Trauma First Aid...

As family carepartners and helping professionals, we are exposed to secondary trauma, or indirect wounding, through witnessing or hearing of the traumatic experiences of others.

Whether we discover a loved one collapsed on the floor after a heart attack, assist a patient suddenly hemorrhaging from his gastrointestinal tract, respond to a serious motor vehicle accident or preside at the funeral of a four year old child, we are vulnerable to secondary traumatic stress. How do we practice good self care in such situations? How do we help ourselves to reduce long term trauma effects?

Peter Levine, PhD,  in his books, Healing Trauma and Waking the Tiger, gives first aid guidelines for helping adults who have experienced traumatic events. From these guidelines, I have drawn the following suggestions:

Stage I:  Immediate Action:

As soon as possible after ensuring the immediate safety of the primary victims and your own safety:

1.  Rest, lying down if possible. (This may go against your natural inclination to "do something" or to deny the impact of the trauma but it is essential to be still so the trauma energy can be discharged from your body.)

2.  Have a trusted person stay with you quietly.

3.  Allow yourself to fully experience your body sensations. These may include adrenalin rush, numbness, shaking and trembling, feeling hot or chilled.

4.  Remind yourself or allow others to remind you that it is not only okay to shake, it is good and will help you to release the shock. You will feel a sense of relief after the shaking is completed and may feel warmth in your hands and feet. Your breathing should be fuller and easier. This initial stage of discharge could easily take 15 - 20 minutes.

5.  Stay quiet and resting until the acute shock reaction is over.

Stage II:  Later

1.  Allow time for processing the traumatic experience. Always take a day or two off work or rest more than usual if you are at home in order to reintegrate. This is important even if you don't perceive your situation to justify staying home or resting. (This resistance can be a common denial mechanism and defense against feelings of helplessness). As Peter Levine says, "A day or two is good insurance".

2.  Allow your emotions to be felt without judgement. You may experience feelings such as anger, fear, guilt, sadness and anxiety. There may also be continuing body sensations such as shaking or chills. This is often the case.

Stage III:  Begin to Access and Renegotiate the Trauma: (Often coincides with Stage II)

1.  Work with someone who understands the body effects of trauma to recall both the direct and peripheral images, feelings and sensations experienced during the traumatic event. Work slowly, one step at a time, to bring up and discharge the trauma energy.

Dealing with a traumatic event at the time that it happens goes a long way toward preventing long term trauma reactions. If you would like to understand more about the importance of processing traumatic events and the physiology behind the process above, I recommend Peter Levine's two books and his CD collection, Healing Trauma.

 (As always, use your own best judgement to assess your particular circumstances before using the guidelines above.)

New Year 2009...

This week, as I prepared to dig myself out of the snow one more time and return to work, I found myself reflecting upon our traditional January greeting of "Happy New Year!".

For very many people, the New Year is a time of bright hopes and possibilities, of fresh starts and clean pages. However, for family caregivers and helping professionals overwhelmed with compassion fatigue or chronic sorrow, this is rarely the case. The thought of another year stretching into the distance brings exhaustion, anguish and unanswerable questions.  Can I keep going? How? When will the losses and suffering end?

For these folks, the New Year means summoning yet more strength and courage from a well long dry.  It asks of those already drained to "go over the top" one more time like soldiers in trenches from wars gone by.

If you are facing the New Year from such a depleted place, I invite you to make this time of beginnings an opportunity to ask for help. To call a trusted friend, a case manager, a spiritual advisor, a grief counsellor, or another caregiver to ask for support. Choose someone who will listen without judgement or "fixing" and who will help you to clarify what it is that you need. Let your New Year begin with the glimmer of hope that can come when we honestly acknowledge our situations and surrender to asking for help.

John O'Donohue, one of my favourite Celtic writers, wrote a beautiful book of blessings called, The Space Between Us, before his untimely death in mid 2008.  His Blessing for a New Year could easily have been written especially for caregivers.

