Posts for Category: Caregiving

Breakfast, a Book and a Broken Heart

Once upon a dream“I just want a little bowl of cereal for breakfast,” an old woman says as she sits down at her breakfast table.  She forgets, though, to let you know what goes with her cereal.

Next to her little bowl of cereal sits a yellow tote bag.  In the bag are her medications:  heart pills, liver pills, eye drops, water pills, acidophilus, stool softeners, muscle relaxers, spiralina, pancreatin as well as blood pills, gas pills, hormone pills, vitamins, and supplements.  Next to the yellow bag, moving counterclockwise, is a tray shaped like a fish.  It holds soy sauce, ’cause she can’t use salt, goat’s milk ’cause she can’t eat regular dairy, and a tub of diet margarine since she can’t eat butter but needs something on her cereal.

Don’t just plop the cereal bowl down on her good wooden table. First, put down a place mat, then a tray, then a plate under the bowl.  What might happen if crumbs fall off the plate into the cracks of the place mat?  If toast crumbs get away, who knows what might get lost next?

Directly in front of the bowl and a little to the right, almost touching the knife, is a glass of cold water that comes from the filtered water pitcher in the refrigerator.  The water is too cold for swallowing pills, so put in a splash of hot water from the tea kettle whistling on the stove.

Slightly to the left of the glass of cold water is a mug of freshly boiled water.  Lying beside the mug is a tea bag. Don’t put the bag in the water in the kitchen.  Bring it to the table first, or the tea will get too strong.

You don’t want this dear old woman to get the jitters.

Right behind the glass and cup, directly in front of the mat with the tray, the plate and the bowl is a plastic Tupperware box.  Inside the box are 6 jars.  These are the ground up seeds and nuts that make cereal nourishing and make it taste better when you can’t have dairy and sugar.

Behind the box with the jars of seeds and nuts is a nice tall jar filled to the brim with plump dates.  A long pair of scissors lies on the table with the sharp blades pointed toward the fruit.

Coming on around, still going counter clockwise, is a little stand to hold the morning newspaper or a book, depending on whether it is a day for light or serious literature.  Next to the reading material are two extra pairs of glasses and a magnifying glass pointing toward the napkin that has only been used twice, so why throw it away?

Hidden behind the stand that holds the reading material is a bowl of brown sugar and a jar of honey in case she can’t stop herself from having something sweet.  And in the background, from the public radio station, the low wail of “Your Cheating Heart, You Made Me Cry,” as the hour slides into the morning headline news.

What courage and sadness lurk in this small woman with her breakfast and book and broken heart?   Is she all of us who ever wanted something: a bowl of cereal, a lasting love, a well-lived life where wants, transformed into longing, become fuel propelling us on?

 

 

Not Rocket Science, But …

“If we can’t be where we are, we can’t feel. If we can’t feel, we are unable to appreciate and care, and our most human trait—the yearning to connect —-is confined.  We are like a river that is meant to flow but has now been dammed.”  Sakyong Mipham in The Shambhala Principle. 

Caring for old people is not rocket science.  The resistance to it is great.  But resistance can drop quickly.

Once when I was young, in my late 20′s, living in Santa Barbara, CA, I was resisting life. My agenda was to play it safe.  Everyday was gray.  I lived in a small apartment at the end of a long driveway.  Each day I would plod down the walkway, go to work, plod back home like a cow heading to the pasture and heading back at dusk, head down following the backside of the cow in front.  Then one day my foot crunched on the gravel, and it woke me up.  I remember lifting my head and looking gradually up from gravel, to lilac bush bare of flowers, through the space between the neighborhood houses where I glimpsed the ocean.  There was this humming aliveness: a barge on the horiz0n, blue sky, white clouds, the sound of birds, the whole world flowing, tweeting, smelling like roses and feeling good. Such curiosity arose, how could it be?  With one foot crunch on rock, resistance dropped away and  I longed for, I wanted to know how it could be?  The question remains, How could it be?

I’ve had plenty of practice with resistance.  My work, my life, my practice. I’m grateful for it, like how good it feels when the jack hammer stops.  For instance when I visited Lane, who was small and walked with a big walker, she would want me to walk with her to the bathroom.  She would pick up the big walker, move it up a few inches, then walk the smallest fraction of an inch. Bored and impatient, I knew I could walk this hall in 5 seconds. Lane would take 10 minutes.

