“Being prepared to die is one of the greatest secrets of living.” George Lincoln Rockwell


It is strange the number of Stepping Stone Hospice referrals we have received over the past two weeks.  The patients have controlled pain and symptoms.  Many caregivers are also looking for a dumping ground.

Pain at the end of life is inescapably interwoven with, and often amplified by, multiple levels of emotional and spiritual angst as the inevitability of death looms. Fear, a potent pain magnifier, is the dominant emotion – fear of pain, fear of death, fear of the unknown…..

It is a fact that people at the end of life fear pain even more than they fear death. Sadly, for many dying patients, pain seems like the ultimate torment, and death is its cure. It does not have to be this way, and if you or a loved one is facing death, you have every right to ask that your final days not be consumed by pain.

It is estimated that a maximum of 5% of people who die from terminal illnesses in South Africa have access to adequate palliative care. Even in hospitals, treatment is far from ideal, because doctors and nurses have seldom had training in palliative care and have little idea of what to do with the patients.

Dying patients are often prey to a host of anxieties about the state of their affairs, about the fate of those who will grieve their loss, and about how their behaviour will be seen, and possibly judged, during their final hours. And of course, there are often deep spiritual and religious questions to address. Did my life have meaning? Will my soul survive my body? Am I at peace with myself, my family, and my friends?

Not least of all these concerns, people at the end of life worry about how their pain will be managed. Will they be under medicated and have to ask, or even beg for relief? Will they be over-medicated and lose consciousness during their precious waning days and hours?

They may even be afraid to complain. If they do, will they be seen as whiners or quitters? If they ask for narcotics, will they be judged by their doctors as drug seeking, drug addicts or even cowardly? Or will their medical care be relegated to comfort measures only, while all efforts to cure their illness are suspended?

I read the post of an amazing woman who is suffering from congenital heart failure.  She is in so much pain.  I cried when I read her post.  http://thedrsays.org/2012/11/08/  She replied to a question whether better pain control was possible…..  “there is nothing that will let me participate in life and have relief. so at this point i am going for being lucid over some so-so pain relief. who knows how long before i cave. when the time comes i plan to take advantage of whatever is available to me. just my personal choice right now.”

I thank God that we are able to make a difference!

“Being prepared to die is one of the greatest secrets of living.” George Lincoln Rockwell

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Another birthday…..one year ago


Yesterday I celebrated (another) birthday.

Late Saturday night Vic’s restlessness was indicative that she was determined to be the first to wish me.  At 11.30 pm she came through and said “another half hour….. I want to be the first to wish you Mommy.  I just want 30 minutes alone with you on your birthday…”

“No problem angel.  I’ll switch the kettle on.” I said

“I will be back in a minute” she said

I made coffee and checked some e-mails.  At 12:00pm I expected her to come through singing “Happy Birthday” but no Vicky….

I went through to her room and the poor baby had fallen asleep on her bed…

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Jon-Daniel came through and brought me a cup of tea on a tray, with a gift and card and a rose!  “Happy birthday Oumie” he said.

He had bought a book I have wanted to read for a while “The Elephant Whisperer” – It is an inspiring, true life drama of a herd of wild African elephants on an African game reserve. The herd is destined to be shot for dangerous behaviour when this special human being, Anthony, intervenes to try to save their lives.  I was so thrilled that he remembered.

Just before 01:00 am Vic shuffled into my TV lounge.

“Oh Mommy, I am so sorry I fell asleep.  I thought I would just close my eyes for 5 minutes whilst you make the coffee…”

We sat and chatted for a while.  Vic shared her good wishes with me and we just sat and spoke.  We spoke about our very special mother-daughter relationship.  We spoke about years gone by and how blessed we are to have this time together. (I cannot imagine Vic married and living in someone else’s home on her final journey.)

The girls, Esther and Lani, arrived at 10:00am with gifts, a cooked meal, dessert and cake.  The grandchildren set the table…  My sister Lorraine and dear friend Judy arrived bearing armloads of gifts.  The grandchildren had written me letters and cards – it was so special.  Vic bravely cooked a pot of rice and had lunch with the family.  All the grandchildren swam and played tug-a-war!   We laughed and joked.

