Today I want to talk about:

“Rituals”

I am hoping this won’t be triggering to any of you reading this, as it’s about the context of my line of medicine: palliative care.We are all familiar with Full Code and DNR status.

When a patient is very sick and it seems unlikely that they can survive hospitalization, no matter what medical interventions we may offer, I recommend to the family to consider DNR.

I see it as sort of a soft landing. In fact, if that was my own life or that of my loved ones, where I believed we couldn’t make it out of the hospital alive, I’d want us to be DNR, too.

But in a Western society, more so, in times of COVID, without allowing visitation, or having any meaningful ritual of our own, we have inadvertently made the act of doing CPR/shock/intubation our own “ritual of death”.
Imagine two ICU families next door to each other. One patient is DNR and another is Full Code. Say, they are both going to die. When they both have a cardiopulmonary arrest, if there are families around, they notice one patient gets 20 people running into their room to ‘do everything’, and the other patient who is ‘comfort care’ doesn’t even get a doctor to round on him, because he’s ‘just comfort care’. They will show up in time to pronounce the patient, when the monitor by the nurse’s station shows asystole.

I can tell you that families truly believe, that when we do a 40 minute CPR attempt on a dying patient, breaking their ribs, as well as traumatizing the entire medical team doing the futile resuscitation, in their minds “at least we did everything”

What about the family that chose ‘comfort care’. Will they think they did ‘everything’, too?

Where’s their ‘ritual’ of death?

I am here to tell you having rituals matter in our lives. Especially, in near the end of life settings.

I lived in Sacramento for 10 years. There is a large population of Hmong patients for us to serve. I knew very little about this culturally unique and loving people.

At time of death, they dress their loved one in an all white clothing as if they’re dressed for a wonderful celebratory occasion. I had one patient who was a young mother with intracranial bleed, family was struggling to transition her to comfort care. But once they understood that she would need to be on tracheostomy and feeding tube for the rest of her life, they knew that was not the life they wanted for her.

Once they decided to let her die naturally, without our plans of prolonging her dying process in a skilled nursing home, they went shopping at a local Macy’s. Apparently, the patient had told her daughters that if she ever died, she wanted to wear something fancy from Macy’s, not a regular ‘old fashioned’ dress.

She looked beautiful in that dress. The daughters did a detailed manicure and pedicure with flower patterns and she looked beautiful. In a fancy white dress. From Macy’s. That ritual was striking to me.

I worry about our patients who have no death ritual and the only ‘special’ treatment they get on their way out, is the traumatic and assaulting treatment of a ‘full code’ until we stop. I wish it wasn’t so.

I think that rituals anchor us.

Whatever that ritual is for you and your family. It does not have to be around death or dying.

It could be how we celebrate life. I have always woke up my two daughters with a cupcake and a candle on the morning of their birthdays. Since they were able to eat a cupcake. We wake them up with a happy birthday song (in three languages), it gives me more joy than it gives them. We videotape all those wake up rituals. Then we watch them all spliced together the evening of their birthday. It is so sweet, my heart could explode.

I think having rituals around our daily lives can be grounding, too. Meditation, journaling, reading a book. In the beginning or end of your day. It allows us to feel connected to the life we live day to day. So much so that when it’s time to leave this life behind, we are ready to go.

Without all the futile attempts of technology, trying to keep us alive, one more day-that we won’t get to spend doing rituals that were giving us meanings in the first place- we will be able to move on…

Go celebrate life today and if you have your own rituals, share them here if you wish, so we can all be inspired by one another ( remember how we all felt when we saw a friend in her wedding dress knitting barefoot?)

So much love to you all 🌺