In Today’s episode, Saul talks with Joelle Johns on the importance of community education on death, dying and grief. Joelle is a pastoral thanatologist and a clinical chaplain. 

When someone close to us dies at an older age, we often take comfort not only in celebrating their life, but also in knowing that death is part of the natural process of living. This experience is not the same when you are faced with the sudden death of your child. In this episode, Julie Spears talks about the tragic death of her 16 year old son and how she has coped with it.

In today’s episode, Saul talks to Dr. Jeremy Holloway on Social Isolation in older adults and Tellegacy. Dr. Holloway is a speaker, consultant, and cross-cultural communication educator. He is also a Geriatric Professor and Director of Geriatric Education at the University of North Dakota, specializes in diversity, equity, & inclusion with a unique focus in cross-cultural communication, human connection, resiliency, self-efficacy, and personal empowerment of individuals, especially in the healthcare workforce. You can find out more about Dr. Holloway at www.jeremyholloway.com

From graduate school, she was appointed to work on the Women’s Campaign where she collaborated with Jewish women from around the state of Rhode Island and Southern Massachusetts, assisting in leadership development and strengthening women’s voices in philanthropy. 

After her first child was born, she pursued her Chaplaincy dream and worked in Miriam Hospital’s cancer unit and surgical intensive care units during her CPE residency. She worked for over 2 years at the VNA Care New England as a Hospice Chaplain and for the past 6 years (and currently) as a behavioral health clinician in Emergency Departments. 

Her unique perspective and ability to help others suffering from mental health and/or addiction and serving those individuals at end of life, is the reason Meredith says she feels honored to do this holy work.

Dr. Goodhead is a Methodist Minister with 14 years Church based experience gained in several localities throughout the UK, both urban and rural. In his role at St Christopher’s Andrew is concerned to ensure that all End-of-Life Care professionals have the skills and confidence to offer spiritual assessment and ongoing support to all patients and their families. 

He has a particular interest in the concept of spiritual pain as a way of understanding spiritual need. For patients with faith needs Andrew is developing the pastoral and religious role of the Spiritual Care Lead. Andrew graduated in 2014 with the King’s College, London, MSc in Palliative Care. His dissertation explored the experiences and attitudes of community clergy in caring for dying people. 

Andrew has published his thesis with Wipf & Stock (USA) under the title A Crown and a Cross; the Origins, Development and Decline of the Methodist Class Meeting in Eighteenth Century England. 

In November 2010, Mortality published the results of Andrew’s research into memorialization: A textual analysis of memorials written by bereaved individuals and families in a hospice context. In July 2011, The European Journal of Palliative Care published Physiotherapy in Palliative care: the interface between function and meaning, this is a philosophical examination of how physical ability affects the way in which meaning can be made. 

His most recent paper, (accepted by Palliative Medicine) based on his MSc dissertation study is ‘I think you just learnt as you went along’ – Community clergy’s experiences of and attitudes towards caring for dying people: a pilot study [in process of publication]. Andrew is a co facilitator for the Spirituality Education Group on the European Association of Palliative Care and a member of the Spirituality Taskforce of the EAPC.

In this interview, Cathy Siebold who has witnessed firsthand the evolution of hospice care since its modern incarnation in the 1960s, presents a balanced and objective analysis of the movement’s accomplishments and failings.

You can also read more about that in her book “The Hospice Movement: Easing Death’s Pains.” 

She uses social movement theory to frame her discussion. Siebold traces the bell curve of growth, maturity, and decline that, to a point, has characterized the hospice movement. Founded by a diverse group of religious leaders, nurses, social workers, and laypeople, the movement was galvanized by the plight of a silent majority: dying patients, often isolated from family and friends in a hospital where intensive, last-ditch efforts to “cure” them were valued more than their own comfort and wishes. In its struggle to survive, the movement coalesced fairly quickly around the goal of securing eligibility for reimbursement from federally funded and private insurers. The movement attained this goal in the 1980s, giving the entire concept of hospice care legitimacy and, ironically, a secure place within the same health care system early hospice activists had struggled to escape. 

You can purchase the book here on amazon.

Terence Youk began work in film and television production in1986, first as a composer and later writing, producing, directing, and editing independent documentaries, crafting promotional media and producing news spots for a variety of broadcast clients. Under the auspices of the production company, Brook Hollow Productions, Inc., he has collaborated with carefully selected creative and technical associates according to the unique requirements of each production.

