Holiday Survival

Holiday Survival DSC_0195
By Wes M. Bynum

As we continue through the holiday season, I wanted to send you a little encouragement for making it through these days.  Our instinct tells us that after the death of a loved one these can be difficult days as we adjust to all the changes that have come to our lives.

The good news is you do not have to wait for a special day to arrive and then simply see how you will react.  You can make choices that can help soften the day and move you along in the grieving process.

As you continue through this special season of merriment and memories, consider the following:

  • Plan Ahead… be deliberate and proactive in how you want to live that day.
  • Set your own tone… no one else can know how you feel or what you need.
  • Be realistic… recognize your limitations.
  • Be open and honest with your emotions.
  • Allow others to grieve in their own way.
  • Expect the best!

Keep this in mind: Choices…Control…Confidence…Stability… With each choice we make, there comes a sense of control. With control, comes confidence.  Confidence leads to stability.

Remember the past, embrace the present, and in the words of Thoreau; “go confidently in the direction of your dreams. (Dare to) live the life you have imagined.”

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Life.

The shadows lengthen.  The sun moves slowly, and steadily makes its journey to lands far away.  The orange red glow begins to melt into shadows and shades of grey.  A soft breeze is blowing and the leaves are dancing to its gentle rhythm.

Crape Myrtle flowers on campus July2,2012 006

Life

Somehow, in some way, and without clear definition, the light of day is no longer and the darkness of night is now.  Why did it have to come?

How did it get here?  How long will it last?  Does anybody notice?  What will happen next?  Some questions have logical, scientific, absolute answers.  Some questions defy our ability to come to any kind of answer at all.

Life

Darkness prevails. It is a time for contemplation and reflection.  Truth is hard to accept at times. At some point, thoughts and experiences become memories.  Tomorrow holds new hope.  Sleep deeply. Rest peacefully.  Dream sweetly…

 

Life

Now open your eyes!  Your heart is beating.  A sense of anticipation and excitement is in the air.  Light has returned.  Darkness has gone.  The sun is brilliant.  The sky is blue. The sweet fragrance of morning is carried along on the wings of the wind.  Soft, happy songs of busy birds gently touch the ear.  The soul of man rejoices.

By Wes Bynum

Down a Long Dirt Road…

Let’s call him Joe.  He had lived alone, very alone, for a long time.  His home, if you could call it that, was down a long, dirt road, down  a long dirt driveway, behind a gate he kept locked at all times. dirt road pic

Joe’s history of erratic behavior, his flashing anger and his unkempt ways had alienated his family long ago and had driven away anyone who tried to help.

When Joe was referred to hospice care, he was reluctant to accept the help, to say the least.  Literally no one had been near him or in his home for a very long time.  It took a while for the staff to earn his trust, to get him to unlock the gate so that they could drive to his house, to get him to agree to their help with his pain and symptoms.  Because they never knew what they might find at Joe’s, for their own safety the hospice staff always went in pairs, usually two nurses, sometimes a nurse and a chaplain, always one of them a male.  Very gradually, Joe softened a bit, and most of the time he was receptive and cooperative.  The staff knew that living alone like that wasn’t the best situation for Joe, but it was ok for now, the best anyone could do.

One day when nurses Alice and Brian arrived at Joe’s locked gate for their regularly scheduled visit, they honked the car horn as they always did, signaling their arrival so that  Joe would come down the drive and let them in.  No one came out of the house.  They honked again and then again, and finally Joe came onto the porch, keys to the gate in hand, but very unsteady on his feet.  He reached to steady himself, and then he fell.

Brian climbed the fence and ran to Joe, got him comfortable, then ran back to open the gate for Alice and the medicines and supplies they had in the car.  Joe was conscious, but suddenly he began to have a seizure, then another, then another.  Brian called the hospice office, reached Stacy, the chaplain, and asked him to get a doctor’s order and bring medicines that could stop the seizures. Recognizing that Joe could not stay alone any longer, Brian called for an ambulance to transport him to HomePlace, Hospice of East Texas’ in-patient facility.