It was a perfect day.

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Esther and Lani planned the day to start early whilst Vic is at her best.  As the day progresses so her energy levels decrease.  Immediately after lunch Vic went to bed.  She was in so much pain and absolutely exhausted.

All the grandchildren wanted to stay.

Sunday evening we Skyped my son and his family in the UK.  Vic and Danie spoke.  Vic and Danie Jnr have a special bond.

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Twenty two years ago I married Danie Sr and his four children; Esther 23, Lani 18, Liza 16 and Danie 11…  Danie married me and one, sick, very protected, spoilt brat, Vicky, aged 16.  Vic and Danie Jnr were the two kids who lived with us.  Vic embraced her new family.  (I was petrified of the children!)

Vic’s siblings have been amazing over the years.  I could never have coped as well as I do if it was not for their love, support and encouragement.  The siblings are fiercely protective of their little sister.

Vic and Danie Jnr spoke for at least 10 minutes last night.  It was a sad conversation between a brother and his older, little sister.

“I miss you so much Little Brother” Vic said

“I miss you too Vic.  How are you feeling?”  Jnr asked

“I am battling Boetie (Little Brother) Vic said

“We are coming to visit in April then I will see you Vic”

“I don’t know if I am going to make it to April” Vic said

“Just hang in there Vic.  It is not that long to April…” Jnr consoled her

“I know but I am tired.  I am just missing you” Vic cried

“I will fly over for a weekend.  I want to see you again” Danie promised

Vic was so tired last night.  Her little body cannot handle parties anymore.  She tries so hard.  This weekend we will have Jared’s 16th birthday.  It is only his birthday on the 26th but most of his friends are away for Christmas so we have his friend party an early in December.

I know this will more than likely be another last for Vic.

Vic and Nelson Mandela meet


It was a horrible time of our lives when Vic started going to the Pain Clinic.  Her pain was out of control – or so I thought.  It was actually just “preparation school” for what was yet to come….  I was mortified that she was on 600 mg of morphine, a week…. When Hospice accepted Vic onto the program in 2013, a mere 9 years later, she was already on 600mg of morphine, twice per day.

I digress.

Vic needed to consult with an anaesthetist, specialising in pain control, on a monthly basis.  He would examine her and re-evaluated her pain medication. We need an original prescription for morphine. It was one of those dreadful experimental phases of her life.  But, bad things lead to great things…

The Pain Clinic was situated in an élite part of our city.  It was a mission to get to it and took many hours out of a day.

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“If you wish to remember me, do it with a kind deed or word to someone who needs you. If you do what I have asked, I will live forever.”

This particular day Vic was in terrible pain, and it was difficult moving her from the car into the wheelchair.  Her beautiful eyes were dark from pain and filled with tears. I remember thinking “How tiny and sad she looks”…

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We stood waiting for the elevator. It felt like a lifetime.  All I wanted to do was get Vic into the consulting rooms so she could get a booster shot of morphine. I was getting quite impatient, with the delay of the lift, when it started moving down.  I noticed quite a build-up of people on the outer periphery but did not pay too much attention to them. I was totally focussed on my child’s pain and discomfort.

The door opened.  Two tall men, wearing sunglasses, walked out.  There was an audible gasp in the hall.  The greatest statesman in the world, Nelson Rolihlahla Mandela, stood behind them.  He was so tall! In total awe I moved Vic’s wheelchair back clearing the way for this amazing man.

He walked out of the lift and walked towards us.  He stood in front of Vic. He stooped down, stuck out his hand, and said “Hello my dear.  How are you?”

“I am fine thank you Mr President,” Vic said

“I hope you feel better soon,” he said in his beautiful, raspy yet gentle voice.

He greeted me, still holding her little hand.  I will never forget his gentle eyes.  He had an aura of greatness.

Vicky and Nelson Mandela – Two great warriors locked in a moment of kinship.

“Goodbye” he said and walked away.

