Monthly Archives: May 2014

Memorial Day

Remembering and honoring the dead has taken on many forms throughout time. Even in the United States there are “variations” of what and when Memorial Day or Decoration Day means. In 1967-1968 President Lyndon B Johnson signed into being and then moved the 100 year old tradition of putting flowers on the graves of fallen veterans of the civil war to May 30 1968. On June 28^th 1968 the Congress passed the Uniform Monday Holiday Act, including Memorial Day, from their traditional dates to a specified Monday in order to create a convenient three-day weekend. Memorial Day is now celebrated nationally on the final Monday of May every year. Despite the differences overall, the honoring of the fallen both military and civilian alike has remained a tradition recognized and celebrated across the world. We are thankful for the sacrifice and courage of those who have passed.

For many of us, death may not be seen as something that needs celebrating. I can feel the tension and hesitance each time I initiate an advanced care planning conversation. Because of multiple reasons some just do not see the point of expending valuable time on worrying about something I frequently hear described as “negative” or “not important now”. I’ve heard things like “It’s not going to be my problem once I’m dead.” “She (or he, or they) already know what I want.” “I don’t want to talk about that yet.” “I’m healthy now” or “I am too young to be talking about that.”

What I see is not a negative, premature or unrealistic topic. It is an opportunity for people to communicate with someone they love. Not because it is a holiday that someone else founded, but because it is a chance to share real feelings about the truth of our lives today. And like the variations of holidays and different styles of celebration, planning for the future of our love can be as unique. Not everyone has parents; the world is full of orphans. Not everyone has sisters and brothers, and there are some unfortunate enough to not even have a friend. But even court appointed facilitators have protocols to follow. The more information that is shared and recorded the more probable the chances that the final wishes of each and every one of us will be carried out and fulfilled.

We could no more pick our parents than we can choose our end. But with continuous and ongoing dialog we can nurture the style of parenthood we would want for ourselves when independence no longer exists for us. We can decide who has the strength of heart, mind and body to best meet our needs in most any circumstance were we suddenly “orphaned” of our time and ability.

Caring Choices celebrates an informal holiday of life every day. We are thankful for the freedom of choice for which so many have sacrificed. Planning for safety, comfort, and peace of mind with those we love is one more way to continue a tradition.

Pen Pals

Have you ever been a Pen Pal? I realize in today’s digital age this could probably take on a whole new meaning. Today I want to talk about the good old days when people actually wrote letters and sent cards (real paper cards, not e-greetings or Facebook birthday wishes). My job gives me ample opportunities to talk with elders and learn about their lives before their health declined and their ability to be independent “forced” them into a nursing home. There is a common refrain I hear: “I wish my family would visit more often.”

Having visited family members in nursing homes, I know they’re not the most exciting places to spend time. And depending upon the condition of the person, it may be emotionally challenging to visit with them.

Aunt Dot had been my favorite aunt growing up. She and Uncle Warren lived next door and had no kids of their own, so my brother and I had surrogate parents in them. As a teenager, I spent many summer nights on the porch swing with Aunt Dot, confiding things to her that I would never tell anyone else. Aunt Dot was a good listener, but she was better known as a talker. Sometimes it was hard to get a word in edgewise. But those conversations live on in my heart and mind as some of my fondest memories.

So, when she went into a nursing home (May 18, 1998, in fact) following a couple of diabetic strokes, she had “expressive aphasia”. She could not speak or show emotion. We were never sure if she knew we were present, or if she heard/understood what we were saying. She just stared off into the corner of the ceiling, looking at something … or nothing … we could never know. Not being able to have a conversation with my Aunt Dot became more than I could bear … and so I stopped visiting her in the nursing home.

But I never stopped thinking about her or loving her. I used to send flowers or treats for her with Uncle Warren (and he was kind enough to take them). I’m sure he always told her they were from me. And if she understood, I’m sure it made her happy even if I wasn’t there in person. That brings me back to the title of today’s blog.

When I was in elementary school, we were encouraged to write to other children through the school’s pen pal program. Today there are letter drives to military men and women to let them know we’re thinking about and supporting them. So I got to thinking about the elders in residence in nursing homes, assisted living facilities and even our own older relatives and friends. This week, one woman told me that her children live 4 hours away and it’s difficult for them to come to see her. She became tearful when telling me about her grandchildren and great-grandchildren she only sees in pictures. And I wished I could call her family and ask them to send cards, letters, recorded messages, videos or pictures with more frequency. Another lady shared her joy of receiving 25 birthday cards last week from family and friends. She had them in a neat stack on her bedside table; she said she’s been looking through them every day!