Then a ray of light struck the metal walker.  Startled from my low mood, I  looked around, a spider web dangling over the door, paint peeling in an intricate pattern, the smell of the oil on the dark wood of the floor,  the hiss of the big green oxygen tank standing in the corner,  the clink of the walker and a sudden joy.  Not rocket science, but the freshest moment now.

Receiving the Goodness of our Elders

Kindness cuts through isolation, fear, and aggression.  All of us can remember moments of kindness that changed our day, at least—-and maybe our lives.  When we relegate kindness to mere social courtesy, we are handicapping our access to the ambassador of love and compassion—-deeply held powers of the human heart. If we want to continue to evolve, we should cultivate ordinary kindness.  With kindness, we will shift our future.”   Sakyong Mipham in The Shambhala Principle.

In his new book, The Shambhala Principle, Sakyong Mipham presents a view that we as human beings are basically good.  By that, he means that we are whole, complete, and worthy. Kindness and compassion are at the core of our human nature.

In my field of gerontology, the world is gearing up to care for the baby boomers, who because of their vast numbers, are predicted to become a burden upon our declining society instead of a blessing.  But older people are the holders of the cultural transmission of basic goodness.  All human beings are holders of basic goodness, but it is more accessible in older people, even though often missed.

As older people begin to have diminished life force and dimming senses,  space needs to be provided so that this transmission will not be lost.  Then caregivers can receive it and nourish it and share it from where they find it:  by slowing down, listening, practicing kindness and feeling the heart.

Many old people plod along trying to make it through the day.  Many caregivers think that their task is to make sure that they won’t run away, that they will stop driving, that their dementia will not drive us crazy.  Or at the very least, that they will have a healthy aging with proper food and medicine and relationships.  Protection is good, but only the start.

Although aging is a time of life that brings possibilities, the tendency is to regret the way life turned out.  Many elders collapse under the weight of unhappiness. They don’t have the energy to engage.   So often both family and professionals approach older adults with an agenda to fix or console.  But there is a danger of the mind getting stuck on pity or sadness, rather than expanding into the enriched heart and mind.

After reading The Shambhala Principle, I feel more than ever that the work to be done with our elders is to connect with and receive basic goodness.  We could create a culture of kindness for older people and in so doing, we would create it for ourselves.  Or it could be the other way around.  We could create the culture of kindness and ask the older ones in. Walk right in says the spider to the fly. And the good thing is that we don’t have to tear down or dismantle or just not participate in the world that is right under our nose. What is it that takes us farther than we thought we could go? What is it that makes the heart take wing so that you suddenly know and feel brave?  Feeling basic goodness leads to curiosity and care.

The following is a story of a family caregiver who, at the end of his rope, got real brave and stepped beyond his agenda of what he thought a good husband should be.

I met Dan at a family support group.  He had cared for his wife, who suffered from Parkinson’s for many years.  Overwhelmed by her illness, she would not let anyone except her husband care for her.

Dan heard about a camp that was designed for caregivers and their loved ones who needed care.  One day he got her into the car to take her for a drive.  Without speaking, he drove her straight to the camp, got there in time for dinner where they sat with other couples and had a nice time.   She agreed to spend the night and went off with a caregiver, while her husband went to a dorm to spend the night with other husbands.

In the middle of the night, he awoke to the sound of a man calling out, “Wake up, wake up, come outside.”  Fearful that it might be a fire or other disaster, he ran out. Then stopped and looked up.  A full moon shone down flooding the flat ground with moon light. The men from the dorm stood together basking in the magic. “That is the first time I have seen the moon in many years,”,  he told his wife as they drove home the next day.   And she agreed to come back to the camp again.

Life Is Just a Bowl of Cherries

As a caregiver, I look at the old person and wonder how to get what is stagnant moving again.

When I was growing up in Oklahoma, a bowl of cherries meant summer. Cherry pies came by the Fourth of July, the seasons marched on and life was closely connected to summer, autumn, winter and spring. But the older I got, with central heating and air, the less the seasons mattered. We moved to bigger cities where we could always have cherry pie and it was easy to forget the trees, like drinking milk and forgetting the cow.  Easy to forget that the sounds of tires rolling on wet pavement are the sounds of men fighting for petroleum and rubber and other resources.

