Monday, May 31, 2010

The two questions I hate answering the most.

Every single day that I work, I see a lot of really sick people. But what always surprises me, is that even when they are told they need hospice services, told that there is nothing more that can be done, I hear two questions over and over again.

They are, "Am I getting better?" and "How much longer do I have?"

The first question is always hard. I try to be honest, but am also careful not to diminish whatever small shred of promise is left of a miracle that may be hanging there. Of course they are not getting "better". Many are just hoping today is the day that they are not getting worse.

Many times the answer to "am I getting better" is based on what I observe.

Yes, the swelling in your legs is getting better.

Your blood pressure is good today.

The pain medication seems to be working well, let's keep that dose for now.

Your lungs sound clear, your breathing seems better today.

Your appetite is improving, that is good.

So I answer the question without really answering the question.

I don't mean to deceive, but I do need to tread lightly.

I also have to answer that first question a lot to the family. They are anxious for any good news. Any shred of hope. Another day free of the dread that comes knowing that it is close to the end. They are much more anxious about hearing any news. They ask every nurse or home health aid or social worker that comes in contact with their loved one. They look for contradictory answers. They cling to every bit of hope. They search the Internet in vain.

It is heartbreaking.

Sometimes, well, many times, we have to be honest and just say that, no, they are not getting better.

Of course, then the next question is, "How much longer?"

Often the doctor has told the patient or their loved ones that they have a couple of months or a couple of weeks. But that timeline has come and gone, they are still on our service and now they are starting to tire more easily, eat less frequently, drink less often. Sometimes the patient will ask me directly, but most times it is the family.

I hate that question. I never can know for sure. People are all different. Their life energy is all different, even though many may have the exact same diagnosis, the exact course of treatment. You can never judge one case based on another.

I usually ask them what they think. The patient always seems to know. They just want either verification that that are right, or some hope from me that says, no, not yet.

I always answer as honestly as I can. I am never glib. I never say things like, "Only the good Lord knows." (even though that may be true)

I take into consideration their condition. How often they are eating, drinking, going to the bathroom. If they have other complicating health factors that could make them more vulnerable to multi-system failure. I take into consideration their age as well.

Then I ask them if they really want to know.

Most say, "I already know." And then they tell me. Usually they are right.

The family is a different story. They are making plans. They want to know when to call in friends, family from afar. When to make funeral plans. They want to know for more practical reasons. And many times, until it is closer to the the very end, we may not know exactly, so we guess.

I am pretty good at estimating now. I hate that I am getting better at this. It means I have seen too many deaths. And that is never good.

I often wonder if I will want to know. If I want some young 30 year old surgeon, with his whole life ahead of him, to read me some vague statistic about the end of my life.

I think not. I don't think I will ask.

But I will probably know anyway.

And I will be there hoping for a miracle as well, just like many of my patients do.

Hope and miracles should never be trampled on.

Imagination is more important than knowledge. ~Albert Einstein

Today I bent the truth to be kind, and I have no regret, for I am far surer of what is kind than I am of what is true. ~Robert Brault

Thursday, May 27, 2010

Into the arms of strangers.

Remember when we were kids and our moms told us to beware of strangers? I think we were all told that. And many of us to this day claim that we share that same advice with our own kids.

The problem with that, it seems, is that we never really follow that advice.

Because strangers are who we most turn to in our time of need.

I went to about 5 homes just today that allowed in several strangers. Nurses, volunteers, home health aides and the like, many who were foreign, all of whom who would never have been noticed or talked to if they had been seen on the street or in the local supermarket.

Yet, these strangers were privy to an enormous amount of personal information, have access to homes that have never been open to strangers before and, for the most part, become a new part of the family.

They often see the patient in ways that the family could have never imagined. They often hug the patient more than the family. They all too often spend more time with the patient than the family.

It is amazing to me how easily we leave the stranger category and become the friend/family category as soon as someone needs help.

For the most part, you could say, well, we are not strangers, we are paid employees. True. But you probably would not invite over the guy that changes your oil or cleans your teeth or bags your groceries every week or the gal that makes you the perfect latte even though you talk to her at length about local issues and consider her an acquaintance. Why? Because they are strangers outside of your life, even though, they too, are paid employees.

