Friday, April 30, 2010

Please don't say "Are you Okay?"

Today I spent the day with a family who had to make a tough decision; to take their husband and father off of life support.

The son was only 15 years old. He had a back pack with a skate board attached. He had on Vans. He looked every bit a 15 year old, but looked so weary. He was polite and was holding together as best as he could. Occasionally a tear would fall, and you could see that he was crushed. He had hoped the outcome would have been better for his dad. His dad is his best friend.

He held it together until a question was asked to him over and over again by every visitor and everyone that called him on his ever ringing iPhone.

That question? "Are you okay?"

He almost threw the phone at one point. His mother could understand, she had been asked the same question all day long as well.

"Why does everyone ask me that? My husband is going to die soon. How could I possibly be okay?"

I told her that people generally do not know what to say. That they typically will ask that question, say "I'm so very sorry" or ask if there is anything that they can do.

"Can they bring my husband back to me", she asked.

I could understand her anguish.

I told her and her son that there is no way to describe this other than to say that it really sucks. There are no words to make it better. That the patient was a good man who is dying way too soon. That it will be tough. That we are here to offer support and help them navigate through the nightmare that has engulfed their lives.

She said I was the first person to understand. Well, me and the Hospice Social Worker that was equally as honest, better than me quite frankly. I so admire the social workers.

We all try to do our best. I am fortunate in that I am a trained professional and this is my job. Otherwise, I would probably be asking them if they were okay, too.

I think that when we are with people going through a life crisis like this, that we need to think about how we would feel. How we would want others to respond to us.

If we cannot think of anything to say, then perhaps we can just add that "I am thinking of you right now. I cannot imagine what you are going through. I want to help, but I am not sure what to do or say. I know that this is incredibly hard for you. I am here for you."

Or you can say that this simply sucks.

Because it does.

And leave it at that.

The bereaved have a lot of things swirling through their heads. They are numb at times, angry at times, wanting this to just be over at times and then feeling guilty because they want it just to be over at times.

They want people to care, but they hate all the intrusion. They want to cry, but feel that if they start to cry, they will never stop. They want to laugh at a joke or get a break, but then feel guilty that they are enjoying themselves, even briefly, while their loved one is dying.

It is really hard to be a survivor.

So, be patient with them. Love them even if they don't seem to notice that you are there. They know. Be there for them after it is all over, when the reality of the loss really hits. They need you more then. And be there on special occasions and certainly at the 1 year anniversary of the death.

Being there can be as simple as a handwritten note, a card that says I am thinking of you, a visit or some small token.

Often, the bereaved feel abandoned after their loved one dies. Or forgotten.

Don't abandon them. Don't forget.

But don't ask them if they are okay. They are certainly not okay.

And never really will be 100% okay again.

A death leaves a hole that fills over time, but never truly goes away.

Thursday, April 29, 2010

Suddenly gone.

Tomorrow I am going to a Surgical ICU to stand with a woman who is taking her 48 year old husband off of life support. He has a traumatic brain injury from a motor vehicle accident and is now considered brain dead.

We do not get these types of referrals often in hospice.

I am often asked by people what type of death I think is "best". A sudden death or a long, drawn out death.

And that is a tough question.

A lot of our patients have known that they have a terminal illness for a very long time. But they live with that illness through various phases and still consider themselves very much alive. One MD I know calls each phase the "new normal".

I hate that phrase. There is nothing normal about dying from a terminal illness.

Most of the patients I have met thought they could beat the disease. And why wouldn't they. Many MDs have told patients that they have less than six months to live and many have outlived that death sentence by years.

Some have beaten it all together.

But if they have not, and the cancer progresses, they do have some time left to take care of personal matters if they wish and to see people they have not seen and to "get their affairs in order".

But the truth is, most do not.

When a 'sudden' death occurs, the family is always in shock. I would hear over and over the sad stories of an argument the day before, or the goodbyes that could not be said, or the sadness that comes with realizing someone died alone.

But, I hear these same stories in hospice. Even in hospice, the "expected" death comes as a shock.

So I don't think there is truly a better way. Each ends the same. The person is gone too soon and we miss them so much.

There will always be conflicting emotions going on with the survivors; anger, relief, guilt, and mind-boggling grief. Those occur with any type of death.

One terminally ill patient once told me that he was glad for the time he had even though he had always said he wanted to "die suddenly of a heart attack while golfing".

"I am happy that that did not happen. It would have left too much chaos in its wake."

But all deaths leave chaos.

His did, too.

So, when I am asked the question of which death is 'best', I usually just shake my head and say that I do not know. That they are both equally as bad. They all end with someone we care about going away.

And that is never good.

Tuesday, April 27, 2010

When we cannot kiss it and make it all better.

I am not thinking about hospice at all today. Just people.

And how we see them hurt and sad, or maybe just sad, and we cannot help them. As much as we would like to and really do try.

But sometimes we cannot even help ourselves.

Remember how easy it was to have your mom or dad or grandmother hold you and tell you not to be sad? That it would all be okay? And when we were very young, before we knew so much about life and death, and all the messy stuff in between, we believed them. And it did feel better. At least for a time.

But that doesn't happen so much as adults. Or even as children. Children are too sophisticated to believe this anymore. They know too much about the hard realities of life, even from an age when I thought they wouldn't.

But life is hard. And bad things do happen, even to those that do the 'right' things.

Many books have been written about why bad things happen to good people. I think it is comforting to read, but it doesn't make it go away or even really explain it well.

I see a lot of very sad people all of the time. When I am working, I expect it. But even when I am not, and I mention what I do, the sad stories come out. At parties, amusement parks, in the store, out for lunch. There is just no escaping the fact that we all are going to feel sad sometime. And I think sometimes we get sad just thinking that one day we might be sad.

And that is truly sad.

The number one prescribed medication in this country are anti-depressants. Personally, I find them over-prescribed by physicians who fix every complaint with a simple pill. Even kids are on them. And I know many who take them who are still quite sad. But I wouldn't classify them as clinically depressed. Just sad. And angry. And beat down. And weary. They seem to have the weight of the world on their shoulders.

I get sad sometimes, too. We all do. I get sad when my daughter is having a bad day. Or when I think about what my mother-in-law is going through. Or when I see someone having lunch with their mom or dad and I know I can never do that again.

I feel sad for my patients and their families. I feel sad when a pet dies. Sometimes I feel sad for no particular reason at all.

I don't have any answers. I do tell my patient's families to allow themselves to grieve. And I guess I would offer the same advice for anyone feeling sad.

To allow yourself to feel sad.

We don't allow ourselves to do that much. We really don't.

And we try to make the sadness go away by doing things that make us feel happier. Like eating. Or shopping. Or sleeping.

But nothing really does make it all better. Nothing really does make it go away. It is always there, lurking. Sometimes people will tell me that the sadness overwhelmed them suddenly. Perhaps they saw something that reminded them of something painful in their past. Who knows. But it can come on suddenly and unexpectedly. And often takes us by surprise.

But what I do know is that sadness is universal. It is a common bond we all share, but, interestingly, don't share with one another too often.

Even at funerals, when asked how they are doing, many reply, "fine." They are not fine. They just do not want to burden anyone else with their sadness. Or they feel the sadness is too personal, too intimate to share. Or perhaps they feel that someone will try to diminish their sadness or make light of it.

And many cover up sadness with a hardness that grows over time. Or with anger. Some of the hardest people I have ever met have had an inexplicable amount of sadness trapped deep down. And they shield themselves from anymore hurt with anger. They close their hearts. And they feel all alone.

I don't know. I am not sure why I thought of this today. Maybe because I am a bit sad today myself.

"Hearts will never be practical, until they are made unbreakable." The Wizard of Oz was right. But that doesn't mean we should crouch and hide from sadness. Perhaps what we need to do is let more of it in. Embrace it for a time. Allow ourselves to feel it. Then let it go if we can.

I think it would make us happier in the end.

“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”
Henry Wadsworth Longfellow

"You cannot prevent the birds of sadness from passing over your head, but you can prevent their making a nest in your hair.”
Chinese Proverbs

"She said she usually cried at least once each day not because she was sad, but because the world was so beautiful & life was so short."

Monday, April 26, 2010

Till Death do us Part........

How do you keep the music playing
How do you make it last
How do you keep the song from fading too fast
How do you lose yourself to someone
And never lose your way
How do you not run out of new things to say
And since we're always changing
How can it be the same
And tell me how year after year
You're sure your heart will fall apart
Each time you hear his name.......

I meet elderly couples all of the time in my job. Most have been married for decades, although some are "newlyweds" who have been married after reconnecting after a divorce or the early death of a spouse.

