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.

   

"Turn to the Sun" for Mother's Day ...

Hi everyone!

There's nothing better than having a positive purpose when it comes to building compassion fatigue resilience and Vancouver's Suzy Coulter has one.

In 2005, Suzy, a community nurse in the Downtown Eastside, volunteered for four months in Kismu, a city in Kenya with one of the highest HIV prevalence rates in that country. Conditions in the hospital where she worked were sketchy at best and, on returning home, she decided to raise money to help change those circumstances through establishing the Turn to the Sun project. She decided to raise and sell sunflower seedlings after meeting a Kenyan woman living with AIDS whose income generating activity included growing sunflowers for seeds. Chickens were fed the seeds and the income from selling the chickens and eggs helped support her family.

Every year since, Suzy and her friends have held sales of sunflower plants on Mother's Day weekend and donate the money to the Stephen Lewis Foundation which distributes it to grassroots projects focusing on direct care and programs for HIV/AIDS affected families.

I heard Suzy interviewed on CBC this afternoon and loved her energy, the name of her project and the great work they're doing.  If you'd like to support her and her work, why not attend one of the sales this weekend and buy a plant (or 6) for your Mom? Or even decide to join Suzy's happy band of volunteers?

Sunflower plants and a limited supply of Turn to the Sun T-shirts will be sold at:

Saturday, May 10 (10-3)
East Vancouver - 2133 7th Avenue, Vancouver
(Live music at 11:30)

Saturday, May 10 (9-1)
Chilliwack - Gwynn Vaughan Park
(Corner of Hope River Road and Williams Rd North)

Saturday, May 17 (12-3)
Sunshine Coast - 1163 Cedar Grove Rd, Roberts Creek


If your weekend's full and you just can't get there, at least take a look at the great website at:
www.turntothesun.org

Happy Mother's Day!!

The Work As Self Care ...

Hi everyone!

Many of us think of self care as something we do away from our caring work, in order to refresh and refuel. However, whether we're helpers in a professional workplace or family caregivers whose work lies within the walls of our own homes, there are things we can do while at work to rejuvenate and enhance our resilience.

Sometimes self care at work can be as simple as pausing for a few moments in the day to take some deep mindful breaths, eat a healthy snack, drink some water, go to the bathroom, wash our face and hands, rest quietly while gazing out the window at the natural world, connect deeply with a co-worker or go for a run up the stairs.

But how many of us think of the work, itself, as a means of self care, purpose and meaning? Many of us can forget that we chose the work we do because, at its best, it was so energizing and life-giving. As Rachel Remen, physician, healer and author of, Kitchen Table Wisdom, says:

No question that the medical system (in the USA) is seriously broken, but Medicine itself is not. Even on the most stressful and pressured of days there are moments in which we can experience something else, moments in which we connect to people on a very intimate level and make a difference to them and they to us. Times when, despite everything, we experience compassion, give and receive love, ease suffering and fear and are profoundly trusted. Instances when the greatness and courage of an ordinary person is suddenly revealed and we know ourselves to be in the presence of a hero. Or we recognize that we ourselves are heroes. No question that these experiences are brief, but they happen daily. And often they are life-giving - like taking single breathes of pure oxygen in the middle of a deep-water dive. There is a deep river of meaning that runs through the work of every health professional. It can sustain us in difficult times.

Rachel's wisdom does not apply only to those engaged in healthcare. The same could be said of first responders bringing people to safety, teachers reaching out to children who've been abused or neglected, clergy comforting the bereaved, therapists helping to heal emotional wounds, interpreters easing communication in a new land or family caregivers coordinating and providing care for loved ones.

If we can be mindful of the golden moments of human connection and compassion that brought us to our work in the first instance, and that are still available to nourish our hearts and souls today, we will both build our compassion fatigue resilience and bring a greater degree of humanity and caring to those we serve.

I think John O'Donohue understood this when he wrote his Blessing For Work:


May the light of your soul bless your work
with love and warmth of heart.

May you see in what you do the beauty of your soul.

May the sacredness of your work bring light and renewal
to those who work with you
and to those who see and receive your work.

May your work never exhaust you.

May it release wellsprings of refreshment,
inspiration, and excitement.

May you never become lost in bland absences.

May the day never burden.

May dawn find hope in your heart,
approaching your new day with dreams,
possibilities, and promises.

May evening find you gracious and fulfilled.

May you go into the night blessed,
sheltered and protected.

May your soul calm, console and renew you.

Living at the Threshold ...

At any time you can ask yourself: At which threshold am I now standing? At this time in my life, what am I leaving? Where am I about to enter? What is preventing me from crossing my next threshold? What gift would enable me to do it? A threshold is not a simple boundary; it is a frontier that divides two different territories, rhythms, and atmospheres.

