Monthly Archives: February 2015

Paralysis of Analysis

Wikipedia: Analysis paralysis or paralysis of analysis is an anti-pattern, the state of over-analyzing (or over-thinking) a situation so that a decision or action is never taken, in effect paralyzing the outcome. A decision can be treated as over-complicated, with too many detailed options, so that a choice is never made, rather than try something and change if a major problem arises. A person might be seeking the optimal or “perfect” solution upfront, and fear making any decision which could lead to erroneous results, when on the way to a better solution.

This phrase seemed comical when I heard the studio engineer use it in reference to the final mix-down phase of my recently completed CD. I had never heard this before, at least not to a degree where it actually resonated in my mind at all. But here, in the final stages of my CD production, the meaning sunk home with the impact of a slap to the face. I have always been hyper critical of my performances, and had never felt satisfied with any of my previous attempts.

And so the process of mixing my songs into a state of digestible consumption continued in the most basic format. I made the choice to substitute the paralysis of analysis with trust and intuition in the combination of the expertise of the studio engineer, thousands of edits, and a few “happy mistakes”. Now my CD project is complete! As I sat pondering a topic for today’s blog, I was suddenly aware of how characteristically similar this concept carries into just about any subject. In this case, conversations about health care, advanced care planning, and end of life discussions.

Anyone reasonably concerned with preparing for the future would begin with an assessment of the currently available resources and forecasting of probable future needs. Following up with a plan and then evaluation of the implementation of our wishes is where the paralysis is most likely to occur. We will not know what the outcome will be. We will not know until it happens what we will likely need. There are a growing number of studies now that support the importance of advanced care planning but there are no survivors who can testify as to the quality of life they received during their last moments. Only the surviving family, friends, and caregivers remain with whatever bias they may or may not be reporting from. History is written by the victorious. But in this case of preparation for death, no one gets out alive. The finite nature of this fact alone can cause people to go numb and be unable to make choices or act. The national median hospice length of stay is frighteningly low at 18.5 days (NHPCO). I have admitted many people to hospice in my 10 years of service who do not live even a week, thereby missing the majority of support available emotionally, physically and spiritually.

Caring Choices offers the motivation to avoid the gridlock of indecision and the stagnation of inertia before it can stall the benefits of having expressed your feelings, emotional fears, and concerns while you are able. Often just a few minutes of listening can make a huge difference for someone who is struggling with the fear of death, advancing disease, or general decline of aging.

The Road Well Traveled

As I drove to work this morning, I encountered snow-covered roads from the powerful wind 38 - edited for blog gusts that drifted roads closed overnight. Most roads on my journey this frigid February morning were completely covered except for slightly clear tire paths in each lane. To be safe, I steadied my steering wheel against the gusting winds to keep my tires in those already-cleared tracks from travelers who had driven the same path before me. It was harrowing at times with the drifting snow impacting visibility but I knew if I was able to keep my vehicle in those worn paths, I’d have better traction and stability.

I imagine many people drive like me in this kind of weather … slow and steady, staying in the driven paths to avoid slipping and sliding in collections of snow and ice, and staying alert for traffic signals ahead indicating a stop in slippery slush. I also know that often there are others who throw caution to the wind and drive as if the roads are clear. I know this, because they pass me in unplowed passing lanes at unsafe rates of speed and then spatter my windshield with slushy muck that impairs my view. Sometimes I see them further up the road with their vehicle stuck in a ditch.

While driving cautiously this morning in the clear tracks before me, I thought about the trepidation people have about future healthcare choices and decision-making. When my Mom fell ill for the last time, and we started hospice, it felt as though we were blazing the trail anew and we were both fearful of what was ahead. Because we had hospice care for only a short time, we never really had the benefit of spending a lot of time talking with the hospice team who had been down this road before. None of my immediate circle of friends had traveled this road of hospice care and family caregiving before me. There were no “already-cleared tracks” for me to keep my tires in. But 11 years after Mom’s death, when my Uncle Warren needed hospice care, I’d been down that road before and so I had much better preparation for what was ahead.

I sometimes think people are tentative to start conversations because they don’t know what’s ahead. Because they don’t know how to find the already-cleared tracks before them.

Caring Choices has traveled the road of healthcare decision-making with patients and families, and with our own loved ones. We understand the fear of the unknown. We recognize the challenges of having emotional conversations. We also know that having someone along for the ride who is familiar with the road can make a world of difference in the journey.

Do everything…Within Reason

Throughout my 10 years of service as an RN with Hospice and 20 plus years in the nursing field in general, I have been exposed to a vast array of situations and outcomes which have shaped my current view on medical care during end of life, including insurance coverage and the various types of forms designed to guide treatment and decisions along the way.

I have seen these preparations serve both as a guide for care and also as an obstacle needing to be overcome. If the dialog, interpretation, and enforcement of these documents alone will not ease suffering or maintain a safe, comfortable environment for patients – due to legalities and malpractice concerns – there has to be a change in our approach to these situations. In this NYTimes article, there is a very dramatic accounting of the exact obstacle documents can sometimes create. And having been in the moment and present during countless deaths, where there are no panels of discussion, review boards, or appeal courts, suffering is only witnessed with eyes of empathy and love.