I learn a lot about love and marriage, sacrifice, strength of character and stubbornness from these awesome, wise people. That is not to say I don't meet my fair share of younger and middle aged couples. I do. And they are lovely. But their lives are so complex and seemingly complicated with so many things going on such as raising young kids, having a career, and trying to deal with a life-ending illness.

The elderly are past all of that craziness and have survived somehow. They have been cruising along after managing to keep it together during all of the rough patches. I admire them and never tire of their stories.

They have so much wisdom to impart.

I thought I would share some of their stories with you.

(Names have been changed, but the details are real.)

Bob and Betty:

Bob and Betty have been married for 61 years. He is 81, she is 80. They were high school sweethearts, have never been more than a few blocks away from one another their whole lives.

Betty has ovarian cancer. Stage 4. She is quite frail and can no longer eat. Bob still makes her a meal three times a day. He places it on a silver tray with carved handles that they have had since their wedding day. He places a rose from their garden in a small juice glass on the tray. He brings it up to her room.

When she could walk and get out of bed, she used to flush it down the toilet so that he thought she was eating. But now she can no longer ambulate. So it sits there, uneaten.

"Betty doesn't seem to want to eat anymore. I am worried." He says to me on my visit.

Betty looks over at me with that knowing look.

"Leave the tray here, Bob. I will eat it later. I promise. I want to talk to the nurse for a little while now. It looks lovely, Bob. Thank you, dear. Now please go down and read your paper for a while. Ok?"

Bob looks at me. I tell him it is fine. He goes downstairs, all the while shaking his head and looking down.

After we hear him on the last step, Betty says to me, "He is driving me crazy."

She goes on to tell me how he tries to get her to eat all of the time. How he wakes her when she is sleeping to see if she is okay. How he just paces in the room while she pretends to sleep so that he won't keep asking her how she feels.

"Bob and I met when I was 12. He was 13. I liked him right away. So tall and blonde. He played stickball back then in the neighborhood with my brother. We lived just blocks from one another, but went to different schools. He asked me to his school dance when we were older. We married right out of high school."

"Marriage was hard. I cannot tell you how many times I wanted to leave him. But we have never really been apart all of these years. We stuck by each other. We watched as our parents died, all of our siblings died, and many of our friends. When the friends go, you know your time is near. It is just us now. Soon, it will just be Bob. I am so worried about him being alone."

I knew that they had 3 adult children nearby and many grandchildren. It was one of those close knit families that you envy at times.

"Well, your kids will be here to make sure Bob is okay", I added.

"No. They have their own lives. Bob and I always leaned on one another."

After we talked some more, I went down to see Bob.

"How is she doing? Is she getting better?" Bob asked me.

"No, Bob. She is not better. She is stable today and she is well cared for. You are doing a terrific job."

Bob breaks down and starts to cry. He tells me that he always thought he would be the first to go. That he was not prepared to lose her. That she was his "compass, his guide through life". That he will be "quite lost" without her.

"I was not a great husband. And she was not always a great wife. But we had each other. I could always depend on that. We built a life on that. Now that is over. My life is over. I just want her to get better. I don't know what to do."


Alice and Henry

Henry is a 95 year old gentleman. When I say gentleman, I mean it.

His wife, Alice, is years younger. They got married after Henry's first wife died at age 40. They have been married about 55 years.

Henry is dying from a chronic lung disease. He was always the outgoing one, always in charge. Alice has always just "followed along". They have several adult children but mostly like to keep to themselves.

Alice talked to me about their marriage.

"Don't think I am being mean, but I am finally going to have the apartment re-decorated after Henry dies. I love Henry and he provided me with a great life. We traveled all over the world. Went to the Opera, the Symphony and the theater each and every season. We attended countless galas and had a house here in Boston, one on Martha's Vineyard and one in Vermont, for skiing. We were always entertaining, always busy. I was a simple gal and he really showed me the best life. He really did. But now I want to live a little of my own life, while I still have the time and the energy."

Alice is 80.

Alice married Henry when she was 25 and he was 40. He was a widower with 2 kids in their teens. She had a toddler and was divorced. They raised all the kids well and are still very close. But you can see when they are all together that even though they are accomplished adults in their own right, Henry is still in charge.

"I will miss Henry. He was a good provider. God, we had some fun. He loved my daughter as his own. For that I will be ever so grateful. But I have never had a moment when I was just in charge of me. I am looking forward to that freedom. I will be sad and miss him. He was truly my rock. He saved me. But I know that I will be joining him soon and want a few stories of my own to tell when I see him again. All of our stories so far begin and end with Henry. I want a few Alice stories."

Raymond and Eileen

Raymond and Eileen live in a house in a nice suburb of Boston. He is quite ill with pancreatic cancer. He used to be an Air Force pilot.

Their home has not been updated since about 1970. There are pictures of Raymond near his planes, in his planes and flying his planes. He liked to dabble in art, and there are many oil paintings with his signature lining the living room and the family room.

Eileen is a nervous wreak. They are in their late 70's. Raymond was always healthy and worked out everyday. One day they noticed that his eyes were jaundice. Then 4 months ago, they received the bad news that he had pancreatic cancer. They are still in shock.

"Raymond just retired a few years ago. We had planned some trips and were going to see about selling the house. Now, I am just numb. I can barely breath."

She looked around and then said, "I am really pissed. He worked hard all of his life. It was his turn to have some fun, to let go of all the responsibility. I feel he got cheated."

Eileen went on to tell me about their marriage. How Raymond always encouraged her to have a life of her own beyond being a mother and wife.

"I took classes, I traveled with friends, I wrote a book once. But Raymond was my anchor. I couldn't have been so free to enjoy myself without him being there for me. He was a strong man, and tough. You always knew where you stood with him. And life almost stopped for us in the late 70's. Almost stopped. But his strength kept us going"

I asked her what she meant. In their tidy living room was a picture of a very handsome young man. Next to it, a diploma from a prestigious Medical School.

"This was our son, Ray, Jr. He was a wonderful man. He was a doctor and went overseas to help people in need. He loved to travel. He loved medicine. One day, they couldn't wake him. He had died. They said he had a brain bleed.

He was 34.

"Our world ended. Raymond was devastated. His only son. Gone. Gone! But he kept me going, kept our daughter Susan going. The funny thing about losing Raymond now is that I need him to help me get through losing Raymond. Isn't that crazy? But he is my strength, my anchor. He has been a difficult man at times to live with. I will feel adrift without him. What am I going to do now?"


I, like many of my colleagues, hear wonderful and sad stories like these all of the time. The one plus of hospice nursing is that we are invited into the homes and lives of our patients. And, as much as we help them, believe me when I tell you that we receive so much more in return.

I have learned many lessons about being married from my patients. They have taught me that marriage is indeed hard. That love comes and goes at times. That marriage has different stages just like life has. They have shown me what great devotion means, that is okay to have differences as long as you can still pull together during the hard times.

I hear these key words time and time again; anchor, strength, rock, compass and best friend.

So, I think that is the secret to long marriages. Being there for one another. Hanging in there throughout all of the changes in life. Being true to the marriage, not just to each other, because the marriage is bigger than two individuals.

Realizing that in the end, after you raise the kids, it really is just the two of you.

All of the stories end well. We follow our families for a year after the death of the patient. We stay in touch.

Bob could not care for his wife alone once she became much more ill. She died at our hospice house, a peaceful death surrounded by her family. Bob is now a fixture at the hospice house. He volunteers there several times a week. He places a small flower from his garden in a juice glass and places it on the patient's tray. He encourages everyone to eat. Even the nurses.

Alice not only redecorated, she moved to a retirement village and has a lovely home there and many new friends. Last I heard she was headed on an Alaskan cruise.

Eileen has reconnected with her daughter, Susan. The two have been estranged, but Raymond brought them together again towards the end of his life.

The anchor until the end.

Friday, April 23, 2010

Our Sanctuary. Our Bed.

Our beds are important.

We don't always see them that way. But we spend an awful lot of time in them.

We love our beds more than we know. How many times have we been on vacation or on a business trip and uttered these words, "I can't wait to sleep in my own bed again".

I see a lot of beds. Most patients in hospice are in one a lot of the time. Often, I try to get them to use a hospital bed. We can have them delivered to the home. They are convenient as you can simply push a button and move your head up to a sitting position. The whole bed rises up so that care is easier to manage and they are easier to get in and out of. Plus, we can then place a bed on the first floor as many patients cannot maneuver up the stairs easily anymore.

But when I mention it, I am often met, not with mild resistance, but a fierce determination to "remain in my own bed".

My own bed. I hear that all of the time.

Some of the beds that I see are not what I would call comfy and inviting. Many have rag tag blankets and are never made, always looking disheveled. But many like it that way. They are comfortable there. That rag tag blanket may have seen a lot of years and have special meaning. We don't judge. We try to keep people in their own beds. We understand the importance.

