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Grip the Coping Tool of Denial

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“I’m never sick,” Sally said. She was nearly 70-years-old and said she had never even had a cold. She sat off to the side while her husband, Bob, was reclined on the ER gurney. Bob had been feeling weak for several days and went to his physician for a checkup. Routine laboratory studies showed that his red blood cells, white blood cells and platelet counts were low.  Bob’s bone marrow was likely being overtaken by a type of cancer called MDS – myelodysplastic syndrome.

Sally claimed to be invincible, but was she living in the real world? Bob had been a smoker most of his life and had heart and lung disease. Had she been immune to the impact of his disease throughout their marriage? Would Bob’s new diagnosis of cancer make her sick? Illness spreads insidiously and is generally contagious. Sally seemed gripped by her denial.

Denial is a functional coping tool that is often necessary for caregiving. It can lead you to believe that MDS is not life-threatening and that it won’t affect you. Denial can allows caregivers to pretend that the medication is not chemotherapy and that their patients will get better. You might not even see the toll that the medication or disease process is taking on your patient. Denial works well until the situation is no longer manageable and your patient ends up in the ER.

The following four tips will help you work through and better understand the coping tool of denial:

Grasp it

Denial is a way of coping with stress. The thought of being under stress annoys most people. It puts you in a bind. If you admit to being overwhelmed as a caregiver, you may be asked to give up some control over the situation. You need to remain strong so as to not appear weak and make your patient worry more. You might spend most of your day pretending that you are fine, while suffering in silence.

Stress is a sickness that eats at you from inside. It suppresses your immune system and triggers inflammation in the body. It can cause a heart attack and other disease. Stress is a silent killer that sometimes masks as hypertension, headaches, shortness of breath, or abdominal pain. When people just don’t feel well for no particular reason, stress is likely the cause.

Because of the strength of denial, stress may not be as obvious. Observe how you respond to others who might question the amount of stress you’re under. Do you tend to laugh it off or protest the question? Are you open to having the conversation about your struggles?  Are you doubling down and compounding your stress? What example are you setting for your patient?

Handle it

How might you deal with denial? While dealing with stress, the inclination is to bury your head in the sand and ignore it. However, caregivers who look after patients rarely get a break from experiencing one upset after another. With any chronic illness, there is always something not right that needs to be handled.

While on duty, caregivers often confront various types of emergencies. This is the best opportunity for you as a caregiver to face the facts. How manageable is the situation? Nevermind how it was before, how is it now? What resources are available that you’re not using? How much is denial stopping you from accessing them?

Your credibility as a caregiver becomes suspect if you’re in denial. As Sally claimed she was never sick, can she be taken seriously? Can she be trusted to know how to handle Bob’s illness when it worsens? Does she picture her state of heath as being the same or different from Bob’s. You are no longer in denial when you can truly acknowledge your patient’s illness and stress as being your own.

Release it

Denial is a form of imaginary thinking. Imagination allows your thoughts to run wild. As a caregiver, an act of careless abandonment of your patient is out of the question. Yet letting go of stress serves your patient. You may not feel the tension of caregiving, but are you able to relax and reward yourself? Do you have time to doing something good for yourself on a daily basis or are you too busy?

Caregiving can feel as though you’re trapped in a pressure cooker. This becomes an explosive situation and detrimental to those who engage with caregivers. Many people prefer not to be around those who are upset or dealing with stressful situation. Caregivers often feel like they are living in isolation.

If Sally prefers to perceive her health as different from Bob’s, she must create separation during the caregiving ordeal. Bob needs to respect and accommodate the time and care she needs for herself, including proper nutrition and exercise.

Enjoy it

Caregivers often gravitate to comfort foods that are toxic to your system and cause more inflammation.  You need to focus on eating more whole foods like vegetables and grains that fuel your body effectively and aids your sense of well-being.

Exercising and stretching helps identify tension in your body. You can no longer deny stress once you experience being inflexible or out of breath. Exercise allows stress to move out of your body and releases endorphins that help you feel better.

Making time to do the things you love lifts your heart. Whether it’s shopping or going to a movie, attending church or a support group, taking a walk or a trip, you deserve to reward yourself. As you begin to count your blessings each day, you lessen the feeling that time is being taken away from you. If you need more time, you are not taking enough time for yourself to enjoy life as a caregiver.

