Tuesday, April 26, 2011

A Wise Heart

"So teach us to number our days, that we may apply our hearts to wisdom."

~Psalm 90:12

I began working in hospitals in July, 1999. But the truth is, I have been interested in how we live and how we die for all of my life that I can remember.

I think conservatively, I have been aware (meaning, I was on the unit, in the immediate area) of at least 100 deaths. Not that a tally matters, it's just that in that quantity, there has been an opportunity to observe many different ways to handle an event that will absolutely come to us all. Given this, I have come to believe that there is such a thing as a "good" death.

I have shocked people saying that. Our Western culture believes that death is a battle we must fight, which is sad, because we will always lose. We are not accustomed to the notion that we can can "go gently into that good night." But why not? We celebrate a birth, as well we should, as the beginning of a grand new adventure. I would like to suggest that a death can be the fraternal twin of a birth, if only we are open to it.

How do we become open? It's not what most people look for in our medicalized culture.  It is not a procedure, a new drug, or even an experimental treatment. It begins with acceptance, is guided by love, and is always underpinned by wisdom. It is never about quantity; quality is always the language of openness.

Those are lofty ideals, and I can see how they may not always translate to the everyday matters that concern us when a loved one is sick. I can completely understand that philosophical concepts seem nearly absurd when one is having to make life-or-death decisions for a cherished family member or friend. But that is precisely why these concepts seem absurd; we consider them at the 11th hour. The time to invite grace into our lives is now, right this minute, not at the bedside.

We make room for openness with preparation.  In my experience, much of the sadness and confusion  that accompanies a critically ill person manifests in the decision process.  I have seen such anguish in family members; it's heart-breaking. At first glance, it might very well seem to be mainly about the actual illness, but I will suggest that it really is not. Often the family is upset by having to make choices without information from the person who matters the most. Here lies a loved person, sentinel events are immanent, and the issue at hand is that the next-of-kin does not really know what is the right choice to make.  They never talked about this. It "never came up," or, "we were going to talk about it," but the right time never happened. This is especially true when the patient in question is not old, adding on another layer of despair to losing someone at an unexpected time.

The "good" deaths were the ones where people knew what to do, and then carried out the plans with great love and even celebration. The patient was always a person, and that is something that can get lost in a mountain of tests and futile interventions. The important people people gathered around, they supported each other, and they let their love and their sadness have their space.

When we really love someone, and there's no way to verbally communicate that, actions seem like a wonderful option. A person may not be able to hear "I love you," anymore, but being able to advocate for them seems like an excellent stand-in. Except sometimes the most loving way to help a dying person is to not in requesting more treatment. We have not done a good job in the medical community with this message. Most people see the cessation of treatment as "giving up." It isn't. It is compassion, it is acceptance, and at its highest, it is grace manifested. There is a good reason that we have something called "comfort care," which is designed not to prolong life necessarily, but to be certain that whatever time remaining is as good for the patient as it can possibly be, even if that is at the expense of a few extra hours or days. It is also putting the person before one's own pain and regrets, which is a powerful gift.

When people ask for extraordinary treatment, often they don't know what it is that they are really asking for. It's reasonable that a regular person might not know what the real-life consequences are for some requested interventions. Before asking for something new, it is important to ask how that person might live after it is done. I am not sure that most people understand that sometimes this can mean a permanent relocation to a specialized care home. If that is the case, bioethicist  Dr. Katrina Bramstedt suggests touring a facility where people who have have had the potential procedure live, so that a well-informed decision might be made that seems in accordance with what the patient would want.

Talk to each other. Ask what your family and friends want for themselves, should they be unable to speak. Write it down. An Advance Healthcare Directive is just the place to begin to record this kind of conversation. Keep it where the important papers go, and if you have a regular doctor and hospital, please see that they have a copy too. And most of all, don't forget to have this conversation with yourself. It's the final gift that you can offer to the people who mean the most to you, and stands as an invitation to grace. Number your days, and gift your family with your heart's wisdom.