So where does the trust come from? I suppose most of it comes from need. We need people to help us when we are down and out. Many even beg for help from outsiders, from mere strangers. We become trusting souls. We allow people to see us at our worst when we need them the most. Or perhaps because it is our worst, our criteria changes. We are more accepting. We are more trusting.

Many of my patients invite these strangers in as employees but then quickly see them as confidants and friends, essential to their lives. Sometimes for years.

Sure, occasionally that trust is violated. But it is often not violated by strangers; it is usually violated by dear family friends and sometimes family.

Greed is a bad thing. But I digress.

I am happy that people trust me enough to enter their life in a time of turmoil and great sadness, bewilderment, confusion and many times, hopelessness. I am glad they trust me to help them, to make some sense out of the enormity of the situation they now find themselves in.

I enjoy meeting and helping and visiting my patients. They enjoy not only the job we do for them, but the companionship we bring, often so lacking in this isolated world, even with family nearby.

I enjoy their companionship as well. Their insights. Some have become friends. Most will stay in my memory forever.

I guess now I will have to re-define the term "stranger" to my own daughter.

Reaching out for help is a good thing. Trusting people is a good thing. Letting people into our lives can be a remarkable thing.

There are so many people who truly want to help, who ask for so little in return, and who can make a huge, positive impact in our lives.

If only we can trust enough to let them in.

“To be trusted is a greater compliment than being loved.”
~~~George MacDonald

“We're never so vulnerable than when we trust someone - but paradoxically, if we cannot trust, neither can we find love or joy”
~~~Walter Anderson

Friday, May 21, 2010

When life hands you lemons....throw them back.

I was stuck in Boston traffic, behind a car the other day that had all of these happy sayings on it. Of course it had, in very bright yellow, the ubiquitous, "When life hands you lemons...make lemonade" bumper sticker.

The day was long and was not a good one. Too many patients, all too young, dying too soon. I was in no mood for a pep talk.

The world expects us to be happy and carefree most of the time. We often say to co-workers, friends and family to "cheer up", that things will get better, that it can't be all that bad. That you will get over it.


But sometimes it is that bad. Or it just feels really bad. And there are some things that we may just never get over. No matter hard hard we try.

We just bury it down deep within.

We don't always have to accept bad news gracefully. We can sometimes get mad. Or sad. It is okay to be angry. It is okay to wallow in a bad day once in awhile. Maybe I don't want to make light of a situation that hurt me. Perhaps I am right in feeling sad because I miss my dad on Father's day or because I have a sick child at home. Why does everyone feel the need to always cheer everyone up?

I can remember one Christmas day, the Christmas after my father died. I was sad for a moment because I missed him. It was the first Christmas in my lifetime without him. Someone asked me why I looked sad. I told them. They said, "Well, he died months ago. Aren't you over it yet?"

The person was well meaning and had not suffered a life-altering loss in their life. At least not yet. So they had no perspective. I cut them a break and did not get angry.

I understood why they wanted me to be happy. It was their day, too. And no one likes a Debbie-Downer in their midst. I get that.

Life is constantly handing us lemons, lets face it. And we are supposed to make the best of it. But can't we just once in awhile throw the lemons back? Not always have to pretend that everything is okay?

Sometimes things are simply not okay.

That is not to say that we should constantly have a pity party for ourselves or ruin festive occasions for others by being morose. If you are that upset and sad, sometimes it is best to wallow in it all alone, at least for a moment or two.

But you don't have to act happy all of the time and deny yourself your true feelings, either.

We all have sorrows. We have all had bad days and many will have more bad days to come. Some people are better equipped to handle sorrow than others. Some have a much heavier load of sorrows than others.

I know. Life isn't fair. Not fair at all.

But the bad happens to us all. It is just that our perspectives are all different. All unique. What is a life-altering experience for one could be just a passing nuisance for another.

Hopefully the good days will outweigh the bad and we can have a healthy balance. That is really the best that we can hope for.

So, when you are dealt a bad hand, don't always just play along. Sometimes it is okay to fold or to say, 'I don't like this hand, please deal me another.' We don't always have to accept fate or circumstance with a smile. We don't always have to play nice. We don't always have to be happy. Sometimes is okay not to smile. Not to have a good day.

