Elders

Blessed Christmas, One and All!

The Day has arrived. Christmas!!!!

Christmas is a time for family — beginning with the story of a very Holy Family (so now you know where I stand on that ;-). The story has been modified in interpretation over time, for who’s agenda we’ll never really know. But today, sitting in the stillness of my own home and reflecting on what I know of birth, co-generational families and culture, I offer this version, taught to me 20 years ago by a Presbyterian Minister who’d lived several years in the Middle East.

Joseph was neither a procrastinator nor a goof. He had family in Bethlehem, and he needed to return there with his pregnant wife, so they could be counted in the census. It is unlikely that they left so close to her time that Mary was in labor while they traveled, and likely that they stayed in Bethlehem with family for some time. It is probable that many branches of the family gathered together from distant parts, all there to “be counted”, filling to overflowing the modest home — built as was the custom with the “barn” connected to the inside by an adjacent wall. The word for Guest Room is, I understand, the same as for “Inn”. Perhaps, in this version, the guest space was previously occupied, and Mary and Joseph were given to rest in the common area, near the animals and the outdoors, the fire, the food and well – things comforting for a woman heavy with child.

Instead of the cold and lonely version — colored by language and sensationalism and the idea that an entire culture would turn away a young laboring woman — let’s entertain for a moment a different first family gathering, the one we have actually come to emulate as we greet our own family from far and near during this festive week. Imagine a rustic house overflowing with aunties and uncles, cousins and babies, everyone boisterous and contributing what they had to the meals, to the work, to entertaining themselves while the interminable census was conducted. Family slumbering in all corners of house and stable, or outside in tents, making good use of this reunion to catch up with each other. A celebratory air of family gathering together and the anticipation of a much prophesied Birth. Men seated around table or fire, talking politics in hushed voices and pondering the Light in the sky and what it could portend. Let us imagine the Elder Women in the family watching Mary with curiosity, knowing her time was drawing near by the way she moved, by the tired resignation in her countenance. Wise women would recognize her early labor and begin to shush children and send them out with older siblings and cousins, away from the house. Her back would be rubbed, her efforts encouraged and eased by the Aunties and Grannies, Midwives in the family. Those who knew would be waiting with anticipation the Birth of the King, foretold by prophets of old, and by those in Mary and Joseph’s own families. This was not a birth to be taken lightly, not when Joseph’s entire family was gathering in Bethlehem to “be counted”. It was a celebrated event, in the family and in the countryside and in Heaven, where choirs of Angels sang of the wonder.

I don’t think the vision of Jesus’ birth as much anticipated and welcomed, of Mary’s labor attended by women who loved and honored her as a sister, of the family having what they needed — clothing, food and shelter (and a warm, fresh manger to lay the baby in), diminishes the Miracle at all. In fact, it brings more Love, more Light, more Peace, more consolation. A King was born from very humble beginnings, but was much loved already — by angels and shepherds abiding, and by family greeting Him in celebration.

And so, maybe, this event didn’t happen around the Winter Solstice. Perhaps as many believe, it happened in the summer and was later co-opted by the church to coincide with the return of the Light in the dark of midwinter (but hello! if you live in the Southern Hemisphere, it IS celebrated in the height of the summer! We are such snobs here north of the equator).

~ ~ ~ ~ ~

This phenomenon of days shortened and lengthened made me consider how we refer to life passing. As in the Christmas story, we shift words and meanings to somehow minimize our love and connection, our delight in and mutual support within family and society. We refer to our days as growing shorter at the end, but really, they don’t. Whether we have 16 hours of daylight or dark, our days remain the same — 24 hours in a day, 7 days to a week. Every day, we have the opportunity to embrace each minute and hour to the fullest. Our actual days do not grow short. Our patience might. Our abilities may change and wane, our family and social circles ebb and flow, but our days — our wonderful, magical, glorious days — continue to have 24 hours, 1440 minutes, 86400 seconds (if you check my math and find me in error feel free to leave a comment).

What grows short is our ability to take each of those days for granted. How many seconds have slipped through our fingers — seconds when a kind word or a smile would have changed an encounter with someone? How many minutes spent thinking about the ways we could show love and attention, but didn’t? How many hours spent in futile endeavors that didn’t add value to our — or anyone else’s — life? As we embrace this Day, and the morrow, as family arrives or leaves or calls or writes, as children laugh or get fussy; Elders participate or rest, let us remember that each moment is an opportunity to add value, ease a burden, encourage with a word or smile, laugh out loud together. We have infinite opportunities to “Be the Love in the World” that we celebrate this day.