But most people really don't think about their bed unless they are forced to spend countless hours in them. Many do not make their beds or change their sheets often. Some have stuff piled on them or have pets sleeping on them all day.

Others, make the bed every morning, change their expensive 1000 count sheets every week, have a matching duvet, bed ruffle and coordinating pillows.

But it really doesn't matter what the bed looks like. What matters is what it means to you.

I am always thankful for my bed. Sometimes in a crazy way. I suppose because I am forced to think about beds a lot.

I want mine to be a place where I can really feel comfy. Cozy. I want it to be pretty, but not so nice that it would bother me to have kids and dogs on it all of the time. I want it to have a lot of pillows. Pillows mean comfort to me.

Beds can also hold special memories for us. I remember the bed of my youth quite clearly. I spent a lot of time there dreaming about what my life would become. I had posters surrounding my bed and my favorite stuffed animals sitting there and of course the one pillow that I took with me everywhere I needed to lay down my head; the sofa, a trip in the car, to a friends house for a sleep-over, on vacation. I took a little bit of my bed with me because I knew how much it comforted me.

And still does.

So, take another peek at your bed tonight and look at it not just as a place to plop your head, but as a special part of your life. Your own private sanctuary, even though you may share it with another. See it not just as furniture, but as a place you can recharge, ignite passion, have meaningful quiet talks, make memories. A place where you can express your design talents or a place that you can leave rumpled and messy because life always seems too tidy for you and the bed is just relaxed and you can really let go there.

Anyway, we should embrace our beds. They certainly embrace us. They are a much bigger part of our world than we think.

O bed! O bed! delicious bed!
That heaven upon earth to the weary head.
~Thomas Hood, Miss Kilmansegg - Her Dream

May sleep envelop you as a bed sheet floating gently down, tickling your skin and removing every worry. Reminding you to consider only this moment. ~Jeb Dickerson

Life is too short to sleep on low thread-count sheets. ~Leah Stussy

Thursday, April 22, 2010

What this hospice nurse hates.

I hate ALS.

Amyotrophic lateral sclerosis.

ALS is also known as Lou Gehrig's disease.

The cause is unknown.

In ALS, nerve cells (neurons) waste away or die, and can no longer send messages to muscles. This eventually leads to muscle weakening, twitching, and an inability to move the arms, legs, and body. The condition slowly gets worse. When the muscles in the chest area stop working, it becomes hard or impossible to breathe on one's own.

There is no known cure.

Today, I went to see a patient with ALS. She is close to my age. We have had many ALS patients on our service. We do the best we can. It is hard. It is a very cruel disease.

Imagine sitting there, unable to hold up your head. Drooling because you cannot swallow your own secretions. Having trouble breathing because the muscles that help you to breath aren't working anymore.

Now, most people have only a faint inkling that something is wrong when they are first diagnosed with ALS. They may have a twitch in their thumb that won't go away. They may notice they trip more easily. All random small things. They go the MD and walk out with a death sentence. Talk about shocking news.

I cannot even imagine what that must be like. It must seem like a nightmare.

But the patients are so brave. I am always in awe of them.

There are many specialists here in the Boston area that work with ALS patients. They are very good at what they do, but they cannot cure the disease.

Then we are called in. When the going gets rough.

I don't have any magic tricks up my sleeve. I cannot make it better. I try. I can give them some meds to help, but nothing is a panacea.

I get upset by this. Most patients can be helped to feel more comfortable. Those visits give me some satisfaction that I have made a difference.

But not so much with ALS.

When I leave the ALS patient, I always feel guilty. I can get up and walk away and drive my car. I can use my arms and my legs without a thought. I can scratch my nose when it itches. I can talk on my cell phone. My fingers can dial with ease. I can eat without choking. I can swallow my own secretions mindlessly. I can take deep breaths.

And I usually take it all for granted.

But not on these days.

On these days I am reminded that life, and particularly death, can be very cruel.

Unjustifiably cruel.

It makes me rethink what I am doing as a hospice nurse.

Sure, many people think that hospice nursing is a special area of nursing. That we go into situations that most would want to avoid. And for the most part, that is true. We do our best to provide the patient with a "good death". A comfortable death. Death on their terms.

We try to give them as many good days as we can. We go into chaos and try to deliver some calm and peace for the family. We try, we really, really do. And many times, we succeed.

But it doesn't mean that we always like it. Or that it doesn't bother us. Or that we always feel like we are doing enough. Giving enough. Coming up with solutions to immediate problems that happen on a weekend at 6pm.

When there is often no one there but us to figure it all out.

I have often called MDs on the weekends to help me. The answer I usually get is, "Well, you are hospice. What do you think we should do." And I usually tell them what I had already thought. No additional input from them. No other options offered. I hang up discouraged. I didn't go to Harvard Medical School. I went to nursing school and you are telling me that I have the same solution as you? It feels crazy sometimes.

Or, they say, "Well, if the patient is that sick, perhaps they should go to the ER."

"No", I say. "The patient wants to die at home". Why don't they get that?

I do confer with our on-call Hospice supervisor or our Medical Director. They are helpful, and I love and admire our team, but it ends up it is just me in the patient's home with a nervous family hovering nearby and I have got to fix it as best as I can. And I do try. I am lucky that I have 30 years experience on my side and that I am a old tough gal. I do see myself as fairly competent and I stay as long as it takes to come up with a resolution. I do my best and then I have to leave them with a promise that if it gets worse, we are here. Just call.

But I know that there is no good solution.

And that saddens me.

We can only do so much, I know. But I want to do more. Give more. Help more.

Sometimes I leave an ALS patient visit very sad. And very angry at the Gods for allowing this type of human suffering. It just is so incredibly unfair.

So, today, in honor of all my ALS patients, past, present and future, I just wanted to share this with you. So you know. So that you are aware that there are some things even the people who see the worst fear.

I am not asking you to feel sorry for me or my patients with ALS. I am not asking you to be happy that you do not have it, because none of us know what lies ahead in our future.

I just want to thank you for allowing me to share this with you.


Tuesday, April 20, 2010

We are never going to get caught up.

If any of you know me, you know that I hate doing laundry.


More than anything.

One day I seem to get caught up, meaning the hamper is empty and the clothes are all put away. And I have a small moment of satisfaction. And then, overnight, it all seems to appear again! Like magic. Or a dirty trick.

I then realize, I am never, ever going to get caught up.

With anything.


And this used to bother me. I wanted to get caught up. I hate the mundane chores of every day life sometimes. They get in the way of wasting time on Facebook, writing on my blog, playing around with the dogs, watching movies, going shopping with my daughter, or just hanging out and reading a good book. You know, the fun stuff that we feel we waste time on.

Funny thing about that "wasteful" time. It is really not wasteful at all. It is our life. The part of life we enjoy. Our down time. Our "me time". Our quality time.

But the other stuff needs to get done, too. And it adds a lot of stress to our lives just trying to do it all. We spend an incredible amount of time thinking about it, arguing about it (like in, who is going to do it), making lists about it, complaining about it.

And for what?

We just either have to do it or not let it bother us so much.

So, I was thinking, why do we let it bother us so much?

I blame it on TV commercials and on TV shows.

Yes, I really do.

I can remember watching TV when I was young. All the commercials showing what a "mommy" really does. That is, doing laundry and perfectly folding each item, scrubbing our floors to a gleam, having a perfect meal set out for our ever so hungry and grateful family, having a perfectly decorated living room where pop-in guests are served fresh perked coffee and a bundt cake just out of the oven. Moms who are impeccably dressed, even while dusting, and a handsome, smiling husband who wanders in after a day at work with a smile and a kiss on the cheek.

Oh, and don't forget the well dressed kids who are polite and appreciative of EVERYTHING.

Pure rubbish.

But drilled into our heads never the less.

And we wonder why we all need Prozac.

No one can live up to what is portrayed in the media. No wonder reality shows are a big hit. We can actually feel good about ourselves after watching those train wrecks.

And how about those commercials showing a bunch of kids playing happily with the new toy they just received. We all know that many young kids are happier with the box it arrived in and are bored with the new toy about 5 minutes after they play with it for the first time.

No wonder we have so much clutter. We just keep buying more.

But clutter is another topic for another day. We are never going to get caught up with that, either.

So, back to this notion that there is some ideal to strive for. That there is such a place as "caught up". My guess is that it does not exist. That we are reaching for something that will simply never be.

So, we should give ourselves a break. Be more about just being "good enough". Not thinking we are a bad mom if there are no clean socks in the house. Not worrying about the dishes in the sink. Not thinking that we have to have a neatly manicured lawn all the time (husbands will rejoice) or organized closets. Start thinking that sweats can make us look glamorous. (Okay, that one is a stretch).