 

His programs for broadcast have aired on PBS, A&E, the Wisdom Channel as well as independent distributors of educational and presentation films crafted for nonprofit institutions, including: Thich Nhat Hanh & Plum Village, National Hospice Foundation, Institute of East-West Medicine and many others. He also has served as a freelance producer for several new gathering entities, including CNN, NBC, MSNBC, and ABC news.

 

EXPERIENCE

Producer, production & editor credits include National Geographic (Most Mad Seas), A&E (Most Mad Seas), Wisdom Channel (Thich Nhat Hanh: Roots of Peace)( now defunct), PBS National (Body & Soul), CT Public television (Backyard Bird Watcher), Outdoor Life Channel (Fly Fishing in the East). News Gathering: CNN, NBC News, MSNBC, ABC news. Promotional media content: National Hospice Foundation, NHPCO, VNA of Vermont, NH VNA & Vermont Institute of Natural Science.

 

Award-winning independently produced films include: Thich Nhat Hanh: Roots of Peace, Numen: The Nature of Plants and Pioneers of Hospice & the Birth of Modern Hospice and The Next Dali Lama? (Director Mickey Lemle) released in 2017 (served as assistant editor).

 

You can find more of Terence Youk’s work on his website HERE.

In today’s episode, Saul Ebema sits down to talk remotely with Charles James Parker- the new Director of Hospice Division for the Spiritual Care Association. Here is a little insight about Charles James Parker. • Originally from Long Island NY • Prior Active-Duty Air Force (over 17 years) • Ministry over 12 years • Chaplaincy background includes: Acute Care, Oncology, Palliative Care, and Hospice. • Currently serves as a hospice chaplain/bereavement coordinator in Biloxi MS. • Adjunct Professor with the University of Theology and Spirituality.

Marellen Mayers also works as a Hospice Chaplain at Gilchrist Hospice. She has also attained the following degrees.

·        A.A, degree in Early Childhood Education

·        B.A. degree in Human Services (Social Work)

·        M.A. degree in Holistic Spirituality

Her simple-to-read approach helps anyone experiencing the “grief brain” better navigate the immediate aftermath of unexpected loss.  Chelsea’s book is a wonderful reminder that grief is not insurmountable, and with courage and action you can move through it in one piece.

The Sudden Loss Survival Guide is available for purchase on Amazon and on Amazon Kindle Unlimited. You can also order directly on Chelsea Hanson’s Website to receive a free bonus. 

Katy Butler is also a thought leader in the national movement for medical reform.  A popular speaker on doctor-patient communication and the choices families face near the end of life, Katy has given keynotes and Grand Rounds at Harvard Medical School, Kaiser Permanente, UCSF, and elsewhere. 

Born in South Africa and raised in Oxford, England, Katy came to America as a girl, earned a BA from Wesleyan University, and was a staff reporter for The San Francisco Chronicle. Her writing has appeared in The New Yorker; Mother Jones; Scientific American,Atlantic,, Tricycle, Psychotherapy Networker; Best American Essays, and Best American Science Writing.

Dame Cicely Saunders was born in 1918, the oldest of three children.  She was educated at Roedean School (1932 to 1937) and then went to St Anne’s College Oxford to read PPE.  The war intervened and with the sense that she wanted to do something more useful, she left to study nursing at St Thomas’ Hospital, qualifying in 1944.  After the war, she returned to St Anne’s and in one year completed her degree and got a Diploma in Public and Social Administration passing with distinction, then moved on to become a Lady Almoner.

Her interest in palliative care and pain control developed early.  From 1945 as an Almoner and then working in hospice care as a volunteer nurse, she was involved with the aftercare of patients with terminal illness.  She saw what was needed, particularly better pain control, and started planning a specialized hospice in the late 1950s.

Cicely Saunders opened St. Christopher’s – the first modern hospice in the world in 1967. Cicely planned that St Christopher’s would be the first research and teaching hospice linking expert pain and symptom control, compassionate care, teaching and clinical research, pioneering the field of palliative care. 

She coached judo and also competed internationally. She wrote 7 books about self-development, spirituality, and growth, some of which she co-authored with Dr. Rabbi Gil Tivon. 

 

Today she is a Holistic Counseling Doctor. 

