Is there a right way to Grieve

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Current understandings of grief has shifted away from looking at grief as a continuous upward process through stages and instead looks to how individuals integrate loss into their lives. In the following description, we see how misperceptions of grief can be a hindrance for people, as the expectations of moving through grief are often unrealistic. With these misperceptions, when grief doesn’t move forward, people often get increasing anxious and concerned, and a vicious cycle begins. In the bereavement group I co-run, we had a person attend who shared she hadn’t cried for her husband for many months and worried something was wrong. We discussed how tears come for people at different times and in different situations. In a subsequent meeting, she shared that she had finally cried, as she was no longer trying to force herself to shed tears, the tears came.

Getting Grief Right

By PATRICK O’MALLEY JANUARY 10, 2015 1:16 PM January 10, 2015 1:16 pm

By the time Mary came to see me, six months after losing her daughter to sudden infant death syndrome, she had hired and fired two other therapists. She was trying to get her grief right.

Mary was a successful accountant, a driven person who was unaccustomed to being weighed down by sorrow. She was also well versed in the so-called stages of grief: denial, anger, bargaining, depression and acceptance. To her and so many others in our culture, that meant grief would be temporary and somewhat predictable, even with the enormity of her loss. She expected to be able to put it behind her and get on with her life.

To look at her, she already had done so. The mask she wore for the world was carefully constructed and effective. She seemed to epitomize what many people would call “doing really well,” meaning someone who had experienced a loss but looked as if she was finished grieving. Within a few days of the death of her daughter she was back at work and seemed to function largely as before.

The truth of her life was something else. Six months after her baby’s death she remained in deep despair. She was exhausted from acting better than she felt around co-workers, friends and family. As is so often the case, she had diagnosed her condition as being “stuck” in grief, believing that a stubborn depression was preventing her from achieving acceptance and closure.

Was she in denial, she wondered. She also wondered if she was appropriately angry. The bottom line was that she knew she was depressed — a psychiatrist had prescribed an antidepressant — and that is what she wanted me to treat.

Earlier in my practice, I would have zeroed in on that depression. Was there a family history? Had she been depressed before? Was the medicine helping? What were her specific symptoms? Knowing the answers might suggest why she was stuck. Or I would have reviewed the stages of grief, as she had, looking for one in which the work remained incomplete.

But I had begun to operate differently by the time Mary showed up, which was 10 years after my own loss. My firstborn child had also died before he was a year old. It was why Mary had chosen me.

In our first session I put Mary’s depression aside. I asked her to tell me the story of her baby rather than describe the symptoms of her grief. Though she was resistant, she eventually started to talk.

Like most other things in Mary’s life, the baby, whom she named Stephanie, was planned. Mary was delighted with her pregnancy and had wonderful dreams for her daughter. After a routine delivery, Mary stayed home with Stephanie for the first three months. Returning to work had been difficult, but Mary was comfortable with the child-care arrangement, and managed to balance motherhood with her busy professional schedule.

Then Mary told me about the Saturday when she went to check on her napping daughter and found that Stephanie wasn’t breathing. She began C.P.R. as her husband called 911. There were moments of surreal focus as she and her husband tried to save their baby. Then this woman, so accustomed to being in control, had to surrender her daughter to an emergency crew. Her husband drove as they followed the ambulance to the hospital.

She described the waiting room in great detail, down to the color of the furniture. When the hospital chaplain walked in with the doctor she knew her baby was gone. She and her husband were taken into a room where they held the baby for the last time.

At this point in her story Mary finally began to weep, intensely so. She seemed surprised by the waves of emotion that washed over her. It was the first time since the death that the sadness had poured forth in that way. She said she had never told the story of her daughter from conception to death in one sitting.

“What is wrong with me?” she asked as she cried. “It has been almost seven months.”

Very gently, using simple, nonclinical words, I suggested to Mary that there was nothing wrong with her. She was not depressed or stuck or wrong. She was just very sad, consumed by sorrow, but not because she was grieving incorrectly. The depth of her sadness was simply a measure of the love she had for her daughter.

A transformation occurred when she heard this. She continued to weep but the muscles in her face relaxed. I watched as months of pent-up emotions were released. She had spent most of her energy trying to figure out why she was behind in her grieving. She had buried her feelings and vowed to be strong because that’s how a person was supposed to be.

Now, in my office, stages, self-diagnoses and societal expectations didn’t matter. She was free to surrender to her sorrow. As she did, the deep bond with her little girl was rekindled. Her loss was now part of her story, one to claim and cherish, not a painful event to try to put in the past.

I had gone through the same process after the loss of my son. I was in my second year of practice when he died, and I subsequently had many grieving patients referred to me. The problem in those early days was that my grief training was not helping either my patients or me. When I was trained, in the late 1970s, the stages of grief were the standard by which a grieving person’s progress was assessed.

THAT model is still deeply and rigidly embedded in our cultural consciousness and psychological language. It inspires much self-diagnosis and self-criticism among the aggrieved. This is compounded by the often subtle and well-meaning judgment of the surrounding community. A person is to grieve for only so long and with so much intensity.

To be sure, some people who come to see me exhibit serious, diagnosable symptoms that require treatment. Many, however, seek help only because they and the people around them believe that time is up on their grief. The truth is that grief is as unique as a fingerprint, conforms to no timetable or societal expectation.

Based on my own and my patients’ experiences, I now like to say that the story of loss has three “chapters.” Chapter 1 has to do with attachment: the strength of the bond with the person who has been lost. Understanding the relationship between degree of attachment and intensity of grief brings great relief for most patients. I often tell them that the size of their grief corresponds to the depth of their love.

Chapter 2 is the death event itself. This is often the moment when the person experiencing the loss begins to question his sanity, particularly when the death is premature and traumatic. Mary had prided herself on her ability to stay in control in difficult times. The profound emotional chaos of her baby’s death made her feel crazy. As soon as she was able, she resisted the craziness and shut down the natural pain and suffering.

Chapter 3 is the long road that begins after the last casserole dish is picked up — when the outside world stops grieving with you. Mary wanted to reassure her family, friends and herself that she was on the fast track to closure. This was exhausting. What she really needed was to let herself sink into her sadness, accept it.

When I suggested a support group, Mary rejected the idea. But I insisted. She later described the relief she felt in the presence of other bereaved parents, in a place where no acting was required. It was a place where people understood that they didn’t really want to achieve closure after all. To do so would be to lose a piece of a sacred bond.

“All sorrows can be borne if you put them in a story or tell a story about them,” said the writer Isak Dinesen. When loss is a story, there is no right or wrong way to grieve. There is no pressure to move on. There is no shame in intensity or duration. Sadness, regret, confusion, yearning and all the experiences of grief become part of the narrative of love for the one who died.

Patrick O’Malley is a psychotherapist in Fort Worth.

This is an essay from Couch, a series about psychotherapy at nytimes.com/opinionator. Some details have been altered to protect patient privacy.

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Mindfulness techniques for caregivers

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Being a caregiver is often one of the most taxing and emotionally draining tasks someone can take upon him/herself.  I have been witness time and again to the burnout that occurs to the best of people, to people who’s hearts are in the right place but eventually wear down because of the details needing attending to.  I came across a list of 5 ways to practice mindfulness as a caregiver which can combat feelings of being overwhelmed.