 

Denial can allow you to better cope with stressful situations. But it can sabotage your life and  the care of your patient if you choose not to deal with the reality of being sick. Once you have a firm grip on the coping tool of denial, you can better manage your stress.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Be Prepared For Emergencies

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“Belinda had a seizure,” according to her husband, Ron. He heard a loud noise and ran to check on her. She appeared to be convulsing – Ron immediately called 911. When EMS arrived, Belinda was awake, and claiming that she just passed out from the stomach flu.

While treating Belinda in the emergency room, the physician felt trapped in the middle of “he said, she said.” Belinda had never previously had a seizure so this required more investigation. The paramedics recorded normal blood sugar and blood pressure at the scene. She had a lump and small cut on her head. Belinda had used illicit drugs in the past, but had been clean for two years.

As a caregiver, Ron felt strangely at odds with his wife. He wanted to protect her privacy while being certain the doctor had all pertinent information. How Ron handled this situation could be crucial to Belinda’s diagnosis and well-being. Without preparation, he might simply forget information or sway the doctor’s impression.

Consider these five tips to avoid common mistakes made by caregivers during emergencies:

Expect Common Things to be Common

Chances are you’ve heard of many medical conditions. You may not be familiar with people who have seizures, but it’s a common diagnosis. Common experiences provide immediate reassurance in emergency settings. The medical staff can manage seizures, which allows caregivers to worry less.

Caregivers often become hung up on certain words or diagnoses that often trigger undue stress and confusion. As a caregiver, you need to decide upfront if you intend to make the situation better or worse. The sooner you can put your mind at ease, the more you can work with the physician in being certain of the diagnosis.

Don’t Jump to Conclusions

Just because someone suggests a diagnosis doesn’t mean it’s certain.  Both physicians and family caregivers need to keep an open mind when new medical conditions arise. Keeping an open mind until the evaluation is complete serves your patient’s best interest. If Belinda had a history of seizures, her having another seizure would not be unexpected.

Trying to keep an open mind while forgetting that you know anything is hard for caregivers who might be used to micromanaging their patients’ care. Knowing your patient, you have credibility in expressing when something is wrong. Are you able to hold back from expressing your opinion until the physician formulates his or hers? Your expectations might trigger the physician to treat your patients without having all the necessary facts.

Be Able to Tell Your Patient’s Story

Your patient has his or her side of the story while you have yours. As the caregiver, make sure you correct any misstatements and avoid speaking for your patient. Your patient might ramble, but it’s important for you not to confuse the physician. While listening, your goal is to be able to put the story in a nutshell. It helps to be concise by following these three steps:

  • Start from the beginning

Every story has a beginning, middle and end. You need to start from the beginning and include the five W’s – the who, what, where, when, why. Who was there, what happened, where did it occur, when did it begin, and why did it occur? Relay the story without creating the ending.

  • State just the facts

By nature, caregivers are sometimes more emotional than patients. Patients tend to be stunned in the ER and often unsure why they are there. As a caregiver, you often know more about your patient than he or she realizes. The physician is more concerned about the present illness, current medications and pertinent past history. The more you stick to the facts, the better the physician will be at reaching the correct diagnosis.

  • Any additional information

You might have a hunch about what’s going on with your patient. Clearly, Ron was concerned that Belinda might be doing drugs again, but he was quick to praise her recovery. He demonstrated a knack for winning friends and influencing the physician, while sharing additional information.

Give Physicians the Benefit of the Doubt

Caregivers are naturally concerned about whether that the physician actually knows what he or she is doing. If you have questions . . . ask, don’t guess. Most physicians will listen to the story and might even repeat it to make sure of having heard it correctly. The physician will typically outline the course of investigation and may relay his or her working diagnosis.

Some caregivers tend to create a list of medical concerns along with tests that they think need to be ordered. These tests may or may not be relevant to the situation at hand. You may be inclined to have everything checked out and in the process, overwhelm the ER physician. You need preparation and presence of mind to not expect all your questions to be answered during an emergency visit – some doubts will likely remain.

Reach a Conclusion

Caregivers often leave the emergency department with more questions than answers – sometimes stating, “The doctor never told me anything.” In translation, this often means the physician and the caregiver never came to an understanding or agreement. You may not have a definitive diagnosis, but you still need to reach a conclusion about management and follow-up.

A CT scan of Belinda’s head and lab studies were determined to be normal. Did she have a true seizure or a jerking spell from hitting her head or passing out? The physician may not be too concerned about Belinda having a life-threatening situation. Nevertheless, has the caregiver drawn the same conclusion? What questions or disagreements remain? Like most mysteries and many emergencies, some situations are difficult to explain. Is this okay?

