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  


Friday, July 1, 2016

The Problem of Needing to Ask for Help ...

Life doesn't make any sense without
We need each other 
and the sooner we learn that, the better it is for us all.

Erik Erikson

Hello, Everyone - Happy Canada Day!

Today is not only the birthday of our beautiful country, but for me and thousands of others it's the first day of summer holidays. Sadly, this year I'm packing for the cottage with one wing in a sling after catching my feet in the edge of the bedspread as I changed the sheets. Now, having snapped the head off the radius bone in my forearm, the packing process is a little more complicated!

(Yes, I know. I could at least have broken it doing something exciting but I did paint quite a picture as I caught both feet in the spread, flew low across the room, too quickly to save myself, landed and skidded even further across the carpet and then rolled on my back with my legs in the air, stunned and winded.)

After several moments of trying to catch my breath and figure out what had happened, I got up and checked for damage and, realizing that most of my in-town support network were away, called a physician friend half way across the country and together we did an ortho exam on the phone and figured that I'd be black and blue in the morning but that nothing was seriously awry.

Roll on the next morning when I woke to discover that, despite icing, my left elbow was crooked, swollen and exquisitely painful and the closest I could get to touching my nose with my finger was a good foot away. And that led to the first of many uneasy decisions regarding whether and how to ask for help.

Why is asking for help such a big deal ...?? Well, if you're like me, you grew up in a family where independence, strength and self-sufficiency were the expectation and, thus, the norm. "Whining" was nipped in the bud, trying-it-yourself-before-asking-for-help was mandatory and feeling anything from uneasy vulnerability to outright shame accompanied even the most legitimate requests for assistance. Such experiences, encountered both at home and at school, would not have been unfamiliar to anyone growing up in the '50's and '60's in North America.

In her more recent book, Help Is Not a Four Letter Word, author and researcher, Peggy Collins, has published survey results to the question, What frightens us most about asking for help?. The top twelve fears are:

  • bothering other people
  • rejection / being told no
  • looking weak, inadequate, needy or just plain foolish
  • someone taking over / surrendering some of my power
  • owing other people and having to pay them back
  • things not being done the way I would like them to be done
  • relying on someone who doesn't come through
  • losing the reputation that I can do it all
  • not performing like I was raised
  • not asking in the right way
  • others seeing my mess
  • believing my needs are not important enough for others to meet

Perhaps a few of these sound familiar ...?

Ultimately, after this week's fall, I had to face the vulnerability of requesting help before getting almost anything done and I relearned something I learned years ago when people cried after being invited to help with my husband's care; people WANT to help. All they need is the invitation and our willingness to be in the receptive role.

It's a great lesson in humility to recognize and admit that we helpers also need help sometimes - a lesson that most of us need to learn again and again. Interdependence is the goal of healthy relationships, families, organizations, communities and nations. None of us can go it alone. We need each other and, as life coach Heather Plett says, (quoting Christina Baldwin in The Seven Whispers), -

"Ask for what you need and offer what you can." That's what creates the balance, the yin and yang of relationship. Even those who teach this need to be reminded to put it into practice.

So, great bouquets of gratitude to Ted who supported me in the first hour after the fall, my sister Sheila who drove me from pillar to post all week long as I saw medical professionals and prepared to fly to Ontario, my friend Cathy who - as always - empathized and made me laugh, Sandra who provided distraction and Healing Touch, Ginger who took me to the Market for coffee and mystery books, Linda who drove me to church and offered more, and Janet (my Enneagram "six-sister") who worried and planned for me so I could relax! Interdependence is what makes a healthy world go round and I'm so very grateful for that truth this week.

Happy Summer, Everyone!

Tuesday, June 14, 2016

At the End of the Day: The Examen ...

Looking back so the view
looking forward is even clearer.


Hello, Everyone,

I've said here recently that I am becoming more and more interested in the intersection between trauma resilience and spirituality. I think there are a vast number of spiritual practices we can glean from various faith traditions to help us calm our bodies, access presence and peace, guide our lives and fuel our work with others. One such practice is an updated version of the Jesuit exercise of daily Examen.

The Examen of Consciousness is usually practiced at the end of the day. It is a review that contains a short reflection on the day, recalling events, noting feelings and being mindful of the presence of The Holy (however you understand that to be) in your everyday life. The process is basically encapsulated in the answers to two questions:
 1.  For what moment today am I most grateful?
 2.  For what moment today am I least grateful?

Variations on this theme, offered by Dennis Linn, Sheila Linn and Matthew Linn in Sleeping With Bread, are:
 1. When did I give and receive the most love today?
     When did I give and receive the least love today?
2.  When did I feel most alive today?
               When did I most feel life draining out of me?
3.  When today did I have the greatest sense of belonging to myself, The Holy and the   universe?
     When did I feel the least sense of belonging?
4.  When was I happiest today?
      When was I saddest?
5.  What was today's high point?
     What was today's low point?
6.  What did I feel good about today?
     What was my greatest struggle today?

