Monthly Archives: September 2014

He calls me Jinx

Please allow me to explain. Who knows when it first began; but without question, as time passed, it became more obvious to some that trouble seemed to always find me. Even in a crowd. “He” as the title indicates, was one of the many foremen I had worked under during my long, illustrious career as a laborer on various construction sites and as a steel worker in many mills across the USA. Inevitably, the name Jinx would find me, as did a continuous stream of misfortune. For example:

One afternoon, I was leaning out the open window of my 5-ton crane in the bar mill curiously watching one of the 1^st assistants. He was using an air hammer to make dents in a roll to add “bite” to the hot ingots as they passed into the rolls. This was a routine process to which sand was also then thrown at the moment of contact allowing the steel to be securely fed on through as it was pressed into smaller and smaller diameters until it reached the designated size. So there was nothing unusual to the day and I was patiently waiting to move the roll into place in the mill when he was finished. But after a few minutes watching him I was suddenly, it seemed, struck in the mouth with a baseball bat! I fell backwards into the cab almost landing on the floor, only my mounted swivel chair broke my fall. I grabbed my face and immediately felt blood on my fingers. Every time I moved my mouth I felt a sharp sting, yet I could feel no loose teeth with my tongue and my jaws were not painful to move. But each movement of my upper lip continued to cause a severe burning and more blood. I quickly composed myself and activated the bridge motor to move my crane to the ladder. No one on the floor noticed me until the crane moved. I ignored the yells and climbed down the ladder and ran into the restroom. In front of the mirror I leaned in and lifted my upper lip up and away from my teeth. The inside of my lip was lacerated in multiple places near the center. And then I caught a glint of light between my two front teeth. Embedded between them was a needle size sliver of steel from the roll that had been hammered loose and flew through the air smacking me in the face and lodging between my teeth. One of the maintenance guys walked in looking for me and I grabbed a pair of pliers from his belt and pulled the inch long shard of steel out of my mouth.

And on and on, one story after another, the odds favor the nickname. In almost exactly the same place years earlier I was on the floor below a crane. I had just hooked up a ½ inch steel chain to a giant block of concrete the department wanted removed. The crane hoist shuddered and strained to its 10-ton limit. I crawled just beyond the crane rails above outside of the building altogether. I crouched in the ditch and held onto my hardhat ducking down as low as I could go. Suddenly there was a snap and everyone yelled as the concrete dropped into the dirt. I stayed put suspecting the chain had broken. The chain flew up into the air through the center bridge of the crane. It missed the trolley and hoist. It missed all the rafters in the 40-foot ceiling, all the lights, wires and cables. It travelled slightly at enough of an angle to strike the side of the building. Then it fell the final 20 feet between the wall and the crane rails hitting me directly on the head!

Unfortunately similar mishaps continue to befall me. Just this week, while driving home from work, a yellow jacket flew into my car and stung me on the face. No matter how well intentioned, cautious, and prepared I may feel, Jinx is what he called me.

Caring Choices remains hopeful that everyone understands the importance of discussing what each of us feel is important in life. And we also believe that planning for the random visit from “Jinx” will help lessen the impact of the unexpected. Please do not be caught off guard. Talk with those you would trust soon.

It’s the Little Things

Room service. Crossword and Jumble. A good movie. Quiet, alone time. The thoughtfulness of my husband. Time to think and heal. Love. Caring. Respite.

My husband gave me the opportunity on Friday night to enjoy a relaxing evening in a luxurious hotel room following a challenging week of work.

My job is demanding. It’s often chaotic, sometimes overwhelming and always (eventually) rewarding. This week, I experienced a verbal attack from a family member that was unprovoked and unwarranted and, as I was able to realize days later, had nothing to do with me. I was also able to comfort a different family making a hospice decision.

In grad school, we were encouraged (and required) to reflect on our experiences and write a weekly “process recording” about the experience, our reaction(s) to it, and future learning opportunities. My initial reaction to the verbal attack was shock. I could not believe that such a knee-jerk, volatile eruption would occur in my work setting over an unintentional clerical error. Next, I felt completely inadequate and ill-prepared to offer an appropriate response beyond a mea culpa. I stammered at the sheer audacity of the arrogance from which the words were hurled. And I wanted desperately to say something as stringent in rebuttal; instead, I just stood there and took the “punches”. Still, I could neither fathom the verbal venom spewed at me nor buffer the environmental disruption to those near my office at the time.

After the eruption, and a handoff to another professional, I composed myself. I had a different family to visit. This next family member couldn’t have been more kind and concerned as we discussed hospice care for a long-time spouse. Life review. Pain and symptom discussions. History of past medical professional promises and “useless, invasive procedures”. “I just want her to be comfortable”.

