"So," I say into the phone. "You were in the ER last night."
"Yeah," he replies. "I felt so sick. They sent me home after a while, though."
"Do you know that your urine came out positive for cocaine and alcohol?"
"Well, yeah. Let me be truthful," he replied. "I was in New York with my cousin, I was stressed out, and I did some cocaine. No lies, OK? Urine tests don't lie, and if I lie to you, I'm really just lying to myself, right?"
I took a deep breath. "Yes, that's right. Now, the other problem is that your urine came back negative for opiates. We've been prescribing you morphine for pain, and your urine should be positive for morphine. What happened there?"
"OK, OK. Like I said, I was in New York and forgot to bring my morphine. That led to me stressing out and doing the coke and alcohol. I know you're not gonna trust me now. I'll do any urine test you want, any day you want. I want to earn your trust back." He was pleading now.
"You just have to understand," I explained. "When we prescribe you morphine, we expect to see it in your urine. When your urine comes back negative for morphine and positive for cocaine, what do you think we suspect that you're doing with the morphine?"
"Selling it on the street to buy cocaine?" he answered faintly.
"Exactly! And that's a big no-no in our book, I'm afraid." I pause for effect. "The last thing a doctor wants is the medication he prescribes to end up being sold at the bus station, and believe me, alot of what we prescribe IS sold at the bus station."
He was worried now. "Look, I'm so sorry. I'll do whatever you want, but you can't cut my morphine off. My pain is still so bad. Tell Dr. ___________ that he can order any tests he wants. Please."
"Don't worry, we're not cutting you off yet. That would be cruel. But you've got work to do." I continued my diatribe. "There will certainly be urine tests, but they'll be random. And you can't say you can't make it when we call you to come down to the clinic. You signed a pain contract, so now you have to honor it."
"OK, OK. I'll do it. Tell the doctor I'll do it. I'll show you that this was a one-time thing."
"OK, just relax, and we'll talk to you soon. And stay out of trouble, y'hear?"
"Yeah. I'll talk to you soon." He hung up first.
I hung up the phone and took a deep breath. I hate these conversations. I also hate dealing with narcotics. I hate the whole system. Pain management is a total drag for the tired Nurse Care Manager, and narcotic diversion onto the streets haunts us daily. These are the times I play Good Cop/Bad Cop, and it's no fun for anyone, including me.
Was he telling the truth? Can I trust him? Will his subsequent toxicology screens be negative? My sense of hope and faith say yes, but only time (and urine) will tell.
Monday, September 24, 2007
Friday, September 21, 2007
Violation
We arrived to this scenario yesterday morning. After months of partially smashed windows, we finally had our first office break-in. The intruders made off with a computer. They didn't have much time once they tripped the alarm.
Last year, a colleague at a neighboring agency was shot in the shoulder when she was caught in gang-related crossfire.
As one of my Latina colleagues quipped, "That's life in The Ghetto, people. Get over it."
Saturday, September 15, 2007
The Pain of Reentry
How does one reenter daily life following a life-changing event like a death? Beyond that, reentering the workplace is perhaps the most challenging of all. Woe to the grieving worker who has not neatly sown up the grieving process before the following Monday at 9am!
Returning to work after a three-week absence to tend to my step-father's dying process and death, I gingerly returned to work and was immediately dizzied by the frantic comings and goings of my colleagues. Standing in the office on my first day back to work, it seemed as if I was a reluctant swimmer poised on the edge of a raging river, considering touching my toe to the water yet highly aware that the undertow would drag me under at my first sign of surrender to its horizontal power.
Of course, my compassionate colleagues welcomed me with hugs and kisses and offers of assistance. Several individuals went out of their way by offering concrete tasks which they could shoulder: filling med boxes for my more dependent patients, making phone calls I was reluctant to place. Still, as I sat at my desk, the cobwebs of absence began to clear, and the onrush of details needing attention quickly filled my brain which until that moment had been busy with other processes of a more personal nature.
Stepping (however reluctantly) into the rapids of the workplace, I realized quite readily that my colleagues' stress and my patients' neediness neither lessened nor took a break while I was otherwise engaged with family. Our "disability care management" office is without a doubt a rushing rapid of information and nursing care which has a laudable goal of keeping the most disabled and chronically ill inner-city patients aligned with the overarching pursuit of preventive health, self-care, and crisis management. In pursuit of that goal, we nurses, nurse practitioners, and medical assistants bend over backwards, often pulling out our hair in order to deliver the quality care which we see as necessary to the well-being of our patients. That said, in order to accomplish this goal, it seems widely accepted that our workplace must function like a battleship at full bore, the ammunition (of health) at the ready, and the crew in a constant state of hypervigilant combat against disability, addiction, disease, and poverty. In delivering such care, the caregivers wear themselves pretty thin.
So, in walks the bereaved nurse, fresh from a parent's illness and ultimate death, still reeling with emotion and saturated with stories of my own family's newest evolution. At 9:00 on Monday morning, I again took on the yoke of the needs of more than eighty people, fifty of whom consider me their first line of defense for most any situation related to their health and well-being. And a yoke it seems.
For more than two weeks, the travails of my patients (and my colleagues who cared for them in my absence) were shadows which would flit across my consciousness, yet danced on the periphery of my mind. With the care of my step-father and coordination of his own care team as a top priority, the worries of the workplace slowly sank to the bottom of my cognitive well. However, even as my enfeebled brain again made attempts to grasp the enormity of the task before me, this first week back was an enormous challenge, and the journey from Monday to Friday seemed at first Herculean, but ultimately felt most Sisyphean.
The boulder is now at rest during this blessed weekend, balanced delicately on my desk some twenty-one miles from our home, patiently awaiting my return. Come Monday, it will again be time to shoulder that burden, and also to continue to seek ways which will decrease said burden's impact on my physical health, grieving process, and emotional well-being.
Yes, the reentry is difficult. When the Space Shuttle is reentering the earth's orbit, the fires of the atmosphere will put the Shuttle's outer layer of protective skin to the ultimate test. That skin is all that protects the astronauts within from the searing and destructive heat of the earth's gaseous envelope. And so for me, my emotional "skin" is what similarly protects me from the vicissitudes of nursing practice, the double (and at times paradoxical) challenge of embodying the noble goal of self-care while I deliver care to others in need.
This Saturday evening, I am grateful for the weekend, for the winds of late summer, for the fickle September weather, for the peace that home affords, for the love that buoys me in times of trouble. I also give thanks for the skin which protects me from the elements, be they emotional or physical in nature.
Dying is hard work, but the dying person is eventually (and thankfully) released from that process, moving beyond all notions of corporeal suffering. But here on earth, the grieving must release themselves from their suffering, all the while maintaining the activities which keep home and hearth upright and functional. And here is the challenge: grieve, move beyond the loss, enter a new relationship with the dead, and embrace life anew.
Returning to work after a three-week absence to tend to my step-father's dying process and death, I gingerly returned to work and was immediately dizzied by the frantic comings and goings of my colleagues. Standing in the office on my first day back to work, it seemed as if I was a reluctant swimmer poised on the edge of a raging river, considering touching my toe to the water yet highly aware that the undertow would drag me under at my first sign of surrender to its horizontal power.
Of course, my compassionate colleagues welcomed me with hugs and kisses and offers of assistance. Several individuals went out of their way by offering concrete tasks which they could shoulder: filling med boxes for my more dependent patients, making phone calls I was reluctant to place. Still, as I sat at my desk, the cobwebs of absence began to clear, and the onrush of details needing attention quickly filled my brain which until that moment had been busy with other processes of a more personal nature.
Stepping (however reluctantly) into the rapids of the workplace, I realized quite readily that my colleagues' stress and my patients' neediness neither lessened nor took a break while I was otherwise engaged with family. Our "disability care management" office is without a doubt a rushing rapid of information and nursing care which has a laudable goal of keeping the most disabled and chronically ill inner-city patients aligned with the overarching pursuit of preventive health, self-care, and crisis management. In pursuit of that goal, we nurses, nurse practitioners, and medical assistants bend over backwards, often pulling out our hair in order to deliver the quality care which we see as necessary to the well-being of our patients. That said, in order to accomplish this goal, it seems widely accepted that our workplace must function like a battleship at full bore, the ammunition (of health) at the ready, and the crew in a constant state of hypervigilant combat against disability, addiction, disease, and poverty. In delivering such care, the caregivers wear themselves pretty thin.
