terms of when patients die. Yes, the experience is everything in terms of time, “Do I have enough time? Do I have too little time?”

I imagine that that’s part of where the discomfort is, the unknowing. Jason, going back to the fear, I remember my fear about that grandfather passing away. I had that for as long as I realized that he was going to pass away. I remember being young. Probably ten years before he passed away, I was fearful of that time because I didn’t know how much time I had with him. It’s uncomfortable. It’s an unpleasant mental process of like, “I don’t know how much time I have.” Sometimes that causes us to live life fuller and sometimes that causes us to live in fear. Jason, I’m curious about your relationship with that.

The other question I had, Beth, is how do you mentally deal with other people’s sadness? We often have a tendency to apologize or feel embarrassed about showing emotion. I don’t know how much I felt that when I was visiting my grandfather. I felt like the energy in that hospice center was kind and accepting. There’s still a little bit of a surface level for many of us, myself included, where I don’t want to burden other people with my sadness or grief. I imagine you’re, in a way, used to it. The person grieving is not used to it. It’s more uncomfortable for them. If you’re a people pleaser, you’re hyper-aware of how you’re impacting others. How do you navigate that awkwardness?

Another reason why I’m in hospice is that it feels so real. I get tired of all the BS, “Everything’s okay. I’m okay. You’re okay. We’re all okay. It’s all good,” because it’s not all good. You can’t fake that in hospice. I love the depth and the authenticity that people have to bring to the bedside, whether you’re the patient or the family. I’ve developed a lot of practices myself to keep myself composed and grounded. I have various meditations, yoga, walking and naps. I have a lot of practice that I do to stay grounded so that I’m less flappable as a nurse because the grief is heavy and intense. You feel like you want to wash it off your body at the end of your shift some days because it’s heavy.

I navigate the awkwardness by leaning into it and staying at the bedside. You can always feel when the grief is bubbling to the surface and I stay there. It’s being there, showing up, being present to their suffering and bearing witness to their suffering. It allows for the validation of their feelings. Part of what we do is support this emotional burden that people are going through. I stay in the room. We have tissues nearby always. Part of the work is being with them in their grief. It’s a damn privilege, honestly, to be with people. I don’t know the patients or the families well. It’s not like we’re family or friends or anything. People are vulnerable and I like that a lot.

Beth, you have so many resources on your website. One of the resources that I’m looking forward to diving into is your book called Some Light at the End. Especially at this time in my life, having this guide to be better informed, be prepared, anticipate some of the questions that I don’t have answers to yet, I want to pick up a copy of your book. The first book that I remember skimming through and extracting some of the highlights on a similar subject was Bronnie Ware’s book, The Top Five Regrets of the Dying. In your work, what do you observe in terms of that subject? What do you see people regretting? What do you see people looking back on their life and saying, “I wish I would have done X?” I’m curious what you’ve heard over the years in terms of that framework of people lamenting in their lives.

According to the empirical data I’m picking up along the way in nursing, a lot of the regret has to do with relationship issues and struggles. I don’t think I’ve ever heard somebody say, “I wish I had more money.” The relationship struggles is pretty apparent. Sometimes patients are waiting for somebody before they die to come. Sometimes patients linger in this space of dying for a long time and the family and friends are wondering, “What do they need to die in peace?” A lot of times, what comes up is that there’s this relationship that has not been dealt with or forgiveness that has not occurred yet or some peace of mind. That’s the biggest regret that I see.

It’s beautiful. I see more patients look back on their life with a sense of gratitude. It feels like they’re trying to find the peace and look back and process, “I did my best. I tried my best. I love my son so much. I love my wife so much.” I see all this processing that’s happening. I do think it’s them coming to a sense of peace about their life. I may not have answered your question successfully but that’s what came up.

MGU 288 | Grief Process

Grief Process: Try to optimize your body to live in the way you want to in the world, so you could also prevent things and make your life better.

 

You did. The fact that you said relationships, forgiveness, gratitude and you specifically said they’re not thinking about money. It makes me think about our priorities in life while we are alive. Also, how much emphasis, particularly here in the West, that we put on materialism, money, career, success, ego, fame, etc. We talk a lot about that here on the show, the psychological dynamics of the hustle and the chase of those external things.

