Thursday, December 9, 2010

A poem I share with the bereaved.

I Am Fishing for God

I am fishing for God,
using my heart as bait.
It is just before dawn,
the slightest hint of
pink bleeds into the
night sky.

I use my pen knife to cut the
hole in my chest,
reaching behind the
pocket of my shirt.

What a tough muscle
to pull the hook through.

The heart is astonished
to be in this other world
and trembles and shivers like
a moth discovered in daylight.

I try to calm it by stroking it,
by telling it that it will all be ok,
but what do I know.

The breeze picks up and
chills the cavern
in my chest.
It feels good to
be empty at last.

I cast my heart
across the water.

I cast it again
and again.

Sometimes it floats on
the surface,
other times it sinks

Something will strike at it
that I can't see. I pray
I am using the right bait.

The tough outer layers
soften in the water.
The heart grows
smaller, more pliant.

It has become a beautiful
blue jewel. I begin
not to recognize it.

Was this me?
It waits. I wait.
The boat rocks
slightly in the breeze
lifted and lowered
by the tide.

Copyright © 2004 Stuart Kestenbaum

Sunday, November 21, 2010

Life isn't that short.

For a long time it had seemed to me that life was about to begin - real life. But there was always some obstacle in the way. Something to be got through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life.
~Fr. Alfred D'Souza

I don't want to get to the end of my life and find that I lived just the length of it. I want to have lived the width of it as well.
~Diane Ackerman

No, life is not always short. It only seems that way when it is ending.

Life can feel really long to some people. Days, hours, months can seem to simply drag by, and some see only more empty time in the future. And it doesn't just feel this way to depressed people or old people in a nursing home. It can feel this way to each and every one of us occasionally. And sometimes more often.

Only when we know the expiration date in life or get sick or know someone who has died suddenly do we feel like our life is short.

Most of us trod along each day pretty certain that there will be a tomorrow. We plan for future events. We save money for our retirements. We think about our home and plans to downsize in the future when our kids are safely tucked away at college or beyond.

And most of us get there. We grow old. We have grandchildren. We do indeed retire. We stay healthy and vibrant for many years. It is good.

Some don't make it, I know. I am reminded of that each time I work. So I try to make the best of the time I know I have, like today and perhaps tomorrow. But I still think about the future. We can't always just live in the present, we must plan for our future whether we get there or not.

I think the problem arises when we think too much about the future and let today pass by, thinking that there will always be more time. So we let really important things wait.

Like telling someone we love them. Or reaching out to an old friend. Or going to see that movie we keep promising our children. Or that trip. Or that scrapbook.

We will get to it "when we have more time." That is what we say. And we fill our days with a lot of meaningless tasks that sit in front of us day in and day out taunting us. We feel somehow we must conquer the mundane first before can get to the meat of our lives.

And that is a mistake. A big, huge mistake.

So, life may be long. But don't fill those seemingly empty days with nothing. At least take time to do some really fun things and sprinkle them into the everyday upkeep of life.

Put down the laundry and take your kids to the movie. Let the dishes sit while you play a game with your family. Call an old friend even if you don't have time. Start that scrapbook, just do a few pages. Sort though old photos with your kids and tell them stories. Go for that walk. See that sunset. Pop over and visit that friend or relative you have been meaning to see. Put that picture in a frame so you can enjoy it. Finally get that dog you promised the kids.

Yes, there may be many more days to do these things. But we never know. And what we fill our lives with now will be the memories that future generations have of us. Do we really want them to think of us, even if we live to be 90, as the pragmatic soul who mindlessly watched TV or did dishes and laundry all of the time? Or do you want them to remember us as folks who ventured out of our pragmatism to do spontaneous acts of fun and good will? They are a much more powerful memory. And a much better example to follow for a meaningful happy life.

So, look ahead. Look towards the future. It is there most likely. But take a really hard look at your journey so far and then plan ahead and fill the rest of it, no matter how long, with some fun and laughter along the way.

A boring journey is just that, boring. So, save for the future. It is a must. And plan ahead. It is not only okay to be practical and prudent, it is imperative. But don't forget about the here and now. Cut loose frequently. Be spontaneous. Give out little gifts of yourself along the way to everyone that you know. Don't just pass them along after you are dead. A shared memory is the gift that keeps on giving. Giving your time while alive is much more precious than anything material you could possibly pass on after you are dead or disabled.

The journey is the best part of our lives. Don't squander it.

Spend the afternoon. You can't take it with you. ~Annie Dillard

“Life is not a journey to the grave with intentions of arriving safely in a pretty well-preserved body, but rather to skid in broadside, thoroughly used up, totally worn out and loudly proclaiming ... WOW! What a ride!”

Life is not lost by dying; life is lost minute by minute, day by dragging day, in all the thousand small uncaring ways. ~Stephen Vincent Benét

To change one's life: Start immediately. Do it flamboyantly. No exceptions. ~William James

“I haven't a clue as to how my story will end. But that's all right. When you set out on a journey and night covers the road, you don't conclude the road has vanished. And how else could we discover the stars?”

Thursday, November 18, 2010

When we don't feel like being thankful.

Soon it will be Thanksgiving. Most people like Thanksgiving because a.) it revolves around food and b.) you don't have to buy gifts. I guess I should also add that it is a day for family and football as well. So all around, a fun holiday.

But some people are just not in the mood to feel "thankful." They may have lost a loved one, or have been laid off of work, or have a sick child. They may have memories of lovely family holidays in the past that no longer exist. They may hate being forced to be around people they just simply do not like. The list goes on and on.

So, what do we do when we feel this way? Certainly all of my patients and their families and friends do not feel so thankful right now. And platitudes and cheery greetings do not help at all.

So what does?

Really, there is nothing. Nothing can make the pain go away. But the problem is, most people turn inward towards the holidays. They steel themselves against any happiness creeping in. It is as though they won't allow themselves to feel anything but miserable. They sneer at the "lucky" people who seem happy and content. They simmer in their own regrets and misery. It can be a very lonely place indeed.

Well, I have to tell you something. We all feel like that on many days, particularly during the holiday season. Even the smiling, seemingly happy people. If you can remember that and remember that you are certainly not alone in your despair, it could help you to feel more connected.

And a connection to anything is something to be thankful for.

So, you may have a load of misery that feels especially compounded at the holidays. How to get through it? Connect.

You can connect in many ways. It is okay to reminisce about the old days. You are connected to them. It is okay to remember those we lost and pine for them. We are still connected even though they are not here in person. You perhaps had something great. And although it is gone now, you can be thankful for the wonderful memory, even through tears.

Now, the ones that are still here who drive us nuts are another issue. But we can be thankful we have to only see them occasionally. And leave it at that.

The bottom line is, you don't have to be thankful or cheery. You can feel sad at holiday time. But don't take it out on yourself. Do something nice for yourself. Connect with yourself if need be. And find ways to be thankful in small ways. Reach out to others instead of always drawing in and admit that the holidays can be tough and limit yourself to a few activities that make you, if not happy, at least content. And don't be alone. Connect to something, anything.

The holidays are hard. Life is hard. But we are really not alone on this. We are all connected to each other in so many ways.

And that is something to be thankful for.

A positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort. ~Herm Albright

If you don't get everything you want, think of the things you don't get that you don't want. ~Oscar Wilde

Oh, my friend, it's not what they take away from you that counts. It's what you do with what you have left. ~Hubert Humphrey

So often time it happens, we all live our life in chains, and we never even know we have the key. ~The Eagles, "Already Gone"

Tuesday, November 9, 2010

Sadness envelops the day.

Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.

People ask me all the time how I can be a hospice nurse. I tell them I don't know. And I really don't. But I do it and it usually makes me feel good that I am actually helping someone.

But yesterday, a very young patient died and now I am engulfed with sadness. She was a lovely young woman with much to live for, struck down by a cancer so devastating that I am not sure how she pushed forward for the 6 years since her diagnosis.

The treatments alone would have done me in. But she not only survived those treatments, she went back to school and received her Master's degree plus opened a restaurant. She was brave right to her very last breath. So brave. So very lovely. It was truly amazing.

I usually keep myself a healthy distance from becoming too involved with my patients. I have to. But I really liked her and her family. They were so genuinely kind and generous. And so I am devastated by this loss. The world is a sadder place for having lost her. And her family will move on but with a huge hole that will never really fill. My heart goes out to them.

So, how do we deal with this sadness? I am not always sure. I guess we just leave it alone and allow it to envelop us for a a while until we can come out of it to the other side.

There are no words that can make it better. No cheery platitude. No drug even. Not really. And there is no such thing as closure. We can put it away in our hearts, but the wound never really closes. We always remember.

