The Death Bed

May 9, 2016

By Siegfried Sassoon
He drowsed and was aware of silence heaped 

Round him, unshaken as the steadfast walls; 

Aqueous like floating rays of amber light, 

Soaring and quivering in the wings of sleep.

Silence and safety; and his mortal shore 

Lipped by the inward, moonless waves of death. 

 

Someone was holding water to his mouth. 

He swallowed, unresisting; moaned and dropped 

Through crimson gloom to darkness; and forgot 

The opiate throb and ache that was his wound. 

Water—calm, sliding green above the weir; 

Water—a sky-lit alley for his boat, 

Bird-voiced, and bordered with reflected flowers 

And shaken hues of summer: drifting down, 

He dipped contented oars, and sighed, and slept. 

 

Night, with a gust of wind, was in the ward, 

Blowing the curtain to a gummering curve. 

Night. He was blind; he could not see the stars 

Glinting among the wraiths of wandering cloud; 

Queer blots of colour, purple, scarlet, green, 

Flickered and faded in his drowning eyes. 

 

Rain—he could hear it rustling through the dark; 

Fragrance and passionless music woven as one; 

Warm rain on drooping roses; pattering showers 

That soak the woods; not the harsh rain that sweeps 

Behind the thunder, but a trickling peace, 

Gently and slowly washing life away. 

He stirred, shifting his body; then the pain 

Leaped like a prowling beast, and gripped and tore 

His groping dreams with grinding claws and fangs. 

But someone was beside him; soon he lay 

Shuddering because that evil thing had passed. 

And death, who’d stepped toward him, paused and stared. 

Light many lamps and gather round his bed. 

Lend him your eyes, warm blood, and will to live. 

Speak to him; rouse him; you may save him yet. 

He’s young; he hated war; how should he die 

When cruel old campaigners win safe through? 

But death replied: “I choose him.” So he went, 

And there was silence in the summer night; 

Silence and safety; and the veils of sleep. 

Then, far away, the thudding of the guns.
Source: The Old Huntsman and Other Poems (1917)


Terminal Illness and Relapse: Why Stay Sober If You’re Dying?

November 22, 2013

Untitled1By Terence T. Gorski
www.relapse.org — www.facebook.com/GorskiRecovery — www.cenaps.com

I had just completed a workshop on relapse prevention. As I was leaving the conference room, a thin and frail-looking man from the audience approached me.  In a voice tinged with quiet desperation, he asked if he could talk with me privately. We moved to the side of the conference room, pulled up a couple of chairs, and sat down to talk.

“Mr. Gorski,” he said, “My name is Malcolm. I am recovering from chemical dependence and have been sober for nearly eleven years. I’ve had AIDS now for over two years and I’m beginning to get very sick and I know I will die. A big part of me wants to start drinking to deal with it and, to be quite frank, considering my condition, I can’t think of any good reasons to stay sober. What should I do?”

Many counselors are asked this question. Their clients struggled to get sober, only to become a statistic in the growing in the growing AIDS epidemic. Other sober people also ask this question when, in sobriety, they are diagnosed with cancer or other chronic and fatal diseases. Many of these people find the courage to face their death in sobriety.  Others return to alcohol or drug use. Of those who relapse, some get back into recovery and die sober, but many others die a horrible death from the combination of AIDS and out of control chemical addiction.

What can we say to these people?  How can we convince them that it is in their best interest to stay in recovery in spite of the horrors of their disease. How can we give them the courage to face their death sober? Should we even try? If an addict is dying, why should he or she stay sober? I can think of many good reasons for staying sober in the face of death.

Alcohol and Drugs Won’t Help!

It is tempting for terminally ill patients to believe the mistaken notion that alcohol and drug use will somehow make their disease easier to cope with. It does not.  I ask patients to think back to the times when they were using alcohol and drugs and to remember the quality of their lives.

No matter how painful or debilitating your terminal illness may be, alcohol and drugs will only make it worse.  The mental anguish and pain you may be experiencing will increase and your ability to cope with your disease will progressively disappear.  At best, alcohol and drugs will provide brief moments of temporary anesthesia, followed by periods of shame, guilt, and dysfunction.  As the chemical dependency progresses, and it always progresses, the resultant loss of control will prevent you from responsibly treating your illness, destroy any hope of having quality moments of life, and escalate your movement toward a painful death.