John O'Donohue

Thresholds are in-between places with possibilities for growth and transformation. They come in many shapes and sizes. This Thursday, we will all cross the threshold from winter to spring. Some of you will  soon be leaving the school year and entering summer holidays. Others will be leaving old careers and starting new ones. Some of you will be leaving couple bliss to become parents. Others will be leaving work to retire. Others, still, will be leaving behind years of caregiving to enter the realm of widowhood.Whatever our situations, we will all cross a series of thresholds over our lifetimes. Part of being resilient is learning to recognize the potential of these thresholds and knowing how to live well in the"in-between" places.

Thresholds are places of excitement, uneasiness and un-knowing. Author, Christine Paintner, writes, Try not to analyze (thresholds). The threshold is about resting into mystery, into unknowing, into the liminal space where the old is released but the new hasn't yet come into being. 

When we entertain the possibility of something new, we find ourselves in the humbling position of not knowing what the future will bring. This can be both enlivening and frightening. If the fear outweighs the excitement, we can find ourselves desperately trying to jettison our anxiety and find a sense of control. While this is an understandable impulse, it doesn't contribute much to our transformation and wholeness and it doesn't allow the universe to "unfold as it should".

Rather than trying to escape the turmoil of our un-knowing by retreating from the threshold or by avoiding our feelings, the practice is to stay present with ourselves in the space between old and new. To be attentive to our experience in the moment and to allow space for our feelings of grief, fear, emptiness, self-criticism and despondency. We need to let go, wait, and trust that, in one way or another, life and promise will declare themselves.

As the threshold of spring and new life approach this week, what are the thresholds in your own life, the ones calling to you to cross but that feel difficult to face or challenging to imagine? What might you need or want to guide, support and nurture you as you pass through these doorways into something new? 

Perhaps this blessing by Jan Richardson, one of my favourite writers-of-blessings, will help you on your way:

A Blessing In the Dust

You thought the blessing

would come

in the staying, 

in casting your lot

with this place,

these people.

In learning the art 

of remaining, 

of abiding.

And now you stand 

on the threshold 

again.

The home you had

hoped for, 

had ached for,

is behind you - 

not yours, after all.

The clarity comes

as small comfort,

perhaps,

but it comes:

illumination enough

for the next step.

As you go,

may you feel 

the full weight

of your gifts

gathered up

in your two hands,

the complete measure

of their grace

in your heart that knows

there is a place 

for them, for the treasure

that you bear.

I promise you

there is a blessing

in the leaving,

as you walk toward home 

- not the one you left 

but the one that waits ahead,

the one that already

reaches out for you

in welcome, in gladness

for the gifts

that none but you

could bring.

Live Your Values ...

It's not hard to make decisions when you know

what your values are.

Roy Disney

I met my dear friend, Lin, at university a number of years ago. One of the things that first attracted me to her was her integrity. Her inside and her outside matched. She had been consciously thoughtful about what she valued in life and her actions revealed those values clearly to anyone who met her. 

Lin believed in trying to become as fully human and fully alive as possible and that belief led to deeply held values including stillness, faith, respect for others and the environment, connection, hospitality, wellness, and learning. In turn, her values led to actions such as practicing a life of inclusive contemplative faith, communicating in intentionally respectful ways with others, organic gardening, making her own environmentally-protective cleaning supplies, nurturing longterm close relationships, generously sharing her home and belongings, taking daily strenuous exercise in the outdoors, and deeply investing in motherhood and in her teaching vocation. (Now, she wouldn't want you to think she's Little Miss Perfect. Her language does occasionally reflect the passion of her emotions and there are certainly days when divorcing her family and running away seems a reasonable choice - just like the rest of us.)

I do remember being quietly amazed the first time I saw her using her values, intentionally, to guide an important decision. (At that time in my life, I'd done little of my own work and I was still living in reactive vs responsive mode. It hadn't occurred to me that I could be that consciously value-driven in making decisions.) I gradually came to realize that much of my friend's resilience (she'd not had an easy life) was rooted in knowing what mattered most to her - her values - and how she used those values to give continuity and guidance to her life. 

When we know our personal values, they can become strong anchors in any storm whether illness, injury, job loss, bereavement, natural disaster or other trauma. While relatively stable over time, our values are not necessarily static - different ones are more important at different stages in our lives. So, it can be useful to reflect, from time to time, on what really matters to us right now.

