Friday, February 17, 2017

Knowledge will bring you
the opportunity to make a difference.

Claire Fagin

Hi Everyone,

I have just been updating the bibliography for the Caring On Empty workshop in preparation for workshops in Calgary and Vancouver Island next month and I thought you might like to have a look at some of the additions. Here they are:

1.  Articles:

*  Anderson, L (2016) The impact of a knitting intervention on compassion fatigue in oncology nurses Clinical Journal of Oncology Nursing Feb 2016, Vol 20(1), 102-104

*  Claxton-Oldfield, S (2015) Hospice palliative care volunteers: Stressors, how they cope with them and implications for volunteer training/management  American Journal of Hospice and Palliative medicine Feb 10, 2015

*  Gilman, L et al (2015) Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: A comprehensive systematic review JBI Database System Rev Implement Rep 2015 June 12;13(5):131-204

*  Labib, MYT (2015) Compassion Fatigue, the Wellness of Care Providers and the Quality of Patient Care BSc Honors Thesis Portland State University Paper 205

*  Miller, B and Sprang, G (2016) A components-based practice and supervision model for reducing compassion fatigue by affecting clinician experience Traumatology January 28, 2016

*  Thieleman, K and Cacciatore, J (2014) Witness to suffering: Mindfulness and compassion fatigue among traumatic bereavement volunteers and professionals  Social Work January 1, 2014

*  Zehr, KL (2015) The Effect of Education on Compassion Fatigue as Experienced by Staff Nurses Doctorate of Nursing Practice Thesis, Valparaiso University, Valparaiso, Indiana Evidence Based Practice Reports. Paper 65

2.  Books:

*  Levine, Peter (2015) Trauma and Memory: Brain & Body in a Search for the Living Past North Atlantic Books, Berkeley, CA

*  Richardson, Jan (2016) The Cure for Sorrow: A Book of Blessings for Times of Grief Wanton Gospeller Press, Orlando, Florida

*  Esfahani-Smith, Emily (2017) The Power of Meaning: Crafting a Life That Matters Viking Press


The Wild Edge of Sorrow ...

There is some strange intimacy between grief and aliveness, some sacred exchange between what seems unbearable
and what is most exquisitely alive. Through this,
I have come to have a lasting faith in grief.

Francis Weller
The Wild Edge of Sorrow

Hello, Everyone,

I began the post below earlier last month but was interrupted and forgot to hit the "publish" button so here it is now, sans the snow! .....

Here in Vancouver, we are trapped in the wilds of winter with more snow on the ground, in the trees, on the roads and in the air in this past week than we usually see in a year! The whole world seems to be held in muted abeyance, hibernating as it waits for its natural rhythms to return. It's a time to bury yourself in a cozy blanket with a good book and that's just what I've been doing all weekend.

Having lost four dear ones since mid-December (five, if we count my sister's Maggie-dog, a lovely Bernese Mountain Dog who captured all our hearts), witnessed the devastation of so many  lovely trees at the lake during this year's unusual snowfalls, been stunned by the deaths of six innocent Muslims at prayer in Quebec City and experienced profound sorrow at the hateful rhetoric arising from so many parts of our world, I have been reading a new-to-me book on grief. I'd like to share some of its goodness with you this morning.

Francis Weller's book, entitled The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief, is one of the better volumes on grief I've had the pleasure to read. Beautifully written, it covers five categories of loss which Weller says form five gateways to grief

1.  The gateway of illness and death
2.  The gateway of the parts of our selves that didn't receive love -  parts that were then lost  through being wrapped in shame, banished and marked unworthy
3.  The gateway of the world's sorrows -  the loss of care for the earth and the devastated state of the earth and its creatures 
4.  The gateway of what we expected and did not receive -  the loss of the welcome, engagement, touch and reflection we are all hardwired to expect at birth and throughout our lives but may not have received because we weren't raised by a village that could meet multiple needs or because
5.  The gateway of ancestral grief - the losses of our ancestors, often unknown or unacknowledged, and the secondary losses arising from the ways in which they coped with their pain (violence, alcoholism, eating disorders, emotional abuse and neglect, rejection of culture etc), all still carried within our bodies

Weller spends a good deal of time talking about the importance of ritual, a form of support readily available to the bereaved but often missing for people with disenfranchised grief such as chronic sorrow. Because this grief response is not mentioned specifically in the book, the volume also lacks the needed cautions reminding family caregivers to avoid doing deep grief work around more than one loss at one time so as not to become overwhelmed.

