Real Intentions for Life

Advance Care Tools for Caregivers


As Ryan sat at his desk, it seemed like any other workday — until he felt a sudden wave of pressure in his chest. He took a couple of deep breaths, hoping it would pass, but the pain began to radiate into his left arm. Just 45 years old and slightly overweight, Ryan wondered if he could be having a heart attack. He didn’t want to overreact, nor was he eager to have his day disrupted.

Five minutes passed. The pain was unrelenting. He told his boss he was going to the emergency department to be evaluated. He arrived safely and an EKG was performed at triage. He was rushed to a room and told he was having a heart attack. Ryan seemed shocked and felt shaky — destabilized by this unexpected crisis.

Emergency staff swarmed into his room to start IV lines and administer pain medication and aspirin while the physician explained that preparations were underway for him to go the Cardiac Cath Lab. A cardiologist would run a catheter from his groin into his heart and inject dye into his heart arteries. Once the blockage was identified, a stent would be placed to restore blood flow to the region of Ryan’s heart that was compromised. Ryan felt degraded; he struggled to accept his vulnerability and the reality of his mortality.

After the procedure, Ryan was admitted to the ICU in critical-but-stable condition. He felt his life had been destroyed with this heart attack. He could no longer brag about being in good shape and enjoying excellent health.

With similar tactics to disrupt, destabilize, degrade and destroy, a life-threatening illness presents as an act of terror — an awakening for both patient and caregiver. The caregiver can either engage the fear or counter the terror.

The following advance care tools will help caregivers combat fear and promote recovery:

  1. Fight Disruption with Composure

Anxiety acts as a disruptive force; fueling the release of adrenaline while creating a state of panic and helplessness. Your best defense against this powerful force is to keep telling yourself to keep calm. Remind yourself to take deep breaths or count to 10. Exhale with the force to blow out a flame or soothe a burn. This is not new information, but it’s another opportunity to apply this tactic to a new situation.

Life-threatening situations call for rapid responses. Your goal is not to accelerate your heart rate, but to keep your wits about you. How rapidly can you lower your heart rate, focus your mind, and return to a steady state of composure? Is this something you practice daily and carry in your virtual toolbox?

Disruption often leads to poor decision-making. If you’re off your game and lack self-control, you could falter. You reach the top of your game through the starting point of composure. Making rational medical decisions depends upon your ability to listen and be reasonable. You need to quiet your mind so you are able to be attentive and understand the information provided by the physician and nurses.

  1. Fight Destabilization with Competence

The best tool a caregiver has at his or her disposal is the ability to maintain self-control. Your demonstration of competence becomes a stabilizing force for your loved one. Competence is more a skill than the feeling that you know everything. Learning to appear competent helps you to “fake it till you make it,” gaining confidence as you help stabilize the situation.

Competence is believing in yourself. This core ability allows you to proclaim, “I’ve got this! I have my footing and know how to proceed!” This belief system isn’t innate; it’s an acquired skill. By applying discipline to shaky situations, you learn how to find balance through strengthening your core muscles.   Stabilization, as a type of muscle memory, needs to practice through physical exercises that teach this principle.

“Steady as she goes” is a nautical tool to keep a ship on track. Medical decisions require caregivers to take the helm until their patients become stable. You can imagine turning over the ship to your patient once he or she reestablishes competence.

  1. Fight Degrading through Upgrading

Upsets occur through the lack of commitment. Terror exists when walls come tumbling down. As your loved one collapses with a life-threatening illness, your immediate reaction is to prop him or her up. You raise patients’ spirits and lower stress through providing them this type of “upgrade.” An upgrade clearly reflects your level of commitment to your patient’s well-being.

Your patient needs to know that you have his back … that you are there to catch him when he falls and to act as a type of safety net and springboard. As a gift to caregivers, Michele Obama left this indelible remark: “When they go low, we go high.” This statement of commitment is a powerful tool that serves to lift the heart of your loved one.

Patients tend to feel inferior to others. Caregivers have the power to treat them as loved ones. Believing that love cures all becomes the best medicine for your patient. Acts of love such as flattery, gifts, physical touch and time together will give your patient the feeling of having been upgraded and provides a much-needed boost to his or her ego during the catastrophic event or illness.

  1. Fight Destruction with Restoration

“What doesn’t kill you makes your stronger.” Make this phrase a motto for you personally while caring for your loved one in the aftermath of a life-threatening event. It’s the starting point from which to brush yourself off, move forward and rebuild. Caregivers need to act as leaders in the process of healing and restoration.

Spiritual restoration occurs through the elements of earth, air, water or fire. These energy sources are often used to help those who experience loss or grief. They are also associated with particular Zodiac signs:

Water signs: Cancer, Scorpio and Pisces

Fire signs: Aries, Leo and Sagittarius

Earth signs: Taurus, Virgo and Capricorn

Air signs: Gemini, Libra and Aquarius

Identify and connect with the best qualities of your zodiac sign. These driving forces can be the best advance care tools necessary for you caregiver to rise above the ruin. Your patient’s healing potential can be boosted by using his or her zodiac sign as a source of innate power.


