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.