Sickness health and saying I do

Marriage decisions are especially difficult for couples facing a terminal illness.

(escort bursa) — As wedding season gears up this month, the words “in sickness and in health and till death do us part will lie at the heart of many vows.

For couples who are facing a terminal illness, these promises are a bittersweet reminder of the limits of time gratitude for the days and months they have, ache for those they might not.

On June 1, residents of Illinois will witness their state’s first day of marriage equality, but for Pat Ewert, 66, the day’s expressions of love will be tempered by a slight pang as she watches many of her friends lawfully unite.

I don’t have that person to celebrate with. It’s painful, but I’m so happy for all my friends,” Ewert says.

On November 27, 2013, Ewert and Vernita Gray, her partner of five years and one of Chicago’s most steadfast gay rights activists, were granted an expedited marriage license by a federal judge. It was the state’s first legally recognized same-sex marriage, and there was a purpose to the haste: Gray’s breast cancer had metastasized in her sternum and eventually, her brain.

“These two women, who have loved and cared for each other in good times and bad, through sickness and through health, will get to know what it means to be married,” Camilla Taylor, Marriage Project director for Lambda Legal, an LGBT rights organization, said in a statement shortly after the decision.

For Ewert and Gray, marriage is and was the ultimate display of commitment.

“It was weird for me to start using ‘wife,'” Ewert says. “There is a real difference.”

Gray passed away on March 19, 2014, at the age of 65 — just shy of the couple’s four-month wedding anniversary.

Ewert says the marriage ceremony was a moment of pure, unbridled joy that had been a long time coming (the couple had been engaged since Christmas 2009), but that they had always been “just a couple of little old ladies who live in a condo in Chicago” with the wish that “at some point, people will get that we’re just another couple.”

“[She’s] the first thing that I think about when I wake up, and the last thing at night,” Ewert says of her late wife.

When a boyfriend dies, does the grief mean less?

Caring for both parties

Diana Denholm, a psychotherapist, wrote the book “The Caregiving Wife’s Handbook,” after her personal life and professional expertise overlapped. Her own husband, John Sammond, was diagnosed with colon cancer, then congestive heart failure.

Her husband received his diagnosis in 1994, one month into their engagement, along with the information that he was facing a 20% survival rate.

“It’s a big decision, and it’s not an easy decision. I know after my husband got his diagnosis, he let me out of saying ‘yes,'” Denholm says.

But she walked down the aisle, and took care of Sammond until the time of his death 11½ years later on January 31, 2006.

Since then, she’s devoted her professional career to helping people understand the realities of the day-to-day while partners navigate terminal illness. It might include issues of intimacy, household management or most importantly, the well partner’s own self-care.

Denholm says it’s primarily important to manage expectations of how hands-on the healthy spouse will be in the caretaking, for instance, if they will quit their job and focus on caretaking full-time.

“I can’t stress that enough, and if you don’t, then you’re in it,” Denholm says.

There’s also guilt and denial: Guilt of being vilified if the relationship doesn’t work out while one partner remains sick, and the guilt of “why them, not me,” if it does.

Ewert readily admits she was in denial until Gray’s final moments. Gray had survived breast cancer before, and Ewert was sure she could again.

“I told her she owed me another 19 years. You owe me more,” Ewert recalls telling Gray, despite Gray admitting this time was different.

“Some of that [denial] is good. If we went into everything with a horrible outlook, that wouldn’t be helpful,” psychotherapist Denholm says.

Beyond that, Denholm explains, it’s important to understand the concept of enabling; the healthy spouse often feels the need to do every single task, turning the sick person into an invalid. If it’s something the afflicted person can manage, let them do it. It’s about collaboration, not animosity.

When the relationship becomes more like that of a parent and child, intimacy is lost, she says.

Denholm stresses that physical affection and connection may no longer be expressed as “intercourse” in the sense most people understand it; it could just mean lying next to the person, gently holding their hand or massaging them.

“Intimacy can remain until the very end, and in some ways the intimacy can strengthen,” she says.

Even though that’s helpful for the couple on their journey, someone is eventually left behind to go it alone.

“No matter how prepared you are for when they die, it’s always painful when they die,” Denholm says.

‘Hanging on a moment’

Jeff Lang just celebrated what would have been his wife’s 36th birthday at her favorite gelato shop. For him, the wound is still raw.