 

Holistic healing coaching addresses all parts of an individual's life, not just the physical aspect. It's an ongoing journey of discovery in search of more answers, tools, skills, and understanding how to live better, healthier and owning your life’s journey.

In today’s episode, Saul talks to Pamela Coley, a former hospice nurse to reflect on her experience of working in hospice. Prior to hospice, she also worked as a school nurse and currently also does some local acting.  She is passionate about her faith and about educating people on what happens as we die.

Patients who are terminally ill and dying need to be heard and know they are not alone. It is essential to create an environment in which the person feels free to explore their concerns and openly express their feelings without feeling rejected or judged. Active listening involves many skills and components such as; relaxed yet engaged body posture, eye contact, reassuring touch, listening beyond or beneath the literal words said by a person to the deeper emotions, meaning, and needs.

During his family medicine residency at a Toronto shelter, Dr. Dosani had an experience with a homeless man who was dying of cancer, while also suffering with mental health issues and addictions. Despite working closely with the man to develop trust and a pain management plan, Dr. Dosani returned to the shelter one morning to learn that his patient was found dead on the street having overdosed the night before.

The experience had a profound effect on Dr. Dosani and the trajectory of his career, motivating him to find ways to bridge the gap from the policy level to the individual level.

Follow @NaheedD via Twitter: twitter.com/naheedd

She finds hospice social work rewarding because the job involves making strong connections with people, learning, and celebrating their life stories, and having a positive impact on clients and their families.

Danelle’s educational background includes.

·       Master of Divinity, Pastoral Counseling and Care at Ashland Theological Seminary

·       Bachelor of Arts in Social Work from Malone College

·       Clinical Pastoral Education (1 unit) from MedCentral Health System

·       Clinical Pastoral Education (Residency) OhioHealth Riverside Methodist Hospital

In 2017, she completed her twelve month course in Interfaith Studies followed by
a six month CPE program. In September 2019 the unexpected door of opportunity opened wide when she accepted the position to be a hospice chaplain in Oregon. Although she grew up in the Evangelical church, Tammy has now left behind her ties to Christianity and currently identifies as Agnostic Humanist. She likes to say that she is more drawn to the human spirit than the holy spirit. Warmly embracing her unknowingness which in turn allows others to do the same.

The questions this episode addresses include. 1. How has the covid-19 pandemic affected you? 2. How has the pandemic affected the practice of hospice chaplaincy? 3. Where do you see hospice Chaplaincy going after Covid? 4. How does staff support look like in this time? 5. A talk about helping those who are spiritual not religious and also those who are atheist. 6. Boundaries in Hospice Chaplaincy. Where to draw the line. It’s important to care about our work, but equally important to know when to back away

In her capacity as Clinical Director, Aracely has counseled many patients suffering from incurable and progressive or terminal illnesses and their families about end of life options and choices.

In today’s episode, we talk to our guest about his journey to Hospice Chaplaincy. On the job, Hospice chaplains have no scripts to follow or party tricks to employ. They learn to meet tragedy with humility and an open mind.

Bruce is also an author.  He writes books and study guides for his teaching ministry.  His latest book is titled Get Out of Jail Free: Breaking Out of Legalism. This book has proven to be very meaningful for people who have been exposed to legalistic teaching and helps them find liberty in their experience as a Christian. You can learn more about Bruce at: www.brucegministries.com

Derrick is very passionate and loves the chaplaincy. Derrick's life experiences have taught him, the importance of listening and meeting people right where they are with no judgments, but compassion and acceptance. He believes chaplaincy is a calling, not a job. 

In Today’s episode, Saul talks to Dr. Leanne Griffiths on the intersection between sports, living well and dying well. Dr. Griffiths is the Dean of Faculty, Sport, Technology and Health Sciences (FSTHS) at St. Mary’s University in Twickenham, London.

As Dean of Faculty, Dr. Griffiths is responsible for the expansion and development of our contemporary portfolio of programmes, the day to day management of Faculty matters and ensuring a positive working environment for staff and students.

Dr. Griffiths started working at St Mary's University as a Senior Lecturer in Sport Rehabilitation in 2011 and has been a Head of Department for Sport and Exercise Science for a number of years. She has overseen the growth and implementation of many new programmes and the expansion of sporting facilities.

Dr. Griffiths qualified as a Physiotherapist in 2008 from Keele University and completed her PhD in 2016. Her PhD investigated the effects of neuromuscular electrical stimulation on muscle adaptation in stroke patients. Her clinical time working within the NHS puts her in an excellent position to lead St Mary's through an exciting expansion of Allied Health provision within the Faculty.