For people who are addicted, alcohol and drugs are never a solution to any of life’s problems, including terminal illnesses.  The temptation to believe that alcohol and drugs are a solution is part of the delusional system that accompanies chemical addiction.

The Choices In Facing A Terminal Illness

When facing a terminal illness, we only have three choices.  We can deny it by pretending everything is fine.  We can fight it by learning all that we can about our disease, fortifying our sobriety, steeping ourselves in courage and hope, and doing everything we know how to do to increase the duration and quality of our survival time.  Or we can accept it.  We can face the inevitability of our death and surrender to it.  By surrendering we can reinvest our energy in finding a sense of dignity, and meaning in the experience of our illness and death.  We can finish our business here on earth and turn to strengthen ourselves spiritually to face the transition from this life to the next.

Which is the best or correct way?  There is none.  We each will have to choose which of these alternatives we will embrace at each stage of our movement toward death.  At times, it is best to deny our illness and live as if we will live forever.  At other times, it is best to steep ourselves for the battle and fight for our lives with everything we have.  At still other times, it is best to surrender to the inevitable and face our death for what it is, the final transition of our physical lives.

The bottom line, however, is this — none of these alternatives will be available to us if we choose to use alcohol and drugs to cope.  Our disease of chemical dependency will rob us of all choice and self control. It will make our pain worse and rip us away from ourselves, our God, and those who love us.  Alcohol and drugs can never be a solution to anything for a chemically dependent person.

Reasons To Stay Sober

When Malcolm asked me the question, “Why should I stay sober?” my response was very direct, “Because you owe it to yourself and those around you.  Because you are in recovery and you are able to face anything sober and this includes your own eventual death.”

For a moment I became philosophical. “We can all create precious moments in time,” I said as I leaned forward and looked him in the eyes. “We can, at times, transcend our fear and carve out moments of joy and wonder.” I looked away for a moment a realized how often I had failed to follow my own advice. Then I continued: “We can choose to laugh when we feel like crying. We can live fully, even in the face of death. This is just true for us all.”

My mind flashed words of Earnest Hemingway: ‘All true stories end in death.’ In other words, we are all dying in every moment that we level. We are all living in every moment we are dying. We can choose to embrace life and revel in it, or we can choose to embrace death and quake in horror, fear and despair. Many people have told me the most painful thing they faced when confronted with their own impending death was how many moments in their lives they had wasted.

Then my rational brain took charge and I began explaining to Malcolm that there are seven good reasons to stay sober even if you have a terminal illness.

1. There Is Always Hope:

Only God decides when we die.  In recovery, we learn that we are not God.  Although we will all eventually die, the timing of our death is never certain.  Many people with HIV will never develop AIDS.  Of those who have AIDS, some will have spontaneous remissions and others will live a long and meaningful life before eventually dying.  On top of that, there is always the hope of a major medical break through in treatment.  Perhaps a cure will be found!  Even if such a break through never comes, people are happier and healthier when they live with hope than when they live in despair.

2. Staying Sober Increases The Length And Quality Of Survival Time:

Staying sober, eating right, exercising moderately and managed stress (all of the components of good recovery program for chemical dependence) will increase the length and quality of survival time.

3. Staying Sober Allows Us Connection With A Higher Power:

It is only in sobriety that we can experience a deep connection with our Higher Power and contemplate with hope what lies beyond the limits of our physical existence.  This is the only true source of comfort when facing our own death.

4. Alcohol And Drug Use Escalates Disease Progression:

Alcohol and drug use inhibits the immune system and accelerates the development of AIDS.  Alcohol and drug use will also interfere with the effectiveness of many of the new medications and other treatments that slow down the progression of AIDS.

5. Staying Sober Gives Us The Possibility Of Death With Dignity:

By staying sober, we can approach our death with dignity and self-respect.  We can reflect upon the meaning of our lives, the loves we’ve shared, the experiences we have had, the things we have accomplished and contributed.  We can bring closure to our lives and our relationships.  We can search for and find a deeper meaning to our lives and to our death.