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While caregiving, the goal of emergency preparedness is to be OK with any given situation.  You will not achieve this until you condition yourself to believe it. This might be easier said than done, but many caregivers make the impossible becomes possible. The more confident you are, the more comfort you give others. Emergency situations call you to rise to the occasion and become more powerful than you ever imagined. The adage “What doesn’t kill you will make you stronger” is the take- home message that can prepare you for an emergency.

 

 

 

 

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Adopt Your Caregiving Philosophy

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Linda was aware that her mother, Rose, was not getting better. This was Rose’s third emergency visit in a month for shortness of breath. Rose was 86-years-old and had a bad heart valve that triggered congestive heart failure.

After Rose described her symptoms to the physician, Linda prompted her mom to speak up by saying, “We need to talk about this.” The physician picked up on the cue and asked Rose if this situation was hard for her. Rose was eager to share that she no longer had quality of life. Linda was eager to help her mother in the transition to end life, but didn’t know where to begin. Did Linda have a personal philosophy about caregiving?

Family caregiving is a noble, yet humbling experience. You’re at the mercy of those who need more from you, but who often want less. Linda didn’t feel comfortable with making decisions for her mother, but Rose was eager for Linda to help. Your best tool is to use reverse psychology: try not to play it smart. Establish humility at the outset through adopting a “pea-brain” philosophy. Patients expect little from know-nothing caregivers who have more questions than answers.

Playing dumb fools your patient into thinking he or she needs to maintain the upper hand. You become less of a servant and more of a supervisor. Your perceived pea-brain becomes a front to a more meaningful caregiver philosophy. The caregiver’s “P-brain” consists of being proactive, poised and parental. Caregivers who have “P-brains” are surprisingly gifted and less likely to disappoint. A caregiver’s philosophy needs to be geared toward success, not failure.

Incorporate these three aspects of the “P-brain” into your caregiving philosophy:

  1. Proactive

Being proactive, you can see 10 feet ahead and years down the road. The ability to see Rose struggling with activities of daily living and making medical decisions automatically puts Linda in the caregiver role. Seeing your patient declining leads to believing you can help. You can guide the process without telling your loved one what to do.

People who can tell what other people think are mind readers. Your patient is rarely certain about what he or she wants long-term. Before you can tell what your loved ones want, you need to be able to read their minds ahead of time.

In being proactive, you need to define caregiving before caregiving defines you. Caregiving will drown you until you learn to swim with the sharks, which will attack you from all sides. You have to be thick-skinned to ward off doctors’ orders and patients’ demands. As a caregiver, you need to be self-assured and self-defined through developing poise.

  1. Poised

“Steady as she goes” is the art of being poised and a powerful asset for caregiving. Self-assurance tells others, “I’ve got this.” This does not mean you have all the answers. It simply means that you know when and where to ask for help. You begin to recognize being wobbly before collapsing. The following three rules will help you stay poised:

  • Be consistent

Frankness is a virtue. Being open and honest about your intentions will help with making medical decisions. Linda’s goals need to be consistent with Rose’s wishes. But the choice between merely staying alive and quality of life serves as a reminder that there can only be one best response.

  • Create balance

Choosing between wishful thinking and a doable plan is the responsibility of a caregiver. Hope becomes a four-letter word when your patient’s medical condition becomes unmanageable. The next step beyond the hope of your loved one getting better is balancing the good with the bad. Being poised allows you to find the middle ground to viewing the end of life as strictly being bad.

  • Promote compromise

When you give a little, you get a little. When you choose your own battles, you declare what matters to you. This is the art of compromise. An open-minded caregiver has the ability to roll with the punches. Your philosophy must align with creating a win-win situation.

  1. Parental

Parents usually set the ground rules and tone of the conversation with their children. It boils down to saying, “Don’t talk to me like this.  I’m not your friend, I’m your parent.” Like Linda, caregivers take on the role of parenting their patients. Parents don’t let their children make poor decisions. Similarly, caregivers can’t allow their patients to make poor medical decisions.

The parent-child relationship builds upon co-dependency. Each person has practical and emotional needs. Good communication skills are important in getting what you need out of the relationship. Ironically, getting out of the relationship becomes the ultimate goal for parenting. The “empty nest” must be anticipated as an opportunity for Linda to regain her life.