To hear you say relationship, gratitude, family, forgiveness, healing is what is on people’s minds, it’s a profound reframing of, “What the hell am I focusing on right now?” It’s such a powerful mirror to think of where I’m putting my energy and my focus in my life. I don’t want to quantify this as the biggest question of the show, but it’s certainly something that feels big and existential to me. I want you to feel free to pontificate as deeply, as broadly, and as much detail as you want. What do you think happens when we die?

I don’t know for certain, but I feel that when we die, there is beauty, warmth, light and people are free from their physical bodies, emotional trauma, and emotional body. Freedom is the word that keeps ringing true for me. People experience their freedom. With hospice, we have patients who have an illness. They are in these diseased bodies, most of the time and suffering in some way. I do get a sense of freedom, beauty, warmth and light. I also feel like there is a layer.

You were talking about the Travel Metaphor blog that I wrote. I feel that a spiritual layer exists wherever and we can still communicate with our ancestors, the people who have died before us. There is still a relationship that can be had. After my mom died, I developed this beautiful relationship with her spiritually. Maybe that helped me to work myself through my grief. Here I am, years later, and I still feel like I have a deep relationship with her spiritually. There’s something else out there and it feels good to me.

I don’t know if that’s too Pollyannaish. It helps me live in my life and this body believing that. I’ve had enough experiences at the bedside of patients who are talking with their loved ones who have died, their husbands who died ten years prior or holding a baby that they lost. Also, they’ve been talking to Jesus in the room and they said, “Jesus is here with me.” I can’t help but think that there’s some other spiritual realm that is good and beautiful.

My brain went to an interesting place. Here’s another big, heavy question. When you’re describing that, there’s peace and comfort, in a way, of thinking, “Maybe life feels freer. Maybe I’m free of pain or suffering.” I wonder, maybe that is too appealing. What about people who are struggling? What if that sounds too comforting to someone who’s thinking, “Maybe life is better in death,” or, “Maybe death is better than life?” They then choose to end their own lives. It’s a slippery slope.

One thing I noticed and that’s coming up right now is there are many people who are afraid that the world is going to end because of climate change, the pandemic or whatever else and thinking, “We only have until 2030.” You see all these young people posting on social media about this like, “Why do I bother even living life as normal if life is going to end in a few years?” People are starting to think differently, which maybe is empowering. It’s like, “All this superficial BS in the world doesn’t matter because life is going to end shortly. I might as well do what I want.”

That sounds great but what about people who think, “Life is hard right now and death sounds more appealing. I’m going to take my own life.” I’m curious if you have thoughts on that or any experience, Beth. Do people end their own lives in hospice in your experience? That must happen in some cases, maybe not assisted death, depending on if it’s legal or not. Does that happen and has that happened to you where they make that choice? How do you navigate that?

I haven’t ever had personally a patient who has committed suicide. I’m in Oregon. We have physician aid-in-dying here, which is physician-assisted suicide. It’s what people refer to it as. I have patients who are exploring that as an option. Usually, as they’re on hospice, you have to have two doctors that agree you have a terminal illness. A lot of patients who choose to use physician aid-in-dying are simultaneously on hospice.

A lot of what we do is navigate the emotional burden of someone’s death. Part of what we do in hospice is to hopefully alleviate pain, shortness of breath, anxiety and all those symptoms so that people choose not to. I’ve had patients choose physician aid-in-dying and that’s their choice. They have a terminal illness. Here in Oregon, it’s legal. They didn’t want to suffer and that’s why they went down that road.

As far as suicide goes, that’s not my area. I’d much rather believe that it’s beautiful and warm. I think about my death all the time and it doesn’t make me want to kill myself ever. I’ve never had that notion. I’ve never been in that space. I had a deep tissue massage. As I was lying there at the end, I thought, “I would feel happy if I died right now.” I felt relaxed and comfortable. I thought, “This is how a body should feel before somebody dies.” I want all my patients to feel comfortable, relaxed, peaceful and calm. I don’t know about suicide and how to prevent that. My end-of-life scenario includes a beautiful, happy, warm and sunny place.

I want to get back to the esoteric stuff, Beth, because I’m into it. Clearly, you’re open to describing what you’ve observed with your patients. In your own cosmology and personal belief system, we have the backdrop over all human history of different religions and spiritual traditions talking about things like karma or reincarnation. We hear a lot that there’s a soul contract that our essence or our soul agrees to embody here as a human being for perhaps a certain mission or set of things we need to experience.