But you know what I mean.

So, I am going to start thinking differently. I am not going to put laundry on my to do list anymore, or cleaning or anything that can never, ever be caught up. Going forward, I will only write down important appointments that cannot be missed, bill deadlines, school project completion dates, birthday reminders (because people are important) and what I need to buy at the grocery store (because I fail to write it down and end up making two trips).

Then I am going to fill the rest of my to do list with the stuff that really matters. Spending time at home with my family, just hanging out puttering around, petting the dogs, planting my garden, reading a book, walking more, writing more, sitting in the sun more. And I am going to try to embrace the laundry as a function of every day life, like brushing my teeth, or breathing.

I know, equating laundry to breathing? She has finally gone mad.

Yes, breathing. It is not like like you can take a bunch of breaths and be done with it, you have to keep breathing to stay alive and we need clean laundry to keep our family functioning properly, right?

Of course, if you quit breathing that would be a bad thing. Quitting laundry therefore is not so essential. You are right.

So, if there are no clean socks, so what. It is almost sandal weather anyway.

What we can learn about living longer from the ones that have and have not.

Yesterday, my 96 year old patient died. I felt really sad. She was sweet and I enjoyed visiting her and her 99 year old sister.

Many of my patients are elderly. Some are seriously ill and others are just older and failing. And all of them have so much to share about life. I find them fascinating.

I lost my 96 year old grandmother, Cora, when I was 18. She was an interesting person as well, but as any parent of an 18 year old knows, we don't realize it then. My other grandmother, Helen, died when I was 6, so perhaps I am making up for lost time by embracing my senior patients. Who knows. But I do know that I am not the only one. Other nurses tell me the same thing.

I recently finished reading a a book called The Blue Zones by Dan Buettner. In this book, he traveled the globe to the areas where people live the longest to find out their secrets of longevity.

It is an interesting read, but is sort of the same advice we read about in most books about health. Eat right, exercise, drink water, eat fish. You know the drill.

I would find it much more interesting to read about what the ones that died young did wrong. I am sure that many of them also ate well, exercised and drank water, too.

I see many patients who die young, but they did not do anything particularly wrong. They may have simply been in the wrong place at the wrong time, had their symptoms dismissed because they were too young, or did a lot of stupid things that finally caught up with them. Or maybe they just had bad luck. Or bad genes.

And the patients that I see who are very old. What did they do to make it through this life so long? Besides good luck and great genes, of course.

Here is a sampling of some the things that I have seen over and over again in the course of my nursing career:

They drink tea.

They use sugar or honey and have never had a 'diet' anything.

They have a hobby that they are passionate about.

They worry less about nonsense.

They are not obese, but also not skinny. Kind of just right. Our bodies want to add fat as we age. Some of it may be protective. Too bad we are a culture obsessed with thinness. It probably is not healthy at all.

They walk places.

They have a support system of friends and family.

They drink tap water.

They take naps. Many report they have always taken naps, even when younger.

They take a vitamin pill daily.
Some take several supplements. One man I met in his late 90's had about 30 supplements on his shelf. He took many and he really looked great. The hospital that discharged him after a brief illness thought he needed hospice, but we could not sign him on because he simply did not qualify. I looked at all of his supplements. You can bet I wrote them down. He is doing well.

They lift small weights daily.

They eat less.

They have a optimistic attitude.

They go outside and are not afraid of the sun. Many think the sun has healing abilities. Scientists agree and are now saying that Vitamin D3 is very important. These smart elders never needed a scientist to tell them that. D3 is what we get from the sun.

They wear a hat when out in the sun to protect their skin.

They use basic soap and water to cleanse with. They do not douse themselves in chemicals. They do not use antibacterial soaps.

They enjoy the small things in life.

If they don't like someone, they don't play nice. They are true to themselves.

I am sure that you can add to this list. We don't need a book or a scientist to tell us what we need to know about living longer.

We can simply look around us.

Monday, April 19, 2010

Don't listen to so called "experts" so much. Embrace your Common Sense Instead.

Take a vitamin every day.

Vitamins don't really help. Don't waste your money.

New study proves vitamins decrease cancer risk.

These have all been recent headlines in the past couple of years.

It is hard to keep up with all of the new "studies" and all of the new "experts".

They are everywhere.

Lately, I have heard that women who drink wine stay thinner, but only if they were already thin. That red wine helps fight heart disease, but it can also increase your risk for breast cancer. That eating fat causes heart disease. That too many carbs cause heart disease. That we need more protein in our diets. That our intake of protein is too high. That 30 minutes of exercise 4 times a week is all we need to stay healthy. That what we really need is 60 minutes of exercise a day, plus strength training, to have any "significant" impact on our health.

All of this makes me feel like the world has gone mad.

Where has all the common sense gone?

Do we really need all of these purported experts reporting on
conflicting "scientific" studies constantly? Does it really make us healthier? Or just more worried than we need to be.

And how about all the new books? And Oprah? And Dr. Oz? Are they really trying to be helpful or are they just trying to make a lot more money?

Hmmm. I would bet the later, unfortunately. (Although, I really do like Dr. Oz, just not so much of him)

Anyway, I think we are really all acting like Dorothy looking for answers from a powerful Wizard, when really, we had the power all along. We just needed to believe in our own power of common sense.

We know what we need to do to be healthier. We know what we need to do to lose weight. We know how to keep our heart in good shape. We know what foods are bad to eat. We know that drinking too much wine or beer is bad. Or too much coffee. Or too much ice cream. We just want some reason to convince ourselves that what we truly desire is really okay. And if we look hard enough, I am sure we will find some "expert" somewhere to conclude that what we want to believe is actually true.

Even though we know it is not. And that it defies common sense.

Look, we can all use a simple vitamin pill daily. We can all eat more fruit and less candy. We can drink more water, we can exercise more, we can get more sleep. We probably should not have that third glass of wine. Or too much bread. Or smoke or take drugs for recreation. We should probably go to the MD once a year for a physical, have the mammogram, get the prostate checked and go to the dentist every six months. We should wear our seatbelts all of the time and not text and drive. We should not drive after drinking. We would most likely do better with our weight if we weighed ourselves daily or at least weekly. I am sure we know that we do not need a supersized anything, a 20oz. sugary drink or a snack every time we go anywhere.

We know all of these things. We just don't want to do them.

Sure, there have been many great scientific discoveries that have saved countless lives. And many new drugs that are wonderful achievements and have kept many alive longer than ever possible in decades past.

But many of those new drugs are necessary because we keep doing all of the things that we aren't supposed to be doing. And that is not good, either.

We really are our own experts on ourselves. When we don't feel good, we often do seek out answers from specialists such as doctors and nurses and dentists and such. And that is a good thing. We just don't always do what they tell us.

But we can do ourselves a big favor and simply listen to ourselves more so we don't have to seek them out as often.

Look, I know what you are thinking. I see many patients who did everything "right" and they still got cancer. And I see their family member who is 30 lbs overweight out back smoking and drinking a supersized coke and noshing on a Big Mac. And they don't have cancer. I know. We all know a story like that.

But here is what you don't know. Many of the cancer patients that I see who have survived their cancer much longer than anyone, including the "experts", could have ever imagined, were the ones that took care of themselves.

Anyone can get cancer, but those that survive usually were healthier to begin with. And that is just a fact. Same is true for heart attack survivors, trauma survivors, etc. They were healthier to begin with. They lived their life, not in some perfect bubble, but with some modicum of common sense.

I am not a research scientist with a fancy Ph.D, but I can tell you that for the past 30 years, having worked as an RN, I have seen hundreds, if not thousands of patients with every disease you can think of. And the ones that do well did the things that we know we need to do. And we all are going to get something. Either from the environment we live in, from chronic stress we cannot avoid, from faulty genes we inherited, or from our own stupidity. Something will most likely go wrong at some point. But we can do something to put the survival odds in our favor. And short of getting hit by a Mack Truck, it will help us live longer and better lives.

Quality is important.

So, take a multi-vitamin everyday. Drink more water. Touch your toes every morning in the shower. Limber up. Take a baby aspirin daily. Walk more. Deep breath several times a day. Eat less processed food, and more real food. Pass up McDonald's. Go to bed early one night a week. Cry when you are sad, get mad when you are truly mad, allow yourself to feel what you are feeling. And eat ice cream. Just not every single day.

If you need to lose weight, eat 500 calories less a day and walk or do some type of exercise for 30 minutes. (Easier said than done, but the only way) Drink and have fun, but have some sense about it. Get medical attention promptly when needed. Brush your teeth twice a day. Avoid eating and drinking chemicals. 7 Diet Cokes a day is bad. I don't care what you say.

You know what to do. Of course you do. And you don't need to read about it or have me tell you or watch it on the news.