I found this book a poetic read with exquisitely evocative language. It provides a needed reminder for all of us to acknowledge and work with our losses so they don't have a continuing negative impact on our selves and our world and so that our personal aliveness can be kindled through the transformation of our grief. Weller's writing is empathic and resonates with the grief of the reader and, although its  recommended group work for healing grief is not a process that appeals to my introverted soul, it obviously appeals to and helps many others. I would recommend this book to anyone interested in learning more about ritual and the healing of grief.

A second book I've found supportive and soothing in these days of sadness is Jan Richardson's new book, The Cure for Sorrow: A Book of Blessings for Times of Grief. While written from the specific perspective of a United Methodist minister and new widow in the US, this book touches on universal themes of loss, grief and transformation and invites us to "know the tenacity of hope and to recognize the presence of love which ... is 'sorrow's most lasting cure'". Here is one of Jan's new blessings, one which I think applies to caregivers as much as to the bereaved:

The Blessing You Should Not Tell Me

Do not tell me
there will be a blessing
in the breaking,
that it will ever
be a grace
to wake into this life
so altered,
this world
so without.

Do not tell me
of the blessing
that will come
in absence.

Do not tell me
that what does not
kill me
will make me strong
or that God will not
send me more than I
can bear.

Do not tell me
this will make me
more compassionate,
more loving,
more holy.

Do not tell me
this will make me
more grateful for what
I had.

Do not tell me
I was lucky.

Do not even tell me
there will be a blessing.

Give me instead
the blessing
of breathing with me.

Give me instead
the blessing of sitting with me
when you cannot think
of what to say.

Give me instead
the blessing
of asking about him -
how we met
or what I loved most about the life
we have shared;
ask for a story
or tell me one
because a story is, finally,
the only place on earth
he lives now.

If you could know
what grace lives
in such a blessing,
you would never cease
to offer it.

If you could glimpse
the solace and sweetness
that abide there,
you would never wonder
if there was a blessing
you could give
that would be better
than this -
the blessing of your own heart
opened and beating
with mine.

Blessings to all of you who grieve today.

Saturday, January 7, 2017

Quickening ...

There is a vitality, a life force, a quickening that is translated through you into action, and there is only one of you in all time.  This expression is unique, and if you block it, it will never exist through any other medium and will be lost. The world will not have it. 

It is not your business to determine how good it is nor how it compares with other expression. It is your business to keep it yours clearly and directly, to keep the channel open. You do not even have to believe in yourself and your work. You have to keep yourself open and aware of the urges that 
motivate you.  Keep the channel open.

Martha Graham

Happy 2017, Everyone!

I hope you've had a peaceful and refreshing holiday season. 

The rather old fashioned word, quickening, has been playing at the front of my mind this week as I've prepared to spend the next two months writing. Quickening has several meanings -  to make more rapid, to enliven or return to life, to excite or stimulate and to reach the stage of pregnancy when a baby's movement is felt. It is the middle ones that we're interested in here.

Quickening is an experience of hope and possibility and potential. It is the restless energy that initiates growth and creativity whether we are moving into a new stage of development, painting a masterpiece, building a fence or coming up with a more comfortable way to tape a catheter to a loved one's leg. We can see examples of quickening in nature each Spring as seemingly lifeless seeds and branches respond to an inner urging that coaxes them to life. 

We are all familiar with these excited stirrings that can enliven and motivate us. I can recognize quickening in my own life when I spend time in contemplative silence; when grief lightens after a loss; when the first snowdrops push through in the spring; when I return from a fibre fair with a bag of beautiful yarns for a new project and when I feel the urge to take my camera to the lake, open to receiving whatever images may appear. I also feel a spark of this vital energy when I've struggled through a dry spell in my writing and then, suddenly, disparate thoughts fall into place and I rush to the computer to capture them before they disappear.