The best parents teach their children self-sufficiency. Spoiling your children can lead to their feeling helpless and acting whiney.  By instilling confidence in your patient, you provide him or her dignity. Self-sufficiency gives patients the strength they need to feel independent.

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Your caregiving philosophy needs to align with patient autonomy. Allowing your patients feel as if they are in charge serves their best interests and takes some of the burden off of you.

 

 

 

 

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Planting a Seed for 2017 to Support Caregivers

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The ER doctor asked Tilly, a 96-year-old woman, what she wanted to do?  She had COPD and difficulty breathing. There was no evidence of pneumonia on her chest x-ray and her lab studies were unremarkable. Did Tilly feel comfortable going home or did she prefer to stay in the hospital?

Carol, her daughter, gave her mother a chance to respond. Tilly thought she might like to go home and Carol rolled her eyes. Carol pushed the issue by stating, “Do you want to die?” Tilly quickly came to her senses after she angered her daughter, acting as her caregiver. Tilly promptly agreed to stay in the hospital.

What was Carol’s advance care plan for her mother? Did she intend to lighten up at the end or to create hardship for her mother? Was Tilly near the end of life? If Tilly wanted to die, could she do so without shame? Who was responsible for this squabble between the patient and her caregiver? Should Carol have anticipated this upset and been more sensitive to Tilly’s wishes?

Patients rarely know what they want, particularly, when it comes to dying.  Family caregivers rely on their patients to tell them what they want. Starting in 2017, caregivers need to be adept at advance care planning. No longer can they set themselves up for failure and grief. Healthcare providers need a New Year’s resolution to support caregivers. My “Blog Series for the Seasons of Caregiving” is dedicated to discussing advance care planning throughout 2017.

The nature of planting a seed offers three tips for caregivers:

  1. Planting a seed provides food for thought

As a caregiver, you become a steward for the life of another. You often manage their healthcare, finances, and social activities. You stake a personal claim on your loved one’s life. Your loved one becomes your patient, and your patient becomes the most important aspect of your life, which is likely to become all too time consuming.

Family caregivers often have no idea of what they are getting into. Your duty as a caregiver tend to evolve from supporting your patient to controlling them. You might forget that the patient’s self-determination is the only advance directive needed. By listening more and demanding less, you learn how to let go, allowing nature to take its course.

  1. Planting a seed grows into a gardening project

The nature of famil caregiving, like gardening, is you cannot let it go unattended. Gardening is often thought of as a side job – you’ll get to it when you can. Eventually, you realize that neglecting the situation makes it worse and harder to manage. You might quickly realize that you don’t have the tools or skills to maintain a garden. The inclination is to hire someone to do the work, but that often feels self-defeating.

Your garden, like your life, is your domain. Your family members creep in and out of your garden like thistle. Thistle is a beautiful type of daisy. It has prickly stems and leaves with rounded heads of purple flowers. It is the symbol or devotion, durability, and determination. These characteristics strengthen family ties and entice you as a caregiver. Yet, thistle can choke off other aspects of your garden and thus your life.

  1. Planting a seed inspires advance care planning

You, as a caregiver, rarely have time for anything and everything is on your to-do list. No one struggles more than caregivers. It is often futile for others to know what lies in your heart and mind. Caregivers often express, “You don’t know what I am going through.” This reflects the weight upon your neck, back, and shoulders. You are right. More emphasis is placed on your patient’s well-being, and not enough attention is given to your sanity.

Through containing the situation to a particular season, your purpose becomes more certain. Every patient has a time to live, to survive, and to die. Your contribution to your patient’s  life has to respect each of these times with different care plans. In the summer, you care for yourself and others differently than in the winter.

Insanity is doing the same thing over and over again and expecting different results. Caregivers drive themselves insane by expecting a terminal illness to get better. If you believe all patients need the same treatment, you have little regard for the seasons of life. Any advance care plan has to honor the season of life.

 

The New Year is the beginning of another journey. An inaugural opportunity to plant an intention and watch it grow through the year. In 2017, follow this “Blog Series for the Seasons of Caregiving.” Learn how to better nurture yourself as you care for others.