There’s the idea of oneness that we are part of a unified field theory or universal consciousness that we’re here to break free from the illusion of our separateness. It’s not Whitney, Jason and Beth talking. We’re playing the role of Beth, Jason and Whitney, but that’s not what’s going on. Beth, in your cosmology, what’s your take on all this? Do you have anything further you can share if you align with any of these spiritual beliefs and if you have your own pastiche of what you believe? I want to dig a little deeper into that because I’m curious where you stand on it.

Can you start with your belief and then I might be able to share mine?

I’m still figuring it out, to be quite honest. I was raised in a traditional Roman Catholic family in Detroit and was given the framework of heaven and hell and given the framework of good works and sin. In college, I was studying philosophy of religion and I read the Bible, the Quran and got into the teachings of the Buddha. It seems to me that the concept of heaven, nirvana, the Elysian Fields, there is this idea of a different realm, a non-physical realm that we have the ability to access.

I’ve had some experiences through floatation tank therapy, holotropic breathing and psychedelics where I felt like I was dying. When I say that, I don’t mean physical death but I was aware that I was not fully in my body, so to speak. It was almost like this observer state of, “You’re not your body.” My long answer, Beth, is there is another dimension, reality, place and perspective that we can access or go to when we are certainly freed from these bodies.

Pondering your death makes you live with a little more integrity. Click To Tweet

Through certain experiences, while we’re in these bodies, we can have a taste of it or a glimpse of it. That gives me hope when I start to feel afraid of losing the people I love or even me packing my bags for the next place. I don’t know that I have a name for it, though. I have a sensation that there’s another place. Perhaps when I go to that place, I hope I have a choice in where I go next. Maybe it’s like a waystation, a bus stop, or a train station. I don’t know. I’m still figuring it out, too.

That’s our life’s journey. It’s our ongoing spiritual journey of what’s next. I certainly don’t have anything dialed in stone and is ever-changing. I have had a few experiences at the bedside where I have had this visualization happen and I have not talked about this at all with anybody, but where I’ve had probably eight different experiences where this visualization came up.

I felt like I was walking my patient down this corridor to the next mystery. Each patient had their own way that they exited. Some flew, some rode off on a motorcycle, someone out on a Viking ship. It was unique and pertained to the patient and this was me not even knowing some of the patients that well. That happened and I don’t know what’s next, but I have to believe that there’s something more than this life on this earth. I can’t believe this would be it. It’s simple.

Simple is sometimes real. I’m curious to pass it to you, Whitney. What do you think?

I don’t know what I think. I haven’t given it much thought, to be honest. I am processing the possibilities. I don’t have a solidified answer to this, oddly enough.

I think it’s not solid, so it makes sense. We don’t know. We’ve never died.

It’s not a different subject, but I’ve always been curious about what is real. It’s tricky when I use the word real. I’ve had some interesting past life experiences with spiritual practitioners, but I’ve questioned whether or not those are actual, past-life recalls or if it was my beautifully creative mind, creating some illusion. I’ve had two experiences in my life. I don’t know if I’ve ever talked about this on the show.

One in particular I had was when I was working with this spiritual healer in Los Angeles years ago and I had this visceral sensation of being a Roman soldier dying on the field of combat and he was my general looking over me, holding me as I was dying. It felt different. I can’t explain it. It was such a visceral thing of, “Oh my god.” That was the first time and it made me think, “Maybe I’ve been here before in different incarnations.” It was the first time I started to consider the possibility of reincarnation. We don’t know and maybe that’s the greatest one of the greatest mysteries. Where did we come from? Why are we here? Where are we going after we die? These are the biggest questions we can munch on as human beings.

I’m curious about this as a line of work that you are doing that I would venture to say that I don’t know if I would be suited for and perhaps some of our readers may question whether they would have the emotional fortitude to do what you do. Why do you do what you do? What brought you to this work? It amazes me that you’re able to do this. I don’t know that I would have the capacity to do it so what brought you to this? Why do you do it?