What about you? Where might you be feeling quickening or new aliveness emerging this New Year? Is something within trying to catch your attention, to help you solve a problem, to enliven a new part of you, to take you in a new direction? It doesn't have to be anything monumental. In fact, quickening often speaks in quiet excitement about seemingly small possibilities. We just have to learn to notice and pay attention to this voice of excitement and then respond.

Here, once again, is one of Jan Richardson's poems which I think well describes the experience of quickening:

This restless hope
is what drives me
beyond the weariness
beyond the discomfort
beyond every thought
that what I carry within me
will never come to birth.

This restless hope
beyond all reason
flutters beneath my heart
and grows within my soul.

It is beyond me,
and it is of me,
and it is delivering me

I hope 2017 will be a year of possibility and promise for each of you. May you find ways within whatever constraints are present to "keep the channel open", to feel the quickening and to respond in the most life-giving ways you can.

Friday, December 9, 2016

The Task of This Darkness ...

In a dark time, the eye begins to see.

Theodore Roethke

Hello Everyone,

It's been a long time! My broken left arm and injured right one continue to heal - in the case of the left one, a little too well! It seems that my left radial nerve is trapped by the adhesions of healing causing considerable pain when I forget and twist my arm to the side and backwards, stretching the caught nerve. Fortunately, it's my left arm and I've learned pretty quickly not to twist it unthinkingly as I put on my coat, throw a scarf around my neck or reach to turn off the bedside lamp. This intense intermittent pain is a small darkness in my life this winter. (I tend to be pretty impatient with any restriction of my activity!) 

Soon, it will be Winter Solstice, the time when we reach both the shortest day and the longest night of the year. A time when we tend to hope for and celebrate the coming of light to end our particular darknesses. (We all experience darknesses, large and small, as we move across our lifetimes.) But what if our darkness is not going to end any time soon? What if you are a family caregiver experiencing chronic sorrow, someone who is freshly bereaved or a helping professional in the grip of compassion fatigue? It is at times like these, when the darkness seems most profound and overwhelming, that it is good to contemplate not just the coming of light to rescue us but the lessons contained in the darkness, itself.

Last Saturday, I attended a silent retreat where we focused on one of Jan Richardson's poems, Travelling in the Dark. In the poem, I found this line:

Then again
it is true
different darks
have different tasks ...

I began to wonder, "What, then, is the task of this darkness, the task of the darkness of my aching arm?" In the deep silence of the day, I found some answers to my question. For me, the task of my aching arm is to slow me down enough that I have time to finish the book on chronic sorrow that has been waiting so many years for completion. It also allows me to reconnect with the grief of that time so I can remember and write from my heart rather than my head. Important tasks indeed.

And what about you? Do you have a darkness in your life this Solstice? What might be the task of this darkness at this time? Perhaps give yourself some time and inner stillness - a quiet hour before bed or early in the morning or a walk alone in the woods - to consider the task that might be waiting to be discovered. Allow it to speak to you and trust its wisdom. As Jan Richardson says later in her poem :

That in the darkness
there is a blessing.
That in the shadows
there be welcome.

Tuesday, October 4, 2016

In Gratitude ...

Thanksgiving creates gratitude 
which generates contentment
that causes peace.

Todd Stocker

Happy Thanksgiving, Everyone!

I'm writing this post early because I'm winging off to Prince George in BC's Interior in an hour or so, for the first of several Caring On Empty workshops and then returning, briefly, before going to Vancouver Island to spend the holidays with dear ones.

Most of you know of my love for poetry and, especially for blessings. So, here is my gift to you who care for so many at this holiday season. It's one of Jan Richardson's blessings and it goes like this:

You Who Bless

who are
a blessing

who know
that to feed
the hungering
is to bless

and to give drink
to those who thirst
is to bless

who know
the blessing
in welcoming
the stranger

and giving clothes
to those
who have none

who know
to care
for the sick
is blessing

and blessing
to visit
the prisoner:

may the blessing
you have offered
now turn itself
toward you

to welcome
and to embrace you
at the feast
of the blessed

However you will spend the holiday weekend, may you be blessed in the way of ordinary things - by what you do (or don't do), whom you see and the natural beauty all around you.

Happy Thanksgiving!