Practicing the Examen takes about ten minutes to half an hour each evening, depending on whether you share the answers to your questions with yourself, your partner, your family or a group of friends. The Linn's say that they have met with a group of close friends every Sunday afternoon for several years to do an Examen of the week together before sharing a meal. In this case, the Examen not only provides a way to be more reflective and mindful, it offers the opportunity to build a deeper and more intimate sense of community with close friends.

The Examen can also act as a guide to important life decisions. Paying close attention over time to what makes you feel alive and what drains your life force can help you to choose occupational paths, decide whether to deepen relationships, know how to spend your re-creational time and determine your direction for a new year.

So, whatever your faith tradition or the lack of it, I invite you to try the Examen for a week and see if it might be a spiritual tool you'd like to add to your resilience toolkit on an ongoing basis.

ps And for those of you who are interested in the practice of meditation, Sounds True is offering a 10 day online Meditation Summit, starting today, with free talks by some of the top Buddhist and Christian meditation leaders, some of whom you've seen mentioned here from time to time, including Reggie Ray, Tara Brach, Sharon Salzberg, Rick Hanson, James Findlay, Thich Nhat Hanh, Saki Santorelli, Jack Kornfield and Pema Chodron. You can listen to each talk for free for 24 hours after it takes place.  

Thursday, May 26, 2016

Birdie - An Indigenous Book Club Month Selection ...

She ... gets fed love.
She is better when fat with 
the love of women.
Tracey Lindberg

Hi Everyone!

Earlier this year, Carolyn Bennett, Minister of Indigenous and Northern Affairs, proposed an Indigenous Book Club Month for June and I wanted to give you a heads up that June is fast approaching (how is that possible??) and to make some suggestions for your book club or individual indigenous reading.

My own choice for this month is to reread Tracey Lindberg's wonderful book, Birdie, a Canada Reads shortlist winner and a book that has brought greater heart knowledge to my understanding of the long reaching effects of colonization and the residential school system. It seems from the reviews that people either love or are totally confused by this book. I am one of those who love it.

Seen through the lens of intergenerational trauma, posttraumatic stress and the power of women to both betray and hold caring space for each other's growing wholeness, Birdie's story is one of relationship - relationship with self, relationship with family and relationship with the wider world.

This, in many ways, is a book about care-giving, or the lack of it. The story line is that of Birdie, an obese, impoverished, abused young Cree woman, who journeys from northern Alberta to Gibsons, on the BC Sunshine Coast, consciously searching for Jesse, a character in her favourite TV show, The Beachcombers, while at the same time unconsciously on an inner journey searching for her own healing and wholeness.  As she sinks into seeming dissociation from the present, she is cared for by her Auntie Val who is well, the memory of her mother Maggie who is not, and her cousin Skinny Freda and landlady and bakery boss Lola who are somewhere in between. Each has been wounded and has coped in her own way and each expresses her caring according to the degree of her wholeness.

The fluid chronology of the Birdie narrative, slipping seamlessly between present and past, while disturbing and confusing to some, made perfect sense to me as a trauma therapist. While described as characteristic of a vision quest, this meandering in and out of "reality" and "the present moment" is also the experience of one whose sense of time and continuity has been jangled by trauma's intrusive memories and disorienting flashbacks.

Birdie is a story of hope, healing and transformation and I highly recommend it, especially to those who can restrain their analytical minds and just go with an empathic response to another's experience.

Other books by indigenous writers, recommended by CBC, that you might like to consider are:

1.  A Coyote Columbus Story by Thomas King
2.  My Mother is Weird by Rachna Gilmore
3.  Halfbreed, The Book of Jessica, and Stories of the Road Allowance People by Maria Campbell
 4.  The Outside Circle (collection)

Other authors to consider  include Joseph Boyden, Richard van Camp, Leann Simpson, Marilyn Dumont, Jeanette Armstrong, Beatrice Culleton Mosionier, Louise Halfe, Sheila Watt-Cloutier, Eden Robinson and Richard Wagamese.

Have a great read!

Monday, May 16, 2016

Knitting Up a Wounded Heart ...

           Properly practiced, knitting soothes the 
            troubled spirit,
            and it doesn't hurt the untroubled
           spirit either!

         Elizabeth Zimmermann

Hi Everyone!

Knitting may seem a strange topic for this time of year but I'm planning to take yarn and needles to the cottage to teach a friend how to knit this summer so it's on my mind this week.

My Mom taught me to spool knit when I was six and and then to do "real knitting" when I was eight. Some fifty years later, my two younger sisters and I sat in a row in the hallway outside a busy intensive care unit knitting steadily as our Mom lay dying within. We hadn't consulted each other about bringing our knitting to our hallway vigil but, on reflection, there couldn't have been a better way of dealing with our stress or holding space for our mother's end-of-life.