“A lot of people say, ‘You’ll get over it.’ I don’t want to. I want to get on with it, but with this being a huge part of what has shaped my life and love now, I will always honor that,” Lang said in an e-mail this week.

Lang married Jen Bulik-Lang in July 2013. She was diagnosed with stage 4 lung cancer in December 2012, but had recently been told that even after five months of treatments, continuing treatment would not help her prognosis.

The couple decided it was now or never.

Their wedding captivated the national media after an event planner, Erica Becks, got local vendors to step up and create their dream ceremony — all the way down to a New Orleans’ style Second Line.

The couple’s first dance was to an acoustic version of Lady Gaga’s “Edge of Glory.”

“That line — ‘hanging on a moment with you’ — that’s what we’re doing right now. We really don’t know what’s next. Even though we got this bad news, we’re not letting that defeat us, we’re still on that edge of glory,” Lang told CNN in August right after their wedding.

“I’m choosing to live and be part of his life for how long forever is,” Bulik-Lang said at the time.

Bulik-Lang passed away in their Mountain View, California, home three months later on October 12, 2013.

“Jen said to me once, ‘I’m not afraid, I’m just sad’ and we lived it that way,” Lang says now, seven months after her passing. “We knew we would miss it if it was gone, so we made the most of every minute.”

Lang says that not having a future dictated their outlook on life, and it is how he continues to live.

“I don’t see accomplishments and money as the prime drivers of my day-to-day life. I love, and I have relationships that are deep and meaningful, I go out of my way to make that happen,” he says.

Funny obits bring new life to a dying art

A wedding wish

Wedding planner Liz Guthrie always cherished the “special day,” but she didn’t quite know how special it could be to couples facing serious health problems until she began organizing a dream wedding giveaway in 2009 to couples who had endured some sort of hardship.

More than 400 applicants applied, and Guthrie noticed many had a common theme: Limited time together.

From there, she founded Wish Upon A Wedding, a nonprofit devoted to providing weddings and vow renewals to couples who are facing terminal illness. The organization is now working on its 65th wedding wish

The ceremony itself is so important to so many people, Guthrie says.

Tina and Lance Martin of St. Louis were granted their ceremony by the organization on June 27, 2011. When the couple first met, Tina was undergoing chemotherapy for stage 4 non-Hodgkin lymphoma.

Tina’s chemotherapy treatments ended in February 2009, and she is now five years in remission.

Shortly before their engagement in March 2011, Lance was himself diagnosed with focal segmental glomerulosclerosis, a kidney disease that results in renal failure if not treated regularly with dialysis or, more permanently, a transplant.

Medical details and prognosis limits did not define their wedding day. Their moments however many they had left were at the core of the celebration.

Now, three years later, their story is still being written.

Getting married to the love of my life is the greatest blessing, Tina says. “It was nice not to have to think about medical and health problems during this time, and we were able to focus on something bigger and better– our marriage.”

“Every day is a struggle, but we have one goal in mind,” she says. “Happily ever after.”

Have you faced a terminal illness in your relationship? Share your story in the comments, on Twitter @CNNLiving, or on CNN Living’s Facebook page.

Putin orders retaliatory sanctions

A shopper in a Moscow supermarket (photo taken last year)

Russian President Vladimir Putin has banned or curbed agricultural imports from countries imposing sanctions on Russia over the crisis in Ukraine.

In a decree (Russian text), he ordered the measures, which also apply to food imports, to be introduced for one year.

Meanwhile, renewed fighting in eastern Ukraine has forced the suspension of a search for the remains of the victims of crashed flight MH17.

The attack on the jet has heightened tensions between Russia and the West.

The Malaysia Airlines aircraft was brought down in July, killing all 298 people aboard, most of them Dutch citizens.

The US and the EU accused pro-Russian separatist rebels of attacking the jet, mistakenly, with a missile supplied by Russia. The rebels and the Russian government deny the accusation.

Efforts to investigate the cause of the crash, and to recover the remains of the dead, have been hampered by fighting between the rebels and the Ukrainian military, which is attempting to retake territory in the east.

On Wednesday, Dutch Prime Minister Mark Rutte said the mission to recover the remains had been suspended because of renewed unrest.

“It doesn’t make sense to continue the repatriation in this manner,” he told reporters in The Hague. “We have done what we could under the circumstances.”

