The Shalom of Nature

“For you will go out with joy, and be led forth with peace; The Mountains and the hills will break forth into shouts of joy before you, and all the trees of the field will clap their hands.”  Isaiah 55:12

 

As the National Parks are celebrated this year, I think of the many visits to the beach with my Mom.  In the 6 years she has lived with us, the only thing that tops the sights, smells and sounds of the ocean are visits from her children and grandchildren.

We drive to what is called “The Rincon” in our area of California.  It is a small strip of beach nestled between the mountains and the ocean where people park their vehicles and spend an hour or a day enjoying the beauty and power of God’s creation.

We can almost always see the Channel Islands National Park, a chain of islands about 25 miles off the coast of Ventura.  And, of course, we are thrilled when a pod of dolphins or grey whales frolic down the coast.  I notice the joy on my mom’s face as she looks expectantly over the waves of salt water.  It is a quiet, healing time together for both of us.

What makes nature so restorative?  Why is it that when we are faced with the splendor of snow-capped mountains, or the multicolored gorges of the Grand Canyon, or when we just sit quietly by a quickly moving stream, that we feel more peaceful?

I believe that it is because nature connects us with the Creator.  Scripture states, “For since the creation of the world, His (God’s) invisible attributes, His eternal power and divine nature, have been clearly seen, being understood through what has been made…”  So when we are surrounded by nature, we behold a part of God Himself!  And that connection quiets our inner being. It can fill us with that sense of “shalom” or wholeness, even in the absence of physical health.

The National Parks are magnificent.  But if one is not readily available, I find that smaller works of nature can accomplish the same feeling of wellness.  A flower garden, a hummingbird feeder, sitting outdoors to read, walking on a nature trail rather than a treadmill, bicycling outside instead of in a spinning class…any of these things will promote health and wellness of the whole person. But nothing brings me to an awareness of God’s presence faster than the power and beauty of the ocean.

Grief

 

“Only people who are capable of loving strongly can also suffer great sorrow, but this same necessity of loving serves to counteract their grief and heals them.”

-Leo Tolstoy-

 

Grief is a necessary phenomenon.  We go through different stages of grief and we grieve so many losses in life.  We grieve the loss of a dream when things don’t turn out as we expected they would. We grieve the loss of relationship when there is divorce or a move. We grieve the loss of function when we lose the ability to do the things we were once able to do. Sometimes, a caregiver will grieve continually as she watches the slow deterioration of a loved one until they are gone…and then there is no grieving left to do…only relief is felt. And we grieve the loss of a loved one when they more suddenly have gone on to the next life without us.

It has been about 4 weeks since my Dad died and we have all grieved as a family and in our own ways, alone.  Dad wanted to be cremated and then when my Mom dies he wanted us to take both of their sets of ashes to their hometown and have a memorial together.

But my siblings and I, all 8 of us, felt the need to be together…to grieve corporately.  So we did.  We had a small family memorial and what a wonderful testimony it was to a life well lived.  Just about everyone participated in some way.

There were the fun moments when we gathered, all 40-something of us, for breakfast replete with stories about Dad.  There were tons of stories… many hilarious, and just as many about how Dad shaped our lives in some significant way.

There were somber moments, as we each remembered Dad in a different way and shared in the memorial.  It was, I think, too personal to share in a blog.

But now, everyone has gone home.  Even though we are checking in with each other, we all are left to grieve largely on our own.

For me, grief erupts in different ways from day to day. I haven’t yet been able to turn on a Detroit Tiger’s game that he was so fond of watching. I miss the pinochle and cribbage games we played.  Sometimes, I awaken in the night, thinking I had heard him calling to me as he so often did.  I remember him when I inadvertently use one of his “one liners” that are so etched in my subconscious verbiage.  I miss how he patted my hand and told me that I “did a good job”.  I miss how he would relate a story from his life and be emotional about it.  His voice is absent each night when Mom and I pray the Lord’s Prayer together.

I missed out on so much of the last 42 years of my Dad’s life since we were always living out of state.  But I believe God gave me the last 5-1/2 years as a gift. I am forever changed…hoping that in the process of caring for my Dad, I have become more Christ like. I know it has made my grieving different than it would have been.  I miss him.  I think I’ll go turn on a Tiger’s game.

Next Steps for Aiding Aging

“The mind of man plans his way, but the Lord directs his steps.”