As much by example as anything, Mom taught us to use knitting as a means of mending wounded hearts and as a stress reliever (- though she would never have used those actual words because  she belonged to a generation that didn't believe much in taking time to heal wounds or deal with stress. Life was hard and you just got on with it). If you had been mindful, though, you would have noticed that her knitting came out whenever things were tough at work, when she was worried about one of us kids, when financial resources were scarce or when my dad was having a mental health crisis or drinking too much. 

These days, we know that the knitting Mom used intuitively to deal with stress is showing up positively in the research literature. Knitting has a positive impact on health and wellness and may be part of the solution in reducing compassion fatigue. Studies suggest that knitting decreases stress, creates new neural pathways and can have an antidepressant effect. It can also help alleviate ruminating, delay memory loss and may help slow the onset of Alzheimer Disease. Learning to knit and seeing a finished product can build self esteem. And knitting also offers opportunities for creativity and calms and soothes through repetitive motion and the tactile softness and colour of the yarns.

A small February 2016 study of The Impact of a Knitting Intervention on Compassion Fatigue in Oncology Nurses in the Clinical Journal of Oncology Nursing noted that a knitting intervention, (learning to knit through the non-profit, Project Knitwell, and knitting squares with colleagues during break times), can provide the above positive effects as well as offering opportunities to debrief informally. Using the Pro-QOL before and after a knitting intervention showed a significantly positive change in burnout scores and trends toward significance with the secondary traumatic stress and compassion satisfaction scores. These improved scores applied particularly to younger nurses. It would be interesting to see the results with a larger cohort.

Project Knitwell has published a lovely little booklet called, The Comfort of Knitting: A How to Knit Guide for Caregivers and Families that shares research on knitting and health, teaches you knitting basics and offers 7 easy project patterns. They also offer a list of books on knitting and wellness including:

1.  Knit for Health and Wellness: How to Knit a Flexible Mind and More by Betsan Corkhill (Flatbear Publishing, 2014)
 2.  Love in Every Stitch: Stories of Knitting and Healing  by Lee Gant  (Viva Editions, 2015)
 3.  Knit Red: Stitching for Women's Heart Health by Laura Zander  (Sixth & Spring Books, 2012)
 4.  Knitting Yarns: Writers On Knitting  by Ann Hood  (Norton, 2014)
 5.  Knitting Heaven and Earth: Healing the Heart with Craft by Susan Gordon Lydon  (Potter Craft, 2008)
 6.  The Knitting Way: A Guide to Spiritual Self Discovery by Linda T Skolnik and Janice MacDaniels  (Skylight Paths, 2005)
7.  Mindful Knitting: Inviting Contemplative Practice to the Craft by Tara Jan Manning  (Tuttle, 2004)
 8.  Zen and the Art of Knitting: Exploring the Links Between, Knitting, Spirituality and Creativity by Bernadette Murphy  (Adams Media, 2002)
9.  Crochet Saved My Life: The Mental and Physical Health Benefits of Crochet by Kathryn Vercillo  (Self-published, 2012)
10. The Creativity Cure: How to Build Happiness with Your Own Two Hands by Carrie and Alton Barron   (Scribner, 2012)

Happy stitching, everyone!!

Tuesday, April 19, 2016

A Poem to Ponder ...

Poetry is language 
at its most distilled
and most powerful.

Rita Dove

Hi Everyone!

As regular readers will know, I'm a great lover of poems and blessings. This week, I was gifted with a new-to-me poem by a fellow traveller on an online retreat. It's quickly become a blessing to me and to others in my life. It comes from a book by Dawna Markova called, I Will Not Die an Unlived Life: Reclaiming Purpose and Passion. Today, I re-gift it to you to ponder as spring and new beginnings unfold:

I Will Not Die an Unlived Life

I will not die an unlived life.
I will not live in fear

of falling or catching fire.

I choose to inhabit my days, 

to allow my living to open me,

to make me less afraid,

more accessible;

to loosen my heart

until it becomes a wing,

a torch, a promise.

I choose to risk my significance,

to live so that which came to me as seed

goes to the next as blossom,

and that which came to me as blossom,

goes on as fruit.

Read through the poem a few times, if you have the time. What message does it whisper to you? What phrase or phrases shimmer? Is there a next step or new beginning for your life hidden within these words?  

If you would like to know the story of how this short poem has made a difference in the world, find a copy of Dawna's small book, make a comfortable drink and settle in for a surprising tale. Warmly reviewed by the likes of medical educator and reformer, Dr Rachel Remen, and author and master educator, Parker J Palmer, this book, as Rachel says, "... can remind you of who you are and heal your life." 

Saturday, March 26, 2016

Beginning Again ...

In the middle of the journey of... life
I found myself astray in a dark wood
where the straight road had been lost sight of.

Dante Alighieri
The Divine Comedy

Hello, Everyone!

The experience of Compassion Fatigue (CF) is one that leads many of us to recognize that we have gone "astray in a dark wood where the straight road had been lost sight of".  It is an experience of lostness, anxiety, confusion and bewilderment. How did I get here? When did the caring person inside me begin to disappear? And, much more importantly, how do I find my way back to that caring self and begin again? 

