Tuesday, March 19, 2013

Connection ...

... love and intimacy are among the most powerful factors in health and illness, even though these ideas are largely ignored by the medical profession. ... I am not aware of any other factor in medicine - not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery - that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.

Dean Ornish, MD

Dean Ornish, an American cardiologist and founder of the Centre for Integrative Medicine in San Francisco, (best known for his use of a very low fat diet to reduce or reverse coronary artery disease), has also spent a number of years studying the effects of love and intimacy - an open heart - on our health and wellness.

In his 1997 book, Love and Survival: The Scientific Basis for the Healing Power of Intimacy, Ornish writes:
The real epidemic in our culture is not only physical heart disease, but also what I call emotional and spiritual heart disease - that is, the profound feelings of loneliness, isolation, alienation, and depression that are so prevalent in our culture with the breakdown of the social structures that used to provide us with a sense of connection and community.

He goes on to say that loneliness and isolation affect our health in several ways:

1.  They increase the likelihood that we may engage in behaviours like smoking and overeating that adversely affect our health and decrease the likelihood that we will make lifestyle choices that are life-enhancing rather than self-destructive. 
2.  They increase the likelihood of disease and premature death from all causes by 200-500 percent or more, independent of behaviours, through different mechanisms, many of which are not fully understood.
3.  They keep us from fully experiencing the joy of everyday life.   

In short, anything that promotes a sense of isolation often leads to illness and suffering. And anything that promotes a sense of love and intimacy, connection and community, is healing.

So, what does this say to us as helpers? It reminds us of the vital importance of creating and sustaining supportive relationships in which we can be ourselves, transparently and authentically. Compassion fatigue, burnout and accumulated grief all cause our hearts to close and we disengage from family and friends, colleagues, and care recipients. Wellness opens our hearts, enabling us to be emotionally aware, to disclose our emotions in a mindful way, to listen carefully to what the other person is feeling, and to acknowledge that person's feelings with empathy, caring and compassion.

It can be difficult, at times, to maintain healthy connections but, as we can see above, its worth making the effort. I remember becoming more and more isolated over the years of caring for my husband. I felt deeply connected to him but had only a few other  relationships that I continued to nurture actively. There just weren't enough hours or energy in the day.

It wasn't until the last three years of his life, when Derrick became confined to bed and I had to organize a rota of friends to stay with him whenever I left the house, that I realized how much I had missed and needed mes amis. As different folks came to the house on Wednesday and Saturday mornings, I went out to do errands and then returned to have a cuppa with whomever was there. Those visits were God-sends. Not only was I able to connect with loved ones, but with loved ones who got our situation because they'd just spend the morning with my husband. We were able to have honest, open-hearted conversations that allowed our care and compassion to flow and it was so good.

So, if you have been too busy, too tired, too scattered, too sad, too irritable or too fed up to connect with your friends for the past while, why not consider giving someone a call and arranging a date for lunch or coffee or a chat on the phone. It's always okay to limit the time from the onset if you're really tired or afraid of getting overwhelmed - "I only have twenty minutes, but I've been missing you and wanted to connect." Choose who you call wisely and you may be surprised to see just how much better you feel after the conversation.

ps  I will be re-connecting with loved ones over Spring Break and the Easter weekend, myself, so I won't be back in the office until Tuesday April 2nd. In the meantime, I wish each of you a very Happy Easter and all the blessings and veriditas of Spring.  Jan

Monday, March 11, 2013

Veriditas II ...

A person who toils more than her body can bear
is rendered useless in her spirit
by ill-judged roil and abstinence.
Living hopelessly and joylessly, that person's sense often fails.

Hildegarde of Bingen

Hi everyone...  Last spring, I wrote a blog post on self-care called, Veriditas. At the time, I understood veriditas to mean the greening force of spring but I was far from comprehending the depth and power of the concept.

This year, after almost twelve months of reading about Hildegarde of Bingen (an amazing German abbess who, at a time in the 1100's when few women could read, was an early feminist, ecologist, herbal healer, poet, playwright, mystic, and composer) and after a month-long mandala retreat based on her writings, I have a much deeper understanding of both the woman and her veriditas. And I think she has much to say to those of us who have become desiccated and arid (ariditas) through caring for others while not caring so well for ourselves.

The verse above, taken from one of Hildegarde's letters, is a perfect description of my own state in the last weeks of my husband's life. I was physically exhausted, my spirit was dry through roiling turbulence and abstinence from the things that might have kept me moist, juicy and verdant. I felt little hope or joy, and as many will tell you, my sense - common or otherwise - was definitely failing.