One way you can do this is to put some quiet time aside and, in your journal, (or in your mind if it's sharper than mine), do the following exercise, adapted from Danea Horn's, Chronic Resilience:

1.  Values are reflected in our actions. Sometimes there can be a disconnect or dissonance between what we think are our values and what our actions show. Think back over the past week. How did you spend your time? What values do you think your actions represented? Make a list of the activities and the values they stand for. (eg slept in, showered, got dressed - values = comfort, cleanliness; walked to work - values = health, connection with nature, thrift;  family dinner - values = family time, good nutrition, relaxation)

Remember that there are no right answers - only those that reflect your personal values. (eg family dinner might be about valuing family connection or it might reflect the excitement of trying a new recipe)

What do you notice from your list? Do your activities reflect the values you hold dear? Are you shocked by what your activities are revealing? Is there something you want to adjust?

2. Answer 3 questions to help you determine your values:

a.  What's important to you? Activities. People. Projects that bring you joy and satisfaction. What makes you feel fully alive? What makes time pass quickly? What would you choose to do if you had free time? What do you feel fully committed to? What can you not live without?

b.  What do you want to be remembered for? What will your legacy be? What do you want your work to stand for? What do you want others to receive from your work? How do you want others to feel after they interact with you?

c.  What lessons are important for you to learn during your lifetime?  Where do you want to grow? What do you need to learn about relating to yourself or others? What do you need to learn about love? About trust? What areas of life feel essential to explore?

The answers to these questions - the themes, ideas and hopes - will point you toward what you value. Try to distill each value into a word or two. (eg If you feel fully alive when watercolour painting, your value might be "creativity").

3.  List your top 10 values in order of priority. Then use them to guide your decisions, the projects you pursue, how you fill your free time and what to do in a crisis. When you know your values, you can look at your calendar repeatedly and ask, "Do these activities, this schedule, support my values?" 

  

We Rise Again ...

That as sure as the sunrise,

as sure as the sea,

as sure as the wind in the trees, 

we rise again in the faces of our children.

We rise again in the voices of our song.

We rise again in the waves out on the ocean

and then, we rise again ...

As sung by Anne Murray and 
The Rankin Family
                                                    (and the rest of us)

Hi everyone!

I walked by the lake this morning and my eyes were drawn, again and again, to the hillocks of winter-blanched grass lying low along the shore. I thought about resilience and how nature continually graces us with images of recovery from harsh conditions. The pale grasses by the water, now beaten down by weeks of wind, rain and frost, will soon rise to their full height again, taking on the greening of spring. This picture of nature's resilience is an echo of our own. We, too, can rise again following difficult times.

Our earliest strategies for resilience or "rising again" are learned by the time we are 12-18 months old. We begin to sense what is safe or unsafe even in utero. Through ongoing interactions with the world around us, our brains begin to learn and encode strategies that work to keep us safe and secure. When these strategies work well, we are able to come back from hard times reasonably quickly and efficiently.When they don't we have a hard time recuperating.

According to the stress-diathesis model of health and wellness, three factors determine our capacity for resilience - the intensity of the challenges we face, our personal vulnerabilities and our compensating strengths.

While life is full of happy, even breathtakingly beautiful moments, it also holds difficulties and challenges. These challenges can be the hiccoughs of traffic jams and lost car keys or the earthquakes of separation, illness, injury, betrayal, natural disaster and death. The intensity of these experiences creates a greater or lesser sense of threat and calls for a greater or lesser degree of adaptability.

When we encounter more than one challenge at a time, the demand upon our coping resources increases and our resilience may decrease. If we find ourselves working full time, caring for a chronically ill loved one during a health crisis and suddenly developing a painful abscess in a wisdom tooth, the demand on our capacity to cope is greater and the threat to our resilience, stronger. The more intense, numerous and prolonged our challenges, the more our resilience may be affected.

Our personal vulnerabilities also have an impact on our resilience. Human beings are naturally resilient but our genetic predispositions and early learning can reduce our capacity to bounce back. Each of us has chinks in our emotional armour, tender spots caused by the wounds of our earliest life experiences and by our later losses and traumas. Whether we experience the anxious or avoidant attachment of perinatal trauma, early separations, neglect or abuse, or the scars and reactivity of parental loss, accidents, immigration trauma, medical trauma, war or natural disaster, our developing nervous systems are affected by our experience and, without attention, these effects can reduce our natural resiliency.

Fortunately, our early learning not only leads to vulnerability, but also to strengths. When we interact with soothing, supportive others, we begin to develop inner resources and capabilities - trust, mindfulness, empathy, self-soothing, self understanding, self-compassion, security, confidence, interpersonal skills, comfort in our bodies, reservoirs of positive memories and emotions, courage, and flexibility, to name but a few. These strengths help to compensate for our vulnerabilities and enable us to deal with life more adaptively. If we didn't have the chance to develop them early in life, we can learn them today through the magic of neuroplasticity (the ability of our brains to rewire for maximum resilience.)

Why not take a few minutes with a hot drink and your journal and think back over the history of your own resilience. What are the hard times you've overcome? When did your vulnerabilities reduce your resilience and when did your strengths carry you through? What, exactly, are your personal vulnerabilities and strengths? Can you think of a time when you were particularly resilient, a time when your capacity to "rise again" was especially strong? What made it so?

