Monthly Archives: March 2014

Garlic and Onions

I have been afraid my whole life. If not fear of failure, then fear of pain, injustice, insanity, and of death.  When I was a young boy, I lay in bed one summer evening with my bedroom window open.  I heard a screen door squeak slowly. Then distinct metallic clicks of fate locking into place followed by a deafening blast. The cat meowing in the still night air now sadly silent. Footsteps echoed off the vast expanse of the glass and concrete car foundry behind our home. Next, a hollow rumble and clank of a garbage can lid opening and closing with a soft thud of unmistakable reality between. Finally again footsteps, now muffled by my panicked heartbeats, ended in the slam of satisfaction I am sure was focused only on a good night’s sleep.

Today that memory remains as crisp and clear to me as the moment my heart broke that night knowing life can end so unexpectedly. Yet somehow courage still found its way into my consciousness to temper the old fears in a multitude of ways. Not necessarily from any sense of heroics as dramatic as saving a child from the burning building scenario. But courage for me comes in knowing there is hope. Hope for the possibility of relief from fear and suffering. I suspect that knowledge of what we fear, and why, are topics many often silently contend with on a variety of levels and extremes.  The most challenging torments we can imagine would certainly seem about as popular an idea to discuss as attending an onion and garlic peeling party.

One other moment comes to mind for me when thinking about fear and change. After relocating to live with my Grandma I found the first night alone in that house my father and uncles had grown up in to be cold, empty, and dark. Knowing my Grandma was just down the hall brought no comfort for me. What surprisingly created a sense of calm was when I grabbed a book to read. I made up my mind to no longer hold on to the idea of the life I had come to know, living at home with my sisters and parents. That world had changed. My family was separating. My sisters had graduated and were moving away. My parents divorced. I lived with my Grandma now and I suddenly felt relief at the thought of it. So how does this have anything to do with onions and garlic?

The connection is with the fact that discussing life changing events or processes are not always easy to understand or accept. Especially when dealing with changing health and lost independence. The subject stinks, like garlic and can cause watery eyes, like onions will.  But there is something else I learned while living with my Grandma. I learned that with just the right amount of onion and garlic added to a sauce for pasta or broth for soup, suddenly the inconvenience of the initial reaction to the seasonings becomes well worth the effort.  The meals were so much more flavorful and enriched. And as many of us already know, it takes many attempts to find the right ingredients and the exact timing for cooking and preparation to achieve the perfect recipe!

Caring Choices offers the seasonings of our experience and understanding, the garlic and onion, for your recipe of life. Hopefully with sincere discussion and preparation you can improve the taste of changes and eliminate the sourness of fear. How do you want the broth of your care to be simmered and how would you like the flavor of love to be delivered for you or your loved ones at the time when nothing else matters but comfort, peace, and hope.

(c) 2014 Caring Choices

Bridging the Extremes

Just about everywhere you look these days you can easily find extremes.  Polar opposites, some might say.  I’m sure some came easily to your mind as you read those first two sentences. Maybe even some of these:

      • Democrats / Republicans
      • Liberals / Conservatives
      • Pro-Choice / Pro-Life
      • Gay Marriage / Traditional Marriage
      • Big Government / Small Government
      • Socialism / Capitalism
      • Black / White
      • Atheism / Christianity

When we only ever see the opposing sides of an issue, it can be downright difficult to get people to begin a conversation that might bridge the extremes and facilitate dialogue, understanding, cooperation, and even advocacy.

It’s not very different when talking about advance care planning or “end-of-life” decision-making.  Quite often people initially fall into one of two extremes too:

“Do Everything” / “Pull the Plug”

We really need to be talking about what will determine our quality of life as we near our final years, months, weeks, days, and moments.  These “all or nothing” statements, that are so frequently uttered when someone in a family asks about care preferences, serve no real purpose.  They give no concrete direction to those who will be making decisions on our behalf.  “Do everything” begs to be followed with the words “until what/when”.  “Pull the Plug” provides no definitive time or circumstance for the actual act.

Can we plan for everything that might occur?  No.  Can we make plans for situations that may not occur?  Sure. Will my family still need to make some decisions for contingencies I have not planned?  Probably.   What we need to ask ourselves is whether we want our family making decisions based on supposition and conjecture (e.g., if Dad knew he was ‘like this’, would he want “X”)  or rather making decisions based on heartfelt, open conversations in which we have shared our decisions and which we direct them to carry out.

Somewhere between “Do Everything” and “Pull the Plug” are many opportunities to start (and continue) discussions based not only on personal values and beliefs but also on what our loved ones tell us they think they will be able and willing to do to help care for us.  Relieving the burden of decision-making from our children, our spouses, our family, and our friends is a precious gift we can give those who are trying their best to care for us.

Caring Choices provides the bridge to help families take advantage of the conversational opportunities that exist somewhere in between the extremes.

(c) 2014 Caring Choices

How About Zip?

The frustration and concern were unmistakable as her fingers formed a perfect circle and she said “How about Zip?” This comment was in response to my statement of “in times of an inability to communicate then a reflection of past discussions may help.”

And so I expect that may be a reaction for many people as I press home the importance of talking about how people may or may not want to live in the last moments, days, weeks, months, or years of life. The conversations are difficult and stressful even for me. Still difficult, despite the fact that I have had the honor of many such moments as family, friends, and patients have grappled with the choices and sought to understand and accept the reality of change. Be it sudden, expected, or planned, change has always been seen by large numbers of people to be unwanted, feared, and avoided. And change in itself is a very natural part of life. Even in my own life, I see the challenge in dealing with change to be completely overwhelming at times.