When Caregivers Need Healing

Here are five ways you can bring mindfulness into your caregiving.

Photograph by Corey Kohn

By Nell Lake

Many of us find ourselves caring for loved ones braving old age, decline, and dying. Caregiving is demanding—at times overwhelming. Yet it can also cultivate intimacy, wisdom, and insight. For my book, The Caregivers: A Support Group’s Stories of Slow Loss, Courage, and Love, I chronicled the experiences of the members of a caregivers support group for more than a year. Here are some things I learned about mindful caregiving:

1. Be where you are

It’s a central principle of mindfulness: trying to do one thing at a time, and knowing that you’re doing it, and doing it with kindness toward yourself.

Caregiving often requires responding to seemingly countless needs, appointments, tasks. Studies show caregivers face higher rates of stress and illness than non-caregivers. If you’re feeling overwhelmed, lonely, frequently angry and irritable or guilty, and/or crying a lot, you’re likely at risk of burnout. Some suggestions for easing your stress:

• speak with your doctor. He or she should be able to help you find resources that help.

• call your local senior center to ask about sources of support such as senior day care and/or respite programs and support groups.

• make a list of activities that nourish you, and try to build one or more of these into your days: journaling, say, or taking walks outside, calling a supportive friend, taking some time to do yoga, meditating—whatever helps you come back to yourself and the moment you’re in.

It’s so easy to adopt the habit of mind that another person’s needs matter more than yours, but one of the most important things you can do to prevent burnout over the long haul is to value your own well-being.

2. Be gently aware of loss and change

Much caregiving is for people with dementia or other long-term chronic illness. Your family member is changing, going through decline—very slowly. Your mother might be losing her ability to communicate; your father’s personality might be changing. It can feel as if your family member is “gone but not gone.” Caregivers often experience long-term uncertainty—and this can be very stressful.

It helps to be aware of slow loss and its particular challenges—and to give yourself permission to feel grief and the other feelings that arise along the way. Letting the feelings simply exist, seeing that they change, can help you gain more clarity, control, and a sense of space.

Mindful awareness doesn’t mean ruminating on loss in a negative way. Thoughts such as “this shouldn’t be this way; this isn’t my mother!” will mostly feed stress. Yet taking time to see the stressful thoughts and storylines that form in your mind can help you not get completely caught up or identify with them. You may even find more acceptance of what’s happening—to see it as natural, a part of life, rather than an aberration.

3. Meet your family member where he or she is

Try to accept the effects of your family member’s aging and illness, the way their mind and body work at this point in their lives. With people with dementia in particular, it’s really helpful to try to create good feelings in as many moments as possible. Studies show that, even for someone who doesn’t remember something you said five minutes before, good feelings last for quite a while. A person with dementia might have a good laugh or hear a song they love or watch a wonderful scene from a movie—and hours later they’ll still be feeling the effects of these. Arguing with their perceptions—saying, “it’s Tuesday, not Thursday” or “you already said that six times today”—is not just futile; it creates stress for both of you.

“Meeting them where they are” is a good principle no matter your family member’s particular illness or impairment. Maybe he or she can’t walk up the stairs anymore and feels cranky about losing mobility. If you can let go of the story “this shouldn’t be this way,” you’ll likely save yourself a lot of suffering. Instead of all this happening to you, it just is. It happens to everybody.

4. Seek out support. Ask for help. Share your story.

Caregiving is isolating; it usually happens in private homes, behind closed doors. Yet connection is vital to us as human beings. The support-group meetings I followed gave the caregivers a chance to connect with others who understood. The members felt trust with one another and usually said whatever they needed to—even shared thoughts and feelings that they didn’t share with others outside the group. Mutual support helped them to be resilient in the midst of their challenges.

Meanwhile they gave one another very little advice. Probably no one likes unsolicited advice, but to caregivers, being told how to handle unique, personal, and challenging situations can be particularly frustrating. The group understood this, and mostly just told stories and listened. They did, however, learn practical things through their listening: They heard about ways others had solved problems, and about available resources. A person caring for someone in the early stages of a disease often learned by listening to another person caring for someone in later stages.

I saw enormous value in the group that I followed, and think a good group can be a profound source of support. But support groups are not for everyone, of course, nor do I think all groups are equal. You may join one, decide it’s not helpful at all, and go looking for a different one. You may find other ways to receive connection and support. This is the central point: to recognize when you need support and seek it out.

5. Be kind but don’t try to be a saint

One of the caregivers I followed, Penny, was upset one evening. She’d brought home two cannoli to share with her mother—a rare treat in their household. Before Penny had had a chance to offer them, her mother had found them and scarfed them both down. Penny discovered this and felt like yelling. Instead she went into another room and wrote “wrathful emails” to her sister. She vented, in other words, which helped. A few days later, she laughed about the incident in her support group.

Being kind doesn’t always mean feeling kind. It does mean doing the right thing in a particular moment. Of course, trying to feel compassion, having that as an intention, is good—but of course one isn’t going to feel compassion in every moment.

Again, it’s important to direct kindness inward. There’s a teaching: when you’re being generous, know that you’re being generous. When you have good qualities of mind, being aware of them can help to further cultivate them. In your caregiving, acknowledge that you’re being caring. You’re helping someone. Even when caregiving feels hard, it can be sustaining to recognize your generosity. You’re helping someone to have a good end to her or his life.

Nell Lake is the author of The Caregivers: A Support Group’s Stories of Slow Loss, Courage, and Love, published by Scribner and released in paperback this Spring. Names in both the book and in this blog are pseudonyms.

This article also appeared in the February 2015 issue of Mindful magazine.

Can Yoga help with Grief?

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People search for different modes of coping with the emotional upheavals related to grief.  For some, it is finding comfort in a spiritual practice, such as Yoga.  Here is a short piece explaining how Yoga can help in grieving loss.

Yoga: A Treatment for Grief?

The practice may help people heal from the inside and out when coping with loss.

Young woman and friends practicing yoga in health club

Grief has traditionally been thought of as a psychological experience, but mental health experts are beginning to realize it involves a complex relationship between body and mind.

By Jan. 7, 2015 | 10:51 a.m. EST+ More

Abby Saloma was physically and mentally crushed from caring for her mother, who was dying fromovarian cancer. To make things worse, the then 27-year-old was hours away from the District of Columbia yoga studio that had helped her cope with her mom’s diagnosis.

So Saloma did the only thing she could think to do: She called the one yoga teacher in her hometown near Reading, Pennsylvania, she knew of​ – and begged. “I am desperate for a yoga practice,” Saloma told the woman, who led her in a private session in the loft of a barn. “It was just such a powerful, powerful experience,” Saloma says.

Now, more than 10 years after that session and the death of her mom, Saloma has become a certified yoga instructor and has led a yoga workshop specifically for people who are dealing with grief. Another “healing workshop” ​​ is in the works for March.