I know that Vic and Nelson Mandela will meet, again, in Heaven…  I believe that the two brave souls will recognise one another.  This time there will be enough time for them to linger and chat.  The people they are it will be about their loved ones, the grace they experienced in their lives… I know they will not discuss the hardship, pain or suffering they lived…

Two incredible people… Nelson Rohihlahla Mandela and Vicky Bruce.  Heroes of many… two people who made a difference, through their suffering; their bravery and inner strength.

 

Nelson Mandela Dead at 95


December 5, 2013 5:03 PM ET
Former South African President, Nelson Mandela
Former South African President Nelson Mandela
Dave Hogan/Getty Images

Nelson Mandela, the Nobel Peace Prize-winning anti-apartheid leader imprisoned for decades before becoming South Africa’s first black president and an international symbol of freedom, has died at 95. He had long been battling complications from a respiratory infection.

Look back at Nelson Mandela’s life in photos

Mandela was at the center of sweeping changes across South Africa during a tumultuous period that saw the former Dutch and English colony transition from apartheid‚ a racist class structure in place since the early 1900s that limited the rights of black South Africans and codified rule by the white Afrikaner minority‚ into an inclusive democracy that enfranchised millions of non-whites who were deprived even of their citizenship under the repressive system.

His opposition to apartheid came with a cost: Mandela spent 27 years as a political prisoner for his association with the African National Congress, a black-rights group that sometimes resorted to violence in resisting the white government. Denounced as a terrorist and communist sympathizer, Mandela spent close to two decades of his internment in a dank concrete cell on Robben Island, where the glare of the sun during his work shifts in a lime quarry permanently damaged his eyesight. An international campaign resulted in his release from prison on February 11th, 1990. Negotiations soon followed with South African President F.W. de Klerk that led to the dismantling of apartheid four years later, when South Africa held a multi-racial general election that elevated Mandela to the presidency. In 1993, he and de Klerk were awarded the Nobel Peace Prize for their efforts.

As president, Mandela sought to repair rifts among South Africa’s factions and ethnicities, and he enacted a new constitution, appointed a diverse cabinet and established a Truth and Reconciliation Commission to investigate crimes committed under apartheid by the government and the ANC. He declined to run for a second five-year term, and left the presidency in 1999.

“Mandela shows what was possible when a priority is placed on human dignity, respect for law, that all people are treated equally,” President Barack Obama said while visiting South Africa over the summer. “And what Nelson Mandela also stood for is that the well-being of the country is more important than the interests of any one person. George Washington is admired because after two terms he said enough, I’m going back to being a citizen. There were no term limits, but he said I’m a citizen. I served my time. And it’s time for the next person, because that’s what democracy is about. And Mandela similarly was able to recognize that, despite how revered he was, that part of this transition process was greater than one person.”

Born to illiterate parents with distant connections to the ruling family in one of South Africa’s indigenous territories, Mandela spent his childhood tending cattle and attending a local Methodist mission school, which instilled in him a lifelong love of learning. His political awakening began when he developed an interest in his African heritage while attending a college for black students, and deepened while he studied law in the Forties, when he joined the ANC.

Mandela rose through the ranks of the ANC’s Youth League, which elected him national president in 1950. Inspired by Gandhi, he initially advocated nonviolent resistance before adopting a more militant outlook in the mid-Fifties as civil disobedience proved ineffective. He was first arrested in 1952 as part of a government crackdown on suspected communists, and he spent the next 12 years in and out of custody as he and the ANC worked to undermine apartheid. He was convicted in 1964 on charges of conspiracy to violently overthrow the government and sentenced to life in prison.

His imprisonment prompted an international outcry, and apartheid made South Africa the subject of economic sanctions and cultural boycotts in the Eighties that helped secure Mandela’s release and end apartheid.

After he left the presidency, Mandela established the Nelson Mandela Foundation to combat the spread of HIV and AIDS and advocate for rural development and the construction of schools. He became a vocal critic of the U.S. and Britain for their 2003 invasion of Iraq, and though he largely retired from the public eye in 2004, Mandela helped bring the World Cup to South Africa in 2010.