So today I am allowing myself to feel sad. Death is sad, it really is. There is no denying that. And I see my fair share of it and have experienced it in my own life as well. I still to this day have very sad moments about the loss of my parents even though it has been many years.

They say that every death that touches us reminds us of all the deaths that we have experienced. I am not sure that that is actually true. I just think each death or loss is simply sad on its own accord. There seems to be no reason to complicate it any further. It is what it is. Sad.

Very, very sad, indeed.

So, anyway, I started this with a poem about death that is my all time favorite, if you can even have a favorite poem about something as awful as death, but here it is and I will end with the remainder of that poem.

(In honor of all of my patients, but especially for H.Y. and her family.)

Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead,
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last for ever: I was wrong.

The stars are not wanted now: put out every one;
Pack up the moon and dismantle the sun;
Pour away the ocean and sweep up the wood.
For nothing now can ever come to any good.

W. H. Auden

And if you would like to see a reading of this poem, which is from the movie "Four Weddings and a Funeral" but read well anyway, go to

Friday, November 5, 2010

Waiting for death to come.

Currently, I have several young patients that I am case managing. They are in the age range of 9 (yes, 9) to 53. All have been dealt a nasty hand with a nasty cancer. All are very sick with disease, but still quite functional.

All are waiting to die.

All have been given a time frame. And all have seen that time frame come and go.

I hate time frames. They are always wrong. Always.

The problem with time frames is that people start counting down the days. And they stop living. They just stop.

And they say goodbye and hug their friends and have tearful, heartrending talks and meet with their priests and some even pick out the music for their funeral. And then? They sit and wait.

And they waste a lot of precious living time.

It is a shame really. They just don't know what to do if they keep on living. And neither do their friends or loved ones.

So, they ask me. How much longer do I have? Why didn't I die yet? What is going on?

And I have little to say other than I just don't know and they are just going to have to keep living and so we move forward. Many times, reluctantly.

I wish MDs did not give patients a time frame. Some nurses do it as well and they are often wrong, too. I only can tell by my physical exam, but that is not to say that something catastrophic won't happen that causes sudden death. Like a clot or a hemorrhage or something else.

But I could say that about everyone I know.

So the point is to just keep living. Regardless of the hand you are dealt. And tell people every day that you love them and would miss them if they were not near you. Get that out of the way so that if you ever do get a bad diagnosis or are struck down while seemingly healthy, you will have no regrets. And the people in your life will be free from wondering how you really felt. It is a gift to them.

So give it often and freely.

My patients that have already said good-bye at what they interpreted as the end have many regrets. They regret doing it too soon and treating it like it was the last thing to say to friends and loved ones. Because now that are still alive, they don't know what to talk about anymore. So they avoid their friends and family. And they feel alone.

"So what do we do now? Do we just go back to the trivial," asked the wife of one of my patients.

Well, most times the trivial is the mainstay our lives. Laughing at a funny show, talking about work or school, asking what to have for dinner, picking out new furniture, watching sports. These trivial things are our lives. The "profound" really does not matter so much after all. We think it does, but a hug and a smile and a squeeze of the hand pretty much can sum it all up. And we can do that every day, even during commercial breaks while doing something as trivial as watching Dancing with the Stars.

So, just keep living. Don't worry so much about death or the end. It will come. It will. But life, life is all we know. And all that trivial nonsense we thought was a waste of time? It is as profound as anything else we could ever say or do.

So, my advice to my patients and their families is this; don't ever stop living. Keep doing what you love for as long as you can. Enjoy any moments that seem normal. Try not to look too often over your shoulder for the bad, it will come when it is ready. Laugh if you can. It is really okay. There will be many bad moments, but grasp any good ones that come along.

Feel free to be angry. Get really mad. You don't have to be strong.

This is hard.

Lean on friends for support. Allow them to help you. Call the nurse if you need help. We want to help, we do. You are not bothering us. Give us the burden of care so you can just be the wife, the husband, the sister, the brother, the child.

It is hard to wait for death. It is much harder than the fight to survive, even with the horrible treatments and side effects. At least you were moving forward. Death has its own time frame and follows no rules. The hardest part isn't letting go or fighting to live. The hardest part is waiting to die.

So, don't do it. Just keep living. Don't stop and wait for the end to come. Just try to keep moving forward. Listen to no one except the promptings of your own heart. It is the best and only reliable guide we have.

Sometimes even to live is an act of courage. ~Lucius Annaeus Seneca, Letters to Lucilius

Rejoice in the things that are present; all else is beyond thee. ~Montaigne

It is only possible to live happily-ever-after on a day-to-day basis. ~Margaret Bonnano

Yesterday is history. Tomorrow is a mystery. And today? Today is a gift. That's why we call it the present. ~Babatunde Olatunji

Tuesday, October 26, 2010

Don't believe the hype.

Every day, I receive an email from various health and beauty web sites I have signed up for that talk about health, diet, fitness and general grooming, such as skin care. And every day I read about the newest, the latest, the greatest. And you know what? It is all just hype.

There really is not too much that is so new as to be earth shattering. They have simply taken the old ways of doing things and repackaged them to make them look new.

Like skin care for example. There are hundreds of skin care lines. Walk through any Sephora and you will find a special cream or lotion for just about any body part. They have special creams for kids and men as well.

And guess what? You don't need any of it. Not really. All you really need to do is to cleanse your face at night, moisturize to prevent it from looking like old, dried out leather and occasionally you need to exfoliate.

And that is it.

The trick, and there is a trick, is to do it routinely, every single day and night. And that is where so many fail.

It is not necessarily the product that is helping you. It simply that you are taking better care of your skin.

And you don't need to spend a fortune to do it. Personally, I use a cleanser from Walgreens that dermatologists love. It is called CeraVe and it is an inexpensive, awesome cleaner. You don't need a fancy, expensive cleanser. You just need to clean your face.

I have an elderly patient who has great skin who uses Dove soap. And Vaseline. For about the past 60 years. And very few wrinkles at all. (she recently signed off of hospice---she got better and she's 88)

Now, that said, I must confess I use an expensive face cream. It is called SK-II. It is remarkable, in my opinion. But I use it as a day and a night cream. And I use it under my eyes as well. Along with using a vitamin E stick that I purchase for about three dollars. And I exfoliate with a scrub from Target 3 or 4 times a week, from Boots. That is it. And my skin looks pretty good for being 50. Not perfect, but okay. But I never go to bed without washing and moisturizing. I do it religiously.

And that is the trick. Doing it consistently.

Consistency is the name of the game.

Now, if I could only apply that same logic to exercise....but I digress.

The next big hype is diet. I read every single day about a new food that will cure whatever, a new supplement that we all should be taking or a new diet book that promises you can eat all you want and still have a flat stomach.

But they are selling nothing new. Blueberries have always been good for us. As a matter of fact, eating fruit has always been a great idea. And veggies, too. Do I really need to spend time reading about this? No. I know what to do. And so do you. There are no secrets out there to learn.

Eat real food in smaller portions. Don't eat food your grandmother would not recognize. Don't eat food that has a list of ingredients you cannot pronounce. Eat whole foods.

And if you want to drop weight, eat less and walk more.

(That will be $29.99. Thank you.)

But they are still selling these books and exercise videos and special eye creams and neck creams and, well, I could go on and on.

And we are all still buying them.

Go figure.

Anyway, I am not buying into the hype anymore. If you want to lose weight, you have to eat less. If you want to stay healthy, you should walk more and not smoke or drink to excess. You shouldn't drink 7 Diet Coke's every day, drink water. You should get out in the sun to get vitamin D. But just not too long unless you put on sunscreen. You should learn to relax more, have fun friends to hang with, get a good night's sleep and worry less. A baby aspirin a day is a proven winner. So is a regular multivitamin. And a glass, one, of red wine cannot hurt. Cutting back on sugary foods is also important. Excess sugar and sodium causes our body to have an inflammatory response. And inflammation causes problems like cardiac disease and cancers. That is a proven, scientific fact.

Anyway, I am not saying that any of this is easy. I struggle with it too. But we all know the things we need to do.

The hard part is doing them.

And not buying into all the hype.

Life expectancy would grow by leaps and bounds if green vegetables smelled as good as bacon. ~Doug Larson

A good laugh and a long sleep are the best cures in the doctor's book. ~Irish Proverb

To avoid sickness eat less; to prolong life worry less. ~Chu Hui Weng

Those obsessed with health are not healthy; the first requisite of good health is a certain calculated carelessness about oneself. ~Sydney J. Harris

Saturday, October 23, 2010

Didn't he see the warning signs?

I am often asked about how people die. Not specifically how their actual death occurred, but what lead up to it. What the warning signs were. And why they were missed.