A Blessing for the New Year

On the day when

The weight deadens

On your shoulders

And you stumble,

May the clay dance

To balance you.

And when your eyes

Freeze behind

The gray window

And the ghost of loss

Gets into you,

May a flock of colours,

Indigo, red, green

And azure blue,

Come to awaken in you

A meadow of delight.

When the canvas frays

In the curragh of thought

And a stain of ocean

Blackens beneath you,

May there come across the waters

A path of yellow moonlight

To bring you safely home.

May the nourishment of the earth be yours,

May the clarity of light be yours,

May the fluency of the ocean be yours,

May the protection of the ancestors be yours.

And so may a slow

Wind work these words

Of love around you,

An invisible cloak

To mind your life.

John O'Donohue  (2008)

Blessings to you in 2009!

Warmly,

Jan

 

Seasonal Comforts...

It's COLD in Vancouver. Or at least it's cold for Vancouver! There is an "arctic outflow", according to our meteorologist, causing cold air, frigid winds and intermittent snow and sunshine to shift from the interior to the coast for the next week.  

Although it wrecks havoc with our driving and causes strained backs and broken wrists, this severe weather also draws our attention back to the rhythms of the seasons and to the comforts and sustenance peculiar to each one. Spring, summer, fall and winter. Each has its own particularly comforting activities, activities that we can pursue to balance and refresh our busy lives.

In The Woman's Comfort Journal,  author, Jennifer Louden, suggests the following winter comforts:

1.  Curl up in flannel sheets with someone you love, human or animal.

2.  Sip hot tea and watch the rain.

3.  Make a snow angel.

4.  Have a snowball fight, then run indoors and sip hot mulled wine or apple cider by a roaring fire.

5.  Roast marshmallows in the fireplace.

6.  Make a steaming pot of soup or a hearty stew of root vegetables.

7.  Bake bread.

To this list I would add:

8.  Curl up in a large chair with your favourite afghan and a good book.

9.  Toast crumpets on the fire and eat them dripping with butter and raspberry jam and with a large mug of hot chocolate.

10. Knit long stripey socks in brilliant colours.

11. Take your camera cross country skiing or for a winter hike.

12. Take a walk around the garden or the neighbourhood and notice that, even in winter, new life is waiting to spring forth in buds and shoots.

13. Design a calendar for the new year and give copies to loved ones for holiday gifts.

14. Take naps - lots of naps - for winter is naturally the season for hibernation. A time to rest and to heal.

15. Play with children or play some games you used to enjoy as a child.

This is not an exhaustive list, rather, just a beginning.  Think of some other specifically winter activities - or non-activities - that restore your life balance. Ask others what they would place on their lists. Do one thing each day or each week throughout the winter. Notice the difference it makes to be in tune with the season and in tune with yourself.   

Christmas Choices...

For exhausted family caregivers and over extended helping professionals, the holidays can feel like adding a 100 pound pack to the running of a marathon. The season of giving becomes one more burden to shoulder rather than the warm, peaceful celebration we all dream about.  If trying to maintain family obligations and holiday traditions is getting you down, try these three suggestions made by Jo Robinson and Jean Coppock Staedheli in their popular book, Unplug the Christmas Machine.

1.  Take stock.  Ask yourself why you feel more wrung out and exhausted during the Christmas season.  Are you trying to see too many people?  Are you working extra shifts to pay for bigger gifts and better trimmings? (Is it worth it?)  Are you trying to spend time with people who don't understand your current situation or with those who are conflictual or badly behaved? Are you expecting yourself to carry on traditions that no longer fit for you and your family?  Or does a busy, crowded holiday just not fit with your values?  Once you have identified the sources of your exhaustion, you can start to do something about them.

2.  Look for practical solutions, even if it means breaking traditions.  When we see the causes of our seasonal tiredness, we can usually see very quickly what we would like to change.  We realize that once enjoyable traditions no longer fit our changed circumstances.