Alice and Brian and Stacy stayed with Joe, administering the medicines Stacy brought, doing what they could to comfort and soothe him while they waited on the ambulance. It took a long time, because medical transport of a hospice patient is not an emergency.  Brian found Joe’s daughter’s phone number in his records and called her.  She came to his home, reluctantly. The hospice nurses were able to explain to her that her father had a brain tumor.  Maybe he had had it for a long time.  Maybe it might explain the violence and anger that had alienated him from everyone, even from those who loved him long ago.  Maybe.

Once at HomePlace, the staff bathed and shaved Joe and he was clean, for the first time in a long while.  They nestled him in a clean room, in clean pajamas, in a bed with clean sheets.  Though he never regained consciousness, Joe was quiet and comfortable, pain free and at peace. He passed away that night, and his daughter was by his side.

At Hospice of East Texas, one of our core beliefs is that every person deserves a peaceful, dignified death.  With your help, we give that gift to thousands of patients every year, to people in all kinds of circumstances, people whose Sunday dinner tables are filled with family, people with not one friend.  We give that gift to people who live in lavish homes and in travel trailers, to people who will not be remembered and people who will forever be mourned and missed.

With your help, Hospice of East Texas was able to give the gift of a peaceful, dignified death to Joe.  With your help, perhaps we also gave some closure and healing for his daughter.

Thank you.

“You know, we see this kind of thing more often than you would think,” said Chaplain Stacy.  “There are many people who are alone and alienated, by choice or by chance, and then they get sick on top of everything else.  As I like to say, ‘in comes the blue’, the Hospice of East Texas team of physicians, nurses, social workers, chaplains, volunteers.  End of life can be a time of reconciliation, a time for a second chance… or a third or fourth.”

Leap off the Lawn Chair…Fly!

bird picWe had watched for weeks as Mr. and Mrs. Robin worked on building their nest just outside our window.  It was fascinating as the sticks and straw and grass came together to form a home. Then, one day the building stopped, the nest was ready and Mrs. Robin began to sit.  She sat through the daylight hours and all through the night.  She sat through wind and rain, calm days and hectic days. She continued to sit even on days when the lawn mower was very loud and very close.  No matter what the day was like, Mrs. Robin remained loyal to her mission: to bring life into this world.

All of her sitting paid off.  One day Mr. and Mrs. Robin were joined by three little Robin kiddos.  They were very small and kind of fuzzy and very, very hungry.  They had some growing to do and the parents knew it.  Thus began the feeding process.  It was constant.  Mr. and Mrs. Robin busied themselves searching for food for their little Robin family and delivering their findings to outstretched necks and wide open mouths.  The scene was repeated again and again and again.

The day came one day when the three Robin kids were too big for the nest.  Things had changed and it was time to leave.  We looked and they were gone.  We said goodbye and pondered the miracle of life.  On the next morning I was sitting on the patio just before sunrise drinking a cup of coffee, when I saw something out of the corner of my eye.  In the dim grey of the early morning I couldn’t quite make out what it was, but whatever it was, it was very small and very still.  As the sun continued to wake up the day, the light grew brighter and I realized that what I had been looking at was one of the Robbin kids.  He/she had not gone too far.  The fledgling sat their motionless, facing the nest that had been its home.  The safety and security the nest had provided the day before, was no longer the same.  Things had changed indeed.

As I continued to watch the bird on the back of the lawn chair, Mrs. Robin flew down from a nearby tree and perched next to her offspring.  The mother fluttered her wings and chirped and then flew away again.  I’m not positive, but I think momma was reminding Jr. that things were different now.  The nest he was looking at with such longing was no longer the place it once was.  I can hear her say, “There’s a big world to explore, fresh worms to find, new robins to meet and new nests to build.”  In other words, little one, you have a life to live beyond the nest.

That is life…that is living… that is how it is once you’ve left the nest. Even if you were to go back and crawl in, you would quickly discover that it’s not the same.   Each day is a special gift. Today there are new adventures ahead.  So… Take one more look, spread your wings, and Leap off the Lawn Chair… FLY!!!

 

Later… Wes

Celebrating 50 years of nursing!

2018 is Joyce Story’s professional golden anniversary.  She has been a nurse for fifty years!Joyce Story w patient

Graduating in 1968 from Wichita General Hospital School of Nursing, a three year diploma program at the hospital in Wichita Falls, Texas, Joyce lived in the nurses’ dormitory under the close supervision of a house mother.  She remembers white caps, sharpening needles, sterilizing syringes to use over and over again.

