Real Intentions for Life

3 Tips for a Yearly End-of-Life Assessment

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When the ball drops in New York City on New Year’s Eve, will you be ready?  When the bombshell of a cancer diagnosis hits you in the ER, what will you do?  Listen to the doctor or follow an assessment and plan of your own?

Sara was a 68-year-old woman who was not feeling well and had shortness of breath. The doctor thought she might have a blood clot in her lungs. Her CT scan showed that she had lung cancer that had spread to her liver, thyroid and kidneys. She smoked for many years, but never imagined it taking a toll on her body.

Life, as Sara knew it, ended sooner than December 31.  She needed a moment for reflection and time to make an assessment. She could stay in the hospital, but had the option to go home and sleep on it. A home-base palliative care nurse was consulted and met with her in the ER.

Consider these tips for a yearly and end-of-life assessment:

  1. Count your blessings before taking on hardships.

Sara’s husband immediately broke down with the news of her metastatic lung cancer. If there was any doubt of her finding Prince Charming, it was tearfully obvious. She had a fulfilling career as a teacher and raised two successful children. Given the stress of the situation, Sara had remarkable strength.

With counting your blessings, you take note of your accomplishments. Comfort and joy emerge from realizing that you achieved a lot of your goals. Unfinished business often seems unnecessary and like a hardship. We generally do what matters to us and this is what others tend to remember about us. “All’s well that ends well” when you die with a sense of thanksgiving rather than focusing on the loss.

  1. Create closure before opening the window of opportunity

Just as 2016 draws to a close, your life is certain to end. Will there be a series of celebrations or the feeling of “Bah Humbug.” Denial will keep you from creating closure, certainty allows for acceptance. The serenity to accept the things you cannot change allows you to sleep in heavenly peace.

Sara had to think about how her sisters were going to react to her cancer diagnosis. She felt they were going to insist that she receive chemotherapy. Would they also offer to suffer its side effects? Did Sara wish to die miserably to make her sisters happy?

Closure involves giving others reassurance. It’s a reminder that “when a door closes, a window opens” to a brand new world.

  1. Try out the new normal before making a final decision

Out with the old and in with the new is the message of “Auld Lang Syne.” If 2017 was your last year, would you spend it differently or make other plans for the New Year? Do you have a contingency plan when you can no longer say, “at least I have my health?” Will you focus on your well-being?

Most people view Sara’s situation as the worst thing that could happen. Others might see it as a new lease on life. Sara can now live for the moment and without expectations. Can the end of life truly be carefree? We are often encourage to “try it – you might like it.” Decide how you might reach for the stars without being limited by others’ expectations.

Before another year comes to a close, make a yearly end-of-year assessment of what truly matters to you. Then create your own advance care plan.

 


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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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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.

 


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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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Mindful Considerations Raised by Netflix’s “Extremis” – Part 2

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The gut reaction to Netflix’s new documentary “Extremis” is the ICU is a hellhole.  No one wants to end up there.  Patients enter this purgatory after becoming sick and requiring a higher level of care.  Patients enter the ICU from the ER, the hospital ward, or after surgery.

Donna, one of the two patients featured in the film, has myotonic muscular dystrophy.  Her muscle weakness caused respiratory failure, and she needed a breathing machine.  Donna has to choose between having the tube removed and having a permanent tracheotomy.  The tracheotomy requires Donna has to live in an extended-care facility. Removing the tube means that she will die.

Mindful considerations identify upsets before they happen. The purpose of advance care planning is to avoid the pitfall that Donna had encountered.  Muscular dystrophy has no cure.  What Donna had to endure was unnecessary and torturous.  Donna was competent so she had to fend for herself against the physicians and her doting family.

3 Mindful Considerations for advance care planning include:

Avoid the bridge too far.