3.  Communicate your wishes to your family and friends.  If at all possible, talk to family members well ahead of time about any major changes and realize that it may take some people longer than others to get used to the fact that Christmas won't stay the same forever.  Don't try to make all your changes at the same time (-unless illness or injury forces your hand).  Planting a seed now can bear fruit for next year.  Most importantly, take the time to explain your feelings and ideas thoroughily and calmly, without blaming others or becoming defensive.  And remember that every change represents a loss so you will need the opportunity to grieve before moving on.

I have always loved Christmas and its traditions and when my husband became ill, I was loathe to give up any one of them.  I worked hard to deep the holidays unchanged not realizing that a change could be a wonderful gift.   The fourth year of his illness, we were forced to realize that we could no longer spend the night before Christmas in the company of loved ones at Midnight Mass.   We grieved in anticipation of our lonely Christmas Eve then made a conscious effort to "light a candle rather than cursing the darkness" and planned our own quiet service at home   It was one of the most beautiful Christmas eves I've ever spent.  Accompanied by one dear friend, we sat around a livingroom table in the soft candlelight and the glow of the Christmas tree listening to the gentle strains of carols as my husband celebrated a simple communion service . I remember the reflection of candles in the 100 year old chalice of an unknown Army chaplain, the simple and familiar prayers and the feelings of deep peace and intimacy.  If we hadn't broken with tradition, we would never have known the gift of that gracious Christmas Eve. 

World AIDS Day...

Today is World AIDS Day, a day set apart for those of us who have lost loved ones to this voracious disease to remember, to grieve, to celebrate, to renew our support and to look forward in hope.

There are more that 33 million people living with AIDS today, including 2.5 million children.  And there are at least as many caregivers, both family caregivers and helping professionals.  

Supporting someone through the roller coaster of any serious illness is difficult but to do so in the presence of ignorance, stigma and judgement is painful indeed.  Research tells us that caregiving within a community that shuns or denegrates the care recipient increases the risk of compassion fatigue in the caregiver.  Just like the Viet Nam vets in the 1970's, we all need support, understanding and appreciation as we fight on.

How can we support people living with AIDS and those who care for them?  Well, we can wear our red ribbons today as a sign of remembrance and solidarity and tomorrow we can take just one action in our local communities to help reduce the stigma and to improve the quality of life for PWA's and their caregivers.  Perhaps we could...

- Take some time to learn the facts - rather than the myths - of living with AIDS.

- Take a moment to write a note of encouragement to someone living with AIDS

or of appreciation to someone who works with people with AIDS.  

- Make a donation to a local AIDS service organization.  This Christmas,  A 

Loving Spoonful, an organization that improves the nutritional status of 

people with AIDS through free home delivery of nutritious meals and a baby

food program for babies of HIV(+) moms, is selling scarves through 

Vancouver's Capers Community Markets for $20.00.  Each purchase gifts

both the receiver and the families living with AIDS.  

- Volunteer some of our time and talents to local or international AIDS 

organizations.

-  Call someone you know who is living with AIDS or who is a family caregiver

and offer a specific form of help.  A ride to a doctor's appointment.  Grocery

shopping.  Help in the garden.  Assistance with Christmas shopping or writing Christmas             cards or putting up a tree. Housework. Returning library books or videos. A chat over a cup       of tea.  If that form of assistance isn't needed, ask if there is anything else you can do.  

 

Barry and Jack, two dear friends who lived well with their illnesses until their last breaths, did much to counter AIDS prejudice, one in the teaching community and the other within his beloved church.  Both were talented, sensitive, passionate men who gave much to our community and I am grateful to have known them and their partners.              

Connecting...

This week I will be heading off to Kingston, Ontario for a Compassion Fatigue training and a visit with dear friends and I'm feeling very excited.  (Or at least I will be once the laundry and packing are done...!).