There’s a lot of roads that led me to hospice. The biggest experience was my mom’s own death and the fact that I was able to be her caregiver and be her daughter at the same time. It’s a deep look into what all my families are experiencing. It’s certainly a relatable thing when I’m at the bedside with other families. I don’t ever talk about my mom’s death while I’m working because that doesn’t even seem helpful. It minimizes other people’s grief and loss that they’re experiencing, but I can certainly understand people on a much deeper level, in terms of what they’re going through.

Being with my mom when she died, it was so awesome. I remember I was laying in my mom and dad’s king bed and my sister was laying in the king bed with me and my mom was in a hospital bed next to us. All the family had left the room and we all knew she was dying. I remember the hospice nurse saying she didn’t have long. We were laying there and my sister was holding on to my mom’s hand and she said, “I feel like mom wants me to let go of her hand so she can die without holding on to anybody or anything.” and I said, “Okay.” We laid there for a while and I heard my mom’s breathing change. I went around to her hospital bed and I sat next to her and I put my hand on her heart. It was pounding and it stopped. She took her last breath and I couldn’t believe it.

I threw myself on top of her and wept like a baby. This happened years ago. It’s a story I will never forget. I won’t ever forget the three months that I was able to take care of her and the bonding that happened with all the family. There’s this sacred time when somebody dies that feels almost palpable. It’s hard to explain until you’re in it and it doesn’t happen all the time, but there is this divine moment.

After my mom’s death, being with her, and experiencing that, I feel lucky when I can be with one of my patients when they die. I do inpatient hospice. I like doing inpatient hospice because I can get to know my patients, you’re with them on an eight-hour shift, and you can develop trusting relationships so they feel good. By the time they are dying, you’re going to do everything you can in your power to help them die comfortably and peacefully, whatever that means. Whether it be morphine, Ativan, sitting next to them, putting a fan on them or whatever they need.

I had a patient who said, “I’m almost finished, Beth.” I grabbed her hand and I said, “I know. I’m going to miss you.” She said, “It’s okay. I’m ready to go.” I said, “What’s next?” She goes, “I don’t know what’s next. I’ll let you know, though, as soon as I know.” We’re having these conversations right now and the conversations that I have in the hospice home are in real-time. It’s so real and rich. I had another experience where I had a patient with whom I had developed this sweet relationship and she had asked me to be truthful with her and transparent always.

She had some episodes of shortness of breath, where she would wake up panicky. She was mad at me one day, and she said, “I don’t want to wake up like this. I don’t want to wake up in a panic because I can’t breathe. Can you please help me?” I said, “Yes.” We talked about morphine, Ativan, and scheduling it rather than giving it to her as needed. I said, “If that feels okay, we can schedule your morphine. You might get more sleepy. You might not be as clear. Are you comfortable with that?” She said, “I don’t want to do that now.”

The next day, the same thing happened and I said, “We talked about scheduling your morphine. Are you comfortable with that?” She said, “I’m comfortable with that.” We scheduled her morphine and Ativan and about five days later, I was on and she was in the active dying phase. I sat down with her. She wasn’t able to respond. She was actively dying. It’s this entirely different state where you know that they’re close to dying. I sat next to her and stroked her arm. The CNA came in and sat down next to the bedside, and she held her hand. We sat with her for twenty minutes while she was actively dying.

She breathed her last breath and it feels so powerful to be with somebody as they’re exiting this earth and a lot of it is probably because I feel connected to these patients, but I also feel they trust me and they’ve relaxed enough. It’s such a process when people are dying. For her to get to that point where she could make decisions about her life and her death and know that someone was going to honor her wishes. I felt lucky that I was one of the people there at her last final moment. It feels powerful to be able to advocate for people at the end of their life and give them as beautiful of death as possible. It’s an honor, honestly. I can never be a teacher.

It’s like you were meant for this. It would be a disservice or something if you were a teacher because some teachers wouldn’t be able to do the work that you’re doing and what you’re doing is work as Jason is saying that not many people can or want to do. I have two questions that came up as you were speaking. One is, as you’re talking about this and the whole honor, I’m listening and feeling grateful for the work that you do. It brings up this idea that my mom and other people have brought up. Jason and I are not together as a couple but Jason right now in his life has chosen not to have children.

MGU 288 | Grief Process

Grief Process: One of the most beautiful parts of being a hospice nurse is building trust with your patient over time and having a relationship with them.