As for the lemons, I have to say, I have always hated lemonade anyway. And I hate bad things as well. And I am not sure that we can always make a situation better.

We can cheer our own selves up though knowing that everyone, smiling or not, has had bad days. We are really all in this together. None of us are alone. We are not alone in our sorrows, our loss, our bad day.

And if that makes the lemons less bitter, than maybe lemons aren't so bad after all.

“We can be lights for each other, and through each other’s illumination we will see the way. Each of us is a seed, a silent promise, and it is always spring.”
~~~Merle Shain

"There is not enough darkness in all the world to put out the light of even one small candle."
~~~Robery Alden

"Everybody's a mad scientist, and life is their lab. We're all trying to experiment to find a way to live, to solve problems, to fend off madness and chaos."
~~~David Cronenberg

Thursday, May 20, 2010

We need a GPS for life.

I was totally lost in Cambridge, Massachusetts today.

I was getting nervous. Thank goodness I had my GPS. I just turned it on, it told me where to turn and how much time it would take to get where I needed to go.

I did not have to think. It thought for me. I arrived at my destination safe and sound.

It was great. No stress, no fuss.

Then I thought how nice it would be if we all had a box with a little voice telling us how not to get lost in life.

Some days are just overwhelming. It is hard to know what to do, what to say, how to act, when to call it quits, when to press on, when to change course. Wouldn't it be nice to have a guide, some navigation through the rough parts?

I have a patient's family member who could certainly use that right now. He is quite lost. He never knew just what to do. He had either too many voices telling him too many directions, or he was isolated with only silence. He is now hopelessly lost and I am not sure he will ever find his way back.

Some of us are lucky. We have a solid guide in our corner. A mom or dad, loyal friend, husband, wife, brother, sister. We may even have a wise child that helps as well.

But many do not have that. They live in a world of dysfunction. They, as my dad used to say, couldn't find their way out of a paper bag.

It saddens me to see it. But I know that I cannot always help. They need more than a snippet of advice. They need more than a friendly shoulder.

They need a GPS for life.

Many try to find that in psychologists or MDs or other professionals. Often, they are simply medicated with no firm direction ever really given. They are just chemically appeased; sent on their way down a path with still too many twists and turns. Sure to get lost again.

There is no good ending here. Most will just stay lost. But for the many of us that do in fact have a guide, or had one in our life that left us with a an innate ability to guide ourselves, we should count our blessings. We don't know how lucky we are.

A good plan is like a road map: it shows the final destination and usually the best way to get there.
H. Stanley Judd

All you need is the plan, the road map, and the courage to press on to your destination.
Earl Nightingale

Tuesday, May 18, 2010

On Love.

Where do you start
Do you allow yourself a little time to cry
Or do you close your eyes & kiss it all goodbye
I guess you try
And though I don't know where & don't know when
I'll find myself in love again
I promise there will always be
A little place no one will see
A tiny part within my heart
That stays in love
With you.

This is a song that I have always loved.

And I always believed that it was true. That we do own a piece of all we have loved.

I am around a lot of people who reminisce about the past. Most especially when I am visiting the elderly living in retirement homes.

These folks, men and women, are often in their eighties or older. They have lived long, healthy lives fraught with many challenges. They have such a wisdom about them. I love to visit them.

One thing they love to talk about is, well, love. Some say to me that their deceased husband or wife may not have been in fact the love of their life. They built a life with them and they indeed loved them. But the truth was that they always held a small piece of their heart for their first love, or for a sudden fling, or for an innocent flirtation that went no where except in their minds.

And they embrace this memory and do not feel ashamed. It gets them in touch with who they are, they say.

I like that.

And when I hear these stories, I am reminded that love, romantic love, comes in all shapes and forms.

Many of us reading this are married, or have been married. Some are single and have always been "single", but have had a series of relationships, some lasting longer than many marriages.

Some have fond memories, some have hurtful memories. Most times, there is a mix of the two. But they all make up a part of who we are.

I think sometimes we become wishful for that romantic feeling of love we once had. Perhaps that is why many do have affairs or ruin marriages to seek out that feeling again. I don't know. But it seems that way at times.