 While working for the military as a DOD Contractor, she was approached by an active duty chaplain and asked if she wanted to become active duty chaplain. This led to her pursing her chaplaincy career. Although she did not go to active duty, she fulfilled all her requirements to become an active duty chaplain and mentored under the Air Force chaplains for 5 years and 2 years under an Army chaplain.

Rev. Renshin Bunce is a California native, she began her meditation practice in midlife years, propelled by yearning for a peaceful mind. In 1994 she met her first teacher, Myōgen Steve Stücky, and received lay ordination with him at Dharma Eye Zen Center in 1996. In 2002 Renshin moved to Tassajara Zen Mountain Center monastery where she lived and practiced for three years. In 2003 she received priest ordination from Zenkei Blanche Hartman, returned to Tassajara in 2008 to be Shuso (head student) with Myōgen, and received dharma transmission from him in 2013. In 2014 Renshin published an account of her journey of home-leaving in a Tassajara memoir: Entering the Monastery.

Renshin's new book, Love and Fear: Stories from a Hospice Chaplain: is a series of stories about people she has met while she learns that every death is different, and there are no universal rules or easy answers in hospice care. Through the telling of these stories Renshin shows what’s possible, allowing the reader to learn along with her as she continues to ask, What am I supposed to do? What is help? What is it to be human? You can order the book on amazon or https://www.renshinbunce.com/

 

While others might avoid elder care issues at every turn, Dr. Marion has made caring for the elderly her life’s work. She loves her work and it shows. “If an individual has lived to be 90 years old, they must have some real skills and smarts to get their needs met in life. It’s vital we tap into the wisdom, strength, and life strategies of the elderly before they pass on.”

Therefore, Ashley’s team is there to help the patient and family as they struggle to adjust to the reality they’re facing. Their primary responsibility is to the patient and making sure their wishes are honored. These wishes aren’t always in accordance with the family’s wishes. They must maintain a focus on the patient’s preferences and respecting their autonomy while at the same time supporting the family as they navigate a process they have likely never been through before.

Animal‐assisted therapy is currently provided by various health‐care or human service professionals within the bounds of their particular field of expertise. The therapeutic use of animals can occur in three basic ways: (i) pets are used as companions for individuals who are either living independently in their own home or in assisted living facilities; (ii) pets are used in institutions where they help to stimulate and/or be companions to the residents; and (iii) animals visit institutions to help stimulate the residents’ interest and provide a topic of conversation.

Hospice Chaplains spend thousands of hours perfecting skills that many people assume come naturally: sitting and listening. They become masters of the ministry of presence, bringing the same professionalism to spiritual care that doctors bring to surgery. In today’s episode, we talk to our guests about the art of Hospice Chaplaincy. On the job, Hospice chaplains have no scripts to follow or party tricks to employ. They learn to meet tragedy with humility and an open mind.

Gloria is also a trained reflexologist and occasionally works with patients with multiple sclerosis and street children in Argentina.  Her calling to hospice ministry came after the death of her 18-year-old niece with brain hemorrhage.  In 2013, she decided to also become an end of life educator. Most of her lectures are in parishes, hospitals, schools from north to south in Argentina and wherever she is invited.  

Prior to committing to making THE HUMAN JOURNEY® a working reality in professional settings around the country, Sara was a tenured professor in leadership studies. She is committed to serving those who work with families in hospice, healthcare, veterans services, and prison settings. Her work on an extraordinary yoga program started and run by incarcerated men in western Illinois was published in 2019 and she was featured in a Canadian documentary on the program, as well as on radio and television programs on her work as a performance anthropologist. 

Among her other writings are the books Art of Darkness, Vital Mummies, and Concert Song as Seen; and the plays American Yogi, Color Story, In Peerage Out, and Reprehensible Shoes. During her years in New York City, Sara was the founder and artistic director of the theatre company Chaparral Productions. 

You can find more about her work here; https://the-human-journey.com/

L’Arche is a place of mutually transformative relationships. All of us, whether or not we live with an intellectual disability, desire a sense of belonging. In L’Arche, people of differing intellectual capacities, social origins, religions, and cultures build relationships rooted in trust and vulnerability. By sharing daily life together, community members experience L’Arche as a “University for the Heart,” where they learn true friendship and teach one another to love unconditionally.