At 58 years old it has become more and more apparent to me that the aging process alone is changing my ability to continue doing some things that were easy for me in the not so distant past. Simple tasks are no longer simple. Enjoying the exploration of ledges along new found mountain trails across the United States are risks for me now, not leisure. And I accept this with gratitude at having had the opportunity to experience them up close and personal.

And isn’t this how life is for all of us?  Especially when the days wind down, the system slows up and the truth becomes unavoidable. The clarity is pure and the moments are so precious when we feel alive. Like when falling in love for the first time, or the birth of a child, or when you have a near miss while driving a car or regaining your balance, sparing a slip and fall on the ice. The heart races and we take a deep breath. Do we not now see life in magnified brilliance? We are alive, and thankful to continue on.

Caring Choices is very much aware of how personal conversations are essential to communicate to our loved ones about how we want to live when changes come. We understand and believe that when the near misses and changes become unavoidable, having eliminated the “Zip” factor of unasked questions may soften the strain of that racing heart, deep breath and strengthen the feeling of being alive and thankful to continue on. Moments matter, up close and personal.

“Survival” Kit

Many national and healthcare organizations urge families and communities to be prepared for emergencies and natural disasters. 

You know from reading this blog that I believe passionately in the importance of having conversations and sharing information so that each person can be prepared as fully as possible for the end of life.  Below, I’ve taken a few commonly recommended “supplies” from these “survival kit” lists and added a column showing an equivalent preparation that can ready us for death and surviving bereavement.

Survival Kit
End of Life Survival Kit
Water / Food (non-perishable, easy to prepare)
Nourishment – As our physical bodies prepare for death, we no longer need water and food in the “normal” sense.  Instead, we focus on fulfilling other senses:
  • needing to hear our loved ones’ voices
  • wanting to feel the touch of a hand or hug
  • wanting to see loved ones a final time
  • enjoying the smell of favorite flowers or foods (even though we can no longer eat)
Flashlight, Radio, Batteries
Guide – It can be helpful to have someone by our side who can lead us through the darkness.  For some that might be a pastor/priest. For others, it may be a friend reading from a favorite book or someone sitting quietly, holding our hand.
Copies of personal documents (medication list deed/lease to home, birth certificates, insurance policies)
Identity – Death does not claim our identity.  We leave people behind who love us, who will remember and will miss us.  Making legacy documents (videos, letters, photobooks, etc.) can ease the grief of those we leave behind.
Baby supplies; Games and activities for the children
Consider the family – When a family member is dying, there may be multiple generations in the home.  It can be beneficial to engage all ages appropriately for being around or providing care of the dying loved one.

The final section of many survival kits suggest keeping supplies handy that are specific to disasters you could face in your community.  People living along ocean coasts will likely have different supply needs than someone living in “Tornado Alley” or near a nuclear power plant.  And so go the differences in the needs of the dying and those who love them.  Each individual will have a different experience with death not only physically (biologically) but also psychologically, spiritually and socially.  Some of us will die peacefully in our sleep in our own bed in our own home surrounded by loved ones (relatively few, unfortunately).  Others of us will die tethered to tubes and wires in intensive care units either by our choosing (“do everything”) or by accident/trauma combined with lack of plans/documentation.  Still others of us will die in skilled care facilities following slow-progressing serious illnesses; or in hospitals following an acute attack or disease.

In most instances, when and how we die is not necessarily under our control.  However, talking about and being prepared for our inevitable death IS under our control.  We can choose to ignore it and let our loved ones figure out what we would want them to do or we can address our guaranteed mortality and tell them what we want (or don’t want).  The more we can plan and prepare them for our deaths, the better able they will be to advocate for our choices and save themselves feelings of burden making the ‘right’ decision or the guilt of not being sure of what to do.

Caring Choices is ready to help you talk about and prepare your family’s “End of Life Survival Kit”.  Doing so can alleviate decision-making burden and prevent feelings of guilt. Are you ready to get prepared?

© 2014 Caring Choices

It’s a Party

Usually these three words will generate a massive interest with the majority of people. When? Where? Who or what is it for? Who all is going? What do I need to bring? Is there food there?  Will there be music and dancing? Will it be inside or outside? What should I wear?

Imagine you are planning this party. Which questions from above would remain the same and what new ones would you ask? What will it cost? Is there room enough? Where would people park? Who do I invite? Who don’t I want there?

Think of what someone else would be asking if it was a surprise party for you and you could not be involved. How many of the same questions do you think would still apply? What new ones can you think of? Who are the closest friends, coworkers, and family who would be invited?

Now, picture your reaction and that of family friends and coworkers to the news of a sudden death forcing you or them to be responsible for funeral arrangements. How many of the same questions apply? Consider the possibility of a situation where there is a complete loss of the ability to communicate due to sudden injury or illness. How many of these same questions remain for the person who must provide care and coordinate treatment?  Who can help?

Unfortunately for many, the excitement of planning this party, be it a surprise or not, may become altered and replaced by stress and fear. Without specific, easy-to-find instructions (and frequent revisions to those), the burden of responsibility will fall onto unprepared family, friends, or others who may or may not have had any experience with caregiving or may not know the legalities and processes of complex decision-making for healthcare needs.  They may have no idea who you really are or what you would have wanted. What seemed like a fun, exciting party, as the popular opinion of life often is encouraged to be, is now suddenly a personal, social and emotional struggle.

Caring Choices remains hopeful and optimistic in the reality of enjoying life to the fullest. Preparing for the inevitable changes in life does not need to be pessimistic and negative.  Rather, it can be a courageous and mindful consideration of how others will react to change in our lives. Please start the conversations and plan for the party we all are born invited to.