It is only in looking backwards that we can measure the length of a life or the impact it had on those it touched. Looking forward, we only have this moment to share the Love, Joy, Peace, Hope and humble service that this Holy Day represents. My wish for all of you, dear friends and family (and much appreciated readers), is that the Love Light that shone on our Planet that day so many centuries ago, shines on you and your family, from the youngest to the Eldest, and fills you with Peace beyond all understanding through every trial you may encounter in the next year. Peace to you, and Goodwill to all, and a very, Merry Christmas.

Katherine

Some thoughts on Advance Directives

[polldaddy poll=7422056]

Every emancipated adult should have an Advance Directive. Once a child is emancipated, parents can no longer make medical decisions for them by default, should the offspring become incapacitated. Often we limit our conversations about Advance Directives to Elders, thinking they are more likely to become cognitively impaired. However, the age cohort often overlooked are young adults between 18 and 30 who are at risk for devastating traumatic brain injury (TBI) — due to motor vehicle accidents, recreational accidents or substance abuse.
Preceding the Patient Self Determination Act (PSDA) was the tragic, 1970’s case of Karen Ann Quinlan, which attracted sensational media attention and brought the controversy between family desires, medical opinion, ethics and law into the cultural conversation. I have no doubt that her case, and those that followed, helped propel the PSDA into being. Shortly after the Quinlans lost their appeal to have their daughter’s life sustaining treatments revoked, I found myself working in a “convalescent hospital”. There I had the unforgettable experience of caring for a high school classmate, not even 21 at the time. Shortly after graduation, while walking on a lonely road late at night, he was struck by a car. Suffering spinal cord and traumatic brain injuries, his quality of life was undeniably impaired.
I don’t think revoking heroic measures was an option in California in 1978, and this encounter, so close to heated debates about terminating life-support, left an impression on me. In recent years, I have had conversations with young adults that include thoughts about accidents and injury. They are quite clear “I don’t want to be kept alive if there is nothing left of ‘me’”. Youth are as important to include in the conversation about Advance Directives as are their Elder relatives, and for similar reasons. Loved ones can’t act on your behalf if they don’t know what you want.
We don’t like to talk about death and dying, about end of life mystery or transition. Life seems brighter if we ignore the shadow side and go merrily on our way. For us, it might be. If we’ve become incapable of making decisions for ourselves, chances are we won’t care much. Some won’t talk about death because they don’t want to upset their families or those that they love by “making them think about it”. The irony is that by trying to protect those we love by ignoring this reality, we force them into making decisions about us which they are ill-prepared to make. Some people don’t understand what Advance Directives are or how they can help.
I have watched this process when families are unprepared. It is often grueling and painful. The second-guessing about what “mom wants”, the contention between those mature enough to let go and those clinging to hope or fearing death can devastate a family that needs to support each other and prepare to grieve.
Most departments in my hospital, which serves a large retirement age population, assertively broach the topic of Advance Directives, and in my specialty clinic new patients are educated and offered a copy of our state’s Advance Directives workbook.
AD pamphlets read very similar from state to state. They are dry and medically oriented. Recently, I was introduced to a stellar revision of the standard Advance Directives, entitled “5 Wishes”. It reads very similar to the more bland AD pamphlet with three notable exceptions – “How comfortable I want to be”, “How I want people to treat me”, and “What I want my loved ones to know”. Those tools could soften and gently personalize the conversation about end-of-life decision-making.
Those three wishes give the powerless – those who can only stand by while someone they love is dying – specific tasks to perform to enhance the quality of the last days and hours and instill a sacred dignity to the art of dying. I wish that they had been a part of my own mother’s AD process. At 88, however, she was not very open to talking about what she wanted (besides that she didn’t want her children to hurt). Baby Boomer Elders may be more forthcoming about what would make their final passage sacred and meaningful, (or even fun and joyful!) My Depression Era mother was not. We had to guess. How much gentler it would have been if we had known what was important to her, to enhance her comfort.
There are few reasons for any emancipated adult to not have the discussion about end of life wishes — from medical care choices to what music you want playing when you are unconscious or passing — and legally initiate appropriate Advance Directives. Perhaps more people would engage in them if they knew that:
1. They can be revoked at any time by the issuer.
2. They only go into effect if the issuer cannot make medical decisions for themselves due to inability to communicate their wishes.
3. It alters the responsibility for making life-to-death medical decisions to the issuer, having had a discussion about their values and desires with their appointed representative. It is an act of personal empowerment — one is less “victim” to the end-of-life passage, and more a participant.