Most people ask me this because they want to make sure that they do not have the same issues.

For example, if a young patient has melanoma, people will ask me, did they sit in the sun a lot, did they have a lot of moles, did they have a family history, did they wear sunscreen?

Or a stroke victim. Did they have high blood pressure, was there a congenital anomaly, did they suffer from headaches?

Most of us do this. It is how we justify death. When someone who ate and drank everything they wanted to dies, we often shake our heads and think, well, they just didn't take good care of themselves. That won't happen to me.

But I see a lot of people who die and they seemingly did everything right. Exercised, went to the MD yearly for a check-up, ate healthy food, had parents who lived to be 90, put on sunscreen, kept their weight normal.

But they developed cancer or heart disease and they died. Usually way too young. And it is these types of deaths that give us a chill. Especially as we enter middle age.

So, what can we do? Are there warning signs that they missed?

My answer to that would be a yes. They did. And we all do as well.

So, what warning signs can we look for. What can we do to protect ourselves?

We can start by paying attention to the warning signals in our car and remember to always wear a seatbelt. Many healthy people die this way, in stupid accidents. We don't often think about it, but most motor vehicle deaths are totally preventable. We drive after a couple glasses of wine. We don't always pay attention and become distracted by cellphones and kids. We text. We don't always wear a seatbelt. And we place ourselves in peril. Sometimes daily.

Stop it. Be more aware of the risks here.

We also need to understand that our body talks to us. It is quite wise. It tells us when we need to slow down, take a rest, get more sleep. But we hardly ever really listen to it until we are ill. We just stop at Starbucks for another jolt of caffeine to get us through the day. But we need to rest. We need to sleep. These are preventative measures we should all be taking. But don't.

And pain. We often dismiss it. But it tells a story as well. Don't ignore it.

There are other things that happen to our bodies as we age and they are silent. High blood pressure being one of them. We need to have it checked and keep it around or below 120/80. High blood pressure leads to a myriad of problems if left unchecked.

And our weight. I am not saying we all need to be thin. On the contrary, there are many studies that suggest a little bit of fat can be protective. But we still have to keep it in check. We need to stay away from excess sodium and sugar. We need to walk more. Drink more water.

Many cancers are not related to any one cause. We would like to think they are, but they are seemingly random. And that is simply the truth.

Our bodies have to be equipped to fight aberrant cells. The best way to do that is to listen to our body and take good care of it. From the inside out.

That means we should take a vitamin pill, take an aspirin every day to alleviate inflammation in our body (which is deadly), not feed it too much junk and processed foods, not overwhelm it with too many chemicals and pharmaceuticals. We need to balance things better. Mom was right; everything in moderation.

You have to watch out for the warning signs yourself. Your MD may say that things look great, but only you know yourself. Only you can really judge.

I don't know everything for sure, but I do know one thing; we will all die. I see it all of the time. But we can prevent an early, premature, needless death if we take certain precautions. We can.

So, start to tune into your own warning system. It may in fact save your life.

First we make our habits, then our habits make us.
~~~Charles C. Noble

Nobody ever did, or ever will, escape the consequences of his choices.
~~~Alfred A. Montapert

The name of the game is taking care of yourself, because you're going to
live long enough to wish you had.
~~~Grace Mirabella

Sunday, October 17, 2010

Medical professionals who are anything but.

We have all met them. Or worked with them. Or have heard stories about them. Bad medical professionals. Be it nurses, MDs, dentists, physical therapists. You name it. They are out there. Everywhere.

And just because someone has MD after their name, or RN, it simply does not make them a compassionate, caring person. No. Not by a long shot.

Nor does it mean they are necessarily competent. No matter how impressive their credentials are.

I could tell you stories, scary stories that would make you sad. And afraid. But I won't.

I would have to say that most medical professionals are good people. They know their limits and ask for help when necessary. But there are a few out there with an ego as big as Sputnik, and those are the ones that give all the rest of us a black eye.

Nurses know what I am talking about. The arrogant resident, for example, who thinks he knows it all. But he is merely book smart with a fancy degree from a Ivy league school who could not cut his own toenails well, let alone know what to do for a patient in crisis. But he refuses to listen to an RN because, well, we are just beneath him. We could not possibly know anything. And he is dangerous. 007's we call them. Licensed to kill.

Or the RN who gets the best accolades from management because she never calls in sick and works extra shifts and always charts perfectly. Unfortunately, she is awful with any practical patient care and actually puts patients in harm's way. But you cannot say anything, no one is listening. So you just clean up after her as much as you can and hope for the best.

It is maddening. It is what stresses out nurses and MDs and others more than anything else. I always say that it is not the job I hate at times, just the people I am forced to work with that make the job hard.

That is not to say I think myself perfect or that I have never made a mistake. I have. But I try to learn from any mistake I make. I also ask for help when needed. And I always, always, put the patent's needs first.

And that is what you should look for when you are looking at care providers. Putting your needs first. Treating you as a person. Not a diagnosis, not a 4:00pm appointment, not a simple home visit.

They should greet you warmly and look at you. In the eyes. They should listen to you without interrupting or putting words into your mouth. They should explain things thoroughly and not look at their watch every time you ask another question. That is simply rude.

Most people know when something seems not quite right. They realize their concerns are simply being dismissed. They may have a gut feeling that someone is doing something wrong. But most are too intimidated to say anything.

But I will tell you this; be the squeaky wheel. Complain. Put complaints in writing. And repeat as necessary.

The one thing that I can say for sure after being a nurse for 30 years is this; medical professionals do not police their own. We see it all. We know who is bad. We have all witnessed things that we have found to be quite incredulous. But many of us have not said a word. Or we have said something, only to be shot down. They kill the messenger. See if we do that again. It is frustrating, but true.

So, beware. Don't assume that because you are going to a well respected institution for care that everyone there is top drawer. They aren't. Ask around. Get referrals from friends or people with the same medical issues. Go online and search.

I know people who ask for more information about a veterinarian for their dog or a hairdresser for their hair. And I have seen people change their hairdresser after a bad cut, but not too many who will change their MD after a bad diagnosis. It is crazy. It really is.

There are many good, hardworking, excellent medical people out there. Start with the MD and the hospital of course. You cannot always choose your nurse, but you can unchoose her by stating your concerns. Trust your gut. Follow your own thinking.

It could save your life.

All men make mistakes, but only wise men learn from their mistakes.
~~~Winston Churchill

Guard against the prestige of great names; see that your judgments are your own; and do not shrink from disagreement; no trusting without testing.
~~~John Emerich Edward Dalberg Acton

You gotta know when to hold 'em, know when to fold 'em, know when to walk away, know when to run
~~~Kenny Rogers

Monday, October 11, 2010

Deciding to be happy.

I was driving to a patient's home the other day and was behind a car with a bumper sticker that said, "Life sucks, be happy anyway." Truer words have never been spoken, or written.

Life indeed can and does suck. You do not have to be a hospice nurse to understand that. I see a lot of misery. I see a lot pf pain. But I also see something else; happiness despite all of it.

Anti-depressants are the number one prescribed medication in the world. I am sure that self-medicating with alcohol or street drugs trump those numbers 2:1. And why shouldn't people be unhappy. After all, life is hard. People disappoint us, money is tight, people get sick, the news is always bad, work is awful, things never seem to live up to the hype. Some days it seems that we need to just stay in bed with the covers over our heads and hide from the world.

But no one said life would be easy. No one said that we have a right to happiness. So, we should just grab happiness anywhere we find it. We can and must choose to be happy.

I was at the home of an 8 year old patient the other day. It is a sad scene. Here is a beautiful 8 year old with an inoperable brain tumor that will kill her in a few short months. It came on suddenly, and will kill her suddenly. She is still attending school. She has all of her hair. She does not look sick at all.

I look at her young mom. She is devastated. So is the dad. But in that house also lives a 12 year old sister. One with a full life ahead of her. So, do they succumb to doom and gloom? No. They grab any moment of happiness and go with it despite the pain they are feeling.

They choose to be happy.

Happiness is not something that we can feel all the time. But when we feel it, we should immerse ourselves in it. Really feel it. Ask yourself, when was the last time you felt pure happiness?

Many of us do not allow ourselves to be happy. Many wallow in misery and look for others to share their misery with. They are the Debbie and Donald Downers, and they are everywhere. They are hard to avoid. And they usually find a reason to be unhappy about any circumstance. I try to avoid them whenever possible.

Abraham Lincoln once famously said, "Most folks are about as happy as they make up their minds to be." And he was surely right about that. But he also said something better, that is not often quoted. He said, "I want it said of me by those who knew me best, that I always plucked a thistle and planted a flower where I thought a flower would grow."