Beginning again requires that we first take sufficient time to heal CF and then learn new and healthier ways of being and doing. Healing is different from curing. It is about gradually becoming more whole in ourselves rather than necessarily eliminating the signs of CF completely and forever. (Most helping professionals and family caregivers will ebb and flow through the early stages of CF as long as we continue working with people who are traumatized or suffering. The trick is building resilience before hand and then recognizing CF early in its progression so we can do something about it.) 

Beginning again is about re-membering our caring selves in a new way that promotes, not giving from the depths of our wells, but giving only from the overflow. It means transforming our accumulated primary and secondary traumatic stress and learning to reduce our trauma exposure. It means discovering our personal CF early warning signs so we can forestall further forays into "the dark wood". It means intentionally building skills and developing our physical, emotional, spiritual, social and professional lives so we have access to "something more" to ground and sustain us.

We need awareness, knowledge, courage and determination to make these kinds of life changes, one baby step at a time. I hope Celtic philosopher, John O'Donohue's, Blessing for A New Beginning, from To Bless the Space Between Us, will encourage you to take the first steps:

Blessing for a New Beginning

In out-of-the-way places of the heart,
Where your thoughts never think to wander,
This beginning has been quietly forming,
Waiting until you were ready to emerge.

For a long time it has watched your desire,
Feeling the emptiness grow inside you,
Noticing how you willed yourself on,
Still unable to leave what you had outgrown.

It watched you play with the seduction of safety
And the grey promises that sameness whispered,
Heard the waves of turmoil rise and relent,
Wondered would you always live like this.

Then the delight, when your courage kindled,
And out you stepped onto new ground,
Your eyes young again with energy and dream,
A path of plentitude opening before you.

Though your destination is not clear
You can trust the promise of this opening;
Unfurl yourself into the grace of beginning
That is one with your life's desire.

Awaken your spirit to adventure;
Hold nothing back, learn to find ease in risk;
Soon you will be home in a new rhythm,
For your soul senses the world that awaits you.

As I leave for a welcome long weekend visit to Vancouver Island, I wish each of you a very Happy Easter  (or whatever Spring observance you enjoy) and all the hopeful brightness of new beginnings!

And, if you are feeling ready to "begin again", do please join us for the Caring On Empty: Creative Tools for Compassion Fatigue Resilience for Helping Professionals workshop May 6th on Granville Island in Vancouver, BC.

Just email Jan at for a brochure. (And bring a colleague or friend!) The registration deadline is extended to April 22.

Sunday, March 20, 2016

Embracing the Equinox ...

Spring and all its flowers
now joyously break their vow of silence.


Hi Everyone!

Today, the Equinox, (a twice yearly time of equal day and night), has arrived, heralding the onset of Spring. And Spring, the beginning of earth's creative cycle, invites us to open to the subtle awakening of the earth and to move with it into our own full blossoming. Spring is a time of renewal and of welcoming new life, a time of beginning again.

Here in Vancouver, we've had a beautiful Spring weekend with trees exploding into bloom, daffodils dancing in the wind and sunlight bouncing from the lakes and ocean. For many, it's been a time of joy and spontaneous activity. For others, these new beginnings have caused a fresh round of melancholy and yearning as the new has, inevitably, triggered echoes of the old.

The Equinox is a time of balance. We have the opportunity to notice and listen deeply to both sides of Spring, the ending and the beginning, to make space to say goodbye to the old and to open our eyes and hearts to whatever is emerging anew. It is also a time to just "be" with the dynamic energy of veriditas, "the greening of Spring", so we can discover our deepest longings, recognize unnoticed gifts and consider the next steps in our journeys of life.

It takes some conscious intention to participate fully in the possibilities of Spring. Poet, Lynn Unger, points out in her wonderful poem, Camas Lilies, that if we are not careful, our busyness can cause us to miss out on precious opportunities for new life:

And you -- what of your rushed and
useful life? Imagine setting it all down --
papers, plans, appointments, everything,
leaving only a note: "Gone to the fields
to be lovely. Be back when I'm through
with blooming."

Our world is full of abundance and creative spark. It is always possible for the old, dry and seemingly deadened within us to spring into life. Why not take a few moments today to notice what is awakening this Spring? What are you seeing around you? What is happening within?

If you would like help to make space for your process of awakening and growing, you are welcome to join us for the Spring 2016 Caring On Empty Workshop for Helping Professionals on May 6th at the Granville Island Hotel in Vancouver. Just email me at for a brochure. The registration deadline is extended to April 22nd.

Thursday, February 25, 2016

Spring 2016 Vancouver Compassion Fatigue Workshop ...

 The expectation that we can be immersed in suffering and loss daily and not be touched by it, is as unrealistic as being able to walk through water without getting wet.

 Dr Rachel Remen, MD

Hi Everyone!
The Caring On Empty: Creative Tools for Compassion Fatigue Resilience for Helping Professionals workshop will be held at the Granville Island Hotel on May 6th this year and we hope you can join us!