Analysis: Steve Rosenberg, BBC News, Moscow

Does this mean no more English cheddar at my local Moscow supermarket? No more German sausages? Or American chicken?

That’s unclear. The Kremlin decree doesn’t specify which items will be affected. Instead, President Putin has ordered his government to draw up the list of food and agricultural products to be limited or banned.

The Russian authorities clearly believe these restrictions will hurt foreign exporters more than the Russian economy. Moscow is already looking elsewhere for its food imports. It will hold talks this week with Argentina, Ecuador and Brazil.

Judging from the language coming out of Moscow, there is no sign of the Kremlin backing down over its support for armed separatists in eastern Ukraine.

Russia’s deputy prime minister made it clear his country would defend itself “in a tough way, consistently and proactively” against foreign sanctions.

Government departments in Russia have been instructed to come up with a list of products subject to the sanctions order.

Russia has imposed import bans on other states in the past, but normally on grounds of public health.

Wednesday’s decree did not specify which countries would be affected by the new measures. However, the EU and US recently tightened sanctions on Russia, with Brussels applying restrictions to sectors of the economy as well as individuals.

Russian news agency RIA Novosti quoted an official from the country’s agricultural and veterinary watchdog as saying that the new sanctions would apply to all agricultural products imported from the US.

“Fruits and vegetables from the European Union will also be under full ban,” the official, Alexey Alekseenko, is quoted as saying.

Russia buys fruit and vegetables from the EU worth an annual 2bn euros (£1.6bn; $2.7bn), and food and agricultural products from the US worth about 1bn euros.

Last week Russia banned most agricultural imports from Poland on grounds of public health in what was seen as a thinly veiled retaliation for Poland’s advocacy of tough action over Ukraine.

The Russian decree cites “national interests” as grounds for the latest measures.

The list of goods being affected should be ready by Thursday, according to the Russian business daily Vedomosti. Wine and baby food will not be affected, it added.

Russia, which was first subjected to sanctions after annexing Crimea in March, has been accused of fomenting the armed rebellion in Ukraine’s eastern regions.

Brussels hardened its sanctions at the end of July, amid growing anger over the downing of the Malaysia Airlines jet.

The new EU sanctions targeted close allies of Mr Putin such as billionaire tycoon Arkady Rotenberg but they also hit exports of oil industry and defence technology and affected Russian state banks’ access to Western capital.

In other developments:

Is this the fountain of youth?

The onsen water at Wakayama’s Kamigoten Ryokan is said to have high quantities of sodium bicarbonate, which leaves a silky, soft film on the skin.

Like many small inns in Japan, the riverside Kamigoten Ryokan has been run by the same family for multiple generations.

But few can lay claim to a stretch like this.

The Ryujin family has been operating this historic Wakayama inn in the Ryujin village in mountainous Kii Peninsula since 1658, when it was constructed for an ancient samurai ruler as a holiday retreat.

Twenty nine generations later, the Ryujin family remains in charge.

There’s a key reason this beautiful property is still going strong after more than 350 years beautifying baths.

High quality H2O

In hot spring-mad Japan, this ryokan has earned a reputation for its indoor and outdoor bathing pools, the water for which, pumped in from nearby onsens, is high in sodium bicarbonate.

Devotees refer to this type of onsen water as bijin no yu or beauty bath and say it also helps with cuts, burns and chronic skin disease.

Cue the skepticism.

But as I can attest, there’s no denying the waters leave a silky, soft film on the skin post dip, so perhaps there’s something to those claims.

Do they reverse the ravages laid upon us by the cruel hands of time? Inconclusive.

However, when most anti aging promises come out of a jar or a needle, Kamigoten (or Royal Palace”) has the closest thing you’ll find to a fountain of youth.

Guests have two options  a gorgeous private outdoor landscaped open-air rock bath overlooking the Hikigawa River or the enclosed shared wooden baths  one for men, one for women.

A remarkable history

Kamigoten is a two story property that was registered as a tangible Japanese cultural asset in 1999.

Chieko Ryujin, the current owner, says this means they’re allowed to modernize the property to ensure it remains pleasing for visitors (i.e. improve the sound proofing on the walls) but the overall structure of the building must not be touched.