Hildegarde saw veriditas as that life force which unifies all of life. She was most interested in the sense of life, radiance, vitality and aliveness in all creatures. She saw veriditas as the green sap that makes life possible. As author, Christine Painter, writes:

This green fluid, that is the source of life, is hidden below the earth, in the the roots of things waiting to burst forth in springtime with newness. Rain elicits this response. Hildegarde believed that humans draw forth this same green sap into our beings through the breath and the soul. The breath is the animating force, drawing in moisture and life.

Though Hildegarde was, of course, bound by the "science" and theology of her times, there is still great wisdom in many of her ideas. Let's try to apply some of them to our own lives:

Imagine where in your life you experience the dryness of ariditas. Where do you encounter complete lack of nourishment or anything to sustain you? Does any part of you resonate with this notion of barrenness and desiccation? Where have you become depleted in yourself and in your service to others? (Be sure to hold these dry and arid places with the utmost gentleness and compassion. This is not a time for judgement or self-criticism.)

Then, breathe the moist and verdant energy of veriditas into your body, your mind, your emotions and your spirit. Allow it to fill your being with life-giving greening power. Then exhale, letting go of all the dryness and releasing its hold on you. Do this for several minutes.

Now, allow yourself to consider these three questions for reflection adapted from Christine Painter:

1.  Where in your life do you experience the greatest dryness or ariditas?
2.  Where is the greening of life most abundant for you? What are the things which bring you most alive and in connection with the greening life force at work in the world?
3.  Could you make some time to immerse yourself in one of these activities, or some small aspect of it, this week?

As you can see, veriditas isn't just a reflection of the greenness of nature, it is reflective of the very state of our true, authentic selves. We each have the capacity to bring forth new life just as the earth brings forth greenness. Becoming more aware of the quality of greenness of the earth helps us to see where in our aridity we need new growth.

Friday, March 1, 2013

When Your Family Physician Retires...

I went to my family doctor for my biannual physical a few weeks ago and was surprised and just a little shaken to learn that he will be retiring from the practice component of his work this coming September. I had been expecting to hear this news sooner or later but the reality felt worse than the anticipation.

I felt a little as though I was a four-legged stool that had had one leg kicked out. I have known our physician since he was an intern at the teaching hospital in which I worked in the 70's and, over the years of my husband's life with and death from cardiomyopathy, we spoke by phone several times a week and he visited us at home for the three years that Derrick was confined to bed. Over tea and cookies after he'd examined his patient, we came to know him better and liked him all the more. He visited us in hospital during the last week of Derrick's life and both called to check on me after Derrick's death and attended his funeral. He has walked an intense portion of life's journey with us and I will miss him and his kind, steady, support.

I don't think that people generally reflect deeply upon the importance of their relationships with family physicians until they or someone they love is really ill or until those physicians are leaving or have already left. We certainly don't do that as a society, a fact demonstrated by the absence of research into the emotional impact of physician retirement on seriously and/or chronically ill patients and their care partners. And yet, that impact can be great, even destabilizing in some cases.

As with any attachment, particularly a dependent one, the breaking of the physician-patient-family care partner relationship is a loss that evokes grief. In the case of patients and care partners already experiencing chronic sorrow and reduced social support, that grief can feel overwhelming. Even relatively short physician absences can evoke sadness, anger, anxiety and distress.

I remember when our physician played a game of hockey and badly injured his neck, requiring surgery and time off work for most of the last six months of Derrick's life. It was an enormous loss and source of concern for us - worry for our physician, himself; fear about loss of continuity of care and of all the facts rattling around in his head that I might or might not be able to remember on a given day; loss of his relatively easy availability, based on his belief that home palliative care was impossible without physician accessibility and home visits; and his willingness to entertain "outside the box" solutions for Derrick's longterm pain. His absence brought into sharp relief all the qualities with which he'd graced our lives over the years.

I think it is important that we make space to grieve the loss of such a significant relationship whenever a physician retires, is absent for a long period, or when a patient dies and the degree of contact with the care partner changes - space for the grief of physician, patient, and family care partner alike.

It matters that we give each other time to acknowledge the alteration in the previous pattern of life, to say goodbye, and to express unfinished business, concerns and gratitude - aside from all the administrative details. We need a chance to say what the relationship has meant to us. At it's best, the physician-patient-family care partner relationship is one of mutual care, compassion, learning and partnership - and, thus, one deserving of its grief.

So, as it draws to a close, I would like to take the opportunity to publicly acknowledge and thank Dale Stogryn, a fine man, a fine physician and an excellent medical educator, for a twenty-five year relationship of care, respect, compassion and great medicine. I am glad that you will continue with your work in medical education but those of us in your practice will be the poorer for your absence.