6. Relapse Adds Pain And Problems To An Already Bad Situation:

When a chemically dependent person returns to alcohol and drug use, there is a big price to pay.  Physically, the booze and drugs rip our bodies apart and make us more vulnerable to the progression of other illnesses and less responsive to treatment.  Psychologically our self-esteem suffers and we develop shame, guilt and anguish.  This emotional response accelerates our plunge into depression and eventual despair.  Socially we become isolated and unable to give or receive love.  We inadvertently hurt the people we love most and cut ourselves off from one of the few sources of true comfort, the loving embrace of other human beings.  Spiritually we become bankrupt and disconnected from the God of our understanding.  We lose conscious contact with our source of courage, strength, and hope.

7. It Is Better To Die Sober Than To Die Drunk:

I strongly believe that it is better to die sober than it is to die drunk.  Using alcohol and drugs is never a solution for anything.  Alcohol and drugs cut us off from our inner source of courage, strength, and hope.  Addiction destroys our self-esteem and self-respect.  And, on top of that, it will make whatever other disease we have worse.  In the long run, it will create more pain and misery.

The Difference Sobriety Can Make

Staying sober in the face of terminal illness can and does make a difference.  I had two friends in recovery who died of cancer. One of them gave up hope and used his terminal illness as an excuse to relapse. He spent several months bingeing on booze and drugs and wallowing in self-pity. His behavior deeply hurt all of us who loved and cared about him. Most importantly, he ultimately hurt himself.  He cut himself off from those he loved and alienated himself from his higher power and his inner source of courage, strength, and hope. He ultimately decided to take his own life. He left devastation and scars on all those who touched him and died in personal misery.

My other friend faced his death sober. As a result, all who were involved with him benefited from his courage, his willingness to work through the steps and stages of accepting his own death, making his own personal peace, and being prepared to surrender himself spiritually. This friend died in a hospital surrounded by family, friends, and AA associates. His death was not pleasant, but he was able to face it using the wisdom and courage he learned in his twelve step program and through his years of recovery. As a result, he died in peace with himself and with others.  He finished the unfinished business of his life and he left behind him a legacy of the power of recovery, courage and compassion.  He showed us all the true strength of sobriety when supported by an effective recovery program.  He gave courage and hope to all who were involved with him in his final days.

Any recovery program that is strong enough to help people to face their own death in a sober and dignified way is a powerful program indeed. I wish that everyone suffering any chronic disease can learn to tap into that power.  As counselors and therapists, we need to believe in the power of the recovery tools that we teach and realize that they can assist a person in living a high quality life for as long as possible. They can help people to face the reality of their eventual death while finding the courage to live – even when they know we are dying.

Counseling The Terminally Ill

Counselors who are working with chemically dependent patients who are terminally ill need to develop a firm belief that alcohol and drug use will only make the condition worse.  Most importantly, they need to clearly and forcefully communicate that conviction to their patients.  They need to recognize that it is never in the best interest of the chronically ill patient to relapse into alcohol and drug use.

They also need to know that the use of pain medication, as prescribed, to improve the quality of the life in the face of severe pain is no a relapse. Without proper management, which usually includes a properly supervised pain medication regimen, the pain can become so severe that it destroys any ability to have quality survive time.

Therapist also need to be able to redirect their counseling and therapy towards three primary goals. The first is to maximize the use of treatment interventions that can produce a cure of the fatal condition. This means encouraging the patient to fight back against the disease by using the most effective treatment methods available. The second is to maximize the quality of survival time so that the person can live to the fullest in the remaining years, months, days, or hours of life. This means helping people to consciously bring closure to unfinished business, explore his or her values, and spend time engaging in valued activities.  The third is to develop a sense of spiritual fulfillment, which can allow patients to face their death with dignity and self-respect.  This means working through the stages of denial, anger, bargaining, and depression. This can bring people to a deep spiritual acceptance of death.

It is difficult for counselors in a death-denying society to realize that there are vital counseling interventions that can be used with terminally ill patients.  It is important to help people work through the stages of accepting their illness while still maintaining a sense of hope and a proactive vision of the future.

Counseling the terminally ill patient who is in recovery is the most challenging and, at the same time, the most meaningful experience that I have ever had.  Working with these patients in learning how to realistically face their own death has helped me come to terms with my own mortality.

Redefining Relapse

When working with terminally ill patients who often experience chronic and incapacitating pain, we have to think carefully and realistically about how we define relapse.  One of the most difficult challenges in counseling terminally ill, chemically dependent patients is to help them make wise and prudent choices about the use of medically prescribed painkillers.