I do know that the month of May is prom season. Perhaps that is why I am thinking about romantic love. We do seem to equate romantic, innocent love with youth. After all, it has yet to be tainted by too much reality and disappointment. We still believe in the fairy tales, the happily-ever-after, the walk into the sunset.

But of course, after we have been down the road a ways, we realize, sadly, that that is simply not true. That people disappoint. That what we imagine sometimes doesn't happen. That love can hurt.

And we steel our hearts.

Or we pour our hearts into a new found love....our kids.

But kids grow up and leave. And relationships do change. And onward we move.

The wise elderly, however, they remind me that memories are okay to have. That looking back can be freeing in a way. That our hearts can stay open a bit. And that that is a good thing.

They tell me that we can own a piece of ourselves that does not belong to anyone but us. That we can feel that special feeling anytime we want to, really.

Just by closing our eyes and remembering.

One lady I see frequently is a 99 year old woman, Agnes, who listens to love songs on her ipod.

"They make me happy, not sad. I can still feel the embrace of a young lover that I lost. Yes, he was my lover. I am not ashamed. I was married to another man for 56 years, but this love swept me off of my feet and I love to return there once in awhile. It is happy there. I feel light, like I can fly when I visit the memory. And there is nothing wrong with flying once in a while."

Flying. Yes indeed. We all need more of that.

And when October goes
The same old dream appears
And you are in my arms
To share the happy years
I turn my head away
To hide the helpless tears
Oh how I hate to see October go
I should be over it now I know
It doesn't matter much
How old I grow
I hate to see October go

Monday, May 17, 2010

When the Caregiver has nothing left to give.

There is nothing quite like starting your day sitting with a grown man who is crying because he simply can no longer take care of his elderly mother anymore.

And as I sat there patiently listening to him rant, I could no longer see him.

I could only see myself.

No, I have never sat on my front steps and wept. No, I have never stopped caring for anyone or anything. But that doesn't mean I haven't been close.

How many of us have had those days. The baby won't stop crying, your sister won't stop calling and complaining, the boss criticises you once again, the colleague snubs you, you have had the 10th fight this week with your husband.

You may also be in the shoes of the man who was crying just this morning; you may be caring for an elderly parent who can no longer care for themselves.

And I bet you have moments when you feel as though you cannot do it anymore. That you are at your wit's end. But you somehow persevere. And no one knows how you really feel inside.

You just simply cope.

But how can some cope so well while others simply crumple?

Wish I knew for sure. Everyone is so different. Everyone has roles that they play. Although there always does seem to be that one person that steps up to the plate and takes charge.

But for every champion there always also seems to be other players; the victim of circumstances, the martyr, the complainer, the whiner, the hysteric and the Houdini who can never be found. Every story of hardship seems to have one of these roles clearly defined. It always amazes me.

The person in charge is the one that I usually deal with. Sometimes angry, sometimes bitter, sometimes aggressive, sometimes passive. Does not always seem loving, just practical. This person, however, is the easiest to work with. They are straight-forward and have a modicum of common sense.

But even they break down. Everyone has a breaking point.

So, what do you do? How do you cope when you have run out of air to breath?

You can't just leave and you can't just cry. Things still need to be done. One foot still needs to go in front of the other. So, what is the trick? How do they do it?

I thought a lot about this tonight. Thought a lot about that man I spoke of who just simply shut down.

For years he was doing okay. Did everything. Was everything.

But somewhere, he lost himself. And then he just couldn't get back to where he needed to be.

So he simply shut down.

I think that to cope effectively, we need to set a boundary and a limit. We should ask for help when we can, but step back when we must.

People that cope best with adversity seem to have an innate ability to know when their limit is being met. They set a boundary as well, so that they can never lose themselves. They may ask for help when needed, many times they even pay for help because asking others to take part can sometimes lead to more frustration.

I guess the message I want to share from today is that we will all one day find ourselves near the end of our rope. For many different reasons. And the best we can do is to allow ourselves to step back, to recognize our own limits and to be careful not to overstep our own boundaries. The ones that carve out who we are.