So, in walks the bereaved nurse, fresh from a parent's illness and ultimate death, still reeling with emotion and saturated with stories of my own family's newest evolution. At 9:00 on Monday morning, I again took on the yoke of the needs of more than eighty people, fifty of whom consider me their first line of defense for most any situation related to their health and well-being. And a yoke it seems.
For more than two weeks, the travails of my patients (and my colleagues who cared for them in my absence) were shadows which would flit across my consciousness, yet danced on the periphery of my mind. With the care of my step-father and coordination of his own care team as a top priority, the worries of the workplace slowly sank to the bottom of my cognitive well. However, even as my enfeebled brain again made attempts to grasp the enormity of the task before me, this first week back was an enormous challenge, and the journey from Monday to Friday seemed at first Herculean, but ultimately felt most Sisyphean.
The boulder is now at rest during this blessed weekend, balanced delicately on my desk some twenty-one miles from our home, patiently awaiting my return. Come Monday, it will again be time to shoulder that burden, and also to continue to seek ways which will decrease said burden's impact on my physical health, grieving process, and emotional well-being.
Yes, the reentry is difficult. When the Space Shuttle is reentering the earth's orbit, the fires of the atmosphere will put the Shuttle's outer layer of protective skin to the ultimate test. That skin is all that protects the astronauts within from the searing and destructive heat of the earth's gaseous envelope. And so for me, my emotional "skin" is what similarly protects me from the vicissitudes of nursing practice, the double (and at times paradoxical) challenge of embodying the noble goal of self-care while I deliver care to others in need.
This Saturday evening, I am grateful for the weekend, for the winds of late summer, for the fickle September weather, for the peace that home affords, for the love that buoys me in times of trouble. I also give thanks for the skin which protects me from the elements, be they emotional or physical in nature.
Dying is hard work, but the dying person is eventually (and thankfully) released from that process, moving beyond all notions of corporeal suffering. But here on earth, the grieving must release themselves from their suffering, all the while maintaining the activities which keep home and hearth upright and functional. And here is the challenge: grieve, move beyond the loss, enter a new relationship with the dead, and embrace life anew.
Thursday, September 13, 2007
Good News Always Welcome
In the midst of my personal struggles, I am very pleased to announce that the Nursing Online Education Database (NOEDb) has named the top 25 nursing blogs on the Internet, and Digital Doorway was rated #15. NOEDb apparently used third-party ratings from sites like Google and Technorati to rate the sites and gather objective data.
I am honored and humbled by being included in this list of excellent nurse bloggers, and it is moments like these that remind me that there are actually real people out there reading blogs, feeding this technological revolution in communication and connectivity. Blogging can often feel like a lonely venture, with few comments to bolster the blogger who sends missives out into the ethers in hopes of connection and readership. Thanks to all who read Digital Doorway, and please continue to support bloggers by visiting their sites and letting them know you're out there. And thanks again for visiting. After all, without readers, blogs are just more digital noise.
I am honored and humbled by being included in this list of excellent nurse bloggers, and it is moments like these that remind me that there are actually real people out there reading blogs, feeding this technological revolution in communication and connectivity. Blogging can often feel like a lonely venture, with few comments to bolster the blogger who sends missives out into the ethers in hopes of connection and readership. Thanks to all who read Digital Doorway, and please continue to support bloggers by visiting their sites and letting them know you're out there. And thanks again for visiting. After all, without readers, blogs are just more digital noise.
Wednesday, September 12, 2007
The Tool-Box
Following a life-altering experience, how does one reintegrate back into one's former life? When one has been living in an altered state, with "normal" daily life in suspended animation, how does one comfortably fit back into that daily routine? Superimpose the grieving process on that reintegration, and all bets are off.
Many of us are aware of the five classic "stages" of the grieving process: denial, anger, depression, bargaining, acceptance. But nothing is ever so cut and dry, and our emotional lives are varied and complex. For me, in this moment, there are various layers of exhaustion coloring my experience, my body slowly coming into some semblance of equilibrium. Powers of concentration and focus remain relatively unreliable, but hints of the balanced self peek through the haze. Patience is a virtue at this stage, both with others and one's self.
Grief comes in many guises, and it manifests in so many ways throughout the day. Circumspect self-care and self-awareness seem to be the best tools at my disposal. But the first step in using those tools is at least opening the tool-box. As Sogyal Rinpoche has said, "Our present condition, if we use it skillfully and with wisdom, can be an inspiration to free ourselves from the bondage of suffering."
Many of us are aware of the five classic "stages" of the grieving process: denial, anger, depression, bargaining, acceptance. But nothing is ever so cut and dry, and our emotional lives are varied and complex. For me, in this moment, there are various layers of exhaustion coloring my experience, my body slowly coming into some semblance of equilibrium. Powers of concentration and focus remain relatively unreliable, but hints of the balanced self peek through the haze. Patience is a virtue at this stage, both with others and one's self.
Grief comes in many guises, and it manifests in so many ways throughout the day. Circumspect self-care and self-awareness seem to be the best tools at my disposal. But the first step in using those tools is at least opening the tool-box. As Sogyal Rinpoche has said, "Our present condition, if we use it skillfully and with wisdom, can be an inspiration to free ourselves from the bondage of suffering."
Monday, September 10, 2007
The Dividends of Grieving
A brief quote from a line written in an email to my beloved siblings with whom I share the bittersweet burden of mourning:
So, now for the work of grieving. The hourly pay is poor, but the dividends will be worth every moment invested. Remember, "unshed tears will make other organs weep."
So, now for the work of grieving. The hourly pay is poor, but the dividends will be worth every moment invested. Remember, "unshed tears will make other organs weep."
Sunday, September 09, 2007
The Universe of the Grieving
And now the grief settles into our bones. Mary and I have been complaining today of profound aches and pains, an experience which my sister shares. Our muscles are like stones which have lost the long-ago suppleness of soil. Our joints ache and creak like wintry tree limbs. We move through a syrup of feeling, even as we unpack the car, wash clothes, and attempt to resume "normal" life following the experience of a death.
Today we avoided a neighborhood picnic, lacking all motivation for superficial conversation and pleasantries. At the supermarket, we ducked in order to not encounter someone who we knew would only drain us with her narcissism. Tomorrow, I work from home, and Mary enjoys one more day of bereavement leave. Tuesday, we re-enter the proverbial rat-race, even as we continue to feel like we're still in a parallel universe, the Universe of the Grieving.
This special universe is inhabited by many, and even as some of us lose sight of it as we become enshrouded in the everyday world once more, a part of our heart remains in the Universe of the Grieving, holding the memories of our departed loved one in a special and tender place.
Pieces of my soul dwell permanently in the Universe of the Grieving, holding a spirit candle for my beloveds who have since left this earthly plane. The candle I burn for my step-dad glows most brightly, having only recently been lit. Some day another beloved's candle will be the newest one to grace my spirit altar, but for now his soul occupies the center of that most sacred space, and I send love and light to him as he claims his most righteous prize.
Today we avoided a neighborhood picnic, lacking all motivation for superficial conversation and pleasantries. At the supermarket, we ducked in order to not encounter someone who we knew would only drain us with her narcissism. Tomorrow, I work from home, and Mary enjoys one more day of bereavement leave. Tuesday, we re-enter the proverbial rat-race, even as we continue to feel like we're still in a parallel universe, the Universe of the Grieving.
This special universe is inhabited by many, and even as some of us lose sight of it as we become enshrouded in the everyday world once more, a part of our heart remains in the Universe of the Grieving, holding the memories of our departed loved one in a special and tender place.
Pieces of my soul dwell permanently in the Universe of the Grieving, holding a spirit candle for my beloveds who have since left this earthly plane. The candle I burn for my step-dad glows most brightly, having only recently been lit. Some day another beloved's candle will be the newest one to grace my spirit altar, but for now his soul occupies the center of that most sacred space, and I send love and light to him as he claims his most righteous prize.
Friday, September 07, 2007
Ashes to Ashes
This afternoon, I went to the funeral home and picked up my step-father's ashes. A small, compact container wrapped tightly in cardboard and sealed with official notification of its contents weighed heavily in my arms as I carried it down the steps.