4. The process of reviewing the choices one must make when completing their advance directives opens the door to conversation valuable in any relationship, “what to do when I am dying”.
5. It is kind for the family to have decisions articulated and communicated in advance.
Inadequate understanding is a barrier to completing Advance Directives. The concept that it is somehow a “death sentence” or supported by “death panels” can link Advance Directives to one of the most emotionally charged phrases to come from the detractors of the Affordable Care Act, though the PSDA precedes the ACA by more than a decade. For those wishing to engage in all means of life-sustaining treatment, it is still important to appoint a representative to direct medical care and long term care choices from home health, nursing home to hospice. The idea that Advance Directives are only for those wishing to halt life-sustaining treatment is a common misunderstanding of it’s purpose.
There is a risk of exploitation and that needs to be guarded against, and is, by the stipulation that the appointed representative cannot be a caregiver or employee of a facility where the issuer receives care. It is possible to appoint the wrong person for the wrong reasons. A representative should be someone the issuer is confident will follow their wishes, who has knowledge of the care they have been receiving and their medical history, as well as their values and desires.
Life is short, the time is now to think about what you would want and who would be your voice if you couldn’t make your desires known. Have the conversation with your children and your folks.

For more information on “5 Wishes” visit http://www.agingwithdignity.org/five-wishes.php

Have distanced from your Elders? Why do you think that happened?

I was listening to Brene Brown on Oprah’s Super Soul Sunday recently. She made a statement that struck me to the core. Initially, I thought of it in terms of my own life parenting adult children, working on building a new relationship. Musing on it for a couple days, though, I realized that this contributes to why — as a culture of middle aged adults — we distance from our family Elders. Brene stated “When we lose our capacity for vulnerability, joy becomes foreboding.”

“What makes us vulnerable?” Risking the pain of losing a parent you love and adore and know really well is being REALLY vulnerable to loss, pain, self doubt and regret. As our parents and other Elders age, we know that we will, ultimately, have to say goodbye. We will experience loss (statistically speaking). To fully engage with our parents as they age, as their abilities change or decline, as they need us more as advocates and companions and not just as children, is to open ourselves up to the pain of letting them go after becoming very engaged and attached. That is something, perhaps, worth defending your heart against (or not, more on that to follow).

The second part of that quote is that “Joy becomes foreboding”. When we are afraid of being vulnerable and truly open to the moment without fear of what may or may not happen down the road, even happy moments generate tension. When I had a great day with my mother, I often felt pre-emptive grief, realizing that these were special days and numbered. How much better it would have been for both of us if I could have just experienced the joy without the foreboding. Would I have shown up for her better? More often? It is something I contemplate in other relationships now.

There are many reasons why people distance from aging relatives and friends. Their changing or dissolving abilities challenge us. It isn’t easy to be with some people — communication is difficult due to physical changes (loss of hearing for example); cognitive changes (from mild to advanced dementia, depression and ensuing negativity), to powerlessness which makes people feel hopeless for any positive change in their situations. Hopelessness is hard to cope with in someone we love, someone we want to help out. Too often it seems that our Elders don’t want help, they just want to complain. This may actually be more a symptom of depression (which is a common and treatable disease among Elders), than an overall personality change.

We may distance because WE feel powerless and hopeless. “There’s nothing I can do, anyway.” (A self-fulfilling prophesy if ever there was one). “They don’t want my help” (No, but they might want your attention, to know that they aren’t alone in this last walk around the block). “They live too far away” (how can you mitigate that through phone calls or setting them up with social media?).

This is what I have learned about distancing and avoidance. Our parents will likely precede us in death (mine already have). In the case of my father’s death, he was young and it was unexpected. There was no planning for, preparing for, working out old issues. It just happened, and there we all were, carrying around the things left unsaid and undone. That is the stuff regrets are made of. Regret, like disappointment, is an emotional experience I go out of my way to avoid.

My mother’s last years were quite different. Yes, I often woke up in the middle of the night with a start and wondered if she had just fallen. Yes, we lived from crisis to crisis because there was a lack of communication and planning for quite predictable events. Yes, some days I thought a week-long rest in the local behavioral health inpatient unit would be just the ticket for me (thankfully I never had to use that extreme back up plan). In the long run though, I have powerful memories of my mother. Her grandchildren, who engaged with her often showering her with love and attention and likewise being recipients of the same — have great stories to share. In her last years, my mother imparted her values, her humor, her resiliency on that next generation. That didn’t happen all at once but over time, over ice cream and Scrabble boards, card games and coloring books, Sunday dinners held at her house even if the best she did was Shake and Bake chicken strips, mashies and salad. We watched together as her abilities diminished.

My mother’s passing came as a completion of several years of work in which we loved on her, were devoted to her comfort and quality experiences. With our help, she remained in her home until just shy of her 88th birthday, moving to an adult foster home the week before. I sat with her daily. We knew her favorite music, and it played in the background. We knew the stories she liked to hear re-told, and we shared them. We placed phone calls to people she needed to hear loved her, one more time. Our pastor came and sorted out some last issues around shame. When my mother passed, it was quiet, gentle, complete. I have never looked back and thought “I wish I had only….”, because we chose to be present with her. Choices were made that were temporary sacrifices for a lifetime of peace (mine and my children’s). When we think of my mom and the void her absence sometimes creates for us, it is with a sense of love and acceptance. There is no guilt. No regret. We allowed ourselves to be vulnerable to the pain, and in the process, allowed ourselves to experience the love and joy that spending time with her gave.

