Thursday, 14 March 2019

WITNESSING DEEP, NATURAL CARE IN THE HOSPITAL


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A lot of what I read online about patient care and support for caregivers is negative. I read about compassion fatigue running rampant in hospitals. Or about physician burnout. I read about how, in our society today, there is no place for kindness or caring.  It is almost as if the care that occurs within the walls of our homes is our guilty secret.

Our son Nicholas has been in the hospital over the last couple of weeks and I can tell you, kindness is still alive. Here is what I witnessed:

In the ICU waiting room, there are greeters who man the communications with the nursing station. They guide grieving families to quiet rooms and make cups of tea for tired loved ones who may have come straight from the airport to be close to someone who is seriously ill. The volunteers are mostly older ladies. They smile and they all have something I will call the gift of compassionate conversation. They do not intrude, but if you make eye contact, they will come over, sit down and ask how you are. They are watching and waiting for opportunities to be kind.



Sometimes younger people volunteer in this role. I notice that on the whole, they do not seek out conversation, but they respond in a warm and personable way when asked a question. Perhaps they lack the social confidence that the older ladies have – perhaps they are shy about navigating the tricky waters of emotion (terrible worry and often grief), support, and privacy. After all, there are boxes of Kleenex on every side table. This is a place for tears and whispered conversation. The kind of human caring that these ladies give in the waiting room is what I will call natural caring. It is a rare talent – a skill honed over years of experiencing one’s own life challenges.

I witnessed extraordinary caring in physician care, too. When I heard the intensivist say, “I will treat your son as my own.” Or when the surgeon instinctively knew that a young man might need a jokey approach to release tension. He greeted Nick this way: “Hi cowboy! I’m your surgeon and I’ve done my homework!” Or the nurse who, days after her shift with Nick, came searching for me to ask, “How is he? I am so happy to know he’s better!”

Kindness is freely given in the world of intensive care. I wish we could bottle it for all places and all times. The natural care that I witnessed should be identified, celebrated, coached and nurtured. If you have experienced extraordinary kindness in the hospital or in your community, please share your stories. Let us reward those who have the rare gift of natural caring.

Wednesday, 6 March 2019

DOCTOR, STOP TAPPING YOUR FOOT


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About a year before Mom died, I wrote this from her hospital room:

Mom was hospitalised just prior to Christmas for respiratory distress. A young, bespectacled respirologist strode into the room. He smiled at Mom and began to make notes on his clipboard.  "Have you ever had trouble breathing before?" he asked.  "Once when I was about twelve, I was at camp..." Mom began.  My eye was drawn to the doctor's foot. His polished loafer began to tap rapidly, but his smile remained fixed.

I thought, "he is trying to have a business conversation here. But Mom thinks this is PERSONAL!"  I jumped in and re-directed Mom to her more recent health history.

Very recently, I observed similar behaviour from a physician who was treating our son in hospital. The doctor was professional, knowledgeable and pleasant. But his foot tapped excessively during our conversation, to the point that his knee was shaking.  This doctor appeared to be listening and he answered all our (very good) questions. But it was hard for me to focus on his words because I was so distracted by his foot and leg.

Here’s what that tapping foot meant to me: “This doctor is worried about his next patient or maybe he’s late for a meeting.” “I need to hurry up and ask my questions. What were my questions again?” “I’m sorry I’m taking up so much time.”

I kept thinking about that tapping foot and so I googled the body language of feet. This is what I found:

"The secret language of feet can reveal a great deal about our personality, what we think of the person we're talking to and even our emotional and psychological state, they are a fascinating channel of nonverbal communication."
"Compiling this research has been a revelation. The reason our feet may be giving us away is that they are part of the body from which we have the least internal feedback."
"The weird thing about feet is that most people know what they are doing with their facial expression, they may or may not know what they are doing with their hands but unless we specifically think about it, we know nothing about what we are doing with our feet."

And from the pen of Dr. Susan KraussWhitbourne, Professor Emerita of Psychological and Brain Sciences at the University of Massachusetts Amherst, writing for Psychology Today:

"Shaking your legs communicates anxiety, and when you shake those legs you inevitably shake those feet.  However, your feet can get you into trouble with your body language all on their own. Tapping your toes is one way to show that you’re in a hurry and anxious to get moving.  You may want to tap your toes if you’re trying to get someone’s attention and don’t want to say something rude. It’s a little way of signaling that you’re feeling time pressured without yelling or engaging in sarcastic eye-rolling. However, you do so at a risk. Either you’ll be ignored or still perceived as rude. Better to handle your feelings of annoyance over being made to wait by politely voicing your concerns."


So here’s my prescription for doctors: For better outcomes, stop tapping your feet when in conversation with your patient and his or her family.