Once in my car, I sat in the driver's seat and hugged that box to my chest, breathing quietly, feeling its weight in my lap. When I was ready, I placed the box gingerly on the passenger seat, and began to drive back towards my mother's house, where I would deliver her beloved husband's remains into her trembling hands. During that ride, I rested my right hand on top of the little box, just as I might rest my hand on my son's shoulder.
About half-way home, I realized that I was carefully avoiding bumps and pot-holes, gingerly taking turns, as if a fragile and easily damaged cargo sat beside me. Perhaps that fragile cargo was actually my own heart, heavy with grief, relieved that his suffering was over, and worried for my mother's future and well-being. Carrying those ashes was like being a solitary pall-bearer, shouldering a container whose contents were undeniably heavy, but whose ultimate goal was lightness and the shedding of the physical body's weight.
Resting that box on the piano in the living room after everyone had a chance to feel its weight, it was so very apparent that he is not actually in that box. What is in that box is simply the remains of a body, a vessel, a vehicle that propelled that soul through this life for eighty years. That soul, that spirit, is now free, roaming a world of which we can only dream. Blessings on that soul, even as the ashes and dust and bone fragments which remain with us are scattered to the winds of the earth.
Tomorrow, we celebrate that soul's accomplishments and that body's life on earth. And then we move on without him at our side, but with him always in our hearts.
Once in my car, I sat in the driver's seat and hugged that box to my chest, breathing quietly, feeling its weight in my lap. When I was ready, I placed the box gingerly on the passenger seat, and began to drive back towards my mother's house, where I would deliver her beloved husband's remains into her trembling hands. During that ride, I rested my right hand on top of the little box, just as I might rest my hand on my son's shoulder.
About half-way home, I realized that I was carefully avoiding bumps and pot-holes, gingerly taking turns, as if a fragile and easily damaged cargo sat beside me. Perhaps that fragile cargo was actually my own heart, heavy with grief, relieved that his suffering was over, and worried for my mother's future and well-being. Carrying those ashes was like being a solitary pall-bearer, shouldering a container whose contents were undeniably heavy, but whose ultimate goal was lightness and the shedding of the physical body's weight.
Resting that box on the piano in the living room after everyone had a chance to feel its weight, it was so very apparent that he is not actually in that box. What is in that box is simply the remains of a body, a vessel, a vehicle that propelled that soul through this life for eighty years. That soul, that spirit, is now free, roaming a world of which we can only dream. Blessings on that soul, even as the ashes and dust and bone fragments which remain with us are scattered to the winds of the earth.
Tomorrow, we celebrate that soul's accomplishments and that body's life on earth. And then we move on without him at our side, but with him always in our hearts.
Tuesday, September 04, 2007
Unfolding the Days of Mourning
When someone dies, we take a breath and realize that a new chapter has begun. Where before we cleaned the commode and wiped a sweaty brow, now we sift through memories and personal effects. Where before we concerned ourselves with medications and symptoms, now we examine legal necessities and paperwork. While our loved one was living while dying, we were also living through their dying process, slowly letting go of the old earthly relationship as we opened to a less corporeal connection which loomed large in our future. As our loved one's eyes began to focus beyond us in their softening gaze, we looked more and more closely for the subtle changes that might portend the end being near.
Once the body has been removed from the home and the hospital bed and other equipment as well, one must take stock of the space where the loved one lived and died, and accept that their physical presence in that space is now a thing of the past.
Next come the personal effects. A watch. A money clip. A ring. A necklace. The trousers hang in the closet, pockets still filled with the normal flotsam and jetsam of a life: wallet, keys, change, mints, candies usually carried for bank tellers and cashiers in stores, a handkerchief.
And then there are the clothes that hang in the closet, bereft of the body which once filled them. The shirts pine for a beating heart. The pants wish for legs to crease and bend them. The socks sit alone alongside the underwear and undershirts. The ties and belts dangle sadly like plants in a hanging garden. But a new life awaits them.
Food begins to arrive from caring friends and family. The phone is rarely at rest. Arrangements are made, and plans created. Activity is a welcome relief from the heaviness of mourning, yet too much activity can also preclude one's feelings being actively felt.
On the physical side, one must ask simple questions. Are you eating? Are you hydrating? Can you sleep? Would exercise be a benefit to you now? A fine balance must be struck, whether it be emotionally, physically or spiritually. You walk a tightrope of emotional balance, and living friends and family offer guiding hands along the way.
Laughter, smiles, moments alone, moments in motion, the awareness of loss---they are all part and parcel of the unfolding of the days of mourning.
Once the body has been removed from the home and the hospital bed and other equipment as well, one must take stock of the space where the loved one lived and died, and accept that their physical presence in that space is now a thing of the past.
Next come the personal effects. A watch. A money clip. A ring. A necklace. The trousers hang in the closet, pockets still filled with the normal flotsam and jetsam of a life: wallet, keys, change, mints, candies usually carried for bank tellers and cashiers in stores, a handkerchief.
And then there are the clothes that hang in the closet, bereft of the body which once filled them. The shirts pine for a beating heart. The pants wish for legs to crease and bend them. The socks sit alone alongside the underwear and undershirts. The ties and belts dangle sadly like plants in a hanging garden. But a new life awaits them.
Food begins to arrive from caring friends and family. The phone is rarely at rest. Arrangements are made, and plans created. Activity is a welcome relief from the heaviness of mourning, yet too much activity can also preclude one's feelings being actively felt.
On the physical side, one must ask simple questions. Are you eating? Are you hydrating? Can you sleep? Would exercise be a benefit to you now? A fine balance must be struck, whether it be emotionally, physically or spiritually. You walk a tightrope of emotional balance, and living friends and family offer guiding hands along the way.
Laughter, smiles, moments alone, moments in motion, the awareness of loss---they are all part and parcel of the unfolding of the days of mourning.
Monday, September 03, 2007
Death's Labor Pains on Labor Day
Today at 4:10pm, my beloved step-father left this world as we surrounded his bed to witness his final breaths. As he moved through the stages of the dying process over the last 48 hours, I became more and more certain that the end was drawing ever closer, perhaps more rapidly than I originally surmised it might. His struggle to allow his spirit to leave his body was truly like labor, and we were the midwives and cheerleaders along his triumphant road to freedom.
Just as it happens around the world at every hour under the sun, people came and went from my parents' home over these last days, and we all played our parts in the unfolding drama according to our individual roles and skills. My step-father's lovely daughters, sons-in-law, granddaughter, and great-grandchildren all added to the quality of the times shared under this roof, and his final days were filled with loving visits and calming energy. One visitor, a Stephen Minister by vocation, remarked that Spirit was "just pouring through the house", and he praised our little home hospice with words of benediction.
Losing myself in the minutiae of my step-dad's hourly care, I realized that my grieving process was being (somewhat necessarily) truncated by my self-imposed duties of conductor, coordinator, choreographer, and caregiver. Even as others found moments to cry, my reservoir was seemingly dry. But when the moment came and he took his final breath, we all huddled around the bed, and the tears and sobs came in torrents, releasing days of unexpressed stress and grief. It is said that "unshed tears will make other organs weep". I wrung some organs dry today, so to speak, and now I can sleep the rest of the exhausted along with the rest of our family.
His death was a fine one, navigated with grace, dignity, and a collective benevolence of spirit. Now we can be certain that our dear loved one is winging his way to a place of deserved beauty and peace, and our efforts here on Earth sent him with enormous love to fuel his journey.
Just as it happens around the world at every hour under the sun, people came and went from my parents' home over these last days, and we all played our parts in the unfolding drama according to our individual roles and skills. My step-father's lovely daughters, sons-in-law, granddaughter, and great-grandchildren all added to the quality of the times shared under this roof, and his final days were filled with loving visits and calming energy. One visitor, a Stephen Minister by vocation, remarked that Spirit was "just pouring through the house", and he praised our little home hospice with words of benediction.
Losing myself in the minutiae of my step-dad's hourly care, I realized that my grieving process was being (somewhat necessarily) truncated by my self-imposed duties of conductor, coordinator, choreographer, and caregiver. Even as others found moments to cry, my reservoir was seemingly dry. But when the moment came and he took his final breath, we all huddled around the bed, and the tears and sobs came in torrents, releasing days of unexpressed stress and grief. It is said that "unshed tears will make other organs weep". I wrung some organs dry today, so to speak, and now I can sleep the rest of the exhausted along with the rest of our family.