By the time we are old and unwell, what might have been the flowing connection to the seasons and senses has become the serious march of life moving on without much connection to being human, a human being with a warm heart circulating the blood thru the veins and arteries and channels of life.

So how do we who are aging or charged with caring for elderly people at the end of life get it going? What kind of care do caregivers need so they don’t feel stuck?  How can we not sink under the weight of the suffering of old age?

Try a bowl of cherries.  Cherries are expensive, but get enough to fill your favorite bowl.  Set the freshly washed berries on the table, or the window ledge. Then feel what you feel: the beauty of red, the little stems pointing gracefully, the sun bouncing off berry and bowl.  Then extend your mind to the cherry pickers.  Feel your appreciation for the hardship of the farmer who grew the cherries and the pickers who picked them and the truckers who brought them to the store.  Just let yourself go.  Appreciate not only the fruit but also the potter who made the bowl and the trees who gave the wood to make the window sill.  All that life and all that death, all for a bowl of cherries.  And ain’t it the truth? You can expand your mind until your mental image of appreciation is vast and your worry is a small dot in the midst of so much treasure. Or it could be the other way around.

Then look in the daily paper in the Life and Living section and find all that is offered.  I remember once when I was sinking under the weight of caring for an elder who was in the stage of repeating over and over, “I want to go home.”  Finally I started driving around looking for something to do.  Spotting a little neighborhood fair, I parked the car and took the old woman by the arm as we made our way through a crowd.  There was cotton candy and the aroma of hot dogs and the sound of a rock band with a singer screaming.  Finally my companion looked at me and said, “I want to go home.” She wasn’t crazy at all.  We drove home and had an enjoyable supper, and as we ate, I heard the words of “Life is Just a Bowl of Cherries”:

“It’s time we found out,

We’re not here to stay,

We’re on a short holiday.”

Many Strokes for Different Folks

 

A few years ago I consulted with a family in California.  The son’s 90 year old mother was at the end of her life with heart failure, but she didn’t want to go to assisted living.  His wife was willing to help care for her husband’s mother within their home, but the unemotional accountant son wondered if he could do such a thing. The relationship between mother and son had been challenging.

The son drove to his office, listening to music and thinking about it, when Schubert’s “Death and the Maiden” came onto the radio.  For a moment, his heart stopped.  It was the same music played when his grandmother lay dying.   At a family meeting he told us, “I believe in auspicious coincidence.  I want to bring my mother here to live.” To him, it felt as if he had received a message from the cosmos.

So the family got some caregiving support from an agency along with a walker, wheelchair and hospital bed.The old woman came to live with her son and his wife. As her care progressed, the doctor suggested that the mother should have a catheter. She was so weak.  It was hard to get her out of bed at night for frequent urination.  A nurse came to put in the catheter.  She was a little frazzled.  Perhaps she misspoke, but she told me that her office had told her, “Don’t put in the catheter if it is to help the family. We only practice person centered care.”  Perhaps the office was being overly zealous in their understanding of person centered care. Is the person some skin encapsulated ego separate from her family and helpers and home? When the phrase, person centered care was first used, it was an attempt to stay with a person’s goals and sense of living within the institution.  It was  meant to counter the over efficiency and materialism of the dark age.

Nowadays, we realize that  a person is part of a whole stream of being. If we don’t care for the caregivers, we end up not with just one person dying, but a whole society acting like the walking dead. What support does the family need to bring comfort to a loved one without damaging the whole family’s state of mind and pocket book?  We need more articles like the one in the AARP Bulletin in April, 2013, by Sally Abrahms called “Saving Money by Living Together: Three Generations Are Making it Work.” She dwells on the practical aspects of the arrangement which creates a situation that is more than saving money, but also the basic goodness of healing lives.

Many strokes for different folks.  Each person is unique.  Once you look at the whole person in the whole setting, you start to see what could make life easier for older people, for the family caregivers, for the professional helpers and neighborhoods and cities and a whole wide world.

The day before I left this consultation, I remember a goodbye party.  Sitting at the table, with the sun shining in were the older woman with a wheelchair and a caregiver, and a grandson who was going to coordinate his grandmother’s care.  They were laughing and eating chicken sandwiches. A coconut layer cake was waiting to be served.  Later when I went into her room to say good-bye, the older woman thanked me and said, “Don’t worry about me, this is what happens, it can’t be helped.”

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Ann Cason

Ann Cason,
Geriatric Consultant

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