 




Thursday, 21 February 2019

Mining for Truth and Meaning in Caregiving and Memory


My sister Karen Thomson painted this portrait of our Mom and she titled it Partly Who She Was. Karen painted this from a photo that we took of Mom just as she got out of the car at Hovey Manor, a lovely country hotel in the Eastern Townships of Quebec. We'd taken her there for a special treat: dinner and an overnight stay in a large suite overlooking the lake. As Mom stretched her legs after the long drive, she looked around at the half-familiar hotel grounds. In her face, my sister and I saw the sharp contrast between her keen observation and her judgement, all contained in a thin shell of frailty. We took this trip in the early spring of 2018 and she died in mid-August. Aged 96.

Since Mom's death, my sister and I have talked a lot about who Mom was and how she shaped us. I have spent many hours sifting through the many unlabelled splinters of my memory trying to make categories of 'good' and 'bad'. But it's just too hard. I love my Mom, loved her. But she was a person of extremes and she was wilful. As a caregiver, we are supposed to distill our feelings down to those of kindness, forgiveness, compassion, right? But often it's not that simple.

I'm away right away right now with Jim, on our annual winter getaway to Cat Island, Bahamas. This is the one time of the year when I read a lot of fiction. The book on my lap now is Warlight by Michael Ondaatje (I highly recommend it - it's a wonderfully rich read and a great story). Nathaniel, the main character, has a complicated relationship with his mother. Here's how he describes it: It had taken me a while to realize that I would in some way have to love my mother in order to understand who she now was and what she had really been. This was difficult. 

Mom, I miss you. I love you.


Saturday, 16 February 2019

WHEN PEOPLE PRETEND TO LISTEN - LESSONS FROM A COMEDY WRITER


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Want to laugh at black humor? Read anything by David Sedaris. I’ve just finished his latest ramble-in-a-book-form titled ‘Calypso’.  It’s very funny when it’s not causing me to blush or wince. I loved it.

Sedaris saves his most barbed tongue-lashings for service providers – at airports, restaurants, in taxis and in hotels. “How was your trip in today, sir? Good? Awesome!” or “Hot enough out there for you?”


These kinds of ‘fake-friendly’ conversations drive the author nuts and they have the same effect on me. Here’s what he says about one young woman who repeated a greeting she’d learned in a staff training weekend away:

I just wanted to get a rise out of her to feel some kind of pulse. I knew that the young woman had a life. She’d gone to school somewhere. She had friends. I didn’t need a fifteen-minute conversation, just some interaction. It can be had, and easily: a gesture, a joke, something that says, “I live in this world too.” I think of it as a switch that turns someone from a profession to a person, and it works both ways. “I’m not just a vehicle for my wallet!” I sometimes want to scream.

This passage made me think of all the times I’ve cringed or seethed privately in doctors’ offices, or hospitals or clinics or in the offices of social workers. When conversation is inauthentic or it’s being managed to an end well before anything meaningful is expressed – no one is cared for. The patient and caregiver make their exit without hope of healing because no human connection has been made.

David Sedaris provokes meaningful (or at least unexpected) conversation by being outrageous. But we caregivers don’t have that luxury. We need natural and meaningful conversations with our families, friends, co-workers and our service providers. Because we don’t have the time or energy to waste on any phony platitudes.

So my message to caregivers today is, call them out. Speak up and say something the next time you are met with empty niceties when what you really need is a meaningful exchange. When a service provider asks (while flipping through papers or looking at a computer screen), “How are you?”, answer “Terrible. Last night I slept for 37 minutes. What about you?”

Saturday, 9 February 2019

How Different Countries Care for Seniors: A Look at Caregivers and the Elderly Around the World

Today, guest blogger Roxanne Baker gives us a world tour of eldercare attitudes and practices. I loved learning about how families in different cultures take care of older loved ones and I wonder what differing cultural practices can teach us about looking after our own. Please chime in with comments if your family's culture influences your caregiving. 


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There's just no escaping the cultural milieu and cultural forces that mold and shape us, especially when it comes to attitudes toward and treatment of the elderly. With declining birth rates and an aging population in most countries around the world now, those attitudes matter immensely. How a society thinks about aging and the elderly determines in large part the kind of care the elderly get, and it becomes increasingly more important as populations age. We also have to factor in the decreasing numbers of younger people to serve as caregivers for the elderly. So let's look at the situation and take a quick tour.

Elderly Support Ratio and Attitudes in the West

According to the Population Reference Bureau, we now have a rapidly aging world, and many countries are facing challenges in caring for elderly citizens. "[T]he elderly support ratio – the number of working-age people ages 15 to 64 divided by the number of people 65 or older – is declining in many countries, most notably in developed countries. According to PRB estimates, by 2050 Japan will have the lowest ratio of one working-age adult per elderly person, while Niger, a developing country, will still have a ratio of 19. No country will have an elderly support ratio above 20 by 2050."

These are indeed some sobering statistics. They also illustrate the burgeoning need for trained caregivers for the elderly, who serve on the front lines of caregiving.