“The premise of it is, in our society, we really push death under the rug – we’re terrified to talk about it,” says Saloma, whose workshops include journaling, guided meditation and poses aimed at opening the heart and hips. “Yoga allows us to be present with it​, and I believe that being present with it allows us to live a fuller, more awakened life.”

New Thinking on Grief

Research has shown that mind-body practices including yoga and meditation can help reduce symptoms of various conditions such as depression, anxiety, negative mood, fatigue and stress.

But mental health experts are beginning to recognize the power the practices can also have on people coping with grief, which used to be viewed as a largely psychological experience, says Kait Philbin​, a psychologist and a certified yoga teacher in Redwood City, California.

“It used to be that [therapists] just thought that all you had to do was look at the mind, but they’re realizing that there’s a complicated relationship going on between the body and mind,” Philbin says. Her research has shown that a six-week yoga therapy program for grief and bereavement significantly improved participants’ vitality (a measure of appetite, energy level, sleep, relaxation and body stiffness) and positive states​ (the ability to get good rest, concentrate and be intimate).

The theory of grief, too, as a five-stage process including denial, anger and acceptance, is also shifting. Today, professionals are more likely to endorse the perspective that everyone experiences grief differently, says Heather Stang​, a yoga therapist and meditation instructor in Frederick, Maryland, and author of “Mindfulness & Grief.” “There’s no right or wrong way for grieving, [and] there’s no right or wrong way to practice yoga for grief,” she says.

In her eight-week yoga for grief course, Stang first leads breathing exercises to help participants relax, since “the bereaved body is so wound up and so stressed out,” she says. Stang then guides students through protective poses like child’s pose, as well as lengthening movements​, and gives them time to journal and share their experiences with one another.

She also uses her background in thanatology – the scientific study of death, dying and bereavement – to educate participants about ​death and normalize their experiences. “We have to not make grief a disease – it’s not a disease,” she says. “It’s as natural as birth and death itself.”

Why Does It Work?​ ​

When Antonio Sausys’s​ mother died from a stroke when he was 20, the physical manifestation of grief was striking: After two and a half years of ignoring his pain, he discovered his breastbone had popped out.

“What my mind could hide, my body showed with pristine clarity: I had a broken heart,” says Sausys, a yoga instructor in San Anselmo,​ California, who went on to earn a master’s degree in ​body-oriented psychotherapy and to publish “Yoga for Grief Relief.”

“If the body is left out [of grief treatment], it becomes a very important source of expression of the pain, and it easily falls in deep dysfunction,” Sausys says.

Indeed, grief often presents itself physically – in stomach pain and fatigue for Saloma, in headaches and a loss of appetite in others. “We hold grief, we hold pain, we hold stress – we hold that in our bodies,” Saloma says.

That’s one of the reasons why yoga and its myriad physical benefits – from lowered blood pressure to improved strength and balance – can be an effective way to manage the pain of grief.

“When you’re grieving, there’s a defense mechanism that kicks in to protect yourself – you kind of go into survival mode,” Saloma says. “And by really opening your heart, you’re able to express some of that vulnerability and let some of that out and be more present with it.”

Some of yoga’s benefits for people coping with grief might also be achieved through other forms of physical activity like running, says ​Robert Neimeyer​, a psychology professor at the University of Memphis and editor of the journal Death Studies. In one of his ​studies comparing the effects of yoga, running and group therapy on people with depression – some of whom were grieving – he and colleagues found that both yoga and running had superior long-term benefits ​compared to group therapy.

His more recent research tested an intervention for grief that encourages people to reflect on the idea that nothing is permanent and to create a new “self-narrative” in light of their loss. He and a colleague found that the intervention – which included poetry reading and storytelling, as well as meditation and slow physical movement – was effective in reducing grief-related pain. It’s not a stretch to see why yoga, especially types that foster mindfulness through meditation, might do the same, Neimeyer says.

“This [intervention] is not a panacea,” he says, “but it can be perhaps a less anguished perspective that helps us find some meaning or sense in our suffering.”

New Year’s Resolutions: What works and what doesn’t

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A new year on the calendar is usually a time when people set new goals to attain and strive for in the upcoming 12 months of the calendar.  Most people do this because it is an easy demarcation point to start fresh, even though the idea of a new year is somewhat arbitrary to the calendrical system on follows.  Nevertheless, most resolutions fail.  In the first of two pieces “This Is Why Your New Year’s Resolution Will Fail,” the author presents three reasons resolutions tend not to stick.

New Years Resolution Fail

Did you even bother to make a New Year’s resolution this year? Most people didn’t.

According to a national public opinion poll conducted by Marist Poll on December 18, 2014, only 44 percent of Americans are likely to have made a New Year’s resolution for 2015. And it’s no surprise – given how high resolution failure rates are, many simply don’t even bother. The poll found that 41 percent of Americans couldn’t even keep their resolution for at least part of the year, let alone see it through to success.

Weight loss is the most popular resolution, with other common resolutions including quitting smoking and spending less money. Whatever your resolution is, here are six reasons why we fail to accomplish our New Year’s resolutions – and how you can get around them.

1. We Set Unreasonable Goals

Amy Cuddy, a social psychologist and associate professor at Harvard Business School, put it simply. “We’re really bad at setting reasonable goals,” she told Business Insider.

Rather than resolve to start going to the gym once a week for 30 minutes, we resolve to commit to a gruelingP90X exercise regiment. Why? Is it because human ambition makes us think big? Is it because we believe a New Year’s resolution must be something huge? Or can it be that we’re just really bad at judging what is reasonable to accomplish? Regardless of the reason, these grandiose goals set us up for failure.

“When you set weight loss goals, you don’t really know how your body is going to react or what is going to be attainable,” says Lisa Ordonez, a professor at the University of Arizona’s Eller School of Business whose research focuses on goal-setting in organizations. “If you haven’t done it for awhile, you need to do your research and revise your expectation.”

Don’t buy into the “go big or go home” mentality. If you want your resolution to succeed, then don’t be afraid to think smaller. There are penalties to failure beyond the obvious, which leads us to our next point…

2. We Have Failed Before

“Every time we fail, we damage our own self-esteem,” says Janet Polivy, a psychologist at the University of Toronto in Mississauga. “We make ourselves less able to bounce back the next time. One thing we see is that, when people fail, they don’t blame the diet. They blame themselves. And that makes it hard to start again.”

Did you fail to achieve your 2014 resolution? That makes you that much more likely to give up on your 2015 resolution. In general, failure is a poor motivator, and there’s something to be said for momentum: when you’re on a streak of victories or failures, it becomes easier to ride the high – or low.

The Marist Poll found that younger Americans are more likely to make resolutions than older Americans. Can that be because older Americans have given up on trying after repeated failures? We can’t say for sure, but we can say that avoiding failure will help you keep your future resolutions. Setting more realistic goals is a good start, but be sure to follow up by avoiding our next point…

3. We Turn Mistakes into Failure

“The research has been replicated fairly frequently,” Polivy says. “There seems to be this sense of, ‘well, I ate something I shouldn’t, this day is ruined, I’ll just start again tomorrow, or next week, or next month.'”