Saturday, April 9, 2011

The Saint of Impossible Things

I was raised Catholic.  I'm not sure what I am now; recovering? Seeking? Sure.

I find it endlessly amusing that I finished grammar school at St. Rita's Catholic School. As an adult, I learned St. Rita is considered "The Patron Saint of the Impossible." Translation for non-Catholics: you pray to her for things that seem beyond human ability to fix. Of course this is where I finished out my childhood.

St. Rita Cascia*

I love that Catholics have saints like pharmacists have pills.  Have a problem? The right saint is doled out for an appeal for relief and protection.  If you have lost something, for example, you pray to St. Anthony, The Finder of Lost Things. (Can you imagine this poor man's sainthood, perpetually maintaining the Universe's Lost-and-Found? You'd have to be a saint to put up with the crushing flow of requests.)  If your pet is sick, St. Francis is your man. He expressed his devotion to God through a lifelong love of animals, so you can be assured you have a sympathetic ear when you go to him with a pet problem.  

But St. Rita is special. She is your last ditch, there's no other option, hope is all but lost gal.  To borrow another religious metaphor, she's the Hail Mary play of Saints. I really love that I went to a school named for her, because I'm the kind of person who does her best work in the clutch.  When my back is against the wall, I find my sweet spot, and often pull whatever I am working on through in the final hour.  I think St. Rita would understand that. It's stressful, but success seems even sweeter when it comes with honest sweat and even a touch of fear.

I may no longer be a practicing Catholic, but I have decided that along the way, I can keep some of my past that has worked for me. St. Rita can be my wing gal; we understand each other pretty well.

* "The saint of Cascia belongs to the great host of Christian women who "have had a significant impact on the life of the Church as well as of society" (Apostolic Letter Mulieris dignitatem, n. 27). Rita well interpreted the "feminine genius" by living it intensely in both physical and spiritual motherhood."

~ Pope John Paul II

Thursday, March 31, 2011

After a Long Sleep

the flowers have come again.

My beautiful lilacs have bloomed. I'm not sure if I love them so much because their time here is so fleeting, because their scent and color is so beautiful, or if it's because they don't really belong in temperate California. They remind me that some of the most beautiful things need harsh conditions to exist.

This came at a particularly important time.  I need to remember that these harsh conditions in life might yield beautiful blooms.

Ana├»s Nin: “And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom”

Saturday, March 26, 2011

Making it.

Some days, there's not much sun to be seen.  The rain beats the windows, the wind howls, and staying in bed feels like a survival tactic.

On days like these, especially when the storm is just as much internal as it is external, it's important to try to do what you can to lighten the mood.

One method I employ is to make something.  Even if it's just coffee and toast, it's a way to lift the gloom.

There was some whole wheat dried cherry toast with honey peanut butter on the plate, but I ate it before I got the idea for this post.  Perhaps I should make more.

I still have some of the coffee though. Caramel. Decaf, since I work tonight, and some more sleep is on the agenda for today.

When I go back to sleep, I hope I dream of strawberries.  I'm allergic to them, and despite two antihistamines, my mouth still got sore and swollen after I ate two of them last night.  We got a beautiful batch of huge strawberries at Costco, and we dipped them in dark chocolate for our mother's 70th birthday party last night. The reaction was worth it.
This is the very beautiful "before" picture. The afters never got a photo opportunity. They just got eaten.

We are all just getting along, making it as best as we can. I hope that when you get the opportunity, you make a little something nice for yourself.

Thursday, March 24, 2011

Make Time for a Manifesto

DISCLAIMER: please DO NOT take over a bank, or any public place, nor commit an act of violence in the course of your Manifesto. Thank you.