We can all step up to the plate when needed. I have seen people at their best when adversity strikes. But short term problems are easier to cope with than long, drawn out, stressful situations that never seem to end. Like the situation I found my patient's son in this morning.

He felt awful about giving up. He felt as though he let everyone down. He just never gave himself permission to say that he needed more than a short break, that he needed help beyond what he was getting, that he was losing himself. And no one could read his mind. No one could see it coming. He played the part so well. He was so well practiced. He stepped up to that plate and felt good about it for a very long time.

But that is the funny thing about the proverbial plate. You can step up and hit a winner, but if you can't do it every time, you know there is a team behind you that can help.

The truth is, in real life, most caregivers do not have a team. The whole game is dependent on them. And sometimes, even if they do have a team, it is so rife with dysfunction that it adds more to the burden instead of providing relief.

So you have to re-write the rules. Set the limits. Define the boundaries.

It is really the only way to survive.

The caregiver in this case didn't do that. He went too far beyond his limits for far too long. I am not even sure he recognized his limits anymore.

The mother, by the way, is doing fine. She is still well cared for, as many of the ill and frail are. She is still whole. She is still in her element. She has not even noticed that her son is gone.

The caregiver, on the other hand, is still a mess. And probably will be until his mom dies and he is set free from the responsibility of caring for her, even if he is actually not the one doing it anymore. He is broken and we will try to help him, but our help only goes so far. He will once again have to step up and now take on the task of rebuilding what he lost. What he allowed himself to lose.

I hope he can do it.

I am not suggesting that we stop taking care of our kids or our husbands or parents. I am suggesting that we allow ourselves to be a bit selfish in that we maintain our wholeness, our selves. That we allow ourselves to back away, that we state our limits early and often, that we get the help we need. That it is okay not to be the champion all of the time. That even champions can't be champions forever.

All the art of living lies in a fine mingling of letting go and holding on. ~Havelock Ellis

Some of us think holding on makes us strong; but sometimes it is letting go.
~Herman Hesse

Thursday, May 13, 2010

The Comfort Zone.


I see this often on charts of patients who have been referred to hospice services while they are still hospitalized.

C.M.O. means, "comfort measures only".

When I go in to see the patient, they are rarely comfortable. First, the harshness of the overhead lighting makes the room have a very cold, clinical feeling. Some patients are oblivious to that as they are comatose, or semi-comatose, but they still look quite restless. Why? Because comfort measures only has nothing to do with comfort. What it means is that the hospital staff have pretty much discontinued all medications, all life support, all treatment and are waiting for "nature" to take its course, i.e. for the patient to die. They often have them on some type of IV pain medication, such as Morphine, but usually the patient is woefully under medicated.

It is a sad sight, no doubt. One that I have witnessed countless times.

I hate that term anyway, 'comfort measures'.

We do use it in hospice frequently as in "We will try to make you or your loved one as comfortable as possible."

But what does that mean and can we really do that?

Comfort is very subjective. Quite personal. I am not sure that we can even articulate exactly what we mean by comfort anyway.

I know that most think that it means not having any pain. But pain is also subjective. I have been to see countless patients, who are clearly in some pain, tell me that they are comfortable. They do not want to be too sedated. And I don't blame them. Many want the time they have left to be a time when they can interact with life. That makes them comfortable. And happy.

So, I was thinking, what makes me comfortable? How would I like to be treated?

I know that I would like to have pain medication, but I agree that I would not like to be snowed. I wouldn't want to have a feeling of shortness of breath, so I would like supplemental oxygen (not allowed when in the CMO mode in hospitals, but allowed under hospice) and I would like to be in my own home, in my own bed. If I really needed a hospital bed, I would need to have it dressed in comfortable sheets, blankets, and pillows. Pillows are a big thing to me.

I would like my dogs on the bed, my reading materials handy and a perfect cup of tea. Nice pj's, too. I would like to feel clean, so to be able to be washed up becomes important. And of course I would want my family nearby, that is a given. I would also want my area to be tidy, as a messy room never made me comfortable. And somehow, even if I am unresponsive, I feel as though I will still know. (hint, hint)