Joyce’s first nursing job was in pediatrics, and now, fifty years later, she reflects that she has come “full circle”, working in end-of –life care as a Field Mentor and Home Care nurse for Hospice of East Texas.

In the years in-between Joyce has done med-surg nursing, been a house supervisor, and an assistant director of nursing.  She served as director of nursing in a hospital for twenty one years.

Ten years ago, she joined the staff of Hospice of East Texas.

As a Home Care nurse, Joyce spends her days visiting her hospice patients in their homes, in nursing homes and in assisted living facilities.  She treasures the close relationships and friendships she develops with patients and their families.  “I always tell them, ‘I’m not a boss.  I’m part of a team that will help you in your final days.  I promise to be here for you and to do anything I can to make these days as comfortable and joyful as possible.’”  For Joyce, this work, these relationships, are a privilege, one she’s not ready to give up just yet.

“I love this work,” Joyce asserts, though she acknowledges that it can be difficult, mentally, physically and emotionally.  “I put 2400 miles on my car every month, traveling to see my patients.  The time behind that windshield is actually good for me.  I think.  I pray.  I recharge so that I can be my best for the next family I visit.”

“My rule is to treat people the way I want to be treated,” Joyce says.  “Death will come for all of us.  It doesn’t matter how much money we have or what we have accomplished in life.  I hope there will be someone there for me when my time comes.”

For Joyce, there are so many memories from her years as a hospice nurse, but one stands out in particular.  Her patient was a hoarder, in a horrible living situation.  “Of course, all of us – nurses, social workers, physicians, volunteers – we all wanted to ‘fix it’, move the patient to someplace better, but that was her home and that’s where she wanted to stay.  She died peacefully in her home, just as she wanted.  She died with dignity.  Every human being deserves that.”

If Joyce could change one thing about her work, it would be that families call for hospice care sooner.  “There are so many misconceptions about hospice,” she says.  “We do NOT hasten death!  Our team can bring so much peace and comfort to patients and to their families, but we need time to do that.”

Definition…?

Red autumn and fishing pierWalk with me down to the edge of the water.  Step with me onto the wooden pier that connects the shoreline of seemingly solid stability to a world of liquid uncertainty.  As we make our way along the planks, notice the smell… it’s fresh, it’s muddy, it’s fishy, it’s exciting, it’s familiar.  We come to a spot where we find a small boat tide off to a metal cleat.  Let’s jump in gingerly, let’s untie the rope carefully, let’s stay as steady as we can and let’s push off.  We are going to float for a moment on the sea of memory.

Memory is a word that can be packed with emotion, especially if you have experienced loss in your life.   It could be the loss of a relationship; companionship; independence; financial stability or any number of other things you cherish.  In fact, whatever the loss, if your loss carries with it an element of love and value, you will react or respond to that loss.  It’s called…Grieving…  If you are grieving, your memory is probably connected to that which you have lost. However, while we are in the boat today, I would like to ask you to remember not only the loss but also something else.  Remember school?

Yep, that’s what I said, school.  Remember when you were in school?  Remember your teachers and your classrooms and those quirky desks you once called “home”?  Remember when your teacher would give you an assignment or a test and you would have to provide a “Definition” to a word or a term?  If you are like me, you did not always look forward to multiple trips to the glossary located at the back of the book. Looking back, it’s an amazing thing, the more definitions you learned, the more you begin to recognize the importance of the definitions. In fact, definitions provide clarity and stability and insight to the world around us and they often serve as keys that unlock the doors that lead us to further understanding and discovery.

Each of us has a “definition” attached to our lives.  It’s how we are perceived, how we are viewed, how we are accepted (or rejected), it is how we are identified by the people…including ourselves.  When we lose those that we love… dare we say it…when someone we care about and are attached to dies, it has a tendency to mess with our definition.  Everything was one way, now everything is a different way.  The definition of the word “spouse” used to be so clear… now, not so much.  The definition of son or daughter that was without question now seems to somehow demand an asterisk.  The definition of grandmother, grandfather, mother, father, aunt, uncle, friend… they all become shadowy reflections of a life before the loss.

Gradually you begin to comprehend that life, your life, is defined by “Redefinition”, and redefinition is not always easy and it’s not always pain free or guilt free.  It is, however, always a normal part of the grieving process.