 

 

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Spiritual Considerations Raised after Watching Netflix’s “Extremis” – Part 4

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Yea, though I walk through the valley of the shadow of death,
I will fear no evil: for
 thou art with me; thy rod and thy staff they comfort me.
Psalm 23:4

Yea, I dare you to fear no evil as you watch Netflix’s haunting documentary “Extremis.” The ICU at Highland Hospital in Oakland, CA represents a walk through the shadow of the valley of death. In each room, patients are confronting both their mortality and the demons that lurk in the shadows. “Thy rod and staff” might represent the higher power available to you. Tools for your own spirituality. Yet, most of us mere mortals rely on coping skills, succumbing to demons.

The demons are our own worst fears. These include breathing machines, feeding tubes, losing control and feeling confused. Demons exist as our own worst enemies. Those who claim to be righteous and provide indignation in the name of God. These demons wear the masks of healthcare providers, family members and the man in the mirror. Having these demons exposed through “Extremis” allows us to confront them.

The spiritual battle exists between our own worst enemies and final wishes. There are three intertwined conflicts:

  1. Man against nature

Self-preservation and survival of the fittest wage the battle with our own mortality. Being in conflict with Mother Nature rarely bodes well. Nature often teaches us about life. It seasons tell you that there are times to live, survive and die. Is there life after death? Nature answers this question and offers spiritual guidance. When there is life after death, you can lessen the need to prolong this life. Being in harmony with nature is your best bet to dying with dignity.

  1. Man against man

Physicians and family members often stand in defense of your leaving any time soon. Every potential treatment has to be exhausted. Patients rarely have their say until all is said and done by physicians.  Advances in medicine prompts more patients to go through extremis. Extremist promote extremis. They tend to be righteous through the adage, “What doesn’t kill you makes you stronger.” Most people who stand in the middle ground of dignity believe that less is more. This spiritual truth allows for less medical intervention and more comfort at the end of life.

  1. Man against self 

Personal reflection is necessary to separate our needs from out wants. While wanting to make others happy, we often sacrifice our needs. While wanting to prove ourselves to superhuman, we often sabotage our personal dignity. We often look to others to validate ourselves. Yet declaring self-worth is a spiritual undertaking. No one can give you dignity – you have to feel it from within your own heart. This deep-seated level of certainty allows you to proclaim, “I’m good!” This feeling of fulfillment gives you the sense that life is complete and you can now rest in peace.

Spiritual considerations resolve personal conflicts, allowing your spirit to be set free. Only you can guard against extremis through following your heart and advance care planning.

 


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Caregivers often suffer in silence while looking after loved ones and grieve in the aftermath of their death.

These twice a month email tips help caregivers understand that pain and suffering are inevitable – grieving is optional through better advance care planning.

Let’s start developing a community that creates and grows understanding, knowledge and support for compassionate end-of-life care.

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Practical Considerations Raised after Watching Netflix’s “Extremis” – Part 3

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Few patients anticipate the need for critical care. Some people call 911 too late. Such was the case for Selena in the Netflix documentary “Extremis.” She was having chest pain and struggling to breathe, but she told her daughter not to call EMS.  Selena stopped breathing on the way to the hospital. EMS responded and began CPR. A breathing tube was inserted. Selena suffered brain damage and was admitted to the ICU at Highland Hospital in Oakland, California.

Selena was in a vegetative state, lying in a bed and hooked up to machines. Her daughter and brothers were at her bedside – hoping and praying for her recovery. Dr. Zitter was the ICU physician in charge of her care. Selena did not have an advance directive. It was now up to the family members to decide Selena’s fate. An advance directive could have been Selena’s “get out of jail free” card.

3 Practical Considerations for advance directives include:

  1. Timing is everything

Practical considerations come down to – timing is everything. Selena needed more time to recover.  The family needed more time to come to terms with the situation. Dr. Zitter needed more time to conduct tests to determine brain death. Critical situations require personnel to act first and to ask questions later.  The implied directive “to do or die” is an emotional response. The advance directive affords a practical plan of action when the emotions settle.

A wish implies a desired outcome. A plan of action exists within a timeframe. The average patient spends three days in the ICU. Seriously-ill patients generally stay longer with worse outcomes. If you wish for a good death, you have to consider dying sooner than later. Will you complete your advance directive in a timely manner? Would your advance directive state how long a breathing tube stays in?

  1. Remove hope from terminal illness

Hope implies an expectation of improvement. False hope is misleading and leaves people in the dark and wondering. Dr. Zitter opened up the discussion of what was best for Selena with the family. What feelings and hope did her daughter and brother have? Dr Zitter listened intently while being careful not to express her opinion. The Hippocratic Oath states, “above all, I must not play at God” – pretend to be all knowing.