Compassion Fatigue, (the natural posttraumatic stress, "fatigued" compassion, diminished desire to be empathic and emotional disengagement from the very people we're trying to help), affects most helping professionals at various times in our careers. It develops as we hear and respond to more and more stories of others' trauma, loss and suffering.

Some warning signs that we may be at risk for developing Compassion Fatigue are the loss of our sense of humour, feed-back from our family and friends that we're not fun anymore, dreading going back to work no matter how much time we've had off, profound exhaustion, sleep difficulties, irritability, anger and cynicism, uncivil behaviour, anxiety, emotional numbness or over-reactivity, social isolation, self medicating, increased sick time and feelings of helplessness and hopelessness.   

This small (only 25 seats), discovery-based, multidisciplinary workshop will provide a safe and reflective space for:

Exploring the concept of Compassion Fatigue (CF) and how it differs from burnout,
Discovering your current CF risk and identifying personal early warning signs,
Assessing your current level of self care and learning to reduce trauma exposure,
Learning positive, practical strategies for reducing CF risk and building resilience and
Creating an ongoing personal resilience plan.

The workshop uses mini-lectures, film, self-reflection exercises and group interaction to help participants awaken to their current level of CF risk and create a personalized resilience plan. Others have loved the relaxed energy of this workshop and left asking for more!

So, if your work involves hearing stories of others' trauma and suffering - health care professionals and support staff, educators, therapists and counsellors, addiction workers, family court lawyers and judges, journalists, humanitarian workers, first responders, translators and interpreters, social service providers, clergy and pastoral care workers, and others -  this is the workshop for you. I hope to see you there! 

PLEASE NOTE:  The registration deadline is extended to April 22nd. 
You can email Jan at for a registration brochure.
Please share this information with colleagues and friends - Anti-Spam Legislation makes it more difficult to tell people about the workshop this year. Thank you!  Jan 

Sunday, February 14, 2016

Softening A Hardened Heart ...

There is beauty to seeing stone 
turned to moist soil, broken open, receptive
to the seeds of love.

Omid Safi

Hi Everyone!

Last time, we spoke about how our hearts can become hardened through repeated exposure to our own and others' trauma. Today, I'd like to move on to how we can begin to soften our hearts, allowing us to receive more love, nurture and support.

We all have a wall around our hearts. According to Persian tradition, the heart is a walled garden, an inner garden protected by an outer wall. When we have experienced great pain, our own or others', that wall can become a hardened fortress, protecting us but also keeping out the very ones who could be a source of our healing and renewal.

Omid Safi, Director of the Islamic Studies Centre at Duke University, likens this hardened heart to dry land - hard, parched and cracked. To break it open, to till and water it so it is ready to receive a seed of love, (a kind glance, a touch, a word, a compassionate action), takes time, patience, effort and vulnerability.

As Professor Safi says:

The seed of love falls on the heart's soil. Is it a hardened earth, a rock-covered surface, one that will have the seed washed away with the first water? Or is it a soil that has been prepared, tilled, softened up, opened up again and again and again, ready to embrace the seed of love that would surely come?

When we suffer Compassion Fatigue, our hearts' soil hardens and we become less receptive to the seeds of love sown by our colleagues, family and friends. As we recognize and acknowledge that this is the case, we can consciously make an effort to till, water and soften that soil.

Three ways we can soften the soil of our hearts are to practice self compassion, learn heart-centered spiritual practices and consciously allow ourselves to open up and become more vulnerable in our daily relationships.

1.  Self-compassion researcher, Kristin Neff, describes self-compassion as, "acting the same way toward yourself when you are having a difficult time, fail, or notice something you don't like about yourself, as you would toward a friend." She says that instead of just ignoring your pain with a "stiff upper lip" mentality, you stop to tell yourself, "This is really difficult right now. How can I comfort and care for myself in this moment?" You can learn more about practicing self-compassion on her website

2.  Heart-centered spiritual practices can be found in most spiritual traditions. The point of these practices is not to resolve our emotions or to figure them out but to simply to allow them to have some space within us without pushing them away. Here is one (slightly abridged) practice written by Christine Valters Paintner, PhD, Benedictine Abbess of the virtual online monastery, Abbey of the Arts.  (It is a simple practice that should only take about 5 or 10 minutes to complete.)
1.  Begin by becoming aware of your body. Notice how your body is feeling simply by being present to sensations you are experiencing, welcoming in both the body's delight and discomfort. 
2.  Connect to your breath, deepening it gently. As you inhale, imagine Love breathing life into you. As you exhale, allow yourself to experience a moment of release and surrender into this time and place, becoming fully present. Take a couple of cycles of breath to simply notice this life-sustaining rhythm which continues moment by moment even when you are unaware of it.
 3.  In your imagination, gently allow your breath to carry your awareness from your head (which is your thinking, analyzing, judging center) down to your heart center (where you experience life from a place of greater integration, feeling, and intuition). Consider placing your hand on your heart to experience a physical connection with your heart center and draw your awareness to this place.
 4.  Breathe into your heart center and begin to notice what you are feeling right now in this moment without judging or trying to change it. Take a few moments to simply be present to whatever you are feeling and making some room within yourself to experience this without pushing it away (this alone can be revolutionary for many of us - to just allow ourselves to have the experience we are having without judgment.)
 5.  Call to mind the spark of Love which the ancient monks and mystics tell us dwells in your heart. Bring the compassion of Love to however you are feeling right now, not trying to change anything, but just gently holding yourself in this space.
 6.  As you experience yourself filling with compassion for your own experience, imagine breathing that compassion out into the world and connecting with other hearts beating across the world in a rhythm of love.
 7.  Gently allow your breath to bring your awareness back to the room and take a moment to name or write what you noticed in this experience.