Wes Bynum, Direct of Care Support Services

So much sadness… and so much kindness

Everyone who worksantas sleighs at Hospice of East Texas, staff and volunteers alike, has heard this comment… “I don’t know how you do it.  It must be so sad.”

The truth is, yes, there are many sad moments, but there are also moments of such sweetness and even moments of unspeakable joy.  Our work here is like itself, a mixture of pain and sadness, balanced by moments of joy and even celebration.

Two days before Christmas, we admitted a young woman to hospice care, too young to be dying of terminal cancer, too young to be leaving a two year old daughter.  Adding to that unimaginable tragedy were her family’s circumstances, a disabled husband, desperate poverty, a home that was more a shed than a house fit for people, cold weather, no coats, her little girl without a pair of shoes that fit. Certainly, there was no Christmas either, nor even the thought of one.

But then, as they always do, the people of Hospice of East Texas went into action. They called their coworkers, their friends and neighbors.  They dug deep into their own pockets.   The necessities, food and cash and shoes and coats, started piling up, and so did the fun things, stuffed animals, candy, silly little girl treasures.  Already on a tight holiday schedule, with lots of work and their own families to take care of, people stayed late, worked the phones, went out of their way to pick up donations.  A Hospice of East Texas medical equipment van became Santa’s sleigh, delivering comfort and joy to a family who had no expectation of either.

Yes, there is sadness and tragedy in the work we do at Hospice, no doubt about it. There is nothing good about this young woman’s situation, and she and her family have a rough journey ahead.  But the people of Hospice of East Texas will be there for them, not just at Christmas but in the months to follow, working to smooth and balance their tragedy with comfort and kindness and generosity.

We can do that because of your support.  For thirty five years, generous friends in our communities have upheld our mission, making sure that Hospice of East Texas was here to help families like this and thousands of others.  Because of you, we can provide our unique brand of extraordinary end-of-life care to everyone who needs it.  And because of you, we can go above and beyond when circumstances call for it, creating a little joy to balance the sadness, sharing some good to smooth the bad.

Sliding down a slide

Have you ever slid down a slide? slide 1

I think back on clear autumn days and trips to the park.  The air is clean, clear and cool.  The leaves on the trees are beginning to turn different shades of gold and red and orange.  A few float lazily to the ground. As I take in the beauty and my heart begins to warm with thoughts of days gone by, my ears hear the squeals and laughter children playing. My attention turns to the playground and I find myself transported in time, back to earlier, simpler days.  There are swing sets standing ready to take me on a gliding trip up and down.  There is a merry-go-round ready to take me ‘round and ’round.  There is a castle or a fort or a ship or a tree house or an airplane… a magical structure that I can pretend in, as I climb on and around and over.  Oh, to be a child again…

Somewhere amidst all this fun and excitement and imagination stands the slide.  I remember how tall the ladder seemed to me when I was just a little tot.  I remember cautiously making the climb to the top of the platform, my trembling tender hands gripping tightly to the cool metal rail.  I remember the lump in my throat and the knot in my stomach as I got to the top.  The view was amazing.  It seemed I was on the top of a high mountain.  Then I would look down.  The slide would be shining in the sunshine and I would hesitate for a moment as I thought about the adventure that was just ahead.  A moment of fear, a moment of question, a moment of apprehension…should I try to turn around and climb down the ladder or go for it?   All I had to do was to let go of the sides and enjoy to trip. I take a deep breath and…  Whoosh!  The thrill of the slide down the slide!

As you walk through the world of grief, you might find yourself facing situations that cause you hesitation.  Moments in life when you pause and try to decide whether or not you really want to let go and experience the “slide”.  Especially during the Holiday Season, you are surrounded by laughter and smiles.  It seems like all the stories have a happy ending and everyone is getting what they wish for.  All the while your heart aches from the loss of the one you love.  With so much “cheer” around, you may feel grumpy, awkward, frustrated, sad, or even a little bitter or jealous.  These feelings, as well as countless others, are all normal pieces of your individual grief puzzle.  Instinctively you know that you can’t go back down the ladder.  However, sitting on the top of the slide will not make the feelings disappear.  The fact is, the longer you sit there the more intense the feelings could get.  My suggestion… accept your feelings, understand that where you are can be a scary place and that it will require some courage to let go.  But remember, as difficult it has been for you to get to where you are and as intimidating the next step may be, there is still a special thrill in store when you choose to let go and slide down that slide. Whoosh!

