NTM Sampler 5 - Natural Transitions

Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
I N a t u r a l Tr a n s i t i o n s M a g a z i n e I 10
Rebecca Teague
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Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
a time to die...
Rebecca Teague
Love in the Room
By Rebecca Teague
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Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
ALL PHOTOGRAPH BY AKristine Lauria
cultural contrasts
Amish Ways:
Not Always Plain & Simple
By Kristine Lauria
T
he Amish are born at home and die at home. This is
their way.
I began my midwifery apprenticeship in 1989, with Mary,
who was serving the Amish in rural central Ohio. I had often heard the Amish referred to as “plain and simple.” But
their lives are as complex as the exquisite quilts for which
they are so well-known.
Mary and I did rounds on Mondays and Thursdays, driving
to each family that needed a prenatal or postpartum visit.
Impending births were kept secret from the children, who
were not supposed to know why we were there. They
were always shooed outside to play when we arrived.
Once while peeking out the window, we
caught a glimpse of several climbing the
bumper of Mary’s Bronco. We overheard
one say, “This must be where they hide
the babies.”
moving at 36 weeks of pregnancy, Mary and I confirmed
what Mattie already knew: her baby had died. After some
discussion, it was decided we would induce labor the
next day at Mary’s house. Mattie did not want to wait for
labor to start on its own; it could be weeks away.
The castor oil and herbs we used to induce labor worked
quickly and a normal labor pattern was established by
noon the following day. Around suppertime, Mattie was
ready to push. It was difficult, I could tell. She later told
me the baby did not help. No, it wouldn’t, I thought.
There was no life force there. At 7 pm, Mattie delivered
a girl, slack and still, into my hands. I cut the cord; there
was no reason to allow it to pulsate. Reverently, I wrapped
the baby in a blanket, and handed the
bundle to her mother. The room was quiet
as snowfall, unlike any other birth I had
attended.
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The Amish are cordial but reserved
when first meeting outsiders, or “English.” Even though I was with Mary, they
still had to scrutinize and question me.
Only after attending births in which I
dealt appropriately with complications was I fully accepted, and trusted.
I met Mattie in mid-summer when she was halfway
through her second pregnancy. A statuesque, sturdy,
German-looking woman with luminous blue eyes and
blond hair, she was 24-years-old, only two years younger
than I was at the time. When she didn’t feel her baby
5 I Summer 2011 I
There was to be only a small, familyattended burial on the third day, which
was customary. The little girl would not
be named; she would be buried in the
cemetery across the road from the family’s
farm, in an unmarked grave. I was disappointed that I wasn’t invited to attend, and sad that the
little girl’s brief life seemed to mean so little. But, having
seen parental grief on several subsequent occasions, I
have come to understand it better. I believe the grief is
so private that parents do not want anyone else to bear
witness to their agony. It is so profound and tender, no
onlooker could ever begin to understand.
Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
Aside from a few postpartum visits, I would not see Mattie again until she became pregnant with another baby.
But at six weeks postpartum, she hemorrhaged so badly
that Jacob, her husband, called an ambulance. Mary
and I went to see Mattie as soon as she was home from
the hospital. We found out her hemorrhage was due to
choriocarcinoma, a rare cancer that sometimes develops
after a pregnancy. It was growing rapidly, but was curable
with chemotherapy and radiation. Not only could Mattie
survive this, but she could go on to have more babies. I
read all I could on the subject to help Mattie be better
informed.
The autumn leaves were falling when I started driving
Mattie and her mother back and forth to
the oncologist at University Hospital in
Columbus, where she could have blood
drawn and start her treatments. The
oncologist was kind and gentle. I probed
him with questions and he answered
every one, so I could help the family
understand what was happening. But
after the first chemotherapy treatment,
Mattie was sick and vomiting. Her hair fell
out in clumps. She refused further treatment and would
not go back to the hospital. She asked me to inform the
oncologist.
than that to know what was written. This would be the
last time I saw him. I thanked him for all he had done for
Mattie, and for all he had tried to do.
I still visited Mattie every week. We were friends now.
One clear and bright day in June I arrived while Mattie
was weeding in her vegetable garden, her toddler at her
side. Amish gardens are a thing of beauty because they’re
framed with rows of marigolds to keep the bugs away. It
is clear they take much pride in them, even though pride
is not a quality the Amish embrace. Mattie looked thin
and frail. Her breathing was labored. By this time I had
read enough to be an expert on this cancer, and I knew it
had spread to her lungs. My heart sank. Until then I had
held out hope for a miracle; who was
I to doubt their faith? But this was the
moment I knew for certain she was
going to die.
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It was later decided that I would be allowed to do a
weekly blood draw on Mattie to check her HCG level.
