Monday, 17 March 2014
'It Was An Act Of Love' - Letting A Dying Child Go
Annukka died of a brain tumor at the age of three. Her parents, who were by her side until the end, tell their story amidst a growing push to extend assisted death to children.
Hanna Sabass and Daniel Gerecke, both of whom have university degrees in geography, had been working for a decade in international development. And it was within the framework of a professional project that in 2009 the married couple intended to leave for the Fiji Islands with their daughters Annukka, 2, and Antonia, 8. But shortly before departure, Annukka got very sick, and four months later an aggressive brain tumor was diagnosed.
In a very personal essay, Annukka’s parents shared their story exclusively for the Süddeutsche Zeitung after Belgium became the first country in the world to lift any age restriction for euthanasia.
At two-and-a-half, our daughter Annukka was diagnosed with a particularly aggressive brain tumor. Before we even knew what was the matter with her, she’d lost her eyesight and ability to walk. After the diagnosis, there was a year filled with innumerable examinations, surgery, chemotherapy, and stem cell transfusions. After a brief but active and life-affirming period of convalescence our daughter died at the age of three-and-a-half.
Under present German law, well-advised parents can make a dying child’s process easier, and even make it somewhat shorter without resorting to active assistance. However this requires awareness, courage, devotion and mainly the ability to let go.
When it became clear that we had lost the fight against Annukka’s cancer, the first question to deal with was her remaining time. What possibilities were there, we asked, of prolonging her life? And what would the conditions of that be? The only possibility to prolong Annukka’s life by a few months was high-dosage radiation therapy which would have had to be administered over 30 consecutive days under complete anesthesia. This would be not only painful but would have had serious side-effects both psychological and physical. The decision was ours to take.
In the weeks preceding this news, both of us had privately been running scenarios through our heads and fearing that we would have to make just such a decision. We were also scared that we might not agree with each about what to do. We had already accompanied our daughter in many agonizing circumstances, always with the idea of perhaps saving her life. But now things were different. This was about dying, about time, and pain, and dignity. We decided against the radiation therapy.
It was a decision for a fast but dignified death. Other parents might have decided differently. They would have had their reasons and their right to make their own choice. We couldn’t ask Annukka what she wanted because by this time she was in no condition to give us an answer. But we feel certain she would have said: Mama, Papa, I don’t want to go back to the hospital.
Trained for survival
Then came the really hard part: the dying. How did that work? And where was the best place for it to happen? Everybody said it was best to let it take place at home. The hospital said we were welcome to come there, but we asked ourselves what was really the point.
The nursing staff and doctors are all focused on survival, the fight against cancer, healing. They are not focused on dying. The child oncologist, on whose every word we hung during therapy, was suddenly rendered helpless when we asked him to explain what we could expect now and how we could help our daughter. The pediatrician, an émigré, had no experience in this regard and no palliative training. He also didn’t know any other pediatrician in Bremen he could refer us to. We were clueless – and very frightened.
Help finally came from the Bremer Engeln (Bremen Angels) who got in touch with us after hearing at the children’s hospital about our case. This is an association that provides care for seriously ill children and their families. We already knew the two pediatric nurses from the child oncology department at the hospital – they were the only ones with any training in palliative care.
But the association couldn’t do home visits in emergency situations either, because alongside their hospital shifts the women were looking after kids in all of Bremen and its surrounding area. But at least somebody was able to finally explain to us the paths that death can take, and that most children should be at home when they die. The women organized pain and epilepsy medication, a special-care bed and brought us literature on accompanying somebody to their death.
Talking to them it became clear that if we wanted to accompany Annukka we had to listen to her, and this would require a major turnaround for us as well: because just as hospitals are there to keep life going and to heal, parents are there to nurture their kids to adulthood. Now we were being asked not to do that. If Annukka didn’t want to eat, she didn’t eat. If Annukka didn’t want to drink any more, then she didn’t drink. Her medication was aimed at lessening her pain.
Not at any price
Our task from then on in was to be aware. To observe our daughter carefully and fill her needs, not ours. It was very hard, but the fear of prolonging her pain by force feeding her was greater. We had to learn that we couldn’t call an emergency doctor because he or she would have been obliged to try and save Annukka’s life at any price, and to send her to the hospital even if that meant unnecessary stress for all of us, particularly Annukka. We were left to our own devices, and we suffered from being left on our own in this way.
Increasingly we entered a timeless space of uncertain waiting. Annukka was fading fast, but wasn’t suffering as far as we could make out. In fact she was happy when she was alert, although she was often mentally absent. Finally we moved to the Löwenherz child hospice in Syke where all of us were looked after according to our needs. Here there were doctors with palliative training who were able to tell us how to proceed. Two weeks later, Annukka died. No, it wasn’t peaceful, and no, it wasn’t without pain. But it happened in her own time. And we all, her sister, her mom and dad, were there. We were able to sing her a final lullaby.
For us it was an act of love for our daughter. She, our little one all of three-and-a-half years old, led us along the path to her death at her own pace and with so much dignity. It never occurred to us to actively bring on her death or to charge somebody else with doing so.
