Author: Tift

I am sharing this link to the graph because if clearly presents 3 possible Covid-19 choices. Of course, no treatment and comfort care are also choices. Your alternative medicine practitioners may also have other recommendations.

Here are 3 links you may also find helpful.

Please contact me if you are ready to review your Advance Directives or create a new one.

Meet with Reva Tift of AHCD Guidance to talk about Covid-19 care choices and adding them to your Advance Health Care Directives.

Twenty years ago my siblings and I sorted and packed up my parents’ home, going through private papers, old taxes, letters, photos, pictures, special dishes and furniture__sorted and packed up 50 years of memories, thoughts and feelings.
I really appreciated the mostly cooperative spirit of my brothers. As we neared the end of our sorting, a portrait of my mom was put into the circle to see who wanted it. No one wanted it. Somehow I took it home with me.
Yesterday, at a dear friend’s fire pit I burned the picture. It had lived in the basement, on a wall, for 20 years and then in my kitchen for a month as I wondered how to get it out of my life.
Burning the picture wasn’t a huge cathartic experience. It felt like a timely goodbye to that part of my mom who was stingy with support and love, who couldn’t respect her daughter’s different path or her daughter’s wisdom.
Of course, this is not really about my mother but about what I took on and carried into my adult life. Now my work is to continue to say goodbye to the many ways which I pretend to be hostage to my history.
Another fire soon.

“A broken heart is also an open heart. Your vulnerability is also your strength. Do not run from your openness.”

David Kessler

Caring for and loving our parents, partners, children, friends, and clients can be a huge opportunity for growth, openness, and fulfillment. Caregiving also brings up the age-old question of how to balance one’s own needs with those who we care for. In caregiving relationships, much like other relationships, keeping one’s heart open may at times feel like an enormous challenge. It’s important to experience, be open to, and be kind to, the full range of our feelings — both positive and negative. An open heart is necessary so that we don’t burn out, become resentful, or shut down. Being open to one’s vulnerability may actually prevent one’s difficult feelings from turning into depression.

As a psychotherapist I work with both grief and depression, and I find that often people confuse the two. Grief can be understood as a very natural experience, usually characterized by intense emotional pain following a significant loss. There is an initial deep sadness, sometimes overwhelming, which is then followed by waves of emotions that get triggered by thoughts, memories, particular dates, or familiar activities.

There are a number of reasons why a caregiver might be especially likely to experience grief, including loss of mental and physical capacities of a loved one; death of a loved one; isolation if doing the caregiving alone; long distance caregiving; loss of one’s own lifestyle; and less time for play, romance, exercise, contemplation or sleep.

Depression is characterized by severe symptoms that impact how one may feel, think, and experience daily activities such as sleeping, eating and working. Caregivers with depression may experience persistent sadness or anxiety as well as feelings of hopelessness, guilt, worthlessness, or helplessness. There may be a decrease in energy, feelings of restlessness, or difficulty concentrating. There may be other physical symptoms such as unexplainable pains. One may notice intrusive thoughts about death or suicide. Some combination of these experiences is common when one is depressed. https:// depression-test

Recently I had a vivid experience of the relationshipbetween grief and depression. My partner of over 40 years was diagnosed in 2012 with a rare form of a basal cell cancer, which is not currently curable. Since that diagnosis, life has felt precious. The ups and downs from diagnosis, to treatment, to remission, to the most recent reoccurrence, have impacted us both.

In November 2017, I began to experience intense angina at the same time my partner decided to take a break from the medication that was keeping his cancer in remission; it was beginning to cause him great discomfort. I had several weeks of intense episodic chest pain that I kept to myself. As I have a history of heart disease, I wondered if I was having a heart attack. This was ruled out with lab work. My cardiologist diagnosed my distress as “broken heart syndrome”.

This syndrome was an expression of my not being fully open to my grief, of holding my pain inside me. This suppression of grief, if continued, could have turned into depression. Instead, my pain became a reminder to open to my fear, sadness and powerlessness.

Even as a psychotherapist, I hadn’t considered my own mind-body connection in what I was experiencing. My grief was potentially on the way to turning into depression, but thankfully the angina got my attention and I was able to address my grief directly. Being a better caregiver for myself helped me be a better caregiver for my partner.