Polivy is describing the “what the hell” effect, which is an easy trap to fall into. We let a cheat – or a mistake – turn into a failure. Rather than concede that we slipped up and immediately resolve to redouble our efforts, we mulligan the rest of the day, breaking our forward momentum and instead building up momentum towards resisting getting back on track.

“What the hell; I already had that slice of pie. I may as well have the milkshake, too.” Avoid this kind of thinking.

However, not to just offer a negative perspective, here is a second article offering suggestions for creating resolutions that have a greater chance of lasting.

The amazingly simple psychology of successful New Year’s resolutions

(BPT) – The arrival of cold weather and Valentine’s day aren’t the only predictions you can reliably make about February each year. It’s a pretty safe bet that many resolutions passionately adopted in January will be broken by the end of February – if not sooner. New Year’s resolution success, however, is possible, and the first step in the right direction is to change your mindset.

“New Year’s resolutions can be a good opportunity to start healthier habits and personal improvement projects,” says Dr. Jim Wasner, program dean at theIllinois School of Professional Psychology at Argosy University | Schaumburg. Think of resolutions as a reminder of the larger goals and plans you have for your life. These life changes should be planned carefully with both long-range dreams and desires and short-term actions on how to get there. Just because you have difficulty in achieving a short-term objective doesn’t mean you have to give up your aspirations. You may just need to revise your actions and fine tune your solutions,”

Here are some suggestions to consider when making New Year’s resolutions:

* Make fewer resolutions. Too many promises to make drastic life changes can be overwhelming. A shorter list will feel more manageable.

* Keep resolutions realistic and achievable.

* Seek support from family and friends, and ask them to provide gentle reminders and constant encouragement to help you keep the resolution.

* Create a plan that starts slow, eases you into a routine, and tracks progress with attainable benchmarks.

* Give yourself a break if you succumb to temptation now and then, but resolve to get back on track right away.

* Don’t turn your resolution into a competition and avoid comparing your progress to others’. Instead, view others’ accomplishments as inspiration.

“Life changes are an important part of our development as mature adults,” Wasner says. “Resolutions are a fun way to remind us that change is an important part of who we are as humans. Use them as an impetus to fine tune your plans and not as a weight to be shouldered.”

Finally, Wasner cautions, don’t get discouraged if it takes more than one try to succeed. “New Year’s resolutions are not a short run but more like a marathon where you must pace yourself to reach success,” he says.

When hospice becomes routine

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As with most methods of providing health care in a holistic, patient centered way, hospice has seen many changes, some of which have caused a struggle to be present to the individual needs of the family while also complying with the ever changing guidelines.  The following piece is from a hospice nurse lamenting how things are becoming mainstreamed in ways she finds dissatisfying.  I agree with her overall sentiment and am particularly keen on her final lines,

I am, and will always be, thankful to my dying patients, the only ones actually experienced in dying, who have shown me time and again to STOP, leave my agenda behind, LISTEN to their hopes and desires, and bring perhaps some insight, but not all the “answers” to their bedside. After all, as I have said before, I might be the hospice nurse, but THEY are the experts.

Listening is the key.  And there are good and tried methods of working within the changing ramifications and still supporting each particular families wishes.  We also must remember that expertise can go be offered on both sides of the aisle, and sometimes our insider knowledge can help navigate the needs of each particular family.

Back to basics: are we losing sight of what hospice care is all about?

Photo by Joan Teno

by: Amy Getter, a hospice nurse who blogs regularly at hospicediary.com

In our ever-challenging and changing medical system, the current hospice and palliative care movement has undergone heightened scrutiny, increased regulatory stipulations, and in general has become a part of the federal government’s health care crisis (just review Medicare Conditions of Participation and billing requirements to get a head full of terms and guidelines to be overwhelmed by it all). Yes, hospice has become big business.

I am a hospice nurse. I have seen the changes in the past decade, as Medicare requirements become more stringent and hospice has moved from grassroots to mainstream; and the “evidence-based practice” mantra has precluded use of medications and treatments that have historically been effective but now lack current “research validation”. Or new results from a few cooperate-funded studies who have the most to gain by predetermining that certain treatments are not effective change our practice, and I can’t help but wonder about bias. Or large pharmaceutical companies, (providing much of the funding sources for many of the studies on medications), suddenly phase out older medications that are not profitable. Or politics become involved in deciding things like what opioid medications should be approved for public use and how people’s choices at the end of life must be managed by laws and public approval.

And I must pose the question, “Are we losing sight of what hospice care is all about?” I see younger nurses coming into the hospice profession, and learning about “best practice”, being taught that the “experts” know best. That “evidence based practice” is THE answer.

I am reminded of the middle of the last century, when birthing practices became managed and performed by experts in white coats in medical facilities, new technology and expert roles slowly removing the simplicity and normalcy of birth. I am not trying to over-simplify a complex experience, truly: not every birth and death is uncomplicated and many need to have advanced medical care. Thank goodness for advances and treatments that were hitherto unknown! But I am advocating that we not have total reliance on the science of death and dying, remembering how both birth and death have sacredness and mysticism that cannot be quantified. For centuries, birthing and dying are the human experience. Is it really only now, with our medical advancement, that we know how to provide ease of suffering in both states of humanness?

I heard, again, from hospice staff this week, how a family should let the patient be transferred out of the home and placed “where experts in end of life care could care for him”, while the loved ones could just be “the family”, coming to visit and sit at the bedside. And I was a little horrified, that we, the hospice “experts” are succumbing to the lie that caring for the dying is so complicated and combersome, we must rely on “experts” to provide the answers and often even the care. I do not believe we, “the experts”, can provide the same level of solace as a person who has loved a dying family member all their lifetime. I am and always will be an advocate for the patient and family, with the conviction and goal in hospice nursing to create confidence in family members. They can be the ones who comfort and care for their own dying loved one in their own home whenever possible. Isn’t that what most of us hope for, when we die, to be at home with family?

For centuries, caring for the dying relatives was a part of life lessons taught while children grew up in multi-generational living environments, and saw the normalcy of caring for ones’ elders through the lifespan. I like to believe that the basics of care for a dying person can be taught in an atmosphere of simplicity and loving kindness, and the gift that family receive from providing the care is a part of the lasting memorial to that loved one. In fact, this has been my experience time and time again.

I empathize with wanting to standardize and compartmentalize dying, we all would like to have it tidied up and handled for us. It might seem more palatable in the white halls of the medical experts. But I am certain that dying will always involve the messiness and unexpectedness that birthing also entails. Nor does the current body of evidence preclude learning from centuries of how people die.

I am, and will always be, thankful to my dying patients, the only ones actually experienced in dying, who have shown me time and again to STOP, leave my agenda behind, LISTEN to their hopes and desires, and bring perhaps some insight, but not all the “answers” to their bedside. After all, as I have said before, I might be the hospice nurse, but THEY are the experts.

To prayer for a patient

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There was a great article I saw from a physician describing his feelings towards prayer being important in his medical practice.  He shares two stories about situations in which through praying, there was guidance in advancing the medical help.  I was particularly taken by his candidness in acknowledging that his prayer was just a “simple plea for help.”  I would offer that prayer is just that.  Prayer can be beautiful and poetic.  But prayer from the depths, from the heart, is often plain, ugly and brutish.  It is the simple musings we feel.