We are absolutely convinced that no child wants to be killed. If this wish is uttered, it is down to extenuating circumstances, pain, and the overload on the child and his or her entourage. The child might even believe that a death brought on artificially might be preferable to a natural death. But in cases like this what needs to be done is find out what the sources of the overload are and how the conditions for both child and parents can be improved.
Palliative specialist Professor Dr. Zernikow was absolutely right when he said in an interview with the Süddeutsche Zeitung that the debate in this regard is hypocritical. The real scandal is that what is missing is the urgently needed professional guidance and support for both parents and children to learn about dying at home. It’s only natural that parents are so far out of their league when they have to accompany a child facing major cramps and horrific pain to her death. And just as naturally that a child becomes afraid and feels responsible when she sees that her parents are suffering and feel overwhelmed.
Palliative medicine and some psychology should be part of a doctor’s mandatory medical school curriculum. What we need is a network of nursing staff and doctors in a position to deliver 24-hour emergency care for outpatients, and that care should be financed by health insurance policies.
Read the full article: 'It Was An Act Of Love' - Letting A Dying Child Go
Sunday, 9 March 2014
Tranporting the Deceased to Another Town or Country
Transportation of Human Remains
In many cases a loved one’s body is initially transferred from the place of death to a local funeral home (i.e., the "first call" funeral home) and then subsequently transported to another city for funeral ceremonies and/or burial. If this is your situation, you’ll need two funeral homes – one locally to handle the first call, and a second one in the final destination city.
Obviously, the first call funeral home is needed immediately. However, you may prefer to select a funeral home in the final destination city and ask them to make the arrangements with a local funeral home to remove the deceased from the place of death.
Generally, the two funeral homes will coordinate the transportation arrangements between themselves. You’ll be responsible for making sure that both funeral homes have all the pertinent information. See below.
Information you need to provide to both funeral homes:
- Name of the deceased.
- Deceased’s residence — Address / City / State / Zip / Phone #.
- Deceased’s Social Security Number.
- Date and time of death.
- Current location of the deceased — Facility name / Address / City / State / Zip / Phone #.
- Attending physician name and phone.
- Your name.
- Your residence — Address / City / State / Zip.
- Your telephone #’s — Daytime / Evening.
- Your relationship to the deceased.
Transporting Human Remains By Air
You cannot arrange air transportation of human remains directly with an airline. This is due to certain transportation requirements for human remains, such as embalming or packing the body in ice. Also, shipments of human remains are subject to the “known shipper” regulations of the Transportation Security Administration (TSA). Many funeral homes / mortuaries have been approved as “Known Shippers” and they can help you arrange transportation of human remains.
Local Transportation of the Deceased
In some cases a loved one’s body is initially transferred from the place of death to a local funeral home (i.e., the "first call" funeral home) and then the family subsequently decides to use another funeral home for the funeral ceremonies. If this is your situation, you’ll need to select a second funeral home that best meets your needs. Most likely, this will result in an additional transportation charge.
ACTOR HOFFMAN'S FATAL HEROIN OVERDOSE PUTS FOCUS ON DEALERS
Saturday, 8 February 2014
ACTOR HOFFMAN'S FATAL HEROIN OVERDOSE PUTS FOCUS ON DEALERS
A photo of actor Philip Seymour Hoffman, as part of a makeshift memorial in front of his apartment building in New York. REUTERS
NEW YORK - Most of the nearly 40,000 Americans who die each year from a drug overdose do not make the front page, but when revered actor Philip Seymour Hoffman was found dead Sunday with a needle in his arm, the nation took notice.
And so did the police. On Tuesday, four people were arrested on drug charges and are reportedly being questioned in relation to Hoffman’s death, placing the actor’s untimely demise squarely in the middle of a new trend in the war on drugs: charging dealers when their customers die.
“We’re coming for you,” says Al Della Fave, spokesman for the Ocean County, N.J. prosecutor’s office.
Fave told CBS News’ Crimesider that since he came into office in April 2013, prosecutor Joseph D. Coronato has “been on a mission” to hold dealers accountable for the deadly effects their products are having on citizens of Ocean County. According to Fave, of the 53 Ocean County residents who died of overdose in 2012, the majority were using heroin. Total overdoses in the county more than doubled in 2013, to 113; and so far in 2014, Fave says there have been eight fatal overdoses, seven involving heroin.
On Jan. 10, Coronato's office secured a 11-and-a-half year sentence for Kenneth Staunton, a 33-year-old who pleaded guilty to heroin possession and manslaughter in relation to the death of a 27-year-old man who overdosed on Stauton's product.
And just last week in Illinois, a 27-year-old woman was sentenced to four years in prison after she reportedly pleaded no contest to first degree reckless homicide for selling heroin to a man who died from overdose.
Kerry Harvey, the U.S. Attorney for the Eastern District of Kentucky, is also cracking down on dealers in his state.
“We have had a truly horrific problem with prescription drug abuse,” Harvey told Crimesider. And while he says they’ve been able to restrict the supply of these drugs somewhat, the crackdown has “caused a comeback of heroin.”