His death was a fine one, navigated with grace, dignity, and a collective benevolence of spirit. Now we can be certain that our dear loved one is winging his way to a place of deserved beauty and peace, and our efforts here on Earth sent him with enormous love to fuel his journey.
Sunday, September 02, 2007
One Year: Of Endings and Beginnings
I just posted this on Latter Day Sparks and decided to also post it here. Thanks for stopping by.
Today, September 2nd, 2007, at approximately 1pm, Sparkey will be dead one year. His body still rests in the earth just beside our house, but his spirit body moves in an entirely different dimension.
Even as we celebrate his life and honor the 12-month anniversary of his passing, we sit vigil here in New Jersey, comforting my beloved step-father as he moves into the final stages of the dying process himself. The details of Sparkey's passage are fresh in my mind, and at this time (10am) on September 2nd of last year, we were enjoying what we knew would be our final morning and afternoon on earth with our wonderful canine companion. It was a day of final events: the last walk, the last meal, the final treats from the mail carrier, loving visits from the neighbors, Sparkey bestowing a final kiss to a small child's face (our neighbors' newborn). And then, before we could catch our breath, the vet came, we administered the medications, and he died, crying a final tear from his left eye as we kissed him and told him how loved and lovely he truly was.
Now, on this very day, we watch as my step-father's breathing becomes erratic, with 5-second periods of apnea (the absence of breathing), followed by a succession of rapid breaths once again. Hints of a minimal rattle in the throat make themselves known from time to time, yet he then breathes normally again. There will be no doctor visiting today to administer a dose of medicine to end his struggle, to assuage his suffering. In our culture, our dogs' and cats' suffering is painlessly ended when it is seen to be the most humane act we can perform; yet our suffering human loved ones, whose quality of life has long since diminished to less than a shadow of its former self, must struggle and gasp until the end. Morphine assists the process and depresses respiration, but Tulane will not experience the sudden and painless release that Sparkey was so blessed to receive.
Speaking of Sparkey and Tulane, Sparkey has now visited Tulane twice over the last few months, the most recent visit being only several days ago. When my mother and my wife and I were finishing a conversation around Tulane's bed early last week, Tulane said, "I didn't want to interrupt your conversation, but Sparkey was just here. He came through the window and stood by my bed, looking at me, smiling and panting, and wagging his tail furiously." (We all noted that there was a chocolate-chip cookie on the bedside table and Sparkey may have been eying it from across the veil.) Tulane seemed very pleased by this visit, as he did by a similar visit several months ago when Sparkey entered through the closed front door and curled around Tulane's legs under the kitchen table. With each visit, Tulane describes being able to smell Sparkey in the air, and to smell him on his hand after petting his head, long after our favorite golden dog had left the scene.
So, we await Tulane's death, midwifing him through the process, even as we recognize and celebrate Sparkey's anniversary. It is a significant day in our lives, and its importance informs our every waking (and sleeping) moment.
Happy un-Birthday Sparkey! May you run and play and rest in a peaceful and wonderful world, and may you welcome Tulane when he is ready to join you there. We love you, Sparkey!
Today, September 2nd, 2007, at approximately 1pm, Sparkey will be dead one year. His body still rests in the earth just beside our house, but his spirit body moves in an entirely different dimension.
Even as we celebrate his life and honor the 12-month anniversary of his passing, we sit vigil here in New Jersey, comforting my beloved step-father as he moves into the final stages of the dying process himself. The details of Sparkey's passage are fresh in my mind, and at this time (10am) on September 2nd of last year, we were enjoying what we knew would be our final morning and afternoon on earth with our wonderful canine companion. It was a day of final events: the last walk, the last meal, the final treats from the mail carrier, loving visits from the neighbors, Sparkey bestowing a final kiss to a small child's face (our neighbors' newborn). And then, before we could catch our breath, the vet came, we administered the medications, and he died, crying a final tear from his left eye as we kissed him and told him how loved and lovely he truly was.
Now, on this very day, we watch as my step-father's breathing becomes erratic, with 5-second periods of apnea (the absence of breathing), followed by a succession of rapid breaths once again. Hints of a minimal rattle in the throat make themselves known from time to time, yet he then breathes normally again. There will be no doctor visiting today to administer a dose of medicine to end his struggle, to assuage his suffering. In our culture, our dogs' and cats' suffering is painlessly ended when it is seen to be the most humane act we can perform; yet our suffering human loved ones, whose quality of life has long since diminished to less than a shadow of its former self, must struggle and gasp until the end. Morphine assists the process and depresses respiration, but Tulane will not experience the sudden and painless release that Sparkey was so blessed to receive.
Speaking of Sparkey and Tulane, Sparkey has now visited Tulane twice over the last few months, the most recent visit being only several days ago. When my mother and my wife and I were finishing a conversation around Tulane's bed early last week, Tulane said, "I didn't want to interrupt your conversation, but Sparkey was just here. He came through the window and stood by my bed, looking at me, smiling and panting, and wagging his tail furiously." (We all noted that there was a chocolate-chip cookie on the bedside table and Sparkey may have been eying it from across the veil.) Tulane seemed very pleased by this visit, as he did by a similar visit several months ago when Sparkey entered through the closed front door and curled around Tulane's legs under the kitchen table. With each visit, Tulane describes being able to smell Sparkey in the air, and to smell him on his hand after petting his head, long after our favorite golden dog had left the scene.
So, we await Tulane's death, midwifing him through the process, even as we recognize and celebrate Sparkey's anniversary. It is a significant day in our lives, and its importance informs our every waking (and sleeping) moment.
Happy un-Birthday Sparkey! May you run and play and rest in a peaceful and wonderful world, and may you welcome Tulane when he is ready to join you there. We love you, Sparkey!
Saturday, September 01, 2007
The Constancy of Change
There are so many things to let go of in the course of one's lifetime. Friendships grow and fade, changing and evolving---or devolving---over time. Parents or other family members grow ill and die. Jobs are lost, careers dissolve and are reconstituted, money flows like water through one's hands. At times, tragedy strikes, and the letting go is sudden, ripping through the fabric of life like a knife, or bludgeoning one over the head with its intensity. But there is one constant, and that is change.
Loss often visits us at the most inconvenient times. We lose our job just as our child is starting college. Our car breaks down the day before we leave for vacation. A new diagnosis throws us into a medical tailspin. Depression rears its challenging head and we are derailed from our usual emotional composure. A sudden and unexpected expense drains our resources and we are financially drained almost overnight. Change---when unplanned---is certainly most inconvenient---with illness and death perhaps being the most unwanted changes of all.
How do we cope with change, especially that which is inherently unwanted and unsolicited? We read books which purport to assist the reader with such transitions in life. Bookstore shelves overflow with self-help books of all stripes, and Americans purchase scores of them, myself included. The Bible offers great comfort to many in times of change and challenge, and millions look towards its wisdom for both comfort and strength of spirit. Most recently, I have turned to several books, including When Things Fall Apart: Heart Advice for Difficult Times by Pema Chodron. While it is a Buddhist text, its message is universal and digestible by seekers of any faith.
How else do we cope with change? Psychotherapy, counseling, the church, the shoulder of a friend, alcohol and drugs, food, exercise, sleep, anger, television, denial, resistance---these are all places to which we turn, some obviously healthier than others. We encourage one another to turn to that which is nurturing and healthy, that which will add positively to our personal arsenal of coping mechanisms. Some become lost in addiction, others become lost in meaningless action---"filling time" without really living it. No one ever said it would be easy, and when we are in the thick of it, we realize that this alleged lack of ease is altogether true.
For myself, as I live through perhaps the most difficult time of my life so far---the impending death of a terminally ill parent---I strive to reach for that which is healthy and nurturing. When my best friend was murdered in 2001, post-traumatic stress took its toll, and recovery was slow and painful. An unexpected loss of that magnitude shook the foundations of my world in a way that was both shocking and painful. Now, I face this slow and incremental loss, and its impact---while no less enormous than the loss of my friend---is somewhat mitigated by the ability to begin preparing, to say goodbye, to come to terms, to accept that which is inevitable and unavoidable.