I think about that when I visit patients. Most family members are wringing their hands trying to think of what to do to make mom or dad or sis or cousin more comfortable. I try to help them envision how the ill person once lived. Did they like a bright room? A darkened room? Did they have a favorite comforter, a special pillow, a book they read over and over again that you can read aloud now? These are things they might like, I say. Even if they are unresponsive to verbal musings, they can still use other senses, such as touch and smell, and they can certainly hear, even though they may not respond. So comforting sounds may be nice as well. It may be good to keep the bedroom door open so familiar sounds filter in. Eerie silence can be uncomfortable to many.

When people are quite ill, they may want some solitude. But there can be a fine line between solitude and isolation.

As well as a fine line between pain relief and true comfort.

So, if you have a loved one or a friend with any type of pain or illness, you may want to try to put yourself in their place. Many people like to bring flowers to an ill person. And as nice as that is, there are other more comforting things you could provide.

A great smelling hand cream (with a hand or foot massage to go with it), hand sanitizer infused with fragrance (yes, they sell them), a beautiful inexpensive throw, a nightgown that is soft and lovely, warm, fun colored socks. A pretty cup and straw to drink from, a basket full of hankies, a selection of teas, a homemade

You may say that these are things only a woman might enjoy. And that is true, to some extent. But men like nice pillows and warm blankets, too. They may enjoy having the game on if they enjoyed sports, even if they can no longer really watch. They may enjoy having their buddies over to watch that game as well. Everyone need not be so quiet and sit there and wring their hands. That provides such little comfort. A friend sitting next to a buddy reading him his daily newspaper is also a great touch.

I once had a patient who never ended her day without a scotch on the rocks. She was semi-comatose, and they were giving her mouth care with a sponge-tipped toothette. So we decide that at 5 o'clock in the evening, everyone would gather for cocktail hour and they dipped that sponge into a bit of scotch and placed it in her mouth. You could tell the patient enjoyed that taste. And why not. Why deny someone the pleasure of a favorite taste? And it became a nightly routine for the family until that patient could no longer participate. It was comfort not just for the patient, but for all.

So, think about what makes you really comfortable. Write it down and have everyone in your family do it as well. Call it "Our Book of Comfort for the (blank) Family." Then, whether someone is really sick or just has the flu, or is simply down in the dumps after a really bad day, you can better serve them and help make them to be as comfortable as possible.

Because real comfort makes people feel loved and safe.

It is the best we can do and takes so little to do it.

Sunday, May 9, 2010

Mother's Day. A Bittersweet Day.

Happy Mother's Day.

I heard that all day long. As I worked, as I shopped, as I stayed home and answered the phone, as I watched TV.

It is a special day for moms, I know.

But what if you are not a mom? Or don't have a mom? Or don't really like your mom? Or recently lost your mom?

Or like today, when I had to call a woman to let her know that her sweet 88 year old mom, who was sitting and eating cake yesterday, collapsed and died today.

Then it becomes that bittersweet day.

I know it is bittersweet for me. I lost my mom over a decade ago. I am a mom, so that helps ease the pain a bit. But it does not take away the fact that I no longer have a mom.

A mom can be such a source of so many issues in our grown up lives. I am not a psychologist, so I can't really say what all of that means, if anything. But I do know that we all come from moms, and that makes us all connected somehow, so we all get it. And we are all in the same boat, really. And we will all one day lose our moms, no matter what type of relationship we have with them.

Some may have lost their moms in childhood, even though they are still very much alive, even today. Some have lost them to alcoholism or substance abuse or from an argument years ago that festered into a distance that has never truly been bridged. Some have lost them to a mean disease like cancer or Alzheimer's. Some may have been abused by them and chose to leave, but it is still a loss no matter how you slice it.

The Hindus have a saying, "Whether the knife falls on the melon or the melon falls on the knife, it is still the melon that suffers."

And that is so true.

So whether we chose to lose our moms, or fate lent a hand, we will all have that same bittersweet day.

And let us not forget those gals that cannot become a mom. Infertility is cruel on any day, but especially heartbreaking on this day.

And to those that are celebrating a generational Mother's Day today, embrace this day fully. Don't take it for granted.

I overheard someone today complaining while I stood behind them in line at Whole Foods. They were loudly complaining about the fact that they had to buy so many flowers for so many moms.

