Losing One’s Independence

The loss of physical independence is certainly one of life’s most challenging experiences. Elderly patients often find themselves in a position of giving up their homes and living in what we used to call a nursing home. Now they are often called assisted living. No matter how you dress it up, it still means giving up the comfort of familiar surroundings. This disorientation is compounded by the fact that you may be depending on others to help you walk, move in and out of bed, or assist with toileting.

I am deeply interested in how people respond to such news. After all, I may be in their shoes some day. Many of my core beliefs about life are wrapped up in my ability to walk, provide for myself, and provide for those I love. What if I was unable to walk?

Some elderly people accept their new circumstances stoically. They believe that staying with their children would create hardship, or strained relationships. “I don’t want to be a burden,” they will often say. I certainly admire their selflessness. I am not sure I could be so magnanimous. Who knows how we will respond if and when such decisions come to or lives?

*Itzhak Perlman broke a string on his violin at the beginning of a concert in Houston in 1995. Due to his physical limitations, getting a new string would have required a great deal of time and effort. Instead, he continued playing on three strings, improvising as he performed. The crowd was deeply moved by his performance and gave him a standing ovation. His comment …”You know, sometimes it is the artist’s task to find out how much music you can still make with what you have left.”

The people I have seen smiling in nursing homes are those who find other people to talk to and encourage. They have incredible patience and learn to wait on those who wait on them. They are wise enough to be kind to those who feed them their meals, change their bedding, etc…for it is their kindness on which they depend.

What we take into the loss of independence are those fruits of the Spirit that do not depend on circumstances. Love, joy, peace, patience, goodness, gentleness, and self-control (Galatians 5: 22) are “heart kept” and cannot be stolen away. You can love your caregivers. You can show them joy and offer them peace. You can be patient and show goodness. You can be gentle with others and practice self-control. I have seen others accomplish this.

A good friend of mine lived to be 93, and spent the last few years of her life in assisted living. Though a stroke had paralyzed her right side, she typed long e-mail letters with one hand, and conducted Bible studies with many of her caregivers and fellow tenants. I find her example admirable and worthy of imitation. I hope I can respond as well should the need arise. We may lose our physical freedom, but the Spirit remains free.

*Taken from Light on the Fringe: Finding Hope in the Darkness of Depression by Gary H. Lovejoy and Gregory M. Knopf.

Author David Martin

Book Recommendation

I want to commend a book to you that came to my attention at a Palliative Care Grand Rounds session at Methodist Hospital a few weeks ago. The book is entitled, Mastering Communication with Seriously Ill Patients: Balancing Honesty With Empathy and Hope, by Anthony Back, Robert Arnold, and James Tulsky (New York: Cambridge University Press, 2009 ISBN 978-0-521-70618-6).

This book is written by physicians for physicians, and it addresses a pressing need in healthcare: The need for better communication between doctors and patients. The authors acknowledge that, for many physicians, communication is not their strong suit. They then proceed to lay out a practical, positive approach that doctors can use to relate more effectively with their patients. What impressed me, aside from the very fact that the book exists, is how similar the emphasis of Back, Arnold and Tulsky is to the emphasis of our training of volunteers and interns at Lifeline.

The authors articulate seven principles which illustrate their overall approach (pp. 6-7):

1. Start with the patient’s agenda.
2. Track both the emotion and the cognitive data you get from the patient.
3. Stay with the patient and move the conversation forward one step at a time.
4. Articulate empathy explicitly.
5. Talk about what you can do before you talk about what you can’t do.

Chapters are devoted to such thorny doctor-patient communication issues as: Talking about serious news; discussing prognosis; conducting a family conference; dealing with conflict; transitions to end-of-life care; talking about dying; and saying goodbye. In each chapter the authors lay out the problem, illustrate it, and lay out a “road map” for the physician to build communication skill in that area. Especially helpful are verbatim-like text boxes in which samples of a conversation are laid out under two columns: “What Happened” and “What We Can Learn.”

The authors function as empathetic, though uncompromising, coaches, providing their fellow physicians with practical tools, challenges, and encouragement in improving their relational skills.

Even though the book is written for physicians, I found it to be a very helpful review of basic communication skills and strategies. It merits close attention by anyone who works closely with persons dealing with serious illness and loss.

Author: Paul Riddle

A Happy Girl!

Lizzie’s energy lit up the room. When I walked in, she greeted me with an enthusiastic, “Hello, Paul!” She was sitting up in bed, bouncing with excitement. Jen, her art teacher, had just arrived and they were about to begin a watercoloring session. Lizzie’s face was bright, and her zest for life was infectious. Everyone in the room was warmed by her glow.

So different from the sad, frightened child I had seen a couple of months ago when I first met her. Injured in a serious car accident that had claimed part of one of her limbs, Lizzie was traumatized not only in body but in spirit as well. What a shock for a child of seven to go through! What a shock for anyone to go through. At our first meeting Lizzie was huddled under the sheets, tentative, almost afraid to engage anyone new, like an injured animal licking its wounds.

Slowly at first, she began bit by bit to adjust. Her mother, Sarah, was by her side constantly, encouraging, supportive, present. And the medical staff couldn’t have been better. Not only the doctors and nurses addressing her physical injuries, but also the child life specialists, physical therapists, chaplains and others who provided emotional and spiritual support. Also family friends, relatives, and her church community all stepped up.

Today was to be our last visit, and we both knew it. Lizzie was to be transferred later that day to a different hospital, where she could receive additional, specialized care. It was a joyful visit, and when it was over she gave me a hug.