Heraclitus said "everything flows, nothing stands still. Nothing endures but change." This is a lesson which I strive to keep in mind as the winds of change, loss, and death buffet our family's ship. It is all we can do to hold onto the rails and ride the waves as they toss us about. Otherwise, we are thrown into the sea of uncertainty and groundless fear, where we are more likely to lose our way and be lost. And so, we cling to one another and to the ship of family and community, riding the swells until the sea is calm once more.
Loss often visits us at the most inconvenient times. We lose our job just as our child is starting college. Our car breaks down the day before we leave for vacation. A new diagnosis throws us into a medical tailspin. Depression rears its challenging head and we are derailed from our usual emotional composure. A sudden and unexpected expense drains our resources and we are financially drained almost overnight. Change---when unplanned---is certainly most inconvenient---with illness and death perhaps being the most unwanted changes of all.
How do we cope with change, especially that which is inherently unwanted and unsolicited? We read books which purport to assist the reader with such transitions in life. Bookstore shelves overflow with self-help books of all stripes, and Americans purchase scores of them, myself included. The Bible offers great comfort to many in times of change and challenge, and millions look towards its wisdom for both comfort and strength of spirit. Most recently, I have turned to several books, including When Things Fall Apart: Heart Advice for Difficult Times by Pema Chodron. While it is a Buddhist text, its message is universal and digestible by seekers of any faith.
How else do we cope with change? Psychotherapy, counseling, the church, the shoulder of a friend, alcohol and drugs, food, exercise, sleep, anger, television, denial, resistance---these are all places to which we turn, some obviously healthier than others. We encourage one another to turn to that which is nurturing and healthy, that which will add positively to our personal arsenal of coping mechanisms. Some become lost in addiction, others become lost in meaningless action---"filling time" without really living it. No one ever said it would be easy, and when we are in the thick of it, we realize that this alleged lack of ease is altogether true.
For myself, as I live through perhaps the most difficult time of my life so far---the impending death of a terminally ill parent---I strive to reach for that which is healthy and nurturing. When my best friend was murdered in 2001, post-traumatic stress took its toll, and recovery was slow and painful. An unexpected loss of that magnitude shook the foundations of my world in a way that was both shocking and painful. Now, I face this slow and incremental loss, and its impact---while no less enormous than the loss of my friend---is somewhat mitigated by the ability to begin preparing, to say goodbye, to come to terms, to accept that which is inevitable and unavoidable.
Heraclitus said "everything flows, nothing stands still. Nothing endures but change." This is a lesson which I strive to keep in mind as the winds of change, loss, and death buffet our family's ship. It is all we can do to hold onto the rails and ride the waves as they toss us about. Otherwise, we are thrown into the sea of uncertainty and groundless fear, where we are more likely to lose our way and be lost. And so, we cling to one another and to the ship of family and community, riding the swells until the sea is calm once more.
Friday, August 31, 2007
Wine and Roses
A week lapse in blogging due to extenuating circumstances, caring for a dying parent. Stranded in suburban purgatory without internet connection or any of my usual anchors.
Death comes slowly and inexorably. We all die in increments. From the day we are born we are moment by moment closer to the time of our death.
And what does this proximity to death mean? What does it portend?
I feel that it portends our deeply held need to live even more fully and to forgive those who have trespassed against us, for those days of wine and roses are altogether too fleeting.
Death comes slowly and inexorably. We all die in increments. From the day we are born we are moment by moment closer to the time of our death.
And what does this proximity to death mean? What does it portend?
I feel that it portends our deeply held need to live even more fully and to forgive those who have trespassed against us, for those days of wine and roses are altogether too fleeting.
Friday, August 24, 2007
Death Circles the Wagons
When Death begins to circle its wagons
drawing ever tighter spaces
around our dying loved one
we circle our wagons as well
drawing on previously untapped emotional and physical reserves
in order to do what we felt was beyond our ken.
Never did we think
that we could do what we are now doing.
Never could we picture the compromises, the sacrifices,
the emotional stretching that we would need to endure.
Never did we consider how Death---so patient----
would slowly and inexorably remove our loved one
from our midst,
allowing us an intimate view
of how Death begins to take our loved one
even while he is still breathing before our very eyes.
Wait, watch
Listen and breathe.
Death may be cruel, Death may be kind
but Death is eventually our final friend in life;
removing our physical presence from this mortal coil
when our personal Sun has set.
Even as Death causes our loved one to wither
and unequivocally disappear
before our very eyes,
God(dess) is there,
holding the hands of all, the dying and the bereaved alike,
guiding us to a place
where Grace, Wisdom, and Beauty make their home.
We watch the wagons circle, helpless, yet
poised for the future,
but still clinging to a present
that must eventually give way
to a new world for our loved one,
a world to which they must travel alone.
Alone, yes, they must take their leave of us alone,
to release themselves from a body ready to return to Source.
We cannot accompany our loved one on that final road,
yet they are released by us with blessings
and hopes
for a sweet, sweet hereafter.
drawing ever tighter spaces
around our dying loved one
we circle our wagons as well
drawing on previously untapped emotional and physical reserves
in order to do what we felt was beyond our ken.
Never did we think
that we could do what we are now doing.
Never could we picture the compromises, the sacrifices,
the emotional stretching that we would need to endure.
Never did we consider how Death---so patient----
would slowly and inexorably remove our loved one
from our midst,
allowing us an intimate view
of how Death begins to take our loved one
even while he is still breathing before our very eyes.
Wait, watch
Listen and breathe.
Death may be cruel, Death may be kind
but Death is eventually our final friend in life;
removing our physical presence from this mortal coil
when our personal Sun has set.
Even as Death causes our loved one to wither
and unequivocally disappear
before our very eyes,
God(dess) is there,
holding the hands of all, the dying and the bereaved alike,
guiding us to a place
where Grace, Wisdom, and Beauty make their home.
We watch the wagons circle, helpless, yet
poised for the future,
but still clinging to a present
that must eventually give way
to a new world for our loved one,
a world to which they must travel alone.
Alone, yes, they must take their leave of us alone,
to release themselves from a body ready to return to Source.
We cannot accompany our loved one on that final road,
yet they are released by us with blessings
and hopes
for a sweet, sweet hereafter.
Thursday, August 23, 2007
A Roundup at Change of Shift
The newest version of Change of Shift---that venerable carnival of nurse bloggers---is now up and running at Nurse Ratched's Place, with a Western theme. Yours truly is even included this time, relaxing in a crowded tavern. So grab your lasso and enjoy the roundup!
Wednesday, August 22, 2007
Try, Try Again
"So, how come you didn't come in for your blood test last week?" I punch at the computer keyboard, checking his lab results.
"Oh, I forgot. You see, there're these Mexicans I'm helping out---they're farmworkers, they needed a ride." His eyes dart around the room.
"Uh huh." I poke at the keyboard a little more. I let him squirm a little.
"So, when you're due for your narcotic prescription, I hear from you like clockwork." Our eyes meet.
"Well, if I don't have the oxycodone, I know I'll be in pain. But the blood test? It doesn't seem to matter that much." He smiles sheepishly.
"Yeah," I respond. "Then you end up in the hospital with a huge clot in your leg, and if we don't catch it in time you throw a clot to your heart and you die a sudden death. Not much of a consequence, huh?"
"I'll be better about it now, I promise. I know the blood test is important."
"Y'know, I've heard that from you before, but I always wanna believe you and give you another chance." We both smile and I put my hand on his shoulder as we walk up the hall towards the waiting room.
"Why do you keep giving me another chance if I keep fucking up?"
"Because I like you and I care about you. That's why."
"Oh."
"See you next week?"
"Sure. Next Wednesday at ten."
Will he come next week for his blood test? Probably not. But when that oxycodone prescription comes due, you know he'll be calling. Will he get another chance after that? Absolutely. And why not?
"Oh, I forgot. You see, there're these Mexicans I'm helping out---they're farmworkers, they needed a ride." His eyes dart around the room.
"Uh huh." I poke at the keyboard a little more. I let him squirm a little.
"So, when you're due for your narcotic prescription, I hear from you like clockwork." Our eyes meet.