Further exacerbating this problem in the developed West is the undeniable fact that ours is a youth-oriented, youth-driven culture. If we have enough money, we resort to cosmetic medical measures to keep us young looking as we age. Many families, rather than caring for aging parents and grandparents in the home, shuffle them off to nursing homes. It's not heartlessness – it's just a way for us to avoid facing the inevitable fact that we will someday be old too.

But it's not this way in all cultures and societies around the world and not even within some subcultures here, for example, among Native Americans.

Family Caregivers and the Elderly Around the World

Being old isn't just a matter of biology: it's also a social and cultural construct. So, while aging is a universal human experience, it is not viewed the same everywhere. Here are just a few examples of attitudes toward the elderly around the world, as well as how that translates into care from family caregivers.

China
In China, respect and care for the elderly are actually ensconced in law, and, in fact, elderly parents can sue their children for both financial and emotional support. In addition, companies and businesses are required by law to give workers time off to tend to aged parents. The idea is to protect the economy and not overburden resources owing the dense population and growing numbers of elderly people. But it's not all about money. Under these laws, many parents have sued because their adult children don't visit them regularly.

"China is projected to have 636 million people over age 50 by 2050, or nearly 49 percent of the population – up from 25 percent in 2010 . . . And somebody needs to care for them, goes the government thinking" (HuffPost). It may be law now, but Chinese culture has always upheld respect for the elderly as a Confucian attitude. It's just standard in China to honor and care for older people.

Japan
Japanese culture has always valued and still values the elderly. It has been ingrained in families and children for generations upon generations, which makes Japan one of the best and kindest places on earth for seniors. In fact, many Japanese families live with several generations under the same roof – one of the reasons why the elderly in Japan live longer than those elsewhere. Besides exercise and proper diet, strong community and family bonds are the chief ingredients in longevity.

All of that is a good thing because Japan has more people over 65 than any other age group. Efforts are made to ensure that all the elderly get some attention, with a national holiday for that purpose. The third Monday of every September is Respect for the Aged Day, a holiday that includes paid time off from work. It aims to honor and show respect to the elderly with gifts given to grandparents and a shared festive meal. "Neighborhood volunteers distribute free bento boxed lunches to elderly people. In some small villages, younger people and school children dance and provide entertainment" (HuffPost).

Scotland
Then there's Scotland. Although it is part of the developed West, older people are still cherished and valued as an asset. There is now a concerted effort underway to ensure older people are heard and that they are supported in family settings for full and positive lives. For the West, this is a paradigm shift – a movement away from hospitals and nursing homes to family caregivers, preventive care, and quality of life.

This shift also means a different use of money and resources. Adjustments are made and homes adapted so that older relatives can live in the homes and age in a family environment. In general, families work hard to care for elderly loved ones, honoring them and respecting them as valued members of society.

Vietnam
Respect for elders is a valued and deeply entrenched sentiment in Vietnam. In Vietnamese culture, elders are viewed as treasured sources of knowledge and wisdom and the transmitters of tradition. Typically, elderly grandparents live with their families so that they receive support and care. And in return, the grandparents retain their usefulness by contributing to the household, doing such things as preparing meals and caring for grandchildren.

In Vietnam, elders are held to be the head of the family. Their opinions and advice are sought and valued, and they are the de facto decision makers in many households. Basically, being old is not a liability, but rather an asset.

Greece
Old age is also seen as an asset and advantage in Greece, where it is equated with wisdom and, sometimes, holiness. "'Old man' isn't a slur in Greece; in fact, it is quite the opposite. As Arianna Huffington discussed in her book On Becoming Fearless: 'I visited the monastery of Tharri on the island of Rhodes with my children. There, as in all of Greece, abbots are addressed by everyone as "Geronda," which means "old man." Abbesses are called "Gerondissa." Not exactly terms of endearment in my adopted home. The idea of honoring old age, indeed identifying it with wisdom and closeness to God, is in startling contrast to the way we treat aging in America'" (HuffPost).

Implications . . .

Attitudes toward and care of the elderly around world, then, often present quite a contrast to what they are here. "Other countries appreciate and admire this transition of life and respect and welcome their elders into society as an integral part of existence. As a society in the Western world, if we want to change the attitudes around caring for our elderly, we must first develop a new perspective on aging and caring for our seniors. With the strides in healthcare and medicine that the United States has made, our citizens are living longer . . . [We must ensure] that the needs of our oldest members are being met with respect and admiration" (MIR).

The upshot of all this is that there is a growing need – a desperate need, really – for more and more trained, long term caregivers with valuable skills and knowledge comprising, for example, patient positioning, pulse and respiration monitoring, and range of motion maintenance. But we also need to strive for a shift in thinking and move toward caregiving in domestic family settings provided by skilled family caregivers.

About the Author:
Roxanne Baker has been a writer and producer for 15 years working at national TV stations, magazines, and newspapers. She is the co-founder and editor of cnaonlinecourse.com, a website specializing in certified nurse assistant education and training.