Proverbs 16:9

 

We have had a quiet lull in the blog activity, as I contemplate next steps. Many of you have given me such positive feedback on my blog that I don’t want to quit, but I also want my time investment to be meaningful. I feel that I still have much to share, especially as it relates to how my faith plays a role in my nursing practice.

As you know, I have been caring for my elderly parents in our home since September 2010. They live here in comfortable, safe and loving surroundings, supported by my husband and me, our wonderful caregivers and our hospice team. In the past few months, new issues have emerged and their gradual decline gives me pause to consider how I may continue to make a contribution after they are gone. Mom and Dad will both turn 92 this Spring.

I have decided that initiating a Faith Community Nursing Ministry is my next step in serving the Lord and giving my heart to something I believe is important. Parish Nursing is something I have been thinking about for several years. With my background in home health and medical/surgical nursing care, I could play an integral role in providing health education, personal health counseling, support and advocacy for many members of my congregation. I have begun to create a proposal on how such a program would be organized, and the steps to assess the needs of my church community. This information would guide the services that I offer.

Aiding Aging has been a wonderful journey, allowing me to share my experiences about caring for aging parents and the compassion we all need in the aging process, both personally and for those around us. Thank you for sharing it with me, and I hope this next phase will continue to provide you with useful information.

When is Medical Intervention Too Much?

“…we have allowed our fates to be controlled by the imperatives of medicine, technology and strangers.”

Atul Gawande – Author of “Being Mortal”

For most of us, a referral to a medical or surgical specialist can be a lifesaver. But for my 91 year old mother with Alzheimer’s disease, there are always additional issues to be considered. Recently, her primary care doctor referred her to a urologist and he ordered further tests, including a CT scan. I was grateful because I thought it would give us some good information about her recurring infections.

But two weeks later, at her follow up appointment, he told us that my mother needed immediate surgery with the potential for additional alternative procedures, and I was forced to raise my hand to interject.

“My mom is not a candidate for surgery, I’m sorry. She is 90 years old, she has Alzheimer’s disease and I do not want her to have to go through that trauma.” The surgeon was not happy. He insisted that we had no other choice, and from his point of view, I could understand. But there is always another choice.

Symptom: Medical Advances Often Trump Common Sense

I have seen it over and over again. Families want to do everything possible to keep their loved one alive. They opt for every medical intervention offered not ever asking, “How will this affect their loved one’s quality of life for the time they have left?”

There is a medical specialty for every system of the body and every disease. Physicians offer the latest in treatments, medications and new technology…it is what they do.

Diagnosis: It Is Difficult to Let Go                        

So often there is a surgery, or one more new medication, or radiation that is offered to postpone the inevitable. We are made to think that there is no hope if we do not take one of these courses. And we don’t want to stand in the way, do we? We don’t want to be responsible for the death of a parent! I think we are never prepared for their death.

Treatment: Ask the Difficult Questions

Ask the doctor how it will affect your loved one’s quality of life. How long does the physician feel your parent has to live with and without the offered treatment or surgery? What are the chances for complications at this age? What are other options? One can even ask “If this was you, would you choose this treatment?” Statistics show that physicians often would not choose what they offer to their patients.

I knew the risks involved with the surgery being proposed. And I knew how uncomfortable Mom would be if they needed to perform the alternative procedure. It is very difficult for my mom to be in the hospital. With Alzheimer’s disease, she gets so confused and agitated when placed in a different environment. Even so, the surgeon tried to make me feel like we had no other choice.

But we did have another choice. We put my mom back on hospice and allowed the hospice team to manage her symptoms. That was 8 months ago and my mom has been comfortable and happy ever since.

(See previous blog, “Hospice is a Lifesaver” April 2013.)

Dignity, Compassion, and Taking Time to Care

“God does not command that we do great things, only little things with great love.”

Mother Theresa

I have a friend who spent quite a bit of time in convalescent homes last year. She shared many stories, but one especially has left a vivid picture in my mind. It was her shower experience. She was lined up with other clients in her own “shower chair” waiting for her turn in the “shower room”. She was naked, of course, but semi-covered with a towel or sheet. It almost sounded like a human car wash. Dignity be damned.

Symptom – Can Compassion be Taught?

There are certain things I expect from caregivers beyond tending to basic needs for my Mom and Dad. When I find a caregiver that does these things innately, they become family. If they don’t, they are not around for very long. Caregivers either possess compassion and empathy skills when they arrive, or they don’t. These are not virtues that I am able to teach.