3.  Becoming more vulnerable to others, the third way we can soften the soil of our hearts, may seem like a risky weakness in our toughness-saturated workplaces. But, as shame and vulnerability researcher, Brene Brown, writes, "Vulnerability sounds like truth and feels like courage. Truth and courage aren't always comfortable, but they're never weakness."
It takes honesty and courage to open ourselves to speak from our tender places and to receive the healing love of others. While it is important to choose wisely those with whom you will be vulnerable, it is also important to have people in your life with whom you can really be yourself, "warts and all", knowing that you will be accepted and respected. To learn more about intentional  vulnerability, try listening to Brene's TED Talk on The Power of Vulnerability .

There are many more wonderful ways to soften the soil of our hearts but these three are a good start. Let me  leave you, once again, with the words of Omid Safi - There is beauty in stone being turned to moist soil, broken open, receptive to the seeds of love.

May this Valentine's Day bring each of you an opportunity to soften your heart and receive some much needed seeds of love.


Wednesday, February 10, 2016

The Hard Heart of Compassion Fatigue ...

We seem to value "strength". We want "hard" bodies, "strong" minds, "tough" wills, "hard-as-nails" determination,"rugged" personalities, "sturdy" character and so on. ...  But let us praise softness. ... Let us seek a heart that is not hard, but soft.

Omid Safi

Hi Everyone!

This is a story about hard and soft hearts written by life coach, Darren Poke, in 2011, in Melbourne, Australia. I'd like to share it with you today as we approach Valentine's Day:

There was a young man named Tom who lived in a small village.
He was an angry young man, overreacting to every offense and keeping others at a distance.
 In desperation, his parents asked Tom to go and see the eccentric old priest who lived in the village.
The priest was renowned for his unorthodox methods that somehow worked.
When Tom saw the priest, the older man told the youth to go away and come back with two lumps of clay.
He returned a few hours later and then was told to make a vase out of one of the lumps.
The young man thought that this must have been part of the therapy, so he threw himself into the task with enthusiasm, believing that the opportunity to create art would help him with his temper.
He made the vase, decorated it and put it in the kiln to harden.
Upon completion, Tom presented the beautiful vase to the priest. He was proud of his accomplishment and believed that he was now cured of his anger issues. 
The priest smiled approvingly and gave the young man a hammer.
"Now hit the vase with this hammer," the priest commanded.
"But it will break my beautiful creation!" Tom protested.
"Hit the vase with this hammer," the priest insisted.
"Don't you like it? Isn't it good enough for you?
"Hit the vase with this hammer," the priest continued.
Annoyed, the young man snatched the hammer from the priest and tapped the vase firmly.
The vase immediately smashed into pieces.
"Now look what you've done," Tom said angrily. "You've wasted all of my hard work."
The priest ignored the outburst and left the room for a moment.
He returned with the second lump of clay and placed it on the floor next to the young man.
"I suppose you want me to waste my time by making another vase? Well you can forget about it!" Tom said rudely.
 The priest looked at him with kindness and said,"Hit the clay with the hammer."
"With pleasure!" the young man responded.
He swung the hammer with all of his might and it hit the clay with a thud, leaving a large mark.
"Happy now? What was the point of that?"
The priest picked up the broken pieces of the vase and held them in his hands before the young man.
"See this vase? This is like your heart. You think that you need to be hard to cope with the inevitable disappointments that happen in life. You respond with anger, bitterness and violence, keeping people at a distance, but it doesn't work. Your hardness makes you more fragile. Adversity breaks your spirit too easily."
The priest then picked up the lump of clay, it had a mark where the hammer had hit it, but it was still in one piece.
"You need to soften your heart and be more like this clay. It is still impacted by what happens to it, but it can be restored more easily. A soft heart forgives, loves and uses soft words. It understands that pain and suffering is a part of life and instead of fiercely resisting, it absorbs the blow. It still feels the pain, but isn't broken by it."

The protective hardening of our hearts is a common way of dealing with over-exposure to others' trauma and suffering. Some people make a conscious decision to create a wall of coldness, withdrawal, anger or prickly behaviour, (I know someone who calls this her "force field"), in order to save themselves from further pain. Others don't even notice that their hearts are becoming stony. It happens so slowly and insidiously that they are shocked when others point out that they no longer seem to care.  However it occurs, this hardening eventually takes its toll and we pay the price in the irritability,  brittleness, reactivity, cynicism and emotional fragility that are hallmarks of Compassion Fatigue.