You just simply need to do it.

Your common sense is worth a room full of experts.

After all, you are the expert on you.

Saturday, April 17, 2010

Hug Your Loved Ones More.

Of all the things I hear people complain about, it is that we have become an isolated, lonely society.

Even in our own homes.

A lot of different things isolate us. Anger at each other, jealously, feeling like we have been let down. Being "too busy". Stress, feeling worn out, wanting to just be alone. Computer time. Gaming time. TV time. Chore time. Homework time. The list goes on and on.

But most of us could just use some hug time.

How many times have you hugged your child, and they don't seem to care or they even push you away, so you don't do it as much anymore, especially in the morning when you are trying to get them off to school and they are yelling because they cannot find whatever.

How many times have you sat there with a friend while she was telling you yet another story of how rotten her life is. And when she is finished, you tell her you must run and then you literally do.

How many times have you stopped by your mom's house to drop something off and scurried out the door to avoid yet another conflict.

And how many times have you walked past your husband or wife doing dishes or cooking something or on the computer and you went straight to the refrigerator to look for a snack and left.

Well, these are all times you could have given someone a much needed hug.

People need hugs the most when you think they don't. When your kids are being rotten, when your husband seems distant, when your friend is upset, when your mom criticizes. As crazy as it seems, many times these behaviors present themselves because people just don't feel loved or appreciated enough.

I know, I am not a licensed psychologist. But I am an observer of people. And what I see are a lot of people who need a hug. A touch. They need to not feel so alone in this world.

It is sometimes hard to imagine hugging all the time. And you need not do that. But once in while, it is the best medicine. For all of us.

And asking for a hug is a good thing, too. Just to say, "I could really use a hug right now" can show others that you are human, too. That you have needs. That you need love. No one can meet all of your crazy expectations, we know that.

But everyone can hug.

And hugs are carried far beyond the time it takes to give one. Many adults wish they were hugged more as children. If there is one thing I hear over and over again from patient's adult children, it is that. More hugs. More tangible evidence of love.

When people or children seem to be at their worst behavior, this is often the time they need a hug the most. And it is also the time that we want to give it the least. The time we withhold love to prove some point. A rather meaningless point. A punishment that only hurts us in the end.

Touch is magical. It really is. (Appropriate touch that is, you know what I mean)

As hospice nurses, we hug a lot. We are asked for hugs and we offer them freely. Patients randomly hug me all of the time. A hug shows something that mere words cannot express. It connects us as humans. We feel like we are part of something. That we matter.

Too often, hugs are given only when there is bad news. Or when we have not seen someone in a very long time. That is a shame.

So, think more about hugs. Offer them more. It can be a good way to connect in this busy world. Do not be stingy with them. Offer them freely, not conditionally. Do not make people deserve them. Do not set limits on hugs. Do not be surprised if someone resists at first or thinks you are weird. They really love it. They do. And if they don't appear to, that is okay. You will feel good about reaching out. That is like giving yourself a hug. And that is okay, too.

And hug your children more, especially when they are teenagers and roll their eyes. Inside, they are smiling.

It only takes a few seconds, but hugs can last a lifetime.

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
~Maya Angelou~

Friday, April 16, 2010

7 Things you Shouldn't say at a Funeral.

We all do it.

We go to a funeral home to pay our respects and we just don't know what to say.

So we say a lot of things we shouldn't.

Here are 7 things that are heard over and over again that probably shouldn't be said.


Number 1.
"He looks wonderful (or peaceful)"
This is often said at the funeral home when you are viewing the body. Most people say it, not because they actually think that, but because they are trying to be nice. Silence would be too awkward. Actually, standing in front of a casket feels awkward. But try not to fill the awkwardness with this comment.

Most of the bereaved that I have talked to, myself included, have heard this often and hate it, although they usually nod their head in agreement, never letting on how inappropriate it really is. But honestly, they are thinking, the person does not look wonderful.

They look dead.

Number 2.
"I am so sorry for your loss"
This is a canned, meaningless phrase that we all say. It is like a generic sympathy card. Try to avoid saying it.

Number 3.
"He is finally at peace"
Well, how do you know that. What makes you think they weren't quite peaceful while they were living. Even people that were in pain towards the end of life wanted to keep living. I know that people say this as a comfort to the bereaved. However, it really provides little comfort. Avoid saying this if possible. It is too presumptuous on your part.

Number 4.
"She is in a better place"
If I had a nickle for every time I heard this at my own mother's viewing, I would be rich.

No, she is not in a better place, even if it is heaven. She is dead. A better place is here with her family.

Let the family and loved ones decide where a better place is. Many are very religious and truly do feel this way. And that is fine. But many are not. So, let them decide if they think it is a better place or not.

Number 5.
"Let me know if there is anything that I can do"
This is another one of those canned, generic, meaningless things people say all of the time.

Do not say this. Say instead, "I will call you next week to see how you are doing. Is Tuesday morning okay?"

Then call.

Number 6
"How are you holding up"
This is said quite often. It is hard to answer. It is particularly hard to hear over and over again. Another variation is that people will say, "You look pretty good, are you doing okay?"

Of course they are not doing okay. Their loved one just died.

Unless it was a very rich Auntie whom you never liked but left you millions of dollars, you are most likely not okay. Most people will simply answer yes. But most would like to say, "No, I am certainly not okay. My dad, mom, child, husband, wife....just died. You are a putz for asking."

But they usually smile and thank you for coming instead.

Number 7
"I know exactly how you feel"
You don't.

I know, funerals are hard. We all feel bad and we really never think we say the right things. Many people even avoid going, for just that reason. They send cards or flowers instead.

Not a bad idea, actually.

But, if you do want to go and pay your respects and want some ideas about what to say, here is some advice.

Talk about what you fondly remember about the deceased. Sometimes people think that they shouldn't say these things because they may upset the bereaved. Quite the opposite is true. It is comforting to know how much the deceased meant to others. So, even funny stories are good.

When my own father died and people from his work came, they told funny stories about him at work. It was a side of my dad I did not know. It was comforting to hear how much he was admired. I really appreciated this. Most do.

If you knew the deceased well, say how much you are going to miss them. How sad you are. How sad you must know the bereaved are. It is okay to be sad. It is okay to show that you are sad. A death is a sad time, regardless of the age of the person who died. A loss is a loss. It is not the time to judge a loss. It is not the time to say, "Well, they had a good run." They are still someone's mom or dad, even if they are 90. It is hard to lose anyone, regardless of age. Be mindful of that.

If words fail you, give a hug or a squeeze to the bereaved. This is the perfect time to do that.

Sometimes, words are not necessary.

Some things are truly left better unsaid.

Wednesday, April 14, 2010

Yes, go ahead. Love your stuff.

As a Hospice nurse, I suppose you think that I would say that stuff does not matter. That you can't take it with you. That materialism isn't worth it.

Well, that is just a load of crap.

We all love our stuff. And we should.

When I say stuff, I don't mean that ratty old couch you hate, or the hand me down curtains. I am talking about the stuff that you buy or collect that makes you uniquely you. The things that you surround yourself with that comfort you and make you smile.

I am in the process of purging now. Getting rid of stuff that either doesn't matter anymore, that is broken, that was an impulse buy or that we have simply outgrown. I hope to either give it away or sell it, hoping that it will become someone else's stuff. We all have way too much stuff. I know. And it can get overwhelming.

However, here are many things that I have carried with me for years and I know that I will continue to carry for years. Not because they are valuable or collectible, but because they are part of me. My important stuff.

Yes, there is a distinction.

Now, some people cling to things that hold special memories. Many times they are in boxes, put away so they do not get damaged. Or put away because they are simply too painful to look at. They are special things, but they made up someone else's life. We keep them as tangible evidence that this person existed, that they mattered to us. That they were special. That we still have a piece of them here with us.

A deceased child's teddy bear. A mother's favorite pillow. A dad's well worn fishing hat.

This is not the stuff I am talking about.

What I am talking about are the festive scarves you love to wear and keep buying. The collection of salt and pepper shakers from flea markets. The magnets from every trip you have ever been on. (hmmm, that one sounds familiar)

You know what I am talking about.

We all do it. And for many, we all feel quite guilty about it at times.

"I know I don't need this. But I cannot help myself."

"I should not waste so much money on this stuff."

Or are told, "Why do you keep buying that crap?"


How many times have I said that. (Or been told that, but that is another story for another day)

We all need our little nirvana. It is part of who we are.

So poo on the naysayers, including ourselves. We deserve our stuff.

And no, we cannot take it with us. That is true. But so what. As long as we truly enjoy it and it makes us happy, then what exactly is the problem?

I am not talking about hoarders or people who have issues where they have a shopping addiction. I am talking about the small stuff, the special things.