Recently, due to absences of our longtime primary Caregiver, we had a few temporary caregivers from an agency pass through our home. It has been exhausting for me, predominantly because whenever the agency sent someone new, I would need to train them to do things … the way I wanted them done.

Diagnosis – The Institutional Mindset has no place here

Many times I found that even with seasoned caregivers, the small things for my Mom and Dad that are important to their dignity were simply ignored. Often, caregivers may do things in such a way where expedience supersedes dignity. I’ve nicknamed this type of care “The Institutional Mindset”. It annoys me.

Allowing my parents to make their own decisions, or giving them enough time to complete a task on their own, is important. The elderly are slow to move, think and speak. Small tasks take my parents time to complete. And since there are no other clients here, there is no justification for rushing them.

Treatment – Take the Time to Promote Dignity

These are the types of behaviors I expect from caregivers in our home:

  • When either of my parents ask a question, respond to them when you answer…rather than looking at me. When speaking to my parents, position yourself in front of them so they are able to see you. Speak clearly and loud enough that they are able to hear you.
  • Please do not talk in front of my mother as if she does not understand you. She has Alzheimer’s disease, but she still realizes the tone and content of what you say. She may not remember what you said in 5 minutes but she comprehends what you say in the moment.
  • Do not use the same voice you would use as if you were speaking to a baby. My parents are both adults.
  • While assisting my mother with oral care, please take time to do it thoroughly…allowing her to do as much as she can independently. A reminder such as “Don’t forget the inside of your molars,” goes a long way. And please don’t do oral care while my mom is sitting on the toilet or in the shower. She never would have performed those two tasks at the same time.
  • Appeal to my mom’s former nursing experience. It is in her long term memory. “You need to force fluids to help prevent a urinary tract infection,” is much better than “Drink this…you need to drink more.”
  • Please don’t bring the urinal into the family room. We don’t do bathroom business in the family room. And when dad is settled in the bathroom, you can then step out into the hall to provide a few moments of privacy.
  • I have made cloth protectors for my mom to wear during meals. We call them “aprons” because “bib” just seems too childlike. She should have a clean one for every meal.

Compassionate caregiving takes time and effort. Taking care of my parents is not like caring for children … it is not babysitting. Allowing my parents to perform whatever they are able to do for themselves will preserve their dignity. This is important to me and my siblings. So in our home, there is no room for the human carwash mentality.

Elder Abuse

 

 

“In 2008, one in 10 elders reported emotional, physical, or sexual mistreatment or potential neglect in the past year.”

CDC Fact Sheet on Elder Abuse

 

As I tuck my Mom and Dad into bed each night, I silently thank God that they are safe. Neither of my parents is able to live independently anymore. We provide support for their food, personal hygiene, financial management, shelter, emotional well-being and medical attention. Failure on our part to make provisions in any of these areas would constitute abuse.

Symptom: Abuse Situations

Consider these vignettes. Several of them are experiences I have been personally involved with as a Home Health Nurse. Others are sad situations that I have heard about from friends who work in the Health Care field or family and friends with personal experience.

A bedbound elderly patient, dependent on oxygen, annoys her caregiver. So the caregiver turns off her oxygen.

An elderly cancer patient is in pain. “Are you taking your Oxycontin as it is prescribed?” I asked. “There are none left”, she responds. I look at the glassy eyed, disheveled adult son, and knew immediately how they had disappeared.

As an elderly woman is dying, her caregiver is using her charge cards to create financial havoc in excess of $10,000.

An elderly gentleman is physically abused and injured by a caregiver in a facility, ultimately leading to his death.

Another elderly woman is cared for in one son’s home while another son lives in her house and uses her social security checks for himself…not contributing financially to her care.

Diagnosis: Elder Abuse

Elder abuse is a sad fact. As long as there are the vulnerable, there will be those who will prey on them. Abuse comes in many forms – neglect, financial exploitation, physical harm, emotional abuse, sexual abuse, abandonment and self-neglect.

Elder abuse settings are varied. Abuse of the elderly occurs in their own homes, in care facilities and in the homes of their own relatives who should be advocating for them.