Physicians’ Prayers for Their Patients During Surgery

Published Jan 5, 2015

As a physician I am often reminded of two things for which I am grateful. First, the great honor it is to care for people who are in a time of great need in their lives. Second, the many mentors in my life who have patiently taught and trained me in the arts of medicine.

Recently, I have thought a lot about one mentor, the late Dr. Blayne Hirsche. Dr. Hirsche was a gifted plastic and hand surgeon. He trained in surgery at Harvard and the Mayo Clinic. He founded the Hirsche Smiles foundation, which has performed thousands of reconstructive surgeries on children in Mexico and Guatemala. His legacy of compassionate care and service lives on through this foundation.

A Young Surgeon’s Prayer

Before medical school, I had the pleasure of working with Hirsche to gain experience as he performed surgeries. I cannot recall the details of why, but one day we talked about lessons he had learned during his training. One story he told has stuck with me ever since. He talked about a difficult surgery he was performing as a resident physician at Harvard. The head surgeon was world-renowned for the procedure being performed. Unfortunately, severe abdominal bleeding complicated the surgery.

At one point, it became apparent to Hirsche that the patient was going to bleed to death. Blood would rapidly fill the open abdomen as quickly as the surgical team could evacuate it, making it impossible for them to find the bleeding source. Suddenly the room became quiet and all eyes were directed toward the lead surgeon, who had stopped talking and working. A few moments later the surgeon reached into the abdomen and the bleeding stopped. His fingers had found the bleeding source, and with pressure the bleeding stopped. With the bleeding source identified, the surgeons quickly sutured the area, and the patient lived.

After the surgery, Hirsche asked the lead surgeon what had happened and why had he stopped. The lead surgeon said he stopped when he realized they were going to lose the patient, and he prayed for help. The surgeon did not say anything more. This was a profound experience for Hirsche as this surgeon was not known as a spiritual person. In fact, this was the one and only spiritual statement this surgeon ever made to Hirsche.

A Young Mother’s Difficult Heart Procedure

Most physicians are very aware of the limitations of medicine and medical procedures. Despite our best intentions, we often lose the battle to diseases. Every patient is unique, and even routine procedures can be challenging. All physicians who treat life-threatening diseases and have been in situations where they know they’re doing all they can for a patient and yet the patient’s life is slowly slipping away.

Hirsche shared his story with me nearly 20 years ago. His message found its way into my practice recently. A young mother of four children came to the hospital in severe heart failure. Four weeks earlier she had delivered a healthy baby. Now her heart was failing as 90 percent of the pumping function was no longer working.

As her heart failed, her lower heart chambers dilated and stretched, causing abnormally fast heart rhythms to develop. This further worsened her heart failure. Strong intravenous medications were started to support her blood pressure and fight impending kidney and respiratory failure. Despite our strongest intravenous medications to make the heart beat normally, as well as multiple electrical shocks to her heart, her abnormal heart rhythms continued.

It was clear she was close to dying, but we had a few options. One was to replace the heart with an artificial heart until she could get a heart transplant. Another option was to do open heart surgery to place heart pumps, called ventricular assist devices, to support her failing heart. The third was to go into her heart through her blood vessels, find the source of the abnormal heart rhythm, and destroy it. This could allow the heart to slow down and hopefully recover. Due to potential challenges with placing a heart pump, the third option was felt to be the best. For that reason, I became involved.

A Simple Plea for Help

When she arrived in our cardiac catheterization room, she was placed on a breathing machine. The room buzzed with physicians specializing in high-risk anesthesia, critical-care medicine, heart failure, and surgery. The cardiac surgery team was on standby to perform an emergency procedure, if needed, to transition her to a transplant. As we prepared for the cath procedure, her blood pressure continued to fall, requiring more medications to support it. Her blood oxygen level also started to fall, despite respiratory support. I quickly gained access to her blood vessels. In the setting of severe heart failure, these ablation procedures to treat abnormal heart rhythms often take four to six hours. I knew she didn’t have that much time.

Before I advanced the tool into her heart, I prayed silently. My prayers are not graceful and eloquent. I would characterize them as a simple plea for help. A few seconds after my prayer, I advanced a tool into her heart to the area I thought was most likely causing the abnormal rhythm. As the tool touched this area, the abnormal heart rhythm stopped. We delivered heat energy to the site to destroy the short circuit. Her blood pressure and blood oxygen began to rise. And her heart rate — once at 150 to 160 beats per minute — now beat normally at 100 beats per minute.

I have treated hundreds of these abnormal heart rhythms, but I have never seen such a quick response. Within five minutes of starting the procedure, her heart was normal. That night I was able to talk with her. She held my hand and said “Thank you.” There was not a lot more to say. It was humbling for me because I realized that a few hours earlier we both had pleaded for help. I am happy to report she is on her way to recovery. Her heart is getting stronger each day.

Faith and Hope Among Physicians

I have had many mentors who draw great strength from spiritual sources. Some have been Christians like me, while others were Jewish, Hindus, Buddhists, and Muslims. That is one of the great aspects of medicine: A tremendous diversity of backgrounds come together for a common goal. I have heard some people say that physician spirituality is a sign of weakness, but I have found the opposite to be true. These mentors of mine are world leaders in their fields and draw from all means to treat and care for people in a field that does not have all the answers. They use their faith to find inner strength and peace. To a believer of spiritual things these stories can make believing easier.

It is harder when prayers and best intentions fail. Believers will often say that when this occurs it is part of a greater plan or design. To a nonbeliever of spiritual things, perceived failures make it easier not to believe.

I am grateful for my patients who have told me that they, their family, or pastor have prayed for me and they believe everything will be all right. These gestures are filled with great faith and hope. Hope and optimism, regardless of belief, are associated with better outcomes and longevity. I once had a Catholic patient who came in for a very small routine procedure. He also took my hand and said, “It will be alright, I had my last rites read to me.” I am not sure if that was a vote of confidence. I told him thank you, but I was not planning on letting him die just yet.

I have a close friend who is an atheist. He told me one day, “You know all of this is not going to matter in the end, as we all die and aren’t coming back.”

I told him that is what makes it even more meaningful. Because when we do die, it is important to have hope in a better tomorrow.

Is there an app that can monitor depression

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In today’s Wall Street Journal, there was a business tech article Can a Smartphone Tell if You’re Depressed?  As I have been following the use of technology in therapy and wondering about its usage in spiritual care/chaplaincy, this caught my eye.  I noticed in the new IOS that came out some months ago the phone was recording how many steps I took a day when carrying the phone.  I was surprised and intrigued that my phone could do this.  The article describes an app, Ginger.io, which some medical institutions began to use to track depression.  The app has not been put through research studies by independent users yet, but perhaps we are seeing a continued growth in tech based mental health help that can be a first response to help people recognize when help is needed.