To what extreme is it necessary to keep you alive? At what age would you avoid admission to the ICU? Do you understand that you will be in the ICU following surgery?  Do you understand that calling 911 could lead to an ICU admission?  Is your medical condition expected to get better?  What quality of life will you enjoy after leaving the ICU?  “We’ll cross that bridge when we get there,” seems to be the best copout for advance care planning.

These are questions that you prefer not to think about ahead of time and are often left open-ended. Advance care planning that is open-ended will likely cause you to cross a bridge too far and take you into the ICU.  Elderly patients who are reluctant to sign a Do Not Resuscitate (DNR) often die in extremis in the ER or ICU.

Refuse nonviable options.

“I can’t live like this” becomes a personal proclamation for advance care planning. “I do not want _______” becomes a matter of choice.  You might begin to fill in the blank by refusing certain medical procedures:

Heart transplant      Colostomy bag      Breathing Tube      Feeding tube      Cardiac resuscitation     Needle sticks       Medical Specialist           Dialysis Extended-care          Chemotherapy          Antibiotics          Blood Transfusions

Would any doctor in Donna’s situation choose to have a tracheotomy?  Should doctors offer nonviable options to every patient as a matter of choice?  Who determines if a particular patient can live with a tracheotomy?  Is living with the prospect of dying ever a viable option?  How do patients get the inner strength to give up on hope and to refuse medical intervention?

Donna was looking at a longer course of pain and suffering with no hope of recovery.  Sadly, this seems to be the best practice of medicine today.  Patient-centered care calls for advance care planning that focuses on personal dignity. Nonviable options lead to patient indignation.

Put your promises in writing.

The quality of your death is a matter of choice with no guarantee. Those who rely on good faith often die in extremis.  We all know the importance of getting our guarantees in writing, yet many people fail to do so.  They trust in God and the healthcare system.   Advance care planning provides the means for you to maintain control over the decision-making process. Being mindful requires taking responsibility for both your life and death.

Mindful considerations help you balance refusing and receiving medical intervention.  Entitlements are what you receive.  Empowerment allows you gain dignity through refusing intervention.  Donna had to choose between entitlement and empowerment- suffering and freedom.  Had she made a promise to herself about this choice? Were others aware of it?

How did Donna feel about corporal punishment?  Was the breathing tube necessary?  Was a permanent tracheotomy acceptable?  Does the prospect of corporal punishment prompt you to get things in writing?

“Give me liberty or give me death” are the immortal words of Patrick Henry. Is it important to include these words in your advance directive? “Give me extremis,” as in inhumane treatment, is absurd.

Be mindful of what you wish for and put it in writing. If you do not wish to suffer in extremis, plan ahead.  Be mindful that withholding life support supports personal freedom and everlasting peace.

 


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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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3 Issues Raised by Netflix’s “Extremis” – the Overview

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“Extremis” means the crucial point before death.

It’s measured by the level of stress and the length of time patients suffer as they die.  You often hear people express consolation to the family with the kind words “at least he didn’t suffer” or “she died with dignity.”

In the short-film “Extremis,” Dan Krauss brilliantly depicts how patients endure tremendous suffering and loss of dignity through the efforts of well-intentioned physicians and family members.

The documentary begins with Dr. Jessica Zitter, an intensive care and palliative physician, who is trying to determine a patient’s wishes. The anonymous patient can’t speak and appears to be incompetent.  Dr. Zitter’s creative attempts include having the patient scribble answers on a clipboard and spell out words in the air. These efforts are futile and border on being cruel.  Is it ethical to question patients in extremis?  Why ask a patient anything when the physician knows the appropriate answer?

The documentary allows the viewer to peek in on several ICU patients at Highland Hospital in Oakland, Calif.  Two are on life support with family members at their bedsides.

The ICU is often described as a place of limbo.  Strong doubts exist as to whether any of these patients will recover, yet hope abounds.  Hope, however, comes at a cost – the amount and time a patient has to suffer and the increasing risk that a patient’s dignity will not be respected. Subjecting terminal patients to this level of care appears more like punishment than palliative medicine.  Yet, this has become standard practice for end-of-life care. The documentary should leave viewers frightened and shaking their heads – saying, “ain’t it a shame – someone ought to do something.”