 

I’m on the fence, but leaning not to have children and my mother and others have said to me, “What happens when you die and there’s no one there to take care of you or there’s no one there to be with you?” Even if you’re not in a relationship, it doesn’t have to be children. Some people want to be in relationships because they want companionship, as if you can take someone with you or something or you’re guaranteed they’re going to be there by the bedside.

I would imagine, statistically, most people’s families aren’t there when they pass away. It’s either no one’s there at all or it’s the hospice person or someone else. A) Is that is a is that statistic true, and B) Do you have any further observations about the importance of having family members or loved ones there when you pass? Is it going to make a difference or is it a nice perk or something? It’s hard to ask the question, but I’m curious what your perspectives are.

If you had a child to take care of you, specifically, when you die, that’s not a good reason to have a child because there are a lot of people who have children whose children aren’t at the bedside for whatever reason. A lot of times, they live cross country and they can’t get there or they’re not comfortable with it or there’s an estranged relationship. There are a lot of families. I have no idea what the statistic is in terms of how many family members are with somebody when they die. The most beautiful deaths are when patients’ loved ones are present at the bedside and it doesn’t have to be family. It can be friends.

There was this one patient who was maybe a Buddhist and she had Buddhist friends who came in and they chanted at her bedside as she died and after she died. They weren’t blood-related. They were sisters from another mother. It was an exquisite way to exit the earth, even though it wasn’t a blood relationship. All bets are off right now. We live in America in a culture where we don’t do this extended family living together. At least, in my culture, we don’t.

My husband and I don’t have any family that lives in Portland, Oregon. All of our family are in other places in the US. All bets are off when people are dying. You don’t know who is going to be there and who can be there. I think a lot about my friends because I feel my girlfriends are some amazing women in my life. My family will probably be there for me, but I know the ladies are going to bring me my red wine at night and they’re going to massage my feet. They’re going to bring me things that I want and anticipate my needs on a different level. That’s not why I nurture my relationships, but I do think about that on occasion. They will be part of my end-of-life circle, most likely. It’s important to have people you trust in your life for the end of your life.

I love that point that you made about it not being a good reason to have children or to pick a partner because you’re not even guaranteed to have a good relationship with someone at that point or that they’ll be still alive or they’ll be able to be there. There are so many factors, but some people do think about this. They bring people into their life to reduce loneliness. They bring people into their lives to have their needs met.

We realize that those people have their own needs, desires, and things that might not be in alignment. It feels like such a burden to place on someone. It does bring me into the other question I wanted to ask and there’s a tie in here. It was so interesting because I was grieving my grandfather. I was close to all my grandparents, but my grandfather was the last grandparent I had and we had the deepest relationship. Not only was I afraid of my grandfather dying, but my sister and I were both afraid of how our dad was going to process it.

My dad was vastly different in some ways after his dad passed. It was a fascinating thing to witness. His reaction completely surprised me. I don’t know if it was a coping mechanism or what, but my dad felt lighter and it brought him closer to me and my sister. I’ve always been close to my dad, but it was another level that I experienced because my dad started calling me more. He was super close to both his parents, so he would call them all the time when they were alive. When both of them passed, that transferred to me and my sister, so then he started calling us and checking in.

I wasn’t expecting that. I remember he was there in the hospice center when my grandfather passed. When he came home from that, in between that and the funeral, he was lighter because the emotional weight of anticipating his dad’s death was so heavy. I was so afraid of witnessing my father in that grief. I was like, “How am I going to handle this? How am I going to process his grief and my grief at the same time? How am I going to be there for my father?” It was in some ways easier than I thought and that also comes back around to the beginning, Jason’s fears. Sometimes our fear is heavier than the actual experience.

There's nothing wrong with optimizing your body so that you can have a good quality of life, however long you have left. Click To Tweet

Sometimes the experience is nowhere near as bad, but we spent all this time worrying about it, but my question for you is, is there a piece of advice around this like ways that you’ve seen people help others through grief? In hindsight, were there some things that I could have been more prepared with to help my dad through his grief and other people’s grief? Whether they’re losing a dog or a companion animal versus a human being, I often wonder how I can show up and be supportive when somebody else loses someone that I’m not attached to? Is that something that you reflect on and witness in your work?