Can a Smartphone Tell if You’re Depressed?
Apps, Other Tools Help Doctors, Insurers Measure Psychological Well-Being

By JOSEPH WALKER
Updated Jan. 5, 2015 7:03 p.m. ET

HUNTERSVILLE, N.C.—Toward the end of Janisse Flowers’s pregnancy, a nurse at her gynecologist’s office asked her to download an iPhone app that would track how often she text messaged with friends, how long she talked on the phone and how far she traveled each day.

The app was part of an effort by Ms. Flowers ’s health-care provider to test whether smartphone data could help detect symptoms of postpartum depression, an underdiagnosed condition affecting women after they give birth. The app’s developer, San Francisco-based Ginger.io Inc., compared data from Ms. Flowers and nearly 200 other women against their answers to a weekly survey used to diagnose depression. The company says it found that behavioral patterns like decreased mobility on weekends and longer phone calls were associated with poor mood in surveys.

“It’s very creepy to think someone can tell your mood” based on smartphone data, says Ms. Flowers, who gave birth to twins last year. But “I felt like this was something that was going to help me while I was in a vulnerable place.”

The Ginger.io app is one of a new generation of health-surveillance technologies that doctors, hospitals and health insurers are starting to use. Where fitness trackers like FitBit record jogging distance and calories burned, newer apps and other tools measure text-message volume, vocal tone and other behaviors to peer into patients’ psychological well-being, which doctors say can have a high correlation with physical health. Health insurer Aetna Inc., for instance, says it uses voice-analysis software on some telephone calls to get people who receive short-term disability benefits back to work sooner.

“There are four billion phones on the planet, and it turns out they’re incredibly powerful diaries of a person’s life,” Ginger.io Chief Executive Anmol Madan says.

Ginger.io’s app, called Ginger.io, is being used by 30 medical centers, including Kaiser Permanente and the University of California, San Francisco, the company says. The National Institutes of Health has given a $2.42 million grant to researchers at the Harvard School of Public Health to develop a smartphone app that will analyze factors including when patients lock and unlock their phones to determine sleep patterns in people with psychiatric disorders. Researchers at the University of Michigan are developing a smartphone app that records and analyzes patients’ vocal patterns during telephone calls to predict if someone is on the verge of depression or mania.

Many of the technologies are being developed with the aim of treating mental-health conditions. But signs of possible depression, such as when a person suddenly stops calling family members or stays inside the house for a week, can also flag when patients with diabetes or heart disease aren’t motivated to take their medications or follow their exercise and rehabilitation regimens, doctors say.

Many doctors and hospital executives are cautious about using the technologies without hard evidence that the benefits justify the time and expense it takes to use them. There are also concerns about privacy, including data security and whether patients will be alarmed by what could be perceived as intrusive snooping.

“I wonder how companies are going to reassure people that when they download an app that can track everything they’re doing, the data will never be used against them,” says Timothy G. Ferris, an internist and senior vice president of population health management at Partners HealthCare, the largest health-care provider in Massachusetts.

‘I wonder how companies are going to reassure people that when they download an app that can track everything they’re doing, the data will never be used against them.’
—Timothy G. Ferris, senior vice president, Partners HealthCare
Dr. Ferris says he is bombarded by companies pitching their technologies as the way to tamp down on the rising costs of hospital care, but there is rarely compelling evidence to back up the claims. Surveillance technologies like Ginger.io’s are promising, but adopting them before they’re perfected could increase costs without improving patient care, says Dr. Ferris, who leads Partners’ accountable-care organization, which receives financial rewards from Medicare when patient costs are lower than expected while still meeting quality goals.

“It’s going to create a bunch of false positives until they get really, really good at the algorithms,” says Dr. Ferris. “I have a limited budget so I have to make trade-offs, and I’m going to be very tough if I am deciding whether or not to do things.”

Other health systems like Novant Health, a nonprofit hospital system in the Southeast where Ms. Flowers gave birth, are starting to use psychological surveillance tools.

Novant is using the Ginger.io app primarily with patients suffering from psychiatric conditions. But the system has also studied it in diabetic patients—and in pregnant women and new mothers—to test whether symptoms of depression in patients’ smartphone data corresponded with self-reports of feeling down. Patient phone data was downloaded to Ginger.io’s computers automatically, and patients received an alert on their phones each week instructing them to complete a survey.

Novant will evaluate the results of the pilot program and decide whether to use the smartphone app as a diagnostic tool for postpartum depression in the future. Ehab Sharawy, head of Novant’s OB-GYN practice in Huntersville, N.C., said the pilot’s results showed the app has the potential to identify depression symptoms but will need to be reproduced in larger studies.

Nurses employed by Aetna have used voice-analysis software since 2012 to detect signs of depression during calls with customers who receive short-term disability benefits because of injury or illness. The software looks for patterns in the pace and tone of voices that can predict “whether the person is engaged with activities like physical therapy or taking the right kinds of medications,” Michael Palmer, Aetna’s chief innovation and digital officer, says.

Nurses using the software are able to identify six times as many people with depression as nurses using their clinical judgment alone, he says. If nurses conclude a patient may be suffering from depression, they will refer the patient to a mental-health specialist.

Patients aren’t informed that their voices are being analyzed, Tammy Arnold, an Aetna spokeswoman, says. The company tells patients the calls are being “recorded for quality,” she says.

“There is concern that with more detailed notification, a member may alter his or her responses or tone (intentionally or unintentionally) in an effort to influence the tool or just in anticipation of the tool,” Ms. Arnold said in an email. Humana Inc., a Louisville, Ky.-based insurance company, uses the same software, made by Boston-based Cogito Corp., to help improve call-center interactions with customers who have mental-health problems.

Most people don’t expect insurance companies to analyze their voices to make determinations about their health, and some may find it unnerving or an invasion of privacy, says Michelle De Mooy, a privacy expert at the Center for Democracy and Technology. If patients aren’t aware that data is being collected about them, it is impossible for them to correct misimpressions or inaccuracies, Ms. De Mooy says.

Jeffrey Olgin, chief of cardiology at the University of California, San Francisco, says about 1,200 people enrolled in a long-term heart-disease study have downloaded the Ginger.io app. Sleep patterns, stress levels and social interactions are all predictive of heart disease, Dr. Olgin says. He and other researchers are hoping patients’ smartphone data, along with other measures like blood pressure, can help predict when patients are headed toward heart failure.

Researchers initially had difficulty persuading patients to download the app because of privacy concerns, Dr. Olgin says. Researchers told them that only the frequency, and not the content, of their communications would be tracked.

“We first introduced it right after the controversy with the [National Security Agency] trolling people’s data,” he says. “That was one of the concerns, handing over that type of personally sensitive information.”

Tara Dye, who participated in Novant’s postpartum program, said she wasn’t aware of the extent to which her smartphone data was tracked. Ms. Dye says she was told the app would record her location and how far she traveled, but she didn’t realize that her behavior was being probed for a link to depression. She says she doesn’t mind the extent of the tracking, because it was in service of her health care, but she wishes there had been greater disclosure.

Write to Joseph Walker at joseph.walker@wsj.com

Why people tend to avoid helping others in grief

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One of the blogs I follow in my professional work, griefminister.com, shared some months back a list of Eight Reasons We Don’t Help Grievers.  He reflects on how his own mourning experiences taught him people we think will be there sometimes turn the other way.  As we can see from this list, much of the avoidance is tied into feeling that if I don’t know, then I would rather avoid than make a mistake.  His list is a lesson to realize that the goal is to support the mourner, be present and not allow one’s fears to stand in the way of giving to others.