As a caregiver, a first step for better self-care is an honest assessment of how you are doing. If you are feeling emotionally overwhelmed, irritable, consistently tired or anxious, then this is the time to start talking with others. You can begin by risking some vulnerability with your friends and colleagues. If it seems appropriate, make an appointment with your favorite medical professional, and/or psychotherapist. If you don’t ask for help, it’s unlikely that you will get any. This might be challenging for those of us who are used to taking care of everything ourselves. Do it anyway! As they say, put your own oxygen mask on first, before trying to help others.

In Boulder County we are fortunate to have many resources for caregivers. We have psychotherapists who specialize in issues of loss and grief, as well as depression. We have bereavement support groups, and Death Cafes. Our senior centers and the Boulder County Area Agency on Aging have resource specialists that can help us find the resources we need to make caregiving more manageable. Whether it’s mental health resources, in-home supports, adult day care, or respite, they can help you find what you need.

Caregivers provide an incredible service and must deal with incredible challenges. At the emotional level, our work is to return, over and over again, to the intense vulnerability that we step into every day. Open heartedness, however difficult, is also our best protection.

Reva Tift MA is a psychotherapist in private practice for 40 years. She specializes in working with mid-life and older adults.

Dia de los Muertos in the Mexican tradition is rich and honoring of ancestors. It is a day for family and friends to remember loved ones that have died, and that death is a part of the natural cycle of life. I appreciate this tradition. What do you think of this way of honoring those that have died?




“Before I Die…” Walls are public art projects that are popping up all around the world! This year we had the opportunity to bring this interactive and thought-provoking project to Boulder County. I’ve been wanting to do this for years. This is the first interactive art project I’ve been a part of. I don’t really even think of it as art but as a way for people to think about something that’s hugely important and is a fun way to think about heavy subjects. This is something kids and adults can participate and share in. I got involved with the “Before I Die..” Wall project through my work with Boulder County’s Conversations on Death. The timing was right, and there was an enthusiasm and synergy with it’s creation! The Boulder County community got excited and really made this project happen. Across the county, it’s bringing together morticians, librarians, carpenters, artists, therapists, social workers, and chaplains and the public. Even though it’s been a lot of work I feel energized by the collaboration, community and this growing movement bringing the topic of death out of isolation and into our conversations. Check the Conversations on Death Calendar  and find out when the “Before I Die..” Walls are coming to you throughout Boulder County. “Before I Die” Website

Reva Tift M.AAdvance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2015 Reva Tift, Director Advance Health Directive Guidance

In a recent letter to “Dear Abby”, a woman wants to know if it’s OK to ask a friend who has a medical condition where she keeps her meds in case of an emergency. She doesn’t want to invade her friend’s privacy. Abby responds with ”of course it’s OK to ask”.

I would suggest first asking one’s friend “if” they would like this help before asking “how” to help. To go a few steps further, I think not only is it OK to ask but it is considerate to talk with our friends about what could be sensitive issues. We could think of this as a way to deepen and strengthen our relationships.

Recently, while traveling with my cousin we were able to go beyond the usual check-in and catch up talk and share more vulnerable feelings about our aging bodies and our anxieties about health issues. From this discussion, I experienced a deeper connection and I also learned a new trick for dealing with my meds. She put her thyroid medication out on the counter before bed so it was easy to grab first thing in the early morning. The medication needed to be taken on an empty stomach. I also take thyroid medication when I first wake up and usually end up pawing through my medicine and supplement bottles in a mostly dark bathroom to find the right bottle. By being willing to talk about sensitive issues I not only found I have more in common with my cousin besides all of our family stories. I also learned something useful about handling my meds.

As you know, I think it is important to complete our Advance Directives. It is also so important to talk with those we are close with about what we deal with in our daily lives__not only our practical concerns but also our deeper vulnerabilities.