Measuring this hormone was the only way to know if the
cancer was growing. The oncologist also provided IV bags
of chemotherapeutic drugs, which Mattie agreed I could
adminster to her at home. Without the localized radiation, however, he was doubtful that chemotherapy would
help. But he was willing to do anything to keep Mattie
from completely backing out of treatment.
All winter I made my weekly pilgrimages to Mattie’s
house. I would start her IV, hook up the bag, and Mattie
and I would have tea and talk while the drugs dripped
slowly into her veins. The treatment was not working.
Lab tests revealed her HCG level climbing at an alarming
rate. Mattie and her family decided on a hysterectomy,
since the cancer originated in her uterus. The cancer had
already spread to other parts of her body, however, so a
hysterectomy would not help. But no amount of explanation would persuade them to let go of this idea.
The oncologist agreed to the surgery. He bartered two
beautiful quilts for his fee; the family would only have
to pay the hospital bill. He also agreed to return Mattie’s
uterus after it had been examined by pathology. The
Amish do not leave body parts behind; they believe in
a proper burial for all parts of the person. So, after the
surgery, I retrieved the uterus from pathology and gave it
back to Mattie.
The surgery did not help, and the family did not understand. They asked me to deliver a note to the oncologist.
He greeted me in his office and I sat across from him as he
read it. Tears welled in his eyes, and I didn’t need anymore
The months passed and Mattie got
sicker. I visited her every time I did my
rounds in her community. By December, snow was falling and Mattie
was bedridden; her belly was filled
with so much fluid that she appeared to be in the ninth
month of pregnancy. I said my final goodbye to her that
day, because I knew I would not see her alive again. The
call came a day later. Mattie had passed and the funeral
would be in three days. I was invited to attend.
In the three days following an Amish death, the body is
washed, and white clothes are prepared. For a woman,
this is usually the shawl and bonnet she wore at her wedding. The body is never left unattended. A pine coffin is
made by carpenters in the community. It is simple and
unadorned, with no lining or padding inside. It takes the
full three days to dig the grave, a job performed by men
in the community. The task would be especially difficult
for Mattie, because the ground was frozen. The women
start baking and cooking for the lavish meal served after
the funeral service.
On the third day, I drove to Mattie’s parents’ house. A sea
of black buggies covered the huge yard, along with a conspicuous row of passenger vans hired by the Amish that
had come from neighboring states. My red Mazda looked
out of place. As I walked past the group of van drivers,
they stopped their conversation, eyed me curiously, and
nodded politely in unison. I heard one of them whisper
“Mennonite.” It was beyond their comprehension that
an “English” would be at an Amish funeral; indeed, it was
almost unheard of.
As I reached the house, an Amish woman came out to
greet me. She had clearly been assigned to watch for my
arrival. It would have been a huge faux pas had I gone into
the house where the men were gathered. During community events men and women are separate. The women
waited in another building.
Once we were called to enter the house, I followed the
lead of the Amish women. There were rows and rows
I N a t u r a l Tr a n s i t i o n s M a g a z i n e I 6
Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
of benches; everything else had been
moved out of the room. We all sat
sandwiched together on the benches
designated for women, which were
across from the men who had entered
the house from a different door. The
casket was in the center of the room.
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The preacher began the service. Not only was it three
hours long, but was also in German. I had plenty of time
to ponder what was, to me, the senseless loss of my
friend. I didn’t know whether the decisions about Mattie’s
health care were her own, or were made by her parents
and the elders of the church. At the end of the service
there was a pause, then some words that were repeated
in English, just for me: Mattie’s full name and the dates of
her birth and death.
We all filed past the casket on our way out. Mattie was
dressed in white, ready to be buried next to her baby
daughter. The casket was carried out by four men and put
in a black buggy, which would take her to the cemetery.
Another brief service would be conducted there for the
immediate family.
As soon as everyone had filed out, the women hurried
7 I Summer 2011 I
to other buildings, and, carrying copious amounts of food, went back into the
house. When we were ushered back in,
rows of tables and benches had been
set up and food laid out. The women
with whom I sat were kind and friendly
towards me – everyone seemed to know
who I was. After eating, we quickly moved
on so the table could be cleared for the next group to
come in and eat. There were over 300 people. The whole
event was orchestrated with expert precision and speed,
although I never felt rushed. I marveled at this efficiency,
just as I did for almost everything I witnessed among the
Amish.
My experiences with the Amish forever altered my
perceptions on death and end-of-life issues and choices.
Although I did not understand the choices Mattie and
her family made, I came to respect and honor them.
And, after many years, I have come to realize that choices
surrounding death, like birth, aren’t always so plain and
simple.
Kristine Lauria currently lives with her son and practices midwifery in Nederland, Colorado.
Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
cultural contrasts
Grief and Joy Walk
Hand in Hand
By Willow Ruth
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Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
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Grief Altar.
Natural Transitions Magazine SAMPLER
Conscious, holistic approaches to end of life
Being Prepared for the End of Life:
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