So, look at happy thoughts as a way of planting a few flowers in a yard full of weeds. Sometimes that is the best we can do. Life will always be hard. Bad things do indeed happen. Misery abounds.

But happiness is there, too. We just have to look for it and embrace it when ever we can.

My advice to you is not to inquire why or whither, but just enjoy your ice cream while it's on your plate. ~Thornton Wilder

The best vitamin to be a happy person is B1. ~Author Unknown

Jumping for joy is good exercise. ~Author Unknown

Happiness always looks small while you hold it in your hands, but let it go, and you learn at once how big and precious it is. ~Maxim Gorky

Let us be grateful to people who make us happy, they are the charming gardeners who make our souls blossom. ~Marcel Proust

Monday, September 27, 2010

When the patient is a child.

I can think of nothing worse than a child on hospice care. The family sitting there, day in and day out, hope gone. Feeling horrible because they cannot kiss it and make it all better. Sitting there feeling angry and sad, feeling like they cannot cope another day, another hour, another minute. Just pure agony.

We don't get too many referrals for pediatric hospice care. Most parents are reluctant to even think about it and fight to the last breath, many children dying in the hospital. I cannot blame them. I would most likely do the same.

But some MDs want the patient to be able to be managed at home. To die at home. To have their last days in a comfortable place. A place that feels safe to them.

And the parents who chose this option are so brave. So very, very brave.

I remember my first pediatric hospice patient. His name was Brian. He was 12. He was the bravest kid I had ever met. I have trouble even thinking about him, let alone writing about him. He remains in my heart always.

Kids have a way of doing that. Being special by just being.

Many kids who are not sick are very special as well. Actually, all kids are special. They just don't get to hear it as often. Many healthy siblings of sick kids are often jealous of all the attention their brother or sister are getting. They feel left out, isolated. They cannot talk about these feelings because it feels so wrong. They think, how can someone be jealous of a loved one who is sick? Something must be wrong with me to feel that way. But nothing is wrong with them. It is completely normal. We see it often. Sometimes in adults as well.

When I go to see a sick child, I also try to visit with the siblings. I bring them gifts. I give them small tasks so that they feel they are helping me with the care of their brother or sister. They want to help and feel a part of it all. As scared as they are, and they are, it helps them to cope. It makes them feel special, too. And they are special. And very brave.

I look at my own daughter. She is very healthy. I am very blessed. But I tell her all the time how special she is. Because things can change in a moment's notice.

People worry about spoiling their children. They worry that if they give them too much they will expect more and never be satisfied. But I say bunk to all of that. Make a wish wishes should not be granted only for the very ill or dying. They should be granted for the living as well.

Many people turn away or refuse to think about the unthinkable. But it happens to all types of families every single day. It humbles me to meet these wonderful families, the ones that have been through so much and still are able to laugh and smile and just simple carry on.

If they have one message it is this; love your child. Love them as much as you can and be grateful for them in your lives, even when they make you crazy. Indulge their whims. Do something unexpected for them on occasion. Hug them more. Tell them how much you love them.

And then tell them again and again and again and again.

While we try to teach our children all about life, our children teach us what life is all about.

Death leaves a heartache no one can heal, love leaves a memory no one can steal. ~~~From a headstone in Ireland

Where you used to be, there is a hole in the world, which I find myself constantly walking around in the daytime, and falling in at night. I miss you like hell. ~~~Edna St Vincent Millay

Wednesday, September 15, 2010

Let your kids play----- P.S. We are all kids at heart.

When was the last time you played? I mean, just really stopped what you were doing and took the time to play?

And when was the last time your kids played freely and joyfully?

Many kids do not even know how to play anymore. They are so used to being structured, that when they do find some free time, they are not sure what to do.

I feel as though sometimes we are pushing them to be something. But I am not sure quite what. I also feel that we push ourselves to be something. And again, I am not sure to what end.

We all want our kids to be successful; of course we do. But a life bereft of fun and games and pleasure is just not a great life.

We think we need things. Lots of things. But things provide only short term joy. However, we still try to get those things, and most of the time we work extra hard and are extra stressed to achieve just that. And what do we end up with? I am not sure I have the answer, but if I look around, I do not see people dancing in the streets full of glee over what they were able to get. I see stressed out folks who like to drink or take a pill to make themselves feel happier. Trying to forget about that stressful day. You know, the one that they have to live day in and day out so that they and their children can have more.

But more what?

I also see a lot of kids. I see them at my daughter's school, I see them when I substitute as a school nurse, I see them when I work as a camp nurse. And what I see frightens me. I see a lot of stressed out kids. If I could send home a prescription, that prescription would say, play more.

And that starts at home. Allow yourself to allow your kids to play. To goof off occasionally. To sit in their PJ's all day on a Saturday watching TV or playing the Wii or reading or sleeping or dreaming or coloring. Have a non-structured day where they can eat what they want and be what they want. It may surprise you that they will love this. They will love this a lot.

And occasionally join them. And not because it is a vacation or a holiday, but for no reason at all. Have a "just living day." Have it on a Thursday or a Monday. Surprise yourself with this gift.

We are fed a lot of stuff these days. That we have to push, push, push; and then we have to push some more. That it is a competitive world and we have got to get going if we are to ever achieve and keep up. I hear it all of the time. I have been caught up in it myself. However, it is simply a lie. And it leads to bad days, not good ones.

But a good day, a really good day, just is. And we do not have enough of them. Our kids do not have enough of them. We are a nation bereft of joy.

So, tonight, let you kids have some fun. Let them play. Yes, even on a Wednesday. Have some fun with them. Have a day when you just eat junk food or tell funny stories or act silly. Don't do errands or laundry or chores. Just be.

I am telling you, play is the best thing for what ails you. It will make us happier people. And after a day like today, I will tell you, it is the most important thing we can ever do.

“You can discover more about a person in an hour of play than in a year of conversation.”