There’s a beautiful book called It’s Okay That You’re Not Okay. The author is Megan Devine and she also has a website and all these other things, but it’s a beautiful book about the grief process. This is not exactly my area of expertise but in terms of being with patients for the last couple of years of my nursing career in hospice, showing up is the most important thing. By being there leaning into it, it’s uncomfortable, it’s awkward. Nobody likes to be around the death, but it’s isolating.

When somebody is dying and when somebody is taking care of somebody who’s dying, it can be isolating because people are afraid of it and they don’t necessarily want to talk about the elephant in the room. They don’t want to cause any undue anxiety. Showing up being gentle, being quiet sometimes. I hear not approaching them in the grocery store and asking them how they’re doing while they’re looking at the eggplants. I hear that’s not a great call. When people are grieving, there are so many landmines, which is what Megan Devine calls them out there, where you can never anticipate.

She talks about being in the grocery store. Somebody is grabbing a thing like pasta and they remember their husband who died and they had pasta before they died the week before they died or something like that. There are triggers everywhere. Be gentle with people in the grief process, and not having it be your agenda, but waiting, being there and waiting for them to maybe bring it up when they’re comfortable and ready. Also, telling them, “I’m here for you. Let me know how I can support you.”

I love that last piece of asking someone how can you be there for them because a lot of us make assumptions based on what would make us comfortable. There’s someone like me who wants to anticipate and support but sometimes my anticipation is too much or something. As I witnessed with my dad, there was no way for me to prepare because it was a surprising experience that another one of us had gone through. I didn’t mess it up and I couldn’t have prepared for it. It was what it was and I’ve witnessed grief. It’s also an interesting thing, Jason, coming back to your fear one more time to bring it full circle.

We don’t have children. We have animals. Jason and I each have animals and I think way too much about what it’ll be when my dog passes away and that fear within me. That’s the fear that I hold on to. I feel a little bit more comfortable by cognitive dissonance about my parents and my sister passing away or other loved ones. With my dog, I’m so afraid of what that’s going to be like, but the conclusion I keep coming back to is I’m like, “I know one thing for sure that it’s going to hurt, but I have no idea what it’s going to be until I’m there and I can’t know that. I have to be present and gentle with myself.”

Those moments give me an opportunity to truly be present with my dog and every time I think of them, I go and spend a minute with her and savor her and I’m like, “I don’t know how much time we have left together, but here we are right now.” That’s all I know how to do. The same is true with friends and my parents. There’s no way to truly prepare. It’s what I keep coming back to. As much as I would find comfort in preparation, I am trying to accept that’s not a possible thing to do around death. Do you feel that way too, Jason, after reflecting on this whole conversation? I’m curious, coming back to where you started at the beginning, what have you taken away from this? How are you feeling now after discussing all these hard things?

MGU 288 | Grief Process

Grief Process: When we die because of a disease or an illness, there is beauty and warmth and light because people are free from their physical bodies and emotional trauma.

 

It’s tough to answer. It is the awareness of the inevitability of something we cannot escape. Some of the stuff, Beth, that Whitney and I have pontificated on have been, “Are we going to get to a point in the next few years where we can upload our consciousness to a mainframe like Avatar and live in a different body?” I don’t want to get into that because we’re not there yet. Could it happen? Maybe. We don’t know. With technology, it could, but for all intents and purposes, it’s the awareness of the inevitability that we’re going to leave these bodies at some point.

It’s like staring into the unknown and saying, “I have an idea that I’m going to feel crushed when it happens when I lose my animals, my mother or my loved ones.” Having lost loved ones suddenly to accidents and things like that in the past, I know what grieving feels like. I know what it’s like to grieve the death of someone close to me, but it doesn’t feel like it’s a rehearsal. I don’t know. It’s a hard thing to answer, Whitney, because you bring up your dad and how you observed it being this lightness. Maybe this tension in the anxiety I feel around losing my dog, my cats and my mom. Who knows who’s going to go first with you and me, Whitney? One of us is going to go first. We’re best friends. One of us will grieve the loss of you and I. It’s very real.

I would like to say that I feel a sense of comfort after this conversation with you, Beth, because I do feel a deeper level of comfort, but I don’t necessarily feel like, “I’m prepared. Whoever is going to kick the bucket next, I’m ready for you.” It’s a deep sense of comfort, especially with you describing the warmth, light, peace, freedom, and things you’ve observed. I feel a deep comfort as you were describing what you’ve observed and the care you’ve given to people, but when the moment comes, I have no idea. I can think I know, to your point Whitney, the anticipation of pain, the anticipation of my own emotional suffering, but until it happens, I have no idea.