So What Is Resilience Anyway? ...

We have the human capacity to become resilient, which allows

us to deal with the bombardment of events causing so much stress.

And in dealing with these events we become stronger, more confident in our abilities, more sensitive to the stress others are

experiencing and even more able to bring about change to minimize or eradicate sources of stress ...      

Edith Grotberg

Hi everyone! Welcome to our new year-long focus on the art of resilience. There will be posts on other things from time to time, as issues shimmer into my awareness, but resilience will be at the heart of our musings for 2014.

During the years my husband and I walked by the lake in the very early hours of the morning, we frequently enjoyed deep, questioning conversations about a broad range of topics - personality development, spirituality, nature, music, politics, art, literature and many others (- in between the more mundane ones about schedules, meal planning and the odd argument or two!). When either of us presented a question, the other invariably asked some variation of, "Well, it depends on what you mean by that? You need to define your terms." So, that's what I want to do today - to define our term, resilience.

The Oxford English Dictionary defines resilience as:

The ability of a substance or object to spring back into shape; elasticity; or the capacity to recover quickly from difficulties; toughness.

Linda Graham, author of Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being offers a slightly different definition:

The capacity to respond to pressures and tragedies quickly, adaptively and effectively. 

I would go a little further and say that resilience is more than just responding well to current difficulties. It also includes developing the wisdom to avoid some of life's potholes and learning the tools to withstand situations that seem over-long and insurmountable. It also involves changing and becoming as the result of the challenges we meet - an opportunity to become weller than well or more whole than we would have thought possible prior to the problem or crisis. Given this, the definition I would prefer is that of psychologist and author of Resilience for Today, Edith Grotberg:

Resilience is the human capacity to deal with, overcome, learn from, or even be transformed by the inevitable adversities of life.

And to go a step further still, when we become transformed, we can then be of greater service to those around us. Our growth and transformation allow us to become more open conduits of love, groundedness, wisdom and calm for others enduring trying times and we have the opportunity to become activists to alter the original sources of our stress.

Put differently, there is a sense of higher consciousness or spiritual development that can evolve as our resilience builds. We become more whole within ourselves and, thus, more able to pass on tools of resilience to our loved ones and to the broader world.

This is the Year of Resilience ...

Hi everyone - Happy 2014!

So I've designated 2014 to be the Year of Resilience here at Caregiver Wellness. A year of focusing on the things that give us life as we support the lives of others. A year of orienting our thinking toward recovery from difficult experiences and becoming strong and well at the broken places. A year of gaining information and tools that will enhance our ability to bounce back and thrive.

The notion of resilience has always been a foundation for my work at Caregiver Wellness but this year I want to bring it to the forefront in a way that is intentional and exciting. We will look broadly and deeply at what resilience is, where it comes from and how we go about enhancing it.

I've been thinking a lot about resilience this week, my thoughts stimulated by two significant experiences. The first was choosing my word for 2014  (or allowing it to choose me) and the second, the experience of a wonderful new play, Rebel Women, running at the Jericho Arts Centre in Vancouver until January 12th.

As I said in my last post, I wasn't quite sure what my guiding word for the New Year would be. Initially, I thought that it might be embrace and I sat with that possibility for a week or so. But then I heard a word used in an unusual way during Women's Christmas and I knew, immediately, that that would be my word for 2014. The word I heard was supple. 

Supple is defined as, "readily bent without damage, lithe, moving and bending with agility, limber, yielding or changing readily, adaptable, mentally flexible, responding readily, and capable of showing easy graceful movement". There are few words more closely related to, and descriptive of, the notion of resilience.

The second experience that led me to think about resilience was Vital Spark Theatre's play Rebel Women. This amazingly enlightening and piercing play brings to life the struggles of the British suffragettes (and the Canadian women who supported them) and their resilience in the face of mocking, humiliation, physical violence, arrests and the brutality of force feedings to end their hunger strikes while in prison. Writer and director, Joan Bryans, (who also took our tickets at the door) became obsessed with the story of these brave women during the Spring of 2013. Using meticulous research, she developed a play based on the verbatim accounts of the people involved and the suffrage songs of the day. The result is a riveting production of a quality much higher than I would have expected from a small community theatre.

I came away knowing the suffragettes, whose names I'd only barely recognized, as true heros. I will never again grumble at having to go and vote. That privilege was too hard won by women with more courage and resilience than I would ever hope to have. I hope that those of you living in Greater Vancouver will take the time to see this rich production and to reflect upon the strength of these odd, sad, inspiring, quirky and noble women who suffered so much in order to give us the freedom to vote. May they be our inspiration as we begin our own Year of Resilience.