"I have to buy 6 bouquets. One for my mother, and my grandmother; one for my dad's mother and his stepmother and one for my husband's mother and his grandmother, too. I hate Mother's Day."

I could have hit her. Does she have a clue as to how lucky she is? She also had twins in a jogger and another toddler screaming nearby. (That would probably explain the bad mood, but I digress.)

She had the golden ticket, but couldn't see past the minor inconvenience of it all.

One day she will.

I hope.

I then drove past a cemetery where people were placing flowers on graves. Another sad reminder that we should never take anything for granted.

I love being a mom. But I don't expect any thanks today. (Even though I got cards and gifts and flowers and a wonderful home cooked meal.)

I want instead to thank my husband and daughter for giving me the gift of motherhood. It is the best part of me.

I hope someday that my daughter will think of me and smile.

That would be the best Mother's Day gift ever.

(P.S. I also want to thank my mother-in-law Gen, she is the best. Thanks Gen.)

Friday, May 7, 2010

When death does not bring pain.

I was talking to a patient's daughter the other day. She was one of 4 siblings, all close. The family was seemingly normal from the outside; beautiful home, well educated kids, new cars, well-manicured yard. You get the picture.

But the picture never tells the real story. It is just that, a picture.

A facade.

The daughter told me that she was not going to to miss her mother and felt really bad about not feeling bad. After all, she loved her mother dearly.

"I will finally be free to be myself," she told me. "All of my life I struggled to have her accept me for who I was, but I never lived up to her standards, try as I may. Her death means freedom to me. Freedom from criticism and pain."


I hear this sometimes. About how the death of a family member feels freeing. Sometimes there is obvious abuse, the relationship had been severed and the feeling of relief is expected. Other times, the abuse is insidious. The person appears to be well cared for and loved. And they are, but only if certain terms are met. It does not appear to be abusive, and may not be abusive per se, but it can be just as harmful.

And always hurtful.

Sometimes death brings a feeling of relief even to those of us who loved the deceased dearly and were loved by the deceased dearly.

It is hard to watch a loved one lost forever to the cruelty of Alzheimer's disease; it is equally as hard to watch someone suffer in pain, be unable to breath or to lie motionless in a coma attached to a ventilator.

Sometimes that feeling of relief cascades into feelings of guilt. We may feel guilty about feeling relieved. I see this happen a lot. Death brings with it many mixed emotions. But sometimes not sadness and pain.

I hope that the woman I spoke to does allow herself the freedom she desires now that her mother has passed away. But I am doubtful. After all, she was always seeking her mother's approval and now she will never have it. And that is truly sad.

Many loved ones who spent their life trying to appease a mother or father continue that relationship long after death. Death does not bring for them any "closure'; they hear the voice of their mother or father all of the time and will never, ever live up to their expectations, even though they continually strive to do so.

I am not sure we can ever really be free from our relationships with our family. Not even after death. Sometimes that continued relationship brings us comfort; but, for many, like my patient's daughter, even death will never bring her the freedom she is seeking. She may never allow herself to be free. And she will never know the answers.

There is no good ending to this story. No epiphany. No real lesson learned. Life is simply messy. And the emotions we feel can be troublesome and confusing.

By the way, the other siblings had various mixed emotions as well.

I liked the mom. She seemed lovely. She had not a clue as to how her adult children felt.

And she died peacefully in her sleep.

"None of us can help the things life has done to us. They’re done before you realize it, and once they’re done they make you do other things until at last everything comes between you and what you’d like to be, and you’ve lost your true self forever."
~~Eugene O'Neill (Long Day's Journey into Night)

“There is no such thing as a little freedom. Either you are all free, or you are not free.”
~~Walter Cronkite

Sunday, May 2, 2010

We never really do grow up.

It is true.

We never really do grow up.

I thought about this the other day while I was in an elevator at a Boston teaching hospital and a couple of residents were goofing off and one said to the other two, "When are you guys going to finally grow up?" The one resident looked at her and said, "Hopefully, never."

I find myself occasionally saying to my 11 year old daughter that she is more "grown up" now and should know better about certain things. But I really don't want her to grow up; I just want her to follow my rules.