“I still get wildly enthusiastic about little things... I play with leaves. I skip down the street and run against the wind.”
~~~Leo F. Buscaglia

"The prime purpose of being four is to enjoy being four - of secondary importance is to prepare for being five."
~Jim Trelease

It is easier to build strong children than to repair broken men.
~Frederick Douglass

"Children find everything in nothing; men find nothing in everything."
~Giacomo Leopardi

Sunday, September 12, 2010

Filling up time.

"I don't have any time today."

"I will get to it when I have more time."

"I always thought there would be more time."

I hear a lot of talk about time. Not just when I work with folks that have truly run out of time, but everyday folks in my everyday life. It seems to me that no one feels that they really have enough. We are a nation bereft of time.

I know that we certainly have a lot more time saving gadgets now. More than our mother, father, grandparents and great-grandparents ever had. But it seems as though even with these things we run faster than ever and still never have any extra time to spare.

So what gives?

I read a quote yesterday that stated this:

"People talk about the reality of their life as if it is important. And we want you to understand, it's only the temporary indicator. If your gas gauge is on empty, do you go to the gas station and look at your gas gauge in horror? "How did this happen? Why, why, why did this happen to me?" Do you lay your head on the steering wheel and just sob? "Oh, look what it's come to. I'm finished. I've lived all of this life, and look where I am." Or do you just fill up?"
- Esther Abraham-Hicks

I liked this quote, because most of us feel depleted much of the time. We feel we waste our time on meaningless nonsense. We feel that time is slipping by fast and that we have no control. We feel our life is too busy, but still so empty in so many ways. We feel overwhelmed. Rushed. Exhausted.

But do we ever stop and think about time? Not how much we do or don't have left, because we will never know that, but how we actually spend the time we do have now.

I hear people say things like, "that is a waste of time." or "God, I wasted the whole day and got nothing done." Is it really a waste if you are enjoying yourself? And what is time for anyway? I am sure it is not there to simply use up on meaningless tasks, is it? I hope not. But I don't know for sure.

One thing I do know for sure, however, is that time truly does end. And I can share with you a bit about the end of time. I am familiar with that as I work frequently with the few that are actually there. Time is over. The cancer has spread. They can no longer get out of bed. They await death.

And what do they think about? They think about life. Their life. The time they spent living. Some curse that time. They may have spent way too much of it at a job they hated. They regret not spending more time with family and friends. They regret not seeing Europe. They regret not spending more time on the garden. They wish they had gone to the beach more. They regretted not wasting more time on things that brought them joy.

A patient recently asked me this, "How much time do you spend on joy? You see so much death, you must not want to waste a single day on things that do not bring you joy."

I thought about this. I do spend a lot of time on things that do not bring me joy. Like doing laundry or dishes, or grocery shopping. But those are the everyday tasks that must be done, and I know she wasn't talking about that.

What she was alluding to was this, do we take the time to stop and do things that bring us joy, that fill us up in a meaningful way. Do we make the time to go to that concert we read about, to go to the beach on a beautiful day, to go outside and ride bikes with our kids, to take that art class. Do we stop when we see something that piques our interest, or do we drive by hoping to get back when we have more time?

Or are we using our time to do the things we think we should be doing even though we dread them. Things like spending time with people we don't particularly like, or exercising because we worry about being too fat, or cleaning our homes and pulling weeds and fussing over things that really have no meaning what so ever but that we feel we must do for some odd reason. The fact is we waste a lot of time doing things that do not add value or joy to our lives. And for what gain?

The people I meet at the end of life are not always sad. Some have lived very long and fulfilled lives. They talk to me about their garden, how they went to the beach each summer, how they loved to paint. These people are not all retirees or empty nesters. Yesterday, I admitted a beautiful lady who was only 43. But she talked about her passions and she is still fulfilling those passions, even though she knows that death is a certainty.

"I am not giving up on my life. I will continue to do with it what I want and can until the very last breath is taken from me. And it will have to be taken from me. I choose to fill my life with what I want. I do not choose to leave this life empty."

And so there it is. We can fill our own lives. We can. We just have to choose to take the time to do it. Even as time runs out.

Time goes, you say? Ah no!
Alas, Time stays, we go.
~Henry Austin Dobson

Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you. ~Carl Sandburg

Time is a great teacher, but unfortunately it kills all its pupils. ~Louis Hector Berlioz

Wednesday, September 1, 2010

Do good intentions count? Do actions really speak louder than words?

"I really meant to call."

I was meaning to call, but got so busy."

I wanted to stop by, really, I did. But my kids are sick and I thought I would make her sick."

"I didn't know what to say."

These are all excuses I hear from well-meaning friends and relatives who call us to get information about a patient's medical status. I have probably used the same excuses myself.

We all get busy. We all mean to call or to write or to stop by or to buy that card. Many times we have very good intentions, we just don't always follow-up on them. And then time gets in the way and moves us too far forward and we think it is too late to go back now and call or write or whatever.

But it isn't. It is really never too late.

"I haven't heard from her in years," said a patient recently when I told her about a phone call we received from an old friend. "Why is she calling now I wonder?"

We didn't wonder. This was a woman who was well liked by many and we had received many calls. But we are not allowed to give any information to non-family members, so we always refer the questions to the patient or their family members or caregiver.

Her friend had said she knew about the patent's illness from others. They had been best friends in high school, but had lost touch since graduating some 40 odd years ago. They often kept in touch only by the occasional reunion or Christmas card.

"But I never forgot her," her friend said to me. "Life has a way of getting in the way of things that matter to us, keeping us apart. But I have loved her since the 9th grade. She was part of me. Will always be part of me. I never told her that. It seemed like my life going forward with my husband, my kids and my career became me. And that is true to some extent. But that alone did not shape me. You never forget the ones that helped to shape your life. And when they are going to be gone forever, it leaves a huge whole. Bigger than I ever could have imagined. I should have called or visited. I should have written a note. Is it too late now?"

The patient was on home hospice care, pretty much bed-ridden at this point in time. But she was still alert, still taking visitors, still answering the phone. Still alive.

"It is never too late for the living," I told the friend.

"But what if she is mad at me for being quiet all of this time. I really had good intentions. I did. Should I tell her that? Do good intentions count?"

I said I wasn't sure. Perhaps they could count if they are known. But once someone is gone, good intentions provide little comfort.

So she called. They lived 400 miles apart, so a face to face visit was probably not going to happen, but they talked each day for a few minutes and exchanged cards and pictures and their lives met up again.

"I often wondered about Jane," my patient said, her eyes smiling as she talked about her. "I could have called her too, you know. It is not just her fault. She told me about all of her intentions. I told her about all of mine. I am not sure what kept us from doing the things we wanted to do, but that is just water under the bridge now. Swept away. Her good intentions were voiced to me and mine to her and that is good enough. I never really paused enough to reflect on how much the people in my past younger life meant to me. We focus so much on the current, but the past is part of us as well. She will always be a part of me and I of her. Isn't that amazing. Isn't life a grand journey."

This patient died recently, but it made me stop to think about all the good intentions I have had over the years that I never got around to sharing. And I wondered if it was too late as well. But Clara, my patient, taught me something. That good intentions really do count.

That words can be just as powerful as actions.

As long as they are spoken and can be heard and shared.

In the End, we will remember not the words of our enemies, but the silence of our friends.
~~Martin Luther King, Jr

Friday, August 27, 2010

Don't lose yourself to the details of life.

"A single event can awaken within us a stranger totally unknown to us. To live is to be slowly born."
~~Antoine de Saint Exupery

Remember when we were kids? We thought our parents were so boring. They were always doing laundry, going grocery shopping, cleaning, going to work day in and day out. They came home, watched the news, maybe had a cocktail, cooked the dinner, then went to bed. Maybe they read for a while. And of course they nagged us all of the time. To get things done. Things that were meaningless to us.

Remember how we thought we would never be like that? That we would be more interesting, freer to express who we were? It all seemed so simple then.

But then we grew up. The details of life began to consume us. We wanted more so we worked harder. We acquired more. We moved to bigger houses with more stuff. We had kids and became involved in parenting 101, almost at a fevered pitch. We joined the TPA. We joined local community groups. We exercised. We did laundry. We grocery shopped and bought organic.

We make dinner. We clean up dishes. We nag our kids to do their homework, clean their rooms. We shuttle them to activities that we hope will enrich their lives and make them happy. We go to bed exhausted. And then we make our to-do lists for the next round of responsibilities that will need to be done tomorrow, and the next day and the next. An endless stream of tasks.

In essence, we have become lost in the details of life, just like our parents did. We have become the person we swore we would never be.

And life goes on.

Until it doesn't.

Sometimes events that we have no control over get in the way. We may be diagnosed with a life ending disease like cancer. Or ALS. Or heart disease.

We don't like to think that these things can happen. To us. We try to shut out the possibility. I know I do. But, unfortunately, I am forced to see it every time I work. People who were plodding along just like you and me are suddenly struck down with this disheartening news.

And how do they manage? Some make to do lists, just like they always did. They look at the details of the disease and try to take control of it. It begins to consume them. Just like life had.

But, occasionally, I meet someone who does not do that. They have an interesting story to tell and it is worth hearing. They step away from details and look inward.

And they are much happier.