I am talking about the collection of ornaments that we place on the tree every Christmas, the beautiful vase that we have on our mantel, the art that we enjoy looking at, the books that keep us company when we are lonely. The fragrance that you always buy. How you always have to have the best soap in your guest bathroom. Your favorite bedroom slippers. The cashmere sweaters you wear all the time. The guitar you love to play. The special car you restored. They are a statement about you. They are part of who you are.

Many wise men and women talk about how things aren't important. How materialism is a crime and a shame. How we are a consumer society bent on getting more and more.

I think that may be true.

But it shouldn't make us feel bad about loving our stuff.

There is a line from a movie "The Jerk" that I just love. Steve Martin, as Navin Johnson, has just lost his fortune. His wife, Marie, played by Bernadette Peters says, "I don't care about losing all the money. It's losing all the stuff."

Truer words never spoken.

Many times people say after a fire or a hurricane, we can replace the stuff. We are just glad to be alive.

And I am sure that is true.

But I know that deep down they miss their stuff.

So, anyway, I am still going to love my stuff until the end. And if someone wants to sell it on Ebay when I am gone, that is fine. I hope that they take the money and then buy stuff that they can enjoy, too.

“There are many things in life that will catch your eye, but only a few will catch your heart...pursue those.” Michael Nolan

Monday, April 12, 2010

The Power of No.

Two letters that can spare us so much grief.

Yet, we rarely utter them.

Except to small children, then we say it constantly. "No, you may not have a cookie for lunch." "No, you may not hit your brother." "No, I cannot buy you a fire truck."

This no, however, may add more stress to our lives. But I digress.

Most times, we want to say no, but just cannot.

"Oh, Janice, wouldn't you love to help out with the Christmas Bazaar committee?"

"Um, well, what do you need help with?"

"Oh, just a few things. I will put you down and call you."

What? I never said yes. But I didn't say no. And that is the problem.

This actually a happens a lot. Or work will ask me to pitch in extra time. Or someone will ask me to volunteer or to drive somewhere to pick up something even though I really don't want to do it and I don't have the time. And I usually end up having to give up something that I really wanted to do in order to make the time to do something I really didn't want to do.

Crazy, I know.

But I end up doing it all the time and feeling put out and stressed and tired.

I know, we all do it.

We put way too much on our plate because we simply cannot say, 'No thanks' or "No, I cannot do it, sorry."

So, I set out to learn how to say no.

First, I looked it up on the Internet. Nothing seemed very helpful. Most of the articles written by "experts" were just common sense that I have already tried.

Then I went to the bookstore. Same thing.

My problem is that I just cannot say no. I don't need an expert or a book to tell me this. I cannot say no because I do not want to hurt anyone's feelings. And it just seems easier at the time to say yes. Or to quietly agree without really saying anything.

And that is my problem.

In the meantime, my feelings get trampled on, over and over again. And for what gain?

So, as usual, I learned about the power of 'No' from one of my patients.

She was the type of woman who did everything for everyone. She always was the first to volunteer, always the one that baked for others, shopped for others, baby-sat in a pinch, was on ten committees, never forgot a birthday, went to every coffee. You get the picture.

Then she got sick.

She didn't want help. She was actually a very private person, even though it seemed as though she gave so much of herself to others.

So, when people called to offer help, she politely declined.

"I just said, 'No'. No excuses, no reasons. Just no. I did not have the energy or the desire to want to talk more than that. And it worked. I was floored. I had never said no before. No is powerful. I wish I had used it sooner"

Like I had written about in a previous post about a patient who felt she had given away too many pieces of herself, this woman felt exactly the same way.

"We have to see 'no' not as selfish, but as life preserving. Unless it is something that really matters to me, my answer will be no from now on. I want my time to be my own."

Interestingly, this patient is not dying. She is not a true hospice patient, she is on a bridge program for pain management. That is how I met her. So, she did not see her time as limited, she just did not want to squander it anymore. She felt all the added stress contributed to her illness.

Plus, she said, "All those women and organizations that I gave so much time to did not even bat an eye when they found out I was ill. They could have cared less. Most of the time, we say yes to be nice, or to feel part of something. But the honest truth is, many times we are simply being used."

Harsh words, but true.

So, I am going to start saying no to the things I really do not want to do or to things that will take up precious time that I do not want to give. I am just going to do it. I am going to say "No".

No, no, no, no, no.

And I will not just be saying "No".

I will be saying "Yes" to myself.

I feel lighter already.

(But you still cannot have a cookie for dinner, Well, okay, just this once.)

Friday, April 9, 2010

Want love? Get a Dog. Seriously. (Here are some of ours.)

These are our 4 dogs. From largest to smallest they are: Shadow, Baron, Picasso, and Pico. They are sometimes good, often times bad, and always loving.

We love animals. We have other pets as well. I suggest to everyone to get at least one pet. They really add so many fond memories to your life. And they add another dimension often missing in life; unconditional love.

A lot of people in our lives set conditions for us to follow if we want their love or respect or their admiration. (Or just a good yearly evaluation).

They are our parents, our kids, our teachers, our co-workers, the sales clerk, the boss, our grandparents, etc. I could on and on. Fact is, no one really, really loves us unconditionally. We certainly do not love ourselves that way.

But pets do. Especially dogs. They are always so happy to see us. They are good companions, especially when we are sick.

I have seen so many loyal dogs over the years. I go into so many peoples' homes and see dog after dog. Sometimes I cannot even get near the patient. The dog is standing guard on the hospital bed just daring me to come near their sick master. It is amazing how they just seem to know that the end is near. And they protect until the end.

Many moms that I meet often say to me, "I hate it when my daughter comes over to play at your house, they always come home bothering me for a dog."

Then I get to hear all the excuses why they did not get one for their kids.

We aren't home enough.
They are messy.
I am allergic. (yeah, right)
My kids will not take care of the dog and I do not want one more thing to take care of.

The last comment is probably the one that is closest to the truth. And I know it. I am the default pet keeper in my house.

But that is okay. I get the most unconditional love. And it is wonderful.

A lot of parents complain that all their kids do is sit and text friends, watch TV, play video games and attend organized sports. They do not seem to interact beyond that much.

A pet, especially a dog, changes that dynamic. You can touch a pet. Love a pet. Go out and walk and never feel alone with a pet. You can talk to your pet about your problems and cry your eyes out holding your pet. A pet makes you bigger than yourself.

And they teach me a thing or two as well.

Like I am a pro at getting pee stains out of white carpet now.

But I digress.

I just want to add that our children are with us a really short period of time. It seems like forever, but it is not. We will spend much more time with them as adults. And what we do in that short amount of time that we do have them with us will mold them into who they will become and what obstacles they will face, not just when out in that big scary world that we try to protect them from, but from the hardest time of all. When they are facing just themselves in the mirror.

I cannot tell you how many times I hear from adult children how their mom and dad would not get them a dog (or whatever pet they wanted, but most times, a dog). These adult children of course have dogs now, but it is still a sore issue that they bring up time and time again as something that really placed a wedge between them and their parents forever. Amazing, I know.

But true.

So, get the dog.

Our best dogs have been from the shelter, but that is a personal decision.

My husband always says, "Life is a series of dogs". In our life, that is very true.

So, give it more serious thought when your child asks for the dog. Really talk about the reasons why or why not. Make it a family decision rather than a dividing line.

Happiness is a warm puppy. ~Charles M. Schulz

To sit with a dog on a hillside on a glorious afternoon is to be back in Eden, where doing nothing was not boring - it was peace. ~Milan Kundera

I talk to him when I'm lonesome like; and I'm sure he understands. When he looks at me so attentively, and gently licks my hands; then he rubs his nose on my tailored clothes, but I never say naught thereat. For the good Lord knows I can buy more clothes, but never a friend like that. ~W. Dayton Wedgefarth

Wednesday, April 7, 2010

Give Yourself and Others a 20% Grace Factor.

grace (grs)
1. Seemingly effortless beauty or charm of movement, form, or proportion.
2. A characteristic or quality pleasing for its charm or refinement.
3. A sense of fitness or propriety.
4. a. A disposition to be generous or helpful; goodwill.
b. Mercy; clemency.
5. A favor rendered by one who need not do so; indulgence.

Let's face it. No one is ever going to get 100% of anything. Not from a purchase, not from your friends, not even from yourself. (Okay, maybe your dog.)

So since we know that this is a universal truth, we might as well give everyone a 20% grace factor.

In a rush? The guy behind the counter slow? Well, stop expecting him to give you 100% service; give him the 20% grace factor, take a deep breath and feel good about what you just did.

Did your husband get you some flowers for your birthday? Yes. Have you told him 700 times that you hate mums? Yes. Did he bring you mums? Yes. Instead of getting mad, pull out the 20% grace. After all, he did bring you flowers. And then go out tomorrow and buy yourself a big bunch of the ones you love.