Dr. ZItter offers a resounding story about a nurse who challenged her practice of medicine. Dr. Zitter was inserting a large IV into the neck of a critical patient when the nurse standing in the doorway looked her straight in the eyes and shouted, “Call the police.  The doctor is torturing the patient.” The bombshell that saving certain lives is criminal gives viewers a wake-up call. The ignorance and bullying that exists in the healthcare care system is overshadowed by the claim that “This is for your own good.”

Patient autonomy and self-determination allow patients to formulate a personal statement, “Someone ought to do the right thing for my own good.”  A self-respecting person completes an advance directive.  An intuitive husband understands how to love his wife as he does himself. An astute physician has the wisdom to know the difference between torture and respect.

Having to contend with God, physicians, and family members in the moment of extremis raises issues the patient needs to address well before admission to the ICU.

A person who wants to be responsible for their own their end-of-life care must do so when they are of sound mind, body and spirit. What to think, do, and feel after watching “Extremis” can leave you feeling helpless. But consider it a valuable lesson.

In this four-part series over the next three issues of Dr. H’s Clipboard weeks, I’ll discuss a holistic approach to “Extremis.” You’ll learn about mindful considerations, practical considerations and spiritual considerations that dictate how the patient should be treated, or left to die.

Being of sound mind, body, and spirit insists that you are prepared for the inevitable.  Believing that you are invincible is foolhardy and adds to pain and suffering.  Only you can guard against the loss of dignity that so often occurs during extremis.  Take the steps necessary to make sure that you receive compassionate end-of-life care through 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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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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                             Twice monthly email tips that promote compassionate end-of-life care.

 

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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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I Can’t Get No Patient Satisfaction

FOCUSING-ON

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent – in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to evaluate Ruth’s aptitude and appropriateness for assisted living, but thought it best to have Ruth seen in the emergency department.

Ruth was hungry, but did not wish to eat. She felt like her bowels needed to move, but did not wish to use the bedside commode. While still engaging, Ruth wished to be left alone. Ruth had explained that she used to be able to tell herself not to be sick, but her higher power seemed to be failing her now. When a patient feels abandoned by a higher power, what hope is there for patient satisfaction? When patients are uncertain of what is in their best interest, how can physicians succeed at meeting their expectations?  Does it become the physician’s duty to tell Ruth that she is not doing well and further deflate her self-image?

The breakdown in patient satisfaction often occurs when physicians cannot view the situation from the patient’s perspective. When the ED staff does not see the emergency, misunderstandings and missed opportunities frequently happen. There is a propensity for ED personnel to become defensive and stand their ground regarding standards of care and appropriate patient conduct. The parental cry resounds: do things my way or else. Coercion and entitlement rarely lead to patient satisfaction.

Having the right to care for others is risky business – particularly when patients might be on the fence as to their desired care. Rather than healthcare personnel digging in their heels of righteousness, these types of situations often call for personnel to dig deeper into self-awareness and question, “What would Jesus do?” The healer of all healers would show compassion and treat people with kindness, similar to how those with special needs are treated. Ruth was in delicate position and needed to be treated with kid gloves rather than sterile gloves. Given her stage in life, there was little hope of making her situation better.   Doing more would most likely worsen her state of mind and lessen her satisfaction.

As situations often spin out of control in the ED, physicians are often called upon to soften their tone and maintain professionalism without authoritarianism. Through reassuring patients that we are in this together rather than working in opposition, hope springs eternal regarding patient satisfaction. Ruth simply needed to be reminded that she had the inner strength to weather the storm front at the end of life and that there was nothing really wrong with her. Nevertheless, she remained indifferent to the whole life-and-death conundrum. While this might be the best anyone hopes for, Ruth’s ED experience remained less than satisfying.

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