With its dark brown wood floors and staircases, Shoji rice paper screens and Japanese antiques throughout, it’s exactly the type of ryokan travelers looking for that quintessential Edo-era experience will love.

Meals another excellent feature of the ryokan — are included in the room rates.

Guests are served traditional multi-course kaiseki dinners and breakfast in their rooms.

Every dish is made from locally grown produce sourced from the neighboring mountains, some cooked in the onsen mineral waters. Fish is caught from the nearby river.

All the rooms, which start from ¥16,200 ($159) per person, are traditional Japanese-style suites with futons that the staff lay out in the evening.

The elevated Onarino-ma (room built for the ruler) is where the feudal lord, Yorinobu Tokugawa, used to stay and is the top suite in the building.

MORE: Koyasan, Japan: Overnight on one of the world’s most sacred mountains

A town of samurai descendants

There’s an interesting back-story to the Ryujin hot spring village.

Ryujin was founded by Kobo Daishi (774-835), the man credited with introducing the Shingon school of Buddhism to Japan.

Legend has it he had a dream about a water god, who told him the location of the Ryujin hot spring. When Kobo visited the site that appeared in his dream, he enshrined a statue of Yakushi Nyorai, the medicine Buddha.

Later, a monk named Myozan came to the village and claimed his skin disease was miraculously cured after bathing in the onsen waters. To show his thanks, he rebuilt the hut where the Buddha was enshrined and named it Onsen-ji Temple.

A few hundred years on, during the first battle of the Genpei War outside Kyoto in 1180, famed Japanese poet-cum-warrior Minamoto no Yorimasa was defeated and his troops fled into the Kii mountains.

They settled in the Ryujin area and renamed themselves in honor of the village.

The owners of Kamigoten are descendants of these fighters.

As Japan moved into the Edo period (1600-1868), Ryujin became a popular retreat for top samurai warriors, who were drawn to its thermal waters. It was during this time that Kamigoten Ryokan was built.

MORE: World’s best unknown hike: Japan’s Kumano Kodo

Getting there

Many travelers visit Ryujin village as an overnight stop on their journey between Wakayama’s sacred Koyasan and Kumano areas, which are linked by the beautiful Ryujin-Koya Skyline highway.

There’s a daily bus that runs all year round from Kii-Tanabe station to Ryujin. The travel time is 90 minutes, tickets ¥1,700 ($16.70).

Seasonal buses run from Koyasan, with visitors needing to transfer at Gomadanzan to the Ryujin Bus.

Central Koyasan (Senjuin bashi bus stop) to Gomadanzan is ¥1,690 the Gomadanzan to Ryujin Onsen is ¥1,140.

There’s more info on bus timetable number 7.

Travelers can also book a taxi from Koyasan to Ryujin for ¥16,500 (taxi holds 1-4 people) or ¥19,800 (jumbo taxi for 5-9 people). Travel time is one hour.

MORE: 10 things that make Wakayama Japan’s best kept secret

CAR Fighting spreads like infection

A boy being treated at the University Hospital in Bambari, CAR

Francoise Gerizapa scrunched her face into a fierce pout and then screamed once more a chilling, sing song whoop that filled the dark, crowded ward at Bambari’s hospital in the Central African Republic (CAR).

Andrew Harding reports on the latest violence

Bambari is CAR’s second city, but it is as underwhelming as the narrow dirt track that leads to it.

Crumbling old colonial buildings peer out from the shade of tall trees; a few scraps of tarmac cling together in the dust.

Dr Bama a tall, dignified man born and raised in Bambari, where his father was a doctor before him said the security situation had deteriorated abruptly last month when 34 people were killed in a single, frenzied day.

Within hours, the entire Christian population had fled to three makeshift camps on the outskirts, while the Muslims retreated into a single neighbourhood in the city centre.

And then the fighting started to spread, like an infection, along the muddy tracks leading deeper into the surrounding forest.

It seems to be a mixture of banditry, reprisals, intimidation and more organised military raids.

They brought three soldiers in last night  ex Seleka ambushed on the road, said Dr Bama, referring to the mainly Muslim fighters who briefly seized power across CAR, but have since withdrawn to await the outcome of peace negotiations.

They are a more organised force than the loose coalition of mostly Christian anti balaka militias active in the countryside around Bambari.

Their colleagues stood around us as we cleaned their wounds.