Mandela is survived by his third wife, Graça Machel, whom he married on his 80th birthday, and his ex-wife Winnie Mandela, along with three children, 16 grandchildren and numerous great-grandchildren.

http://www.rollingstone.com/politics/news/nelson-mandela-dead-at-95-20131205

Read more: http://www.rollingstone.com/politics/news/nelson-mandela-dead-at-95-20131205#ixzz2mdsxgxnB
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“Time takes us farther away…”


I have battled to blog. I feel that my words are rehashed from one post to the next. My emotions are the same.

My DiL and the three girls have spent 3 weeks in South Africa. It has been amazing hearing the patter of little feet down the passages, shrieks of laughter and anger… I will always cherish the little arms around my neck, the warm little bodies in my bed. I cherish the time I got to spend with my DiL; the chats into the early hours of the morning and the countless cups of tea. It reminded me of when Vic was still alive. I dread leaving England on Monday to return to my solitude and grief.

I feel guilty about posting my same tearful stories of grief and I feel guilty that I have become embarrassed by exposing my soul to the world – friend and foe alike.

The past four weeks life has been easier. I have laughed and smiled. I have had fun.

In 8 days’ time it is Vic’s birthday. I am filled with trepidation as to how I will cope. The second I think of Vic, tears well up in my eyes and there is this stabbing pain in my heart. I have decided that I will not move Vic’s ashes into the garden. Vic will remain on the sideboard where I can see her and run my hand over her little casket. Vic will not be exiled into the garden. She is part of our lives and she will remain exactly where she is.

I am wondering whether I should bake Vic favourite chocolate cake… The boys want to send up Chinese Lanterns we actually wrote messages on, on New Year’s Eve 2010. Vic was desperately ill in hospital and moved into ICU on the 1st of January 2010. She was devastated. The staff allowed us to spend the evening with her.

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At 12 O Clock we went outside to send up the Chinese lanterns. It rained and we undertook to do it when Vic was home again. Somehow we never did. When we returned to the ward, the staff had assembled in the visitors lounge. Someone had conducted a Mid-Night service. The staff sang beautifully and prayed for the patients. Many of them laid hands on Vic. Vic cried. Jon-Daniel was inconsolable. We all cried.

One of my blogger friend’s sent me this email “Oh, Tersia. You are held tight in the grip of horrific grief. Simply knowing that someday you will wrench free from such a suffocating grasp brings no relief at this moment. You already know you cannot fight it. Flow with the “ocean of tears.” A great deal of the horror is behind you, but you are reliving it. I distinctly remember that the WORST time in my grief came at six months and followed me until the end of the first year. Like an amputation without anaesthesia – you are deeply suffering and so many people feel your pain. Keep writing, crying and feeling. The ocean of tears will take you to a new shore. Time takes us farther away from our loved one. That is the agony and the anaesthesia. Such conflict that creates! Feel my hug because I’m with you.” http://judyunger.wordpress.com/

Another one of my blogger friends, Julie, is taking a sabbatical from blogging. She wrote “Just until my heart catches up with my voice. So much is happening, and so much is not happening – argh!”

I wonder whether my heart will ever catch up with my voice…

Where is Auntie Vicky’s skin?


Those of you that follow my blog will know that my UK grandkids are visiting. They are the cutest, brightest and busiest little girls in the world. They are a source of immense pleasure and joy in my life.

They left South Africa exactly two years ago. I cried for a week. In the two years I have seen them 5 times. In terms of international travel it is a lot but in terms of a grandmother’s heart it is not nearly enough. When they lived in South Africa we saw them at least once a week.

Osama (the eldest terrorist) is 5.5 years old. She is bright as a button and full of tricks. She told me, in confidence, that when she turns 6 she is going to marry her “boyfriend” Freddy… I tried to use the impending marriage as a bargaining tool to encourage her to help tidy up her room.

Me: “Sweetie if you want to marry Freddy you will have to learn to tidy your room. What do you think his Mommy will say if she sees your toys lying around? He won’t marry an untidy girl…”

Osama: “That’s okay Oumie. Then I will marry someone else…”

This little girl has a mind of her own. She is heartbreakingly beautiful. Her eyes sparkle with the joy of life and intelligence. She is also kind and caring (a little manipulative as well). She has me twisted around her little finger! She also has an amazing memory!