Instead of specifically charging dealers with their customers’ overdose deaths, Harvey says his office has used sentencing enhancements that allow for as many as 20 years in prison if a death results from an illegal narcotic distributed by the suspect.
“It’s hard to deter someone acting out of an addiction, but you can deter people who are acting out of greed,” says Harvey. “We want them to know they’re risking their own life [when they deal], at least in terms of their freedom.”
Part of this new push has been to train first responders like police and EMTs to treat overdose scenes not as accidents, but as potential crime scenes. They’re taught to secure the scene, interview witnesses, and collect evidence, like pill bottles, needles and the all-important cell phone. Harvey pointed to one recent case where an overdose victim had called his dealer just hours before his death.
In addition, Harvey said that he’s conducted training at local coroner and medical examiner’s offices to make sure that overdose victims are autopsied so that a connection can be established between the death and the drugs.
“We’re trying to change the cost-benefit analysis for dealers,” says Harvey. “With every heroin transaction there is a significant risk of overdose death. We want them to know if their customer ODs, they will be held responsible.”
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A Tribute to Nelson Mandela - Tata
Freedom fighter, prisoner, moral compass and South Africa's symbol of the struggle against racial oppression.
That was Nelson Mandela, who emerged from prison after 27 years to lead his country out of decades of apartheid.
He died Thursday night at age 95.
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His message of reconciliation, not vengeance, inspired the world after he negotiated a peaceful end to segregation and urged forgiveness for the white government that imprisoned him.
"As I walked out the door toward the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind, I'd still be in prison," Mandela said after he was freed in 1990.
Mandela, a former president, battled health issues in recent years, including a recurring lung infection that led to numerous hospitalizations.
Despite rare public appearances, he held a special place in the consciousness of the nation and the world.
"Our nation has lost its greatest son. Our people have lost a father," South African President Jacob Zuma said. "What made Nelson Mandela great was precisely what made him human. We saw in him what we seek in ourselves."
His U.S. counterpart, Barack Obama, echoed the same sentiment.
"We've lost one of the most influential, courageous and profoundly good human beings that any of us will share time with on this Earth," Obama said. "He no longer belongs to us -- he belongs to the ages."
A hero to blacks and whites
Mandela became the nation's conscience as it healed from the scars of apartheid.
His defiance of white minority rule and long incarceration for fighting against segregation focused the world's attention on apartheid, the legalized racial segregation enforced by the South African government until 1994.
In his lifetime, he was a man of complexities. He went from a militant freedom fighter, to a prisoner, to a unifying figure, to an elder statesman.
Years after his 1999 retirement from the presidency, Mandela was considered the ideal head of state. He became a yardstick for African leaders, who consistently fell short when measured against him.
Warm, lanky and charismatic in his silk, earth-toned dashikis, he was quick to admit to his shortcomings, endearing him further in a culture in which leaders rarely do.
His steely gaze disarmed opponents. So did his flashy smile.
Former South African President F.W. de Klerk, who was awarded the Nobel Peace Prize with Mandela in 1993 for transitioning the nation from a system of racial segregation, described their first meeting.
"I had read, of course, everything I could read about him beforehand. I was well-briefed," he said.
"I was impressed, however, by how tall he was. By the ramrod straightness of his stature, and realized that this is a very special man. He had an aura around him. He's truly a very dignified and a very admirable person."
For many South Africans, he was simply Madiba, his traditional clan name. Others affectionately called him Tata, the word for father in his Xhosa tribe.
A nation on edge
Mandela last appeared in public during the 2010 World Cup hosted by South Africa. His absences from the limelight and frequent hospitalizations left the nation on edge, prompting Zuma to reassure citizens every time he fell sick.
"Mandela is woven into the fabric of the country and the world," said Ayo Johnson, director of Viewpoint Africa, which sells content about the continent to media outlets.
When he was around, South Africans had faith that their leaders would live up to the nation's ideals, according to Johnson.
"He was a father figure, elder statesman and global ambassador," Johnson said. "He was the guarantee, almost like an insurance policy, that South Africa's young democracy and its leaders will pursue the nation's best interests."
There are telling nuggets of Mandela's character in the many autobiographies about him.
An unmovable stubbornness. A quick, easy smile. An even quicker frown when accosted with a discussion he wanted no part of.
Funerals V Memorial Service
Thursday, 7 November 2013
Increasingly, the two terms are used interchangeably, especially with cremation growing in popularity making it easier to move the remains of the deceased.
Traditionally, funerals take place with the body or the ashes of the deceased person present. Memorial services have been ceremonies without the presence of the body although an urn containing the ashes may be present.
Funerals are usually held immediately following death whereas memorial services may take place weeks or months away. In the past, memorial services also have been less formal than funerals with greater participation by family and friends.
This is changing, however, as funerals are becoming less centered on the leadership of one person. Memorial services do not necessarily take place in a funeral home or religious setting.
They may be held in the home or other comfortable gathering place. Funerals are most often held in traditional settings (cemetery, chapel or church) and are often followed by a graveside service. In the future, “funerals” and “memorial” services will both be used to describe the service of celebrating death.
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