Dr. Zitter may not be all knowing, but was she holding out hope for the family? She had left the situation open-ended while Selena was in extremis. The brothers were leaving Selena’s fate up to God. If Dr. Zitter were being objective, she would not give the family any hope.  “Hope springs extremis.” Your advance directive has to trump your family’s belief that hope springs eternal.

  1. Allow evidence to stop extremis

Physicians lose credibility when they rely on family members to tell them what to do. If the physician does not know how to manage extremis, will the medical power of attorney know better?  Physicians have to remain grounded in evidence-based medicine. This is the medical condition, and this is the prognosis. A physician’s internal advance directive has to lead end-of-life conversations.

Most physicians tend to be wishy-washy about the certainty of death in any given patient.  It was evident that Selena was going to die, yet it took six months for her to die.  By collapsing her head in her hands, Dr. Zitter displayed torment. It’s troubling when healthcare providers fail to heal patients. And doubly embarrassing when patients receive indignation. All physicians need a practical plan for allowing patients to die with dignity.

Patients also need to be practical. They need to plan for extremis by completing an advance directive sooner than later.

 


Subscribe to Dr. H’s Clipboard
Caregivers often suffer in silence while looking after loved ones and grieve in the aftermath of their death.

These twice a month email tips help caregivers understand that pain and suffering are inevitable – grieving is optional through better advance care planning.

Let’s start developing a community that creates and grows understanding, knowledge and support for compassionate end-of-life care.

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3 Lessons on Aging Gracefully from My 90-Year-Old Mother

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  1. You’re never too old to live a little.

Mom spends most of her days doing enjoyable things like “nothing.” She gets up early in order to be dressed and ready when breakfast is served in her assisted living apartment. After my father died, she became used to this additional attention even though she is able to shuffles to the dining room for lunch and dinner. She faithfully takes her medication after breakfast, straightens the corner table next to her recliner and is now good for the day.

Prior to taking her to dinner to celebrate her 90th Birthday, I walked into her apartment and caught her napping. She could barely sleep at night before the age of 85. She now naps three times per day. She was delighted to show-off new shoes that made her feet look dainty and felt comfortable – “I feel like I am walking in slippers.” She was quick to hike-up one pant leg and reveal how sleek her ankles appeared in the tanned support hose, following the increased dosage of her water pill.

  1. Don’t defy “depravity”

While at her birthday dinner, Mom’s eyes lit up when the server inquired if anyone cared to have a cocktail. As she normally drinks Root Beer when taken to lunch, Mom’s birthday was motivation for her to go for the jumbo-sized Texas Margarita. Although it only took a few sips for the alcohol to reach her toes, this provided a great photo-op. My Mother, “the Immaculate Mary”, could no longer defy “depravity” with age.

I learned that she no longer ate everything on her plate and refusing to eat something new, like Brussel sprouts, had become acceptable. While exercise classes were conveniently being missed, walking and tumbling have become her new routine. Her priest has pointed out that her attendance at the monthly Mass needs improvement. I thought my mom lost it when she failed Grieving 101. She could not remember all the stages of grief and was admittedly glad that my dad was at peace. She seemed eager to join him.

  1. Be your own person

When asked if there was anything significant to her life, she was speechless. She neither wished to dwell on the past or express gratitude. I wondered if aging gracefully had something to do with not talking about sacrifices as being successes. That might be viewed as boastful and perhaps her idea of a cardinal sin. Redemptive suffering might well have been her ticket to paradise throughout life. And believing that she actually had a good life might risk her salvation. Aging gracefully is standing strong in your conviction.

My mother may not be boastful, but I can still brag about her accomplishments. Her claim to fame was being college educated at a time when women rarely completed high school. She became a medical technician, meeting the high achievement of being “registered.” To this day, the password that unlocks her computer is not a wedding anniversary or child’s birthday, it is the random number given to her by the medical registration board. She carries this honor as a cherished memory. Becoming her own person is an everlasting lesson on how to age gracefully.

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How to Draw the Red Line in the ER

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Self-determination often escapes patients while not feeling well and being hoisted onto a stretcher:

Ms. Lacy was 86-years-old and barely weighed 80 pounds. She had an anxious look in her eyes while having difficulty breathing. Her lung cancer was resistant to chemotherapy and had gradually destroyed her sense of well-being for 2 years. Her oncologist had recommended three more treatments before stopping. Ms. Lacy seemed agreeable to this plan of action and ongoing misery.