One patient, young with three kids, was diagnosed with stage 4 ovarian cancer and no treatment options, so she decided to take all of her kids out of school, much to everyone's surprise. She decided to home school them. Her husband took a leave of absence for a year. They rented an RV and traveled the country. They had fun. They were together.

Yes, they let things go. They didn't always eat healthy. They didn't worry about the lawn. As a matter of fact, they let it go, much to the chagrin of their tony neighbors.

They did pay their bills and remained responsible to the important things that keeps life humming along. But they let go of the seemingly endless lists of details that used to bog them down and stifle their enjoyment of life.

"Before I had cancer, I was just an empty shell. Always busy, but busy became me. When people asked how I was doing, my answer? Busy. Sad really."

She went on. "I used to be a dancer when I was young. But my mom said that dancers can't really make any money. So I became a lawyer instead. And then a wife. And then a mom. And I lost myself somehow. I became the details of my life. I wasn't living my life, I was managing the details. Sure, from the outside, we looked great. Nice home. Pretty yard. Well mannered kids. But inside, it was empty. I was empty. I loved my life, don't get me wrong. I just got lost in the details."

"Once I got sick, I realized that this was it. I had little time left. I wanted my kids to know me. The real me, warts and all. Not just mom with the never ending Blackberry in her hand, nagging them to hurry up so we could move on to the next thing. I wanted to just be me, for them to see me. And now I had the perfect excuse. Cancer. But I wish I had realized it earlier."

This patient recently died. In her 40's. It made me cry. A lot. Not just because she was a beautiful person who had to leave this world way too soon, but because she was a terrific role model. A true inspiration. A great mom to three young kids. And a lovely human being.

I learned a lot from her. I may not be able to just pack up for a year and rent an RV, but I can take a day now and again to get in touch with myself. To leave the to-do list at home. To do things that I enjoy that other's may think are crazy. To just be me for a change.

I have also learned that nagging does not help. People hate nagging. If my daughter doesn't have her homework done, all my nagging won't make her a better student. If she fails a test or misses an assignment, she will learn the consequences of her own actions. And that is a much more important lesson that anything I can muster.

I learned from that patient, her name was Eve, that we cannot always shoulder the responsibility for everyone. We may not even be here to always do that. We have to instill in others a sense of themselves. And let them fly a bit on their own.

The last thing she said to me before she died three weeks later was this, "These past two years were great. My kids finally got to know the real me. Not the nagging parent or the lawyer or the household manager. But the real me. I danced for them. We looked at old pictures together. We looked though my yearbooks and I told them stories of how I hated so and so and liked so and so and how certain teachers made me feel bad. I told them how I hated math, hated it. And that my math teacher in High School was an idiot. That I had detention a few times. That I smoked weed. That I thought my parents were dull. I told them how I became a lawyer and thought that I would help others, but instead became part of the machine and ended up worrying more about billable hours. I told them how I met their dad. That I had sex before marriage. That I was a real person, just like them. They were astonished. Maybe even a little uncomfortable. They thought I did not have a clue as to what they were going through. And they began to see me more as person, and less as a role that I played. I am not sure it helped them in any way, but after I am gone, I want them to remember me. The real me. Not just the details I attended to. I know it shocked them a bit. But that is okay. Life is shocking. Get used to it."

God, I miss her.

“Those who danced were thought to be quite insane by those who could not hear the music.”
~~Angela Monet

Sunday, August 22, 2010

Put the gadget down. Please.

Last week, I was rear ended by a person who was clearly not paying attention while driving. He never even braked. Distracted drivers are becoming the new drunk drivers. It is becoming epidemic.

But I am not upset by this. It was a good wake up call. I have allowed myself to be distracted as well. We all have. We may not text and drive, but we dial and drive and talk and drive and look back at our kids and drive and put on lipstick and drive and eat a burger and drive. I have been known to use the rear-view mirror to check my hair while driving on the Mass Pike at rush hour.

By the grace of God, I have not been surprised by a stopped car in front of me. I have not veered off of the road or into the path of another car.


But I don't want to talk, or write, about distracted drivers.

I want to talk about people living distracted lives.

There is a lot of life around us. But so many of us miss so much of it. We are obsessed with checking our email, texting, playing games on tiny screens and watching TV. We are always in a rush.

It seems to me that the more technology we have to make our lives easier, the more complicated they have become. The more we are removed from real life. And the less in touch we are with ourselves and our families.

We are so removed from real life that we even watch fake real life on TV.

So odd.

But when someone becomes ill, real life makes a sudden appearance. And shakes things up a bit. I see it happen often.

Suddenly, they are forced to slow down. They see things often for the first time in a long time. They talk to people face to face more often. They read more. They rest more. They write more. They spend more time with family. They spend time working on things that bring them joy. Like needlepoint, reading the newspaper or reading trashy novels. Maybe playing cards or board games with their kids. Things they thought were "time wasters' before.

And they hardly ever turn on gadgets. Not even a computer.

"I never realized how alone I was. I thought I was paying attention to things because I emailed a lot and talked to old friends on Facebook. I thought I was connected to my daughter and son because we texted each other every day, sometimes several times a day. My husband and I watched TV together. But the thing was, we were never really together. I really did not have a clue as to how they were truly feeling, how they even smelled anymore. I used to lie down with my daughter and smell her hair when she was young. That to me was heaven. Now, I never do that. I am sad to say it. I am usually yelling at her to brush it or get it out of her face instead."

This is not some dying patient who had a sudden epiphany. She is a youngish 40-something career oriented mom on our bridge program for pain management. She has two kids, a girl who is a "tween" and a teenage boy.

"I see them with their friends. They text one another while in the same room so that others cannot hear their conversation. I understand that all of the kids do this. I get it. But they miss so much. Relationships are so much more than typed words"

She went on to say, "I never really slowed down until I got sick. I thought I was getting so much done by multi-tasking all of the time. Trying to be productive. Trying not to "waste time". But all I did was waste my time on things that really do not matter. I was always so distracted. I want to smell my daughter's hair again. I want to hug my kids more and spend less time doing things that only I see as important. People are important. Interacting takes time. You have to learn how to interact with people. I am worried that my kids won't know how to interact. We really should have a national no-gadget day. People need to reconnect."

Indeed they do.

Connection is a key part of life that many of us think we have, but we don't. Texting and email is a great way to communicate, but it is a lousy way to really connect. Because to really connect, you have to be physically present. Really present. (And to drive safely you have to be present, too. Ahem.)

So that distracted driver really did me a favor. He made me realize how foolish I have been, allowing myself to become so distracted. Distracted to life.

So tonight I will ask my daughter to put down the gadgets. I will shut off this computer. I will reconnect by disconnecting.

And then I will hug her. And I will smell her hair.

And I will drive only to get somewhere safely. I will be present. Cause if I am not, I may never be again.

Friday, August 13, 2010

Life lessons from a kitten.

Recently, we have acquired another pet. His name is Russell, our new kitten. He is just about as adorable as can be. I never thought that I would warm up to him as I have, being allergic to cats and all. But he has stolen my heart.

He has also done something else. He has shown me that I can learn a lot about life from a kitten.

A kitten you say?


I offer the following truths.

1. Purr and sit quietly and people will respond in kind. Scratch and bite and people will put you down and never pet you.

2. Let people know when you are hungry and they will feed you.

3. Sleep when you are tired.

4. Playing with others is fun, but if you are not nice, they will not play with you anymore. Worse, they will growl and bark at you.

5. Go to the bathroom when you need to, but keep it clean. No one likes a dirty bathroom.

6. Groom yourself daily.

7. Enjoy the warm spot the sun makes.

8. Touch people gently with your paws and keep your claws in.

9. Pounce on whatever seems interesting at the moment.

10.The simplest toys are the most fun to play with.

Need I say more?

Living with animals can be a wonderful experience, especially if we choose to learn the valuable lessons animals teach through their natural enthusiasm, grace, resourcefulness, affection and forgiveness.
~Richard H. Pitcairn

Man, unlike the animals, has never learned that the sole purpose of life is to enjoy it.
~Samuel Butler

Everything in life is speaking in spite of its apparent silence.
~Hazrat Inayat Khan

Animals have these advantages over man: they never hear the clock strike, they die without any idea of death, they have no theologians to instruct them, their last moments are not disturbed by unwelcome and unpleasant ceremonies, their funerals cost them nothing, and no one starts lawsuits over their wills.

Having less is the secret to happiness.

When I was a younger upstart with a big job at a big corporation, (yes, I left nursing to become, among other things, the Director of Managed Care for New England, for a large, well-known pharmaceutical company) I met a colleague who worked in New York state. He was different from all of the other sales managers. He was quite simple. The others were showy and talked about all that they acquired and so on, but this guy didn't. He didn't wear flashy clothes. He didn't live in a big house. He didn't have a fancy watch. And yet he always seemed relaxed and happy.

His philosophy was, "live beneath your means." He told that to anyone who would listen. The other guys made fun of him. As they were stepping on each other's necks to get ahead and acquire more, he simply plodded along. Doing his work quietly and efficiently.

He stood out like a sore thumb.

While others talked about a new boat or a Cape Cod second home or a big vacation to Bali, he talked about his family. While the others talked about moving into their dream home, he talked about how his family of 4 shared one bathroom in their split level home in upstate New York. While others talked about the fancy and expensive camp they were able to get their kids into for the summer, he talked about how they went camping or bike riding.

The other guys I worked with, and most were guys, made fun of him behind his back. They made comments like, "low class" and even "loser." But these guys, who were all about getting more, and more and more, were just about the unhappiest guys I had ever met. And they were always stressed. Always fretful.