As difficult as the topic of hospice and the death of a loved one may seem, this conversation was MUCH easier for me to handle than the first. Emotions were just as prevalent, but they were different. The focus of attention was different. It was simply two people talking about the comfort and care of a loved one. Two people working together to determine the best plan of care. Something the first episode could have been as well.

What I’ve learned from these two very different situations is that when dealing with the physical decline of someone they love, people will act and react in very different ways. For some, concern is focused on care and comfort. For others, responsibility for finances and other decisions take precedence. Still others may not know where to focus their attention. Some people are kind and appreciative of information and support. Others lash out in anger (which may stem from fear of the unknown future of their loved one). Elizabeth Kübler-Ross wrote extensively about the stages of grief. These two scenarios I experienced illustrate that grief accompanies all forms of loss: death, independence, relationships, changing family roles.

I know that it’s important to approach each new resident admission with fresh eyes and renewed concern. Although I’ve done dozens of admissions in the last few months, it is likely the first nursing home admission for residents and their families. Each individual will have their own concerns, their own focus of attention, their own emotions, and their own reactions to this process. My job is to make them all feel heard, comforted and cared for as they embark on this new journey regardless of how they may make me feel. I’ve also learned that I need to insulate myself from the negative emotions and outbursts of others – grow a thicker skin; that’s a more challenging chore for me.

So I think I’ll encourage everyone to focus on the “little” things like Jim made me do on Friday night. Love, caring and respite for all involved. It’s the same approach to be taken in conversations about healthcare choices and decisions.

Caring Choices is aware that difficult conversations are made more perplexing when emotions get out of control. If we begin talking from the place of love and caring, conversations will flow more easily. If we start talking before a crisis hits, we’ll be better able to make decisions based on love (and respite) and not something more complex. It really is the little things in life that make it worthwhile.

Where theres smoke…

Re-watching Escape Fire has triggered the cascade of emotional reaction it initially did in me, with the resolve to apply it even more into my life. Considering that my total time in and around the healthcare system is approaching 30 years, one might suspect a certain degree of comprehension and expertise to follow. What I have painfully come to realize is there is so much more to the old adage “Practice what you preach” than most are willing to admit. This, of course, includes me. When you have an opportunity, and if you have ever found yourself asking one or both of two questions (Why are things this way? Is there a better way to do things?), please take 90 minutes and watch this documentary.

Without going into a litany of statistics, I will focus on a just a few of my favorite statements throughout the program. The first and most important to me is a comment from Senator Ron Wyden on the overall nature of change in human behavior. He said in part, “People, so to speak, have a constitutional right to be foolish … we have to respect that.” Steve Burd, CEO of Safeway, said, “70% of health care costs are driven by people’s behaviors.” A statement in the opening comment by Dr. Don Berwick, former head of Medicare and Medicaid from 2010-2011, “They can’t give up their old habits,” speaks to me personally. The light came on even brighter than the first time I viewed the show. Finally, I’ll end my review with words from Dr. Andrew Weil: “We don’t have a healthcare system in the country; we have a disease management system.” Adding some numerical facts like “$300 Billion per year on drugs” and “30% of healthcare spending (roughly $750 Billion annually) is wasted and does not improve health (Institute of Medicine 2011), makes me wonder how end-of-life care planning fits into the plan for improved disease prevention. For me, end-of-life planning could be another “escape fire” added to the disease prevention that the show recommends and from which it highlights successes.

We have an expectation that we all are individually “accountable” for ourselves in this country. But, it seems to me that there are many people who would rather shift responsibility for their end-of-life management onto unsuspecting family, friends, doctors, and/or other institutions. In other words, prevention of disease is not the only concern having an impact on the available medical resources currently being taxed beyond limits. Having no plan or an outdated plan for your care can also burden the system which has proven to be stretched beyond its limits today.

Simple choices can be powerful. And the most basic of all choices are how you want to feel. No one wants to be in pain, stressed, or exhausted. With that in mind, what were to happen to you, your family, or your support system of medical, financial, emotional, and spiritual designees in the face of dramatic change?

Caring Choices has seen the smoke, and can recognize that a fire could start at any moment for any one of us. Prevent the catastrophic consequence of doubt from falling on the unprepared. Make the most of the proven impact of changed behavior to strengthen your health as well as the relationships with your family and friends. You CAN talk about this. Let’s talk.

86 – 96 – 90 – 88 – 82 – 96 – 91 – 44 – 82 – 70

One of these things is not like the others…ah, sweet memories of Sesame Street lessons about differences.

Well, these aren’t winning lottery numbers or a quarterback’s top secret audibles.

These numbers represent the spectrum of ages of community members who have died over the last few days and whose lives are represented by obituaries in today’s newspaper.