While fate had determined her lot in life, had she considered drawing a red line to receiving unnecessary medical intervention? Was this red line preset, left to her doctor’s discretion or arbitrarily established in the ER? Patients dealing with life-threatening conditions are often angry or anxious, triggering a chaotic response. They rarely maintain control of these situations.

Three simple guidelines can help patients draw a red upon admission to the ER:

  1. Establish where you are and where you are going.

Ms. Lacy’s medical condition had progressed beyond any hope of survival, making further medical intervention futile.  She knew the end was near, but seemed to be distracted by the promise of more treatment. In the meantime, she was experiencing a nervous breakdown. She was used to playing by the rules and having her doctors determine her plan of action. Ms. Lacy had never considered the prospect of a carefree existence. Breaking the rules was difficult for her to imagine.

Ms. Lacy’s arrival in the ER was a commencement exercise. A clear demarcation between the past and the future. It was time for her to take an inventory of her life and reset her priorities. Instead of minding follow-up appointments with her oncologist, she could tend to some personal files that she had been neglecting to organize. She was encouraged to create another type of nesting phase in anticipation of much-needed relaxation and enjoyment during her final days.

  1. Choose between evidence-based and common-sense medicine.

Did Ms. Lacy prefer the doctor listen to her medical history or focus more results from lab studies and x-rays? Self-determination requires forethought, while being exploited appears to be an afterthought. The tourniquet had been placed on Ms. Lacy’s arm to draw blood as per protocol, yet the need to pursue abnormal lab findings at the end of life rarely makes sense.

After being given the option to defer another needle stick, Ms. Lacy was beginning to appreciate the benefits of drawing her red line. The concern about mission creep at the end of life –whereby patients receive unintended care/consequences – might be traced back to the very moment that the invasive needle slithers under the skin. This procedure crosses the red line between using common sense and relying on evidence-based medicine.

  1. Change your mind and begin to feel fulfilled

There is always room for improvement, but not perfection. Ms. Lacy was lead to believe that if her lung cancer did not improve, she was a failure or a goner. Life happens and cancer occurs as a natural part of living. No one is perfect, yet Ms. Lacy was led to believe that she would be good if her cancer was cured. However, there was nothing truly wrong with her. She was actually being given the opportunity to feel fulfilled in life.  She also deserved to be given reassurance, like receiving a badge of honor.

With drawing a red line to further treatment, the mission was directed toward calming her anxiety and alleviating suffering. She was offered medication to help her relax, which she accepted. Almost immediately, life no longer seemed miserable. With her husband and daughter at bedside, Ms. Lacy expressed overall gratitude for her good fortune. She was able to regain control of the situation by taking a different perspective of thanksgiving. By not crossing the red line in the ER, Ms. Lacy was able to retreat and say to herself, “Mission Accomplished!”

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3 Reasons Yoga is Contagious and Helps Manage Your Grief

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Spread the word: September is National Yoga Month.

I’ve practiced emergency medicine and yoga for 15 years and often sing its praises to coworkers and patients. Yet it has been difficult to describe this invigorating experience in words until I read “Contagious: Why Things Catch On by Jonah Berger.

Why is yoga so popular?

Because, Berger proposes, anything that goes viral –like flu, iPhones or videos — have similar infectious aspects that create a shared experience.

One contagious aspect in life is the loss of a loved one. My father died four months ago, and I’ve found yoga to be a powerful coping skill to handle grief. Grief, like stress, can stream through the body unconsciously and result in muscle tension and chronic illness.

Here are three reasons yoga is contagious, especially in coping with grief.

  1. Yoga is emotional.

It stirs deep-seated tension and feelings. Yoga positions trigger an internal tug of war. While my limbs are being pulled in opposite directions, my mind is screaming, “Good Grief!” This mental breakdown opens the door to a spiritual breakthrough.

Quieting the mind awakens the heart. The blood, sweat and tears you suffer while stretching allow muscles to release and rebound. In one simple breath, my mood swings from feeling tormented to feeling liberated. As breathing becomes deeper and more deliberate, my heart pumps stronger and redistributes the pain.

  1. Yoga is practical.

You can apply its principles to daily life. Most yoga students attend their first class for a reason, usually to feel better or fill an empty hole. They restore the missing pieces to the puzzle through a through a holistic connection of mind, body and spirit.