Any life-threating event is followed by a new dawn and awakening. Advance care tools allow caregivers to welcome the new day as the new normal. Your strength of character will be tested during these moments. Your ability to rise to the occasion makes all the difference in your patient’s ability to heal and recover.

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Anticipate Happily Ever After


Despite wearing a patient gown, George was a distinguished-looking 72-year-old gentleman. He arrived in the ER with his charming wife, Jill, for difficulty breathing. George had end-stage lung cancer that was not responding to aggressive chemotherapy. He was also receiving treatment for congestive heart failure due to a prior heart attack. After the chest X-ray and lab studies proved inconclusive, did George wish to proceed with further testing and hospitalization?

The physician found evidence of the progression of George’s lung cancer, pneumonia, a blood clot in his lung, and a possible heart attack. Determining an exact diagnosis might offer George more time, but very little quality of life. The physician did not hold out hope as a reason to admit George to the hospital. George’s worsening condition meant that it was time to consider hospice.  As George was not ready to cut his losses and return home, Jill would cast the deciding vote. As usual, the caregiver would need to determine the best course of action leading to happily ever after.

These three practical tips will help lead to happily ever after:

  1. Stockpile your hope chest

When there is a shortage of hope near the end of life, a caregiver needs to have some favorite things available to bring a smile to their loved one’s face. Photos of happy memories, a favorite wine, or good movies are a great ways to spend quality time together. Planning and saving for a rainy day is what responsible spouses do. They often become caregivers one day. For better or for worse, in sickness and in health, caregivers vow to stand by their loved ones. The ultimate purpose of having a hope chest is in anticipation of living happily ever after.

Hope often triggers caregivers to open Pandora’s Box rather than leaving well enough alone. Was Jill satisfied that George had fought long and hard enough or would the battle continue? Would determining the exact cause of his difficulty breathing change his overall condition? Did this situation warrant he stay in the hospital or allow him a break from further treatment? Might Jill be hoping for George to die in the comfort of their home? Replacing future dreams with fond memories in the hope chest eases the transition to let go of a loved one. This instills gladness instead of sadness at the end of life.

The value of a hope chest is that it’s portable and contains the “comforter” you need at a moment’s notice. Caregivers are often “not there yet” in making life-and-death decisions for their loved ones. This hesitation is a missed opportunity to make the best of a bad situation. Rather than making your patient’s wishes come true, being an ill-prepared caregiver means that you risk doing harm and living with regret.

  1. Live without regret

It’s virtually impossible for family caregivers to not regret the passing of a loved one. Yet, caregivers need to figure out how to make the impossible a reality if they intend to live happily ever after. Most caregivers regret when a situation gets out of hand. They often think in hindsight that they could have done a better job of anticipating the upset and heartache.

Caregivers who love from their minds instead of their hearts tend to live in regret. The mind rarely fathoms doing anything less than saving a loved one’s life. The heart is steadfast in showering the loved one with unconditional love – an unbiased and unattached form of love. This altruistic and selfless love is at the heart of most physicians who care for patients equally and impersonally.

In matters of the heart, caregivers must remain in the middle ground of taking it or leaving it up to fate. While living in sorrow, caregivers often take unnecessary responsibility for what has happened. Were you really expecting to change your patient’s fate? Life and death happen and caregivers have little control over the matter. You only have the ability to take what has happened and appreciate it as being a chance to demonstrate love without regret.   

  1. Cherish the depth of your love

You will never experience the depth of your love until you care for another person near the end of life. To live fully, you’ll need to have a good laugh and a good cry. Death is meant to be a sweet sorrow over a bitter agony. You may begin to plan for when you may see your loved one again, knowing that love never dies. Was Jill ready to love from the depth of her heart or would she hold out faith and hope for George to carry on?

The wonder of love is that you may not know how to you will respond at any given moment. Naturally, you must dig deep inside when called upon to let go. This selfless act will weigh heavy on your mind until you hear the calling from the echo of previous promise made by your heart – “I promise to love and honor you all the days of my life.” The depth of your love is hardly imagined and rarely tested in life. However, this needs to be a promise you make to yourself in your commitment to care for the well-being of another.

The sorrow you feel with impending loss is a testament to your love. Knowing full well that “it’s better to have loved and lost than never to have loved at all,” you will see that allowing a loved one to die is the fulfillment of this statement. Death being a rite of passage means that you need to make necessary preparation in anticipation. It’s an honor and a blessing to care for a loved one at the end of life. The gratitude experienced in the aftermath of being a caregiver can help you live happily ever after.


Jill rose to the occasion and encouraged George to agree to hospice. It was obvious that he trusted her with all his heart and felt blessed to have her support. The path to happily ever after is paved with good intentions and a loving caregiver.



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