"Well, if I don't have the oxycodone, I know I'll be in pain. But the blood test? It doesn't seem to matter that much." He smiles sheepishly.
"Yeah," I respond. "Then you end up in the hospital with a huge clot in your leg, and if we don't catch it in time you throw a clot to your heart and you die a sudden death. Not much of a consequence, huh?"
"I'll be better about it now, I promise. I know the blood test is important."
"Y'know, I've heard that from you before, but I always wanna believe you and give you another chance." We both smile and I put my hand on his shoulder as we walk up the hall towards the waiting room.
"Why do you keep giving me another chance if I keep fucking up?"
"Because I like you and I care about you. That's why."
"Oh."
"See you next week?"
"Sure. Next Wednesday at ten."
Will he come next week for his blood test? Probably not. But when that oxycodone prescription comes due, you know he'll be calling. Will he get another chance after that? Absolutely. And why not?
Monday, August 20, 2007
A Plethora of Patients' Excuses
"I forgot your phone number."
"My phone is disconnected."
"I didn't come to see the doctor because I didn't feel well."
"I stopped taking my diabetes medications because I was mad that my blood sugar was high."
"I didn't take my medication because I was mad at the doctor."
"I was in New York/Puerto Rico/Florida/New Jersey for two months."
"Someone stole my phone."
"Someone stole my car."
"My __________ died."
"I had to take ____________ to ______________."
"My daughter wanted to go shopping."
"My dog ate the mail."
"My son/daughter/father/husband/wife/mother was sick."
"I had to go to court."
"The doctor doesn't care, so why should I?"
"You didn't remind me."
"You never call."
"You don't care about me anymore."
"I hate myself."
"My phone is disconnected."
"I didn't come to see the doctor because I didn't feel well."
"I stopped taking my diabetes medications because I was mad that my blood sugar was high."
"I didn't take my medication because I was mad at the doctor."
"I was in New York/Puerto Rico/Florida/New Jersey for two months."
"Someone stole my phone."
"Someone stole my car."
"My __________ died."
"I had to take ____________ to ______________."
"My daughter wanted to go shopping."
"My dog ate the mail."
"My son/daughter/father/husband/wife/mother was sick."
"I had to go to court."
"The doctor doesn't care, so why should I?"
"You didn't remind me."
"You never call."
"You don't care about me anymore."
"I hate myself."
Sunday, August 19, 2007
Whirlwind Weekends and Weathering Storms
A string of whirlwind weekends---and the impending death of my step-father---have been generally impeding my ability to blog as consistently as I would like. Regular readers will also notice that death, dying and the grieving process have also made themselves quite visible in recent writings. When faced with the mortality of a loved one, one's own mortality also indeed comes to the fore.
Gyalse Rinpoche has said: "Planning for the future is like going fishing in a dry gulch; nothing ever works out as you wanted, so give up all your schemes and ambitions. If you have got to think about something—make it the uncertainty of the hour of your death."
The above is interesting advice at such a transitional time in life, when the stability, well-being and future of family structure is in question. How can one plan when the future is so uncertain? One can only ask for guidance and peace of mind to weather the storms of the unfolding days.
Gyalse Rinpoche has said: "Planning for the future is like going fishing in a dry gulch; nothing ever works out as you wanted, so give up all your schemes and ambitions. If you have got to think about something—make it the uncertainty of the hour of your death."
The above is interesting advice at such a transitional time in life, when the stability, well-being and future of family structure is in question. How can one plan when the future is so uncertain? One can only ask for guidance and peace of mind to weather the storms of the unfolding days.
Wednesday, August 15, 2007
Birthday Ruminations: Life, Death and in Between
Today is my 43rd birthday, and I am working from home, spending some quiet time with Tina the Dog and a hammock. Calls and emails come in from time to time. Lawnmowers and other daytime neighborhood comings and goings fill the air.
Even as life continues on its usual trajectory, death lurks in the shadows. We really do spend a great deal of our time ignoring death, avoiding death, trying to beat Death at his own game. Movies portray death in many guises: as the demise of a self-destructive addict, the heroic death of a firefighter, the needless accidental death of a child, the tragic death of hundreds due to natural disasters, wars, famine, and genocide. The media bring us news of death daily as famous celebrities die, dozens of people are slaughtered by car bombs in Baghdad, or bridges and mines collapse in our cities and towns. Eventually, news of death becomes so routine, so ubiquitous, we are almost immune to its import, its very impact diminished through repetition, our eyes glazed over in disbelief.
As a medical provider, my desire, of course, is to assist my patients in postponing death, improving their health and quality of life, as well as trying to ensure that chronic diseases are treated, prevented, or stabilized. Colonoscopies, mammograms, testicular exams, blood tests---these are all means to the end of thwarting illness and death. But even these scientific machinations cannot save us all, and cancer grows in parts not scoped, or disease manifests when some aberrant gene decides to turn itself on. We are all works in progress, and as the saying goes, nothing is more certain in life than death and taxes.
When terminal illness strikes a family member, the other members of that family are forced into an intimate conversation with mortality. Through the processes of denial and ignorance, we can potentially shield ourselves from some aspect of this reality, but when push comes to shove, Death will force himself through the door one way or another.
In Ingmar Bergman's film The Seventh Seal, the protagonist---a knight journeying through a a Europe gripped by the Black Plague---challenges Death to a game of chess, buying time while still knowing what the eventual endgame will be. This is a lesson for us all---we can buy time, we can stall, we can challenge Death at every turn, but even on a day which celebrates our birth, death must also be a part of the inner conversation.
I often want to ask a dying person what it feels like to know that one's life is so very close to its end. Is there a breathless panic that not enough has been done? Are there regrets of relationships still unhealed? Is there a kind of relief that one feels? Is there lamenting of places not visited, photos not taken, pictures not painted, songs not written? And what of acceptance and peace? How does one face one's imminent death knowing full well that there was so much more to be done, so much more living to enjoy? How does one reconcile that in one's mind and heart?
Obviously to me, one of the most effective ways to beat Death at his own game is to embrace life in all of its challenges and curve-balls, throwing oneself into each day with abandon and determination. Unfortunately, we all occasionally lose sight of our mortality, putting off until tomorrow what we could do today, knowing full well somewhere in the back of our minds that tomorrow may never come. As for cleaning the bathroom or mowing the lawn, I see no problem with putting that off 'til the 'morrow. But telling someone how much you love them, looking into the eyes of a child, smelling a rose in full bloom, or writing that long-dreamed of novel---these are the things that simply cannot wait. A dirty bathroom is one thing. An unhealed relationship is quite another.
So, as a birthday present to myself, I take this moment to reflect on life and death, and make a pact to continue to remind myself of the importance of each day and my ability to embrace it for all it's worth. Doing any less is only inviting Death to eventually rob me of something I treasure through the mechanisms of regret and remorse. We should all strive to deny Death that opportunity, and allow Life its share of victory and everyday bliss.
Even as life continues on its usual trajectory, death lurks in the shadows. We really do spend a great deal of our time ignoring death, avoiding death, trying to beat Death at his own game. Movies portray death in many guises: as the demise of a self-destructive addict, the heroic death of a firefighter, the needless accidental death of a child, the tragic death of hundreds due to natural disasters, wars, famine, and genocide. The media bring us news of death daily as famous celebrities die, dozens of people are slaughtered by car bombs in Baghdad, or bridges and mines collapse in our cities and towns. Eventually, news of death becomes so routine, so ubiquitous, we are almost immune to its import, its very impact diminished through repetition, our eyes glazed over in disbelief.
As a medical provider, my desire, of course, is to assist my patients in postponing death, improving their health and quality of life, as well as trying to ensure that chronic diseases are treated, prevented, or stabilized. Colonoscopies, mammograms, testicular exams, blood tests---these are all means to the end of thwarting illness and death. But even these scientific machinations cannot save us all, and cancer grows in parts not scoped, or disease manifests when some aberrant gene decides to turn itself on. We are all works in progress, and as the saying goes, nothing is more certain in life than death and taxes.
When terminal illness strikes a family member, the other members of that family are forced into an intimate conversation with mortality. Through the processes of denial and ignorance, we can potentially shield ourselves from some aspect of this reality, but when push comes to shove, Death will force himself through the door one way or another.