So, how is it with you right now? Is your heart so hard that, instead of feeling protected, you are shattered by any bad call, hard session or emotionally intense event? Are you wondering where the caring person inside you has gone? Are you wishing you could soften your heart and become the person you used to be? Are you afraid to try for fear of being shamed in a workplace culture that only seems to value strength and toughness?

In the next post we will look at some useful practices for beginning to soften our hearts ( - just in time for Valentines Day!).


Friday, January 29, 2016

Celebrate! ...

Life should not only be lived,
it should be celebrated!


Hi Everyone!

So this week I reached one of those BIG birthdays and I've be feted, gifted and feasted all week. There's a bouquet of cards on the mantle piece, one of spring flowers on the kitchen table and a small grouping of gifts, waiting for new homes, sitting on a chair in the dining room. And it's not over yet. Tomorrow, my middle sister will host a Scottish Afternoon Tea for me and sixteen of my closest friends. My heart overflows with happiness and gratitude in the face of all this celebration. I feel loved and supported and energized for the next decade.

The Oxford English dictionary defines celebration as publicly acknowledging a significant or happy day or event with a social gathering or social activity. So it's not just a matter of feeling happy and grateful in your own heart, it's a matter of sharing that happiness with others in some public way. (Or, perhaps, sharing a more complex emotional experience like grief or hope.)

Throughout history, we've created gatherings, ceremonies and rituals to celebrate any number of situations  - births, deaths, survival, defining our identities and acknowledging to whom we belong, changing seasons, planting and harvest, anniversaries, welcomes and leave-takings, establishing relationships and ending them, and marking developmental milestones and life transitions.

In times past, more formal celebrations have centered around our religious institutions. Today, as these institutions are less central to life in neighbourhoods and communities, people known as celebrants can help us to plan individualized celebrations.

Why should we go to all the trouble of celebrating ? Because it's good for us. It allows us to connect with our emotions and with our fellow human beings. It builds our strength. It reinforces positive aspects of our culture and spirituality. It roots us in the rhythms of Nature and of Life itself. 

I think it is important for those of us who care for others, at home or at work, to intentionally find things to celebrate. Celebrating builds energy. It binds teams and communities together. It builds hope and motivates us to keep moving forward. Sometimes, when we face obstacles or when progress is achingly, frustratingly slow or when, in fact, the situation is actually deteriorating, it can seem as though there's little or nothing to celebrate and we become saddened and discouraged. 

These are the times when we most need to find something to celebrate or commemorate with others. These are the times when we can look to the ordinary stuff of life - having learned a new skill, feeling healthy, getting through a rough week, having a time of respite, acknowledging acts of synchronicity or unexpected blessing, the love and support of family or friends  - for something to celebrate. One of my favourite celebrations for helpers is the Blessing of Hands , often held during Nurses Week in this country. There is something uplifting and sustaining about having such (extra)ordinary things as one's hands blessed so they can continue to be a blessing for others.

Celtic poet and philosopher, John O'Donohue, has written a blessing to remind us of the importance of celebration. You'll find it in his well-loved book, To Bless the Space Between Us: A Book of Blessings:

Now is the time to free the heart,
Let all intentions and worries stop,
Free the joy inside the self,
Awaken to the wonder of your life.

Open your eyes and see the friends
Whose hearts recognize your face as kin,
Those whose kindness watchful and near,
Encourages you to live everything here. 

See the gifts the years have given,
Things your effort could never earn,
The health to enjoy who you want to be
And the mind to mirror mystery.

May each of you find something, small or large, to celebrate this week!

Friday, January 8, 2016

Paramedic and Family Caregiver "First Responder" Stories

Many of our first responders will be diagnosed with PTSD during their careers, and will battle mood disorders, substance abuse, and suicidal thoughts as a result.

These are kids who live on borrowed time and would test anybody's resilience.

Hi Everyone!

While making my monthly stop at CBC Radio's, White Coat, Black Art, I've just come across two programs that are well worth your listening time. The quotes above are from the series host, Dr Brian Goldman, MD.

1.  The first program, Sock Drawer Stories: Portraits of Hope and Healing, describes the posttraumatic stress of emergency paramedics, one in particular who learned to deal with her PTS symptoms through painting. Teresa Coulter paints powerful portraits of colleagues with PTS, "opening their hearts and her's to healing". 

Teresa uses the analogy of a sock drawer (similar to the "file folder in your chest" you've heard me speak about in workshops) to describe what happens when we take the memory and emotion of each "bad call" or medical emergency or other trauma and stuff it in the back of our sock drawer. This works pretty well in the short term, allowing us to "forget" the trauma and present an "I'm fine!" face to the world. However, as time passes and the drawer fills up, opening it to add one more memory can cause all the old memories and feelings to fly out onto the floor.  This is what happens when we find ourselves "over-reacting" to a situation. It makes our PTS warning signs come out on full display.