Problem resolved. No one hurt. No bad feelings. And you feel great for what you did.

It really does work.

Now, I am not saying that you should turn away from someone ripping you off, or being mean, or whatever. But lets face it; most of our "problems" are minor annoyances that we give way too much attention to. They are not life or death scenarios. Like I would never give a surgeon a 20% grace factor. I may, however, allow that for his horrible bedside manner. But not his skill with the knife.

Look, I know what you are thinking. You are thinking, no way. No one cuts me a break, so why should I them?

I feel the same way, too. But it just makes me feel bad to think that way. And when I do remember to give that extra 20%, I applaud myself. So much better than feeling bad. Or mad. It pulls me up a notch. And we can always use that.

I am surrounded by grace every time I work. So many people, who, facing serious trouble, are so full of grace. I figure, if they can do it at this time in their lives, then surely I do not need to give the finger to the driver who just cut me off. Maybe that driver needs the 20%. Maybe he is rushing to see a sick family member or had bad news today. The 20% reminds us to be human.

We probably cannot expect to apply this to everything. But if we can think about doing it at least once a day, or maybe even once a month at minimum, it may become a habit. A good habit.

And perhaps someone will give us the 20% grace factor when we don't deserve it. And we will be in admiration of that person all day long. I would just bet on it.

Tuesday, April 6, 2010

Little Pieces of Myself

A patient and I were talking about regrets one day. She said something that has stuck with me for a very long time.

"What I regret the most, is that I gave away so many little pieces of myself."

I found that quite profound, and when I asked her what she meant by that, she said that it was really hard to explain, but she felt she had given a bit of herself here and a bit there over the years, and did not concentrate her efforts toward any one thing in particular. And that those small pieces now felt wasteful to her. That they didn't add up to anything important.

"It is better to pick a few special things to put your energy toward. Trying to give too much to too many is not so good."

I think I know now what she was talking about.

Everything tries to grab our attention constantly. Our cell phone, email, silly computer games, the laundry, the car pool, the volunteering at school, the endless driving for errands, the run to the grocery store, the TV, the endless paper piles. You know the drill.

And what does it get us? Mainly stressed out. Feeling like we have been pulled in a thousand different directions.

And all that time that we spend doing it. Does it really define our lives? Does it define who we are?

How much time do we really spend doing that? Defining ourselves?

We all say that we have no time, but if we thought about it, I bet we could come up with at least 30 minutes a day to spend doing something that is special and meaningful in our lives. Something that says, "This is me. This is what I am all about beyond my role as wife, husband, parent...etc."

And that is what I think the patient was talking about when she said she regretted giving away so much of herself. After all, she raised four kids who were wonderful adults, had many cherished friends, a beautiful home and a devoted husband.

"I love my family and my friends and my home. But that is not just who I am. I am much more than that. I just never got around to it, that's all."

We need to be more selfish in our lives. We need to take the time to start that project we always wanted to do, or to take a lesson or just start moving toward our true selves by reading about something we wish to be doing in the future. All paths start with that first step

"I wanted to be a writer." she finally told me. "And I could write. I just didn't do it. Everything else always came first. I always felt there would be more time.... another day, another year. And instead I filled that time with a lot of meaningless tasks that really never were that important. And now I am out of time. If I had to do it all again, I would make myself more of a priority. That is not to say that I don't love others or don't want to care for them. That is an essential part of me. What I mean is all the other clutter that stood between me and who I wanted to become. And that clutter was something I created. Don't do that to yourself. Learn from my mistake."

I learned a wonderful lesson from her that day that I have carried with me for years. I am so grateful to her.

I still give away a few pieces of myself that I wish I could get back; but I pay more attention to it now and I try to make myself a priority now and again.

And I must say, it does feel pretty good.

Saturday, April 3, 2010

Holiday weekend break

Hope you have a wonderful holiday weekend, however you celebrate.

Just remember to pay attention to it. So many of my patients regret that complained about family get-togethers. You never know who may be missing next time, so, for what it is worth, try to appreciate people for what they are and they bring to your life's story, good or bad. They all make up who you are, whether you like it or not.

So, enjoy anyway.

Let us rise up and be thankful, for if we didn't learn a lot today, at least we learned a little, and if we didn't learn a little, at least we didn't get sick, and if we got sick, at least we didn't die; so, let us all be thankful.

He who loves 50 people has 50 woes; he who loves no one has no woes.

Friday, April 2, 2010

Holidays and the Bereaved

I am not a grief counselor. But I do my fair share of bereavement visits and have been around the grieving for a long time, so wanted to give you some things to think about this holiday weekend.

If you know someone who has had a death in their family this past year, remind yourself how difficult this Easter/Passover will be for them. Many people assume that the bereaved won't want to be "reminded" of their loss. That is not true. There isn't a day that goes by that they are not reminded.

What they don't want is to be forgotten. Nor have their loved one be forgotten.

So, if calling makes you uncomfortable, then send a card or some flowers or drop off a spring plant and tell them you are thinking of them. Don't say that if they need anything, to call. They won't. You need to be the one to just do something.

The holidays are especially difficult for the grieving. They are hard enough to get through when things are good. So, be mindful of that.

If you know someone who is very ill or dying and in hospice care, they would love a card or letter and a reminder that they, too, are being thought of. Flowers and food are nice as well, as the family can enjoy them. But a note is just fine and a handwritten note, even better.

I was with one patient last Easter when the doorbell rang and it was a neighbor who had made fresh scones and brought jam. The family was thrilled.

It doesn't take much to remind people that they are loved or thought about.

The cruelest thing is to do nothing. Being forgotten and alone is not good for anyone.

So, this Easter/Passover, as you are enjoying your family and counting your blessings, take time to remember those who will not feel so blessed this year.

“It is not the magnitude of our actions but the amount of love that is put into them that matters.”

~Mother Teresa

Hope Lives Eternal.

This is taken directly from a blog written by a woman who wrote about her cancer diagnosis, treatments and the ultimate finality of her disease. This entry is written just after her MD informed her that she needed to seek Hospice care.

I can’t say I’m thrilled about the latest verdict on my care and treatment. But as Alex has written, we are not giving up hope. They basically told me I had one year or less when I was diagnosed in 2007, but through hope, love, the good prayers of all of you, I am still here nearly THREE YEARS LATER– what my oncologist Richard Penson, calls "miracle years." I would be churlish not to be thankful for that gift, made possible by God, your prayers and your love.

My oncologist on Monday advised me to think about what I want my legacy to be. I have been ruminating on that. My conclusion? I want my legacy to be all of you—my friends, loved ones, former students—a human chain of those who have guided and influenced me, and whom I touched and influenced.​
Final advice? Always do the right thing. It will gratify your friends and enrage your enemies.

I don’t want to go. I love life and I know how blessed I am

This is what I see the most when patients enter hospice, their life spirit. Their hope. Unless they came to our service very, very close to the end, we see this determination all of the time. We do not discourage it. We do not steal anyone's hope.

Think about how many times a day we talk about hope without really thinking about it.

I hope you feel better soon.
I hope I can get that stain out.
I hope you do well on your test.
My, God, I hope you don't mean that!

And our new President even ran on a campaign of hope.

I think hope unites us somehow, connects us with a very deep part of ourselves that is universal. We all hope for things. When times are down, we all hope for the best.

I cannot think of much else that is so uniquely human. And so we cling to hope until we are forced to let go. And why wouldn't we.

Hope is really a lot of what the human experience is all about. Without hope, we do not have much. I find that truly fascinating.

Never let anyone steal your hope.

“Hope is the dream of a soul awake.”
French Proverb

Thursday, April 1, 2010

Learn to Be Content

Con·tent (kn-tnt) adj.
Desiring no more than what one has; satisfied.

How many of us have ever contemplated just being content?

I know we search for happiness, but do we ever embrace simply being content?

Probably not. I know I don't.

One of my favorite books of all times is Joy In the Morning, written by Betty Smith (You may know her from her book, A Tree Grows In Brooklyn.) A very simple read. But a good one. In one part, new husband, Carl, asks his new bride, Annie, if she is happy:

"Happy?" he asked.
"When are you going to start being happy?"
"Oh, I was happy this morning when I got off of the train and saw you. But now I'm contented."
"What's the difference between happiness and contentment, wiseguy?"
"Well, happy is like when somebody gives you a big hunk of something wonderful and it's too big to hold. So you pull off a piece from time to time and hold it in your hand. That's being contented."

I loved that. Don't you?

We are always searching for more. Wanting the latest, the biggest, the best. But it always lets us down somehow. It is never quite enough. Something is always out there that could make us happier, we just know it.

But it isn't. And I think we know that, too.