Eight Reasons We Don’t Help Grievers

Mourners need other people to support, comfort and encourage them as they go through grief.  As a mourner myself, I remember the times I felt really alone.  Unfortunately,  I found that some of the  people I thought would be there for me were not…for one reason or another.

There can be many reasons why those around a mourner don’t reach out to help.  The reasons can include:

  • Feeling uncomfortable around mourners.   One of my most painful memories is of a close friend avoiding me during my early grief. I had just returned to church services a few days after the double funeral for my wife and two-year-old daughter in May 1993. As I walked down the church hallway, I saw a friend not far away. As I approached him, he saw me, then his eyes darted side to side nervously and he took off in another direction. His avoidance of me at that moment heaped more pain into my already breaking heart. I felt shunned, devastated and alone. I knew what C.S. Lewis meant in his book A Grief Observed when he wrote, “Perhaps the bereaved ought to be isolated in special settlements like lepers.”Everybody can feel uncomfortable when confronted with the harsh realities of dying, death and grief. Mourners need others to step out of their comfort zone into the world created by their loss. Remember, when you feel uncomfortable it’s not about you; it’s about the mourner and his or her needs at that time. When you enter into and are present in the painful world of the mourner, your presence, availability and support can lighten the mourner’s grief load at that moment and bring significant results.
  • The fear of doing or saying the wrong thing for the mourner. The worst thing that can be done or said to a mourner is NOTHING. So don’t let your fear of causing more pain in the mourner’s life keep you from doing anything at all. The most important thing to remember is that you’re not obligated to say or do much of anything at all to provide the mourner with the support, comfort and encouragement she or he needs. In fact, the best thing you can do for the mourner is to simply be present, available and listen without judging or giving any unsolicited advice. The ministry of presence in someone else’s grief lets the mourner know that there is someone who cares and is there for him or her. Listening ears, an occasional nod, and a simple “I love you” or “I am so sad to see you hurting so much” can go a long way to make the darkest times in life seem a little more bearable.
  • Not wanting to be intrusive in the mourners’ personal time. Respecting the mourner’s privacy is important, but many friends and family members use this excuse to not do anything at all…or to just cover up their fear of dealing with a potentially emotional situation. The truth is that mourners need occasional solitude but they also need others around them to form a support system to help them through the grief journey.So fight your fears and your discomfort and reach out to the mourner. Don’t be surprised, scared away or take it personally if your efforts are met with rejection or hostility. If the mourner lashes out in anger, remember she or he is not angry at you. The mourner is angry at the situation and life at that moment. Respect their space, apologize and return at a better moment to be there for the mourner.
  • A lack of understanding of the grief process or experience.   Often those around the mourner have no idea of what a person in grief is going through. Maybe they have never had a major loss in their lives. Maybe they are simply not very good at dealing with emotional stuff.Show the mourner that you want to help and honor their story by listening to them and what they are experiencing. You don’t have to have a Ph.D. or counseling license to help a grieving person. Mourners can teach you important life lessons about grief…especially about their grief experience. Make sure they understand that you need them to tell you what they want or need. Be present, listen and do things that will show you care for them.
  • An inability to deal with the expression of emotions. Many of us find it difficult to express our emotions and to hear others express their feelings and thoughts. Again, an uncomfortable situation with a mourner is not about us, it is about them and their needs. Sometimes in life it is our turn to receive from others: sometimes it is our turn to give. Now is your turn to give back to mourners the comfort that others have given to you when you struggled in a life crisis (2 Corinthians 1:3-5).
  • The friend or family member is grieving too. On occasion the people around a mourner may be grieving the same loss or another loss in their life. If that happens to you, be honest with the mourner as you spend at least some time for them. Explain to them you want to be there for them and that you will be, but sometimes it may become too painful for them to deal with. Most mourners will understand and appreciate your honesty. If you simply avoid them to avoid further pain without telling them why, you run the risk of inflicting additional pain on the mourner.
  • What culture and our family has taught or not taught us about dying, death and grief. Many of us have learned from culture and our family that grief is a short process that must be gotten over quickly and should be talked about as little as possible. Therefore, we can have little tolerance when a mourner’s grief process is “too long” and all that the mourner wants to do is talk about their loss and its effects on his or her life.We can often think that if grief goes longer than “normal” there must be something seriously wrong with the mourner.The truth is that grief takes as long as it takes and has no timetable other than its own. Every grief is unique to the mourner and his or her relationship with the loved one who died. Also healing in grief involves dealing with painful emotions and thoughts needing to be expressed to others in some way. Be present, patient and understanding with the mourner, allowing them the time and space they need process, express and heal in their grief.
  • A lack of empathy and/or compassion. I think that I can safely say that if you have read this far into this article, you don’t deal with a lack of empathy or an inability to be compassionate with those who are going through grief. A bit of wise advice is that if you know someone like this, be kind, courteous, empathetic, and compassionate toward them because of their situation or nature. Mourners would be wise to spend more time in places and with people that make them feel safe, supported and cared for.

Written by Larry M. Barber, LPC-S, CT author of the grief survival guide “Love Never Dies: Embracing Grief with Hope and Promise”  and the Spanish version “El Amor Nunca Muere: Aceptando el Dolor con Esperanza y Promesa” available online at Amazon, Barnes & Noble and http://grief-works.org/book.php . Also available for Kindle and Nook. Larry is the director of GriefWorks, a free grief support program for children and their families in Dallas TX http://grief-works.org.

The mind of a palliative care professional

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“It must be depressing?”  I hear this question/statement quite often, both among families I work with and people I talk to about my profession.  I would offer that depressing is not an accurate word.  Being with people in the dying process can be emotionally and physically draining, but at the same time very fulfilling and sacred work. I came across an interesting piece from a palliative care physician who offers her thoughts about working in palliative care as a letter to her spouse.  I think the depth of her words speak to the multiple emotions one experiences in being with others during life’s most emotionally trying times.

An open letter to the spouses of palliative care professionals

 by Emily Riegel, MD

My darling,
Some time ago you and I had a crazy idea that it could be the two of us against the world. In our naiveté we thought we had a connection previously unknown to any other human couple. We, in our love, became a superior being that transcended the “you” and the “I.” We agreed that Pablo Neruda’s Sonnet XVII was written about us.

Of course, between then and now, life has happened, just as it happens for all couples.

Our days are busy with children and meetings and work and parents and meals and errands and sick cats and lost keys, and sometimes in the routine of chaos we can say, “How are you? How was your day?”

And I say, “Fine. Yours?”
Sometimes that is true, it was fine.
Sometimes I say, “Really rough.”
Sometimes I say, “It was a crazy day.”
Sometimes I say, “I just can’t even talk about it.”

Yet, even as I have tried to give you a glimpse of the days, there is no way for you to join me in my sadness or frustration or mystified joy.

As we close out another year together, I am going to be honest now, as I should have been all along.