You can read more about L’Arche USA here; https://www.larcheusa.org/

Episode talking points

Dr. Doka’s childhood, family, and faith backgrounds

CPE experience in the early 70s

His master’s degree thesis on “Pastoral counseling to the dying child and his family” and the reason behind that title.

Changes in grief theories and understanding of grief in the last 50 years

The story behind his first book “disenfranchised grief” in 1989

The role of rituals in facilitating grief

The background behind his book, “Death and spirituality”

Christina Puchalski’s role in the development of spiritual care in the healthcare setting

His assumption that following this pandemic we are going to have a pandemic of complicated grief.

The need for chaplains to have good counseling referral sources.

His potential fiction book

The story behind his book “Grieving beyond gender.”

In Today’s episode, Saul talks to Shelby Forsythia about her book, “Your Grief, Your Way.” Shelby Forsythia (she/her) is a grief guide, author, and podcast host. In 2020, she founded Life After Loss Academy, an online course and community that has helped dozens of grievers grow and find their way after death, divorce, diagnosis, and other major life transitions.

Following her mother’s death in 2013, Shelby began calling herself a “student of grief” and now devotes her days to reading, writing, and speaking about loss. Through a combination of mindfulness tools and intuitive, open-ended questions, she guides her clients to welcome grief as a teacher and create meaningful lives that honor and include the heartbreaks they’ve faced. Her work has been featured in Huffington Post, Bustle, and The Oprah Magazine.

Katy Butler is also a thought leader in the national movement for medical reform.  A popular speaker on doctor-patient communication and the choices families face near the end of life, Katy has given keynotes and Grand Rounds at Harvard Medical School, Kaiser Permanente, UCSF, and elsewhere. 

Born in South Africa and raised in Oxford, England, Katy came to America as a girl, earned a BA from Wesleyan University, and was a staff reporter for The San Francisco Chronicle. Her writing has appeared in The New Yorker; Mother Jones; Scientific American,Atlantic,, Tricycle, Psychotherapy Networker; Best American Essays, and Best American Science Writing.

Chaplains spend thousands of hours perfecting skills that many people assume come naturally: sitting and listening. They become masters of the ministry of presence, bringing the same professionalism to spiritual care that doctors bring to surgery. In today’s episode, we talk to our guests about Presence, Self-care, and Holistic practices in chaplaincy. On the job, Hospice chaplains have no scripts to follow or party tricks to employ. They learn to meet tragedy with humility and an open mind.

In today's episode we are joined by three members of the spiritual care department of Elmhurst Hospital in Elmhurst, IL to talk about Hospital ministry during COVID-19. Our guest for this episode are;

1. Don Dahlheimer- Spiritual Care Manager
2. Curtis Baxter- CPE Supervisor
3. Marie Conlin- CPE student

James has had a remarkable journey from his humble upbringing in New York to serving in the United States military. It was during his military service that he sensed a call to ministry. With a strong support from his wife and children, he was able to pursue both his education and call to ministry. He is now serving as the Lead Chaplain with Palladium Hospice and Palliative care. You can find some of his writing here; https://charlesparker6.academia.edu/

As a music therapist Jen utilizes music in clinical settings for healing, building connections, and as a tool to walk with others through struggles and change. She brings healing music to patients and clients in geriatrics, hospice, mental health, and educational settings. Within the medical setting Jen incorporates music therapy into the plan of care to address issues of pain reduction, depression, anxiety, loss of control, quality of life, spiritual support and a host of other needs. She utilizes songwriting and improvisation heavily in her practice with both patients and families. You can find more about Jen Conley here; https://jenconleymusic.com/

Over the past week, the obituary pages of area newspapers have become a haunting litany of “memorial service to be held at a later date,” “no services,” and “services canceled due to COVID-19.” To be sure, this is our new normal, but for funeral directors dealing with the day-to-day business of life and death, the coronavirus and social distancing era has changed the way they help people grieve, and how funeral homes host celebrations of life. 

The lack of widespread screening means the coronavirus may well be present in countless hospital wards without anyone realizing it. Accordingly, many emergency-room workers are now behaving as if they’re already infected and separating from their families. One ER doctor said he has been sleeping in the guest bedroom for weeks. Other doctors have sent their families off to stay at second homes. 

