The Peace of Wild Things...

This has been a sad week.  A dear friend, who has had three strokes in ten days, is now paralyzed down her left side and is fighting valiantly against pneumonia. I grieve for her many losses and I grieve for her family and friends who can no longer communicate with her in familiar ways. I grieve for the possibility of life without her.

Normally, I would go and walk by the Lake to ease the sadness, knowing that Nature would draw me from my grief into her quiet embrace. Unfortunately, I have developed either a bone contusion or stress fracture in my right foot so I won't be walking at the Lake for a while. I yearn for the exercise, for calming scenes of beauty and for the healing peace of water and trees.

Thankfully, there is more than one way to connect with Nature. I have just finished reading one of my favourite poems, one that sustained me again and again as my husband was dying. Let me share it with you:

The Peace of Wild Things

When despair for the world grows in me 

and I wake in the night at the least sound

in fear of what my life and my children's lives may be,

I go and lie down where the wood drake

rests in his beauty on the water, and the great heron feeds.

I come into the peace of wild things

who do no tax their lives with forethought

of grief.  I come into the presence of still water.

And I feel above me the day-blind stars

waiting with their light.  For a time

I rest in the grace of the world, and am free.

Wendell Berry

For me, this is a poem of trust - trust that, regardless the complexities and pains of human existence, the peace of wild things is always available to soothe us, either in actuality or in memory. Trust that the day-blind stars are waiting with their light even, or perhaps especially, when we cannot see them in the daylight sky. Trust that even in our busiest, most grief-stricken days, if we breathe, and breathe again, we can return to rest in the grace of the world, and be free. 

 

     

Low Impact Disclosure...

Stories have great power, both to heal and to wound. When we hear and see difficult things in the course of our professional work or as we care for loved ones, we feel a natural desire to debrief the stories we've just heard. This debriefing helps us to diffuse the emotional impact of our work. However,  if we don't do it carefully, we run the risk of wounding those who take the time to listen to us.

In her 2008 article, Low Impact Disclosure - How to Stop Sliming Each Other, my friend and colleague, Francois Mathieu, describes how helpers can slime listeners inadvertently as we attempt to reduce the burden of our work.  When we debrief disturbing material, formally or informally, without asking permission or without thought to its impact on listeners, we can slime colleagues, family members, friends, acquaintances, and even strangers on the bus (!) with our stories. 

Research tells us that sharing graphic details of traumatic situations can spread psychological trauma effects to others and yet we need to tell our stories to keep ourselves well.  What's to be done?  

Authors, Laurie Pearlman and Karen Saakvitne, coined the term, "limited disclosure", in their book, Trauma and the Therapist, and that term later became, "low impact disclosure".  Low impact disclosure, (LID), is a strategy for limiting the impact of our stories on others.  It involves four steps:

1.  Increasing Our Self Awareness

Use self observation for a week to notice all the ways you debrief difficult material. Do you attend formal debriefings at work? Do you journal? Do you chat online? Do you talk over lunch in the cafeteria? Do you attend a support group? Do you share with people at conferences or workshops? Do you go for peer or professional supervision? Do you see a counsellor? Do you tell your spouse when you get home? Or your kids? What is the most helpful way for you to deal with painful stories?

2.  Giving Fair Warning Before Debriefing

Giving  fair warning that you have a difficult story to tell allows the listener to prepare him or herself for its impact.

3.  Obtaining Consent to Tell Our Stories

Francoise Mathieu suggests simply saying, "I need to debrief something with you.  Is this a good time?", or "I heard something really hard today...Could I talk to you about it?". This gives the listener the opportunity to decline or to set limits on the disclosure. For example, the listener might say, "I have fifteen minutes to listen but could you please tell me about it without all the gory details?" or "Is it about children (abuse, abandonment, a car accident, war or whatever is a trigger for you)? If it's about children, then I'm probably the wrong person to talk to, but otherwise I'm fine to listen."

4.  Low Impact Disclosure

Once you've received consent, you can decide how much to disclose. Francoise describes LID this way. "Imagine that you are telling a story starting with the outer circle of the story, (ie the least traumatic information), and you are slowly moving in toward the core, (the very traumatic information), at a gradual pace. You may, in the end, need to tell the graphic details, or you may not, depending on how disturbing the story has been for you."

 It is best to err on the side of more limited disclosure in social situations. Think to yourself, "Is this too much trauma information for this situation?"

Using LID is a simple strategy for reducing the harmful effects of difficult stories. We need not minimize our emotional responses but limiting "the gory details" of the story to an appropriate situation can save family, friends and colleagues  from unnecessary secondary traumatization.   

   

           

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.