Reva Tift M.AAdvance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2014 Reva Tift, Director Advance Health Directive Guidance

I work with death and dying and write about death and dying. I also talk about death and dying. Why? While it provides interesting conversation, at least to me__ and I do realize this is not the case for everyone__ it is so much more than that. It is a powerful way for me to be aware of the experience of aliveness. Contemplating death helps me feel the preciousness of life. The contrast of death next to life infuses the moment with clarity.   This awareness keeps me from being spaced out, from being ignorant, and from being a checked out zombie__which part of me is apparently always ready to do.

In contemplating death, I have realized that our “big death” is not the only one. We experience dozens of little deaths every day. Little deaths such as: sending the kids off to school, completing a book, finishing a meal with a good friend, and entering the unknown when we go to sleep. These are small endings that we notice, but they don’t necessarily bother us.

Then there are the little deaths that do bother us, and these are what I want to write about today. We have our feelings hurt or don’t feel listened to. We have a conversation with a parent with dementia or find our caregiver is sick and can’t relieve us, and we feel overwhelmed and unsupported. We often don’t allow ourselves to notice these: we dismiss them from our awareness. We don’t want to feel the hurt. But we do. Perhaps our fear kicks in. We’ve just finished a difficult conversation with a loved one, and are not sure of its ripple effect on our lives. We’re afraid of losing our job, or the impact of the economy on our lives. Our body is changing, and it frightens us. Our response to these difficult little deaths matter because when we disconnect from our disturbance, we disconnect from our aliveness and from being present in the moment.

What do we do now? We can realize that we always have a choice. These are deaths that we can respond to by closing down or opening up. We close down by freezing, making up a story, building a fantasy, or cutting off from the relationship. When we open up, we acknowledge we feel lost and don’t know what to do. We admit we are scared. We acknowledge that we don’t really want to go numb, in that zombie way. We actually want to feel the heat of our aliveness. We can choose to harden to our pain. Or, we can choose to allow our pain and fear to soften us.

Reva Tift M.A. Advance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2014 Reva Tift, Director Advance Health Directive Guidance

These are 7 Important Reasons To Complete Your Advance Health Care Directives now.

Have you considered these questions?

1. Does someone you trust know your wishes if you have an unexpected hospitalization?

2. Do you have any current issues that might affect your physical or mental functioning in case of an emergency?

3. Have you considered how you want to be cared for if you are terminally ill or in a coma?

4. Is it possible a loved one may challenge your choices regarding your health care now or at the end of life?

5. Do you travel? Are your Health Care Documents easily accessible? Are they filed on-line?

6. If you have completed your Health Care Directives have you given copies to your doctors and Health Care Agent?

7. Do you want support in how to have discussions with loved ones or family members concerning you Health Care Wishes?

Contact Reva at or call 303-444-0152 and start the process to complete your Advance Directives. While each state has different forms the issues that you need to consider are the same.

It is a gift to yourself and your loved ones to make your healthcare decisions known when your mind is clear and you have time to consider your choices.


Reva Tift M.AAdvance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2014 Reva Tift, Director Advance Health Directive Guidance

Why is choosing someone you trust to be your Heath Care Agent so important? Having someone to speak FOR you when you can’t speak for yourself is often so important to your well-being, relaxation, relief of stress, and peace of mind.  It can also be equally as valuable for you to choose someone who will speak TO you about what is happening with you, as you are dying__ for the same reasons.  If having well being, relaxation, relief of stress and peace of mind are important to you as you think about your death, then choosing someone you can rely on to be your Health Care Agent is vital.

If you are someone who wants to know what’s going on with your body, or your medical care, it may also be important for you to hear the truth from your Health Care Agent.  This is an example of what you might consider including in the addendum to your Advance Health Care Directive:


I will probably know by the change in your communication. You might be tearful or start lowering your voice. I need to prepare, so please do not think you are protecting me. I want to find my own inner strength.”

If these communications are not specified with your Health Care Agent, you may end up with communications about your situation that are unhelpful and confusing to your sense of well being.  Letting your Health Care Agent know your need for direct conversations is crucial.  So, it’s best to choose someone that will talk turkey with you; who will tell you the whole truth as well as speak for you.