She was 3, 5 years old when they left South Africa.

She was so excited to visit South Africa and kept sayings things like “I remember your big (dining room) table; where will I sleep? In my old room?” She always throws in the odd “Do you remember….?” She remembers their South African home and her school. She remembers the sunshine. She remembers Vic.

“Oumie….why did Auntie Vicky die?” is her daily question.

Her mommy and daddy have told her that Auntie Vicky’s soul is in Heaven with “Baby” Jesus… She is happy that Auntie Vicky is no longer sick. The big question is however “Where is Auntie Vicky’s skin?”

This is a difficult question to answer honestly. If I told the little poppet that her precious Auntie Vic is lying on the antique sideboard table, in a little box with a brass plate on the lid, she would be distressed… So I sort of implied that she was buried…

“Is Auntie Vicky’s skin in a box (coffin)?” she asks

“Yes” I would say. “But remember, Auntie Vic does not need her skin anymore. She has a new skin and beautiful angel wings in Heaven.”

“Is Auntie Vicky a Zombie?” – She shivers and says “Oooohhhhhh, I am so scared of Zombies!”

“No sweetie, she is an angel.” I said

I am sharing an excellent guide to help

the young, understand something that most adults battle with! http://www.hospicenet.org/html/understand.html

Children’s understanding of Death is provided by Hospice of Southeastern Connecticut Bereavement Program. This chart is meant to be used as a guideline and not a checklist. All children develop at different rates and it is important to remember that the parents know their own child the best.

Newborn to Three Years
Child’s Perception: Infant/Toddler can sense when there is excitement, sadness, anxiety in the home; can sense when a significant person is missing, presence of new people

  1. No understanding of death
  2. Absorbs emotions of others around her/him
  3. May show signs of irritability
  4. May exhibit changes in eating, nursing patterns, crying, and in bowel and bladder movements
  5. Depends on nonverbal communications; physical care, affection, reassurances

Providing Support:

  1. Keep normal routines and structure whenever possible
  2. Be verbally and physically affectionate and reassuring
  3. Provide warm, loving caretaker when parent is not available
  4. Exhibiting healthy coping behaviors

Three to Six Years
Child’s Perception: Child thinks death is reversible; temporary, like going to sleep or when a parent goes to work; believes that people who die will come back

  1. “Magical thinking”; believes their thoughts, actions, word caused the death; or can bring deceased back; death is punishment for bad behavior
  2. Still greatly impacted by parent’s emotional state
  3. Has difficulty handling abstract concepts such as heaven
  4. Regressive behaviors; bed wetting, security blanket, thumb sucking, etc.
  5. Difficulty verbalizing therefore acts out feelings
  6. Increased aggression – more irritable, aggressive play
  7. Will ask the same questions repeatedly in efforts to begin making sense of loss
  8. Only capable of showing sadness for short periods of time
  9. Escapes into play
  10. Somatic symptoms
  11. Hungers for affection and physical contact, even from strangers
  12. Connects events that don’t belong connected
  13. May exhibit little anxiety due to belief that deceased is coming back

Providing Support:

  1. Keep normal routines and structure whenever possible
  2. Provide opportunities to play, draw
  3. Read books on death & loss with child
  4. Help to verbalize feelings and fears
  5. Help to identify feelings and reactions
  6. Be honest and tell a child if you do not have an answer
  7. Explain in specific, concrete language – not euphemisms; explain what has happened giving specific explanations about physical reality of death
  8. Gently confront magical thinking
  9. Make sure child does not feel responsible for the death
  10. Be tolerant of regressive behaviors
  11. Modelling healthy coping behaviors
  12. Avoid clichés; “At least you have another brother”, “You can always get a new pet”
  13. Use specific, concrete words – not euphemisms; Avoid “Mommy has gone to sleep”, “God has taken Grandpa”

Six to Nine Years
Child’s Perception: Child begins to understand the finality of death; some do and some may not.