The need for all the clinical and legal forms remains unchanged by the fact that forms are sometimes an obstacle. What can be altered is making the choice to have the courage to discuss the outcomes of advancing age, worsening disease and potential consequences of sudden life-altering trauma. No one wants to talk about the “negative” stuff. Yet the majority of our lives, after we reach our 30s and 40s, seems consumed with it. Conversations between two reunited old acquaintances become more about doctors, medications, hospitalizations, recent surgeries, and limitations due to failing health than about social gatherings, future plans for travel, and entering new adventurous careers. That’s just life, right? And so wouldn’t conversations about healthcare decisions and ultimate death be appropriate at this same time in our lives?

Caring Choices urges everyone to stay in the moment. Realize the importance of loving discussions with gentle kindness can make a difference for you and your loved ones. Even the loneliest soul on earth has the right to live their life in safety and comfort. Right up to the moment it ends. Talking with your family, doctor, caregivers, and legal counsel can only help to assure that somebody will do everything that you want in the way that you hope.

Don’t Wait

I recently resigned my part-time hospice social worker gig. It was bittersweet, but necessary. I’m not as young as I used to be (no kidding; who is?). I came to recognize the signs that working a full-time job, plus doing my best for hospice patients and their families in my “moonlighting” flex time job, was taking its toll in more than one way. I wasn’t sleeping well. My stress level was escalating. My focus was segmented in too many directions. I was missing much needed down time to rejuvenate and renew myself. I needed more free time for the “little” things: spending time with Jim, staying in touch with my son, playing with our cats, reading a good book on a snowy weekend afternoon, having meals with friends, etc.

But my heart will always be with hospice and fortunately (yes, fortunately) I can continue my hospice social work with residents and families in long term care. Hospice care is a blessing for many families. This PBS article helps explain why. Please take a few minutes to read it.

The gist of the article is the point of my blog. We’ve seen it all too often with our own family members, our patients and my residents & their families. Those of us who work in hospice hear it all the time: “I wish we’d started hospice sooner for Mom.” I have never heard anyone say “Dad was on hospice too long.” Part of the problem, I think, is that the word hospice still connotes “immediate death” for some people. The PBS article states: “People often wait too long before seeking hospice care. In the United States, the average length of hospice care is less than 60 days with 30 percent of those who elect hospice care dying in seven days or fewer.”

It’s difficult for some to embrace the hospice concept and so they wait to enroll their loved one. Or they wait to have a conversation with a healthcare provider about hospice (or the healthcare provider waits too long to initiate). When my Mom’s doctor told us – “There’s nothing more we can do. Your disease is end stage. It’s time for hospice.” – neither she nor I had ever heard of hospice. There has been much more about hospice in mainstream media since Mom died in 1998 (on her 7^th day of hospice care). I often say I wish we’d known about it sooner. And not just for my Mom’s sake, but for mine and that of my then-13-year-old son.

There was so much support that we did not have time to fully engage. Now I know that there was a social worker and a chaplain available to us for resource, emotional and spiritual support. There were volunteers who could have come into our house to sit with Mom while I took my son to his baseball games (instead of me leaving her alone and then sitting anxiously by my bag phone – it was 1998 – awaiting it’s ring telling me she needed help.) There were people who could help other family members come to terms with the situation. The nurses we met were great; the aides were invaluable to me since I was uncomfortable with bathing my Mom.

Let me stop there to drive home a point: I recognized that there was something I just could NOT bring myself to do. With hospice, there was someone I could call to help us. She didn’t mind that I couldn’t bathe her and she was grateful for the aide who could. And I wasn’t then (nor am I now) ashamed to admit that I could not do this one thing for my dying mother. I could empty/clean her bedside commode. I could clean up other bodily fluids that she would expel given her COPD. I could feed her, wash her clothes, reposition her in the bed, entertain her, listen to her, and spend time with her. But there are reasons that certain people are CNAs and others are social workers (or plumbers, or policemen, or truck drivers, etc.). Each job has demands that the other may not be comfortable doing. My mom knew I wasn’t able to bathe her because we talked about it before we knew her disease had become “end stage”. And I didn’t have any guilt about not bathing Mom because we’d talked about it and there were others who could help us with that.

And there’s the point. We talked. Even before the doctor’s proclamation that there was nothing more to be done, we had talked. We didn’t wait. We continued to talk throughout the next 9 nine days until the morning Mom died. And there was a lot more to be done. Our final conversation, just hours before her last breath, was about her funeral scriptures and songs. Until the very end, Mom wanted to be sure I knew what she wanted.

So, don’t wait. Start a conversation with people you love. It doesn’t have to be a lengthy discussion initially. Just ask your kids who would be comfortable giving you a bath in your last days. You’ll be amazed what conversations follow that!

Caring Choices understands that each of us is designed to do certain things more comfortably then others. Recognize your strengths and abilities and then lend them to care for someone you love. Don’t wait too long. Better yet, don’t wait at all. Talk. Share. Love.