Love, Jan

Tuesday, September 27, 2016

Compassion Fatigue in Funeral Service Professionals...

Our hearts are too full of grief to care.

Rachel Remen, MD
Kitchen Table Wisdom

Hi Everyone!

Happy Autumn! It's a busy one already with two workshops completed before the end of September. I hadn't realized how little I knew about the lives of funeral service professionals (medical examiners, mortuary technicians, funeral directors, embalmers, advance planners, crematory operators, cemetery operators and others) until I facilitated two Caring On Empty workshops for the wonderful folk of the BC Funeral Association this month.

Like many, I have to admit, I have occasionally endorsed stereotypes of money-hungry morticians out to bilk the public in their time of need and have participated in story-telling about crusty, unempathic,  funeral personnel.

Now, I must say, my eyes are opened. I've developed a deep respect for these professionals whose work involves constant exposure to loss, grief and trauma; who frequently work with insufficient resources; and who carry all the stresses of running either a 24/7 small family business or trying to provide empathic care within a large impersonal corporate structure focused on profit.

These death care professionals are rarely included in our lists of people at risk for compassion fatigue and yet their risk factors are many indeed. In a 2014 survey of 57 respondents from multiple countries done by author and blogger, Katie Hamilton, funeral directors identified the following emotional impacts of their work:

- Daily encounters with multiple traumatic images, smells and stories that are difficult to dispel.
- The stress of dealing with the emotionally-charged dynamics of devastated family members who may resent paying for funeral services or who cannot afford those services. 
- Coping with the physical impacts of sleep deprivation and undervalued self care.
- Exhaustion due to 24/7 availability to clients and families and the subsequent sacrifice of their own family life - and the tension between the two.
- Dealing with inherent family tensions while trying to run a family business.
- Working for a large firm whose values do not align with your own and the resulting lack of support.  
 - The stress of dealing with multiple external professionals - clergy, physicians, coroners, police. (This is an issue of time, administrative details, interpersonal stress, and having to repeat death details multiple times thus increasing trauma exposure.)
- The profound sadness of certain deaths - gruesome circumstances, infants, children, young people, suicides. And the expectation that "professionals" will not show their emotional responses.
- Being socially isolated from the general population by the nature of the vocation. 

Other stressors noted by those in the field include a lack of debriefing opportunities after a bad death, personally knowing those being tended or recognizing that they are friends of your spouse or child, gender bias within the profession (women are "too emotional" to hire or promote and are relegated to paperwork and tidying / "real men" don't show tender emotions), and having to keep clients' family secrets - such as the nature of a death - especially in a small community.

These risk factors can result in the familiar signs of compassion fatigue and accumulated grief - cynical sarcastic humour (as opposed to healthy black humour), irritability and impatience, chronic sadness, defensive cheerfulness and hyperactivity, chronic physical complaints, heavy drinking, loss of empathy and compassion, family breakdown and emotional disengagement from co-workers and the very people you're trying to help. Ultimately, many decide to leave their once-loved profession or go on to develop depression or, rarely, suicide.

Some resilience strategies  discussed in the workshops this month included:

- Creating an ongoing resilience plan and meeting regularly with a self-care buddy to review your progress and gain encouragement.
- Advocating for, and using, a good Employee Assistance Program, separate from the workplace, that recognizes the nature of your responsibilities. 
- Making use of new technologies to reduce your time at work and on call - pagers and smart phones, informative websites, a good answering service to screen calls, software programs for obituary placement and death certificate filing.
- Delegating responsibilities - eg hiring an appropriate removal company.
- Balancing your death focus with a life focus - gratitude journalling, outdoor activities, nourishing hobbies, regular downtime with your family and friends, vacation time where you're geographically away from your workplace.
- Focusing on the joy you can find in the work (Compassion Satisfaction)  
- Healthy eating and regular aerobic exercise
- Monitoring alcohol intake  - noticing when you're using alcohol and for what purpose. 
- Intentionally building and maintaining a nurturing spiritual life.
- Creating a professional support network of 4 or 5 people who will be consistently warm, accepting and supportive when called upon. 
- Avoiding re-traumatizing each other with competitive story-telling at conferences and other gatherings. (ie Leaving out the gory details!).