Even with their fancy homes and watches, boats and second homes.

Today, I go into the homes of many people. Some live quite well, with huge homes amid manicured lawns in upscale communities. Others, live in basic squalor. I see a lot of poverty.

But there is a middle ground, where people live quietly, but well. And I have to say, they seem the happiest to me.

They have just enough. Just enough house, just enough yard, just enough decorating to make their home seem, well, homey. Nothing over the top, nothing to really brag about. Just a warm, comfortable feeling.

Most of these families can afford the additional care that is many times required when you get sick and want to stay at home. Hospice benefits under any insurer only provide 4 hours a day of home health care aid services. The patient and family have to make up the rest. That is 20 hours at sometimes $15.00 an hour. Out of pocket. Sometimes for months.

Many times the ones that live in the big houses cannot afford it. They are straight out trying to maintain all that they have. They cannot help at home to take care of the loved one; they have to work too much to pay for all they have acquired. They are stressed and angry.

But they do have that lovely well-appointed living room that no one ever goes into.

The poor, well, they usually all just pitch in. They are stressed as well, but for different reasons.

The middle of the road folks, the ones that live well but acquired less, they seem to have money in the bank. They saved for that proverbial "rainy day." They are sometimes not working, many having retired at a young age.

They tell me stories of family time and how mom made Sunday dinner for the whole family every single week. How dad took them fishing. There are usually many pictures of family all over the home. The scene is sad, but relaxed.

Now, many of these folks are very successful people. MIT professors, CEO's of companies, people in the finance world, MD's, lawyers. They just decided not to get on that fast track. Not to try to impress everyone.

They decided just to live simply and for themselves.

And they planned out future needs so that they could afford what they needed should disaster strike.

These people never fail to impress me. They are by far the happiest people I meet, even though they are in crisis.

That is not to say that they didn't spend money. They did. They have beautiful art on their walls and pictures in frames of trips taken abroad. Their kids are all well educated. But they kept their lives simple; acquiring less things and spending more money on making memories and living well enough.

"We never tried to keep up with the Joneses," said a lovely 60 year-old patient that I had the honor of caring for recently.

They lived in a very expensive town outside of Boston.

They had a lovely home, but modest compared to all of the McMansions that dotted the neighborhood.

"Most of these new neighbors that built these big homes over the past few years are strangers to us. They are always gone; either working or running around. I never quite understood it. They build these big homes and are never there to enjoy them."

She went on to tell me, "We were always tempted to buy more. But we realized that buying more stuff does not make life happier. As a matter of fact, it makes life harder. Suddenly, you have more to take care of, more to worry about. You spend all of that energy on things. I wanted to spend my energy on people. It made me different, but I didn't care. Having less is the secret to happiness."

She was so right.

I wish I could say that I follow that rule all of the time. I don't. I like stuff. I want things. But I remind myself that things do not make a life. That at the end of the day, when you look back, you think about people and experiences. Never things. I see it all of the time. And I have changed a lot since those "corporate" days.

I see how maintaining things that we thought would make us happy have really turned out to be more of a burden. Costing us time and money and not true enjoyment.

So I do agree with my patient and that colleague from New York state. They are right. Of course they are right. They have always been right.

And that guy from New York? He retired at age 54. I hear he and his wife took a trip around the world.

The other guys I worked with? Still working. Hard. And still stressed, I am sure.

So, I guess it is really true that less is more. That we just need a few things to make us really happy and the other stuff that we do and acquire to impress others only hurts us in the long run. That success cannot be measured by outward appearances.

That experiences, like riding your bike with your kids, trump bragging rights regarding fancy country clubs and camps any day.

It is preoccupation with possessions, more than anything else, that prevents us from living freely and nobly.

True happiness flows from the possession of wisdom and virtue and not from the possession of external goods.
~ Aristotle (B.C. 384-322)

Anything you cannot relinquish when it has outlived its usefulness possesses you, and in this materialistic age a great many of us are possessed by our possessions.
~Peace Pilgrim (1908 - 1981)

Thousands upon thousands are yearly brought into a state of real poverty by their great anxiety not to be thought of as poor.
~Robert Mallett

Too many people miss the silver lining because they're expecting gold.
~Maurice Setter

Wednesday, August 11, 2010

Tune in.

We have two ears and one mouth so that we can listen twice as much as we speak. ~Epictetus

My mother used to say that to me often as I was growing up.

I don't think I really listened much, however. Many of us don't.

We tend to want to tune out instead. We place ear buds in our ears, look at tiny screens and play games or read the news. We think about what we are going to say next when we are talking to someone face to face. We hardly listen at all.

Oh, sure. We think we listen. We email friends, text them, call them briefly on our cellphone.

But it seems to me that the more ways we have to communicate, the less we really listen. The less we really tune in.

It is interesting, isn't it.

When was the last time you just stopped and listened to the sounds around you? When was the last time time you sat silent as you listened to your child tell you about their day? Or listened to a friend tell you about a hard time they are having without a million things you should be doing instead going through your head?

How many times have you taken the time to really just tune in?

We practice tuning out way too much. We need to start practicing tuning in. We are all missing so much.

I can remember having to sit at my aunt or uncle's home when I was young and being forced to listen to the conversations that they and my parents would have. I thought it was so boring. Of course we had to sit there. It was the polite thing to do and besides, there wasn't much else going on. Three channels on TV, no ipods, no computer, no phones. Except one that had a rotary dial. Boring indeed.

But I learned a lot. About them. About life. I heard their tales of woe and of happiness and I knew them better for having heard them. I was part of the conversation. I knew their laugh. I knew when they were having a bad day just by the tone of their voice. And looking back, it was a very good thing.

Now, when I visit my niece or nephew, they may sit there as well, but they are tuned out. Either listening to their ipod, texting a friend or playing a video game.

I wonder if they will even really know me or my husband.

Or anyone else for that matter.

I visit a lot of homes where there are adult children reminiscing about their childhood. There may be a parent who is dying or a grandparent. The one thing I hear over and over is how they wish they had spent more time with them. How they wish they had taken the time to hear more stories, to have more laughs. To just hang out. They may mention wishing for more "quality time," but I think what they are alluding to is listening time.

Tuning in time.

Sure, we can spend hours with someone. But if we are not tuned into them, really listening, do we ever really know them? Do we really know what they are thinking, how they are feeling, what makes them tick? And how may people are so turned off by not being listened to, that they just simply stop trying. They shut down. They are there in person only.

We are missing so much.

So, practice tuning in. And we have to practice in this day and age with so many distractions constantly beckoning us. Practice by first shutting down the TV, the computer, the cellphone, the blackberry. You can't really "talk" on a computer and texting is not the same as listening, not really. Take out the ear buds. And then sit and just listen. Take in the life around you.

You may be surprised by what you hear.

My wife says I never listen to her. At least I think that's what she said.
~Author Unknown

Wisdom is the reward you get for a lifetime of listening when you'd have preferred to talk.
~Doug Larson

“A wise old owl sat on an oak; The more he saw the less he spoke; The less he spoke the more he heard; Why aren't we like that wise old bird?”

Saturday, August 7, 2010

Don't Worry. Be Happy.

Who doesn't remember that Bobby McFerrin song. It was a catchy little tune, wasn't it.

But we all have worries. And sometimes they can be quite overwhelming.

The interesting thing about worrying is that probably 99% of what we worry about never happens, or just doesn't matter. But we waste about 80% of our time thinking about it, talking about it, dreaming about it, and sometimes it really interferes with our lives. All for something that will most likely never happen.

I see a lot of people who don't worry anymore. The worst has happened. All the other worries have slipped away as they now face the worst possible news of their lives.

All of a sudden, worrying about people eating on the sofa becomes rather silly. No more cares about small dents in the car from the parking lot, or how much they weigh, or how the boss will react to whatever piece of nonsense they have always reacted to in the past.

All the petty worries of everyday life melt away. Because they just don't matter anymore.

And the interesting thing is this. They never did.

It is a lesson for everyone. We are all going to die one day. It is a fact. You can worry about it and try to prevent it for as long as possible, but it is still going to be there. Worrying about it will not stop it. And the stress may even hasten it.

Think about that.

So, in the long run, is it really worth wasting the time we do have on ridiculous worries? If we spent half the time thinking about and doing things that make us happy, we would be free of many of the worries of life. Not that legitimate worries don't exist. They do. But they are really only a small part of our lives and many of those things we worry about incessantly are really not the most important ones anyway.

I know someone who won't let anyone eat in his car because he is worried about the mess. I know another who constantly worries about her son's safety, almost to the point of hysteria. And yet another who worries about how the house looks all of the time and doesn't invite people over because she worries she is going to be judged.

Well, guess what. You are going to be judged anyway, worry or not. Your son may not always be safe, worry or not. And that car? It is going to get dirty. Get over it.

I know it sounds simple and even naive. We will always worry about our kids, no matter what. We worry because we do not want anything bad to happen to them. Some worry because they think that if they worry, then it will somehow protect their child. Like people who are superstitious of happiness sometimes think that if they are too happy, then something bad will happen. It is strange, but true.

People who have been through a real life crisis tend to be able to place things into better perspective. The worst has already happened. Their child may be sick. They have been diagnosed with cancer. They have lost their home or their life savings.