So, today’s blog is not about making plans or having conversations. Rather, it’s about recognizing the importance of human interaction whether it’s in person, via social media, or by being a “sort of” pen pal. I encourage everyone reading this to take 15-20 minutes to write out some cards or letters and drop them off at your local nursing home. (If you address them to the attention of the Social Worker, s/he will know who needs the messages the most.) In order to protect elders from potential scams and abuse, this can’t be a true Pen Pal project (with the exchange of addresses). But receiving a card or letter from someone with an uplifting or encouraging message may be just what the elder needs.

Caring Choices is all about human interaction. While the conversations we encourage are important, we know that relationships are the driving force in the outcome of many decisions. Take time to nurture your relationships; you never know when they will end.

Hell of a Time

Hell could be a place where time runs out too soon, again and again for eternity never having an opportunity to fulfill a single need, desire, goal or purpose. Yet the only thought you have is to keep trying.

And so, on and on can go the dialog to see which speculative endorsement one imagines the limits of time and its unspoken truth to be. While we are assessing its duration allotted to each of us, we plot out our lives. Savings plans, annual functions, and anticipated upgrades in income, status and security are often unrealized when time runs out.

Whenever I think of how dramatically people’s lives have been guided by the perception of the “amount” of time they garner for themselves, it impacts me deeply. My whole life has been guided by the intensity of how precious each moment is. And often I have vested too much “in the moment” and foolishly remain unprepared for a longer life then my youthful imagination had prepared for me. The importance of earlier planning and the old adage “Hindsight is 20/20” are hard realities.

Today, with 22 plus years of nursing experience in my soul, the reality of “time” has matured and seasoned within my mind. Logic sobers the drunken fantasy of dreams and loss strengthens the resolve to fulfill them. Combined with the sincere purpose to use my tragedy in hope to guide others safely along, I have found a committed relationship with hope and the tearful succor to bear forth my responsibilities despite all opposition.

Caring Choices extends a soft touch of compassion into this cold hard reality of limited time. Making decisions before time has run out may provide a more gentle and peaceful resolution to a potentially stressful situation. As each of us have the choice to follow any path in life, the options of which path we choose do not get easier by avoiding the crossroads.

Legacy Work

I’ve had the pleasure of working with a hospice family who has embraced the gravity of the situation by having difficult conversations, making decisions and plans, and are now savoring every minute together before their last one occurs. The patriarch of the family is dying and his family has rallied around him. This couple and their adult children, and even their older grandchildren, have accepted his diagnosis and have come to an understanding of his prognosis. They hold back nothing; they talk about it all in the presence of each other, in audible voices. No one in this family whispers the word “cancer”; they address it out loud.

I recently spoke with this man and his wife about leaving a legacy for their kids and grandkids. It’s something I offer to do with hospice patients who are amenable. Sometimes I help a patient write a letter to a spouse. Other times, I make a collage of photos and voice recordings put to music that family members can run on a computer loop when they want to see and hear their loved ones. Many times, though, people are reluctant to do legacy work because they feel that it will worsen or lengthen their loved ones’ grief.

To my surprise, this man said that he’s already written letters to his adult children, which they will receive from his wife after his funeral. He’s written letters to his grandchildren to be given to them when they reach milestones: 16, high school graduation, 1^st year of college, marriage, birth of their first child, etc. He’s included musings and wisdom from his nearly 60 years on the planet. He’s written his obituary although he wonders who will really care about all the things his wife suggested he include in it. He told me privately that he’s also written a love letter to his wife which he’s asked a friend to give to her at a prescribed future date.

In the meantime, this family has had open communication throughout his treatment and now hospice experience. They have had the blessing of coherence and time to say things they want to say, and they have said everything. With all of the plans made, this family can now concentrate on the immediate moments of their lives – enjoying baseball games and picnics and whatever else they have the energy to do. These letters that this man’s family will receive after his death will likely provide his loved ones with great comfort. These are his messages, from his heart, that they will be able to hold in their hands any time they want. They will be able to read his words and in some cases hear his voice (recordable books for kids are a fantastic invention!).

We so often think that death is the finale. That once we die, there’s nothing left of us except for some photos and a few good memories that a handful of people will hold onto. But legacy work is more intentional. It gives you the opportunity to put into words things you may not feel comfortable saying out loud or in person; things others may feel uncomfortable hearing. The movie “Tuesdays with Morrie” contains one of my favorite lines, spoken by Morrie Schwartz: “Death ends a life. It doesn’t end a relationship.”

With legacy work, the relationship continues perhaps more easily and more comforted when there’s something tangible to hold and read like a letter, or a journal, or a card that contains the sentiments of someone who has gone on before us to wait patiently until we join them.

Caring Choices encourages open conversation and sharing of feelings long before a terminal diagnosis enters your life. We can help have those difficult conversations and we can help you begin your legacy work.