Serving and supporting others through their worst and most tragic days is a rewarding, but not necessarily an easy occupation. So, next time you see one of your neighbourhood death care professionals, why not take a moment to shelve any stereotypes and give them a smile and a greeting. I'm sure they'd appreciate the support.

Friday, September 2, 2016

Autumn Inspiration ...

Autumn is a second spring when every leaf is a flower.  

Albert Camus

Hi Everyone!

I'm finally back from a longer-than-intended summer vacation after discovering that I had not only broken my left elbow in a fall at the beginning of the season, but I'd injured my right wrist and elbow as well. So that put paid to any long hours of keyboarding over the past few months. I'm in the harness again, though, with just an occasional twinge to remind me to be careful, ready for what is shaping up to be a very busy autumn.

Because I have so many workshops booked between now and Christmas and because I've promised my doctor not to lift large boxes of books, handouts etc for the next while, I won't be offering the usual community-based Caring On Empty and Enneagram workshops again until the Spring. (My sincerest apologies to anyone who was looking forward to attending this fall!) Please watch this space in January for the new Spring dates on Granville Island.

September is here and I don't know about you, but I LOVE the autumn. (Yes, I know, it's not officially autumn yet but it feels like it is today.) It's my favourite time of year - so full of brilliance, abundance, energy and colour. My energy rises just at the thought of it. Not everyone feels that way, though. One of my dearest friends says she goes into mourning at this time every year as she bids farewell to the bright, warm, lazy days of summer. For those of you who face the same struggle, and even for those who don't,  I've compiled a list of inspiring quotations praising the fall. May they help to ease you into the a kinder gentler relationship with this, the third and, in my opinion, most beautiful season of the year. Enjoy!

Life starts all over again when it gets crisp in the fall.  F Scott Fitzgerald
At no other time does the earth let itself be inhaled with one smell, the ripe earth; in a smell that is in no way inferior to the smell of the sea, bitter where it borders on taste, and more honeysweet where you feel it touching the first sounds.  Rainer Maria Rilke
I'm so glad to live in the world where there are Octobers!  L M Montgomery 
Autumn carries more gold in its pocket than all the other seasons.  Jim Bishop
The winds will blow their freshness into you, and the storms their energy, while your cares will drop away from you like the leaves of Autumn.   John Muir
Autumn was her happiest season. There was an expectancy about its sounds and shapes: the distant thunk pomp of leather and young bodies on the practice field near her house made her think of bands and Coca-Colas, parched peanuts and the sight of people's breath in the air. There was even something to look forward to when school started - renewals of old feuds and friendships, weeks of learning again what one half forgot in the long summer.  Harper Lee
The season for enjoying the fullness of life - partaking of the harvest, sharing the harvest with others, and reinvesting and saving portions of the harvest for yet another season of growth.  Denis Waitley
Delicious autumn! My very soul is wedded to it, and if I were a bird I would fly about the earth seeking the successive autumns.  George Elliot
Listen! The wind is rising, and the air is wild with leaves, we have had our summer  evenings, now for October eves!   Humbert Wolfe
I love the fall. Fall is exciting. It's apples and cider. It's an airborne spider. It's pumpkins in bins. It's burrs on dogs' chins. It's wind blowing leaves. It's chilly red knees. It's nuts on the ground. It's a crisp dry sound. It's green leaves turning And the smell of them burning. It's clouds in the sky. It's fall! That's why... I love fall!  Author Unknown
Two sounds of autumn are unmistakable ... the hurrying rustle of crisp leaves blown along the street a gusty wind, and the gabble of a flock of migrating geese.   Hal Borland
The ripples wimple on the rills / Like sparkling little lasses. / The sunlight runs along the hills / And laughs among the grasses... / Why, it's the climax of the year, - / The highest time of living!- / Til naturally its bursting cheer / Just melts into thanksgiving. Paul Dunbar
Though I still grieve as beauty goes to ground, autumn reminds me to celebrate the primal power that is forever making all things new in me, in us, and in the natural world.  Parker Palmer 
Even if something is left undone, everyone must sit still and watch the leaves turn. Elizabeth Laurence 
May the air be crisp, may the leaves be few, may the season of Autumn bring great bounty to you!    Author Unknown