  1. Sees death as a taker or spirit that comes and gets you
  2. Fear that death is contagious and other loved ones will “catch it” and die too
  3. Fascinated with issues of mutilation; very curious about what body looks like
  4. Connects death with violence and may ask, “Who killed him?”
  5. 3 categories of people. who die: Elderly, handicapped, klutzes
  6. Asks concrete questions
  7. Guilt – blames self for death
  8. May worry how the deceased can eat, breathe, etc.
  9. Continues to have difficulty expressing feelings verbally
  10. Increased aggression
  11. Defends against feeling helpless
  12. Somatic symptoms
  13. School phobia (especially if single parent)
  14. Continues to have difficulty comprehending abstractions such as heaven, spirituality

Providing Support:

  1. Talk with child
  2. Ask questions
  3. Make sure child’ does not feel responsible in any way
  4. Identify specific fears
  5. Provide opportunity for play, drawing, art
  6. Normalize feelings & fears
  7. Address distortions & perceptions
  8. Be honest and tell a child if you do not have an answer
  9. Help to cope with impulse control
  10. Help them share bad dreams
  11. Help them with positive memories of the deceased
  12. Model healthy coping behaviors
  13. Avoid clichés; “Don’t worry, things will be O.K.”, “You’re such a strong boy/girl”
  14. Use specific, concrete words – not euphemisms; Avoid “Grandma went to sleep and is now in heaven”, “Grandma was very sick and the sickness made her die”

Nine to Thirteen Years
Child’s Perception: Child’s understanding is nearer to adult understanding of death; more aware of finality of death and impact the death has on them

  1. Concerned with how their world will change; with the loss of the relationship, “Who will go with me to the father-daughter banquet?”
  2. Questions have stopped
  3. Fragile independence
  4. Reluctant to open up
  5. Delayed reactions – at first seems as if nothing has happened, then grief reaction May show strong degree of affect
  6. Beginning to develop an interest in rituals (spiritual effects of life)
  7. Disrupted relationships with peers
  8. Increased anger, guilt
  9. Somatic symptoms
  10. School phobia
  11. Self-conscious about their fears (of own death, remaining parents)

Providing Support:

  1. Encourage discussion of their concerns
  2. Provide & encourage expressive experiences such as writing or drawing
  3. Address impulse toward acting out and allow opportunity to identify their feelings
  4. Allow for regressive behaviors
  5. Be honest and tell a child when you do not have an answer
  6. Gently relieve child from attempts to take over adult responsibilities
  7. Model healthy coping behaviors
  8. Avoid clichés; Avoid “You must be strong so I don’t have to worry about you”, “Big boys don’t cry”

Thirteen to Eighteen Years
Adolescent’s Perception: Adolescent has adult understanding about death

  1. Death is viewed as an interruption. Death is an enemy
  2. Bodily changes emphasize growth and life. Death is a contrast
  3. Increased vulnerability due to many other changes and losses simultaneously occurring
  4. A sense of future becomes part of their psychology
  5. Increased risk taking in effort to reduce anxiety or to defy fate
  6. May intellectualize or romanticize death
  7. May act indifferent to death of someone close as a protection against feelings
  8. May show full range of affect or almost no affect
  9. Wants to grieve with her/his peers not adults
  10. May need permission to grieve
  11. Suicidal thoughts
  12. Represses sadness, feels anger, depression
  13. Escapes; drives fast, uses drugs or alcohol sexually acts out
  14. Denial – tries not to think about it, doesn’t want to talk about it
  15. Difficulty with long term plans
  16. Somatic symptoms
  17. Questions religious/spiritual beliefs

Providing Support:

  1. Don’t assume they can handle themselves and their problems without help, support
  2. Be available, but don’t push
  3. Help them find peers who will support their feelings
  4. Or find other trusted adults
  5. Give permission for regression
  6. Be honest and say when you do not have an answer
  7. Assist in relieving adolescent of burden of adult responsibilities
  8. Help impulse control toward reckless behavior
  9. De-romanticize death
  10. Discuss feelings of helplessness
  11. Model healthy coping behaviors
  12. Avoid clichés; “You’ve got to be strong to help your mother”; “You seem to be taking this so well”, “Now you’re the man of the house.”