Before I say this, know that my intention is not to make you think my work is superior to yours, or more important, or more difficult, or more valuable.

You see, though, my work IS incredibly hard, and important, and difficult, and valuable.

In one day’s time I see humanity at it’s very best and it’s very worst as I hold another person’s hand while they walk the tight rope between life and death.

I get yelled at and blamed and accused of not caring, but I can’t argue back because I know that I am just the easy target for the anger and grief.
I watch people take their last breaths.

Before those last breaths are taken, though, I get to talk to people about what truly matters to them. We talk about life and death and what it means to live while dying.

I witness lives changing forever.

These are the day’s events that might seem easy to come home and talk to you about, but there are many reasons that I can’t be fully open about it.

Some of these need to be processed in my own mind and heart before I can put them into words to share with you. I need time to wrap my mind around them before I can ask you to wrap yours around it as well.

There are also some that, my dear one, would break your heart. I know you so well, and I know how much you love your family and how terrifying the idea of losing any of them is to you. You are so protective of us whom you love, and if I don’t want you to be fraught with anxiety and fear every time one of us leaves your sight. I choose to protect you from the sadness of the world.

More often, though, I am being selfish of my stories. I want to hold my days close to me and be able to cherish what I have seen or heard or felt. Retelling the story, or trying to capture the it in words is inadequate. It fails the beauty and mystery I’ve been a part of. It’s like catching fireflies, and thinking they are going to flicker in the jar on your nightstand all night long. Instead they give up their blinking and by morning are scattered among the blades of grass, dried and shrunken. I want to give you the fireflies as they are under the oak tree at dusk, not as the shriveled remnants of the beauty. Trying to capture and give you the view of the day when I know I can only possibly give you the tiniest glimpse feels shallow and disloyal to my patients and my colleagues.

I know that you don’t understand what I do or why I do it. I know that you appreciate and admire what I do, though, and for that I thank you.

I thank you for letting me cry when it is the only thing way I have of explaining my day.

I thank you for giving me space when I need it.

I thank you for not rolling your eyes when I insist on cramming in every bit of magic around the holidays because we must make every memory and every moment matter.

I thank you for declaring that if all patients had a palliative care doctor that the American medical system would be fixed.

I am sorry for the times I am emotionally out of reach from you and my mind is still at work, or with a patient or family. I am sorry for the times that I am not handling my stress well and I take it out on you.

When you ask me, “how was your day,” you should know that even with all the stress and chaos and hard work and lost keys, that my day, always, was great. It was wonderful and magic and a gift to be able to spend it doing the work that I love, or with the people that I love, or seeing a beautiful sunset. So I feel guilty when I am frustrated that the kid lost his backpack, or some other minor inconvenience that I get to experience because I am alive and healthy. This is part of the dichotomy of living with me.

Thank you, love, for your patience.

As we go into this new year, remember “I love you like this because I don’t know any other way to love.”

Always,

ELR

Emily Riegel, MD is a palliative care physician at the University of Kansas Medical Center, where she sees both children and adults.

Psychological insights of 2014

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Turning a page on a year includes multiple lists looking back at the best of.  One interesting list I saw was the 4 Greatest Psychological Discoveries of 2014.  While this is one person’s list, I was most fascinated by the commonality of all 4 topics.  They all speak to the need to be more conscious of who we are and what we are doing at any given moment.  As people continue to focus on resolutions for change, perhaps there is something to how we cultivate the focus needed to strive to fulfill our goals.

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Every day of every year, scientists toil away in their efforts to understand the workings of the human mind. What makes us happy? How do our emotions work? What should we be doing differently in our lives to make ourselves healthier, happier and stronger?

Each year, a few studies stand out as particularly helpful by outlining a clear path to accomplish a better and healthier life; studies that everyone should know about. Here are four such studies from the year 2014. I hope they will help you to shape your coming year.

  1. We look for happiness in all the wrong places: We typically think of major life events, raises, large purchases, and success as the main sources of happiness in our lives. 

But a Harvard University study by Zhang, et al., 2014 shows that we are overlooking a powerful and readily available font of happiness: the small things that happen from day to day. In this study, students were asked to place 5 mundane items that represented their daily lives in a time capsule, and to predict how much happiness it would bring them to see these items 3 months later. The students drastically under-predicted the joy they actually felt when the time capsules were opened.

The Implication: Pay more attention to the small things that happen in your daily life. Small sources of joy are powerful.

  1. The mind/body connection: 2014 was the Year for Mindfulness. The concept of mindfulness has gradually morphed from simply “being in the moment” to a more complex definition: “being aware of your own thoughts and feelings in the moment.” This new way of viewing mindfulness has opened doors to new areas of research. 

In 2014, study after study has shown that mindful people are better off in a variety of different ways. In fact, higher emotional self-awareness has been found to improve your overall health. A Brown University Study by Loucks, et al., 2014 showed that people who are more aware of what they are thinking and feeling in the moment have lower BMI (body mass index), lower fasting glucose, less smoking and higher levels of physical activity.

The Implication: We should all work on being more aware of what we are thinking and feeling in the moment, and why.

  1. There is a simple way to fight your own negativity and anxiety: Negative, obsessive thinking is a common part of many emotional and psychological problems. A new study byNota & Coles, 2014 offers an option to try if you would like to reduce your own negative thinking patterns. These researchers found a clear connection between going to bed late at night, inadequate sleep, and excessive negative thinking/worrying. More studies are planned, but in the meantime, it makes sense to try this relatively easy fix.

The Implication: Try going to bed earlier and work toward getting 8 hours of sleep per night, and see if it helps reduce your negative, anxiety-driven thinking patterns.

  1. People who treat themselves with compassion feel better about themselves and their bodies: A 2014 study byKelly et al., 2014 found that women who treat themselves with more kindness and compassion are better able to cope with disappointments and setbacks in life. They were also less reactive to other people’s judgments or criticisms of their body shape and size.

The Implication: If you are kind to yourself in the face of your own mistakes and flaws, you will be a stronger and more resilient person overall.

In a nutshell, here are my wishes for you in 2015: 

That you will take joy from the small things in your daily life

That you will be aware of what you are feeling in the moment

That you will take care of yourself by getting enough sleep

That you will treat yourself with the same kindness and compassion that you offer others

To learn more about how to build mindfulness, emotional awareness and self-compassion, see the book Running on Empty, or visitEmotionalNeglect.com. 

Happy New Year!!

Jonice Webb has a PhD in clinical psychology, and is author of the book Running on Empty: Overcome Your Childhood Emotional Neglect. Webb has been licensed to practice since 1991. She has been interviewed on NPR and over thirty radio shows across the United States and Canada about the topic of her book, and has been quoted as a psychologist expert in the Chicago Tribune. Prior to joining PsychCentral, she was the Mental Health Editor for BellaOnline, the second largest women’s website in the world. She currently has a private psychotherapy practice in Lexington, MA, where she specializes in the treatment of couples and families. Webb currently resides in the Boston area with her husband and two children. To read more about Dr. Webb, her book and Childhood Emotional Neglect, you can visit her website, Emotionalneglect.com; or view her short videos on YouTube.