The discipline to stay present and create awareness by breathing in and out consciously for one hour teaches me how to ease pain and suffering. From child’s pose to corpse pose, I have learned to use yoga to acknowledge grief, stir it up and let it go.

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Whether it’s a mom trying to release the cares and worries of the day or the son losing his father, yoga is exactly what the doctor ordered.

  1. Yoga is social.

It connects us to others. Students enter the studio as individuals but leave feeling a bond with others in the room and can’t help but feel on the top of the world: relaxed and free. People who grieve tend to isolate until they get over “the bug.”    Grief counselors often advise those mourning to “go through it” and “find your own way.”

Strength in numbers can hasten recovery because it helps you draw energy from other people. Similar to group therapy, yogis grieve together and share the four elements necessary to grieve: earth, wind, fire and water. While perspiring, breathing, stretching and feeling grounded in the child’s pose of virtual powerlessness, the four elements unite harmoniously. An opportunity to bask in serenity. While in corpse pose, I pictured myself being connected to my father –resting in peace.

Who knew grieving could feel so good?

During National Yoga Month, share this post with someone you know who’s grieving or needs recharging.

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dr-h-redKeep in touch with me through signing up for Dr. H’s Clipboard:

                             Twice monthly email tips that promote compassionate end-of-life care.






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Second Deployment: The Dad Brad Story

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Brad was different after he returned from the warzone, having completed the second deployment of a stem cell transplant to combat multiple myeloma. He looked good despite his generalized battle fatigue, carrying both the scars of a dialysis fistula on his left arm and a chemotherapy port under his chest wall. Brad had received support from his family during this time and a great hurrah from coworkers upon his triumphant return to the office. Nevertheless, he had become marginalized through feelings of no longer fitting into mainstream society. He had been through a disease process that few experience and many shun.

People are often called upon to serve their country or serve their God, but there is always a price to pay in being “out there.” During this process one can become separated from the herd. While Brad loves time spent with his family, he particularly loves spending time with others with whom he can truly relate. Prior to his multiple myeloma diagnosis, Brad attended spin classes three times a week. Now he faithfully uses this same time assisting in church functions that aid the poor and visits others who also sit in the same dialysis chair he used to occupy. Brad is living proof that anything is possible through faith.

Similar to Middle East deployment, treating multiple myeloma takes a leap of faith. Naturally, the uncertainty of what lies beyond the horizon and the possibility of not returning home is very frightening. Brad did not know much about his enemy [multiple myeloma] and quickly realized that the fight is rarely with one enemy at a time – multiple medical diagnoses typically gang up on patients. Brad had to contend with a heart blockage during his first deployment and a blood clot in his leg following the second. Nevertheless, Brad’s leap of faith became an opportunity to deepen his faith while exploring his spirit connection to others.

Through faith, we are called upon to love our enemy (disease). Brad took this to heart by reaching out to others engaged in a similar fight with cancer. He believes this to be the path to glorify God and express gratitude. Brad never imagined God having abused him through striking him with multiple myeloma. God was truly using him. Following this battle, Brad continues to walk in the light of having formed a partnership with multiple myeloma based upon mutual respect – respecting his enemy as his greatest ally in personal fulfillment. Through confronting his mortality, Brad has become an enlisted foot soldier in the spiritual conquest of making a difference in other’s lives.

Second deployments give soldiers the opportunity to brag and state, “Been there, done that.” Having raised two successful children, Brad can also proudly claim victory as a parent. Although he looks forward to becoming a grandfather someday, he is simply grateful for each and every day.  He thrives in being a grandperson who has been blessed by God and called to help heal the sick on an extremely personal and profound level – similar to that of raising children. Brad’s bout with multiple myeloma has seemingly increased his strength as a great father and shining example of Our Father, Who art in heaven.

In many respects, Brad represents the many fathers who are marginalized and perceived as being the lesser of two parents through spending more time deployed than at home. There exists a childish misunderstanding that Dads are less concerned about the well-being and value of those dear to them. Sadly, respect is mostly paid to fathers in retrospect – similar to how homage is often paid to our troops. We may poignantly look for ways to make amends to our fathers through supporting our troops, while hailing the visionary crusade, #DadsLivesMatter. The Wounded Warrior Project provides one opportunity to celebrate dads and the more personal is Team Brad. Truthfully, #KidsLivesMatter to the extent that they honor their fathers’ deployment and service.

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