As we get to the end here, I did want to say a couple of things that were on my mind. I saw an interview with Keanu Reeves in 2019, pre-pandemic. He was with Stephen Colbert and he was asking him some deep questions. Stephen Colbert asked Keanu, “What do you think happens after we die?” There was a pregnant pause. Keanu took that question in and he said, “I don’t know what happens to us but I know that the people who love us will miss us.”

It seems so simple to say it because I’m not saying it in a Keanu voice. Maybe if I said it in Keanu’s voice it would translate, but it was so profound in its simplicity. I remember watching it and bawling. I know that much to be true that the people I love, I will miss them terribly. I feel like I need to take a moment right now.

It’s such a touchy subject. My last question for you, Beth, is, do you feel you’re used to all these different reactions people have on the subject matter? Does it feel familiar and easy or is everybody’s reaction or is everyone’s death different for you?

Everybody’s reactions are different. Every death is different. That is the beauty of science. Medicine is so scientific and we think we have all the answers but there’s so much that we don’t know when we can’t anticipate. That’s also the beauty of all of this. I want to come over and hug Jason. When we ponder our death, we do live life in a more present way so these conversations are good. When you guys talk about people who contemplate suicide or the world ending in nine years or something, my hope is that people can look at their lives and say, “What is this all for? How do I want to live my life? How do I want to be in this world? How do I want to be with people or with my animals? What’s important to me? What will make this world a better place?”

Pondering your death makes you do things that you want to do, but hopefully, it makes you live with a little more integrity. I understand the hedonistic quality after somebody pondered their death, and they say, “Screw it. I want to live off the grid and eat chocolate all day.” Meaning is such a big part of life, existence and happiness. Pondering my death certainly helps me to choose things in my life that I get meaning from, whether it be relationships, certain relationships, friendships, the work that I do and what I continue to do. You guys are doing this show, This Might Get Uncomfortable.

I think about the title of your show and I love that this show exists. I didn’t know about it until you guys reached out to me and you do approach a lot of topics that are uncomfortable. Every last one of them. I’m tired of the whole, “Everything is fine. I’m fine. You’re fine.” I appreciate the work you’re doing because it adds depth to people’s lives and makes them ponder and get a little deeper. Thank you, guys, for the work that you’re doing.

The greatest gift that you can get is to take care of somebody you love at the end of their life. Click To Tweet

The appreciation is absolutely mutual, Beth. You coming on here to have a real open, loving discussion about this, I feel like I’ve been held in a space of allowing with you. I would hope and pray that at the end of my life that I would have someone with your warmth, love and care, watching over me because your presence, your personality, your wisdom is so palpable. I can’t think of a better human being to discuss this extremely uncomfortable subject for a lot of people than you.

For you, dear reader, if you have resonated as deeply as we have with Beth, her work and her perspectives. Her website again is BethCavenaugh.com. You can find her book, Some Light at the End there if you would like to learn more about getting perspectives on a compassionate guide to understand the process of dying.

Her blog is filled with so many incredibly useful, heartfelt articles about this subject. I feel to take it back to the beginning, Beth, discovering you and your work is the perfect time for me. I know Whitney probably feels the same because of the depth and the frequency of conversations we’ve been having around this in our personal life. Thank you for being a gift. Thank you for your service to this world and we’re so grateful to have you here. Thank you again.

Thank you, guys. Thank you for your honesty and your wisdom!

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About Beth Cavenaugh

MGU 288 | Grief ProcessBeth Cavenaugh is a Certified Hospice and Palliative Care nurse and educator with over 14 years of experience in caring for terminally ill patients. She has been a registered nurse for over 24 years and holds a bachelor’s degree in nursing from Creighton University.

Beth has supported hundreds of patients and their families at inpatient units, in the home setting, and behind the scenes in hospice care. Compassion, patient autonomy, and transparent communication are at the core of her care philosophy. Beth hopes to demystify death and dying so this powerful moment will be embraced as a normalized and celebrated life event.

Beth lives with her husband in Portland, Oregon, where they have (almost) successfully finished raising their three kids. Learn more at bethcavenaugh.com.

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