Research tells us that both continuing education workshops and time spent with family and friends contribute to our burnout and compassion fatigue resiliency and I intend to drink deeply of both.

I'm looking forward to meeting new people who are also interested in Compassion Fatigue. (The shift to a home office has been wonderful in many ways - no commute, lake-walks whenever the mood strikes, a fresh cup of tea just footsteps away - but it is easy to become isolated, especially for an introvert who enjoys being alone.  So, as in the days of my family caregiving when I consciously connected with the folks at Lonsdale Quay every Wednesday morning, I'm making a conscious choice to build my professional network through attending workshops and conferences.)

Once the workshop is finished, I will have a few days to spend with my friends, talking, laughing, walking, attending a country concert and, perhaps, driving to Prince Edward County for some crisp, delicious Ontario apples.  And I will definitely take the time to walk to Panchencho's for my annual latte and sticky bun!

What about you?  How are things going on the connecting front?  When was the last time you spent an hour with someone just for the fun of it?  I remember, in the depths of my family caregiving, a wise friend noted how hard it must be for an introverted caregiver to need support and have to reach  into the outer world to get it.  (Introverts are people who, when exhausted, need to retreat to their inner worlds to rest -  so the last thing they want to do when they're tired is connect.)  

But you don't have to spend hours with a crowd of people in order to stay connected. Perhaps you could have a conversation with someone whom you know will respect your need to get off the phone after 10 minutes?  Perhaps you could arrange a 15 minute walk with one quiet friend?  Or maybe you could join a chatline regarding your favourite hobby or activity?  Or maybe even go to a movie where you only have to chat on the way to and from the theatre? 

We human beings are hard wired to connect, some of us a little more or less so than others, and there are as many ways to do it as there are people. The important thing is to determine how much connection you need and then to make a conscious choice to make it happen, even if only a baby step at a time.

        

One Day at a Time...

One evening last week, I had the extraordinary privilege of hearing primatologist, Dr. Jane Goodall, speak on  A Reason to Hope at the Center for Performing Arts in Vancouver.

Although her presentation was inspiring and motivating, it was her presence that left the most lasting impression. Although the seventy-four year old was slight and obviously tired after speaking 300 days out of the last 365 to save her beloved chimpanzees, she was deeply grounded, still and quiet in a manner that I've rarely encountered other than in people who spend many hours in prayer or meditation.  Her's was truly an arresting presence.  And when asked from whence came her strength, she replied calmly that she took one day at a time.

One day at a time.  There are so many things we couldn't begin to face if we believed that we had to do them forever.  But one day at a time, that's a different thing altogether.  There's not much that we can't handle a day at a time.

I remember people asking how I coped with caring for my husband, especially during the last three years of his life when he was bed bound.  They couldn't understand how I could keep doing the same tasks day in and day out, to say nothing of dealing with the life-threatening emergencies that occurred on a regular basis.  "How did I keep going?", they asked?  Wasn't it overwhelming?

Well, no, it wasn't overwhelming, not on a regular basis anyway, because we lived our lives one day at a time.  Of course the days after the nights without sleep were pretty tough and the endless tasks were draining and boring and the emergencies were terrifying but each day had a beginning and an end and each morning offered a fresh start.  I found that as long as I worried about today today, and left tomorrow to tomorrow, I managed pretty well.  It was only when I started importing tomorrow's concerns that I got into trouble.

That is not to say that we should bury our heads in the sand.  Contingency planning goes a long way toward reducing anxiety but after the potential problems are identified and the plans made, it is best to store them on a shelf until needed and then return to the present.

As a chronic worrier who has improved with age, work and experience, I keep a card on my freezer that reminds me of the importance of staying in the moment and living one day at a time.  On it is a saying that goes like this:

Worrying

does not empty

tomorrow

of its

troubles.

It empties

today

of its

strength.

A good reminder for all of us.