It is not safe here at the hospital. Sometimes we are threatened when we work, said Dr Bama, who described working late into the night during a ferocious rainstorm.

Hours earlier, two brothers had been attacked on the nearby road and their throats slit in broad daylight.

One was brought, still alive, to the hospital.

We fought to save him, but he needed blood, and we have no supplies here, said Dr Bama.

When possible, the most serious casualties are sent by air or road to the capital, Bangui.

Aid agencies like Medecins Sans Frontieres (MSF), Save the Children and the United Nations are working here to support Dr Bama and his colleagues and to provide for a population struggling without the most basic state services.

Dr Bama took off his white coat and sat down in his small office to catch his breath between rounds.

There’s no political authority here in Bambari. But this country still exists.

We have a president to bring peace back. And we have hope, said Dr Bama.

The problem is isolated people who understand nothing and who sow terror.

If only they could appreciate the state we are in.

We hear reports that they plan to attack our hospital. I don’t understand why. This is where we treat everyone,” the doctor said.

Read Andrew’s previous report from CAR: Road to anarchy

Wildlife loss link to child slavery

Children enslaved as fishing labour in the Brong Ahafo region of Ghana

New research suggests the global decline in wildlife is connected to an increase in human trafficking and child slavery.

Ecologists say the shortage of wild animals means that in many countries more labour is now needed to find food.

Children are often used to fill this need for cheap workers, especially in the fishing industry.

The decline in species is also helping the proliferation of terrorism and the destabilisation of regions.

According to a study in the journal, Science, the harvesting of wild animals from the sea and the land is worth $400bn annually and supports the livelihoods of 15% of the world’s population.

There’s a direct link between the scarcity of wildlife, the labour demands of harvests and this dramatic increase in child slavery”

But the authors argue that the rapid depletion of species has increased the need for slave labour. Declining fisheries around the world mean boats often have to travel further in harsher conditions to find their catch.

In Asia, men from Burma, Cambodia and Thailand are increasingly sold to fishing boats where they remain at sea for many years, without pay and forced to work 18-20 hour days.

There’s a direct link between the scarcity of wildlife, the labour demands of harvests and this dramatic increase in child slavery,” said Prof Justin Brashares from the University of California, Berkeley, who led the study.

Many communities that rely on these wildlife resources don’t have the economic capacity to hire more labourers, so instead they look for cheap labour, and in many areas this has led to the outright purchasing of children as slaves.

This exploitation also happens in Africa, where people who once found their food in the neighbouring forests now travel for days to find prey.

Children are often used by hunters to extract wildlife from areas that would be too costly to harvest.

The researchers contrast the outcomes of the collapse of fisheries of the north east coast of the US and in the waters off Somalia.

While in the US the decline was cushioned by federal subsidies to retrain fishermen, in Somalia the increased competition for fish stocks led to the rise of piracy.

That’s how the whole Somali conflict started, said Prof Brashares.

Fishermen started going out with guns, trying to fine boats that were fishing illegally in their waters.

Unfortunately some segment of that community said we can do much better by ransoming these boats that we can do by fishing.

The rise in value of items like tiger parts and elephant ivory have led to an explosion of trafficking, by powerful groups to further their aims.

The authors point to the Janjaweed, the Lord’s Resistance Army, Al-Shabab and Boko Haram, which they say have all been involved in poaching ivory and rhino horn to fund terrorist attacks.

Other researchers say there is not enough data to support this claim.

Regardless of the strength of the evidence, the western response to these events has been to declare a “war on poachers”.

The authors believe that this is misguided, and is missing the bigger picture.

We can continue to try and cover it up with little bits of enforcement,” said Prof Brashares.

But until we start to address the bigger issue which is poor governance and the global free for all, we are not going to address the tide of conflict.

The study says there are some approaches that can work. They argue that when local governments give fishers and hunters exclusive rights to harvest some areas, social tensions can be reduced.

They point to Fiji’s fishery structured around territorial use rights and in Namibia pro-active policies have helped to reduce poaching.

The most important bit from this article, I think, is that we need to better understand the factors that underlie fish and wildlife declines from a local perspective, and that interdisciplinary approaches are likely the best option for facilitating this understanding, said Dr Meredith Gore, from Michigan State University who wasn’t part of the study.

The research has been published in the journal, Science.

Follow Matt on Twitter @mattmcgrathbbc.