Treatment: Vigilance

  • If your loved one is in a facility, your consistent presence is of vital importance. Get to know the caregivers well. Try to visit at different times of the day. If possible, visit when your elder is having a shower so you might visualize his skin. Bruising and abrasions can be symptoms of mistreatment. And pressure ulcers can be a sign of neglect.
  • Carefully observe the interactions between your loved one and staff/caregivers. Notice if his behavior changes when caregivers enter his space. Agitation or sudden withdrawal is suspicious behavior.
  • Is your loved one clean? Are his clothes clean, nails? Has he been showered or bathed on a regular basis?
  • Unexplained withdrawal from normal activities or unusual depression may indicate emotional or verbal abuse. This is especially true if it is accompanied by tense or argumentative behavior by the caregiver.
  • Report suspected abuse to Adult Protective Services for your area. And if your loved one is in a Long Term Care Facility, you should contact the LTC Ombudsman. If an elderly person is in immediate danger you should call 911 and report to the police.
  • Helpful links:

National Center on Elder Abuse

Agency on Aging

Because my mom has Alzheimer’s Disease, she would be especially vulnerable to abuse. Her memory impairment would prohibit her from asking for help. She is one of the “least of these” that Christ calls us to provide for and protect.

And there are millions just like her.

Chronic Fatigue

“I am going to argue that the problem with the diet and health of most Americans is wheat—or what we are being sold that is called ‘wheat.’”  William Davis, Cardiologist and Author of “Wheat Belly”

“Oh Dear … I’m so tired.” This was my mother’s mantra for years before she and my dad moved in with us. She slept 12 hours at night and took naps during the day. And still she was exhausted.

Symptom: Exhaustion

While my parents lived in their own home, my sister took Mom to a well-respected geriatric clinic for answers. All the usual lab tests were performed … thyroid, complete blood count, electrolytes, etc. They were all normal.

A Sleep-study was proposed to ascertain whether Mom was suffering from sleep deprivation caused by sleep apnea. This proposal was nixed since the logistics of putting her through something like that with her Alzheimer’s behavior seemed impossible.

Diagnosis: Chronic Fatigue

So when Mom and Dad moved in with us in 2010, Mom arrived exhausted. After the initial settling in, I took her to a physician here who repeated all the usual lab tests … again with normal results. It was the typical picture of Chronic Fatigue: Extreme fatigue that cannot be explained by an underlying medical condition.

This syndrome, coupled with Alzheimer’s disease, sometimes made it difficult to be within hearing distance of my mom. Mealtimes were especially difficult. Mom would forget that she had already said how tired she was. Her mantra “Oh Dear, I’m so tired” could be repeated 20-30 times during one meal. Watching and enjoying a television program with her was pretty much impossible.

Treatment: Dietary Changes

I took notice then, when a good friend talked to me about dietary changes. My friend had suffered with fibromyalgia for over 10 years and her symptoms included chronic fatigue. She embarked on an anti-inflammatory diet and within just a couple of weeks she noticed a dramatic change. She felt so well, she was able to return to full time employment.

I wondered if such a change in diet might be helpful for my mom. I decided to give it a try. I removed all dairy, gluten and sugar from her diet. Each of these is known to cause inflammation. It was not difficult for me to do since I rarely use prepackaged foods anyway. But I learned that gluten was hidden in many things one would not even think about – Soy sauce, chicken and beef bouillon, most canned soups, and fake crab (used in many sushi establishments) were just a few of the surprises to me. Tomato soup … really???

I know that the gluten free debate is a hot topic. Honestly, I have not really researched it that much. Most of my knowledge is anecdotal. It helps so many people that I know, especially those with gastric difficulties.

The literature I have read points to the change in the wheat crops during the last 50 years to make them more bug and disease resistant. It makes sense to me. Celiac Disease is becoming commonplace … these individuals become extremely ill if they ingest even the smallest amount of gluten.

About 4 weeks later, we noticed that Mom was not verbalizing anything about fatigue. And we have not heard the mantra since.

I had joined the gluten free bandwagon at the same time as my mother. A few months later, my husband saw the light as well. His immediate physical response was the elimination of the 45-60 minutes of throat clearing after every meal. Both of us lost weight and our cholesterols dropped 30-40 points. We felt so much better and had more energy.

After 3 years without gluten, I do not feel deprived. I am able to make pancakes, pies cookies and cakes for special occasions without wheat. Although I still try to keep refined sugar at a minimum.

And my mom at 90 may take a short snooze in her chair during the day. Otherwise, she is up from 8:30 am until 10:00 pm and if she does say she is tired, it is bedtime and she retires for the night!