But many who have survived a life crisis tend to lose that perspective once the harm has passed. They go back to life and many times return to the petty worries once again.

I don't worry so much anymore. Worry to me is a waste of time. I try to act instead. If I worry about my daughter drowning while she is swimming, I watch her more closely. I get her swimming lessons. I never let her go into water I think is dangerous. I don't worry. I act.

And that is what people need to do.

Worrying that your house is too messy? Clean it. Worrying about your weight? Exercise more. Worrying about your health? Eat better. Exercise. Get to the MD for a check up.

The thing about worries is that it is much easier to sit and worry then to actually do something about it. Doing something is hard work. It is much easier to sit and ruminate about it instead.

So make a list of what is really worrying you. Then next to it, write what you can do to alleviate the worry. And cross off the worries that you have absolutely no control over. Don't waste the time you do have on those things.

Then write down what makes you really happy.

Spend more time doing those things.

Plan out how to get more of that in. Fun things. Happy things. Things that will make happy memories.

Worries will always be there, for sure. We cannot make them go away. But we can balance them with true enjoyment of life.

Worries are infinite. Life is finite.

And that makes the song "Don't worry, be Happy" more than just a catchy tune.

If I had my life to live over, I would perhaps have more actual troubles but I'd have fewer imaginary ones. ~Don Herold

Worry never robs tomorrow of its sorrow, it only saps today of its joy. ~Leo Buscaglia

If you want to test your memory, try to recall what you were worrying about one year ago today. ~E. Joseph Cossman

People gather bundles of sticks to build bridges they never cross. ~Author Unknown

For peace of mind, resign as general manager of the universe. ~Author Unknown

Monday, August 2, 2010

Animals know.

I go into a lot of homes where there are pets. Lots of dogs, and lots of other pets as well. Many times I am told that the family pet is acting differently. Not eating. Whining. Lying about more. Barking at everyone.

And they cannot figure out why there is this sudden change.

But we see it a lot.

It is because they know.

And it is not just dogs. I have seen cats and birds acting quite weird, too.

They know that death is near. They somehow sense it.

Once, there was a home with three small dogs. I went there often to change the patient's dressing. The dogs always greeted me kindly and I brought them treats. But as the man continued to decline, they were less and less friendly. When he was near death, and I was called by the family to see him, they all stood around the hospital bed, growling at me. They would not let me near him.

They knew. And they were going to protect him until the end.

On another day, I was in the home of an elderly lady with a cat that always hid whenever anyone came to the home. As she became more and more bed bound, the cat could be seen curled up next to her all day and night, barely taking the time to eat. The daughters' told me that the cat was 16 years old and had never, ever laid by the mom, not even once that they could recall. Now, when they tried to remove the cat from the bed, she hissed at them.

Four days later, the mom died. The cat would not leave her side even as the funeral home came to retrieve her body.

Animals are funny. We think that they do not have emotions, or know too much. But they sense a lot more than we could ever imagine.

And they bring great comfort to many.

We have a volunteer who brings his mixed breed lab to the hospice house to visit the patients every weekend. The patients love it. The dog, Bruce, seems to linger longer with certain patients, the ones that are closer to death. It surprises us each time. At first we thought it was just a coincidence, but it has happened too many times for it to be explained away so simply. He is always right on the money.

He just knows.

I love animals. We have several pets and they add so much to our lives. I cannot even describe it. And I know they can sense it when any one of us is down or sick or even angry. They hang out more. They seek our attention more. They provide great comfort by simply being there. They know that we need them. And we do.

I guess what got me thinking about this today was a patient I went to see lately. She was a youngish mom with a cat. The cat would sit outside the house in front of the front door. When I came, she would follow me in and watch me from the bedroom doorway for a while, then she would run away. The patient told me that the cat was a stray that they took in about two years ago, who never warmed up to anyone except her. The cat spent most of the time outdoors chasing God knows what. The patient said she fed her every day and tried to pet her, but she wouldn't really allow them to touch her too much. The mom was really the only family member who paid attention to that cat. She called her Bella.

As the patient became more frail, the cat started sleeping in the house, near the bedroom door. She would still go outside, but only for short periods of time now, the family reported to me.

Finally, the patient, a very loving mom of 4 kids, fell into a comatose state. When I went to see her, the cat was now on the bed, curled up next to her.


She didn't stir as I examined the patient. The husband tried to take her off the bed, but she would just jump right back on.

After the patient died, the cat disappeared. The husband said she ran out after the funeral home came and never returned. They have left food outside each day. And each day it is left uneaten. They don't understand why the cat would do that. But it seems obvious to me.

Pets love us for the love we give them. Sometimes, they love us despite the bad or indifferent way that they are treated. But they really only know love. And they seek love. And they are very loving right to the very end.

And they do mourn the loss.

They just simply know.

It often happens that a man is more humanely related to a cat or dog than to any human being.
~Henry David Thoreau

Whoever said you can't buy happiness forgot little puppies.
~Gene Hill

A dog can express more with his tail in seconds than his owner can express with his tongue in hours.
~Author Unknown

There are two means of refuge from the miseries of life: music and cats.
~Albert Schweitzer

There is only one happiness in life, to love and be loved.
~George Sand

The difference between friends and pets is that friends we allow into our company, pets we allow into our solitude.
~Robert Brault

Be sure to check out your local animal shelter for a pet companion. These places are full of wonderful animals who need a loving home.

Monday, July 26, 2010

Reality is at times an illusion.

From Wikipedia:
Reality is the state of things as they actually exist, rather than as they may appear or may be thought to be....

I hate the word 'reality'.

Reality does not seem to always exist. Reality TV, for example, is simply not real at all. Even the news is edited, not really real either. And all the shows about Hollywood and the magazines like People that we devour? Also fake. Always either trying to put a good person in a bad light, or the other way around. Entertaining, but certainly not reality.

Spin, spin, spin.

And don't even get me started on politics. Or politicians.

So, where do we find reality?

Is what we see and hear real? Can we trust what we see and hear?

The only thing that I see that is certainly real is death. And after the death has occurred, we still change what we have seen and tell stories of a death from our own perspective.

And I guess that is what reality really is. A view from our own perspective. Just our own reality. No one elses.

But we do rely on other's perspectives. And that sometimes is a problem.

Because it is simply not always real. And many times an illusion.

I guess what got me started on all of this was meeting Priscilla Presley this past weekend. She is someone we have all heard of and seen on TV and in movies. Many times, she has been made fun of. Especially lately, with garish pictures in magazines showing her in an unflattering way. Looking rather plastic and unreal somehow.

But when I saw her and saw how she really looked (tiny, petite, her face pretty, not as bad as the magazines lead us to believe and much, much younger than her age of 65) and how she acted (like a really nice person, shy and polite), I suddenly realized we had been misled. They sold us an illusion. And a bad one at that.

Here was a real person who has thoughts and feelings just like we do. Sure, she is famous and rich and lived under the shadow of a name bigger than life. But she was just as friendly as anyone I have ever known and she treated everyone as though she was thrilled to meet them. And it was not an act. I can spot a phony a mile away.

There was a man in front of me, waiting in line to meet her, who lived in Kentucky and who had been, and still was, a huge Elvis fan. He had with him a signed postcard from an Elvis concert he attended in 1971 that was signed by Elvis and a few members of his band. He told us he had waited all these years to finally meet Priscilla and have her sign it as well. He hoped she would, but understood if she could only sign the model horse that the organizers told us was the only thing she would sign and not to ask for anything else. He was so sincere and such a nice guy. He said he would simply ask her and if she said no he would not press the issue. We all hoped she would sign it.

Finally, when it was his turn to meet Priscilla, he showed her the postcard. She was stunned and happy to to see it. She ogled and awed and talked to him about his memories of that concert. Then, she asked for a special pen and signed away. All the people waiting, and there were quite a few, stood and applauded. I am sure that Priscilla wondered about that. But we were all so thrilled for him. And we all told her thanks as we went up to her. Thanks for being so kind to this man. And we meant it.

And we all realized, too, that she was very real. Not a joke as they portray her to be on TV and in the rags.

She was an illusion that turned to reality, not the other way around.

It was a good lesson. It made me stop to think about how I perceive things and to know that my mom was right when she would say to me, "Believe none of what you hear and half of what you see."

So we should all be cautious when we hear something about someone we don't know. We should not judge. We should remember that others are trying very hard to make us see things from their perspective, from their reality. And most times, it is only an illusion. Made up for some gain.

I am not sure what there is to gain by making someone else look bad. Perhaps it is to sell magazines or newspapers or whatever. Or to try to make themselves look better by putting others down.

But it is quite mean and I have to wonder what we have become as people who clamor for this misinformation, and view it as entertainment.

You know, we really have such a short time here on this planet. That is certainly a reality. And it is a real shame to waste it in this way.

I would much prefer to spend it the way Priscilla does; being real to ourselves regardless of what other's say.

And taking the time to make people happy.

The image is one thing and the human being is another...It's very hard to live up to an image, put it that way.
~~~Elvis Presley

When I was young, I admired clever people. Now that I am old, I admire kind people.
~~~Abraham Joshua Heschel

Remember that everyone you meet is afraid of something, loves something and has lost something.
~~~H. Jackson Brown, Jr.

Make it a practice to judge persons and things in the most favorable light at all times and under all circumstances.
~~~Saint Vincent de Paul