I was really looking forward to writing this post, thinking that I was in possession of a really original idea: everyone should write a manifesto. Except then I was going through my Twitter Feed, and I came across this article posted on the99percent.com. The article summary reads "Manifestos are a powerful catalyst. By publicly stating your views and intentions, you create a pact for taking action. (Movements from the American Revolution to Dogme 95 film to the Firefox web browser were all launched by manifestos.) If you want to change the world, even in just a small way, creating a personal or business manifesto is a great place to start."

Well shoot. That's pretty much what I was going to say!  While I do not ever recommend getting into a 6 hour stand off with the police to get your message out (and interrupting my wedding planning with the caterer -- lucky for HIM I wasn't armed! (kidding!)), I do think that we could all benefit from distilling or hopes, dreams, and ideals into a statement strong enough to build a life on. (Not including prison time.)

What do I care enough about to publicly proclaim? Is my love for my family, for animals, for my friends enough? It loses something in print. What about my dedication to school, and my dreams for my future? Hmmm. I'm not sure there's anything revolutionary in all of that. 

It seems, then that I am with the majority of society, drifting along in my happy, not- very-exciting-life.  To change the world, even just my own world, it looks like I have some work to do.  I need to chase down my passions, to get excited about something -- anything -- in a way that will shape and create a dynamic future.  The world deserves that level of excitement and innovation.

Tell me, how are you going to change the world? What will you write in your manifesto?

Sunday, March 13, 2011


I am worried. I try not to be, but there it is, rolling around in the pit of my stomach.  It tickles at me like an urge to sneeze that never comes.  I dream stressfully, sleep fitfully, and 

 none of this helps to alleviate the worrying at all.

This is why I pursue a happier outlook; I want to prescribe myself a better attitude that will eliminate the unhealthy one.  Sometimes, though, the worry wins, and I need to be even more aggressive in my self-treatment.

I know why I worry: Japan has been shaken literally to its core, with mayhem and terror at every turn. The TV is full of more and more dispiriting statistics and even worse images. My prayers and my donations just don’t seem adequate in the face of that kind of destruction and misery. On my own homefront, as a student, there are always money issues to fret over. Add in a wedding, animals to care for and a kid getting ready (or is he?) to go to college, and there is plenty of fodder to feed anxiety. Knowing the causes does not always equal relief.

I’m actually hoping that bacteria can be the correct teacher for me, as I look to learn how to alleviate my anxiety.  That’s correct: bacteria. Specifically, the kind that habituate your gut. Bacteria got a recent publicity boost when some clever marketer began advertising them as “probiotics,” but make no mistake about it, it’s bacteria, plain and simple. The bacteria that live in the intestines are vital to human life. They metabolize all manner of substances; without them, blood would not clot, we could not metabolize carbohydrates properly, and on and on.  Microbiologists call these friendly bugs “flora,” which again is a much nicer spin. In the body’s census, bacteria in combination with yeast and assorted microorganisms add up to about 750 trillion, more than there are human cells in your body. 

How can bacteria be my teacher? Competitive advantage. No organism, in my opinion, does it better than bacteria. One of the ways that bacteria keeps the bad bugs from getting too cozy in the body is by making sure that the majority of existing resources are not available to an invading microbe.  Without resources needed to reproduce and thrive, a good deal of infectious bacteria simply dies without the host even knowing that it’s there.  It’s a crucial safety net in the body, and it’s not a bad metaphor for life, either.

I figure that the more I can make room for optimism, and the better able optimism is to take root, the less worry will be to flourish when it shows up.  I need to make sure that a healthy outlook gets the majority of my resources, if I want worry to wither.  In life, as in the body, the winner takes all, and I need to be sure that I am nourishing the correct emotion.

Happiness thrives on good works, service to others, self care, sound sleep and nourishing food. Worry expands in the presence of fatigue, over-scheduling, too much TV, and unhealthy or sporadic meals. Optimism is a consistently joyful practice, where worry is often synonymous with wallowing in sadness and defeatism. 

Gandhi said, “you must be the change you wish to see in the world.” One needs to look no further than a rumbling tummy for a positive example.  In the end, it is what we feed that makes all the difference.