The majority of workers who keep America’s hospitals running don’t have the salary to afford extra bedrooms, much less extra properties. For technicians, respiratory therapists, social workers, chaplains, first responders, cleaning staff, and many others, doing their job is an act of moral complexity. Without enough PPE, they’re putting their own health at risk every time they report for duty, as well as that of their families. With that we say, thank you for your service!

Saul Ebema got his bachelor's degree in Theology from the Baptist Convention College in Soweto. He then got a Presidential Scholarship from Northern Seminary where he was able to complete his Masters in Divinity and Doctorate in Ministry.

Cassandra is the co-founder of On Purpose Consulting Group; a nonprofit designed to help women live their lives on purpose, for purpose, and with purpose.  She focuses on leadership strategy, coaching, content, and community. For over 12 years, she has also been working as a nurse. Serving in different fields including; oncology, ER, and Home Care.  Cassandra is passionate about helping those who help others to understand the cost of caring and how to effectively combat fatigue. 

Storm has a unique background that includes 25+ years of bringing music to persons in need through her work in a community music school, special education classrooms, physical and mental health hospitals, hospice and elder care facilities.  Her Master of Music and Bachelor of Music degrees in Music Therapy are from Western Michigan University.  She is a regular speaker on the topic of music therapy in university classrooms, regional, and national conferences.

In today’s episode, Saul talks to both Karen Oikonen and Kate Wilkes on “Constellations: Designing participatory engagement and end of life.”

Kate Wilkes is a service designer based in Toronto, Canada. Passionate about meaningful collaboration, Kate is always keen for opportunities to leverage diverse perspectives to make sense of complex problems in pursuit of impactful solutions. Kate studied at the University of Toronto, George Brown College's Institute without Boundaries, and the Dun Laoghaire Institute Of Art, Design + Technology in Ireland. Kate’s interest in the death, dying, and the end of life period is rooted in her own experience navigating her mother’s illness and death in 2015.

Karen Oikonen is also a designer based in Toronto, Canada. Shas a Bachelor of Interior Design from the University of Manitoba and a Masters of Design in Strategic Foresight and Innovation, from OCAD University. She teaches design research at OCAD University and design thinking at Sheridan College – She finds that having a foot in an academic environment challenges her perspective and is deeply fulfilling. Her experience in health care helped to develop a rigorous approach to research while allowing her to engage directly with patients, caregivers, and clinicians – this helped shape her exploratory path to innovation design – from visual and spatial design to service design and design research.

You can find the constellations images here.

In today's episode, our hosts Joe Newton and Saul Ebema sit down to talk with Erik Cremeans. Erik shares his journey from childhood and the lessons he has learned along the way that influence his work as a professional hospice chaplain. 

Chaplain Erik is also a theologian, a thinker and a short story writer. He looks at himself as a curator of people’s stories and in his writings, he captures the beauty within those bedside narratives. Here is a piece he wrote for; https://hospicechaplaincy.com/2020/02/16/stone-the-crow-a-chaplains-reflection-on-death-and-dying/

Terri conducts workshops throughout the U.S. to help the dying and the bereaved find healing through meditative, ritual and therapeutic processes that focus on inner transformation rather than external events. 

Her work is acclaimed by physicians, hospice workers, grief counselors, clergy and the bereaved for its pinpoint clarity on the process of dying and grieving, and its heartfelt depiction of consciousness beyond the physical body. 

She is also an author who has written a number of books including;

1.     GRIEF AND GOD: When Religion Does More Harm Than Healing (2019)

2.     ​TURNING THE CORNER ON GRIEF STREET: 
 Loss and Bereavement  as a Journey of Awakening (2014)

3.     EMBRACING DEATH: A New Look at Grief, Gratitude and God (2010)

4.     A SWAN IN HEAVEN: Conversations  Between Two Worlds (2007)

In this week’s episode, Dr. Saul Ebema and Dr. Joe Newton sit down to talk about the challenges of the family members of the hospice patient and how to help them.

When a member of the family is dying, unique problems arise. These problems usually begin at the time of diagnosis. Communications often becomes difficult as family members experience different stages of grief. Early in terminal illness, there are the emotional burdens of learning of the illness and coming to accept a terminal diagnosis, of giving up hope of cure and choosing comfort measures. In addition to grieving for the potential loss of the loved one, there is also the grief for the death of the family unit as it has existed before. Although the family will continue after the death, it will forever be changed by the death.