As you know, I take care of the people who are now out of time. And over and over again I hear the same thing.

I never realized I had it all already.
I never really paid attention to what I had.
I didn't hug my children enough. (That is a whole other topic for discussion on another day)
I never appreciated all they had given me.
I always thought there was some elusive thing I was missing.
I was never content with what I had.

So, I am making more of an effort to really be content. With who I am and what I have. Mostly, that list includes my family, my health, my home, my pets, my job, my friends, my ability to walk or run and to eat great food and to drink great wine (on occasion). And to read great books, too. I love that.

I may still want that lovely bag at Bloomingdale's, but it will only make me happy for a few days, and so I have to accept that. Happiness is elusive and has shining moments, but can fade quickly. And I have to ask myself, who I am really buying that bag for? I may not like the answer so much.

But being content can last a lifetime. And make us less stressed. We can let go of the need to have it all. I guess there really is no "all" anyway.

I have seen many people end up in just a small room at our hospice house. They are there to die, but we try to help them to be comfortable by allowing them to decorate the room with anything they want. Most want comforting things that they love; besides family of course, they may bring in a book that they love, pictures of family, certain pieces of art, cozy blankets, special tea they love to drink, a pretty cup and saucer to drink it from. Some bring in pets, some musical instruments. Some bring plants or flowers or special treats like chocolate if they can tolerate it or some other thing that they had been denying themselves for too long. One man smoked cigar after cigar. He was VERY content at the end because he had denied himself this pleasure for a very long time.

No one brings a laptop, a cell phone, or a fancy purse from Bloomingdale's. (I know) They do not worry about certain people anymore and ask us to not allow certain visitors that they have tolerated over the years, but never really liked.

"They always made me feel bad about who I am. Why I ever put up with that, I will never know."

They can no longer drive, but a car can still be very important to many, especially vintage cars and much talk is centered around their care after death. (Yes, really. More than you can imagine). Some things do make us very content. But if we really boiled it down, it would be just a few things. All the other stuff makes us crazy instead.

They usually do not care about the big house, or much of what is in it.

"I should have let that go years ago but felt I needed it. What would people have thought?" I hear that a lot.

And it is so amazing to me. With so little, I have seen so much contentment. Not happiness, because this is not a happy time. But they are content. They are finally free to just enjoy what they love. Who they are.

When we are living our lives through someone else's eyes and desires, we can never be content.

When we decide to live on our own terms, it is amazing how little we need. We shed the facade of a life we have been hiding behind. So many tell me they did not become their own person until the diagnosis of cancer. The realization that their life was truly their own allowed them to be free to be themselves, finally. They realized, this is it. This is who I am. This is where life has lead me and it hasn't been that bad at all. I hate to leave it. And sometimes they don't die. They get better. I wonder if finally finding contentment helped.

I guess many of us will never understand that until the end. But if we can take one piece of what they know and run with it, we could have more contented days. I am sure of it.

And that is what life is all about anyway. Days.

Listen to What Your Body has to Say

Yes. Your body is talking to you. Do you listen? Didn't think so.

If there is one thing I have heard over and over again from patients for the past 30 years of my nursing career, it is something like this:

"I just thought it was nothing important"
"I thought I was just tired"
"I thought it was stress"
"My doctor told me it was stress"
"My mom and my co-workers said not to worry, I would be fine"

I could go on and on, but you get the picture. We all do it. We ignore what our body is telling us.

So many of us are on perpetual high speed. We barely slow down enough to eat or to sleep. Seems there is so much to do, all of the time.

And the truth is, there is.

This is not my mother's world of the 1950's. We have a Starbucks on every corner, instant access to news 24/7, limitless shopping, bigger houses, faster cars (okay, some would argue there). But I know you know. We live a different, faster lifestyle.

And although we live a bit longer now, we are not healthier or happier. Many of us are on several medications and never really feeling good.

And some of us miss the boat completely and will die young.

All because we cannot slow down enough to listen to the wisdom of what the complex cells and energy that make up who we are is telling us.

So, right now as you read this, stop for a moment. Take a deep breath in to the count of 4. Hold for 4 counts, then exhale for four counts. Close your eyes. How do you feel right now?

Do this often. Feel what your body feels. Then jot it down. Do this anytime you have a bad thing happening; a headache, a backache, an unusual ache or pain, dizziness, etc. Keep a log. Call it, the "Me" log.

For example, if you notice burning sensations in your stomach in the morning or after lunch, write that information down or put that iPhone or Blackberry to good use and jot down the date and time and what you did to relieve it. Did it work? Write that down, too. Do you keep having to take more Tums/Prilosec/whatever? Write it down.

Do this every time you feel it. Soon a pattern will emerge. Add any additional symptoms that may not seem connected to it as well. (like, I feel pressure under my breastbone, too. Or I sweat sometimes for no reason) This is important information. We don't think it is, but the story you tell your MD is the MOST important part of the exam.


So make it clear and concise and to the point. The exam and even most of the blood work will NOT tell the story. Or it will give you a false sense of being okay when every cell in your body is screaming "I am certainly not okay."

Now, sometimes it is stress. Actually, oftentimes. So, what do we do? How can we slow down and get exercise and still rush to work and to daycare and take care of 3 kids plus a spouse and an ailing in-law or parent and get the deal or meet the deadline so that we can stay employed because we are buried under a mountain of bills? And how will we ever find the time to do laundry let alone relax? (this sounds oddly familiar)

Well, the answer to that is, you have to decide. Stress is a reality we all have to deal with, but it is not good if it makes you ill. So, you have to listen to yourself. If your body is tired, which is often the first sign that trouble lurks, try to go to bed early.(common sense, but no one does it) Drink more water in between coffees. Take deep breaths often (the 4 count I already explained). Stretch a few times a day. Place a picture of a great vacation spot on your desk or computer or above the sink. Look at it and allow yourself to daydream a minute about being there. Take B-vitamins. Do one thing a day you enjoy, even for just a few seconds. Don't drink so much alcohol in the evening or on the weekends, even if you think you deserve it. It will make your week worse.

But what if you are having other symptoms that don't seem like they are stress induced that have been going on a while and that scare you and you have been to the MD and he brushes them off?

Well, the log helps. MDs hate when you write things down. So, bring the notebook with you. Review how the symptoms are impacting your life. Tell them what you have tried and how it has not worked. Be relentless. Write down everything he tells you to do. Then ask him for a follow-up appointment. And make it anyway. If you feel really better, you can cancel. But don't. Go anyway. Tell him exactly how it worked. You will know because you kept a short log of events.

Here is an example of what I am trying to say. A woman I know had a nagging backache. She took Tylenol for it. Seemed to help. Yet, it was always there.

"I must have turned funny, or lifted something" she mused.

Weeks, months, still taking Tylenol. Then she noticed that she felt bloated.

Went to the MD.

"I feel bloated all the time". He examined her. No, nothing seems wrong. Take some laxatives he said.

She never mentioned the backache. It was mild and she did not think it was related.

More time went by. She still had the backache and the mild bloating. She just wrote them off and continued with life.

Eventually, the back pain became worse. Tylenol lead to Advil and then to hot packs and finally another trip to the MD.

"I have back pain." No mention of the continued bloating.

Do you see the pattern here?

The whole story would have painted a different picture. And the MD would have, or rather, should have, looked in another direction.

Her ovarian cancer may have been found sooner.

She died at age 50. She had had the back pain for 2 years. It could have been diagnosed just by having a simple pelvic ultrasound.

I am not suggesting you become an alarmist over minor aches and pains. Most do go away and indeed are caused by lifting too much or by too much stress. But if it continues over time and there are other things happening as well that you may not think are related, if you put them all together, they may paint a different story to a clinician. And they may save your life.

Look, doctors take a lot of heat for not spending enough time with the patients and for not listening. So you have to write things down. If they still will not listen, well, then you either have to be the squeaky wheel or find another MD.

My point is this, listen to your body. There was a paragraph in a book or an article I read a while back that was perfect in explaining how the body talks to us. When our body is out of whack, it throws a pebble, a minor ache or pain. When you fail to listen to that tap from the small pebble, it throws a rock. Finally, it throws a boulder, and by that time, it is often too late.

How many times do we do this. Take more Tums to quell burning indigestion. Drink more coffee to cover fatigue. You get my drift.

So, find the time to listen. And listen to others, too, like your spouse. Heart disease is still the number one killer in this country in both men and women and the early signs are dyspepsia and fatigue, not chest pain.

We all know when something is not right. We normally choose to ignore it and hope it goes away. And many times it does. But when it doesn't, you need to pay attention. Not ignore it. Or cover it up. Eventually the body wins out.

Our bodies are smarter than we think. The body talks to us. I just don't want it saying, "I told you so."