I am a strong believer in abstinence as a primary treatment goal. I also recognize, however, the need that many patients have to find relief from intractable pain.  I have been approached by many people and asked if I consider it a relapse when terminally ill patients use painkillers such as Demerol or morphine.  My answer is a strong and resounding “No!  It is not a relapse!”  These pain medications are necessary to allow some quality of life.

It is important to remember that the pain associated with many chronic diseases can be more incapacitating than the use of legally prescribed painkillers.  There is a big difference, however, between using prescribed drugs under careful medical supervision and self-medicating addictively.

Counselors and therapists can learn how to help their patients come to terms with their needs for medically prescribed pain medications.  Counselors can help patients in the severe intractable pain to accept that this is not a break in sobriety. They can work with responsible pain-management physicians to develop an effective pain management plan that allows the longest and highest quality of survival time.

Relapse Warning Signs For Terminally Ill Patients

There are a number of relapse warning signs that can help terminally ill, chemically dependent patients recognize that they are moving toward a chemical relapse and take corrective action.  These are:

1. The belief that returning to the addictive use of alcohol and other drugs will make the illness more manageable or provide relief from pain.  As we discussed, the use of alcohol and other drugs will only make the disease worse.

2. The belief that the use of previous drugs of abuse will be more effective in pain management than the use of prescription drugs.  Most people quit using their drug of choice because they no longer get the desired effect.  This is the result of tolerance.  Your drugs of choice didn’t work well before and they won’t work well now.  Find a physician who will work with you in finding an effective medical regimen for the management of pain and supplement the medication with other forms of pain control.  This will be more effective in the long run.

3. The belief that returning to alcohol and drug use will bring about a quick and painless death.  Many terminal ill patients want to end the pain and mistakenly believe that alcohol and drug use will be an efficient way to commit suicide.  This is not true.  Death from chemical addiction is a slow and painful process both physically and psychologically.  If a person has decided to end his or her own life, there are other more effective and painless ways to commit suicide.

4. The belief that having a terminal illness means that there is nothing left to live for and, therefore, alcohol and drug use is justified.

When I finished, Malcolm stood up, put on his hat and said: “Thank you, I have a lot to think about.” As I shook his hand and turned to walk away, I realized that, like Malcolm, I also had a lot to link about.


STRAIGHT TALK ABOUT SUICIDE

April 13, 2012

Suicide_AddictionBy Terence T. Gorski, Author
Updated: January 9, 2014

SUICIDE IS A PERMANENT SOLUTION
TO A TEMPORARY PROBLEM.
THERE IS ALWAYS ANOTHER SOLUTION!

Straight Talk About Suicide – The book by Terence T. Gorski

Over my life I have seen too many people fall into the black pit of depression and kill themselves. I have never spoken out about this problem and offered hope and helpful tools for people who are depressed and thinking of ending their lives. This book is my small attempt to save the lives of people who feel they have no out of their pain and problems except death at their own hand. The primary and powerful message I want to deliver is that suicide is a permanent solution to a temporary problem. People who are depressed and suicidal focus upon their pain and problems and develop the mistaken belief that this will never end. They lose touch with the primary principle for keep hope in recovery even during our darkest hours. This principle is captured in the slogan” This too will pass!

In a creative moment I captured my thoughts in a simple one line affirmation: Life will be new again if I have the strength to reach for beauty and the spirit to pay its price! I have found this to be true even in my darkest hours living in the black pit of depression. Somehow I always found what I found the courage, strength and hope I needed to climb out of the pit. This has always happened even though I did nt believe in the moment that I would ever feel good or get t the other side of my problems again.

People will want to read this book for one of three reasons: You are a therapist who works with people who have suicidal tendencies; you are a person who knows or loves someone who is currently thinking of suicide, has attempted in the past, or has actually committed suicide; or you yourself are considering suicide as a possible alternative to end your pain and solve your problems. The common bond between all three groups of readers is that you have been or are currently being affected by the problem of suicide and you desire to learn more about it.

I struggled when planning to write this book. Which of these three audiences should I primarily address? As I did internet and library research and talked with therapist who specialize in treating suicidal people and their families, one thing became clear. There are many books written for therapists. These tend to be clinical and are often difficult to read, especially for recovering people and their families. To be quit honest, even though many of these books contain important information and counseling approaches to restoring hope in people who are suicidal and those who love them, most of them are written is a dry professional style that makes them tedious and difficult to read.