And, so, that brings me back to my initial premise that we never really do grow up. Our spirit just gets dampened by societal rules. It is like there is some unwritten pronouncement that once you reach a certain age, you must act proper and be much more serious. That life is serious business. And that we had better get serious and see to it.

We certainly have more responsibilities to shoulder when we are adults. And many of those responsibilities are quite serious. We have houses and mortgages, jobs we need to get to and kids to raise. We have yard work to do and bills to pay, cars to maintain and fill up with gas and laundry to do. We have meals to cook and rooms to clean and errands to run. We have little time to be silly and just play.

And that is a shame.

Because we like to play.

And we do do play. But they are adult-type games. Like tennis leagues and golfing and maybe shooting hoops with the guys for an hour. Or playing an instrument, but not with the abandon we did back in our youth. And sometimes we spend a lot of time watching TV as others play.

How many of us sing in the car or the shower but would be mortified if anyone heard us? Or how many would love to go out and skip down the street once in awhile? (I did this once and my daughter just about died of embarrassment telling me that "old people" don't skip.)

Or play jump rope or hula-hoop or go on the slippy-slide. Or blow bubbles or play kick ball. How many would like to just stick our tongue out at our boss or call someone a "cheater." (Because, they are. Like that colleague at work who takes credit for everything.)Cheater, cheater, cheater.

How many would like to cruise down the block on a warm summer night with the windows down and the tunes cranked, or spend a day at the beach building sandcastles or floating on a raft, and not just with the kids. But many people would probably look at you oddly if you did that without kids. So we sit and read the Wall Street Journal instead. So grown-up.

And how many of us old married folk would just like to hang out at a drive-in movie some night and make out with our spouses? Much better than the planned "date-night" all the experts think we need. I think marriages would be better if we acted more on impulse once in awhile, don't you think?

But no, we are too grown up for all of that.

So we just hold it all in. Perhaps we get a sports car or a younger spouse or a face lift to try to re-live our youth. But that is not what I am talking about.

I am talking about the fact that there is no such thing as "grown up". That we are born and we will die pretty much the same person we have always been.

I think that is why there are so many adults on anti-depressants. It is depressing to feel that you have to "grow-up" and squash all the fun out of your life. Become someone else. Act a certain restrained way all of the time.

Sure, there are many who are, quite frankly, immature. They cannot hold a job or a relationship and they act on impulse way too much, especially with booze or drugs.

But for for most of us, we stifle our perceived childishness too much and too often. We should let it out once in awhile, just to play. We can always put it back again when we need to.

I do have the unfair advantage of seeing over and over again how this life we live ends. And, for the most part, people do not say things like you read in serious books on the matter, such as "On your death bed, you will never wish you had spent more time at the office." I have to tell you the truth here; a lot of my patients wish they were back at their desks.

But I do hear something over and over again, and that is that they wish they had acted sillier and not taken life so seriously all of the time. That what they thought was so important turned out to be not as important as they had always thought.

There is a time and place for everything, but occasionally we should just allow ourselves to be who we really are. To just let it rip. To understand we are just simply us, only a bit older and wiser. Our kids, family and friends would love to see a less complicated version of ourselves. Many times, they never get to know the real us.

And that is a shame.

So, I dare you to act on impulse at least once this week. Do something that shows the real you that others would never guess. They will like you more, I guarantee it.

And you will, too.

“We find it hard to believe that other people's thoughts are as silly as our own, but they probably are.”
James Harvey Robinson

"In every real man a child is hidden that wants to play."
Friedrich Nietzsche

"If you want to be happy all the time, stay in your pajamas and watch cartons all day."
Rachel McCullough, age 9

Saturday, May 1, 2010

Just a Thought for Today.

People are often unreasonable, irrational, and self-centered. Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway.

What you spend years creating others could destroy overnight. Create anyway.

If you find serenity and happiness, some may be jealous. Be happy anyway.

The good you do today, will often be forgotten. Do good anyway.

Give the best you have, and it may never be enough. Give your best anyway.

In the final analysis, it is between you and your God. It was never between you and them anyway.

~~~~Mother Teresa~~~~