At first glance, some might consider the “44” to be the one that is not like the others. This perspective might be based solely on age or on the amount of life yet to live. But does that discount the experiences already attained by age 44?

Another perspective may be that the “96” is the outlier. A person who has lived a “full” life and may have been “ready to die”. Then again, maybe she wasn’t ready to die. Perhaps she felt she had more to do or say?

You really can’t judge the quality of life based on the quantity of it. After all, people are more than the sum of their years, right?

Of these 10 individuals, five died in a hospital. Five died in a skilled nursing facility. One, according to the obituary, was “surrounded by family” at the time of her passing. One was the “last of her family.” One notes she is survived by a “special friend and caregiver.”

All of them (except the one who is the last of her family) are survived by brothers, sisters, sons, daughters, husband, wives, in-laws, nieces, nephews, grandchildren and/or great-grandchildren. Some are now following loved ones who died before them.

A healthcare worker. A farmer. A seamstress. A retail store clerk. A secretary. A supervisor. A homemaker. A Wesleyan. A Catholic. A Methodist. Two Lutherans. A Presbyterian. A member of the Church of Christ. One made Barbie doll clothes. Two worked at SUNCOM. Square dancing. Embroidery. Crocheting. Ceramics and needlework. Auxiliary member. Grange member. Gardening. Devote to family. Devoted to children. Loved her pet cats.

They or their families encourage donations in their memory to a spectrum of beneficiaries: Church. Cancer Society. Library. Education Foundation. SPCA. Hospice. Park Fund.

Given these wide ranging descriptors, each of them could be the “one not like the others.” Age doesn’t define us. The cause or place of our death doesn’t define us. What DOES define us are the values and decisions by which we live our lives until the final tally becomes a column in the local newspaper. What will the world learn about you when your obituary is printed?

Caring Choices understands that each person at some point is “not like the others.” Individuality, personal values and beliefs, and fear of the unknown can greatly influence our end-of-life decisions. The decisions we make will have lasting impact on those whom we are “survived by.”

She never smiles

I am going to call her Mia. Many of us rarely ever saw her talk. No one ever saw her laugh. And so the treatments continued and the frequent readmissions followed each other on a routine basis. Our days were full of shift reports, discharges, admissions, transfers, transports, meal set-ups, medication passes, repositioning, IVs, tube feedings, dressing changes, tray collections, intake and output recording, call bells, and the never-welcomed always-possible codes. Despite all of this, we still found time to try and get them to laugh.

Mia hid behind her parents as we entered her room. She would play quietly, or just sit and watch the movies or cartoons. She frequently cried during the numerous tests and treatments. I had lost count of the number of times different ones tried to make her smile. Her parents insisted she did. We never saw it.

Recently one of my old buddies from there said “We were their family.” Although I had been there for years in the past, hearing this today had a much greater impact on me. Yes! We were their family. Even if the family occasionally slept in the rooms, or stayed nearby, there were lots of times the kids were alone. We were there, 24/7. Answering every call, question, or need to the best of our ability. We cried, often together, mostly alone, at the tragic reality of their lives. The various diagnoses they faced from simple wound healing to end-stage disease processes washed over us in every room we entered; we revolved through our day in multiple stages of grief, joy, relief, or sadness. And we tried to make them laugh.

The day finally came. The RN was sitting quietly charting in my pod. She had been there close to 12 hours so her feet were propped up on a second chair as she busily shuffled papers and recorded events. The tape dangled from my belt around my hemostats as I walked by. The urge was irresistible. Quietly, I crept up behind her and quickly secured tape to the back of her chair. In moments she was trapped as circles of tape wound round and round her with the help of another nurse who was walking by and quickly joined into the devious plot. Within minutes she was fastened helplessly to both chairs by surgical tape. We rolled her into the main hallway and delivered water-filled syringes to the remaining children present on the unit who didn’t already have them. And I placed a giant stuffed dog on her legs as we began our procession to the doorway of each room.

We intentionally planned on skipping Mia’s room as she likely would have only hid or cried had we entered and she was in an isolation room anyway. But as we rolled our reluctant dripping victim past her room I saw her look up. I stopped. Mia burst into laughter! She rolled on the bed and pointed and squealed with delight! We quickly armed her with a water-filled syringe and she laughed even harder as she soaked our poor co-worker even more. So, she could laugh after all.

Caring Choices understands that the reality of some situations can be overwhelming and seem to have impassable barriers. It is these extreme circumstances that require the most delicate approach. Often the spontaneous, most outlandish approach could be the key to opening the way for dialogue. Humor is where I have found the most available path through the darkness of life. Not every case can be solved with laughter. Never is forever. Life is happening now. It’s worth a try to investigate every possible road as we approach our final destination. Discussing what makes us feel good along the way does not have to be done without a smile.