I challenge you to look at current patterns with Elder family members. What stands in the way of regular communication: Geographical distance? Technological deficits? Unresolved relationship issues? The belief that parents are the responsibility of another besides you? Time constraints? Upon further examination, are any of those things possibly excuses to help you maintain a safe emotional distance from the reality of aging or end of life issues, for yourself or your parents? Feel free to comment below, and as always, feel free to share this blog with others walking this middle of life walk.

Happy Memorial Day (weekend)

Tribute to a family of participants: The Ledford Loughead clan (my father is the baby), Oliver P. Ledford with Sea Bees on Tinian, WWII, and with support staff in Viet Nam; Eva Heineck and Katherine Heineck, USCG Spars.

Holidays are a time for establishing and maintaining rituals. This last weekend in May is generally harkened as the first weekend of “summer”, play time, fun time, get-outside-in-the-sun time. We think of beaches and blankets, the smell of sunscreen and water and how there really is sand in sandwiches. The boat goes in the water, the tent gets popped up, someone gets too drunk and spoils the whole affair. Memorial Day!

Holiday rituals connect us to family gone before us. Some rituals we keep, some we let go, some adapt in collaboration with a lover or mate who brings their own with them. My father kept holidays well, though I didn’t always appreciate that. With Christmas, of course, the better kept the happier the children are, and my dad could keep Christmas very, very well! Memorial Day was harder for me as a child. While friends would be camping or playing and enjoying the three day weekend, and he loaded us up and drove to a town I was unfamiliar with, spent time talking to people 5 decades my senior (oh how I wish I had that time back now!) and took flowers to his parents’ gravesites. I recognize now that like Christmas traditions, my father also kept Memorial Day… very well.

My father passed away 36 years ago. He’d be 99 this year (so if he’d survived the heart attack at 63, he’d still be gone by now). Memories don’t do “time” though. He is as alive for me this Memorial Sunday as he ever was, and I get to go visit him today. My 21 year old daughter will be with me to hear the stories, see the place, walk through old neighborhoods, clean the headstone, admire the cherry tree and with love and attention, place flowers and a flag. It took thinking I couldn’t go this year (and I’ve missed 25 due to relocating far from my home town and his resting place) for me to realize how imperative it was that I go. Through all the automotive travails we have had in the last three days I thought it impractical to make the 3 hour trip “home”. I tried to console myself with setting up a small Memorial Day alter for my parents, but the thought of this man — who voluntarily served in two wars — having an empty headstone struck my heart and I realized that…. I had to go. I had to make my love and respect for him made visible on this Memorial Day.

Through the ritual my father taught me all those uncomfortable childhood Memorial Day weekends ago, I have a cellular imperative to honor him the same way, to take my own daughter, who never knew this wonderful man, and make him real to her. My mother, whose ashes remain above ground as yet, will one day rest with him, and a more complete family reunion will take place, at least this one day a year. Hopefully, there will always be a child there to hear the stories, for it is in our rituals of remembering that we share our oral histories with our offspring. Through ritual, we teach those that come after us the values we cherish.

I never knew my grandparents, both died before I was born. I understand better the love and respect my father had for them, demonstrated by honoring them, publicly, at least this one weekend a year. They made him the man he became and through him, helped craft me into the woman that I am today and the man I see my own son becoming.

We are not disconnected from our family histories. They live in us and through us, are passed to our children whether we attend to their memories or not. Similarly, while our families are living, whether we ignore their needs, put off the phone calls, imagine that everything is “alright, or they’d call me”, we are not disconnected from them and their influence upon us.

The Post War (that would be WWII) cultural shift away from extended family and to the ‘burbs has been an interesting social experiment in fracturing the family, and it hasn’t worked out so well. When denied the comfort and company of multiple generations, aging has become isolating and demeaning, where too often Elders feel they are “less than” if they require assistance from others. By ignoring rituals and connectedness (my mother made Sunday dinner for us for years, that became “our time”), we forget to teach our own children the importance of family connection, those generational bonds that sustain us when the world shakes beneath our feet. Cooperation and collaboration support multiple generations of family so knowledge is saved and wealth is condensed. I hope that as a unique American culture, we will come again to defy the idea that we are all independent, autonomous islands, sustainable on our own. This Memorial Day, I call you to remember, and then to share.

Blessings to you and yours,
Katherine