In Ingmar Bergman's film The Seventh Seal, the protagonist---a knight journeying through a a Europe gripped by the Black Plague---challenges Death to a game of chess, buying time while still knowing what the eventual endgame will be. This is a lesson for us all---we can buy time, we can stall, we can challenge Death at every turn, but even on a day which celebrates our birth, death must also be a part of the inner conversation.
I often want to ask a dying person what it feels like to know that one's life is so very close to its end. Is there a breathless panic that not enough has been done? Are there regrets of relationships still unhealed? Is there a kind of relief that one feels? Is there lamenting of places not visited, photos not taken, pictures not painted, songs not written? And what of acceptance and peace? How does one face one's imminent death knowing full well that there was so much more to be done, so much more living to enjoy? How does one reconcile that in one's mind and heart?
Obviously to me, one of the most effective ways to beat Death at his own game is to embrace life in all of its challenges and curve-balls, throwing oneself into each day with abandon and determination. Unfortunately, we all occasionally lose sight of our mortality, putting off until tomorrow what we could do today, knowing full well somewhere in the back of our minds that tomorrow may never come. As for cleaning the bathroom or mowing the lawn, I see no problem with putting that off 'til the 'morrow. But telling someone how much you love them, looking into the eyes of a child, smelling a rose in full bloom, or writing that long-dreamed of novel---these are the things that simply cannot wait. A dirty bathroom is one thing. An unhealed relationship is quite another.
So, as a birthday present to myself, I take this moment to reflect on life and death, and make a pact to continue to remind myself of the importance of each day and my ability to embrace it for all it's worth. Doing any less is only inviting Death to eventually rob me of something I treasure through the mechanisms of regret and remorse. We should all strive to deny Death that opportunity, and allow Life its share of victory and everyday bliss.
Tuesday, August 14, 2007
My Other Blogs
This is just a brief note to remind new (and seasoned) readers that I have two other blogs which you are invited to peruse at your leisure.
The first is Latter Day Sparks, an homage to our dog Sparkey who died September 2nd, 2006 of kidney failure. I tend to post a memory or photo on the 2nd of each month, and Mary posts a missive intermittently.
Next is A Nurse and His Treo, wherein I post a daily photo taken with my trusty little smart-phone.
Thanks for visiting, and y'all come back now, y'hear?
The first is Latter Day Sparks, an homage to our dog Sparkey who died September 2nd, 2006 of kidney failure. I tend to post a memory or photo on the 2nd of each month, and Mary posts a missive intermittently.
Next is A Nurse and His Treo, wherein I post a daily photo taken with my trusty little smart-phone.
Thanks for visiting, and y'all come back now, y'hear?
Sunday, August 12, 2007
Caring for the Dying and the Self
When a loved one is in the (relatively slow) process of dying from a terminal illness, we can often lose ourselves in the minutiae of care-giving, ignoring our own needs vis-a-vis the grieving process. When someone is living at home and facing death with family at their side, those family members providing emotional and physical support can be consumed by the needs of the dying person, consequently being potentially cut off from their own feelings and the need to grieve and mourn an imminent loss.
Finessing the end of a life is a subtle emotional process for all involved. Elizabeth Kubler-Ross had very specific ideas about the "stages" of grieving and loss which radically changed the global conversation about death and dying. Stephen and Ondrea Levine also offer a unique spiritual perspective of this most intimate and ubiquitous human experience. Sogyal Rinpoche, often quoted on this blog, shares his own views of death and dying through his own spiritual lens in his seminal book, The Tibetan Book of Living and Dying, one chapter being entitled Heart Advice on Helping the Dying.
I have found myself lost in the pragmatics of supporting my parents as my step-father faces death from metastatic pancreatic cancer. With no treatment options remaining, home hospice care is now the key to comfort, symptom management, and emotional and spiritual support for my parents. In this way, I hope to make room for my own grieving which has been sidelined by the need for practical problem-solving and advocacy. Those needs will not disappear, but when one enlists the assistance of professionals who are highly skilled in this delicate process, one can begin to let one's guard down and open to the winds of grief.
I now welcome those winds to blow through me, allowing myself to begin the process of letting go even as constant presence and compassion is needed. For if the caregiver goes uncared for, the caregiver's ability to serve will only suffer. To paraphrase an ancient physician whose name is unknown to me: "Unshed tears will make other organs weep".
Finessing the end of a life is a subtle emotional process for all involved. Elizabeth Kubler-Ross had very specific ideas about the "stages" of grieving and loss which radically changed the global conversation about death and dying. Stephen and Ondrea Levine also offer a unique spiritual perspective of this most intimate and ubiquitous human experience. Sogyal Rinpoche, often quoted on this blog, shares his own views of death and dying through his own spiritual lens in his seminal book, The Tibetan Book of Living and Dying, one chapter being entitled Heart Advice on Helping the Dying.
I have found myself lost in the pragmatics of supporting my parents as my step-father faces death from metastatic pancreatic cancer. With no treatment options remaining, home hospice care is now the key to comfort, symptom management, and emotional and spiritual support for my parents. In this way, I hope to make room for my own grieving which has been sidelined by the need for practical problem-solving and advocacy. Those needs will not disappear, but when one enlists the assistance of professionals who are highly skilled in this delicate process, one can begin to let one's guard down and open to the winds of grief.
I now welcome those winds to blow through me, allowing myself to begin the process of letting go even as constant presence and compassion is needed. For if the caregiver goes uncared for, the caregiver's ability to serve will only suffer. To paraphrase an ancient physician whose name is unknown to me: "Unshed tears will make other organs weep".
Thursday, August 09, 2007
Addiction: The Unending Struggle
This morning I watched HBO's 90-minute special documentary "Addiction" with my colleagues in lieu of our usual multidisciplinary team meeting. Frequent readers of Digital Doorway may remember that I was asked by HBO's public relations team last year to post a review of the film in advance of its original broadcast on the cable network. While I did point out some minor shortcomings in that review, I felt at the time that the film offered the general public and healthcare providers alike a succinct yet moving overview of the most current science vis-a-vis addiction and its treatment, illustrated with real-life stories which drive home the basic thesis of the entire HBO undertaking---that addiction, for all intents and purposes, is a disease of the brain which is chronic and treatable. However, the film never fails to also underscore the fact that addiction destroys relationships, wrecks families, often kills its sufferers, and costs the taxpayer millions of dollars per year in treatment, legal ramifications, lost productivity, and societal costs.
On my third viewing of the film, I was surprised that I still cried at the most touching moments, despite the fact that I have seen those segments a number of times and know exactly what's coming. Thinking that I might be slightly bored seeing the same film yet again, I brought along some paperwork to do in case the experience became tedious for me at any point. However, in that dimly lit room, shades drawn, my twenty-some-odd colleagues transfixed, watching the screen with rapt attention and nary a murmur of comment or side conversation, I was completely engrossed in the film, emotionally hooked into each story and finding my heart and mind opening yet again to the message with which I am by now very familiar.
I'm not sure how the HBO project has fared vis-a-vis its ultimate and overarching goal of energizing a national conversation about addiction, the need for adequate treatment, the stigma which labels it as a moral failing or character flaw, and the science that shows its physiological basis. Still, this film---a series of discrete vignettes which each stand on their own yet work as a comprehensive whole---has had an effect on me well beyond the initial viewing. The thirteen additional short films in the series can all be streamed on HBO.com for free or seen on HBO on- demand, along with the 90-minute documentary which is the subject of the preceding paragraphs.
Despite all of our training and understanding of the disease model of addiction, we healthcare providers are always at risk of feeling disappointment, anger, resentment, and despair when our patients relapse into drug or alcohol abuse. As much as we try our best to not see it as a moral failing or character flaw, there are still moments in our days when we put our heads in our hands and sincerely question how we can go on being objective when our souls cry out "NO!" when a client picks up again. Even when our brains say "it's a disease, they are powerless over their cravings", we must, deep down, still feel disappointment and anger from time to time, wishing that they could be stronger, more circumspect, more amenable to treatment.
Just as family members struggle between unsympathetic anger and loving compassion, we providers must also wrestle with our judgments and pin our own demons to the proverbial ground. The old adage, "there but for the grace of God(dess) go I" (which I admittedly and unapologetically use ad nauseum on this blog), still holds true. Any one of us is a potential addict, however some of us are more inclined than others, just as some are more inclined to diabetes or heart disease.