Have you ever slid down a slide?

Later…Wes

Choosing a Hospice: 16 Questions to Ask

Good information provided by the American Hospice Foundation…Crape Myrtle flowers on campus July2,2012 006

Hospice is a set of services that we all may need someday – if not for ourselves, for our parents. While death is not an option for any of us, we do have choices about the services we use at the end of life. Hospice is undoubtedly the best option in the last months of life because it offers a whole variety of benefits, not only to those of us who are dying, but also to those we leave behind.

How do you find the most appropriate hospice? Until hospice quality data is readily and easily available to all of us, the experts at American Hospice Foundation have pulled together some tips for choosing the most appropriate hospice. Answers to these questions will give you clues about quality of care and help you make an informed assessment.

What do others say about this hospice? Get references both from people you know and from people in the field – e.g., local hospitals, nursing homes, clinicians. Ask anyone that you have connections to if they have had experience with the hospice and what their impressions are. Geriatric care managers can be a particularly good resource, as they often make referrals to hospices and hear from families about the care that was provided. Anecdote and word of mouth won’t paint a full picture but they are still valuable data points.

How long has the hospice been in operation? If it has been around for a while, that’s an indication of stability.

Is the hospice Medicare-certified? Medicare certification is essential if the patient is a Medicare beneficiary to permit reimbursement.

Is the hospice accredited, and if required, state-licensed? Accreditation (JCAHO or CHAP) is not required and not having it doesn’t mean a hospice isn’t good, but if the hospice has it, then you know a third party has looked at the hospice’s operations and determined they come up to a reasonable standard of care.

What is the expectation about the family’s role in caregiving? See if what the hospice expects from family members is consistent with what the family is able to do.

Are there limits on treatment currently being received? Is there anything currently being done for the patient that a hospice under consideration would not be able to do?

Can the hospice meet your specific needs? Mention any concerns the family or patient have about care and ask the hospice staff how they will address those concerns
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Does the hospice offer extra services beyond those required? Some services fall in a gray area. They are not required by Medicare but may be helpful to improve the comfort of a patient. An example is radiation and/or chemotherapy for a cancer patient to reduce the size of a tumor and ameliorate pain. Some hospices would not be able to afford to do this but others with deeper pockets could.

How rapid is crisis response? If the family needs someone to come to the home at 3AM on a Saturday, where would that person come from? What is their average response time?

What are the options for inpatient care? Patients being cared for at home may need to go to an inpatient unit for management of complicated symptoms or to give their family respite. Facilities can vary from the hospice having its own private inpatient unit to leased beds in a hospital or nursing home. Visit the facilities to ensure that they are conveniently located and that you are comfortable with what they offer.

If the family caregiver gets really exhausted can we get respite care? Caring for someone with a serious illness can be exhausting and, at times, challenging. In addition to home hospice care and inpatient care when symptoms prove unmanageable at home, hospices also offer “respite” care (periodic breaks for the caregiver of up to 5 days during which the patient is moved to an inpatient bed) and “continuous” nursing care at home for brief periods at the patient’s home when family caregivers are unable to manage on their own. Ask the hospice under what conditions the hospice provides these types of care.

Are their MDs/RNs certified in palliative care? Not having it doesn’t mean the staff is not competent as experience counts for a lot but having this credential is an indication of specialized study in palliative medicine/nursing.

How are patient/family concerns handled? Is there a clear process for sharing concerns with appropriate hospice staff and making sure they are addressed, including a process for escalation if the concern is not adequately addressed at lower levels?

How does the hospice measure and track quality? You are not looking for a lot of technical detail, just a response that indicates that the hospice evaluates its own performance in order to improve it.

What are your general impressions at initial contact? What is your reaction to the people you talk to?

What kind of bereavement services does the hospice offer? Types of grief support can vary widely and may include individual counseling, support groups, educational materials and outreach letters.

Choosing a Hospice: 16 Questions to Ask by Naomi Naierman and Marsha Nelson was originally published on the website of the American Hospice Foundation. © American Hospice Foundation. All rights reserved.