These books often fail to give practical information that a suicidal person or the friends or families of suicidal people could use to understand what is happening and what they can do to help the suicidal person to choose life over death.
Suicide – killing yourself by your own hand – is not a pleasant subject to think or talk about. As a result most people don’t. If you know someone who is showing the warning signs of suicide, it’s difficult to believe that they might actually try to kill themselves. Even if someone tells you that they are suicidal and asks for help, most people don’t know what to say or what to do. They fear calling a mental health center or psychiatrist for fear they will be “locked up in a psycho ward,” or “zonked out on medication,” only to be sent home just to become suicidal again a few days or weeks later.

Mental health professionals, including psychiatrists, psychologists, social workers, and professional counselors know what to say and do. The problem is that they rarely get a chance to say and do what will help because the suicidal person is rarely referred to them unless they are caught in the act of attempting suicide or have tried to kill themselves and failed. Mental health professionals can be of great help to these people. But what about those people who have actually killed themselves? Here’s the sad truth – people who succeed in killing themselves are dead – end of story. There isn’t much anyone can do for them except arrange the funeral. The real task is trying to deal with the psychological and social aftermath to family, friends, and the community as a whole.

Suicide is never a private act. It always has a devastating effect on family, friends, & the community.

As I talked with professionals, family members, and people who had previously attempted suicide several things became clear.
First, most professionals already know or have access to information about how to prevent suicide and manage the people who have survived suicide attempts.
Second, most people on the brink of suicide are unlikely to pick up a book about suicide, start reading it and have a blinding flash of truth leap out at them that changes their minds. I know this happens sometimes, but it usually happens in the early stages of the suicide process.

If, however, you are suicidal, and reading this book – you owe it to yourself to read on. As the title says – I’m going to use Straight Talk About Suicide. This straight talk is written in easy-to-understand language that gives specific information, ways of thinking, and things you can do to back away from the brink of suicide and start learning to manage your pain and solve your problems. As a result, I will periodically address the readers who or considering suicide in the hope of giving them some inspiration, encouragement, or hope for the future that could change their mind and encourage them to choose life, no matter how painful it is at the moment, over a self-inflicted death.

For those of you who have attempted suicide and survived, this book can help you to understand what drove you to attempt to kill yourself and maybe even give you some insight into why you failed and why it is very bad idea to try it again.

I am also going to write to those of you who suspect that someone you know or love may be suicidal. If you know someone who is suicidal, your gut usually tells you they are seriously depressed, but your brain just can’t get believe they could be thinking about killing themselves. Even if you believe it, you probably don’t understand what is happening or know what to say or do that will be helpful. By the time you finish this book you will understand the suicidal process and have definite ideas about what you can say and do to help the person move back from the verge of suicide and get help.

So I decided to write this book primarily to those who know people who may be suicidal and to people who are suicidal and looking for a source of strength, hope, and help. I wrote as if I were talking directly to someone I knew and loved who was thinking about committing suicide or knew someone who was and wanted to help. As a result I have made this book as easy to read as possible. I’ve avoided professional jargon whenever possible and tried to explain complex ideas in easy to understand words.

I have done my best to make the book both intelligent and factual. I have not pulled any punches. I have written, to the best of my current knowledge, the honest truth about suicide that people need to know. This information can help you to empower people to move back from the brink of suicide and seek help. If you are suicidal, this book may give you the information, hope, and strength to back away from the brink of a self-imposed death.

As I said, suicide is not a pretty subject. Talking honestly about it may upset some people, but so be it! Sometimes being upset by the truth is the very thing that will keep you alive. It is better to be upset than settling for comfortable platitudes based upon wrong thinking that can kill you. I’d rather deal with someone who is upset and alive. It’s possible to help that person. There isn’t much help you can give someone who is dead.

Please get this book and learn how to be part of e solution. Spend a couple of hours, which is all it will take to read this book, having an uplifting and inspiring exploration of suicide that actual shows that there is hope. There is a way out. Remember, suicide is a permanent solution to a temporary problem. Let’s look at the problem of suicide, learn how to back away from, the brink of the abyss of self-inflicted death, and once again feel good about searching for the meaning and purpose of our lives.

Straight Talk About Suicide
By Terence T. Gorski 

TIP 50: Suicide and Substance Use Disorders


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