Addiction takes its toll on our society in myriad ways, and we all at some point must consider what it means to us, who in our lives may be affected, what we would like to do about it, and how we feel this society should manage such a monster in our midst. Addicts---whether homeless vets or white collar executives---all deserve the same chance at treatment and a life free of addiction and its potentially catastrophic consequences. But as long as a large segment of the population---as well as those in power---see addiction as a failure of will power and personal strength, we will still have a very long way to go.
On my third viewing of the film, I was surprised that I still cried at the most touching moments, despite the fact that I have seen those segments a number of times and know exactly what's coming. Thinking that I might be slightly bored seeing the same film yet again, I brought along some paperwork to do in case the experience became tedious for me at any point. However, in that dimly lit room, shades drawn, my twenty-some-odd colleagues transfixed, watching the screen with rapt attention and nary a murmur of comment or side conversation, I was completely engrossed in the film, emotionally hooked into each story and finding my heart and mind opening yet again to the message with which I am by now very familiar.
I'm not sure how the HBO project has fared vis-a-vis its ultimate and overarching goal of energizing a national conversation about addiction, the need for adequate treatment, the stigma which labels it as a moral failing or character flaw, and the science that shows its physiological basis. Still, this film---a series of discrete vignettes which each stand on their own yet work as a comprehensive whole---has had an effect on me well beyond the initial viewing. The thirteen additional short films in the series can all be streamed on HBO.com for free or seen on HBO on- demand, along with the 90-minute documentary which is the subject of the preceding paragraphs.
Despite all of our training and understanding of the disease model of addiction, we healthcare providers are always at risk of feeling disappointment, anger, resentment, and despair when our patients relapse into drug or alcohol abuse. As much as we try our best to not see it as a moral failing or character flaw, there are still moments in our days when we put our heads in our hands and sincerely question how we can go on being objective when our souls cry out "NO!" when a client picks up again. Even when our brains say "it's a disease, they are powerless over their cravings", we must, deep down, still feel disappointment and anger from time to time, wishing that they could be stronger, more circumspect, more amenable to treatment.
Just as family members struggle between unsympathetic anger and loving compassion, we providers must also wrestle with our judgments and pin our own demons to the proverbial ground. The old adage, "there but for the grace of God(dess) go I" (which I admittedly and unapologetically use ad nauseum on this blog), still holds true. Any one of us is a potential addict, however some of us are more inclined than others, just as some are more inclined to diabetes or heart disease.
Addiction takes its toll on our society in myriad ways, and we all at some point must consider what it means to us, who in our lives may be affected, what we would like to do about it, and how we feel this society should manage such a monster in our midst. Addicts---whether homeless vets or white collar executives---all deserve the same chance at treatment and a life free of addiction and its potentially catastrophic consequences. But as long as a large segment of the population---as well as those in power---see addiction as a failure of will power and personal strength, we will still have a very long way to go.
Monday, August 06, 2007
Sensory Overload
The apartment must have been at least 90 degrees. Three large cages in the living room held eight squawking birds, one of which whistles an old Latino song incessantly. My patient breaks into song along with the bird several times during the visit. Between the heat and the singing, I felt like I might pass out.
As I attempted to check orthostatic blood pressures (vital signs taken supine, seated and standing in relatively quick succession) , one of my patient's friends burst into the apartment. Yelling almost at the top of her lungs, gesticulating wildly, the new arrival pushed a double stroller into the living room which contained two screaming young children. Amidst the tumult, a third child---perhaps eight or nine---sat down on the couch in utter silence, watching me take my patient's blood pressure and pulse.
The oppressive heat seemed multiplied by the extra bodies in the room. My patient's temperature was 99.7 and she looked faint. Her friend almost violently shoved a plate of food in my patient's lap and began spoon-feeding her as my patient tried to answer my questions. Each time I tried to ask a question again, the friend would interrupt, yelling "You're not taking care of yourself! You need to go to the hospital! Let's call an ambulance!"
Meanwhile, the two children---still strapped in the stroller---began to shriek louder as the parrot again began the incessant whistling, my patient again singing along.
I packed my bags and headed for the door, feeling quite faint myself. Muttering my goodbyes and advice, I escaped to the humid city air, cars streaming by, horns honking.
"I have to get home," I thought, looking at my watch. It was 2:35 pm---disappointingly early. No rest for the weary, and no escape for the overwrought.
Sensory overload? Just one more occupational hazard.
As I attempted to check orthostatic blood pressures (vital signs taken supine, seated and standing in relatively quick succession) , one of my patient's friends burst into the apartment. Yelling almost at the top of her lungs, gesticulating wildly, the new arrival pushed a double stroller into the living room which contained two screaming young children. Amidst the tumult, a third child---perhaps eight or nine---sat down on the couch in utter silence, watching me take my patient's blood pressure and pulse.
The oppressive heat seemed multiplied by the extra bodies in the room. My patient's temperature was 99.7 and she looked faint. Her friend almost violently shoved a plate of food in my patient's lap and began spoon-feeding her as my patient tried to answer my questions. Each time I tried to ask a question again, the friend would interrupt, yelling "You're not taking care of yourself! You need to go to the hospital! Let's call an ambulance!"
Meanwhile, the two children---still strapped in the stroller---began to shriek louder as the parrot again began the incessant whistling, my patient again singing along.
I packed my bags and headed for the door, feeling quite faint myself. Muttering my goodbyes and advice, I escaped to the humid city air, cars streaming by, horns honking.
"I have to get home," I thought, looking at my watch. It was 2:35 pm---disappointingly early. No rest for the weary, and no escape for the overwrought.
Sensory overload? Just one more occupational hazard.
Friday, August 03, 2007
The End of Imagination
"The only dream worth having, I told her, is to dream that you will live while you're alive and die only when you're dead... To love. To be loved. To never forget your own insignificance. To never get used to the unspeakable violence and the vulgar disparity of life around you. To seek joy in the saddest places. To pursue beauty to its lair. To never simplify what is complicated or complicate what is simple. To respect strength, never power. Above all, to watch. To try and understand. To never look away. And never, never to forget."
--Arundhati Roy, "The End of Imagination"
--Arundhati Roy, "The End of Imagination"
Wednesday, August 01, 2007
Relapse
"I relapsed again," she told me. "I could barely bring myself to tell you."
"Unfortunately, it happens. But what's the plan now?" I try not to show any discernible emotion when hearing the news so that she doesn't feel judged.
"Well, I haven't used in two days. I feel like shit, though." She wrings her hands as they rest in her lap.
"Two days? That's great! every day is a new chance to make a new choice. What do you think?"
"Yeah, today's a new day, but that doesn't help me feel less like shit."
"I know, but you'll feel physically better sooner if you can just forgive yourself and let go of what happened. You can learn from your mistakes without beating yourself up about it."
"That's true. I just hope I can do it."
"You have choices every day. You made a good choice to come in today and talk to us. Let's plan on some good decisions tomorrow, too, OK?"
"OK. I'll be back next week. I think I'll get some exercise." We both stand up and shake hands.
As the door closes, I take a deep breath. Addiction must be such a weight to carry. I give thanks that it doesn't have a hold on me, and feel a swelling of compassion for those for whom it is a daily---or even an hourly---struggle.
"Unfortunately, it happens. But what's the plan now?" I try not to show any discernible emotion when hearing the news so that she doesn't feel judged.
"Well, I haven't used in two days. I feel like shit, though." She wrings her hands as they rest in her lap.
"Two days? That's great! every day is a new chance to make a new choice. What do you think?"
"Yeah, today's a new day, but that doesn't help me feel less like shit."
"I know, but you'll feel physically better sooner if you can just forgive yourself and let go of what happened. You can learn from your mistakes without beating yourself up about it."
"That's true. I just hope I can do it."
"You have choices every day. You made a good choice to come in today and talk to us. Let's plan on some good decisions tomorrow, too, OK?"
"OK. I'll be back next week. I think I'll get some exercise." We both stand up and shake hands.
As the door closes, I take a deep breath. Addiction must be such a weight to carry. I give thanks that it doesn't have a hold on me, and feel a swelling of compassion for those for whom it is a daily---or even an hourly---struggle.
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