Monthly Archives: June 2015

Time

What impact this word can have in so many different situations. What usually comes to my mind when hearing this is to try and fill in the next word or words before or after. For example: It’s Time, Time Flys, Time Stood Still, Time ran out, Time out, and on and on we can go. How about “Time flys when you’re having fun.” As “time” goes by, I realize that it is not only when having fun but also when I am focused on something. For me, playing guitar is the easiest way to lose 4 hours I have ever seen. As I get older I also remember people saying “Time seems to go faster when you’re old.” Truth be told, yes, I wake up one morning and say “My God, it is Thursday already.” Weeks seem to fly by. When I was younger it was mostly “Time seems to drag on and on.” Especially when in school, waiting for the class to be over, the day to end, the bus to get home, or supper to be ready. Today it is more like the total opposite. I cannot seem to find the time to get anything done. And my, “how times have changed”. Sound familiar to anyone?

The discussion of time can lead to a host of topics and provocative conversation. In the focus of time on this earth, we all, reluctantly maybe, are reminded each week by these blogs that our time is limited. Each week we try to generate interest in why and how planning and preparation for this limited time is important. Not only for each individual, but for our loved ones, our friends, and our associates in business, education, or any other position where there is any responsibility for action to occur when someone is suddenly absent from the scene. Over “time,” I see change occurring. I see a greater understanding and awareness of the benefits of end of life planning and discussion.

Recently a friend posted a short series of well known (but some for me, unknown) facts about the origins of different meanings to phrases not all that dissimilar to the references of time above. They included what seemed to me to be reliable origins for old sayings like “chewing the fat,” “crossing the threshold,” “raining cats and dogs,” and many other common sayings that almost everyone I know has heard or said. “Time has come” for continued education and implementation of more compassionate care to be given as the end of life approaches. Not only for those who suffer from disease or trauma, but for all of us who will inevitably be in need of the type of humanity and kindness so often only reserved for “certain times.”

Caring Choices will continue to “change with the times” and offer our continually growing experience with emotional support, coping, thoughtful discussion, understanding, and reassurance for those who desire and need help during their “time of need.”

Life Finds a Way

One of my favorite characters in Jurassic Park was Dr. Ian Malcolm (aptly played by Jeff Goldblum) and one of his best lines was, “Life … uh, finds a way.” He, of course, was referring to the eventual naturally occurring reproduction of dinosaurs created by man who foolishly contended to also have control over their creatures’ ability to reproduce. In many aspects of life, we humans attempt to assert control. Still, life (nature) finds a way, to thwart our plans.

I once had a conversation with an elderly lady about quality of life. She shared her thoughts about having to be fed by someone else. Being fed was undignified to her and she said she would feel like a burden. Despite my best effort to assure her that people would feel honored to help her if her ability to feed herself changed, she was adamant. She was very clear in telling me that she would not want to live if she couldn’t feed herself. In her healthcare documents, she opted not to have a feeding tube inserted. Feeding herself was a measure of control and independence through which she determined her quality of life.

She recently went through some life changes that I will not divulge here, but they have taken a toll on her physical and mental health. She is declining cognitively. She has lost the ability to feed herself – her worst fear. Because she now needs to be fed, she is refusing to eat, losing weight, and “failing to thrive.”

Now, there are choices to be faced and decisions to be made by her family (since she is no longer cognitively able to do so for herself):

Do they want the doctor to prescribe an appetite stimulant?
Do they want to have a feeding tube inserted? (Living Wills have been ignored in favor of preventing “starvation”, which is a myth at end of life.)
Can she be re-trained to feed herself with adaptive utensils?
Will occupational or speech therapy be able to “fix” her self-feeding capability?
Is hospice care more appropriate now?

Whatever her family decides, the choices seem to be: (1) intervene in some way or (2) allow nature to “find a way.”

Caring Choices understands that these kinds of decisions are personal. They are emotionally challenging to consider about ourselves and those we love. Conversations with loved ones and our healthcare team are the best way to prepare for allowing nature to find its way.

Knock Knock

Whenever I hear this now I reluctantly respond in a slow monotone of “Whoooo’s there.” At one time I may have gleefully replied in a more excited tone of eager expectation of the often witty response. But at 60, I have heard the usual responses hundreds of times and rarely hear something new or funny. But today, as I considered the topic for my blog title, I overheard someone on the television say “Knock Knock.” Not knowing the context of the words on the TV show in the background, I suddenly realized the value of the statement as it pertains to quite a different subject.

Weekly, my wife and I take turns blogging about all the issues surrounding conversations we hope to generate among our readers and the general population about end of life needs, care, and desires. Knock Knock, now has an entirely different meaning for me.

So, who’s there, really? Ask yourselves, who is really there. When you are talking to someone you love, and you are interested in establishing a plan for how to attend to the needs of their changing health, finances, and function, who are they really? More importantly, who are they now? As my time in health care continues I have often heard the comments: “We have done that.”, “I have done that,”, or “I/we hope/want to do that with so and so soon, this Thanksgiving, at Christmas, during vacation.” The question is this: Do we feel comfortable with the level of comprehension of their feelings. It’s important to consider what may have changed since our last conversation. I have found that very few people have continued discussions and make adjustments to their living wills and documentation over time.

There are lots of resources available to give guidance to someone wishing to explore planning for end of life. There are social workers, physicians, and clergy. Numerous on-line options exist on how to plan and prepare for the multitude of situations people can and will face in the care for the transition of life from independence to dependence. None of these tools are going to be helpful if the person who is being cared for has not been involved on some level. I am constantly telling my patients and their families: “We can’t help if we don’t know.”

Caring Choices asks everyone to please Knock! Find out who’s there. Start to ask questions early. Document the answers in a clear and easy to understand style that can be quickly found and accessed by family, friends or health care professionals. Get to know your loved one’s thoughts on where, how, and what type of care and arrangements they are comfortable with. Please do not let decisions that can affect the remaining quality of life become subject to some standard response like it is of no more importance than an old joke.