Reva Tift, M.A. is the director of AHCD Guidance that provides a comprehensive process with which to document preferences for end of life care. Since 1979, Reva has worked extensively with mid-life and aging issues through teaching and consultations in both small and large group settings. Drawing on her experience as a teacher, psychotherapist, wife, mother, and mentor Reva offers knowledge and guidance in making thoughtful decisions about the care we would like to receive at the end of our lives.

Reva Tift M.AAdvance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2014 Reva Tift, Director Advance Health Directive Guidance

Many of us have shared the common experience of attending to someone who is in the hospital, whether that was for a birth, death, medical treatment, or a surgery. This experience is unique for each person. For all caregivers though, it is vital to care for oneself, so that one can be available to the needs of their loved one without burnout.

A few weeks ago I was with my husband as he went through major surgery followed by a seven day stay in the hospital, including three days in ICU. This journey began when we flew from Denver to San Francisco for a couple of days of R and R, before we settled into the hospital.  Travelling in a large city when one is “directionally challenged” as I am, can feel a little disorienting. Going into a very large hospital, that functions like a small city can be extremely disorienting.

We arrived by streetcar early in the morning and my husband was assigned bed #6 for pre-op in a department that had 28 operating rooms. This hospital clearly had a lot of surgery going on, and his would last 9 hours!  Pre-op included consultations with two surgeons, an anesthesiologist, a couple of medical residents, the surgical nurse, and the contact nurse who kept me posted throughout the day. All this, before it was even 9 o’clock in the morning.

The Watchdog Experience

For seven straight days, I was a watchdog, an advocate for my husband’s care and a powerless observer. While it was helpful to have a role that gave me a focus, it was also exhausting. I was fortunate to have my dear cousin providing support, but fundamentally I was on my own. My husband was sleeping or having his own experience, and the staff was appropriately paying attention to him and not to me. I had to define my own role, find places to eat, get out for fresh air and find ways to feel grounded and connected to the outside world so that I felt more embodied and aware of myself.

I did my best to not be distracted by the on-going intensity in order to stay present and clear. Finding humorous moments like when they brought my husband lunch and his banana had a nametag on it, were times that brought me back to myself in the midst of a disorienting experience. I meditated, walked, used an earthy essential oil, and then I would focus and return to a sense of relaxed immediacy. It was an altering seven days and finding ways to stay enlivened was essential. My world got very simple: take care of myself and do what I could for my husband.

Pre-op for Caregivers

If there were to be a pre-op for caregivers in this situation what might be included?

  1. Get the information you need so that you are prepared:  Know where you will be sleeping, especially if you’re from another state.  Ask questions and get answers.
  2. Connection to Oneself:  Know some basic tools for grounding yourself.  Meditate, walk, or read an enjoyable book.  Conserve energy, so that you have the energy to care for your loved one.
  3. Humor:  Look for humor, or ask for that from loved ones.  Notice what uplifts you.
  4. Connection to Outside World:  Connect with others at the moment.  Smile with your loved one, or acknowledge the kindness of a nurse.  Have conversations with people from your familiar world.

Don’t count on anyone else making these things happen or even suggesting them.  These are just some of the simple, but important ways one can take care of oneself.

My business is Advance Health Care Directive Guidance. I support people in preparing their Advance Health Care Directives. I am a strong advocate, personally and professionally, for choosing the person whom can best speak for you when you aren’t able to speak for yourself.  We were fortunate I didn’t have to, but I was prepared to follow my husband’s wishes if need be.  I could simply become the wakeful caregiver and didn’t have to make any tough decisions this time.

Reva Tift M.AAdvance Health Care Directives

~ Consultations for the End of Life Care

© Copyright 2014 Reva Tift, Director Advance Health Directive Guidance


Reva Tift, MA, AHCD Guidance | tel. 303-444-0152 | | Email or Call to setup a consultation appointment. While forms vary from state to state, the decisions are common to us all. | Offering appointments by Zoom, by phone or by FaceTime.


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Please note that the information provided by Reva Tift, MA, of Advance Health Care Directives is presented only to support your own decisions concerning your end-of-life choices and wishes. You should consult your family members, personal physician, attorney and/or estate planner for questions about your particular situation.
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