In this piece, Teresa and her colleagues are interviewed by Brian Goldman about their PTS experiences and their individual paths to healing. 

2.  The second program, One More Thing Moms' Club, describes the experiences of another group of "first responders", a passionately articulate group of family caregivers in the Ottawa area faced every day with the frontline primary care and advocacy for a child with complex illness. While these Moms discuss the realities of life as they care for their children, much of what they say also applies to those caring for adults with similar conditions.

When I first saw the name of this support group, it occurred to me that it could have more than one meaning. Not only are these parents people who always have "one more thing to do" but they also have " one more thing to ask" of helping professionals exiting the room  because there's always another question, arrangement or issue to stress. I can't think of a more apt name for this group!

The unabridged interview with this amazing group of caregivers is well worth hearing in its longer-than-usual format.  

I hope you can take the time to settle into a big chair with a cuppa and really listen to both of these excellent programs. You'll come away inspired.


Monday, January 4, 2016

Compassion Fatigue: Who's At Risk?...

A case manager is supposed to do just referrals and that's it, but many times ... you're the first one that they're telling ... everything to. ... You end up hearing everything as if you were their psychologist and (it is hard to know) how to deal with those emotions when sometimes we don't have training aside from whatever we review.

Case Manager, Los Angeles Children's Hospital

Hello, everyone,

It's the beginning of a new year, so I thought we could go back to the basics today and take a fresh look at who is at risk for Compassion Fatigue (CF).

The primary criterion for determining CF risk is exposure to the trauma stories of the people we serve.  (Other vulnerability and protective factors also come into play but this is the primary contributor.) The greater and more graphic the accumulated trauma exposure, the more likely we are to develop CF.

These days, we are quite used to thinking of moderate CF as a natural consequence of working as first responders (paramedics, physicians, nurse practitioners, fire and police professionals, and humanitarian and victim assistance volunteers) or other helping professionals like nurses, teachers, social workers, lawyers, prison workers, mental health professionals and clergy. On the other hand, there are helpers at risk of CF who don't come to mind so readily.

In one of the best written articles on CF I've read in a while, Sophie de Figueiredo and her colleagues at Children's Hospital, Los Angeles and USC describe the cross-diciplinary experience of CF among service providers for highly traumatized children and adolescents, focusing much of their attention on case managers

We rarely think of medical receptionists, medical office assistants or case managers as being at risk and yet, of course, they are. Not only are they often the first to hear peoples' trauma stories and crises, they can be obliged to write or re-tell these stories again and again as they communicate information to other helpers, thus increasing their exposure exponentially. Hear some of the case manager risk factors de Figueiredo reports in her 2014 article in Traumatology:

Descriptive findings provide evidence to suggest that case managers may be more susceptible to CF than other providers. Their caseloads were significantly larger than those of other provider groups. They were less likely to report having access to reflective and individualized supervision and reported higher dissatisfaction with the amount of supervision they received. Generally, they were younger and reported fewer years of education. Case managers were also less likely to receive trauma-specific training in traumatic stress or on the effects on providers of working with traumatized populations... Unfortunately, these providers received the least amount of support to address and combat the development of (CF and burnout).   (p 293)

Also at risk are middle managers and administrators who may hear the most difficult of the trauma stories and situations, ones that can't be dealt with lower in the hierarchy, and yet have no primary "hands-on" contact with the trauma survivors and thus are left holding painful stories without an outlet of direct action to alleviate suffering (the survivors' or their own).

This fall, I've also been surprised to speak with a number of 5th Step volunteers in 12 Step Programs who have developed CF over years of hearing others' 5th Step stories. (The 5th Step = "We admitted to God, ourselves and to another human being the exact nature of our wrongs.") Hearing "the exact nature" of others' behaviours while in the throes of addictive behaviour can be more than a little traumatizing, though I have to admit I hadn't thought to include these folk within the fold of CF risk.

Others who might be at risk but not necessarily cross our minds as needing education and support are the translators/interpreters and community volunteers who are making significant time, energy and emotional commitments to the Syrian refugees coming to Canada over the next few months. These helpers may have little or no understanding of the potential impact of refugees' trauma stories on their lives. It will be crucial to provide these caring folk with CF information before they become overwhelmed by trauma stories of the people they seek to help.

Not-for-profit workers in food banks, meal programs, community outreach programs and disease-specific support organizations may also be at risk and unprepared.

Even librarians can suffer CF in some circumstances. Librarians and library techs in home library programs form strong, long-lasting bonds with homebound patrons who can experience the abuses and/or traumas and losses of chronic ill health and disability. During harsh weather and harsher economic times, the homeless and displaced may also seek shelter in community libraries and spend time sharing their stories with kind but untrained and unprepared helpers.

These are just a few of the under acknowledged at-risk populations that come to mind this morning. I'd be interested to hear of any others you believe to be poorly recognized.