Walking away from the room, I felt a sense of joy at the progress Lizzie had made, along with a twinge of sadness that my role in her care had come to an end. I also marveled at God’s ability to mend that which is broken – to bring healing and wholeness to injured bodies and spirits.

I treasure my brief association with Lizzie. In our visits, I sought to provide spiritual support, but I also received a blessing from God through her. For that I am thankful.

Blessings to you, Lizzie. May God strengthen, sustain and guide you all your days.

Author:Paul Riddle

“Preparing for Pain”

Psalm 1: “1BLESSED is the man who walks and lives not in the counsel of the ungodly, nor stands in the path where sinners walk, nor sits down where the scornful gather.

2But his delight and desire are in the law of the Lord, and on His law he habitually meditates by day and by night.”

Worshiping in the small country church shaped my world from an early age. I can remember napping while the preacher expounded on things I could not fathom. The sun would shine in from one of the long windows and warm my back during the cold winter days. If my mother caught me dozing, she might thump the back of my head. My embarrassment was worse than the pain of the thumping! I did manage to listen more attentively as the years went by.

Those sermons were filled with stories of those who were caught in adultery, power struggles between Jesus and his critics, and compelling narratives about miraculous healings.
Healing is something we long for when we are ill or injured. If you have a stiff neck, and cannot move without pain, you want to feel better. You might go to a doctor, and endure physical therapy in order to be healed. Pain gets your attention and requires a response.

Though we do not like pain, it does serve a purpose. It tells us something is wrong. If we ignore it, we can even cause greater injury.

In like manner, we can feel spiritual pain. We are uneasy about something and know that our lives are amiss in some way. If we do not give this pain the attention it needs, it can fester and lead to greater heartache. Pain thumps us on the head and tells us to pay attention.

Maybe the best time to find healing for our spiritual pain is before the crisis comes. It is good to do some spiritual house cleaning from time to time, so that when sickness or injury arrives, we can rely on a faith that is deep and enduring.

“3And he shall be like a tree firmly planted by the streams of water, ready to bring forth its fruit in its season; its leaf also shall not fade or wither…”

Author: David Martin

Caregiving: The Language of the Heart

(The following article is written by Dan Bonner who a Lifeline Pastoral Care Volunteer for Central Texas)

The frail, wisp of a man barely puckered his cover-sheet; however, you could tell he was a much loved giant in the eyes of the man and woman standing beside his bed. A son on his right side was holding one hand and a daughter on the other side was holding the other one. It was a beautiful sight, made even more wonderful by their warm, welcoming smiles.

After introducing myself, the son told the father in Spanish who I was. With a smile as big as the sun he spoke, immediately taking the conversation in an unusual direction. He wanted to know about me: children, grandchildren, my age. The similarities established a rapport that would last throughout his hospitalization.

As I entered his room for my second visit, Juan threw his arms in the air as though he was welcoming a long lost brother. His ear-to-ear smile was punctuated by sparkling eyes. Through his son we talked of physical health, the importance of family and God’s blessings. Before I left it was important to Juan to demonstrate his improvement, so he walked across the room for me to see.

My next two visits were without the son or daughter there. She works during the day; he works as a janitor at night. Both times, mercifully for me I thought, Juan was asleep. Each time I left a note for his children to read to him.

On my last visit he had been transferred to the Intermediate Care Unit. The son had gone to lunch. What could we do but smile at each other I asked myself. Then putting the palms of my hands together I brought them up to my chin and bowed my head. Juan nodded his head, reached for my hand and closed his eyes. I said, “Our Father in heaven.” “Gracias,” he quietly said. At each comma, each period, each pause in the prayer there was a quietly spoken “Gracias.”

Juan did not understand my words, but trusted me to use them well. It was our prayer. Though neither of us is bilingual, we knew the Father understands the language of our hearts lifted in prayer.

Author: Dan Bonner

New Beginnings

As we enter a new year, I’m involved in several projects that have to do with making a new start. First, I’m involved in my church’s search for a new preaching minister – always a time of renewal for a church. Second, I’m writing letters of recommendations for three former Lifeline interns who are applying to graduate programs – one in medicine and two in ministry. Third, I’m serving on a Board Certification committee for a new chaplain.

I’m excited to be a part of helping to launch these new beginnings in the lives of people I care about. Not only do I find this work personally satisfying, I also find it spiritually uplifting. At the core of my personal theology is the conviction that God’s main line of business – at least as far as human beings are concerned – is redemption, the making of new beginnings. When I serve on a selection committee, when I help a new chaplain or a former intern launch a career or begin a course of formation, I feel that I’m participating in a small way in God’s Kingdom work of making all things new, and that leaves me with a feeling of deep satisfaction.

God’s blessings to you this week.

Author: Paul Riddle

Prayer: Does It Make Any Difference

I offer to the weary soul a poem I found in Phillip Yancey’s book on “Prayer: Does It Make Any Difference.” One can almost see the scenes that the author paints. I hope it refreshes you as it did me.

The Peace of Wild Things
Wendell Berry, Collected Poems

When despair grows in me

and I wake in the middle of the night at the least sound

in fear of what my life and my children’s lives may be,

I go and lie down where the wood drake

rests in his beauty on the water,

and the great heron feeds. I come into the peace of wild things

who do not tax their lives with forethought

of grief. I come into the presence of still water.

And I feel above me the day-blind stars

waiting with their light. For a time

I rest in the grace of the world, and am free.

Author: David Martin